Review details MRI features and protocol for MOGAD diagnosis

This review summarizes characteristic MRI findings in MOGAD affecting the optic nerve, brain, and spinal cord, as incorporated into the 2023 diagnostic criteria. The authors describe radiologic lag, acute lesion dynamics, and frequent T2-lesion resolution as distinguishing MOGAD from the persistent lesions typical of MS, and report that asymptomatic radiological activity is rare, suggesting surveillance MRI has less clinical utility than in MS. The review proposes a standardized MRI protocol for acute attacks and rebaselining, and outlines imaging red flags for alternative diagnoses.

Most relevant for: Clinicians evaluating patients with suspected demyelinating disease, particularly those distinguishing MOGAD from multiple sclerosis or AQP4-positive neuromyelitis optica spectrum disorder.

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