Multiple sclerosis diagnostic criteria: three years later

2005 ◽  
Vol 11 (1) ◽  
pp. 5-12 ◽  
Author(s):  
Chris H Polman ◽  
Jerry S Wolinsky ◽  
Stephen C Reingold
Keyword(s):  
Multiple Sclerosis ◽  
Diagnostic Criteria ◽  
Wide Distribution ◽  
Mcdonald Criteria ◽  
International Panel ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity ◽  
Work Up ◽  
New Criteria ◽  
Prospective Analyses

New diagnostic criteria for multiple sclerosis (MS) were developed by an International Panel in 2001 and have had wide distribution and discussion since publication. These provided the first formal incorporation of magnetic resonance imaging (MRI) in a diagnosis work-up for patients suspected of having MS. The so-called McDonald criteria have been studied in retrospective and prospective analyses for sensitivity, specificity and utility, and have been proven to compare favourably or to be an improvement upon prior MS diagnostic criteria. The purpose of the current review is to present and evaluate the key studies that have been performed using the McDonald criteria since 2001 and to set the stage for an upcoming re-evaluation of the new criteria based on data-driven information gathered since their development.

Application of the 2010 McDonald criteria for the diagnosis of multiple sclerosis in a Spanish cohort of patients with clinically isolated syndromes

2011 ◽  
Vol 18 (1) ◽  
pp. 39-44 ◽  
Author(s):  
M Gómez-Moreno ◽  
M Díaz-Sánchez ◽  
A Ramos-González
Keyword(s):  
Multiple Sclerosis ◽  
Mri Scan ◽  
Clinically Isolated Syndromes ◽  
Mcdonald Criteria ◽  
International Panel ◽  
Clinical Onset ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity ◽  
New Criteria

Background: Recently the International Panel on Diagnosis of Multiple Sclerosis (MS) has proposed new magnetic resonance imaging (MRI) criteria for the diagnosis of MS in patients with clinically isolated syndromes (CIS). We aimed to evaluate the accuracy of these new criteria for lesions dissemination in space (DIS) and time (DIT), from a single MRI scan, to predict conversion from CIS to clinically definite MS. Methods: We studied 67 CIS patients with baseline MRI performed within the first 3 months after onset. The follow-up was of at least 24 months. The sensitivity, specificity and accuracy of Barkhof–Tintoré criteria and the new proposed MRI criteria for DIS and DIT were calculated with SPSS v.15.0. Results: The mean age for clinical onset was 30 years and 64% of patients were female. The overall conversion rate was 74%. In our cohort, Barkhof–Tintoré criteria showed a sensitivity of 71.43%, a specificity of 66.67%, with an accuracy of 73.1%. New DIS criteria showed a sensitivity of 85.71%, a specificity of 64.71% and an accuracy of 80.30%. We also evaluated the new DIT criteria with a single MRI scan in 54 patients with baseline scans that included gadolinium-enhanced images. The sensitivity of the test was 52.63% with a specificity of 75.00% and an accuracy of 59.26%. Conclusion: New DIS criteria are simpler and more sensitive than previous criteria. The sensitivity of DIT criterion using a single MRI scan was rather low, as other previous studies showed, reflecting its stringency, but it could improve the accuracy of early MS diagnosis in that group of patients with typical CIS and gadolinium-enhancing and non-enhancing lesions on their baseline scans. These results reinforce their use in MS diagnosis.

Application of the McDonald 2010 criteria for the diagnosis of multiple sclerosis in an Argentinean cohort of patients with clinically isolated syndromes

2013 ◽  
Vol 19 (10) ◽  
pp. 1297-1301 ◽  
Author(s):  
L Patrucco ◽  
JI Rojas ◽  
JS Miguez ◽  
E Cristiano
Keyword(s):  
Multiple Sclerosis ◽  
Diagnostic Criteria ◽  
Latin American ◽  
Predictive Value ◽  
Genetic Population ◽  
International Panel ◽  
High Level ◽  
Sensitivity Specificity ◽  
New Criteria

