Brain and spinal cord MRI lesion criteria differentiate AQP4- and MOG-disease from MS (P6.411)

Objective: Test the ability of a brain and spinal cord MRI criteria to differentiate Aquaporin-4- and MOG-disease from MS. Additionally, we tested this MRI criteria in patients with clinically isolated syndrome (CIS). Background: MOG-disease, Aquaporin-4-positive neuromyelitis optica and Neuromyelitis optica spectrum disorders (NMOSD) can present with similar clinical and radiological features to multiple sclerosis (MS). Previously, a brain MRI diagnostic criteria was proposed to distinguish the three demyelinating diseases, but the utility of spinal cord imaging and its relevance in CIS is currently unknown. A simple brain and MRI criteria may aide in distinguishing between those three inflammatory CNS diseases in adults and children, supporting early diagnostic decisions such as antibody testing. Design/Methods: We included 176 participants (25 Aquaporin-4-positive neuromyelitis optica, 11 MOG-disease, 20 Neuromyelitis optica spectrum disorder, 50 adult-onset relapsing remittin MS, 25 pediatric-onset relapsing remitting MS and 45 clinically isolated syndrome). Brain and spinal cord MRI scans were anonymised and scored on two different criteria by 2 raters: one previously described by Mattews and colleagues and a modified version including spinal cord features (at least 1 lesion adjacent to the body of lateral ventricle and in the inferior temporal lobe, presence of subcortical U-fibre lesion, Dawson’s finger type lesion, and non longitudinally extensive cervical lesion). Results: MRI brain and spinal cord lesion criteria were able to separate relapsing remitting MS with a sensitivity of 100% and with a specificity of 77.3% against AQP4-positive neuromyelitis optica, sensitivity of 100% and specificity of 72.7% against MOG-disease and a sensitivity of 100% and specificity of 80% against NMOSD. Brain and spinal cord criteria were less sensitive and specific in patients with CIS. Conclusions: Our data suggest that radiological criteria can be useful to separate MS from MOG- and Aquaporin-4 disorders. Further work is needed to support its use in CIS. Disclosure: Dr. Bensi has nothing to disclose. Dr. Gonzalez has nothing to disclose. Dr. Chertcoff has nothing to disclose. Dr. Osa Sanz has nothing to disclose. Dr. Schteinschnaider has nothing to disclose. Dr. Correale has nothing to disclose. Dr. Farez has nothing to disclose.