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. 2021 Dec 1;4(12):e2137833.
doi: 10.1001/jamanetworkopen.2021.37833.

Frequency of New Silent MRI Lesions in Myelin Oligodendrocyte Glycoprotein Antibody Disease and Aquaporin-4 Antibody Neuromyelitis Optica Spectrum Disorder

Valentina Camera  1   2 , Leah Holm-Mercer  2 , Ali Asgar Hatim Ali  2 , Silvia Messina  1   2 , Timotej Horvat  1   3 , Wilhelm Kuker  1   3 , Maria Isabel Leite  1   2 , Jacqueline Palace  1   2
Affiliations

Frequency of New Silent MRI Lesions in Myelin Oligodendrocyte Glycoprotein Antibody Disease and Aquaporin-4 Antibody Neuromyelitis Optica Spectrum Disorder

Valentina Camera et al. JAMA Netw Open. .

Abstract

Importance: In multiple sclerosis, magnetic resonance imaging (MRI) new silent lesions contribute to the diagnostic criteria, have prognostic value, and are used in treatment monitoring; but in aquaporin-4 antibody neuromyelitis optica spectrum disorder (AQP4-NMOSD), they are rare between attacks. Their frequency and their association with relapses in adults with myelin oligodendrocyte glycoprotein antibody disease (MOGAD) are still unclear.

Objective: To examine the frequency and characteristics of MRI new silent lesions in MOGAD and AQP4-NMOSD.

Design, setting, and participants: This retrospective cohort study analyzed clinical and MRI data of 404 patients with MOGAD or AQP4-NMOSD between February 1, 1994, and April 1, 2021; data were prospectively recorded on the Oxford NMOSD clinical database under follow-up. The study was conducted at the Oxford National Referral Center for NMOSD. Participants included patients with MOGAD and AQP4-NMOSD who were treated within the Oxford National NMO Specialist Service.

Exposures: Seropositive MOGAD and AQP4-NMOSD patients who had MRIs during attacks and the remission phase of their disease.

Main outcomes and measures: Frequency of new silent lesions detected by either attack MRIs (during the acute clinical event) or remission MRIs (performed outside of a relapse and at least 3 months from last attack). Median time to next relapse in the presence of definite (reference MRI performed at least 4 weeks from last attack onset), probable (reference MRI performed during last attack), and no new silent lesions on remission MRIs was also evaluated.

Results: One hundred eighty-two MOGAD patients and 222 AQP4-NMOSD patients were included. Of the MOGAD patients, 113 (62%) were female, median age at onset was 28 years (range, 2-72), and median follow-up was 52 months (range, 11-253). Of the AQP4-NMOSD patients, 189 (85%) were female, median age at onset was 43 years (range, 2-82), and median follow-up was 87.5 months (range, 11-260). MOGAD patients had 296 attack MRI sessions and 167 remission MRI sessions. New attack silent lesions were found in 97 of 296 (33%) attack MRI sessions, whereas new remission silent lesions were found in 5 of 167 (3.0%) remission MRI sessions. Median time from remission scan to the next relapse in the presence of definite or probable new remission lesions was 2 months (IQR, 1-6), whereas in the absence of any new remission lesions it was 73 months (IQR, 20-104; hazard ratio, 23.86; 95% CI, 7.51-75.79; P < .001). AQP4-NMOSD patients had 470 attack MRI sessions and 269 remission MRI sessions. New attack silent lesions were detected in 88 of 470 (18.7%) attack MRI sessions, whereas new remission silent lesions were found in 7 of 269 (2.6%) remission MRI sessions. Median time from remission scan to the next relapse in the presence of definite or probable new remission lesions was 5 months (IQR, 2-6), whereas in the absence of any new remission lesions it was 85 months (IQR, 29-167; hazard ratio, 21.23; 95% CI, 8.05-53.65; P < .001).

Conclusions and relevance: In contrast to that reported in multiple sclerosis, results of this cohort study suggest that new remission silent lesions are rare on follow-up scans in MOGAD and AQP4-NMOSD and appear to indicate a high risk of imminent relapse.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Camera reported receiving a grant from the European Charcot Foundation during the conduct of the study and financial support for a scientific meeting from Janssen outside the submitted work. Dr Leite reported receiving research grants from Myaware and University of Oxford; receiving speaker honoraria or travel grants from Biogen Idec, Novartis, and the Guthy-Jackson Charitable Foundation; and serving on scientific or educational advisory boards for UCB, argenx, and Viela Bio and on the steering committee for Viela Bio outside the submitted work. Dr Palace reported receiving advisory board and speaker fees from Merck Serono, Novartis, Chugai, Alexion, Roche, MedImmune, argenx, UCB, Mitsubishi, Amplo, and Janssen; and grants from Amplo to the Physiotherapy Department and research fees from Alexion outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Association Between New Silent T2 Lesions at Remission MRIs and Time to Next Relapse in MOGAD and AQP4-NMOSD
Blue line indicates no new remission SL; and orange line, new remission SL. AQP4-NMOSD indicates aquaporin-4 antibody neuromyelitis optica spectrum disorder; HR, hazard ratio; MOGAD, myelin oligodendrocyte glycoprotein antibody disease; MRI, magnetic resonance imaging; and new remission SL, definite and probable new remission silent lesions.
See this image and copyright information in PMC

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