Abstract Details

Title Imaging Features of Spinal Cord Inflammatory Lesions in Children: Comparison Between Anti-MOG Antibody Associated Disease, MS and Seronegative Monophasic Disease

Topic Multiple Sclerosis

Presentation(s) MS and CNS Inflammatory Disease Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 143

Objective

To characterize the imaging features of spinal cord (SC) involvement in children with anti-MOG associated disease (MOGAD), multiple sclerosis (MS) and seronegative monophasic acquired demyelinating syndrome (monoADS), and assess their discriminative diagnostic utility.

Background

SC involvement is a common finding in pediatric acquired demyelinating syndromes (ADS). Long lesions favor non-MS diagnoses, and comprehensive characterization of SC involvement in children with defined anti-MOG serology may provide further diagnostic insights.

Design/Methods

We analyzed spine MRI scans from 217 children and adolescents with ADS recruited in the prospective Canadian Pediatric Demyelinating Disease Study. Anti-MOG and anti-AQP4 antibody serology were assessed in archived serum samples obtained in proximity to clinical presentation. MRI scans were analyzed through a standardized scoring tool, blinded to brain MRI findings and clinical diagnosis. The imaging features were compared between MOGAD, MS and monoADS using descriptive statistics. AQP4-positive children were too few for meaningful inclusion.

Results

SC lesions were detected in 107/217 (49%) children (40/107 with MOGAD [37%], 21/107 MS [20%], and 46/107 with monoADS [43%]). The median age at first scan with lesions was 10.6 years (IQR 5.6-13.0). Lesions restricted to SC white matter were found in 2/35 (6%) children with MOGAD, vs 13/19 (68%) with MS (p<0.0001) and 6/43 (14%) with monoADS (p=0.28). Axial gray matter T2-hyperintensity (“H-sign”) was observed in 22/35 (63%) children with MOGAD, 14/43 (33%) with monoADS (p=0.015), and in none of the participants with MS (p<0.0001). Longitudinally extensive lesions (>3 segments) were common among children with MOGAD (30/40, 75%), rare in MS (1/21, 5%, p<0.0001), and observed in 27/46 (59%) children with monoADS (p=0.096). The presence of spinal leptomeningeal enhancement was highly suggestive for MOGAD (23/32 [75%], vs 0/15 MS and 7/38 [18%] monoADS, both p<0.0001).

Conclusions

Multiple spine MRI features can help distinguish pediatric MOGAD from MS and other seronegative idiopathic myelitis.

Authors/Disclosures
Giulia Fadda, MD (University of Ottawa) PRESENTER	Dr. Fadda has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen/Horizon Therapeutics. Dr. Fadda has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for roche. Dr. Fadda has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Fadda has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Novartis.
Cesar Alves (CHOP)	No disclosure on file
Julia O'Mahony (The Hospital for Sick Children)	Ms. O'Mahony has nothing to disclose.
	No disclosure on file
E. Ann Yeh, MD, MA, FRCPC (Hospital for Sick Children)	Dr. Yeh has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pipeline therapeutics. Dr. Yeh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Yeh has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for SCN. Dr. Yeh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Yeh has received research support from CIHR. The institution of Dr. Yeh has received research support from National MS Society. The institution of Dr. Yeh has received research support from SickKids Foundation. The institution of Dr. Yeh has received research support from MSSC. The institution of Dr. Yeh has received research support from Garry Hurvitz Foundation. The institution of Dr. Yeh has received research support from Leong Centre. The institution of Dr. Yeh has received research support from OMSLife. The institution of Dr. Yeh has received research support from Canada's Drug Agency. Dr. Yeh has received personal compensation in the range of $0-$499 for serving as a Author with Medscape. Dr. Yeh has a non-compensated relationship as a Editorial Board with Neurology that is relevant to AAN interests or activities. Dr. Yeh has a non-compensated relationship as a Editorial Board with MSJ that is relevant to AAN interests or activities.
Ruth-Ann Marrie, MD, PhD (University of Manitoba)	The institution of Dr. Marrie has received research support from CIHR. The institution of Dr. Marrie has received research support from MS Canada. The institution of Dr. Marrie has received research support from National MS Society. The institution of Dr. Marrie has received research support from Crohn's and Colitis Canada. The institution of Dr. Marrie has received research support from US Department of Defense. The institution of Dr. Marrie has received research support from The Arthritis Society. The institution of Dr. Marrie has received research support from CMSC.
Douglas L. Arnold, MD, FAAN (Montreal Neurological Institute, McGill Univ)	Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for BMS. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Frequency Therapeutics. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck. Dr. Arnold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Arnold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Xfacto communications. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Find therapeutics. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GSK. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Idorsia. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kiniksa. Dr. Arnold has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Clario.
Amit Bar-Or, MD, FRCPC (University of Pennsylvania)	Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche Genentech. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merk/EMD Serono. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving as a Consultant for cabaletta. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck/EMD Serono. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi/Genzyme. The institution of Dr. Bar-Or has received research support from Novartis. The institution of Dr. Bar-Or has received research support from Biogen. The institution of Dr. Bar-Or has received research support from Roche/Genentech.
Arastoo Vossough, MD (University of Pennsylvania - Children'S Hospital of Philadelphia)	Dr. Vossough has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Syneos Health. Dr. Vossough has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for DeepSight. Dr. Vossough has received publishing royalties from a publication relating to health care.
Brenda L. Banwell, MD, FAAN (Johns Hopkins University)	Dr. Banwell has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Banwell has received personal compensation in the range of $0-$499 for serving as a Consultant for UCB. Dr. Banwell has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. Dr. Banwell has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Banwell has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Banwell has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Dr. Banwell has received research support from National MS Society. The institution of Dr. Banwell has received research support from NIH.

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