2024 American Academy of Neurology Abstract Website

Objective:

The aim of this study is to investigate the use of susceptibility-based imaging (SbI) in distinguishing between pediatric-onset multiple sclerosis (POMS) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).

Background:

MOG antibody-associated disease (MOGAD) and pediatric-onset MS (POMS) share clinical and MRI features but differ in prognosis and management. Early POMS diagnosis is essential to avoid disability accumulation. Central vein sign (CVS), paramagnetic rim lesions (PRLs), and central core lesions (CCL) are susceptibility-based imaging (SbI)-related signs understudied in pediatric populations that may help discerning POMS from MOGAD.

Design/Methods:

T2-FLAIR and SbI (3D-EPI/SWI or similar) were acquired on 1.5T/3T scanners. Two readers assessed CVS positive rate (%CVS+) and their average score was used to build a receiver operator curve (ROC) assessing the ability to discriminate disease type. PRLs and CCL were identified using a consensual approach.

Results:

%CVS+ distinguished 26 POMS cases (mean age 13.7 years, 63% females, median EDSS 1.5) from 14 MOGAD cases (10.8 years, 35% females, EDSS 1.0) with ROC=1, p<0.0001, (cutoff 41%). PRLs were only detectable in POMS participants (mean 2.1 ± 2.3, range 1-10) discriminating the two conditions with a sensitivity of 69% and a specificity of 100%. CCLs were more sensitive (81%) but less specific (71.43%)

Conclusions:

%CVS+ and PRLs are highly specific markers of POMS. After proprer validation on larger multicenter cohorts, consideration should be given to including such imaging markers for diagnosing POMS at disease onset.