Brain Imaging Differences Between Multiple Sclerosis and Neuromyelitis Optica

Neuromyelitis optica (NMO) spectrum disorder can be caused by antibodies to either aquaporin 4 (AQP4) or myelin oligodendrocyte glycoprotein (MOG). Investigators evaluated differences in brain magnetic resonance imaging (MRI) findings in 26 patients with MOG antibody, 26 with AQP4 antibody, and 31 with multiple sclerosis (MS); 22% of the patients were children.

On the basis of 29 imaging features, the investigators identified the best classifiers. MOG antibody was associated with fluffy brainstem lesions in the pons, peduncles, and adjacent to the fourth ventricle, alone or in combination, and with ≤3 lesions. MS was best differentiated by ovoid lesions adjacent to ventricles (Dawson fingers), T1 hypointense lesions, and >9 T2 MRI lesions.