Criteria improving multiple sclerosis diagnosis at the first MRI

Abstract

The introduction of the McDonald criteria has enabled earlier diagnosis of multiple sclerosis (MS). However, even with the 2010 revised criteria, nearly 50% of patients remain classified as "possible MS" following the first MRI. The present study aimed to demonstrate that time to MS diagnosis could be shorter than 2010 revised criteria, and established after a single early MRI in most patients with the association of the symptomatic lesion and at least one suggestive asymptomatic lesion. We also evaluated the short-term predictive capacity of an individual suggestive lesion on disease activity. We analyzed initial MRI results from 146 patients with MS from a multicenter retrospective study. Visualization of the symptomatic lesion was used as a primary criterion. Secondary criteria included one suggestive lesion (SL) aspect or topography on MRI, or one non-specific lesion associated with positive CSF. The proposed criteria led to a positive diagnosis of MS in 100% of cases, from information available from the time of the first MRI for 145 patients (99.3%). At least one SL was observed for 143 patients (97.9%), and positive CSF for the 3 others. Compared to the McDonald criteria, the proposed criteria had 100% sensitivity, with a significantly shorter mean time to reach a positive diagnosis. Furthermore, the simultaneous presence of corpus callosum, temporal horn, and ovoid lesions was associated with radiological or clinical activity after a year of follow-up. The proposed diagnostic criteria are easy to apply, have a good sensitivity, and allow an earlier diagnosis than the 2010 McDonald criteria. Nevertheless, prospective studies are needed to establish specificity and to confirm these findings.

MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines

“…The HR of MS was higher for patients with a symptomatic lesion (HR=7.2) than for those with a single asymptomatic lesion (HR=5.7), or with no lesions (HR=1), in the same regions. Another retrospective study in 146 CIS patients who fulfilled the 2010 McDonald criteria 10 found that the presence of a symptomatic lesion identifies with a high sensitivity those patients with MS. 13 In a recent study of 30 CIS patients who were studied for a mean of 7.3 years after onset, the sensitivity/specificity/accuracy of the DIS criteria was 73/73/73% for the 2010 McDonald criteria, 80/73/77% when asymptomatic lesions in the symptomatic region were included, and 87/73/80% when any lesion in the symptomatic region was included. 14 These results suggest that including lesions in the symptomatic region in DIS may increase the sensitivity of MRI criteria for diagnosing MS without compromising specificity.…”

An investigation of the association between focal damage and global network properties in cognitively impaired and cognitively preserved patients with multiple sclerosis

“…Especially the interaction between leukocortical lesions and global network metrics such as modularity and density were associated with SDMT outcomes. Due to their location in the lower part of the cortex and superficial white matter, leukocortical lesions affect short association fibers connecting two cortical gyri below the cortex (i.e., U-fibers) ( Caucheteux et al, 2015 ), whose disruption has been previously associated with memory and executive function impairment ( Miki et al, 1998 ; Rovaris et al, 2000 ). Our results confirm previous findings reporting an association between juxtacortical lesions and cognitive deficits in pwMS ( Lazeron et al, 2000 ; Louapre et al, 2016 ; Shaaban et al, 2021 ), and further elucidate the mechanisms underlying this association.…”

Clinical Application of 2017 McDonald Diagnostic Criteria for Multiple Sclerosis

“… 8 In fact, some studies reported that the presence of a symptomatic lesion identified patients with MS with a high sensitivity and accuracy and without compromising specificity. 9 10 11 …”