MRI findings and clinical manifestations in adult Mexican patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)

Rebeca de J. Ramos-Sanchez, Department of Neuroimaging, Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Secretaria de Salud, Mexico City, Mexico;
Katherine I. Jacome-Portilla, Department of Neuroimaging, Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Secretaria de Salud, Mexico City; Centro de Estudios Especializados de Xalapa, Xalapa, Veracruz. Mexico;

Introduction: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an inflammatory demyelinating disorder of the central nervous system. The clinical and imaging characteristics of MOGAD in the Mexican population remain unknown. This study describes the clinical manifestations and magnetic resonance imaging (MRI) findings of the brain, optic nerve, and spinal cord in adult Mexican patients with MOGAD. Material and methods: This cross-sectional study included adult patients with suspected MOGAD who were evaluated at a national Mexican referral center. Demographic data, clinical manifestations, anti-MOG antibody status, and MRI findings of the brain, optic nerve, and spinal cord were reviewed. Descriptive statistics were calculated. Results: Twenty patients with MOGAD were included. All patients had a positive anti-MOG antibody. Decreased visual acuity and pain with eye movements were the most common clinical manifestations, occurring in 15 (75.0%) patients, while optic nerve abnormalities on MRI were identified in 16 (80.0%) patients. The predominant MRI findings were longitudinally extensive T2 hyperintensity involving the anterior or intraorbital optic nerve in 15 (75.0%) patients, bilateral involvement in 10 (50.0%) patients, and perineural enhancement in 6 (30.0%) patients. Brain lesions were observed in 5 (25.0%) of 20 patients, predominantly presenting as fluffy cortical and infratentorial T2/FLAIR hyperintensities. Spinal cord lesions were identified in 4 (20.0%) patients, mainly as short-segment cervical and thoracic lesions, with conus medullaris involvement in 2 (10.0%) patients. Conclusion: In patients with MOGAD, optic neuritis was the predominant clinical and imaging phenotype. Brain and spinal cord involvement was less frequent and exhibited characteristic MRI patterns. These findings represent the first description of the clinical and MRI features of MOGAD in a Mexican cohort and support the recognition of characteristic imaging patterns.

Keywords: Central nervous system diseases. Demyelinating diseases. Magnetic resonance imaging. Myelin oligodendrocyte glycoprotein. Optic neuritis.