Contributions
Abstract: P331
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Introduction: Migraine may be a common diagnosis in patients initially referred to evaluate the possibility of multiple sclerosis (MS). On MRI, white matter hyperintensities (WMH) may be detected on the T2-weighted sequences in migraine patients. The periventricular region, traditionally considered a hallmark of MS, may be not so rarely involved, thus contributing to misdiagnoses. The number of periventricular lesions (PVLs) required to fulfill Dissemination in Space (DIS) requirements varies among different diagnostic criteria. 3 PVLs have been suggested by the MAGNIMS group while the Panel recently maintained the requirement for 1 PVL.
Objectives: To analyze the differences on WMH volumes and locations; to evaluate the involvement of periventricular region in two large cohorts of migraine and Clinically Isolated (CIS) patients.
Aims: to evaluate the impact of 1 vs 3 PVLs on sensibility and specificity of the DIS criteria according to the MAGNIMS group and the Panel in two large cohorts of migraine and Clinically Isolated (CIS) patients.
Materials and methods: White matter T2/FLAIR hyperintensities of 84 migraine and 79 Clinically Isolated Syndrome (CIS) patients were volumetrically and topographically assessed by using manual segmentation technique and, subsequently, by generating Lesion Probability Maps (LPMs) and Voxel-Based Lesion Symptom Mapping (VLSM). A logistic regression analysis based on lesion location was performed to evaluate the impact of 1 versus 3 PVLs on the sensibility and specificity of the 2017 revisions and the 2016 MAGNIMS criteria.
Results: CIS patients had a higher WMH number and volume in all the four locations analyzed. Interestingly, 10.7% of migraine patients showed infratentorial WMH, detectable through a careful evaluation of the posterior fossa on the T2-weighted images. Logistic regression analysis showed that PVLs were the best factor separating CIS from migraine patients with a 85% decrease in the probability to be migraineur for each PVL more than one (OR=0.156, 95% CI=0.076, 0.319, p< 0.001). MAGNIMS criteria demonstrated the highest specificity in differentiating CIS from migraineur (100% vs 87%) against a predictable lower sensibility (63% vs 72%).
Conclusions: PVLs play a key role in the differential diagnosis between migraine and CIS, particularly when they are ≥ 3. It might be prudent for the clinician to consider a higher number of PVLs, in order to avoid misdiagnosis.
Disclosure: CL has received honoraria for travel expenses for attending meetings from Roche.
LRS, GB, LB, AG, LR has nothing to disclose.
MPS has received consulting fees from Biogen Idec, Merck Serono, Teva, Genzyme, Roche, Novartis, GeNeuro and Medday.
MP has received research support from Novartis and personal fees from Teva and Merck.
GLM has received honoraria for lecturing, travel expenses for attending meetings, and financial support for research from Bayer Schering, Biogen Idec, Sanofi - Aventis, Merck Serono Pharmaceuticals, Novartis, Genzyme and Teva.
MI has received research grants from NIH, DOD, NMSS, FISM and Teva Neuroscience.
CG has received compensation for consulting services and/or speaking activities from Teva, Merck, Genzyme, Biogen, Bayer, Roche.
NDS: consultant for Schering, Biogen-Idec, Teva, Novartis, Sanofi-Genzyme, Roche, and Merck-Serono; has grants or grants pending from FISM and Novartis, is on the speakers bureaus of Biogen-Idec, Teva, Novartis, Sanofi-Genzyme, Roche, and Merck-Serono; has received travel funds from Teva, Novartis, Sanofi-Genzyme, Roche, and Merck Serono.
Abstract: P331
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Introduction: Migraine may be a common diagnosis in patients initially referred to evaluate the possibility of multiple sclerosis (MS). On MRI, white matter hyperintensities (WMH) may be detected on the T2-weighted sequences in migraine patients. The periventricular region, traditionally considered a hallmark of MS, may be not so rarely involved, thus contributing to misdiagnoses. The number of periventricular lesions (PVLs) required to fulfill Dissemination in Space (DIS) requirements varies among different diagnostic criteria. 3 PVLs have been suggested by the MAGNIMS group while the Panel recently maintained the requirement for 1 PVL.
Objectives: To analyze the differences on WMH volumes and locations; to evaluate the involvement of periventricular region in two large cohorts of migraine and Clinically Isolated (CIS) patients.
Aims: to evaluate the impact of 1 vs 3 PVLs on sensibility and specificity of the DIS criteria according to the MAGNIMS group and the Panel in two large cohorts of migraine and Clinically Isolated (CIS) patients.
Materials and methods: White matter T2/FLAIR hyperintensities of 84 migraine and 79 Clinically Isolated Syndrome (CIS) patients were volumetrically and topographically assessed by using manual segmentation technique and, subsequently, by generating Lesion Probability Maps (LPMs) and Voxel-Based Lesion Symptom Mapping (VLSM). A logistic regression analysis based on lesion location was performed to evaluate the impact of 1 versus 3 PVLs on the sensibility and specificity of the 2017 revisions and the 2016 MAGNIMS criteria.
Results: CIS patients had a higher WMH number and volume in all the four locations analyzed. Interestingly, 10.7% of migraine patients showed infratentorial WMH, detectable through a careful evaluation of the posterior fossa on the T2-weighted images. Logistic regression analysis showed that PVLs were the best factor separating CIS from migraine patients with a 85% decrease in the probability to be migraineur for each PVL more than one (OR=0.156, 95% CI=0.076, 0.319, p< 0.001). MAGNIMS criteria demonstrated the highest specificity in differentiating CIS from migraineur (100% vs 87%) against a predictable lower sensibility (63% vs 72%).
Conclusions: PVLs play a key role in the differential diagnosis between migraine and CIS, particularly when they are ≥ 3. It might be prudent for the clinician to consider a higher number of PVLs, in order to avoid misdiagnosis.
Disclosure: CL has received honoraria for travel expenses for attending meetings from Roche.
LRS, GB, LB, AG, LR has nothing to disclose.
MPS has received consulting fees from Biogen Idec, Merck Serono, Teva, Genzyme, Roche, Novartis, GeNeuro and Medday.
MP has received research support from Novartis and personal fees from Teva and Merck.
GLM has received honoraria for lecturing, travel expenses for attending meetings, and financial support for research from Bayer Schering, Biogen Idec, Sanofi - Aventis, Merck Serono Pharmaceuticals, Novartis, Genzyme and Teva.
MI has received research grants from NIH, DOD, NMSS, FISM and Teva Neuroscience.
CG has received compensation for consulting services and/or speaking activities from Teva, Merck, Genzyme, Biogen, Bayer, Roche.
NDS: consultant for Schering, Biogen-Idec, Teva, Novartis, Sanofi-Genzyme, Roche, and Merck-Serono; has grants or grants pending from FISM and Novartis, is on the speakers bureaus of Biogen-Idec, Teva, Novartis, Sanofi-Genzyme, Roche, and Merck-Serono; has received travel funds from Teva, Novartis, Sanofi-Genzyme, Roche, and Merck Serono.