title: Radiological differentiation of optic neuritis with myelin oligodendrocyte glycoprotein antibodies, aquaporin-4 antibodies, and multiple sclerosis.
abstract: BACKGROUND
  Recognizing the cause of optic neuritis (ON) affects treatment decisions and visual outcomes.
  
  
  OBJECTIVE
  We aimed to define radiological features of first-episode demyelinating ON.
  
  
  METHODS
  We performed blinded radiological assessment of 50 patients presenting with first-episode myelin oligodendrocyte glycoprotein (MOG) antibody-associated ON (MOG-ON; n=19), aquaporin-4 (AQP4) antibody-associated ON (AQP4-ON; n=11), multiple sclerosis (MS)-associated ON (MS-ON; n=13), and unclassified ON (n=7).
  
  
  RESULTS
  Bilateral involvement was more common in MOG-ON and AQP4-ON than MS-ON (84% vs. 82% vs. 23%), optic nerve head swelling was more common in MOG-ON (53% vs. 9% vs. 0%), chiasmal involvement was more common in AQP4-ON (5% vs. 64% vs. 15%), and bilateral optic tract involvement was more common in AQP4-ON (0% vs. 45% vs. 0%). Retrobulbar involvement was more common in MOG-ON, whereas intracranial involvement was more common in AQP4-ON. MOG-ON and AQP4-ON had longer lesion lengths than MS-ON. The combination of two predictors, the absence of magnetic resonance imaging brain abnormalities and a higher lesion extent score, showed a good ability to discriminate between an autoantibody-associated ON (MOG or AQP4) and MS. AQP4-ON more frequently had severe and sustained visual impairment.
  
  
  CONCLUSIONS
  MOG-ON and AQP4-ON are more commonly bilateral and longitudinally extensive. MOG-ON tends to involve the anterior optic pathway, whereas AQP4-ON the posterior optic pathway.
authors.affiliation: Neuroimmunology group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia/Department of Neurology, Westmead Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Sudarshini
authors.initials: S
authors.lastname: Ramanathan
authors.affiliation: Department of Medical Imaging, the Children's Hospital at Westmead, Sydney, Australia.
authors.forename: Kristina
authors.initials: K
authors.lastname: Prelog
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Barnes
authors.affiliation: Neuroimmunology group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Esther M
authors.initials: EM
authors.lastname: Tantsis
authors.affiliation: Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia/Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Reddel
authors.affiliation: Department of Neurology, Westmead Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia/Department of Ophthalmology, Westmead Hospital, Sydney, Australia.
authors.forename: Andrew P D
authors.initials: AP
authors.lastname: Henderson
authors.affiliation: Department of Neurology, Westmead Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia/Western Clinical School, University of Sydney, Sydney, Australia.
authors.forename: Steve
authors.initials: S
authors.lastname: Vucic
authors.affiliation: Boston Children's Hospital, Boston, United States of America.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Gorman
authors.affiliation: Boston Children's Hospital, Boston, United States of America.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Benson
authors.affiliation: Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh, School of Medicine, Pittsburgh, United States of America.
authors.forename: Gulay
authors.initials: G
authors.lastname: Alper
authors.affiliation: Neurosciences Unit, Lady Cilento Children's Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Riney
authors.affiliation: Brain and Mind Research Institute, University of Sydney, Sydney, Australia/Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Barnett
authors.affiliation: Department of Neurology, Royal North Shore Hospital, Central Clinical School, University of Sydney, Sydney, Australia.
authors.forename: John D E
authors.initials: JD
authors.lastname: Parratt
authors.affiliation: Brain and Mind Research Institute, University of Sydney, Sydney, Australia/Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Hardy
authors.affiliation: Department of Neurology, University of Melbourne Department of Paediatrics, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Leventer
authors.affiliation: Neuroimmunology group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Vera
authors.initials: V
authors.lastname: Merheb
authors.affiliation: Neuroimmunology group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Margherita
authors.initials: M
authors.lastname: Nosadini
authors.affiliation: Department of Neurology, Westmead Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Victor S C
authors.initials: VS
authors.lastname: Fung
authors.affiliation: Neuroimmunology group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Brilot
authors.affiliation: Neuroimmunology group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia russell.dale@health.nsw.gov.au.
authors.forename: Russell C
authors.initials: RC
authors.lastname: Dale
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D051401:Aquaporin 4 / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000097:blood / Q000000981:diagnostic imaging* / Q000276:immunology; D063308:Myelin-Oligodendrocyte Glycoprotein / Q000276:immunology*; D009902:Optic Neuritis / Q000097:blood / Q000000981:diagnostic imaging* / Q000276:immunology; D065866:Optic Tract / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: C496030:AQP4 protein, human; D051401:Aquaporin 4; D001323:Autoantibodies; D015415:Biomarkers; C571326:MOG protein, human; D063308:Myelin-Oligodendrocyte Glycoprotein
keywords: Optic neuritis; aquaporin-4 antibodies; multiple sclerosis; myelin oligodendrocyte glycoprotein antibodies; neuromyelitis optica; radiology