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

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Item Type:	Article
Title:	Clinical and MRI measures to identify non-acute MOG-antibody disease in adults
Creators Name:	Cortese, R., Battaglini, M., Prados, F., Bianchi, A., Haider, L., Jacob, A., Palace, J., Messina, S., Paul, F., Wuerfel, J., Marignier, R., Durand-Dubief, F., de Medeiros Rimkus, C., Callegaro, D., Sato, D.K., Filippi, M., Rocca, M.A., Cacciaguerra, L., Rovira, A., Sastre-Garriga, J., Arrambide, G., Liu, Y., Duan, Y., Gasperini, C., Tortorella, C., Ruggieri, S., Amato, M.P., Ulivelli, M., Groppa, S., Grothe, M., Llufriu, S., Sepulveda, M., Lukas, C., Bellenberg, B., Schneider, R., Sowa, P., Celius, E.G., Proebstel, A.K., Yaldizli, Ö., Müller, J., Stankoff, B., Bodini, B., Carmisciano, L., Sormani, M.P., Barkhof, F., 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
Source:	Brain
ISSN:	0006-8950
Publisher:	Oxford University Press
Volume:	146
Number:	6
Page Range:	2489-2501
Date:	June 2023
Additional Information:	Copyright © The Author(s) 2022. Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
Official Publication:	https://doi.org/10.1093/brain/awac480
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PubMed:	View item in PubMed

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