Review Outlines MRI Features and Monitoring Considerations in MOGAD

A review in JAMA Neurology describes the MRI characteristics of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), a demyelinating disorder distinct from multiple sclerosis (MS) and aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder. MRI is central to evaluating attacks and is a component of the 2023 MOGAD diagnostic criteria. The review covers optic nerve, brain, and spinal cord involvement, differential diagnosis, and imaging approaches during and after attacks.

Highlighted features include radiologic lag, changing lesions during acute attacks, and frequent resolution of T2 lesions, contrasting with the persistent lesions typical of MS. The authors propose an MRI protocol for acute attacks and discuss when repeat imaging can establish a new baseline. They also note that asymptomatic radiological activity is rare, suggesting surveillance MRI has less clinical utility than in MS and less value as a surrogate biomarker in MOGAD trials.

For clinicians, recognizing lesion evolution and imaging red flags may support diagnosis and identification of alternative disorders. Standardized imaging could also improve consistency across research studies. This is a review rather than a primary comparative study; the supplied abstract provides no sample size, quantitative effect estimates, or detailed protocol parameters. Full text was unavailable, limiting assessment of the evidence supporting specific imaging recommendations.