Contributions
Abstract: P800
Type: Poster
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background: The MAGNIMS group have recently proposed modified dissemination in space (DIS) criteria for a diagnosis of multiple sclerosis (MS) in patients with clinically isolated syndromes (CIS). These recommendations include an increase in the number of periventricular (PV) lesions required for DIS from ≥1 to ≥3 with the aim of improving the specificity of MRI criteria for diagnosing MS, particularly in light of other proposed changes such as inclusion of symptomatic lesions in DIS.
Objectives: To investigate the performance of ≥1, ≥2 and ≥3 PV lesions in DIS criteria for the diagnosis of clinically-definite MS (CDMS).
Methods: We studied 151 CIS patients (mean age 32.4 years, 102 [68%] female, 124 [82%] optic neuritis) from a prospectively recruited cohort who had MRI (brain + spinal cord) at presentation and 3 months later (brain only). The patients were followed up for the development of CDMS. We retrospectively applied the McDonald 2010 DIS requiring ≥1 PV lesion and modified DIS criteria requiring ≥2 or ≥3 PV lesions. In the subgroup of patients presenting with brainstem, spinal cord and hemispheric syndromes (n=27) we applied the same criteria with inclusion of lesions in the symptomatic region in DIS. We investigated the performance of DIS criteria with varying numbers of PV lesions, alone and in combination with dissemination in time (DIT) criteria for the development of CDMS.
Results: Over a mean follow-up period of 15.1years, 91 (60%) patients developed CDMS. The McDonald 2010 DIS criteria requiring ≥1 PV lesion had a higher sensitivity than modified DIS criteria requiring ≥2 or ≥3 PV lesions (81/74/70% respectively), but were less specific (72/75/77%). In combination with DIT, the respective sensitivities were 64/57/55% and the specificities were the same (78%). The results were similar when the symptomatic lesion was included in DIS; ≥1 PV lesion had the highest sensitivity and the same specificity as ≥2 or ≥3 PV lesions
Conclusion: Increasing the number of PV lesions required for DIS may reduce the sensitivity of MRI criteria for a diagnosis of MS in patients with CIS. Although there was a modest increase in specificity with DIS criteria requiring ≥2 or ≥3 PV lesions this was not maintained when DIS was combined with DIT criteria. Future studies should investigate varying PV lesion number in combination with other proposed changes to DIS criteria and in a larger cohort of patients with brainstem/spinal cord syndromes.
Disclosure: Dr Brownlee has nothing to disclose.
Dr Altmann has nothing to disclose.
KA Miszkiel has nothing to disclose.
Prof Miller has received honoraria through payments to UCL Institute of Neurology from Biogen-Idec, Novaritis, Bayer-Schering and Mitsubishi Pharma Europe.
Prof Ciccarelli is an Associate Editor of Neurology and serves as a consultant for GE Healthcare, Novartis, Roche, Biogen, Genzyme and Teva.
Abstract: P800
Type: Poster
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background: The MAGNIMS group have recently proposed modified dissemination in space (DIS) criteria for a diagnosis of multiple sclerosis (MS) in patients with clinically isolated syndromes (CIS). These recommendations include an increase in the number of periventricular (PV) lesions required for DIS from ≥1 to ≥3 with the aim of improving the specificity of MRI criteria for diagnosing MS, particularly in light of other proposed changes such as inclusion of symptomatic lesions in DIS.
Objectives: To investigate the performance of ≥1, ≥2 and ≥3 PV lesions in DIS criteria for the diagnosis of clinically-definite MS (CDMS).
Methods: We studied 151 CIS patients (mean age 32.4 years, 102 [68%] female, 124 [82%] optic neuritis) from a prospectively recruited cohort who had MRI (brain + spinal cord) at presentation and 3 months later (brain only). The patients were followed up for the development of CDMS. We retrospectively applied the McDonald 2010 DIS requiring ≥1 PV lesion and modified DIS criteria requiring ≥2 or ≥3 PV lesions. In the subgroup of patients presenting with brainstem, spinal cord and hemispheric syndromes (n=27) we applied the same criteria with inclusion of lesions in the symptomatic region in DIS. We investigated the performance of DIS criteria with varying numbers of PV lesions, alone and in combination with dissemination in time (DIT) criteria for the development of CDMS.
Results: Over a mean follow-up period of 15.1years, 91 (60%) patients developed CDMS. The McDonald 2010 DIS criteria requiring ≥1 PV lesion had a higher sensitivity than modified DIS criteria requiring ≥2 or ≥3 PV lesions (81/74/70% respectively), but were less specific (72/75/77%). In combination with DIT, the respective sensitivities were 64/57/55% and the specificities were the same (78%). The results were similar when the symptomatic lesion was included in DIS; ≥1 PV lesion had the highest sensitivity and the same specificity as ≥2 or ≥3 PV lesions
Conclusion: Increasing the number of PV lesions required for DIS may reduce the sensitivity of MRI criteria for a diagnosis of MS in patients with CIS. Although there was a modest increase in specificity with DIS criteria requiring ≥2 or ≥3 PV lesions this was not maintained when DIS was combined with DIT criteria. Future studies should investigate varying PV lesion number in combination with other proposed changes to DIS criteria and in a larger cohort of patients with brainstem/spinal cord syndromes.
Disclosure: Dr Brownlee has nothing to disclose.
Dr Altmann has nothing to disclose.
KA Miszkiel has nothing to disclose.
Prof Miller has received honoraria through payments to UCL Institute of Neurology from Biogen-Idec, Novaritis, Bayer-Schering and Mitsubishi Pharma Europe.
Prof Ciccarelli is an Associate Editor of Neurology and serves as a consultant for GE Healthcare, Novartis, Roche, Biogen, Genzyme and Teva.