Comparison of MRI features of attacks of MOGAD, AQP-4-IgG-NMOSD and MS involving the brainstem, cerebellum or both
| MOGAD brainstem or cerebellar attack (n=37) | AQP4-IgG-NMOSD brainstem or cerebellar attack (n=30) | MOG-IgG versus AQP4-IgG P value | MS brainstem or cerebellar attack (n=30) | MOG-IgG versus MS P value | |
| MRI head features | |||||
| Medulla lesion present (%) | 18/37 (49) | 25/30 (83) | 0.005 | 8/30 (27) | 0.08 |
| No of lesions in medulla, median (range)‡ | 0 (0–4) | 1 (0–4) | 0.006 | 0 (0–8) | 0.16 |
| Medulla lesion diffuse (%)§ | 7/37 (19) | 11/30 (37) | 0.17 | 0/30 (0) | 0.01 |
| Pons lesion present (%) | 26/37 (70) | 16/30 (53) | 0.21 | 21/30 (70) | >0.99 |
| No of lesions in pons, median (range)‡ | 1 (0–7) | 1 (0–7) | 0.09 | 1 (0–14) | 0.69 |
| Pons lesion diffuse (%)§ | 8/37 (22) | 3/30 (10) | 0.32 | 0/30 (0) | 0.007 |
| Midbrain lesion present (%) | 18/37 (49) | 12/30 (40) | 0.62 | 7/30 (23) | 0.04 |
| No of midbrain lesions, median (range)‡ | 0 (0–4) | 0 (0–2) | 0.21 | 0 (0–6) | 0.047 |
| Unilateral or bilateral diffuse midbrain lesion (%)§ | 7/37 (19)¶ | 4/30 (13)* | 0.74 | 0/30 (0) | 0.01 |
| Presence of cerebellar peduncle or parenchymal lesion (%) | 25/37 (68)† | 10/30 (33)** | 0.007 | 18/30 (60)†† | 0.61 |
| No of cerebellar parenchymal or peduncle lesions, median (range)‡ | 2 (0–6) | 0 (0–3) | 0.002 | 1 (0–8) | 0.88 |
| Unilateral or bilateral diffuse MCP lesion (%)§ | 17/37 (46) | 3/30 (10) | 0.001 | 3/30 (10) | 0.001 |
| Enhancement of ≥1 posterior fossa lesion | 22/38 (58) | 17/29 (59) | >0.99 | 19/28 (68) | 0.45 |
| Complete resolution of all prior T2 lesions at ≥6 months (%) | 6/9 (67) | 3/11 (27) | 0.18 | 3/19 (16) | 0.01 |
*Three of the diffuse midbrain lesions in AQP4-IgG-NMOSD were unilateral and 1 was bilateral.
†There were 12 unilateral MCP lesions seen in MOGAD versus 13 bilateral.
‡Some lesions traversed two locations and were counted in both locations,
§Diffuse lesions were defined as involving greater than or equal to 75% of the parenchyma as viewed on axial sequence by visual inspection.
¶Four of the diffuse midbrain lesions in MOGAD were unilateral and 3 were bilateral.
**There were 4 unilateral MCP lesions in AQP4-IgG-NMOSD versus 4 bilateral.
††There were 11 unilateral MCP lesions in MS versus 4 bilateral.
AQP4, aquaporin-4; AQP4-IgG-NMOSD, aquaporin-4-IgG-seropositive-neuromyelitis optic spectrum disorder; MCP, middle cerebellar peduncle; MOG, myelin oligodendrocyte glycoprotein; MOGAD, myelin oligodendrocyte glycoprotein antibody associated disorder; MS, multiple sclerosis.