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Congress: ECR25
Poster Number: C-16728
Type: Poster: EPOS Radiologist (educational)
DOI: 10.26044/ecr2025/C-16728
Authorblock: M. Mukeria, T. Antia; Tbilisi/GE
Disclosures:
Mariam Mukeria: Nothing to disclose
Tamara Antia: Nothing to disclose
Keywords: CNS, Head and neck, Neuroradiology spine, MR, Diagnostic procedure, Inflammation, Monoclonal antibodies
Findings and procedure details

Magnetic Resonance Imaging (MRI) plays a key role in diagnosing MOGAD, revealing abnormalities in the brain, optic nerves, and spinal cord depending on the affected region. These imaging findings often correlate with clinical presentation. Essential MRI sequences include T2-weighted and FLAIR imaging to detect hyperintense lesions, T1-weighted post-contrast imaging for identifying active inflammation and blood-brain barrier disruption, and fat-suppressed sequences for detailed optic nerve assessment. Gadolinium-based contrast further aids in detecting active inflammation.[4,1].

In pediatric MOGAD, cerebral MRI typically shows diffuse, widespread T2 hyperintensities resembling ADEM, whereas in adults, findings are often normal or limited to the brainstem and cortex. Leptomeningeal enhancement is rare but can occur in isolation or alongside cortical lesions, as seen in FLAMES.[5]. Parenchymal enhancement varies, with involvement reported in the brainstem, gray matter, white matter, and periventricular regions. Spinal cord lesions appear as longitudinally extensive transverse myelitis (LETM), primarily affecting the gray matter and frequently displaying the characteristic 'H-sign' on axial imaging.[6].

Differentiating MOGAD from neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) is essential for accurate diagnosis and management. Below are key differentiating features:

NMOSD vs. MOGAD

Optic Neuritis

  • MOGAD: Primarily affects the anterior optic nerves and optic nerve sheaths (optic perineuritis); appears severely swollen, edematous, and tortuous.[7].
  • NMOSD: More likely to involve the optic chiasm and tracts.[7].

Brain Involvement

  • MOGAD: More common in the thalami and pons.[7].
  • NMOSD: More frequently involves the area postrema and medulla.[7].

MS vs. MOGAD

Brain Lesions

  • MOGAD: Larger, fewer lesions, often in an ADEM-like pattern.[7].
  • MS: Multiple small periventricular lesions; Dawson’s fingers (absent in MOGAD).[7].

Spinal Cord Lesions

  • MOGAD: Longitudinally extensive involvement.[7].
  • MS: Typically short-segment lesions.[7].

Optic Neuritis

  • MOGAD: Bilateral, more longitudinally extensive, predominantly affects the anterior optic nerves.[7].
  • MS: More commonly unilateral.[7].

Leptomeningeal Enhancement

  • MOGAD: Can be present but less common.[7].
  • MS: Rare and, if present, usually subtle.[7].

 
GALLERY