scholarly journals Canadian Expert Panel Recommendations for MRI Use in MS Diagnosis and Monitoring

2015 ◽  
Vol 42 (3) ◽  
pp. 159-167 ◽  
Author(s):  
Anthony Traboulsee ◽  
Laurent Létourneau-Guillon ◽  
Mark Steven Freedman ◽  
Paul W. O’Connor ◽  
Aditya Bharatha ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Expert Panel ◽  
Improve Patient Care ◽  
Clinically Isolated Syndrome ◽  
Routine Practice ◽  
Mri Findings ◽  
Mcdonald Criteria ◽  
Consensus Statements ◽  
Mri Protocol ◽  
Magnetic Resonance Imaging Mri

AbstractBackground: A definitive diagnosis of multiple sclerosis (MS), as distinct from a clinically isolated syndrome, requires one of two conditions: a second clinical attack or particular magnetic resonance imaging (MRI) findings as defined by the McDonald criteria. MRI is also important after a diagnosis is made as a means of monitoring subclinical disease activity. While a standardized protocol for diagnostic and follow-up MRI has been developed by the Consortium of Multiple Sclerosis Centres, acceptance and implementation in Canada have been suboptimal. Methods: To improve diagnosis, monitoring, and management of a clinically isolated syndrome and MS, a Canadian expert panel created consensus recommendations about the appropriate application of the 2010 McDonald criteria in routine practice, strategies to improve adherence to the standardized Consortium of Multiple Sclerosis Centres MRI protocol, and methods for ensuring effective communication among health care practitioners, in particular referring physicians, neurologists, and radiologists. Results: This article presents eight consensus statements developed by the expert panel, along with the rationale underlying the recommendations and commentaries on how to prioritize resource use within the Canadian healthcare system. Conclusions: The expert panel calls on neurologists and radiologists in Canada to incorporate the McDonald criteria, the Consortium of Multiple Sclerosis Centres MRI protocol, and other guidance given in this consensus presentation into their practices. By improving communication and general awareness of best practices for MRI use in MS diagnosis and monitoring, we can improve patient care across Canada by providing timely diagnosis, informed management decisions, and better continuity of care.

Early predictors of multiple sclerosis after a typical clinically isolated syndrome

2014 ◽  
Vol 20 (13) ◽  
pp. 1721-1726 ◽  
Author(s):  
Aurélie Ruet ◽  
Georgina Arrambide ◽  
Bruno Brochet ◽  
Cristina Auger ◽  
Eva Simon ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
At Risk ◽  
High Specificity ◽  
Clinically Isolated Syndrome ◽  
Oligoclonal Bands ◽  
Mcdonald Criteria ◽  
Early Predictors ◽  
Patients At Risk ◽  
Magnetic Resonance Imaging Mri ◽  
Periventricular Lesions

Background: The 2010 McDonald criteria allow diagnosing multiple sclerosis (MS) with one magnetic resonance imaging (MRI) scan. Nevertheless, not all patients at risk fulfil criteria at baseline. Other predictive factors (PFs) are: age ≤40 years, positive oligoclonal bands (OBs), and ≥3 periventricular lesions. Objective: The purpose of this study was to evaluate the 2010 McDonald criteria performance and to assess other PFs in patients without dissemination in space (DIS). Methods: Patients with clinically isolated syndrome (CIS) underwent baseline MRI and OB determination with clinical and radiological follow-up. Adjusted hazard ratios (aHRs) for clinically definite MS were estimated for DIS, dissemination in time (DIT), and DIS+DIT. Diagnostic properties at two years were calculated. In cases without DIS, combinations of ≥2 PFs were assessed. Results: A total of 652 patients were recruited; aHRs were 3.8 (2.5–5.8) for DIS, 4.2 (1.9–9.2) for DIT, and 8.6 (5.4–13.8) for DIS+DIT. Sensitivities were 69.6%, 42.3%, and 36.4%, and specificities were 67.3%, 87.9%, and 90.2%, respectively. In patients without DIS, aHRs varied between 2.7–5.5 and specificities ranged from 73.5–89.7% for PF combinations. Conclusion: The high specificity of the 2010 McDonald criteria is confirmed. In patients without DIS, PF combinations could be helpful in identifying those at risk for MS.

