Contributions
Abstract: P803
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
In an attemp to improve the diagnostic accuracy of 2010 McDonald criteria, a new revision was recently published that resulted in a modification of the requirement of both dissemination in space (DIS) and dissemination in time (DIT) criteria.
We aim to compare the diagnostic performance of the 2010 and 2017 McDonald MRI criteria for DIS in predicting the conversion to clinically definite multiple sclerosis (CDMS) in patients with clinically isolated syndromes (CIS).
Inclusion criteria:1)CIS suggestive of central nervous system demyelination (since 2008); 2)clinical assessment and baseline brain MRI within 3 months of CIS onset; 3)spinal cord MRI available if patients presented with spinal cord syndrome; and 4)clinical follow-up of at least 24 months.
We included 188 CIS patients, 129(68.6%) women, with a mean age at onset of 34.4 years. After a mean follow-up of 59.6 months, 123(65.4%) patients were diagnosed as having MS according to the McDonald 2017 criteria. The overall conversion rate to CDMS was 47.3%. Fifty-two (42.2%) patients initiated a disease-modifying treatment (DMT) before the second clinical event. The 2010 McDonald DIS criteria were met in 113(60.1%) and the 2017 McDonald DIS criteria in 123(65.4%) patients with CIS. When symptomatic infratentorial/spinal cord lesions were included, ten more patients met the 2017 DIS criteria than the 2010 DIS criteria. Sensitivity, specificity, positive and negative predictive values of 2010 McDonald DIS criteria were 80.9%, 58.6%, 63.7% and 77.3%, and those for 2017 criteria were 87.6%, 54.5%, 63.4% and 83.1% respectively. Both DIS criteria identified a subset of patients with CIS who were at high early risk of developing CDMS (hazard ratio: 3.77 and 5.33, respectively; p< 0.001).
In our CIS patient cohort, 2017 McDonald MRI criteria for DIS shows higher sensitivity with similar specificity than 2010 McDonald DIS criteria in predicting conversión to CDMS, related with the inclusion of symptomatic lesions. Because DMT can delay or prevent the conversion to CDMS, the high number of patients that initiate these therapies before the second relapse, would explain the intermediate specificity values obtained with both MRI criteria.
Disclosure: We have no conflict of interest to declare.
Abstract: P803
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
In an attemp to improve the diagnostic accuracy of 2010 McDonald criteria, a new revision was recently published that resulted in a modification of the requirement of both dissemination in space (DIS) and dissemination in time (DIT) criteria.
We aim to compare the diagnostic performance of the 2010 and 2017 McDonald MRI criteria for DIS in predicting the conversion to clinically definite multiple sclerosis (CDMS) in patients with clinically isolated syndromes (CIS).
Inclusion criteria:1)CIS suggestive of central nervous system demyelination (since 2008); 2)clinical assessment and baseline brain MRI within 3 months of CIS onset; 3)spinal cord MRI available if patients presented with spinal cord syndrome; and 4)clinical follow-up of at least 24 months.
We included 188 CIS patients, 129(68.6%) women, with a mean age at onset of 34.4 years. After a mean follow-up of 59.6 months, 123(65.4%) patients were diagnosed as having MS according to the McDonald 2017 criteria. The overall conversion rate to CDMS was 47.3%. Fifty-two (42.2%) patients initiated a disease-modifying treatment (DMT) before the second clinical event. The 2010 McDonald DIS criteria were met in 113(60.1%) and the 2017 McDonald DIS criteria in 123(65.4%) patients with CIS. When symptomatic infratentorial/spinal cord lesions were included, ten more patients met the 2017 DIS criteria than the 2010 DIS criteria. Sensitivity, specificity, positive and negative predictive values of 2010 McDonald DIS criteria were 80.9%, 58.6%, 63.7% and 77.3%, and those for 2017 criteria were 87.6%, 54.5%, 63.4% and 83.1% respectively. Both DIS criteria identified a subset of patients with CIS who were at high early risk of developing CDMS (hazard ratio: 3.77 and 5.33, respectively; p< 0.001).
In our CIS patient cohort, 2017 McDonald MRI criteria for DIS shows higher sensitivity with similar specificity than 2010 McDonald DIS criteria in predicting conversión to CDMS, related with the inclusion of symptomatic lesions. Because DMT can delay or prevent the conversion to CDMS, the high number of patients that initiate these therapies before the second relapse, would explain the intermediate specificity values obtained with both MRI criteria.
Disclosure: We have no conflict of interest to declare.