Modification of MRI criteria for multiple sclerosis in patients with clinically isolated syndromes

Abstract

Background: The McDonald criteria include MRI evidence for dissemination in space and dissemination in time for the diagnosis of multiple sclerosis in young adult patients who present with clinically isolated syndromes (CIS) typical of the disease. Although a major advance, the criteria have limited sensitivity for making an early diagnosis.

Objective: To compare the performance of McDonald criteria and modified McDonald criteria for dissemination in space and time for assessing the development of clinically definite multiple sclerosis.

Methods: McDonald criteria were modified using the combination of a less stringent definition for dissemination in space and allowing a new T2 lesion per se after three months as evidence for dissemination in time. Modified and McDonald criteria were applied in 90 CIS patients at baseline and at three month follow up scans.

Results: Both criteria were highly specific (>90%) but the modified criteria were more sensitive (77% v 46%) and more accurate (86% v 73%).

Conclusions: These modified criteria should be evaluated in other CIS cohorts.

Conflict of interest statement

Competing interests: DHM has received grant support from Biogen Idec, Elan, Schering, and GlaxoSmithKline for performance of MRI analyses in clinical trials; honoraria for advisory or consultancy work, lectures, and related travel and accommodation expenses from Aventis, Biogen Idec, Bristol Myers Squibb, GlaxoSmithKline, Schering, Serono, UCB Pharma, and Wyeth. KF received salary support from Biogen Idec. CMD received salary support from Elan. GTP has received travel and accommodation expenses from Alcon. AJT has received honoraria for lecturing from Aventis and Schering. JS and KM have nothing to declare. The organisations mentioned in this conflict of interest statement did not participate in any aspect of the study design, execution, analysis, or write up.