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Clinical and MRI measures to identify non-acute MOG-antibody disease in adults

Item Type:Article
Title:Clinical and MRI measures to identify non-acute MOG-antibody disease in adults
Creators Name:Cortese, R. and Battaglini, M. and Prados, F. and Bianchi, A. and Haider, L. and Jacob, A. and Palace, J. and Messina, S. and Paul, F. and Wuerfel, J. and Marignier, R. and Durand-Dubief, F. and de Medeiros Rimkus, C. and Callegaro, D. and Sato, D.K. and Filippi, M. and Rocca, M.A. and Cacciaguerra, L. and Rovira, A. and Sastre-Garriga, J. and Arrambide, G. and Liu, Y. and Duan, Y. and Gasperini, C. and Tortorella, C. and Ruggieri, S. and Amato, M.P. and Ulivelli, M. and Groppa, S. and Grothe, M. and Llufriu, S. and Sepulveda, M. and Lukas, C. and Bellenberg, B. and Schneider, R. and Sowa, P. and Celius, E.G. and Proebstel, A.K. and Yaldizli, Ö. and Müller, J. and Stankoff, B. and Bodini, B. and Carmisciano, L. and Sormani, M.P. and Barkhof, F. and De Stefano, N. and Ciccarelli, O.
Abstract:MRI and clinical features of myelin oligodendrocyte glycoprotein (MOG)-antibody disease may overlap with those of other inflammatory demyelinating conditions posing diagnostic challenges, especially in non-acute phases and when serologic testing for MOG-antibodies is unavailable or shows uncertain results. We aimed to identify MRI and clinical markers that differentiate non-acute MOG-antibody disease from aquaporin4 (AQP4)-antibody neuromyelitis optica spectrum disorder and relapsing remitting multiple sclerosis, guiding in the identification of MOG-antibody disease patients in clinical practice. In this cross-sectional retrospective study, data from 16 MAGNIMS centres were included. Data collection and analyses were conducted from 2019 to 2021. Inclusion criteria were: diagnosis of MOG-antibody disease, AQP4-neuromyelitis optica spectrum disorder and multiple sclerosis, brain and cord MRI at least 6 months from relapse, EDSS on the day of MRI. Brain white matter T2 lesions, T1-hypointense lesions, cortical and cord lesions were identified. Random-forest models were constructed to classify patients as MOG-antibody disease/AQP4-neuromyelitis optica spectrum disorder/multiple sclerosis; a leave one out cross-validation procedure assessed the performance of the models. Based on the best discriminators between diseases, we proposed a guide to target investigations for MOG-antibody disease. One hundred sixty-two patients with MOG-antibody disease (99F, mean age: 41 [±14] years, median EDSS: 2 [0-7.5]), 162 with AQP4-neuromyelitis optica spectrum disorder (132F, mean age: 51 [±14] years, median EDSS: 3.5 [0-8]), 189 with multiple sclerosis (132F, mean age: 40 [±10] years, median EDSS: 2 [0-8]) and 152 healthy controls (91F) were studied. In young patients (<34 years), with low disability (EDSS < 3), the absence of Dawson's fingers, temporal lobe lesions and longitudinally extensive lesions in the cervical cord pointed towards a diagnosis of MOG-antibody disease instead of the other two diseases (accuracy: 76%, sensitivity: 81%, specificity: 84%, p < 0.001). In these non-acute patients, a number of brain lesions < 6 predicted MOG-antibody disease versus multiple sclerosis (accuracy: 83%, sensitivity: 82%, specificity: 83%, p < 0.001). An EDSS < 3 and the absence of longitudinally extensive lesions in the cervical cord predicted MOG-antibody disease versus AQP4-neuromyelitis optica spectrum disorder (accuracy: 76%, sensitivity: 89%, specificity: 62%, p < 0.001). A workflow with sequential tests and supporting features has been proposed to guide a better identification of MOG-antibody disease patients. Adult non-acute MOG-antibody disease patients showed distinctive clinical and MRI features when compared to AQP4-neuromyelitis optica spectrum disorder and multiple sclerosis. A careful inspection of the morphology of brain and cord lesions together with clinical information, can guide for further analyses towards diagnosis of MOG-antibody disease in clinical practice.
Keywords:Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease, Aquaporin 4-Antibody Positive Neuromyelitis Optica Spectrum Disorder, Multiple Sclerosis, Imaging, Differential Diagnosis
Publisher:Oxford University Press
Page Range:2489-2501
Date:January 2023
Official Publication:https://doi.org/10.1093/brain/awac480
PubMed:View item in PubMed

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