New MRI criteria in the diagnosis of multiple sclerosis

Abstract

No single clinical feature or diagnostic test is sufficient for the diagnosis of multiple sclerosis. Multiple sclerosis is a disabling disease with a chronic but variable course, and accumulating data obtained from randomised clinical therapeutic trials suggest that delays in diagnosis and therapeutic intervention can have irreversible and damaging effects. Therefore, timely diagnosis is vital for clinical practice. 1 CHAMPSInterferon beta-1a for optic neuritis patients at high risk for multiple sclerosis. Am J Ophthalmol. 2001; 132: 463-471 Summary Full Text Full Text PDF PubMed Scopus (70) Google Scholar In the past, the degrees of diagnostic certainty of multiple sclerosis were identified by categories that range from clinically definite to laboratory-supported definite, clinically probable, and laboratory-supported probable multiple sclerosis. 2 Poser CM Paty DW Scheinberg L et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol. 1983; 13: 227-231 Crossref PubMed Scopus (7058) Google Scholar These definitions were revised in 2001 by an international panel, 3 McDonald WI Compston A Edan G et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the Diagnosis of Multiple Sclerosis. Ann Neurol. 2001; 50: 121-127 Crossref PubMed Scopus (5874) Google Scholar with the aim of creating criteria that could be used by a practising physician and adapted for clinical trials, and which integrate MRI into the diagnosis, include the diagnosis of primary progressive disease, clarify the definitions used in the diagnosis of multiple sclerosis, and simplify the diagnostic classification and descriptions. These criteria were further updated in 2005. 4 Polman CH Reingold SC Edan G et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”. Ann Neurol. 2005; 58: 840-846 Crossref PubMed Scopus (4322) Google Scholar The article by Swanton and colleagues published in this issue of The Lancet Neurology5 Swanton JK Rovira A Tintore M et al. MRI criteria for multiple sclerosis in patients presenting with clinically isolated syndromes: a retrospective study. Lancet Neurol. 2007; 8: 677-686 Summary Full Text Full Text PDF Scopus (269) Google Scholar provides an eloquent analysis that compares the value of recently published, simplified MRI criteria 6 Swanton JK Fernando K Dalton CM et al. Modification of MRI criteria for multiple sclerosis in patients with clinically isolated syndromes. J Neurol Neurosurg Psychiatry. 2006; 77: 830-833 Crossref PubMed Scopus (177) Google Scholar with the original (2001) 3 McDonald WI Compston A Edan G et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the Diagnosis of Multiple Sclerosis. Ann Neurol. 2001; 50: 121-127 Crossref PubMed Scopus (5874) Google Scholar or revised (2005) 4 Polman CH Reingold SC Edan G et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”. Ann Neurol. 2005; 58: 840-846 Crossref PubMed Scopus (4322) Google Scholar McDonald criteria for predicting the risk of conversion from clinically isolated syndromes (CIS) to clinically definite multiple sclerosis (CDMS). MRI criteria for multiple sclerosis in patients presenting with clinically isolated syndromes: a multicentre retrospective studyThe new criteria are simpler than the McDonald criteria without compromising specificity and accuracy. The presence of both DIS and DIT from two MRI scans has a higher specificity and risk for CDMS than either DIS or DIT alone. Full-Text PDF