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

¹ NMR Research Unit, Institute of Neurology, University College London, Queen Square, London, UK
² Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square
³ Physician’s Clinic, Moorfields Eye Hospital, City Road, London

Correspondence to:
Correspondence to:
Professor D H Miller
NMR Research Unit, 6th Floor, Institute of Neurology, Queen Square, London WC1N 3BG, UK; d.miller{at}ion.ucl.ac.uk

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.

Abbreviations: CDMS, clinically definite multiple sclerosis; CIS, clinically isolated syndrome

Keywords: multiple sclerosis; clinically isolated syndrome; magnetic resonance imaging; diagnosis

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