Although spinal cord lesions extending up to 3 vertebral segments can be observed in pediatric MS, their frequency in this cohort of children characterized for absence of anti-MOG antibodies is lower than previously reported.6,7 Importantly, longer lesions often represent contiguous smaller independent lesions when carefully viewed in axial planes, highlighting the importance of careful assessment of both axial and sagittal images.36 The H-sign is not a feature of pediatric MS, and leptomeningeal enhancement is rare. This evidence concerns the gene MOG and myeloid sarcoma.