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Should the symptomatic region be included in dissemination in space in MRI criteria for MS?
Neurology 2016; 87(7):680-3Neur

Abstract

OBJECTIVES

To investigate whether inclusion of lesions in the symptomatic region influences the performance of dissemination in space (DIS) criteria for a diagnosis of clinically definite multiple sclerosis (CDMS) in patients with a clinically isolated syndrome (CIS).

METHODS

We studied 30 patients with CIS with brainstem/cerebellar and spinal cord syndromes who had MRI scans at the time of CIS and were followed up for the development of CDMS. We retrospectively applied the McDonald 2010 DIS criteria (excluding all lesions in the symptomatic region) to baseline MRI scans and 2 modified DIS criteria: (1) the inclusion of asymptomatic lesions in the symptomatic region in DIS, and (2) the inclusion of any lesion in the symptomatic region in DIS. The performance of the McDonald 2010 DIS criteria and the 2 modified criteria for the development of CDMS was compared.

RESULTS

The sensitivity, specificity, and accuracy of the DIS criteria was, respectively, 73%, 73%, and 73% for the McDonald 2010 criteria, 80%, 73%, and 77% when asymptomatic lesions in the symptomatic region were included, and 87%, 73%, and 80% when any lesion in the symptomatic region was included in DIS.

CONCLUSIONS

Including lesions in the symptomatic region in DIS increases the sensitivity of MRI criteria for diagnosing multiple sclerosis without compromising specificity. These findings may help inform future revisions of the diagnostic criteria for multiple sclerosis.

CLASSIFICATION OF EVIDENCE

This study provides Class II evidence that for patients with CIS, including lesions in the symptomatic region as part of the criteria for DIS does not significantly increase the accuracy for predicting the development of CDMS. The study lacks the precision to detect an important change in accuracy.

Authors+Show Affiliations

From the Queen Square Multiple Sclerosis Centre (W.J.B., J.K.S., D.H.M., O.C.), Department of Neuroinflammation, UCL Institute of Neurology, London; Lysholm Department of Neuroradiology (K.A.M.), National Hospital for Neurology and Neurosurgery, London; and NIHR University College London Hospitals Biomedical Research Centre (D.H.M., O.C.), London, UK. w.brownlee@ucl.ac.uk.From the Queen Square Multiple Sclerosis Centre (W.J.B., J.K.S., D.H.M., O.C.), Department of Neuroinflammation, UCL Institute of Neurology, London; Lysholm Department of Neuroradiology (K.A.M.), National Hospital for Neurology and Neurosurgery, London; and NIHR University College London Hospitals Biomedical Research Centre (D.H.M., O.C.), London, UK.From the Queen Square Multiple Sclerosis Centre (W.J.B., J.K.S., D.H.M., O.C.), Department of Neuroinflammation, UCL Institute of Neurology, London; Lysholm Department of Neuroradiology (K.A.M.), National Hospital for Neurology and Neurosurgery, London; and NIHR University College London Hospitals Biomedical Research Centre (D.H.M., O.C.), London, UK.From the Queen Square Multiple Sclerosis Centre (W.J.B., J.K.S., D.H.M., O.C.), Department of Neuroinflammation, UCL Institute of Neurology, London; Lysholm Department of Neuroradiology (K.A.M.), National Hospital for Neurology and Neurosurgery, London; and NIHR University College London Hospitals Biomedical Research Centre (D.H.M., O.C.), London, UK.From the Queen Square Multiple Sclerosis Centre (W.J.B., J.K.S., D.H.M., O.C.), Department of Neuroinflammation, UCL Institute of Neurology, London; Lysholm Department of Neuroradiology (K.A.M.), National Hospital for Neurology and Neurosurgery, London; and NIHR University College London Hospitals Biomedical Research Centre (D.H.M., O.C.), London, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27421541

Citation

Brownlee, Wallace J., et al. "Should the Symptomatic Region Be Included in Dissemination in Space in MRI Criteria for MS?" Neurology, vol. 87, no. 7, 2016, pp. 680-3.
Brownlee WJ, Swanton JK, Miszkiel KA, et al. Should the symptomatic region be included in dissemination in space in MRI criteria for MS? Neurology. 2016;87(7):680-3.
Brownlee, W. J., Swanton, J. K., Miszkiel, K. A., Miller, D. H., & Ciccarelli, O. (2016). Should the symptomatic region be included in dissemination in space in MRI criteria for MS? Neurology, 87(7), pp. 680-3. doi:10.1212/WNL.0000000000002975.
Brownlee WJ, et al. Should the Symptomatic Region Be Included in Dissemination in Space in MRI Criteria for MS. Neurology. 2016 Aug 16;87(7):680-3. PubMed PMID: 27421541.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Should the symptomatic region be included in dissemination in space in MRI criteria for MS? AU - Brownlee,Wallace J, AU - Swanton,Josephine K, AU - Miszkiel,Katherine A, AU - Miller,David H, AU - Ciccarelli,Olga, Y1 - 2016/07/15/ PY - 2015/11/06/received PY - 2016/04/22/accepted PY - 2016/7/17/entrez PY - 2016/7/17/pubmed PY - 2017/5/30/medline SP - 680 EP - 3 JF - Neurology JO - Neurology VL - 87 IS - 7 N2 - OBJECTIVES: To investigate whether inclusion of lesions in the symptomatic region influences the performance of dissemination in space (DIS) criteria for a diagnosis of clinically definite multiple sclerosis (CDMS) in patients with a clinically isolated syndrome (CIS). METHODS: We studied 30 patients with CIS with brainstem/cerebellar and spinal cord syndromes who had MRI scans at the time of CIS and were followed up for the development of CDMS. We retrospectively applied the McDonald 2010 DIS criteria (excluding all lesions in the symptomatic region) to baseline MRI scans and 2 modified DIS criteria: (1) the inclusion of asymptomatic lesions in the symptomatic region in DIS, and (2) the inclusion of any lesion in the symptomatic region in DIS. The performance of the McDonald 2010 DIS criteria and the 2 modified criteria for the development of CDMS was compared. RESULTS: The sensitivity, specificity, and accuracy of the DIS criteria was, respectively, 73%, 73%, and 73% for the McDonald 2010 criteria, 80%, 73%, and 77% when asymptomatic lesions in the symptomatic region were included, and 87%, 73%, and 80% when any lesion in the symptomatic region was included in DIS. CONCLUSIONS: Including lesions in the symptomatic region in DIS increases the sensitivity of MRI criteria for diagnosing multiple sclerosis without compromising specificity. These findings may help inform future revisions of the diagnostic criteria for multiple sclerosis. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for patients with CIS, including lesions in the symptomatic region as part of the criteria for DIS does not significantly increase the accuracy for predicting the development of CDMS. The study lacks the precision to detect an important change in accuracy. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/27421541/Should_the_symptomatic_region_be_included_in_dissemination_in_space_in_MRI_criteria_for_MS L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=27421541 DB - PRIME DP - Unbound Medicine ER -