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Quantitative brain lesion distribution may distinguish MOG-ab and AQP4-ab neuromyelitis optica spectrum disorders

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Abstract

Objectives

Antibodies to myelin oligodendrocyte glycoprotein (MOG-ab) and antibodies to aquaporin-4 (AQP4-ab) have been suggested to play roles in commonly separated subsets of patients with neuromyelitis optica spectrum disorder (NMOSD) phenotypes. The aim of this study is to quantitatively delineate and compare the brain lesion distributions of AQP4-ab-positive and MOG-ab-positive patients.

Methods

Fifty-seven and twenty-eight clinical MRI scans were collected from fifty-two AQP4-ab-positive and twenty-four MOG-ab-positive patients, respectively. T2 lesions were segmented manually on each axial FLAIR image. Probabilistic lesion distribution maps were created for each group after spatial normalization. Lobe-wise and voxel-wise quantitative comparisons of the two distributions were performed. A classification model based on the lesion distribution features was constructed to differentiate the two patient groups.

Results

Infratentorial and supratentorial brain lesions were found in both AQP4-ab-positive and MOG-ab-positive patients, with large inter-group overlap mainly in deep white matter (WM). In comparison with those in the AQP4 group, the brain lesions of the MOG-ab-positive patients had a larger size, dispersed distribution, and higher probabilities in the cerebellum, pons, midbrain, and GM and juxtacortical WM in temporal, sublobar, frontal, and parietal lobes. The area under the receiver operating characteristic curve of the lesion-distribution-based classification model was 0.951.

Conclusions

MOG-ab-positive and AQP4-ab-positive groups showed similar but quantitatively different brain lesion distributions. These results may help clinicians in considering MOG versus AQP4 in initial diagnosis, and add rationale for sending corresponding serologic testing.

Key Points

• Brain lesion distributions of AQP-ab-positive and MOG-ab-positive NMOSD patients

• Larger size, dispersed distribution, higher lesion probabilities in the cerebellum, pons, midbrain, and GM and juxtacortical WM in the MOG group

• The lesion-distribution-based classification model differentiates the two groups with AUC = 0.951

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Abbreviations

AQP4:

Aquaporin-4

GM:

Gray matter

MOG:

Myelin oligodendrocyte glycoprotein

NMO:

Neuromyelitis optica

NMOSD:

Neuromyelitis optica spectrum disorders

WM:

White matter

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Funding

This study has received funding by the Scientific Research project of Huashan Hospital, Fudan University (2016QD085), and Science and Technology Commission of Shanghai Municipality (17411953700).

Author information

Author notes

  1. Liqin Yang and Haiqing Li contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China

    Liqin Yang, Haiqing Li, Daoying Geng & Yuxin Li

  2. Institute of Functional and Molecular Medical Imaging, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China

    Liqin Yang, Haiqing Li, Daoying Geng & Yuxin Li

  3. Institute of Biomedical Engineering and Technology, Academy for Engineering and Technology, Fudan University, 220 Handan Road, Shanghai, China

    Wei Xia & Daoying Geng

  4. Department of Neurology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China

    Chao Quan & Lei Zhou

Authors
  1. Liqin Yang
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  2. Haiqing Li
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  3. Wei Xia
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Correspondence to Daoying Geng or Yuxin Li.

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The scientific guarantor of this publication is Daoying Geng.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• retrospective

• cross-sectional study

• performed at one institution

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Yang, L., Li, H., Xia, W. et al. Quantitative brain lesion distribution may distinguish MOG-ab and AQP4-ab neuromyelitis optica spectrum disorders. Eur Radiol 30, 1470–1479 (2020). https://doi.org/10.1007/s00330-019-06506-z

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  • DOI: https://doi.org/10.1007/s00330-019-06506-z

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