Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is an autoimmune-mediated inflammatory disorder of the CNS. Current data on advanced imaging biomarkers for MOGAD are limited.

MOGAD cases from Massachusetts General Hospital and Brigham and Women’s Hospital who met the international MOGAD criteria underwent 7T MRI (Siemens Magnetom Terra) using 3D MP2RAGE and 3D T2 FLAIR sequences with 0.7 mm^3 isotropic voxels. All patients were in remission with a minimum of 90 days since the last relapse at the time of the 7T MRI. Neuroimaging experts identified the presence of the central vein sign with white matter lesions, leptomeningeal enhancement, and cortical lesions.

We studied 11 individuals with MOGAD, 82% of whom were female, with a mean (SD) age of 43.3 (10.8) years at the time of MRI. All patients identified as Caucasian non-Hispanic. The median (IQR) MOG-IgG titer was 1:40 (1:40,1:1000). Ten out of 11 patients were receiving immunotherapy: IVIG (n=6), anti-CD20 (n=2), mycophenolate mofetil (n=1), or tocilizumab (n=1). Leptomeningeal enhancement was detected in 6 (54.5%) patients with a median (IQR) number of foci of 1 (0-3). Cortical lesions were found in 5 (45.4%) patients with a median (IQR) number of foci of 0 (0-1). A total of 21 T2 FLAIR hyperintense white matter lesions were identified, with 4 (19%) lesions being CVS-positive. There was no abnormal parenchymal enhancement of white matter lesions or cortical lesions.