Discrepancies in the interpretation of clinical symptoms and signs in the diagnosis of multiple sclerosis. A proposal for standardization

2005 ◽  
Vol 11 (2) ◽  
pp. 227-231 ◽  
Author(s):  
Bernard MJ Uitdehaag ◽  
Ludwig Kappos ◽  
Lars Bauer ◽  
Mark S Freedman ◽  
David Miller ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Demyelinating Disease ◽  
Clinical Symptoms ◽  
Clinical Findings ◽  
Large Trial ◽  
Mri Findings ◽  
Mcdonald Criteria ◽  
Magnetic Resonance Imaging Mri ◽  
Eligibility Assessment

The new McDonald diagnostic criteria for multiple sclerosis (MS) incorporate detailed criteria for the interpretation and classification of magnetic resonance imaging (MRI) findings, but, in contrast, provide no instructions for the interpretation of clinical findings. Because MS according to the McDonald criteria is one of the primary endpoints in a large trial enrolling patients after the first manifestation suggestive for a demyelinating disease (BENEFIT study), it was decided to organize a centralized eligibility assessment for this trial. During this eligibility assessment it was observed that there were marked inconsistencies in the decisions of participating neurologists with respect to the classification of clinical symptoms as being caused by one or more lesions provoking discussions in about one in every five patients. This paper describes these inconsistencies and their sources, and recommends a systematic approach that attempts to reduce the variability in interpreting clinical findings.

scholarly journals Periventricular lesions and MS diagnostic criteria in young adults with typical clinically isolated syndromes

2016 ◽  
Vol 23 (7) ◽  
pp. 1031-1034 ◽  
Author(s):  
Wallace J Brownlee ◽  
Katherine A Miszkiel ◽  
Daniel R Altmann ◽  
Olga Ciccarelli ◽  
David H Miller
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Clinically Isolated Syndrome ◽  
Resonance Imaging ◽  
Mcdonald Criteria ◽  
Specificity And Sensitivity ◽  
Magnetic Resonance Imaging Mri ◽  
Periventricular Lesions ◽  
Periventricular Lesion

In patients who present with a clinically isolated syndrome (CIS), whose features are suggestive of multiple sclerosis (MS), fulfilling McDonald 2010 magnetic resonance imaging (MRI) criteria for dissemination in space (DIS) and dissemination in time (DIT) enables a diagnosis of MS. While ⩾1 periventricular lesion is included in the 2010 DIS criteria, earlier McDonald criteria required ⩾3 periventricular lesions to confirm DIS and recent Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS)-recommended DIS criteria also require ⩾3 lesions. We investigated the effect of varying the required number of periventricular lesions and found that the best combination of specificity and sensitivity for clinically definite MS was seen for ⩾1 periventricular lesion using both the McDonald 2010 and MAGNIMS 2016 criteria.

Subtle upper limb impairment in asymptomatic multiple sclerosis subjects

2007 ◽  
Vol 13 (3) ◽  
pp. 428-432 ◽  
Author(s):  
C. Solaro ◽  
G. Brichetto ◽  
M. Casadio ◽  
L. Roccatagliata ◽  
P. Ruggiu ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Upper Limb ◽  
Motor Performance ◽  
Clinically Isolated Syndrome ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Lesion Load ◽  
Upper Limb Function ◽  
Vision Condition ◽  
Magnetic Resonance Imaging Mri

