Evaluation of 2016 MAGNIMS MRI criteria for dissemination in space in patients with a clinically isolated syndrome

2017 ◽  
Vol 24 (6) ◽  
pp. 758-766 ◽  
Author(s):  
Jae-Won Hyun ◽  
So-Young Huh ◽  
Woojun Kim ◽  
Min Su Park ◽  
Suk-Won Ahn ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Clinically Isolated Syndrome ◽  
Clinical Event ◽  
Resonance Imaging ◽  
Predictive Values ◽  
Mcdonald Criteria ◽  
Sensitivity Specificity

Objectives: We compared validity of 2010 McDonald and newly proposed 2016 Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) criteria for dissemination in space (DIS) in predicting the conversion to clinically definite multiple sclerosis (CDMS) in patients with clinically isolated syndrome (CIS). Methods: Between 2006 and 2016, we enrolled 170 patients who had a first clinical event suggestive of multiple sclerosis (MS) from seven referral hospitals in Korea. Patients were classified into two groups based on the main outcome at the last follow-up: CDMS converters, who experienced a second attack, and non-converters. Results: Of 170 patients with mean follow-up duration of 54 months, 51% converted to CDMS. The sensitivity, specificity, accuracy, and positive and negative predictive values of 2010 McDonald criteria were 70.9%, 63.1%, 67.1%, 66.3%, and 67.9%, and those for 2016 MAGNIMS criteria were 88.4%, 46.4%, 67.7%, 62.8%, and 79.6%, respectively. When we excluded 80 patients who underwent disease-modifying therapy before the second clinical event, the specificity increased to 92.3% and 84.6%, but the sensitivity decreased to 58.8% and 82.4% for 2010 McDonald and 2016 MAGNIMS criteria, respectively. Conclusion: 2016 MAGNIMS magnetic resonance imaging (MRI) criteria for DIS showed higher sensitivity but lower specificity than 2010 McDonald criteria in predicting conversion to CDMS in CIS patients.

C onversion to multiple sclerosis after a clinically isolated syndrome of the brainstem: cranial magnetic resonance imaging, cerebrospinal fl uid and neurophysiological findings

2003 ◽  
Vol 9 (1) ◽  
pp. 39-43 ◽  
Author(s):  
J Sastre-Garriga ◽  
M Tintoré ◽  
A Rovira ◽  
E Grivé ◽  
I Pericot ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Clinically Isolated Syndrome ◽  
Oligoclonal Bands ◽  
Resonance Imaging ◽  
Predictive Values ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity

B ackground and aim: C onversion to multiple sclerosis (MS) after optic neuritis and myelitis has been thoroughly studied; however, limited data are available regarding conversion to MS after a clinically isolated syndrome of the brainstem (CISB). The aim of this study was to investigate conversion to MS in patients with C ISB. Methods: Fifty-one patients with C ISB were prospectively studied. C ranial magnetic resonance imaging (MRI), determination of oligoclonal bands (OBs) in the cerebrospinal fluid (C SF) and evoked potentials (EPs) were performed. Based on conversion to MS at follow-up, the sensitivity, specificity, accuracy and positive and negative predictive values of these tests were calculated. Results: C linically definite MS developed in 18 (35%) patients after a mean follow-up of 37 months. Paty’s MRI criteria showed a sensitivity of 89%, a specificity of 52% and an accuracy of 65%; Fazekas’ criteria showed a sensitivity of 89%, a specificity of 48% and an accuracy of 63%; Barkhof’s criteria showed a sensitivity of 78%, a specificity of 61% and an accuracy of 67%. The presence of O Bs in the C SF showed a sensitivity of 100%, a specificity of 42% and an accuracy of 63%. No differences for neurophysiological parameters were found between patients who did and those who did not convert to MS. C onclusion: Fulfilling Paty’s, Fazekas’ or Barkhof’s MRI criteria and the presence of O Bs in the C SF are associated with a higher risk of conversion to MS in patients with C ISB. Determinatio n of O Bs in the C SF has the greatest sensitivity of all tests. Barkhof’s MRI criteria have greater specificity (although less than previously published for mixed cohorts of clinically isolated syndromes) in predicting conversion to MS for C ISB than either Paty’s or Fazekas’ criteria.

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.

New-Onset Right-Sided Numbness and Double Vision

2021 ◽  
pp. 14-16
Author(s):  
W. Oliver Tobin
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Immunoglobulin G ◽  
Clinically Isolated Syndrome ◽  
Resonance Imaging ◽  
Deep White Matter ◽  
The Right ◽  
The Brain

A 40-year-old right-handed man sought care for right hand numbness, right-sided facial numbness, and diplopia progressing to maximal severity over 10 days. At his worst he was unable to write. His symptoms remained maximal for 4 weeks. He was hospitalized and treated with 5 days of intravenous methylprednisolone. He improved to approximately 95% of normal over 4 weeks. He had residual mild right-sided facial and right leg numbness. Antibodies to JC polyoma virus and varicella-zoster virus were positive, which indicated prior exposure to these viruses. Total 25-hydroxyvitamin D level was low at 8.2 ng/mL. Optical coherence tomography findings were normal. Magnetic resonance imaging of the brain performed 3 months after the onset of symptoms demonstrated a T2-hyperintense lesion in the left midbrain peduncle extending into the upper pons, without gadolinium enhancement. A small area of T2 hyperintensity was seen in the right frontal deep white matter. Follow-up brain magnetic resonance imaging showed almost complete resolution of the left midbrain peduncle lesion with persistence of the right frontal deep white matter lesion. Spinal fluid analysis showed 1 white blood cell/µL with 95% lymphocytes, protein 35 mg/dL, 0 unique oligoclonal bands, and normal immunoglobulin G index (0.54). A diagnosis of clinically isolated syndrome-first episode of multiple sclerosis was made. After detailed discussion with the patient, he elected to commence disease-modifying therapy with fingolimod. He underwent routine monitoring with magnetic resonance imaging of the brain and cervical and thoracic spine on an annual basis, without any further relapses at 5-year follow-up. Patients with typical demyelinating syndromes may not always fulfill the diagnostic criteria for multiple sclerosis. After careful exclusion of other mimicking conditions, most notably aquaporin-4-immunoglobulin G– and myelin oligodendrocyte glycoprotein-immunoglobulin G–associated disease, a diagnosis of clinically isolated syndrome may be made.

Evaluation of the 2010 McDonald multiple sclerosis criteria in children with a clinically isolated syndrome

2012 ◽  
Vol 18 (12) ◽  
pp. 1768-1774 ◽  
Author(s):  
Barbara Kornek ◽  
Beate Schmitl ◽  
Karl Vass ◽  
Sonja Zehetmayer ◽  
Martin Pritsch ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Demyelinating Disease ◽  
Clinically Isolated Syndrome ◽  
Resonance Imaging ◽  
Mcdonald Criteria ◽  
Paediatric Multiple Sclerosis ◽  
Spinal Cord Imaging

Background: Magnetic resonance imaging diagnostic criteria for paediatric multiple sclerosis have been established on the basis of brain imaging findings alone. The 2010 McDonald criteria for the diagnosis of multiple sclerosis, however, include spinal cord imaging for detection of lesion dissemination in space. The new criteria have been recommended in paediatric multiple sclerosis. Objective: (1) To evaluate the 2010 McDonald multiple sclerosis criteria in children with a clinically isolated syndrome and to compare them with recently proposed magnetic resonance criteria for children; (2) to assess whether the inclusion of spinal cord imaging provided additional value to the 2010 McDonald criteria. Methods: We performed a retrospective analysis of brain and spinal cord magnetic resonance imaging scans from 52 children with a clinically isolated syndrome. Sensitivity, specificity and accuracy of the magnetic resonance criteria were assessed. Results and conclusion: The 2010 McDonald dissemination in space criteria were more sensitive (85% versus 74%) but less specific (80% versus 100%) compared to the 2005 McDonald criteria. The Callen criteria were more accurate (89%) compared to the 2010 McDonald (85%), the 2005 McDonald criteria for dissemination in space (81%), the KIDMUS criteria (46%) and the Canadian Pediatric Demyelinating Disease Network criteria (76%). The 2010 McDonald criteria for dissemination in time were more accurate (93%) than the dissemination in space criteria (85%). Inclusion of the spinal cord did not increase the accuracy of the McDonald criteria.

