MRI Lesion Lag in Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease

Myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) most frequently presents with optic neuritis, transverse myelitis, brain-stem lesions, and cerebral lesions (NEJM JW Neurol Mar 27 2023 and Lancet Neurol 2023; 22:268). Investigators retrospectively reviewed MRI findings from 55 patients with MOGAD and compared these with MRI findings from 38 patients with multiple sclerosis (MS) and 19 with aquaporin-4 (AQP4) antibody disease.

A first MRI was obtained a median 5 days from initial symptoms and was normal in 10% of 58 MOGAD attacks (all of which had initial cerebral symptoms). A second MRI was obtained a median 8 days from the initial scan and showed new T2 lesions in 47% of attacks, stability in 41%, resolution of T2 les…