Abstract: 220
Type: Educational Session
Abstract Category: N/A
Magnetic resonance imaging (MRI) has been formally included in the diagnostic work-up of patients with a suspicious of multiple sclerosis (MS) in 2001, due to its high sensitivity in revealing focal lesions in the central nervous system highly suggestive of this condition. From then, diagnostic criteria have been updated several time, to increase their accuracy. The last update of MS criteria for the assessment of dissemination in space (DIS) and time (DIT) occurred in 2010. Based on evidence-based and expert-opinion consensus on new data on the use of MRI to establish DIS and DIT, MAGNIMS experts proposed modifications to MRI criteria for MS diagnosis in 2016. First, starting from the evidence that the inclusion of symptomatic lesions does not reduce diagnostic accuracy, symptomatic lesions of spinal cord and brainstem were included in DIS and DIT. Moreover, the involvement of the optic nerve and the presence of cortical lesions (CL) were suggested as additional DIS criteria. In order to reduce the risk of false positive, increased number of periventricular (PV) lesions (from one to three) was recommended. The performance of 2016 MAGNIMS criteria was tested on a European cohort of 368 patients with clinically isolated syndrome (CIS). MAGNIMS 2016 criteria showed similar sensitivity of the 2010 McDonald criteria (0.77 vs 0.73) and analogue specificity (0.5). The analysis of each single criterion showed an increase in specificity with the inclusion of at least three PV lesions to assess DIS. These results have in part guided the 2017 revision of the McDonald criteria, which included part of the MAGNIMS 2016 suggestions (inclusion of symptomatic and asymptomatic lesions to assess DIS and DIT and of the presence of CL to demonstrate DIS). A renewed role was also attributed to intrathecal oligoclonal bands. A validation 2017 McDonald criteria is needed. Research to further refine the criteria should focus on the identification of features specific for MS, to minimize the risk of misdiagnosis. For the imaging perspective, the central vein sign, the presence of meningeal inflammation and subpial demyelination are current hot topics to be investigated.
Disclosure: Prof. M. Filippi has received compensation for consulting services and/or speaking activities from Biogen Idec, Excemed, Novartis, and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Teva Pharmaceutical Industries, Novartis, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, Cure PSP, Alzheimer´s Drug Discovery Foundation (ADDF), the Jacques and GloriaGossweiler Foundation (Switzerland), and ARiSLA.
Abstract: 220
Type: Educational Session
Abstract Category: N/A
Magnetic resonance imaging (MRI) has been formally included in the diagnostic work-up of patients with a suspicious of multiple sclerosis (MS) in 2001, due to its high sensitivity in revealing focal lesions in the central nervous system highly suggestive of this condition. From then, diagnostic criteria have been updated several time, to increase their accuracy. The last update of MS criteria for the assessment of dissemination in space (DIS) and time (DIT) occurred in 2010. Based on evidence-based and expert-opinion consensus on new data on the use of MRI to establish DIS and DIT, MAGNIMS experts proposed modifications to MRI criteria for MS diagnosis in 2016. First, starting from the evidence that the inclusion of symptomatic lesions does not reduce diagnostic accuracy, symptomatic lesions of spinal cord and brainstem were included in DIS and DIT. Moreover, the involvement of the optic nerve and the presence of cortical lesions (CL) were suggested as additional DIS criteria. In order to reduce the risk of false positive, increased number of periventricular (PV) lesions (from one to three) was recommended. The performance of 2016 MAGNIMS criteria was tested on a European cohort of 368 patients with clinically isolated syndrome (CIS). MAGNIMS 2016 criteria showed similar sensitivity of the 2010 McDonald criteria (0.77 vs 0.73) and analogue specificity (0.5). The analysis of each single criterion showed an increase in specificity with the inclusion of at least three PV lesions to assess DIS. These results have in part guided the 2017 revision of the McDonald criteria, which included part of the MAGNIMS 2016 suggestions (inclusion of symptomatic and asymptomatic lesions to assess DIS and DIT and of the presence of CL to demonstrate DIS). A renewed role was also attributed to intrathecal oligoclonal bands. A validation 2017 McDonald criteria is needed. Research to further refine the criteria should focus on the identification of features specific for MS, to minimize the risk of misdiagnosis. For the imaging perspective, the central vein sign, the presence of meningeal inflammation and subpial demyelination are current hot topics to be investigated.
Disclosure: Prof. M. Filippi has received compensation for consulting services and/or speaking activities from Biogen Idec, Excemed, Novartis, and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Teva Pharmaceutical Industries, Novartis, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, Cure PSP, Alzheimer´s Drug Discovery Foundation (ADDF), the Jacques and GloriaGossweiler Foundation (Switzerland), and ARiSLA.