Abstract Details

Title Dynamic Optic Nerve MRI Changes in Acute Optic Neuritis in MOG Antibody-Associated Disease

Topic Autoimmune Neurology

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 8-006

Objective To evaluate dynamic optic nerve changes on MRI during acute optic neuritis (ON) in Mayo Clinic patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), multiple sclerosis (MS), and aquaporin-4 antibody positive neuromyelitis optica spectrum disorder (NMOSD).

Background Understanding the imaging evolution of acute ON may assist in diagnosis and treatment.

Design/Methods Inclusion criteria: Two MRIs with fat saturation of the orbits within 30 days of visual symptoms. Location and length of T2 hyperintensities and gadolinium enhancement were analyzed and compared between the two scans and across the three disease groups.

Results We included 14 MOGAD patients [median age, 34 years(range, 9-71); 79% female; median interscan interval, 10 days(range, 4-17)], 5 MS patients [age, 42 years(37-70); 80% female; scan interval, 11 days(4-23)], and 4 NMOSD patients [age, 26 years(13-64); 50% female; scan interval, 7 days(5-17)]. Repeat scans were completed for worsening/persistent symptoms [MOGAD, 12/14(86%); MS 1/5(20%), NMOSD, 2/4(50%)] and to establish a new baseline [MOGAD, 2/14(14%), MS 4/5(80%), NMOSD, 2/4(50%)]. Gadolinium enhancing lesions were common in all groups [MOGAD initial, 14/14(100%) vs follow-up, 12/14(83%); MS, 3/4(75%) vs 4/4(100%); NMOSD, 4/4(100%) vs 4/4(100%)]. The length of MOGAD enhancing lesions was dynamic with improvement in 6/14(43%), worsening in 5/14(36%), and stability in 3/14(21%) at follow-up scan compared to MS [improved, 2/5(40%); worsened, 1/5(20%); stable, 2/5(40%)] and NMOSD [improved, 0/4(0%); worsened, 1/4(25%); stable, 3/4(75%)]. Complete resolution of enhancement occurred in a subset of MOGAD patients [MOGAD, 2/12(17%); MS, 0/5(0%); NMOSD, 0/4(0%)]. Steroids did not significantly impact enhancement evolution. Delayed development of T2-hyperintesities occurred in some patients [MOGAD initial, 8/11(73%) vs follow-up, 10/10(100%); MS, 3/4(100%) vs 4/4(100%); NMOSD, 4/4(100%) vs 4/4(100%)].

Conclusions

Optic nerve changes on MRI in MOGAD acute ON are dynamic. There can be rapid resolution of enhancement and delayed development of T2-hyperintensity which has implications for clinical care and adjudication of relapses in clinical trials.

Authors/Disclosures
Stephanie Syc-Mazurek, MD, PhD (Mayo Clinic) PRESENTER	Dr. Syc-Mazurek has a non-compensated relationship as a Editorial Board Resident and Fellows Section with Neurology that is relevant to AAN interests or activities.
Deena Tajfirouz, MD	Dr. Tajfirouz has nothing to disclose.
Laura Cacciaguerra, MD, PhD (Mayo Clinic)	Dr. Cacciaguerra has nothing to disclose.
Paul Farnsworth, DO	Dr. Farnsworth has nothing to disclose.
Kevin Chodnicki (Mayo Clinic)	Kevin Chodnicki has nothing to disclose.
M. Tariq Bhatti, MD (Kaiser Permanente, Northern California)	Dr. Bhatti has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Receptos . Dr. Bhatti has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH LHON gene therapy study .
Jan-Mendelt Tillema, MD (Mayo Clinic)	Dr. Tillema has nothing to disclose.
Sean J. Pittock, MD, FAAN (Mayo Clinic Dept of Neurology)	Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from NIH. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received publishing royalties from a publication relating to health care.
Eoin P. Flanagan, MBBCh, FAAN (Mayo Clinic)	The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Merck. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology that is relevant to AAN interests or activities.
John Chen	John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. John Chen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB.

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