We evaluated upper limb function in multiple sclerosis (MS) subjects (11 clinically definite MS patients and seven clinically isolated syndrome (CIS) subjects), with a normal upper limb standard neurological examination. Subjects performed center-out reaching movements under visual control, with and without vision of the hand. Their movements were recorded through a digitizing tablet. Motor performance was also related to lesion load, estimated from magnetic resonance imaging (MRI). We found that in MS and CIS subjects, under the hand vision condition, movements were significantly less smooth, and had a less symmetric speed profile. However, the observed impairment did not correlate with MRI findings. This result may be interpreted as evidence of a compensatory strategy, elicited by subtle alterations in sensorimotor control. Multiple Sclerosis 2007; 13: 428-432. http://msj.sagepub.com

Early Identification of Clinically Isolated Syndrome - How this is Best Achieved and the Implications for Patient Outcomes

2010 ◽  
Vol 5 (2) ◽  
pp. 90
Author(s):  
Francisco C Pérez-Miralles ◽  
Filipe Palavra ◽  
Xavier Montalban ◽  
◽  
◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Patient Outcomes ◽  
Clinically Isolated Syndrome ◽  
Resonance Imaging ◽  
Mcdonald Criteria ◽  
Definite Multiple Sclerosis ◽  
Clinically Definite Multiple Sclerosis ◽  
Magnetic Resonance Imaging Mri ◽  
New Evidence ◽  
New Criteria

Magnetic resonance imaging (MRI) evidence for dissemination in space (DIS) and dissemination in time (DIT) are used within the McDonald criteria for the diagnosis of multiple sclerosis (MS). These criteria are complex and in some patients several MRI examinations are needed to achieve an accurate diagnosis. In order to make an earlier diagnosis of clinically definite multiple sclerosis (CDMS) in patients with clinically isolated syndromes (CIS), new criteria have been proposed in which DIS and DIT requirements are simpler, maximising sensitivity and conserving specificity. These data have led to a new proposal of MRI criteria for MS diagnosis. The historical evolution of MS criteria and the new evidence are reviewed in this article.

scholarly journals Application of the 2017 McDonald criteria in a Chinese population with clinically isolated syndrome

2020 ◽  
Vol 13 ◽  
pp. 175628641989808
Author(s):  
Yang Zheng* ◽  
Chun-Hong Shen* ◽  
Sa Wang ◽  
Fan Yang ◽  
Meng-Ting Cai ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Diagnostic Performance ◽  
Age Of Onset ◽  
Asian Population ◽  
Tertiary Hospital ◽  
Clinically Isolated Syndrome ◽  
Chinese Patients ◽  
Mcdonald Criteria ◽  
Lower Specificity ◽  
Higher Sensitivity

Background: Diagnostic criteria for multiple sclerosis have evolved over time, with the most recent being the 2017 McDonald criteria. Evidence is lacking regarding the validity of the 2017 McDonald criteria among the Asian population. Therefore, this study aims to evaluate the diagnostic performance of the 2017 McDonald criteria in Chinese patients with clinically isolated syndrome (CIS). Methods: A total of 93 patients with initial findings suggestive of CIS in a tertiary hospital in China from 2012 to 2017 were included in this retrospective study. Baseline and follow-up data were reviewed. Diagnostic performance (sensitivity, specificity, accuracy), was assessed and survival analysis was performed for the 2017 and 2010 McDonald criteria respectively. Results: Among the 93 Chinese patients with CIS, 57 were female (61.3%) and the median (interquartile range) age of onset was 37 (31.3–41.8) years. The 2017 McDonald criteria displayed a higher sensitivity (75.0% versus 14.6%, p < 0.0001), lower specificity (47.1% versus 100.0%, p < 0.05) but an overall higher accuracy (67.7% versus 36.9%, p < 0.0001) when compared with the 2010 iteration. The novel criteria allow for a better detection of MS at baseline (40.8% versus 9.9%, p < 0.0001). Conclusion: The 2017 McDonald criteria had a higher sensitivity but lower specificity than the 2010 iteration. Overall it facilitated an earlier and more accurate diagnosis of multiple sclerosis in Chinese patients with CIS.

