Key MRI diagnostic features of MS, MOGAD and NMOSD

ICNC2024
Symposia: What Is New In Pediatric CNS Demyelination?

Key MRI diagnostic features of MS, MOGAD and NMOSD
Ming Lim

Magnetic resonance imaging (MRI) is central in the diagnostic workup of children with suspected CNS demyelination given its high sensitivity to detect signs of neuroinflammation involving optic nerves, brain-brainstem, or spinal cord. Differences in patterns of brain and spinal cord lesions between relapsing-remitting MS, AQP4 antibody– positive NMOSD, and MOGAD can be identified. In MS, white matter lesions tend to affect specific brain regions, such as the periventricular and juxtacortical white matter, the corpus callosum, and the infratentorial areas, whereas in AQP4-NMOSD, brain abnormalities are frequently located in areas with high AQP4 expression such as peri-ependymal lesions surrounding the ventricles or involving corticospinal tracts. Patients with MOGAD can show large, ill-defined, or defined lesions, mostly located in the deep gray matter and the cerebellar peduncles. Longitudinally extensive transverse myelitis is the hallmark of AQP4- NMOSD with predilection for the cervical cord, whereas in MS, multiple, short-segment lesions are common. In MOGAD, cord lesions often affect the lower thoracic cord and conus and tend to be longitudinally extensive in the acute stage. In addition, we will also review in this session the ability of MRI to exclude a wide range of differential diagnosis in pediatric patients.

Other Lectures in this symposium
How could we optimize the management of children with CNS demyelinating disorders in different resource settings?
Progress in Pediatric MS Treatment: Real World Evidence with High-impact therapies
Diagnosing MOGAD in pediatric patients. Updated diagnostic criteria from an International Panel.