Multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease (MOGAD) present with overlapping features, which can make a differential diagnosis difficult. Brain and spinal cord magnetic resonance imaging (MRI) is an appropriate method for determining a correct diagnosis.
The overlapping clinical features of multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease (MOGAD) can make establishing the right diagnosis complicated. Although they have similar clinical features, these conditions have distinctive treatment regimens. Therefore, an accurate diagnosis is crucial to successful and timely treatment. The results from AQP4-Ab and MOG-Ab assays can take weeks to obtain and may present inaccurate data. According to this research, imaging methods may be the answer.
A retrospective study was conducted that included a total of 577 patients from healthcare centers across Europe, Asia, and Latin America. The objectives of the study were to assess original and modified brain MRI lesion distribution criteria in patients with MS, NMOSD, or MOGAD. The โone out of threeโ criteria were analyzed according to different phenotypes and ethnic groups. Researchers also investigated the impact on specificity of adding the absence of fluffy infratentorial (FIT) lesions to the criteria, among other effects.
The specificity of the โone out of threeโ criteria was increased by adding the absence of FIT lesions in patients with AQP4-Ab NMOSD and MOGAD, without a compromise in sensitivity. The positive predictive values of the โone out of threeโ criteria for MS were low for Asian patients (84.8 vs 99.1% for White patients). However, adding further criteria increased the positive predictive values (94.1% for โthree out of fiveโ criteria).
Healthcare professionals may find these criteria-based methods useful for differentiating MS from NMOSD and MOGAD, depending on ethnic group and clinical situation. The absence of FIT lesions increases the specificity in patients with symptoms affecting the brain or brainstem [1].
Source:
[1] Carnero Contentti, E., Rojas, J. I., Criniti, J., Lopez, P. A., Daccach Marques, V., Soto de Castillo, I., Tkachuk, V., Marrodan, M., Correale, J., Farez, M. F., Kim, H. J., Hyun, J., Messina, S., Mariano, R., Rocca, M. A., Cacciaguerra, L., Filippi, M., Palace, J., & Juryลczyk, M. (2022). Towards imaging criteria that best differentiate MS from NMOSD and MOGAD: Large multi-ethnic population and different clinical scenarios. Multiple Sclerosis and Related Disorders, 61, 103778. https://doi.org/10.1016/j.msard.2022.103778