Neuromyelitis optica associated with aquaporin-4-antibodies (NMOSD-AQP4) and myelin oligodentrocyte-glycoprotein antibody-associated disorder (MOGAD) have been recently recognised as different from multiple sclerosis. Although conventional MRI may help distinguish multiple sclerosis from antibody-mediated diseases, the use of quantitative and non-conventional imaging may give more pathological information and explain the clinical differences. We compared, using non-conventional imaging, brain MRI findings in 75 subjects in remission with NMOSD-AQP4, MOGAD, multiple sclerosis or healthy controls (HC). Volumetrics, white matter and cortical lesions, and tissue integrity measures using diffusion imaging, were analysed in the four groups along with their association with disability (expanded disability status scale [EDSS] and visual acuity). The volumetric analysis showed that, deep grey matter volumes were significantly lower in multiple sclerosis (p=0.0001) and MOGAD (p=0.02), compared to HC. Relapsing MOGAD had lower white matter, pallidus and hippocampus volumes than in monophasic (p<0.05). Optic chiasm volume was reduced only in NMOSD-AQP4 who had at least one episode of optic neuritis (ON) (NMOSD-AQP4-ON vs NMOSD-AQP4 p<0.001, HC p<0.001, MOGAD-ON p=0.04, multiple sclerosis-ON p=0.02) likely reflecting the recognised posterior location of NMOSD-AQP4-ON and its severity. Lesion volume was greatest in multiple sclerosis followed by MOGAD and in these two diseases, the lesion volume correlated with disease duration (multiple sclerosis R=0.46, p=0.05, MOGAD R=0.81, p<0.001), cortical thickness (multiple sclerosis R=-0.64, p=0.0042, MOGAD=-0.71, p=0.005) and deep grey matter volumes (multiple sclerosis R=-0.65, p=0.0034, MOGAD R=-0.93, p<0.001). Lesional-fractional anisotropy (FA) was reduced and mean diffusivity increased in all patients, but overall, FA was only reduced in the non-lesional tissue in multiple sclerosis (p=0.01), although focal reductions were noted in NMOSD-AQP4, reflecting mainly optic nerve and corticospinal tract pathways. Cortical/juxtacortical lesions were seen in a minority of MOGAD, while cortical/juxtacortical and purely cortical lesions were identified in the majority of multiple sclerosis and in none of the NMOSD-AQP4. Non-lesional FA in NMOSD-AQP4, lower white-matter volume and female sex in multiple sclerosis, and lower brainstem volume in MOGAD were the best predictors of EDSS disability (accounting for 46%, 49% and 19% respectively). Worse visual acuity associated with lower optic chiasm volume in NMOSD-AQP4 and lower thalamus volume in MOGAD (accounting for 58% and 35% respectively). Although MOGAD patients had good outcomes, deep grey matter atrophy was present. In contrast, NMOSD-AQP4 patients showed a relative sparing of deep grey matter volumes, despite greater residual disability as compared with MOGAD patients. NMOSD-AQP4 but not MOGAD patients showed reduced FA in non-lesional tissue.

中文翻译：

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AQP4抗体NMOSD与多发性硬化症对比MOG抗体疾病的脑成像特征

最近已经认识到与水通道蛋白4抗体（NMOSD-AQP4）和髓磷脂少突胶质细胞糖蛋白抗体相关疾病（MOGAD）相关的视神经脊髓炎与多发性硬化症不同。尽管常规MRI可以帮助将多发性硬化症与抗体介导的疾病区分开，但定量和非常规成像的使用可能会提供更多病理信息并解释临床差异。我们使用非常规成像技术对75例NMOSD-AQP4，MOGAD，多发性硬化症或健康对照（HC）缓解的受试者的MRI进行了比较。在四组中分析了体积，白质和皮质病变以及使用弥散成像的组织完整性指标，以及它们与残疾的关系（扩展的残疾状态量表[EDSS]和视敏度）。体积分析显示，与HC相比，多发性硬化症（p = 0.0001）和MOGAD（p = 0.02）的深灰质体积显着降低。与单相相比，复发性MOGAD的白质，苍白球和海马体积要低（p <0.05）。仅在患有至少一发性视神经炎（ON）的NMOSD-AQP4中，视交叉体积减小（NMOSD-AQP4-ON与NMOSD-AQP4 p <0.001，HC p <0.001，MOGAD-ON p = 0.04，多发性硬化症-ON p = 0.02）可能反映了公认的NMOSD-AQP4-ON的后部位置及其严重性。在多发性硬化症中，其病变体积最大，其次是MOGAD，在这两种疾病中，病变体积与疾病持续时间（多发性硬化R = 0.46，p = 0.05，MOGAD R = 0.81，p <0.001），皮质厚度（多发性硬化R ＝ -0.64，p ＝ 0.0042，MOGAD ＝ -0.71，p ＝ 0。005）和深灰质体积（多发性硬化R = -0.65，p = 0.0034，MOGAD R = -0.93，p <0.001）。在所有患者中，病变分数各向异性（FA）均降低，平均扩散率增加，但总体而言，尽管NMOSD-AQP4中有局灶性降低，但多发性硬化症仅在非病变组织中FA降低（p = 0.01），这反映了主要是视神经和皮质脊髓束通路。在少数MOGAD中可见皮层/近皮层病变，而在多发性硬化症的大多数中，NMOSD-AQP4均未发现皮层/近皮层和纯皮层病变。NMOSD-AQP4的非损伤性FA，多发性硬化症中的白色物质含量和女性性别较低以及MOGAD中的脑干体积较低是EDSS残疾的最佳预测指标（分别占46％，49％和19％）。视力恶化与NMOSD-AQP4中较低的视交叉体积和MOGAD中较低的丘脑体积相关（分别占58％和35％）。尽管MOGAD患者的预后良好，但仍存在深层灰质萎缩。相比之下，尽管与MOGAD患者相比，NMOSD-AQP4患者表现出相对较少的深灰质体积，尽管其残障能力更大。NMOSD-AQP4而非MOGAD患者在非病变组织中的FA降低。