The online version of this article (doi:10.1007/s40120-014-0024-7) contains supplementary material, which is available to authorized users.
With the development of magnetic resonance imaging (MRI) and publications about radiologically isolated syndrome (RIS), a lot of patients are referred to multiple sclerosis (MS) tertiary centers to confirm diagnosis of RIS or MS when brain T2 abnormalities are identified, whatever their characteristics. We evaluate prospectively the occurrence of RIS or MS and sensitivity, specificity and predictive value of McDonald criteria in diagnosis for patients presenting with incidental brain MRI T2 lesions.
The authors ran standardized procedures on 220 consecutive patients addressed by general practitioners or neurologists to confirm RIS or MS diagnosis on brain MRI and give a therapeutic advice. All patients underwent neurological tests, extensive blood screening, cerebrospinal fluid (CSF) examination, visual evoked potential (VEP) and follow-up MRI after 3, 6, 12 and 24 months to consider dissemination in time and space.
Patient characteristics were: 165 women and 55 men, mean age: 42.7 years old (23–59). The major symptom motivating MRI was headaches (39%), sensitive atypical manifestations or pain (12%), mood disorders (10%), transient visual symptoms (9%), fatigue (8%), hormonal screening (6%), vertigo (6%), cranial trauma (5%), and dummy run for clinical study (5%). After a structured analysis of T2 lesions, the suspected diagnosis was: inflammatory disease 45%, vascular 33%, non-pathological 19%, genetic 2%, and metabolic 1%. Extensive screening confirmed the proposed diagnosis in 97% of cases. Among all the 220 proposed RIS patients, only 35.4% fulfilled the 2010 McDonald criteria, and 8% can be categorized as RIS. Dissemination in time criteria was present for 82.7% of MS patients and 36% of RIS patients but none of the vascular or non-pathological T2 abnormalities.
Even if RIS was initially suspected on MRI, only a third of the patients had an inflammatory disease. Most of the patients had either non-specific T2 lesions or a non-inflammatory disease. Others were initially well categorized but had experienced clinical symptoms that could possibly be considered as a first clinical event. Overdiagnosis of MS can lead to propose an inappropriate disease-modifying therapy.
Tintoré M, Rovira A, Martinez M, et al. Isolated demyelinating syndromes: comparison of different MR imaging criteria to predict conversion to clinically definite multiple sclerosis. Am J Neuroradiol. 2000;21:702–6. PubMed
Gout O, Moreau T, Debouverie M, Allouche S, on behalf of the Club Francophone de la sclérose en plaques. Pedias: pilot multicentre observational study aiming to standardize diagnosis of an inflammatory neurological event leading patient to consult for the first time. Mult Scler. 2007;13: P370.
Freedman MS, Thompson EJ, Deisenhammer F, et al. Recommended standard of cerebrospinal fluid analysis in the diagnosis of multiple sclerosis: a consensus statement. Arch Neurol. 2005;62(6):865–70. PubMed
Gronseth GS, Ashman EJ. Practice parameter: the usefulness of evoked potentials in identifying clinically silent lesions in patients with suspected multiple sclerosis (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000; 9; 54(9): 1720–1725.
Tintoré M, Rovira A, Río J, et al. Do oligoclonal bands add information to MRI in first attacks of multiple sclerosis? Neurology. 2008;70(13 Pt 2):1079–83. PubMed
Villar LM, García-Barragán N, Sádaba MC, et al. Accuracy of CSF and MRI criteria for dissemination in space in the diagnosis of multiple sclerosis. J Neurol Sci. 2008; 15; 266(1–2): 34–7.
- A Prospective Study of Patients with Brain MRI Showing Incidental T2 Hyperintensities Addressed as Multiple Sclerosis: a Lot of Work to do Before Treating
- Springer Healthcare
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II