Table 2.
Imaging findings in AQP4+NMOSD and MOGAD. MS findings are also shown for comparison.
| AQP4+NMOSD | MOGAD | MS | |
|---|---|---|---|
| Optic nerve | |||
| Bilateral involvement | ++ | ++ | − |
| Longitudinally extensive lesions (>50% length of optic nerve) | ++ | ++ | − |
| Location | Posterior with chiasm | Anterior | Anterior/middle |
| Optic nerve enhancement | +++ | +++ | +++ |
| Optic nerve sheath enhancement | − | ++ | − |
| Perioptic fat enhancement | − | ++ | − |
| Spinal cord | |||
| Multiple lesions | − | ++ | +++ |
| Longitudinally extensive lesions | +++ | +++ | − |
| Location (axial) | Central | Central | Peripheral |
| Grey matter involved | +++ | +++ | + |
| White matter involved | +++ | + | +++ |
| Location (sagittal) | Cervico-thoracic | Cervico-thoracic | Cervico-thoracic |
| Conus involved | + | ++ | + |
| Parenchymal enhancement | Lens-shape, heterogeneous | Faint, ill-defined | Ring, nodular |
| Leptomeningeal enhancement | + | ++ | − |
| Brain | |||
| Shape | Along white matter tracts | Poorly demarcated | Ovoid |
| Cortical lesions | − | + | ++ |
| Juxtacortical lesions | − | ++ | +++ |
| Subcortical lesions | ++ | + | − |
| Periventricular lesions | Peri-3rd/4th ventricle and peri-ependymal lateral ventricles | − | Dawson’s fingers |
| Corpus callosum lesions | ++ | ++ | +++ |
| Deep grey matter lesions | + | ++ | − |
| Diffuse pons/middle cerebellar peduncle lesions | + | +++ | |
| T1-hypointense lesions | + | + | +++ |
| Ring enhancement | − | − | ++ |
| Ependymal enhancement | ++ | − | − |
| Leptomeningeal enhancement | − | ++ | −1 |
| T2-lesion resolution | + | +++ | − |
| Inter-attack asymptomatic accumulation of new T2-lesions | − | − | ++2 |
Note that: “−“ indicates rare findings (<5%), “+” infrequent findings (5–30%), “++” common findings (30–69%), “+++” very common findings (>70%).
1
May be seen with more sophisticated MRI techniques (e.g., post-contrast Fluid-attenuated inversion recovery or at 7.0 T field strength)
2
Depdendent on treatment and is common with low or moderate efficacy MS disease modifying treatments but rare with high efficacy treatments
Abbreviations: MOGAD=myelin-oligodendrocyte glycoprotein antibody-associated disease; MS=multiple sclerosis; AQP4+NMOSD=aquaporin-4-IgG positive neuromyelitis optica spectrum disorder.