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Research paper
Brain lesion distribution criteria distinguish MS from AQP4-antibody NMOSD and MOG-antibody disease
  1. Maciej Juryńczyk1,
  2. George Tackley1,
  3. Yazhuo Kong1,
  4. Ruth Geraldes1,
  5. Lucy Matthews1,
  6. Mark Woodhall1,
  7. Patrick Waters1,
  8. Wilhelm Kuker1,
  9. Matthew Craner1,
  10. Andrew Weir1,
  11. Gabriele C DeLuca1,
  12. Stephane Kremer2,3,
  13. Maria Isabel Leite1,
  14. Angela Vincent1,
  15. Anu Jacob4,
  16. Jérôme de Sèze5,6,
  17. Jacqueline Palace1
  1. 1Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  2. 2ICube (UMR 7357, UdS, Centre National de la Recherche Scientifique), Fédération de médecine translationelle de Strasbourg, University de Strasbourg, Strasbourg, France
  3. 3Department of Radiology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
  4. 4NMO Clinical Service, The Walton Centre, Liverpool, UK
  5. 5Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
  6. 6Fédération de médecine translationelle de Strasbourg, CIC 1434, University of Strasbourg, Strasbourg, France
  1. Correspondence to Dr Jacqueline Palace, John Radcliffe Hospital, West Wing, Neurosciences Offices, Headley Way, Oxford OX39DU, UK; jacqueline.palace{at}


Importance Neuromyelitis optica spectrum disorders (NMOSD) can present with very similar clinical features to multiple sclerosis (MS), but the international diagnostic imaging criteria for MS are not necessarily helpful in distinguishing these two diseases.

Objective This multicentre study tested previously reported criteria of ‘(1) at least 1 lesion adjacent to the body of the lateral ventricle and in the inferior temporal lobe; or (2) the presence of a subcortical U-fibre lesion or (3) a Dawson's finger-type lesion’ in an independent cohort of relapsing-remitting multiple sclerosis (RRMS) and AQP4-ab NMOSD patients and also assessed their value in myelin oligodendrocyte glycoprotein (MOG)-ab positive and ab-negative NMOSD.

Design Brain MRI scans were anonymised and scored on the criteria by 2 of 3 independent raters. In case of disagreement, the final opinion was made by the third rater.

Participants 112 patients with NMOSD (31 AQP4-ab-positive, 21 MOG-ab-positive, 16 ab-negative) or MS (44) were selected from 3 centres (Oxford, Strasbourg and Liverpool) for the presence of brain lesions.

Results MRI brain lesion distribution criteria were able to distinguish RRMS with a sensitivity of 90.9% and with a specificity of 87.1% against AQP4-ab NMOSD, 95.2% against MOG-ab NMOSD and 87.5% in the heterogenous ab-negative NMOSD cohort. Over the whole NMOSD group, the specificity was 89.7%.

Conclusions This study suggests that the brain MRI criteria for differentiating RRMS from NMOSD are sensitive and specific for all phenotypes.

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  • Contributors MJ and JP involved in drafting the manuscript. All authors contributed to revision of the manuscript and involved in contribution of vital reagents/tools/patients. LM and JP involved in study concept or design. MJ, YK and JP contributed to analysis or interpretation of the data. MJ, GT, RG, LM and JP involved in acquisition of data. MJ performed statistical analysis. JP involved in study supervision or coordination.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Oxford Research Ethics Committee C Ref: 10/H0606/56.

  • Provenance and peer review Not commissioned; externally peer reviewed.