Background: The International Panel on Diagnosis of Multiple Sclerosis has proposed new magnetic resonance imaging (MRI) criteria for the diagnosis of multiple sclerosis (MS) in patients with clinically isolated syndrome (CIS). We aimed to evaluate these new criteria in a cohort of patients from Buenos Aires, Argentina. Methods: Patients with CIS, in whom MRI was performed within three months of onset of symptoms, were included between January 2005–June 2010. Poser or McDonald 2005 criteria were used as gold standard diagnostic criteria for MS. MRI was assessed by a blind evaluator identifying recently diagnostic MS criteria. New criteria sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were determined. Results: Altogether 101 patients were included. Of these, 86 patients converted to MS (McDonald 2005/Poser) during the follow-up. The mean follow-up time was 7.3±3.2 years (range 1.8–11 years). Sensitivity was 84%, specificity 80%, PPV 96%, NPV 46% and accuracy 82%. The sub-analysis applied only to non-European descendants (mestizos, natives and zambos) showed a high level of accuracy for these new diagnostic criteria in this local ethnic/genetic population (sensitivity 77%, specificity 72%, PPV 94%, NPV 38%). Conclusions: This study assessing McDonald 2010 criteria in a Latin-American population may contribute to its international validation.

scholarly journals Diagnostic value of DWI-MRI for the detection of acute plaques in the relapse phase of multiple sclerosis

2021 ◽  
Vol 20 (1) ◽  
pp. 35-40
Author(s):  
Mehran Yousefi ◽  
◽  
Mehdi Panahali ◽  
Kamran Azarkhish ◽  
Nazanin Azizi Shalbaf ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Predictive Value ◽  
Brain Mri ◽  
Diagnostic Value ◽  
Gadolinium Contrast ◽  
Mcdonald Criteria ◽  
Contrast Enhanced ◽  
Gadolinium Contrast Agents ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity

Background. The 2010 revision of the McDonald criteria, widely used for the diagnosis of multiple sclerosis (MS), has established that dissemination in time (DIT) can be demonstrated by the simultaneous presence of asymptomatic gadolinium-enhancing and non-enhancing plaques on a single magnetic resonance imaging (MRI). When the use of gadolinium contrast agents is contraindicated, diffusion-weighted imaging (DWI) is utilized to confirm diffusion alterations in active inflammatory plaques. This study intended to examine whether DWI can be a viable alternative to contrast-enhanced T1-weighted imaging for demonstrating DIT in MS. Material and methods.We assessed 30 previously diagnosed MS patients during acute relapse (based on the 2010 McDonald criteria) and evaluated their brain MRI via DWI‚ contrast-enhanced T1-weighted imaging, and FLAIR sequences. Asymptomatic plaques were defined as either hyperintense or non-hyperintense in DWI and enhancing or non-enhancing in T1GAD-MRI. Statistical indices for the prediction of plaque enhancement in T1 GAD-MRI via DWI-MRI were calculated and compared. Results. The 30 participants in our study had a total of 925 demyelinating plaques that were larger than 3mm in size and presented to be hyperintense in FLAIR-MRI. Diffusion hyperintensity and plaque enhancement were significantly correlated. The sensitivity‚ specificity, positive predictive value‚ negative predictive value, and accuracy of DWI were calculated to be 69.66%‚ 99.76%‚ 96.88%‚ 96.86%, and 96.86%, respectively. Conclusions. Hyperintense DWI findings do not necessarily overlap with contrast enhancements in T1 GAD-MRI. DWI was shown to produce a higher rate of false-positive results. Our study concludes that although T1 GAD-MRI should not be replaced by DWI to determine DIT due to its lower specificity, DWI’s continued use as a surrogate screening imaging sequence whenever the use of T1GAD-MRI is of concern is not without its merits.

scholarly journals Three-Tesla MRI does not improve the diagnosis of multiple sclerosis

Neurology ◽  
2018 ◽  
Vol 91 (3) ◽  
pp. e249-e257 ◽  
Author(s):  
Marloes H.J. Hagens ◽  
Jessica Burggraaff ◽  
Iris D. Kilsdonk ◽  
Marlieke L. de Vos ◽  
Niamh Cawley ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Diagnostic Criteria ◽  
Brain Mri ◽  
White Matter Lesions ◽  
Lesion Detection ◽  
Mcdonald Criteria ◽  
Number Of Patients ◽  
Work Up ◽  
Three Tesla

ObjectiveIn the work-up of patients presenting with a clinically isolated syndrome (CIS), 3T MRI might offer a higher lesion detection than 1.5T, but it remains unclear whether this affects the fulfilment of the diagnostic criteria for multiple sclerosis (MS).MethodsWe recruited 66 patients with CIS within 6 months from symptom onset and 26 healthy controls in 6 MS centers. All participants underwent 1.5T and 3T brain and spinal cord MRI at baseline according to local optimized protocols and the MAGNIMS guidelines. Patients who had not converted to MS during follow-up received repeat brain MRI at 3–6 months and 12–15 months. The number of lesions per anatomical region was scored by 3 raters in consensus. Criteria for dissemination in space (DIS) and dissemination in time (DIT) were determined according to the 2017 revisions of the McDonald criteria.ResultsThree-Tesla MRI detected 15% more T2 brain lesions compared to 1.5T (p < 0.001), which was driven by an increase in baseline detection of periventricular (12%, p = 0.015), (juxta)cortical (21%, p = 0.005), and deep white matter lesions (21%, p < 0.001). The detection rate of spinal cord lesions and gadolinium-enhancing lesions did not differ between field strengths. Three-Tesla MRI did not lead to a higher number of patients fulfilling the criteria for DIS or DIT, or subsequent diagnosis of MS, at any of the 3 time points.ConclusionScanning at 3T does not influence the diagnosis of MS according to McDonald diagnostic criteria.

