Radiological differentiation of optic neuritis with myelin oligodendrocyte glycoprotein antibodies, aquaporin-4 antibodies, and multiple sclerosis

Sudarshini Ramanathan, Kristina Prelog, Elizabeth H. Barnes, Esther M. Tantsis, Stephen W. Reddel, Andrew P.D. Henderson, Steve Vucic, Mark P. Gorman, Leslie A. Benson, Gulay Alper, Catherine J. Riney, Michael Barnett, John D.E. Parratt, Todd A. Hardy, Richard J. Leventer, Vera Merheb, Margherita Nosadini, Victor S.C. Fung, Fabienne Brilot, Russell C. Dale*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

163 Citations (Scopus)

Abstract

Background: Recognizing the cause of optic neuritis (ON) affects treatment decisions and visual outcomes. Objective: We aimed to define radiological features of first-episode demyelinating ON. Methods: We performed blinded radiological assessment of 50 patients presenting with first-episode myelin oligodendrocyte glycoprotein (MOG) antibody-associated ON (MOG-ON; n=19), aquaporin-4 (AQP4) antibody-associated ON (AQP4-ON; n=11), multiple sclerosis (MS)-associated ON (MS-ON; n=13), and unclassified ON (n=7). Results: Bilateral involvement was more common in MOG-ON and AQP4-ON than MS-ON (84% vs. 82% vs. 23%), optic nerve head swelling was more common in MOG-ON (53% vs. 9% vs. 0%), chiasmal involvement was more common in AQP4-ON (5% vs. 64% vs. 15%), and bilateral optic tract involvement was more common in AQP4-ON (0% vs. 45% vs. 0%). Retrobulbar involvement was more common in MOG-ON, whereas intracranial involvement was more common in AQP4-ON. MOG-ON and AQP4-ON had longer lesion lengths than MS-ON. The combination of two predictors, the absence of magnetic resonance imaging brain abnormalities and a higher lesion extent score, showed a good ability to discriminate between an autoantibody-associated ON (MOG or AQP4) and MS. AQP4-ON more frequently had severe and sustained visual impairment. Conclusion: MOG-ON and AQP4-ON are more commonly bilateral and longitudinally extensive. MOG-ON tends to involve the anterior optic pathway, whereas AQP4-ON the posterior optic pathway.

Original languageEnglish
Pages (from-to)470-482
Number of pages13
JournalMultiple Sclerosis
Volume22
Issue number4
DOIs
Publication statusPublished - 1 Apr 2016
Externally publishedYes

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