Characteristics of MRI lesions in AQP4 antibody-positive NMOSD, MOGAD, and multiple sclerosis: a systematic review and meta-analysis.

Leitner, U; Chew, SH; Blanch, J; Viswanathan, M; Patil, S; Ward, K; Bhuta, S; Zhang, P; Sun, J; Broadley, SA

Characteristics of MRI lesions in AQP4 antibody-positive NMOSD, MOGAD, and multiple sclerosis: a systematic review and meta-analysis.

Leitner, U Chew, SH Blanch, J Viswanathan, M Patil, S Ward, K Bhuta, S Zhang, P Sun, J

Broadley, SA

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Publisher:: SPRINGER HEIDELBERG
Publication Type:: Journal Article
Citation:: J Neurol, 2025, 272, (9), pp. 560
Issue Date:: 2025-08-07

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Field	Value	Language
dc.contributor.author	Leitner, U
dc.contributor.author	Chew, SH
dc.contributor.author	Blanch, J
dc.contributor.author	Viswanathan, M
dc.contributor.author	Patil, S
dc.contributor.author	Ward, K
dc.contributor.author	Bhuta, S
dc.contributor.author	Zhang, P
dc.contributor.author	Sun, J https://orcid.org/0000-0002-0097-2438
dc.contributor.author	Broadley, SA
dc.date.accessioned	2026-01-28T07:59:09Z
dc.date.available	2025-07-25
dc.date.available	2026-01-28T07:59:09Z
dc.date.issued	2025-08-07
dc.identifier.citation	J Neurol, 2025, 272, (9), pp. 560
dc.identifier.issn	0340-5354
dc.identifier.issn	1432-1459
dc.identifier.uri	http://hdl.handle.net/10453/192498
dc.description.abstract	BACKGROUND AND OBJECTIVES: Multiple sclerosis (MS), aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-Ab + ve NMOSD), and myelin oligodendrocyte glycoprotein-associated disease (MOGAD) are demyelinating diseases with differing pathophysiological processes and treatments. The objective of this study was to compile a comprehensive list of MRI lesions, and to quantify the utility of these lesions in distinguishing between these conditions. METHODS: We searched for articles comparing MRI lesion frequency in MS, AQP4-Ab + ve NMOSD, MOGAD and healthy controls. Bayesian network meta-analysis together with pairwise and pooled case-case comparison analyses to develop sensitivity, specificity, and positive predictive values were undertaken. RESULTS: Sixty-six articles were reported on 2933 MS, 3296 AQP4-Ab + ve NMOSD, and 1559 MOGAD cases, and 561 healthy controls. MRI lesions associated with MS were: periventricular T2, subcortical white matter T2, Dawson's finger, U-fibre T2 lesion, posterior spinal column T2, inferior temporal T2, cortical T2, brain T1 hypointensity (black holes), peripheral spinal cord T2, pons T2, unilateral optic nerve T2 and brain gadolinium enhancing lesions. Optic chiasm T2, LETM, bright spotty spinal cord T2, area postrema T2, hypothalamic T2, spinal cord atrophy and optic tract T2 lesions were associated with AQP4-Ab + ve NMOSD. Conus medullaris T2, fluffy, perineural enhancement, peri-ependymal 3rd ventricle T2 and peri-ependymal 4th ventricle T2 lesions were associated with MOGAD. DISCUSSION: This review identified MRI features supportive of a diagnosis of MS, NMOSD or MOGAD, and has clarified the diagnostic utility of various MRI lesion characteristics, to aid in future clinical decision-making and guide future approaches to research.
dc.format	Electronic
dc.language	eng
dc.publisher	SPRINGER HEIDELBERG
dc.relation.ispartof	J Neurol
dc.relation.isbasedon	10.1007/s00415-025-13303-w
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1103 Clinical Sciences, 1109 Neurosciences
dc.subject.classification	Neurology & Neurosurgery
dc.subject.classification	3202 Clinical sciences
dc.subject.classification	3209 Neurosciences
dc.subject.mesh	Humans
dc.subject.mesh	Aquaporin 4
dc.subject.mesh	Autoantibodies
dc.subject.mesh	Brain
dc.subject.mesh	Demyelinating Autoimmune Diseases, CNS
dc.subject.mesh	Magnetic Resonance Imaging
dc.subject.mesh	Multiple Sclerosis
dc.subject.mesh	Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease
dc.subject.mesh	Neuromyelitis Optica
dc.subject.mesh	Brain
dc.subject.mesh	Humans
dc.subject.mesh	Demyelinating Autoimmune Diseases, CNS
dc.subject.mesh	Multiple Sclerosis
dc.subject.mesh	Neuromyelitis Optica
dc.subject.mesh	Autoantibodies
dc.subject.mesh	Magnetic Resonance Imaging
dc.subject.mesh	Aquaporin 4
dc.subject.mesh	Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease
dc.subject.mesh	Humans
dc.subject.mesh	Aquaporin 4
dc.subject.mesh	Autoantibodies
dc.subject.mesh	Brain
dc.subject.mesh	Demyelinating Autoimmune Diseases, CNS
dc.subject.mesh	Magnetic Resonance Imaging
dc.subject.mesh	Multiple Sclerosis
dc.subject.mesh	Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease
dc.subject.mesh	Neuromyelitis Optica
dc.title	Characteristics of MRI lesions in AQP4 antibody-positive NMOSD, MOGAD, and multiple sclerosis: a systematic review and meta-analysis.
dc.type	Journal Article
utslib.citation.volume	272
utslib.location.activity	Germany
utslib.for	1103 Clinical Sciences
utslib.for	1109 Neurosciences
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Engineering and Information Technology
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/
dc.date.updated	2026-01-28T07:59:07Z
pubs.issue	9
pubs.publication-status	Published online
pubs.volume	272
utslib.citation.issue	9

Abstract:

BACKGROUND AND OBJECTIVES: Multiple sclerosis (MS), aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-Ab + ve NMOSD), and myelin oligodendrocyte glycoprotein-associated disease (MOGAD) are demyelinating diseases with differing pathophysiological processes and treatments. The objective of this study was to compile a comprehensive list of MRI lesions, and to quantify the utility of these lesions in distinguishing between these conditions. METHODS: We searched for articles comparing MRI lesion frequency in MS, AQP4-Ab + ve NMOSD, MOGAD and healthy controls. Bayesian network meta-analysis together with pairwise and pooled case-case comparison analyses to develop sensitivity, specificity, and positive predictive values were undertaken. RESULTS: Sixty-six articles were reported on 2933 MS, 3296 AQP4-Ab + ve NMOSD, and 1559 MOGAD cases, and 561 healthy controls. MRI lesions associated with MS were: periventricular T2, subcortical white matter T2, Dawson's finger, U-fibre T2 lesion, posterior spinal column T2, inferior temporal T2, cortical T2, brain T1 hypointensity (black holes), peripheral spinal cord T2, pons T2, unilateral optic nerve T2 and brain gadolinium enhancing lesions. Optic chiasm T2, LETM, bright spotty spinal cord T2, area postrema T2, hypothalamic T2, spinal cord atrophy and optic tract T2 lesions were associated with AQP4-Ab + ve NMOSD. Conus medullaris T2, fluffy, perineural enhancement, peri-ependymal 3rd ventricle T2 and peri-ependymal 4th ventricle T2 lesions were associated with MOGAD. DISCUSSION: This review identified MRI features supportive of a diagnosis of MS, NMOSD or MOGAD, and has clarified the diagnostic utility of various MRI lesion characteristics, to aid in future clinical decision-making and guide future approaches to research.

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http://hdl.handle.net/10453/192498