Highlights
- •This study used the R2t* measure to quantify tissue damage in lesions and non-lesional tissue in MS and MOGAD.
- •Abnormalities in non-lesional tissue are present in MOGAD but are of modest magnitude compared to MS.
- •WML damage in MOGAD lesions is less severe compared to MS.
- •Overall, MOGAD was associated with less tissue damage compared to MS.
Abstract
Background
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a distinct
central nervous system (CNS) disorder that shares features with multiple sclerosis
(MS) and may be misdiagnosed as MS. MOGAD and MS share a frequently relapsing clinical
course and lesions with inflammatory demyelinating pathology. One key feature of MS
pathology is tissue damage in normal-appearing white matter (NAWM) outside of discrete
lesions, whereas the extent to which similar non-lesional damage occurs in MOGAD is
not known and could be assessed using qGRE. The goal of this study was to examine
the brains of people with MOGAD using quantitative gradient-recalled echo (qGRE) magnetic
resonance imaging and to compare tissue damage with MS patients matched for disability.
Methods
MOGAD and MS patients were recruited to match in terms of age and disability. Similarly
aged healthy control (HC) data were drawn from existing studies. qGRE brain imaging
of HC (N = 15), MOGAD (N = 17), and MS (N = 15) patients was used to examine the severity and extent of tissue damage within
and outside of discrete lesions. The qGRE metric R2t* is sensitive to changes in tissue
microstructure and was measured in white matter lesions (WMLs), NAWM, cortical (CGM)
and deep gray matter (DGM). Statistical inference was performed with linear models.
Results
R2t* was reduced in CGM (p = 0.00047), DGM (p = 0.0055) and NAWM (p = 0.0019) in MOGAD and MS compared to similar regions in age-matched HCs. However,
the degree of R2t* reduction in all these regions was less in the MOGAD patients compared
with MS. WMLs in MOGAD demonstrated reduced R2t* compared to NAWM but this reduction
was modest compared to changes associated with WMLs in MS (p = 0.026).
Conclusion
These results demonstrate abnormalities in lesional and non-lesional CNS tissues in
MOGAD that are not detectable on standard MRI. The abnormalities seen in NAWM, CGM,
and DGM were less severe in MOGAD compared to MS. MOGAD-related WMLs showed reduced
R2t*, but were less abnormal than WMLs in MS. These data reveal damage to non-lesional
tissues in two different demyelinating diseases, suggesting that damage outside of
WMLs may be a common feature of demyelinating diseases. The lesser degree of R2t*
abnormality in MOGAD tissues compared to MS suggests less underlying tissue damage
and may underlie the greater propensity for recovery in MOGAD.
Keywords
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Article info
Publication history
Published online: March 22, 2023
Accepted:
March 22,
2023
Received in revised form:
March 19,
2023
Received:
November 21,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
