Adjustments to the MRI criteria for the diagnosis of multiple sclerosis (MS) have been proposed by UCL researchers.
In a study published in Neuology researchers led by Dr Wallace Brownlee recommended that, when diagnosing MS, lesions in the symptomatic region should not be excluded, as stated in the McDonald 2010 dissemination in space (DIS) criteria.
In common with all MS diagnostic criteria, the McDonald DIS criteria seek to establish evidence of damage to the central nervous system that is disseminated in time (evidence of episode of damage in the central nervous system at different dates) and disseminated in space (evidence of damage to at least two different parts of the central nervous system) using MRI rather than waiting for people with their first symptoms of MS to have a second attack.
The researchers applied the McDonald 2010 DIS criteria to MRI scans for 30 patients that had experienced a first episode of inflammation in the brainstem or spinal cord and compared the results with those for two modified DIS criteria. The first allowed the inclusion of asymptomatic lesions in the symptomatic region in DIS, while the second allowed the inclusion of any lesion.
BRC supported Dr Brownlee said: “We wanted to investigate whether including lesions seen on MRI at the site of the patients symptoms (the symptomatic region) would affect how we diagnose MS in people presenting with their first symptoms, called a clinically isolated syndrome.”
All of the DIS criteria had good sensitivity and specificity, but the two modified criteria were more sensitive and accurate than the McDonald 2010 DIS criteria.
The researchers reported that they would favour modified DIS criteria that included any lesion in the symptomatic region, rather than just asymptomatic ones, “first because the sensitivity was higher and second because the criteria would be easier to apply in a clinical setting.”
The use of DIS criteria, combined with dissemination in time, improved the time it took to diagnose MS. MS was diagnosed on clinical grounds after a mean of 24.9 months, but using McDonald 2010 criteria incorporating MRI this was reduced to 8.9 months. Using the modified DIS criteria allowed MS to be diagnosed sooner, at 6.7 months when asymptomatic lesions were included and 4.8 months with the inclusion of any lesion, although this was not statistically significant in the cohort of 30 patients studied.
Commenting on the findings in a related editorial, Dr Aaron Miller and Dr Daniel Pelletier said: “Making a diagnosis of MS earlier is advantageous, but being correct is critical.”
Dr Brownlee said: “The study confirms that including lesions in the symptomatic region in diagnostic criteria might improve the way we diagnose MS. These results and findings of other recent studies will be considered by an international panel of experts who are meeting in late 2016 to consider revisions to the diagnostic criteria for MS. We hope that this research will help inform the panel and ultimately improve the way MS is diagnosed in the future.”
To read Should the symptomatic region be included in dissemination in space in MRI criteria for MS? in full visit Neurology.
To read the editorial Multiple sclerosis: Rapid diagnosis or right diagnosis? visit Neurology
