Radiological differentiation of optic neuritis with myelin oligodendrocyte glycoprotein antibodies, aquaporin-4 antibodies, and multiple sclerosis

Mult Scler. 2016 Apr;22(4):470-82. doi: 10.1177/1352458515593406. Epub 2015 Jul 10.


Background: Recognizing the cause of optic neuritis (ON) affects treatment decisions and visual outcomes.

Objective: We aimed to define radiological features of first-episode demyelinating ON.

Methods: We performed blinded radiological assessment of 50 patients presenting with first-episode myelin oligodendrocyte glycoprotein (MOG) antibody-associated ON (MOG-ON; n=19), aquaporin-4 (AQP4) antibody-associated ON (AQP4-ON; n=11), multiple sclerosis (MS)-associated ON (MS-ON; n=13), and unclassified ON (n=7).

Results: Bilateral involvement was more common in MOG-ON and AQP4-ON than MS-ON (84% vs. 82% vs. 23%), optic nerve head swelling was more common in MOG-ON (53% vs. 9% vs. 0%), chiasmal involvement was more common in AQP4-ON (5% vs. 64% vs. 15%), and bilateral optic tract involvement was more common in AQP4-ON (0% vs. 45% vs. 0%). Retrobulbar involvement was more common in MOG-ON, whereas intracranial involvement was more common in AQP4-ON. MOG-ON and AQP4-ON had longer lesion lengths than MS-ON. The combination of two predictors, the absence of magnetic resonance imaging brain abnormalities and a higher lesion extent score, showed a good ability to discriminate between an autoantibody-associated ON (MOG or AQP4) and MS. AQP4-ON more frequently had severe and sustained visual impairment.

Conclusion: MOG-ON and AQP4-ON are more commonly bilateral and longitudinally extensive. MOG-ON tends to involve the anterior optic pathway, whereas AQP4-ON the posterior optic pathway.

Keywords: Optic neuritis; aquaporin-4 antibodies; multiple sclerosis; myelin oligodendrocyte glycoprotein antibodies; neuromyelitis optica; radiology.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • Aquaporin 4 / immunology*
  • Autoantibodies / blood*
  • Biomarkers / blood
  • Child
  • Child, Preschool
  • Diagnosis, Differential
  • Female
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Multiple Sclerosis / blood
  • Multiple Sclerosis / diagnostic imaging*
  • Multiple Sclerosis / immunology
  • Myelin-Oligodendrocyte Glycoprotein / immunology*
  • Optic Neuritis / blood
  • Optic Neuritis / diagnostic imaging*
  • Optic Neuritis / immunology
  • Optic Tract / diagnostic imaging*
  • Predictive Value of Tests
  • Retrospective Studies
  • Young Adult


  • AQP4 protein, human
  • Aquaporin 4
  • Autoantibodies
  • Biomarkers
  • MOG protein, human
  • Myelin-Oligodendrocyte Glycoprotein