Objective:

To evaluate dynamic optic nerve changes on MRI during acute optic neuritis (ON) in Mayo Clinic patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), multiple sclerosis (MS), and aquaporin-4 antibody positive neuromyelitis optica spectrum disorder (NMOSD). 

Background:

Understanding the imaging evolution of acute ON may assist in diagnosis and treatment.

Design/Methods:

Inclusion criteria: Two MRIs with fat saturation of the orbits within 30 days of visual symptoms. Location and length of T2 hyperintensities and gadolinium enhancement were analyzed and compared between the two scans and across the three disease groups.  

Results:

We included 14 MOGAD patients [median age, 34 years(range, 9-71); 79% female; median interscan interval, 10 days(range, 4-17)], 5 MS patients [age, 42 years(37-70); 80% female; scan interval, 11 days(4-23)], and 4 NMOSD patients [age, 26 years(13-64); 50% female; scan interval, 7 days(5-17)]. Repeat scans were completed for worsening/persistent symptoms [MOGAD, 12/14(86%); MS 1/5(20%), NMOSD, 2/4(50%)] and to establish a new baseline [MOGAD, 2/14(14%), MS 4/5(80%), NMOSD, 2/4(50%)]. Gadolinium enhancing lesions were common in all groups [MOGAD initial, 14/14(100%) vs follow-up, 12/14(83%); MS, 3/4(75%) vs 4/4(100%); NMOSD, 4/4(100%) vs 4/4(100%)]. The length of MOGAD enhancing lesions was dynamic with improvement in 6/14(43%), worsening in 5/14(36%), and stability in 3/14(21%) at follow-up scan compared to MS [improved, 2/5(40%); worsened, 1/5(20%); stable, 2/5(40%)] and NMOSD [improved, 0/4(0%); worsened, 1/4(25%); stable, 3/4(75%)]. Complete resolution of enhancement occurred in a subset of MOGAD patients [MOGAD, 2/12(17%); MS, 0/5(0%); NMOSD, 0/4(0%)]. Steroids did not significantly impact enhancement evolution. Delayed development of T2-hyperintesities occurred in some patients [MOGAD initial, 8/11(73%) vs follow-up, 10/10(100%); MS, 3/4(100%) vs 4/4(100%); NMOSD, 4/4(100%) vs 4/4(100%)].

Conclusions: