Contributions
Abstract: 141
Type: Free Communications
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background: The McDonald criteria for diagnosis of multiple sclerosis (MS) were revised in 2017 with changes to the MRI criteria for dissemination space (DIS) and dissemination in time (DIT).
Objective: To evaluate the performance of the McDonald 2010 criteria and the revised 2017 criteria in people with clinically isolated syndromes (CIS) suggestive of MS.
Methods: We studied 154 patients within 3 months from CIS onset (mean age 31.3 years, 102 [66%] female, 123 [80%] optic neuritis). Gadolinium-enhanced MRI scans of the brain and spinal cord was obtained at baseline and then after 3-12 months. A cerebrospinal fluid (CSF) exam was done in 41 (27%) patients, including all patients who had DIS but not DIT using the McDonald 2017 MRI criteria. The patients were followed up prospectively over ~15 years for the development of clinically-definite MS (CDMS). The McDonald 2010 and 2017 criteria were applied retrospectively. We calculated the sensitivity, specificity and accuracy of the two sets of diagnostic criteria for the development of CDMS.
Results: 94 (61%) patients developed CDMS over a mean follow-up period of 14.8 years. Including symptomatic supratentorial, infratentorial and spinal cord lesions in DIS/DIT identified an additional 3 patients with MS, and incorporating CSF in patients with MRI evidence of DIS but not DIT identified an additional 7 patients. The McDonald 2017 DIS criteria were more sensitive (88% vs 85%) and more accurate (82% vs 81%) than the McDonald 2010 DIS criteria, and the specificity was the same (73%). The McDonald 2017 DIT criteria were also more sensitive (94% vs 87%) and more accurate (85% vs 82%), but the specificity (72 vs 73%) was lower than the McDonald 2010 DIT criteria. Overall, when DIS and DIT were considered together the McDonald 2017 remained more sensitive (89% vs 81%) and more accurate (83% vs79%) than the McDonald 2010 criteria, but were less specific (73% vs 75%). A higher proportion of patients who developed a second clinical relapse (CDMS) could be diagnosed at the time of CIS with a single contrast-enhanced MRI scan of the brain and spinal cord plus CSF exam using the McDonald 2017 criteria versus the McDonald 2010 criteria (57% vs 44%).
Conclusion: The revised McDonald 2017 criteria are more sensitive than the McDonald 2010 criteria with a modest reduction in specificity. When applied in patients with typical CIS presentations, the McDonald 2017 allow for an earlier diagnosis of MS.
Disclosure: Study funding: United Kingdom MS Society, Neurological Foundation of New Zealand and the NIHR University College London Hospitals Biomedical Research Centre.
Dr Brownlee has received speaker fees for educational activities for Merck Serono and Roche.
Dr Miszkiel has nothing to disclose.
Dr Tur received a post-doctoral ECTRIMS fellowship (2015).
Dr Barkhof acts as a consultant to Biogen-Idec, Janssen Alzheimer Immunotherapy, Bayer-Schering, Merck Serono, Roche, Novartis, Genzyme, and Sanofi-aventis. He has received sponsorship from EU-H2020, NWO, SMSR, EU-FP7, TEVA, Novartis, Toshiba. He is on the editorial board of Radiology, Brain, Neuroradiology, Multiple Sclerosis Journal and Neurology.
Dr Ciccarelli is a consultant for Novartis, Roche and Teva, and is an associate editor of Neurology.
Abstract: 141
Type: Free Communications
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background: The McDonald criteria for diagnosis of multiple sclerosis (MS) were revised in 2017 with changes to the MRI criteria for dissemination space (DIS) and dissemination in time (DIT).
Objective: To evaluate the performance of the McDonald 2010 criteria and the revised 2017 criteria in people with clinically isolated syndromes (CIS) suggestive of MS.
Methods: We studied 154 patients within 3 months from CIS onset (mean age 31.3 years, 102 [66%] female, 123 [80%] optic neuritis). Gadolinium-enhanced MRI scans of the brain and spinal cord was obtained at baseline and then after 3-12 months. A cerebrospinal fluid (CSF) exam was done in 41 (27%) patients, including all patients who had DIS but not DIT using the McDonald 2017 MRI criteria. The patients were followed up prospectively over ~15 years for the development of clinically-definite MS (CDMS). The McDonald 2010 and 2017 criteria were applied retrospectively. We calculated the sensitivity, specificity and accuracy of the two sets of diagnostic criteria for the development of CDMS.
Results: 94 (61%) patients developed CDMS over a mean follow-up period of 14.8 years. Including symptomatic supratentorial, infratentorial and spinal cord lesions in DIS/DIT identified an additional 3 patients with MS, and incorporating CSF in patients with MRI evidence of DIS but not DIT identified an additional 7 patients. The McDonald 2017 DIS criteria were more sensitive (88% vs 85%) and more accurate (82% vs 81%) than the McDonald 2010 DIS criteria, and the specificity was the same (73%). The McDonald 2017 DIT criteria were also more sensitive (94% vs 87%) and more accurate (85% vs 82%), but the specificity (72 vs 73%) was lower than the McDonald 2010 DIT criteria. Overall, when DIS and DIT were considered together the McDonald 2017 remained more sensitive (89% vs 81%) and more accurate (83% vs79%) than the McDonald 2010 criteria, but were less specific (73% vs 75%). A higher proportion of patients who developed a second clinical relapse (CDMS) could be diagnosed at the time of CIS with a single contrast-enhanced MRI scan of the brain and spinal cord plus CSF exam using the McDonald 2017 criteria versus the McDonald 2010 criteria (57% vs 44%).
Conclusion: The revised McDonald 2017 criteria are more sensitive than the McDonald 2010 criteria with a modest reduction in specificity. When applied in patients with typical CIS presentations, the McDonald 2017 allow for an earlier diagnosis of MS.
Disclosure: Study funding: United Kingdom MS Society, Neurological Foundation of New Zealand and the NIHR University College London Hospitals Biomedical Research Centre.
Dr Brownlee has received speaker fees for educational activities for Merck Serono and Roche.
Dr Miszkiel has nothing to disclose.
Dr Tur received a post-doctoral ECTRIMS fellowship (2015).
Dr Barkhof acts as a consultant to Biogen-Idec, Janssen Alzheimer Immunotherapy, Bayer-Schering, Merck Serono, Roche, Novartis, Genzyme, and Sanofi-aventis. He has received sponsorship from EU-H2020, NWO, SMSR, EU-FP7, TEVA, Novartis, Toshiba. He is on the editorial board of Radiology, Brain, Neuroradiology, Multiple Sclerosis Journal and Neurology.
Dr Ciccarelli is a consultant for Novartis, Roche and Teva, and is an associate editor of Neurology.