Distinct patterns of MRI lesions in MOG antibody disease and AQP4 NMOSD : a systematic review and meta-analysis

Background: the distinct MRI features of MOG-antibody disease (MOG-AD) and AQP4-NMOSD are still poorly defined. We performed a systematic review and meta-analysis to identify specific patterns of MRI abnormalities able to discriminate between MOG-AD and AQP4-NMOSD. Methods: fourteen case-series (1028 patients) were included. Outcomes were MRI lesion patterns in optic nerve (ON), brain and spinal cord (SC) that were selected after a systematic literature review and analysed separately as the event rate for individual MRI lesions in MOG-AD (experimental group) and AQP4-NMOSD (control group) by using a random effect model. Results: MOG-AD showed a higher number of MRI lesions than AQP4-NMOSD patients in the retrobulbar ON (OR=5.67; 95%CI=2.11–15.24; p=0.0006) with ON head swelling (OR=8.20; 95%CI=4.13–16.28; p<0.00001), corpus callosum (OR=2.30; 95%CI=1.11–4.76; p=0.02), pons (OR=2.87; 95%CI=1.45–5.67; p=0.002), and lumbar/conus SC (OR=3.47; 95%CI=1.66–7.24; p=0.0009). Conversely, lesions in the canalicular (OR=0.42; 95%CI=0.18–0.98; p=0.05) and intracranial ON (OR=0.30; 95%CI=0.11=0.84; p=0.02), area postrema (OR=0.12; 95%CI=0.02–0.61; p=0.01), medulla (OR=0.40; 95%CI=0.20–0.78; p=0.007), and cervical SC (OR=0.29; 95%CI=0.09–0.92; p=0.04) were prominent in patients with AQP4-NMOSD. Participants’ age was found to be a source of heterogeneity across studies. Conclusion: our study provides further evidence that MOG-AD and AQP4-NMOSD have distinct MRI features that may help clinicians for an early differential diagnosis.