What do we currently know about the clinically isolated syndrome suggestive of multiple sclerosis? An update

2020 ◽  
Vol 31 (3) ◽  
pp. 335-349
Author(s):  
Tomasz Grzegorski ◽  
Jacek Losy
Keyword(s):  
Multiple Sclerosis ◽  
Predictive Factors ◽  
Clinically Isolated Syndrome ◽  
Clinical Image ◽  
Double Blind ◽  
Beneficial Effects ◽  
Mcdonald Criteria ◽  
Clinical Episode ◽  
The Central Nervous System ◽  
Large Groups

AbstractMultiple sclerosis (MS) is a chronic, demyelinating, not fully understood disease of the central nervous system. The first demyelinating clinical episode is called clinically isolated syndrome (CIS) suggestive of MS. Although the most common manifestations of CIS are long tracts dysfunction and unilateral optic neuritis, it can also include isolated brainstem syndromes, cerebellar involvement, and polysymptomatic clinical image. Recently, the frequency of CIS diagnosis has decreased due to the more sensitive and less specific 2017 McDonald criteria compared with the revisions from 2010. Not all patients with CIS develop MS. The risk of conversion can be estimated based on many predictive factors including epidemiological, ethnical, clinical, biochemical, radiological, immunogenetic, and other markers. The management of CIS is nowadays widely discussed among clinicians and neuroscientists. To date, interferons, glatiramer acetate, teriflunomide, cladribine, and some other agents have been evaluated in randomized, placebo-controlled, double-blind studies relying on large groups of patients with the first demyelinating event. All of these drugs were shown to have beneficial effects in patients with CIS and might be used routinely in the future. The goal of this article is to explore the most relevant topics regarding CIS as well as to provide the most recent information in the field. The review presents CIS definition, classification, clinical image, predictive factors, and management. What is more, this is one of very few reviews summarizing the topic in the light of the 2017 McDonald criteria.

Challenges in multiple sclerosis diagnosis: Misunderstanding and misapplication of the McDonald criteria

2020 ◽  
pp. 135245852091049 ◽  
Author(s):  
Andrew J Solomon ◽  
Roman Pettigrew ◽  
Robert T Naismith ◽  
Salim Chahin ◽  
Stephen Krieger ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Optic Neuritis ◽  
Subcortical White Matter ◽  
Web Based ◽  
Mcdonald Criteria ◽  
Correct Definition ◽  
Objective Evidence ◽  
Core Elements ◽  
Magnetic Resonance Imaging Mri ◽  
Definition Of

Objective: To assess comprehension and application of the McDonald criteria. Background: Studies suggest that knowledge gaps for specific core elements of the McDonald criteria may contribute to multiple sclerosis (MS) misdiagnosis. Methods: Neurology residents (NR) and multiple sclerosis specialists (MSS) in North America completed a web-based survey. Results: A total of 160 participants were included: 72 NR and 88 MSS. Syndromes incorrectly identified as typical of MS included: complete transverse myelopathy (35% NR and 15% MSS), intractable vomiting/nausea/hiccoughs (20% NR and 5% MSS), and bilateral optic neuritis/unilateral optic neuritis with poor visual recovery (17% NR and 10% MSS). Periventricular magnetic resonance imaging (MRI) lesions were correctly identified by 39% NR and 52% MSS, and juxtacortical lesions were correctly identified by 28% NR and 53% MSS. The correct definition of “periventricular” was chosen by 38% NR and 61% MSS, and that of “juxtacortical” was chosen by 19% NR and 54% MSS. Regions incorrectly identified for MRI dissemination in space fulfillment included the optic nerve (31% NR and 26% MSS) and the subcortical white matter (11% NR and 18% MSS). The majority of participants assessed previous non-specific neurological symptoms without objective evidence of a central nervous system (CNS) lesion as sufficient for clinical dissemination in time. Conclusion: The McDonald criteria are often misunderstood and misapplied. Concerted educational efforts may prevent MS misdiagnosis.

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