Table 2. Characteristics of Remission MRI New Silent Lesions.
| Type of new SLa | Sex | Age at r-MRI scan, y | DMT at r-MRI scan | Time since last attack, mo | Time since reference MRI, mo | New SL CNS location | New SL features |
|---|---|---|---|---|---|---|---|
| MOGAD | |||||||
| Definite, 1 | Female | 6 | None | 15 | 5 | Subcortical in the frontal white matter adjacent to insular cortex | Scattered and ill defined |
| Definite, 2 | Female | 41 | Pred 7.5 mg once daily | 10 | 6 | Splenium of the corpus callosum | Fluffy, ill-defined margins. No gad enhancement. |
| Definite, 3 | Male | 14 | None | 9 | 5 | Left midbrain and cerebral peduncle | Small, ill defined |
| Probable, 1 | Male | 51 | None | 39 | 39 | Anterior pons | Diffuse, ill-defined margins |
| Probable, 2 | Male | 13 | Pred 25 mg once daily | 5 | 4 | Centrum semiovale, corpus callosum, and right internal capsule | Small, ill defined. No gad enhancement. |
| AQP4-NMOSD | |||||||
| Definite, 1 | Female | 45 | MMF 3 g + pred 20 mg once daily | 7 | 2 | Extension of a previous cervical lesion | Swelling and extension |
| Definite, 2 | Male | 60 | MMF 3 g + pred 25 mg once daily | 8 | 6 | Extension of previous brain white matter lesions | Diffuse, confluent lesions. No gad enhancement. |
| Definite, 3 | Female | 19 | AZA 75 mg twice daily + pred 20 mg once daily | 11 | 6 | Area postrema | Faint intensity, normointense on DWI. No gad enhancement. |
| Probable, 1 | Female | 45 | MMF 3 g + pred 20 mg once daily | 5 | 5 | Cervical cord lesion, C1-C4 | Longitudinally extensive lesion not observed at the previous attack MRI for thoracic transverse myelitis |
| Probable, 2 | Female | 35 | Pred 10 mg once daily | 66 | 66 | Left parietal white matter and periventricular white matter | Scattered defined deep white matter lesions and a Dawson fingerlike periventricular lesion, DWI hyperintense |
| Probable, 3 | Female | 13 | RTX 1 g twice, 2 wk apart, every 6 mo) + pred 10 mg adt | 5 | 5 | Third ventricle, left thalamus | Small, ill defined |
| Probable, 4 | Female | 12 | IVIG every 3 wk + pred 20 mg once daily | 6 | 6 | Right cerebral peduncle and red nucleus | Small, ill defined |
Abbreviations: adt, alternate days; AQP4-NMOSD, aquaporin-4 antibody neuromyelitis optica spectrum disorder; AZA, azathioprine; CNS, central nervous system; definite, new SL found by a remission MRI compared with a reference MRI performed at least 4 weeks after an attack onset; DMT, disease-modifying therapy; DWI, diffusion-weighted imaging; gad, gadolinium contrast; IVIG, intravenous immunoglobulin; MMF, mycophenolate mofetil; MOGAD, myelin oligodendrocyte glycoprotein antibody disease; pred, prednisolone; probable, new SL found by a remission MRI compared with a reference MRI performed at onset or nadir of last clinical attack; r-MRI, remission magnetic resonance imaging (performed at least 3 months from last attack and all had to be completely free of new symptoms); RTX, rituximab; SL, silent lesion.
Number of patients with definite or probable new remission silent lesions either in MOGAD or in AQP4-NMOSD.