Enlarged Perivascular Space Burden Predicts the Risk of Relapse in Myelin Oligodendrocyte Glycoprotein Antibody‐Associated Disease Patients

Background and Objectives: Myelin oligodendrocyte glycoprotein antibody‐associated disease (MOGAD) is an immune‐mediated inflammatory demyelinating disease of the central nervous system, with a complex relapse mechanism involving various factors. The connection between enlarged perivascular spaces (EPVSs) and MOGAD is currently unclear. This study is aimed at exploring the risk factors associated with an increased number of EPVS in MOGAD patients and the association with relapse. Methods: A retrospective study was conducted on 23 patients with MOGAD. We analyzed the correlation between the number of EPVS and age, disease duration, cerebrospinal fluid (CSF) leukocytes, CSF protein, EDSS scores, albumin quotient, and MOG‐IgG titer. We employed linear regression to assess the independent risk factors for the number of EPVS, and Cox regression was used to elucidate the independent factors associated with relapse. Results: The median total EPVS counts were 8 (IQR 4–9) at the initial brain MRI in patients with MOGAD. The number of total EPVS in patients with MOGAD was significantly positively correlated with CSF protein ( ρ = 0.42, p = 0.044), EDSS ( r = 0.74, p < 0.0001), QAlb ( ρ = 0.48, p = 0.022), serum MOG‐IgG titer ( ρ = 0.48, p = 0.019), and CSF MOG‐IgG titer ( ρ = 0.46, p = 0.029). Univariate linear regression analysis indicated that CSF protein ( β = 0.45, p = 0.03), EDSS scores ( β = 0.6, p = 0.002), serum MOG‐IgG titer ( β = 0.51, p = 0.014), and CSF anti‐MOG‐IgG titer ( β = 0.64, p = 0.001) were independent factors associated with EPVS counts. EDSS scores ( β = 0.49, p = 0.002) and CSF MOG‐IgG titer ( β = 0.54, p = 0.001) were independent predictors associated with EPVS count in the multivariable linear regression model. Multivariable Cox regression analysis showed that the total number of EPVS was the only variable that revealed a significant effect on relapse (HR = 1.22, 95% CI 1.01–1.47, p = 0.04). Conclusion: In our cohort, we preliminary explored independent risk factors for increased EPVS. Moreover, EPVS might independently predict the risk of relapse in patients with MOGAD.