Syc-Mazurek Stephanie B, Cacciaguerra Laura, Tajfirouz Deena A, Redenbaugh Vyanka, Krecke Karl N, Thakolwiboon Smathorn, Dinoto Alessandro, Madhavan Ajay, Tillema Jan-Mendelt, Lopez-Chiriboga A Sebastian, Valencia-Sanchez Cristina, Sechi Elia, Chen John J, Pittock Sean J, Flanagan Eoin P
Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA.
IRCCS Ospedale San Raffaele, Milano, Italy.
J Neurol Neurosurg Psychiatry. 2025 Jul 20. doi: 10.1136/jnnp-2025-336684.
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and multiple sclerosis (MS) have both overlapping and distinct MRI lesion features, which vary with imaging timing. This study identified distinguishing MRI characteristics using paired MRIs at clinical attack and remission.
We retrospectively identified Mayo Clinic patients with MOGAD and MS that: (1) fulfilled respective diagnostic criteria; (2) had paired attack (≤30 days) and remission MRI scans (≥12 months) without interval attacks. MRIs were compared between groups for key features.
We included 43 patients with MOGAD (median age 31 years (range, 3-67); 63% female) and 49 patients with MS (median age 39 years (range, 17-65); 65% female). Resolution of at least one T2-lesion differentiated MOGAD from MS (sensitivity, (95% CI 77% to 100%), specificity, (95% CI 86% to 99%); Youden's index (YI)=0.90). Resolution of at least two T2-lesions indicated MOGAD (sensitivity 62% (95% CI 41% to 79%); specificity, 100% (95% CI 94% to 100%); YI=0.62). MOGAD patients were more likely to have normal MRI scans at follow-up compared with MS (brain 14/44 (32%) vs 0/60 (0%), p<0.001; spine 21/27 (78%) vs 7/36 (19%), p<0.001). In addition, the presence of T1-hypointense, ovoid periventricular T2, and enhancing lesions were more common in MS versus MOGAD at attack and remission and in the spine, longitudinally extensive T2 lesions were more common in MOGAD attacks (8/27 (30%)).
Paired MRI at attack and remission revealed distinctive characteristics of MOGAD and MS, with greater diagnostic value at remission driven by the discriminating power of T2-lesion resolution. In MOGAD patients with initial parenchymal involvement, a 1-year follow-up MRI may aid diagnosis and serve as a new baseline.
髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）和多发性硬化症（MS）具有重叠且不同的MRI病变特征，这些特征会随成像时间而变化。本研究通过在临床发作期和缓解期进行配对MRI检查，确定了具有鉴别意义的MRI特征。
我们回顾性纳入了梅奥诊所符合以下条件的MOGAD和MS患者：（1）符合各自的诊断标准；（2）有配对的发作期（≤30天）和缓解期MRI扫描（≥12个月）且期间无发作。对两组的MRI关键特征进行比较。
我们纳入了43例MOGAD患者（中位年龄31岁（范围3 - 67岁）；63%为女性）和49例MS患者（中位年龄39岁（范围17 - 65岁）；65%为女性）。至少一个T2病变的消退可将MOGAD与MS区分开来（敏感性，（95%置信区间77%至100%），特异性，（95%置信区间86%至99%）；约登指数（YI）=0.90）。至少两个T2病变的消退提示为MOGAD（敏感性62%（95%置信区间41%至79%）；特异性100%（95%置信区间94%至100%）；YI = 0.62）。与MS相比，MOGAD患者在随访时MRI扫描更可能正常（脑部14/44（32%）对0/60（0%），p<0.001；脊柱21/27（78%）对7/36（19%），p<0.001）。此外，在发作期和缓解期，T1低信号、脑室周围椭圆形T2病变以及强化病变在MS中比在MOGAD中更常见，而在脊柱方面，纵向广泛的T2病变在MOGAD发作期更常见（8/27（30%））。
发作期和缓解期的配对MRI显示了MOGAD和MS的独特特征，在缓解期T2病变消退的鉴别能力使其具有更大的诊断价值。对于初始实质受累的MOGAD患者，1年的随访MRI可能有助于诊断并作为新的基线。