Revised McDonald criteria for multiple sclerosis diagnostics in Central Russia: Sensitivity and specificity

2014 ◽  
Vol 20 (14) ◽  
pp. 1896-1899 ◽  
Author(s):  
AN Belova ◽  
IV Shalenkov ◽  
DN Shakurova ◽  
AN Boyko
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Predictive Value ◽  
Russian Population ◽  
Mcdonald Criteria ◽  
International Panel ◽  
Central Russia ◽  
Sensitivity Specificity ◽  
Brain And Spinal Cord

Background: The 2010 revised McDonald criteria were developed with data gathered from Caucasian European and North American populations, and their applicability has been questioned for the Russian population. Objective: The objective of this report is to compare the specificity, accuracy, sensitivity and predictive value of MRI criteria incorporated to the new (2010) and old (2005) McDonald criteria for early multiple sclerosis (MS) diagnostics in the Nyzhnyi Novgorod (Russia) population. Methods: A total of 103 patients with symptoms suggestive of MS were recruited from 2008 to 2011 retrospectively. Patients were followed up until MS was confirmed or other proved diagnoses were determined. Their baseline and follow-up brain and spinal cord MRIs were retrospectively evaluated. Sixty-two patients (60%) converted to MS during the follow-up period (mean in 11±4.2 months). Results: In 41 cases (38%) diagnoses another than MS were established. The sensitivity, specificity, accuracy, PPV and NPV of the revised MRI criteria were 74%, 93%, 82%, 94%, 70%, respectively. Conclusions: Despite the limitations of our study, we conclude that the ability of the revised MRI criteria for early MS diagnostics in the Russian population is approximately similar to that determined by the international panel in Europe.

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.

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.

scholarly journals Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria

2011 ◽  
Vol 69 (2) ◽  
pp. 292-302 ◽  
Author(s):  
Chris H. Polman ◽  
Stephen C. Reingold ◽  
Brenda Banwell ◽  
Michel Clanet ◽  
Jeffrey A. Cohen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Diagnostic Criteria ◽  
Mcdonald Criteria

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.

The impact of 2015 neuromyelitis optica spectrum disorders criteria on diagnostic rates

2016 ◽  
Vol 23 (2) ◽  
pp. 228-233 ◽  
Author(s):  
Shahd HM Hamid ◽  
Liene Elsone ◽  
Kerry Mutch ◽  
Tom Solomon ◽  
Anu Jacob
Keyword(s):  
Multiple Sclerosis ◽  
Central Nervous System ◽  
Neuromyelitis Optica ◽  
Neuromyelitis Optica Spectrum Disorders ◽  
International Panel ◽  
Central Nervous System Demyelination ◽  
Spectrum Disorders ◽  
The Uk ◽  
The Impact ◽  
New Criteria

Background: The international panel for neuromyelitis optica (NMO) diagnosis has proposed diagnostic criteria for neuromyelitis optica spectrum disorders (NMOSD). Objectives: We assessed the impact of these criteria on diagnostic rates in a large cohort of patients. Methods: We identified and applied the 2006 and 2015 criteria to all patients ( n = 176) seen in the NMO and non-multiple sclerosis central nervous system demyelination clinic (part of the UK NMO service) from January 2013 to May 2015. Results: The 2006 criteria classified 63 of 176 (36%) patients as NMO. A total of 42 patients (67%) were aquaporin 4 (AQP4) immunoglobulin G (IgG) +ve and 21 (33%) AQP4 IgG −ve. The 2015 criteria classified 111 of 176 (63%) patients as NMOSD, of which 81 (73%) were AQP4 IgG +ve and 30 (27%) were AQP4 IgG −ve. There was an increase of 48 patients (76%) diagnosed as NMOSD using the new criteria. Conclusion: Application of the 2015 criteria led to a rise in diagnosis of NMOSD by 76%. The rise in the AQP4 IgG +ve group contributed 62% and the seronegative group contributed 14%.

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