MR imaging in children with transverse myelitis and acquired demyelinating syndromes


      • One third of children with transverse myelitis are MOG-IgG positive.
      • MRI differences between children with transverse myelitis and MOG-IgG, NMOSD and MS.
      • Leptomeningeal enhancement is a unique feature for MOGAD.
      • Double seronegative children with transverse myelitis rarely have brain lesions.



      Transverse myelitis (TM) occurs isolated or within other acquired demyelinating syndromes (ADS) such as neuromyelitis optica spectrum disorders (NMOSD), multiple sclerosis (MS) or myelin oligodendrocyte glycoprotein antibody associated disorders (MOGAD).


      To describe and compare clinical and MRI features of children with ADS presenting with TM grouped according to antibody status and diagnosis of MS and NMOSD.

      Patients and methods

      Children with TM, radiological involvement of the myelon, MOG and aquaporin-4 antibody status were elegible.


      100 children were identified and divided into MOGAD (n=33), NMOSD (n=7), double seronegative TM (n=34), and MS (n=26). MOGAD children had mainly acute disseminated encephalomyelitis + TM/ longitudinally extensive TM (LETM) (42%) or isolated LETM (30%). In MOGAD, LETM was present in more than half of all children (55%) with predominant involvement of only the grey matter (73%). Leptomeningeal enhancement was highly predictive of MOGAD (16/30; p=0.003). In MS patients spinal MRI showed single (50%) or multiple short lesions (46%) with involvement of grey and white matter (68%). Double seronegative children presented with LETM (74%) and brain lesions were less frequent compared to the other groups (30%).


      Children with ADS presenting with TM reveal important radiological differences such as LETM with predominant involvement of spinal grey matter and leptomeningeal enhancement in MOGAD.



      abs (antibodies), ADEM (acute disseminated encephalomyelitis), ADS (acquired demyelinating syndrome), AQP4 (aquaporin-4), CIS (clinically isolated syndrome), CSF (cerebrospinal fluid), LETM (longitudinally extensive transverse myelitis), MOG (myelin oligodendrocyte glycoprotein), MOGAD (MOG-antibody associated disorders), MS (multiple sclerosis), NMOSD (neuromyelitis optica spectrum disorders), OCBs (oligoclonal bands), TM (transverse myelitis)
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      1. Proposed diagnostic criteria and nosology of acute transverse myelitis.
        Neurology. 2002; 59: 499-505
        • Wolf VL
        • Lupo PJ
        • Lotze TE.
        Pediatric Acute Transverse Myelitis Overview and Differential Diagnosis.
        J. Child Neurol. 2012; 27: 1426-1436
        • Barakat N
        • Gorman MP
        • Benson L
        • Becerra L
        • Borsook D.
        Pain and spinal cord imaging measures in children with demyelinating disease.
        NeuroImage. Clinical. 2015; 9: 338-347
        • Absoud M
        • Greenberg BM
        • Lim M
        • Lotze T
        • Thomas T
        • Deiva K.
        Pediatric transverse myelitis.
        Neurology. 2016; 87: S46-S52
        • Hennes E-M
        • Baumann M
        • Schanda K
        • et al.
        Prognostic relevance of MOG antibodies in children with an acquired demyelinating syndrome.
        Neurology. 2017; 89: 900-908
        • Hacohen Y
        • Absoud M
        • Deiva K
        • et al.
        Myelin oligodendrocyte glycoprotein antibodies are associated with a non-MS course in children.
        Neurology(R) neuroimmunology & neuroinflammation. 2015; 2: e81
        • Spadaro M
        • Gerdes LA
        • Krumbholz M
        • et al.
        Autoantibodies to MOG in a distinct subgroup of adult multiple sclerosis.
        Neurology(R) neuroimmunology & neuroinflammation. 2016; 3: e257
        • Baumann M
        • Grams A
        • Djurdjevic T
        • et al.
        MRI of the first event in pediatric acquired demyelinating syndromes with antibodies to myelin oligodendrocyte glycoprotein.
        J. Neurol. 2018; 265: 845-855
        • Dubey D
        • Pittock SJ
        • Krecke KN
        • et al.
        Clinical, Radiologic, and Prognostic Features of Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Autoantibody.
        JAMA Neurol. 2019; 76: 301-309
        • Hacohen Y
        • Mankad K
        • Chong WK
        • et al.
        Diagnostic algorithm for relapsing acquired demyelinating syndromes in children.
        Neurology. 2017; 89: 269-278
        • Fadda G
        • Alves CA
        • O'Mahony J
        • et al.
        Comparison of Spinal Cord Magnetic Resonance Imaging Features Among Children With Acquired Demyelinating Syndromes.
        JAMA network open. 2021; 4e2128871
        • Lechner C
        • Baumann M
        • Hennes E-M
        • et al.
        Antibodies to MOG and AQP4 in children with neuromyelitis optica and limited forms of the disease.
        J. Neurol. Neurosurg. Psychiatry. 2016; 87: 897-905
        • Mader S
        • Gredler V
        • Schanda K
        • et al.
        Complement activating antibodies to myelin oligodendrocyte glycoprotein in neuromyelitis optica and related disorders.
        Journal of neuroinflammation. 2011; 8: 184
        • Wingerchuk DM
        • Banwell B
        • Bennett JL
        • et al.
        International consensus diagnostic criteria for neuromyelitis optica spectrum disorders.
        Neurology. 2015; 85: 177-189
        • Thompson AJ
        • Banwell BL
        • Barkhof F
        • et al.
        Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.
        The Lancet Neurology. 2018; 17: 162-173
        • Tantsis EM
        • Prelog K
        • Alper G
        • et al.
        Magnetic resonance imaging in enterovirus-71, myelin oligodendrocyte glycoprotein antibody, aquaporin-4 antibody, and multiple sclerosis-associated myelitis in children.
        Dev. Med. Child Neurol. 2019; 61: 1108-1116
        • Jarius S
        • Ruprecht K
        • Kleiter I
        • et al.
        MOG-IgG in NMO and related disorders: a multicenter study of 50 patients. Part 2: Epidemiology, clinical presentation, radiological and laboratory features, treatment responses, and long-term outcome.
        Journal of neuroinflammation. 2016; 13: 280
        • Sato DK
        • Callegaro D
        • Lana-Peixoto MA
        • et al.
        Distinction between MOG antibody-positive and AQP4 antibody-positive NMO spectrum disorders.
        Neurology. 2014; 82: 474-481
        • Mariano R
        • Messina S
        • Roca-Fernandez A
        • Leite MI
        • Kong Y
        • Palace JA.
        Quantitative spinal cord MRI in MOG-antibody disease, neuromyelitis optica and multiple sclerosis.
        Brain a journal of neurology. 2021; 144: 198-212
        • Ciron J
        • Cobo-Calvo A
        • Audoin B
        • et al.
        Frequency and characteristics of short versus longitudinally extensive myelitis in adults with MOG antibodies: A retrospective multicentric study.
        Mult. Scler. 2020; 26: 936-944
        • Jurynczyk M
        • Geraldes R
        • Probert F
        • et al.
        Distinct brain imaging characteristics of autoantibody-mediated CNS conditions and multiple sclerosis.
        Brain a journal of neurology. 2017; 140: 617-627