Contributions
Abstract: EP1291
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
The previous magnetic resonance imaging (MRI) criterion for dissemination in time (DIT), based on a single scan, requires the simultaneous detection of asymptomatic enhancing and non-enhancing lesions on post-contrast T1-weighted scan. This criterion was highly specific for predicting early conversion to clinically definite multiple sclerosis (CDMS) but its sensitivity was rather low. In the 2017 revision of the McDonald criteria, no distinction between symptomatic and asymptomatic MRI lesions is required for DIT demonstration.
We aim to investigate whether inclusion of lesions in the symptomatic region influences the performance of DIT criterion, based on a single scan, for a diagnosis of multiple sclerosis (MS) according to the McDonald 2017 criteria. We also analyse its value for predicting conversion to CDMS.
We performed an observational study based on a prospective clinically isolated syndrome (CIS) cohort. Inclusion criteria: 1)CIS suggestive of central nervous system demyelination (since 2008); 2)clinical assessment and baseline brain MRI within 8 weeks of CIS onset; 3)clinical follow-up of at least 24 months.
We included 143 CIS patients, 98 women (68.53%), with a mean age at onset of 34 year. After a mean follow-up of 56 months, 91 (63.63%) patients were diagnosed as having MS according to the McDonald 2017 criteria. The overall conversion rate to CDMS was 43.35%. Forty patients (43.95%) initiated a disease-modifying treatment before the second clinical event. In 28 patients (19.58%) baseline MRI simultaneously showed asymptomatic enhancing and non-enhancing lesions, whereas in 47 patients (32.63%) simultaneously enhancing (symptomatic or not) and non-enhancing lesions were detected. The DIT criterion recently proposed, based on a single MRI scan, was more sensitive (48.4% v 30.8%) maintaining a high specificity (94.2% v 100%). Both DIT criteria identified a subset of patients with CIS who were at high early risk of developing CDMS (hazard ratio: 2.68 and 4.15, p< 0.001; respectively).
The new DIT criterion based on a single scan, incorporated in the last revision of the 2017 McDonald criteria, is more sensitive that the original one with a slight decrease in specificity.
Disclosure: María Díaz Sánchez: nothing to disclose
Raquel Lamas Pérez: nothing to disclose
Pablo Baena Palomino: nothing to disclose
José Luis Casado Chocán: nothing to disclose
Antonio José Uclés Sánchez: nothing to disclose
Abstract: EP1291
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
The previous magnetic resonance imaging (MRI) criterion for dissemination in time (DIT), based on a single scan, requires the simultaneous detection of asymptomatic enhancing and non-enhancing lesions on post-contrast T1-weighted scan. This criterion was highly specific for predicting early conversion to clinically definite multiple sclerosis (CDMS) but its sensitivity was rather low. In the 2017 revision of the McDonald criteria, no distinction between symptomatic and asymptomatic MRI lesions is required for DIT demonstration.
We aim to investigate whether inclusion of lesions in the symptomatic region influences the performance of DIT criterion, based on a single scan, for a diagnosis of multiple sclerosis (MS) according to the McDonald 2017 criteria. We also analyse its value for predicting conversion to CDMS.
We performed an observational study based on a prospective clinically isolated syndrome (CIS) cohort. Inclusion criteria: 1)CIS suggestive of central nervous system demyelination (since 2008); 2)clinical assessment and baseline brain MRI within 8 weeks of CIS onset; 3)clinical follow-up of at least 24 months.
We included 143 CIS patients, 98 women (68.53%), with a mean age at onset of 34 year. After a mean follow-up of 56 months, 91 (63.63%) patients were diagnosed as having MS according to the McDonald 2017 criteria. The overall conversion rate to CDMS was 43.35%. Forty patients (43.95%) initiated a disease-modifying treatment before the second clinical event. In 28 patients (19.58%) baseline MRI simultaneously showed asymptomatic enhancing and non-enhancing lesions, whereas in 47 patients (32.63%) simultaneously enhancing (symptomatic or not) and non-enhancing lesions were detected. The DIT criterion recently proposed, based on a single MRI scan, was more sensitive (48.4% v 30.8%) maintaining a high specificity (94.2% v 100%). Both DIT criteria identified a subset of patients with CIS who were at high early risk of developing CDMS (hazard ratio: 2.68 and 4.15, p< 0.001; respectively).
The new DIT criterion based on a single scan, incorporated in the last revision of the 2017 McDonald criteria, is more sensitive that the original one with a slight decrease in specificity.
Disclosure: María Díaz Sánchez: nothing to disclose
Raquel Lamas Pérez: nothing to disclose
Pablo Baena Palomino: nothing to disclose
José Luis Casado Chocán: nothing to disclose
Antonio José Uclés Sánchez: nothing to disclose