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MRI criteria for multiple sclerosis in patients presenting with clinically isolated syndromes: a multicentre retrospective study.

Abstract

BACKGROUND

The 2001 and 2005 McDonald criteria allow MRI evidence for dissemination in space (DIS) and dissemination in time (DIT) to be used to diagnose multiple sclerosis in patients who present with clinically isolated syndromes (CIS). In 2006, new criteria were proposed in which DIS requires at least one T2 lesion in at least two of four locations (juxtacortical, periventricular, infratentorial, and spinal-cord) and DIT requires a new T2 lesion on a follow-up scan. We applied all three criteria in a large cohort of CIS patients to assess their performance by use of conversion to clinically definite multiple sclerosis (CDMS) as the outcome.

METHODS

Patients who had two MRI scans within 12 months of CIS onset were identified in four centres in the Magnims European research network. The specificity and sensitivity of MRI criteria for CDMS after 3 years was assessed in 208 patients. A Cox proportional hazards model was applied in a larger cohort of 282 patients that included all patients irrespective of length of follow-up.

FINDINGS

The specificity of all criteria for CDMS was high (2001 McDonald, 91%; 2005 McDonald, 88%; new, 87%). Sensitivity of the new (72%) and 2005 McDonald (60%) criteria were higher than the 2001 McDonald criteria (47%). The Cox proportional hazards model showed a higher conversion risk for all three criteria in those with both DIS and DIT than those with either DIS or DIT alone. When all three criteria were included in the model, only the new criteria had an independent significant effect on conversion risk.

INTERPRETATION

The new criteria are simpler than the McDonald criteria without compromising specificity and accuracy. The presence of both DIS and DIT from two MRI scans has a higher specificity and risk for CDMS than either DIS or DIT alone.

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  • Authors+Show Affiliations

    ,

    Nuclear Magnetic Resonance Research Unit, Department of Neuroinflammation and Headache, Institute of Neurology, University College London, London, UK. j.swanton@ion.ucl.ac.uk

    , , , , , , , , , , , ,

    Source

    The Lancet. Neurology 6:8 2007 Aug pg 677-86

    MeSH

    Adult
    Brain
    Female
    Follow-Up Studies
    Humans
    Magnetic Resonance Imaging
    Male
    Middle Aged
    Multiple Sclerosis
    Proportional Hazards Models
    Reproducibility of Results
    Retrospective Studies
    Risk
    Sensitivity and Specificity
    Survival Analysis
    Syndrome

    Pub Type(s)

    Journal Article
    Multicenter Study
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    17616439

    Citation

    Swanton, Josephine K., et al. "MRI Criteria for Multiple Sclerosis in Patients Presenting With Clinically Isolated Syndromes: a Multicentre Retrospective Study." The Lancet. Neurology, vol. 6, no. 8, 2007, pp. 677-86.
    Swanton JK, Rovira A, Tintore M, et al. MRI criteria for multiple sclerosis in patients presenting with clinically isolated syndromes: a multicentre retrospective study. Lancet Neurol. 2007;6(8):677-86.
    Swanton, J. K., Rovira, A., Tintore, M., Altmann, D. R., Barkhof, F., Filippi, M., ... Miller, D. H. (2007). MRI criteria for multiple sclerosis in patients presenting with clinically isolated syndromes: a multicentre retrospective study. The Lancet. Neurology, 6(8), pp. 677-86.
    Swanton JK, et al. MRI Criteria for Multiple Sclerosis in Patients Presenting With Clinically Isolated Syndromes: a Multicentre Retrospective Study. Lancet Neurol. 2007;6(8):677-86. PubMed PMID: 17616439.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - MRI criteria for multiple sclerosis in patients presenting with clinically isolated syndromes: a multicentre retrospective study. AU - Swanton,Josephine K, AU - Rovira,Alex, AU - Tintore,Mar, AU - Altmann,Daniel R, AU - Barkhof,Frederik, AU - Filippi,Massimo, AU - Huerga,Elena, AU - Miszkiel,Katherine A, AU - Plant,Gordon T, AU - Polman,Chris, AU - Rovaris,Marco, AU - Thompson,Alan J, AU - Montalban,Xavier, AU - Miller,David H, PY - 2007/7/10/pubmed PY - 2007/9/8/medline PY - 2007/7/10/entrez SP - 677 EP - 86 JF - The Lancet. Neurology JO - Lancet Neurol VL - 6 IS - 8 N2 - BACKGROUND: The 2001 and 2005 McDonald criteria allow MRI evidence for dissemination in space (DIS) and dissemination in time (DIT) to be used to diagnose multiple sclerosis in patients who present with clinically isolated syndromes (CIS). In 2006, new criteria were proposed in which DIS requires at least one T2 lesion in at least two of four locations (juxtacortical, periventricular, infratentorial, and spinal-cord) and DIT requires a new T2 lesion on a follow-up scan. We applied all three criteria in a large cohort of CIS patients to assess their performance by use of conversion to clinically definite multiple sclerosis (CDMS) as the outcome. METHODS: Patients who had two MRI scans within 12 months of CIS onset were identified in four centres in the Magnims European research network. The specificity and sensitivity of MRI criteria for CDMS after 3 years was assessed in 208 patients. A Cox proportional hazards model was applied in a larger cohort of 282 patients that included all patients irrespective of length of follow-up. FINDINGS: The specificity of all criteria for CDMS was high (2001 McDonald, 91%; 2005 McDonald, 88%; new, 87%). Sensitivity of the new (72%) and 2005 McDonald (60%) criteria were higher than the 2001 McDonald criteria (47%). The Cox proportional hazards model showed a higher conversion risk for all three criteria in those with both DIS and DIT than those with either DIS or DIT alone. When all three criteria were included in the model, only the new criteria had an independent significant effect on conversion risk. INTERPRETATION: The new criteria are simpler than the McDonald criteria without compromising specificity and accuracy. The presence of both DIS and DIT from two MRI scans has a higher specificity and risk for CDMS than either DIS or DIT alone. SN - 1474-4422 UR - https://www.unboundmedicine.com/medline/citation/17616439/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S1474-4422(07)70176-X DB - PRIME DP - Unbound Medicine ER -