Leptomeningeal enhancement of myelin oligodendrocyte glycoprotein antibody-associated encephalitis: uncovering novel markers on contrast-enhanced fluid-attenuated inversion recovery images

Frontiers in Immunology

Immunology

Wenjing Hu¹  Li Li²  Qifang Cai²  Yuqing Liu²  Qiuhong Ma²  Ke Jin²  Siping He²  Wen Liu³  Zhichao Zuo⁴ 

[1]Department of Neurology, Hunan Children’s Hospital, Changsha, Hunan, China

[2]Department of Radiology, Hunan Children’s Hospital, Changsha, Hunan, China

[3]Department of Radiology, The Third XiangYa Hospital, Central South University, Changsha, Hunan, China

[4]Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, China

关键词: myelin oligodendrocyte glycoprotein;    encephalitis;    contrast enhancement;    FLAIR;    leptomeningeal;   

DOI  :  10.3389/fimmu.2023.1152235

 received in 2023-01-27, accepted in 2023-06-07,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundMyelin oligodendrocyte glycoprotein antibody disease (MOGAD) is a newly defined autoimmune inflammatory demyelinating central nervous system (CNS) disease characterized by antibodies against MOG. Leptomeningeal enhancement (LME) on contrast-enhanced fluid-attenuated inversion recovery (CE-FLAIR) images has been reported in patients with other diseases and interpreted as a biomarker of inflammation. This study retrospectively analyzed the prevalence and distribution of LME on CE-FLAIR images in children with MOG antibody-associated encephalitis (MOG-E). The corresponding magnetic resonance imaging (MRI) features and clinical manifestations are also presented.MethodsThe brain MRI images (native and CE-FLAIR) and clinical manifestations of 78 children with MOG-E between January 2018 and December 2021 were analyzed. Secondary analyses evaluated the relationship between LME, clinical manifestations, and other MRI measures.ResultsForty-four children were included, and the median age at the first onset was 70.5 months. The prodromal symptoms were fever, headache, emesis, and blurred vision, which could be progressively accompanied by convulsions, decreased level of consciousness, and dyskinesia. MOG-E showed multiple and asymmetric lesions in the brain by MRI, with varying sizes and blurred edges. These lesions were hyperintense on the T2-weighted and FLAIR images and slightly hypointense or hypointense on the T1-weighted images. The most common sites involved were juxtacortical white matter (81.8%) and cortical gray matter (59.1%). Periventricular/juxtaventricular white matter lesions (18.2%) were relatively rare. On CE-FLAIR images, 24 (54.5%) children showed LME located on the cerebral surface. LME was an early feature of MOG-E (P = 0.002), and cases without LME were more likely to involve the brainstem (P = 0.041).ConclusionLME on CE-FLAIR images may be a novel early marker among patients with MOG-E. The inclusion of CE-FLAIR images in MRI protocols for children with suspected MOG-E at an early stage may be useful for the diagnosis of this disease.

【 授权许可】

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Copyright © 2023 Li, Liu, Cai, Liu, Hu, Zuo, Ma, He and Jin