Advertisement

Brain and spinal cord lesion criteria distinguishes AQP4-positive neuromyelitis optica and MOG-positive disease from multiple sclerosis

  • Author Footnotes
    1 Both authors contributed equally to this paper.
    C Bensi
    Footnotes
    1 Both authors contributed equally to this paper.
    Affiliations
    Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
    Search for articles by this author
  • Author Footnotes
    1 Both authors contributed equally to this paper.
    M Marrodan
    Footnotes
    1 Both authors contributed equally to this paper.
    Affiliations
    Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
    Search for articles by this author
  • A González
    Affiliations
    Department of Neuropediatrics, Hospital Italiano de Buenos Aires (HIBA), Buenos Aires, Argentina
    Search for articles by this author
  • A Chertcoff
    Affiliations
    Department of Neurology, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
    Search for articles by this author
  • E Osa Sanz
    Affiliations
    Department of Diagnostic Imaging, Institute for Neurological Research Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
    Search for articles by this author
  • H Chaves
    Affiliations
    Department of Diagnostic Imaging, Institute for Neurological Research Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
    Search for articles by this author
  • A Schteinschnaider
    Affiliations
    Department of Neuropediatrics, Institute for Neurological Research Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
    Search for articles by this author
  • J Correale
    Affiliations
    Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina

    Center for Research on Neuroimmunological Diseases (CIEN), Institute for Neurological Research Dr. Raúl Carrea (FLENI), Montañeses 2325, Buenos Aires, Argentina
    Search for articles by this author
  • MF Farez
    Correspondence
    Corresponding author at: Center for Research on Neuroimmunological Diseases (CIEN), Institute for Neurological Research Dr. Raúl Carrea (FLENI), Montañeses 2325, Buenos Aires, Argentina.
    Affiliations
    Center for Research on Neuroimmunological Diseases (CIEN), Institute for Neurological Research Dr. Raúl Carrea (FLENI), Montañeses 2325, Buenos Aires, Argentina

    Center for Biostatistics, Epidemiology and Public Health (CEBES), Institute for Neurological Research Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
    Search for articles by this author
  • Author Footnotes
    1 Both authors contributed equally to this paper.
Published:August 09, 2018DOI:https://doi.org/10.1016/j.msard.2018.08.008

      Highlights

      • MOG and AQP4+ NMOSD can present clinical and radiological features similar to RRMS.
      • Brain and spinal cord MRI criteria may help separate these diseases with high sensitivity and positive predictive value.
      • Brain and spinal cord criteria were less sensitive separating MOG/AQP4+ NMOSD from CIS and POMS compared to RRMS.
      • In patients not fulfilling radiological criteria, antibody testing should be considered from the beginning to avoid diagnostic pitfalls and guide therapeutic efforts.

      Abstract

      Objective

      Test the ability of a brain and spinal cord MRI criteria to differentiate neuromyelitis optica spectrum disorders and MOG-disease from MS. MRI criteria was further tested in patients with CIS and pediatric MS.

      Background

      MOG-disease and neuromyelitis optica spectrum disorders can present clinical and radiological features strikingly similar to those of MS. Previously, diagnostic criteria based on brain MRI have been proposed to distinguish between these demyelinating diseases (Matthews–Jurynczik criteria), but spinal cord imaging and its relevance in CIS have not been evaluated. Simple brain and spinal cord MRI criteria may help separate these three inflammatory CNS diseases both in adults and children, aiding in early diagnostic decision-making, such as need for antibody testing.

      Design/methods

      We included 150 participants (23 with aquaporin-4-positive neuromyelitis optica spectrum disorder, 14 with MOG-disease, 20 with aquaporin-4-negative neuromyelitis optica spectrum disorder, 48 with adult-onset relapsing remitting MS, 24 with pediatric-onset MS and 21 with clinically isolated syndrome). Brain and spinal cord MRI scans were anonymised and scored by 2 separate raters, based on two sets of criteria: one previously described by Matthews and colleagues (including presence of at least one lesion adjacent to the body of lateral ventricle and in the inferior temporal lobe, or presence of subcortical U-fiber lesion or a Dawson's finger-type lesion), and an extended version including spinal cord features (non-longitudinally extensive cervical lesion).

