DAGOBERTO CALLEGARO

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina

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  • article 7 Citação(ões) na Scopus
    Clinical and MRI measures to identify non-acute MOG-antibody disease in adults
    (2023) CORTESE, Rosa; BATTAGLINI, Marco; PRADOS, Ferran; BIANCHI, Alessia; HAIDER, Lukas; JACOB, Anu; PALACE, Jacqueline; MESSINA, Silvia; PAUL, Friedemann; WUERFEL, Jens; MARIGNIER, Romain; DURAND-DUBIEF, Francoise; RIMKUS, Carolina de Medeiros; CALLEGARO, Dagoberto; SATO, Douglas Kazutoshi; FILIPPI, Massimo; ROCCA, Maria Assunta; CACCIAGUERRA, Laura; ROVIRA, Alex; SASTRE-GARRIGA, Jaume; ARRAMBIDE, Georgina; LIU, Yaou; DUAN, Yunyun; GASPERINI, Claudio; TORTORELLA, Carla; RUGGIERI, Serena; AMATO, Maria Pia; ULIVELLI, Monica; GROPPA, Sergiu; GROTHE, Matthias; LLUFRIU, Sara; SEPULVEDA, Maria; LUKAS, Carsten; BELLENBERG, Barbara; SCHNEIDER, Ruth; SOWA, Piotr; CELIUS, Elisabeth G.; PROEBSTEL, Anne-Katrin; YALDIZLI, Ozgur; MUELLER, Jannis; STANKOFF, Bruno; BODINI, Benedetta; CARMISCIANO, Luca; SORMANI, Maria Pia; BARKHOF, Frederik; STEFANO, Nicola De; CICCARELLI, Olga
    MRI and clinical features of myelin oligodendrocyte glycoprotein (MOG)-antibody disease may overlap with those of other inflammatory demyelinating conditions posing diagnostic challenges, especially in non-acute phases and when serologic testing for MOG antibodies is unavailable or shows uncertain results. We aimed to identify MRI and clinical markers that differentiate non-acute MOG-antibody disease from aquaporin 4 (AQP4)-antibody neuromyelitis optica spectrum disorder and relapsing remitting multiple sclerosis, guiding in the identification of patients with MOG-antibody disease in clinical practice. In this cross-sectional retrospective study, data from 16 MAGNIMS centres were included. Data collection and analyses were conducted from 2019 to 2021. Inclusion criteria were: diagnosis of MOG-antibody disease; AQP4-neuromyelitis optica spectrum disorder and multiple sclerosis; brain and cord MRI at least 6 months from relapse; and Expanded Disability Status Scale (EDSS) score on the day of MRI. Brain white matter T-2 lesions, T-1-hypointense lesions, cortical and cord lesions were identified. Random forest models were constructed to classify patients as MOG-antibody disease/AQP4-neuromyelitis optica spectrum disorder/multiple sclerosis; a leave one out cross-validation procedure assessed the performance of the models. Based on the best discriminators between diseases, we proposed a guide to target investigations for MOG-antibody disease. One hundred and sixty-two patients with MOG-antibody disease [99 females, mean age: 41 (+/- 14) years, median EDSS: 2 (0-7.5)], 162 with AQP4-neuromyelitis optica spectrum disorder [132 females, mean age: 51 (+/- 14) years, median EDSS: 3.5 (0-8)], 189 with multiple sclerosis (132 females, mean age: 40 (+/- 10) years, median EDSS: 2 (0-8)] and 152 healthy controls (91 females) were studied. In young patients (<34 years), with low disability (EDSS < 3), the absence of Dawson's fingers, temporal lobe lesions and longitudinally extensive lesions in the cervical cord pointed towards a diagnosis of MOG-antibody disease instead of the other two diseases (accuracy: 76%, sensitivity: 81%, specificity: 84%, P < 0.001). In these non-acute patients, the number of brain lesions < 6 predicted MOG-antibody disease versus multiple sclerosis (accuracy: 83%, sensitivity: 82%, specificity: 83%, P < 0.001). An EDSS < 3 and the absence of longitudinally extensive lesions in the cervical cord predicted MOG-antibody disease versus AQP4-neuromyelitis optica spectrum disorder (accuracy: 76%, sensitivity: 89%, specificity: 62%, P < 0.001). A workflow with sequential tests and supporting features is proposed to guide better identification of patients with MOG-antibody disease. Adult patients with non-acute MOG-antibody disease showed distinctive clinical and MRI features when compared to AQP4-neuromyelitis optica spectrum disorder and multiple sclerosis. A careful inspection of the morphology of brain and cord lesions together with clinical information can guide further analyses towards the diagnosis of MOG-antibody disease in clinical practice. In a multicentre MAGNIMS study, Cortese et al. show that brain and cord lesion characteristics on conventional MRI, together with clinical features, can help differentiate non-acute MOG-antibody disease from AQP4-NMOSD and multiple sclerosis, aiding identification of non-acute patients for MOG antibody testing.