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 accessOne-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 DisordersAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clinical spectrum and prognostic value of CNS MOG autoimmunity in adults: the MOGADOR study.Neurology. 2018; 90: e1858-e1869
- Distributional patterns of multiple sclerosis brain lesions. Magnetic resonance imaging – clinical correlation.J. Neuroimaging. 1994; 4: 188-195
- 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)
- 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
- MOG encephalomyelitis: international recommendations on diagnosis and antibody testing.J. Neuroinflamm. 2018; 15: 1-10
- Brain lesion distribution criteria distinguish MS from AQP4-antibody NMOSD and MOG-antibody disease.J. Neurol. Neurosurg. Psychiatry. 2017; 88: 132-136
- Antibodies to MOG in adults with inflammatory demyelinating disease of the CNS.Neurology. 2015; 2: 1-8
- Failure of natalizumab to prevent relapses in neuromyelitis optica.Arch. Neurol. 2012; 69: 239-245
- Distinction of seropositive NMO spectrum disorder and MS brain lesion distribution.Neurology. 2013; 80: 1330-1337
- Interferon beta treatment in neuromyelitis optica: increase in relapses and aquaporin 4 antibody titers.Arch. Neurol. 2010; 67: 1016-1017
- Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.Ann. Neurol. 2011; 69: 292-302
- Multiple sclerosis.N. Engl. J. Med. 2018; 378: 169-180
- Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.Lancet Neurol. 2018; 17: 162-173
- International consensus diagnostic criteria for neuromyelitis optica spectrum disorders.Neurology. 2015; 85: 177-189
Article info
Publication history
Published online: August 09, 2018
Accepted:
August 7,
2018
Received in revised form:
August 1,
2018
Received:
May 11,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