Application of the 2017 McDonald diagnostic criteria for multiple sclerosis in Korean patients with clinically isolated syndrome

2018 ◽  
Vol 25 (11) ◽  
pp. 1488-1495 ◽  
Author(s):  
Jae-Won Hyun ◽  
Woojun Kim ◽  
So-Young Huh ◽  
Min Su Park ◽  
Suk-Won Ahn ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinically Isolated Syndrome ◽  
Clinical Event ◽  
Predictive Values ◽  
Mcdonald Criteria ◽  
Definite Multiple Sclerosis ◽  
Referral Hospitals ◽  
Clinically Definite Multiple Sclerosis ◽  
Disease Modifying Agents ◽  
Sensitivity Specificity

Objectives: To evaluate the validity of the revised 2017 McDonald criteria for multiple sclerosis (MS) compared with the 2010 McDonald criteria to predict conversion to clinically definite multiple sclerosis (CDMS) in patients with clinically isolated syndrome (CIS). Methods: A total of 163 patients from seven referral hospitals in Korea, who experienced a first clinical event suggestive of MS between 2006 and 2017, were enrolled. Patients were stratified into two groups according to outcome at the last visit: CDMS converters who experienced a second clinical event and non-converters. Results: Of the 163 patients with a mean follow-up of 63 months, 60% converted to CDMS. The sensitivity, specificity, positive and negative predictive values and accuracy were, respectively, 88.8%, 43.1%, 70.2%, 71.8% and 70.6% for the 2017 McDonald criteria and 53.1%, 69.2%, 72.2%, 49.5% and 59.5% for the 2010 McDonald criteria. After exclusion of 82 patients who received disease-modifying agents before the second attack, the specificity of the 2017 and 2010 McDonald criteria increased to 85.0% and 95.0%, but sensitivity decreased to 83.6% and 47.5%, respectively. Conclusion: The 2017 McDonald criteria afforded higher sensitivity and accuracy but lower specificity compared with the 2010 McDonald criteria for prediction of conversion to CDMS in Korean CIS patients.

Anti-myelin antibodies do not allow earlier diagnosis of multiple sclerosis

2005 ◽  
Vol 11 (4) ◽  
pp. 492-494 ◽  
Author(s):  
E T Lim ◽  
T Berger ◽  
M Reindl ◽  
C M Dalton ◽  
K Fernando ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Optic Neuritis ◽  
Myelin Basic Protein ◽  
Basic Protein ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Clinically Isolated Syndrome ◽  
Resonance Imaging

This study investigates whether the presence of serum and plasma anti-myelin oligodendrocyte glycoprotein (MOG) and anti-myelin basic protein (MBP) in patients presenting with a clinically isolated syndrome compatible with demyelination (CIS) predicts early conversion to multiple sclerosis (MS). Forty-seven patients with CIS (46 with optic neuritis) had anti-MOG and anti-MBP antibodies analysed at baseline, and clinical and magnetic resonance imaging assessments. There was no evidence that the MS status based on either the McDonald or Poser criteria relates to the antibody status.

Progressive Gait Difficulties

2021 ◽  
pp. 62-64
Author(s):  
I. Vanessa Marin Collazo
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Progressive Multiple Sclerosis ◽  
Primary Progressive Multiple Sclerosis ◽  
Resonance Imaging ◽  
Primary Progressive ◽  
Mcdonald Criteria ◽  
Mild Reduction ◽  
History Of

A 58-year-old, right-handed man with a medical history of nephrolithiasis, essential hypertension, and type 2 diabetes sought care for a 6-year history of gait impairment. Initially, he noted subtle left foot and ankle weakness with associated falls that progressed over time. Two to 3 years later he again noted progressive left leg weakness and new arm weakness. Subsequently, progressive pain developed on the soles of his feet in addition to edema with erythematous discoloration around the left ankle and foot. On neurologic examination, he was found to have mild upper motor neuron pattern weakness in the left arm and leg, most pronounced in the left hand finger extensor and left hip flexion and abduction. Left patellar reflex was brisk, and there was an extensor Babinski sign on the left. There was mild reduction in pinprick sensation in both feet. His gait was spastic with left leg circumduction. Magnetic resonance imaging of the brain showed left-sided predominant periventricular and subcortical T2 fluid-attenuated inversion recovery hyperintensities. Magnetic resonance imaging of the cervical and thoracic spinal cord showed intramedullary cord T2 signal hyperintensities, eccentrically located on the left at C3, C5, C6, on the right at C7 to T1, and centrally at T4/T5 and T8/T9. A diagnosis of primary progressive multiple sclerosis was made. The patient met the 2017 McDonald criteria for primary progressive multiple sclerosis. After the diagnosis was confirmed and comprehensive education about the disease and the role of disease-modifying therapy was discussed with the patient, he was started on ocrelizumab. Gabapentin was started for management of painful foot paresthesias. Vitamin D3 supplementation was started. Physical therapy was also initiated. Multiple sclerosis is a chronic immune-mediated demyelinating disease of the central nervous system and is the leading cause of disability in the young population. Approximately 1 million people in the United States currently have multiple sclerosis.

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