Imaging Features of Spinal Cord Inflammatory Lesions in Children: Comparison Between Anti-MOG Antibody Associated Disease, MS and Seronegative Monophasic Disease (1590)

Objective: To characterize the imaging features of spinal cord (SC) involvement in children with anti-MOG associated disease (MOGAD), multiple sclerosis (MS) and seronegative monophasic acquired demyelinating syndrome (monoADS), and assess their discriminative diagnostic utility. Background: SC involvement is a common finding in pediatric acquired demyelinating syndromes (ADS). Long lesions favor non-MS diagnoses, and comprehensive characterization of SC involvement in children with defined anti-MOG serology may provide further diagnostic insights. Design/Methods: We analyzed spine MRI scans from 217 children and adolescents with ADS recruited in the prospective Canadian Pediatric Demyelinating Disease Study. Anti-MOG and anti-AQP4 antibody serology were assessed in archived serum samples obtained in proximity to clinical presentation. MRI scans were analyzed through a standardized scoring tool, blinded to brain MRI findings and clinical diagnosis. The imaging features were compared between MOGAD, MS and monoADS using descriptive statistics. AQP4-positive children were too few for meaningful inclusion. Results: SC lesions were detected in 107/217 (49%) children (40/107 with MOGAD [37%], 21/107 MS [20%], and 46/107 with monoADS [43%]). The median age at first scan with lesions was 10.6 years (IQR 5.6–13.0). Lesions restricted to SC white matter were found in 2/35 (6%) children with MOGAD, vs 13/19 (68%) with MS (p 3 segments) were common among children with MOGAD (30/40, 75%), rare in MS (1/21, 5%, p Conclusions: Multiple spine MRI features can help distinguish pediatric MOGAD from MS and other seronegative idiopathic myelitis. Disclosure: Dr. Fadda has nothing to disclose. CESAR ALVES has nothing to disclose. Ms. O9Mahony has nothing to disclose. Denise Castro has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Denise Castro has received intellectual property interests from a discovery or technology relating to health care. Dr. Yeh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Yeh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for biogen. Dr. Yeh has received personal compensation in the range of $0-$499 for serving as a Consultant for medlink. Dr. Yeh has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for ACI. Dr. Yeh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for MS ATL. Dr. Yeh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for EXCEMED. The institution of Dr. Yeh has received research support from Biogen. The institution of Dr. Yeh has received research support from Stem Cell Network. The institution of Dr. Yeh has received research support from CIHR. The institution of Dr. Yeh has received research support from Ontario Institute for Regenerative Medicine. The institution of Dr. Yeh has received research support from National MS Society. The institution of Dr. Yeh has received research support from NIH. The institution of Dr. Yeh has received research support from SickKids Foundation. The institution of Dr. Yeh has received research support from CMSC. Dr. Marrie has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for SAGE Publications. The institution of Dr. Marrie has received research support from CIHR. The institution of Dr. Marrie has received research support from MS Society of Canada. The institution of Dr. Marrie has received research support from National MS Society. The institution of Dr. Marrie has received research support from Crohn9s and Colitis Canada. The institution of Dr. Marrie has received research support from US Department of Defense. The institution of Dr. Marrie has received research support from Research Manitoba. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Arnold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Celgene. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Frequency Therapeutics. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GENeuro. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Arnold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Receptos/Celgene. Dr. Arnold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Arnold has received stock or an ownership interest from NeuroRx. The institution of Dr. Arnold has received research support from Novartis. The institution of Dr. Arnold has received research support from Immunotec. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche Genentech. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen/Actelion. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Atara Biotherapeutics. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merk/EMD Serono. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Atara Biotherapeutics. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck/EMD Serono. Dr. Bar-Or has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi/Genzyme. The institution of Dr. Bar-Or has received research support from Novartis. The institution of Dr. Bar-Or has received research support from Biogen. The institution of Dr. Bar-Or has received research support from Roche/Genentech. The institution of Dr. Bar-Or has received research support from Merck/EMD Serono. Dr. Vossough has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biomarin. Dr. Vossough has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Syneos Health. Dr. Vossough has received publishing royalties from a publication relating to health care. Dr. Banwell has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Banwell has received personal compensation in the range of $0-$499 for serving as a Consultant for UCB. Dr. Banwell has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Banwell has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Banwell has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medscape. Dr. Banwell has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Dr. Banwell has received research support from National MS Society. The institution of Dr. Banwell has received research support from NIH.