Abstract
Purpose :
It has been reported that the rate of asymptomatic magnetic resonance imaging (MRI) optic nerve enhancement is as high as 51% in neuromyelitis optica; however, this has yet to be investigated in patients with myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD). We performed a multicenter retrospective study to determine the frequency of asymptomatic optic nerve enhancement in MOGAD patients.
Methods :
This was a multicenter retrospective study of MRI’s of patients with MOGAD. Study inclusion included positive serum MOG-IgG by a cell-based assay, MOGAD phenotype, and availability of post contrast orbital MRI sequences. The MRI studies were reviewed by a blinded, expert neuroradiologist. Medical records were reviewed for demographic information, details of ON attacks, and outcomes. Scans performed within 30 days of ON attack were classified as attack scans. Images obtained prior to ON attack or at time of non-ON attack were classified as inter-attack scans.
Results :
172 MRIs and 102 sequences (21 unique patients, 48% female) met study inclusion. Inter-attack MRIs represented 59% (60/102) of sequences (median 105 days post ON, range 35-1897). Of the inter-attack scans, 22% (13/60) of scans or 6 unique patients, showed optic nerve enhancement. This enhancement was located at prior sites of ON in 71% (10/13) of scans. Three patients showed enhancement without obvious clinical symptoms of ON, but two had ADEM without an eye examination at that time of the MRI, and one had a preceding MRI without enhancement, but did have a prior MRI with enhancement in that area. Long term visual outcomes were not significantly different between patients with asymptomatic enhancement and those without, with most patients in both groups improving to 20/20.
Conclusions :
Asymptomatic optic nerve enhancement occurred in 22% of inter-attack MRIs, the majority in patients with evidence of prior optic neuritis and occurring at prior sites of ON attack. New asymptomatic optic nerve enhancement in areas without prior optic neuritis was rare. These findings are important for understanding the natural history of MOGAD, the interpretation of symptoms or response to treatment, and the adjudication of attacks in upcoming MOGAD clinical trials.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.