A JAMA Neurology review by an international group sets out the MRI features of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), drawing on the 2023 diagnostic criteria.
Two patterns stand out. First, MRI can lag behind the clinical attack, so an early scan may look less abnormal than the patient. Second, T2 lesions in MOGAD frequently resolve, in contrast to the persistent lesions of multiple sclerosis. Attacks are clinically and radiologically evident, and silent new lesions between attacks are rare.
That has practical consequences. Routine surveillance MRI between attacks is less useful in MOGAD than in multiple sclerosis. A repeat scan after recovery, to set a new baseline, is more informative. The review proposes a standard MRI protocol for acute attacks and lists red flags that should prompt an alternative diagnosis.
- Repeat MRI if an early scan is unremarkable but the clinical picture strongly suggests a demyelinating attack; MOGAD lesions can lag.
- Consider a rebaseline MRI after recovery from a MOGAD attack rather than frequent routine surveillance.
- Lesions that resolve on follow-up favour MOGAD over multiple sclerosis.
- Test MOG antibodies with a cell-based assay when the clinical and MRI pattern fits, not as a blanket screen.
Why it matters
Applying a multiple sclerosis imaging routine to MOGAD wastes scans and can mislead diagnosis.
Don't overread it
This is an expert review, not new trial data; the proposed protocol has not been tested against outcomes.
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