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

doi:10.1177/1352458515593406

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

Mult Scler. 2016 Apr;22(4):470-82. doi: 10.1177/1352458515593406. Epub 2015 Jul 10.

Authors

Sudarshini Ramanathan¹, Kristina Prelog², Elizabeth H Barnes³, Esther M Tantsis⁴, Stephen W Reddel⁵, Andrew P D Henderson⁶, Steve Vucic⁷, Mark P Gorman⁸, Leslie A Benson⁸, Gulay Alper⁹, Catherine J Riney¹⁰, Michael Barnett¹¹, John D E Parratt¹², Todd A Hardy¹³, Richard J Leventer¹⁴, Vera Merheb⁴, Margherita Nosadini⁴, Victor S C Fung¹⁵, Fabienne Brilot⁴, Russell C Dale¹⁶

Affiliations

¹ Neuroimmunology group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia/Department of Neurology, Westmead Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia.
² Department of Medical Imaging, the Children's Hospital at Westmead, Sydney, Australia.
³ NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.
⁴ Neuroimmunology group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia.
⁵ Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia/Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
⁶ Department of Neurology, Westmead Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia/Department of Ophthalmology, Westmead Hospital, Sydney, Australia.
⁷ Department of Neurology, Westmead Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia/Western Clinical School, University of Sydney, Sydney, Australia.
⁸ Boston Children's Hospital, Boston, United States of America.
⁹ Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh, School of Medicine, Pittsburgh, United States of America.
¹⁰ Neurosciences Unit, Lady Cilento Children's Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia.
¹¹ Brain and Mind Research Institute, University of Sydney, Sydney, Australia/Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia.
¹² Department of Neurology, Royal North Shore Hospital, Central Clinical School, University of Sydney, Sydney, Australia.
¹³ Brain and Mind Research Institute, University of Sydney, Sydney, Australia/Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia.
¹⁴ Department of Neurology, University of Melbourne Department of Paediatrics, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.
¹⁵ Department of Neurology, Westmead Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia.
¹⁶ Neuroimmunology group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia russell.dale@health.nsw.gov.au.

PMID: 26163068
DOI: 10.1177/1352458515593406

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.

Keywords: Optic neuritis; aquaporin-4 antibodies; multiple sclerosis; myelin oligodendrocyte glycoprotein antibodies; neuromyelitis optica; radiology.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Age of Onset
Aquaporin 4 / immunology*
Autoantibodies / blood*
Biomarkers / blood
Child
Child, Preschool
Diagnosis, Differential
Female
Humans
Magnetic Resonance Imaging*
Male
Middle Aged
Multiple Sclerosis / blood
Multiple Sclerosis / diagnostic imaging*
Multiple Sclerosis / immunology
Myelin-Oligodendrocyte Glycoprotein / immunology*
Optic Neuritis / blood
Optic Neuritis / diagnostic imaging*
Optic Neuritis / immunology
Optic Tract / diagnostic imaging*
Predictive Value of Tests
Retrospective Studies
Young Adult

Substances

AQP4 protein, human
Aquaporin 4
Autoantibodies
Biomarkers
MOG protein, human
Myelin-Oligodendrocyte Glycoprotein