      Results

      Extended MRI brain and spinal cord lesion criteria were able to separate adult-onset relapsing remitting MS with 100% sensitivity and 87% specificity from aquaporin-4-positive neuromyelitis optica spectrum disorder; and with 100% sensitivity and 79% specificity from MOG-disease. Additionally, brain and spinal cord criteria showed 100% sensitivity and specificity in patients presenting optic neuritis. Brain and spinal cord criteria were less sensitive in patients with CIS and in pediatric MS patients.

      Conclusions

      Our data suggest radiological criteria can be useful to separate MS from MOG- and aquaporin-4-positive neuromyelitis optica spectrum disorders, in particular in patients with optic neuritis. Further work is needed to support their use in CIS.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Multiple Sclerosis and Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cobo-Calvo A.
        • et al.
        Clinical spectrum and prognostic value of CNS MOG autoimmunity in adults: the MOGADOR study.
        Neurology. 2018; 90: e1858-e1869
        • Gonzalez C.F.
        • et al.
        Distributional patterns of multiple sclerosis brain lesions. Magnetic resonance imaging – clinical correlation.
        J. Neuroimaging. 1994; 4: 188-195
        • Hyun J.-W.
        • et al.
        Evaluation of brain lesion distribution criteria at disease onset in differentiating MS from NMOSD and MOG-IgG-associated encephalomyelitis.
        Mult. Scler. J. 2018; (see http://journals.sagepub.com/doi/10.1177/1352458518761186)
        • Jarius S.
        • et al.
        MOG-IgG in NMO and related disorders: a multicenter study of 50 patients. Part 1: frequency, syndrome specificity, influence of disease activity, long-term course, association with AQP4-IgG, and origin.
        J. Neuroinflamm. 2016; 13: 279
        • Jarius S.
        • et al.
        MOG encephalomyelitis: international recommendations on diagnosis and antibody testing.
        J. Neuroinflamm. 2018; 15: 1-10
        • Juryńczyk M.
        • et al.
        Brain lesion distribution criteria distinguish MS from AQP4-antibody NMOSD and MOG-antibody disease.
        J. Neurol. Neurosurg. Psychiatry. 2017; 88: 132-136
        • Kim S.M.
        • et al.
        Antibodies to MOG in adults with inflammatory demyelinating disease of the CNS.
        Neurology. 2015; 2: 1-8
        • Kleiter I.
        • et al.
        Failure of natalizumab to prevent relapses in neuromyelitis optica.
        Arch. Neurol. 2012; 69: 239-245
        • Matthews L.
        • et al.
        Distinction of seropositive NMO spectrum disorder and MS brain lesion distribution.
        Neurology. 2013; 80: 1330-1337
        • Palace J.
        • Leite M.I.
        • Nairne A.
        • Vincent A.
        Interferon beta treatment in neuromyelitis optica: increase in relapses and aquaporin 4 antibody titers.
        Arch. Neurol. 2010; 67: 1016-1017
        • Polman C.H.
        • et al.
        Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.
        Ann. Neurol. 2011; 69: 292-302
        • Reich D.S.
        • Lucchinetti C.F.
        • Calabresi P.A
        Multiple sclerosis.
        N. Engl. J. Med. 2018; 378: 169-180
        • Thompson A.J.
        • et al.
        Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.
        Lancet Neurol. 2018; 17: 162-173
        • Wingerchuk D.M.
        • et al.
        International consensus diagnostic criteria for neuromyelitis optica spectrum disorders.
        Neurology. 2015; 85: 177-189