Performance of the 2017 and 2010 Revised McDonald Criteria in Predicting MS Diagnosis After a Clinically Isolated Syndrome

Filippi, Massimo; Preziosa, Paolo; Meani, Alessandro; Costa, Gloria Dalla; Mesaroš, Šarlota; Drulović, Jelena; Ivanovic, Jovana; Tintoré, Mar; Montalbán, Xavier; Ciccarelli, Olga; Brownlee, Wallace; Miszkiel, Katherine; Enzinger, Christian; Khalil, Michael; Barkhof, Frederik; Strijbis, Eva; Frederiksen, Jette; Cramer, Stig P.; Fainardi, Enrico; Amato, Maria Pia; Gasperini, Claudio; Ruggieri, Serena; Martinelli, Vittorio; Comi, Giancarlo; Rocca, Maria A.

doi:10.1212/wnl.0000000000013016

Cited by 45 publications

(50 citation statements)

References 51 publications

(113 reference statements)

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“…Due to its sensitivity in revealing lesional features that are considered typical for MS, MRI has been formally included into the diagnostic work-up of patients with a suspicious of this condition, to obtain objective evidence of DIS and DIT. Current MS diagnostic criteria perform quite well in terms of sensitivity, in the hands of expert MS clinicians ( Filippi et al, 2021b , Thompson et al, 2018 ).…”

Section: Clinical Applications Of Aimentioning

confidence: 99%

“…A fundamental requirement for the diagnosis of MS is the exclusion of MS-mimics ( Filippi et al, 2021b , Thompson et al, 2018 ). These disorders include many inflammatory (acute disseminated encephalomyelitis, neuromyelitis optica spectrum disorders [NMOSD], neurosarcoidosis, CNS vasculitis, etc.)…”

Section: Clinical Applications Of Aimentioning

confidence: 99%

“…The identification of specific imaging biomarkers for MS is a high-priority area of research ( Filippi et al, 2019 ). Indeed, current diagnostic criteria ( Thompson et al, 2018 ) show high sensitivity, but specificity still needs improvement ( Filippi et al, 2021b ). In this perspective, advanced MRI sequences show promise ( Bendfeldt et al, 2019 ), but their acquisition is time and resource consuming ( Filippi et al, 2018 , Wattjes et al, 2021 ).…”

Section: Technical Applications Of Ai For Mri Acquisition and Analysismentioning

confidence: 99%

“…A recent evolution was introduced by La Rosa et al ( La Rosa et al, 2020 ), who were able to build a CNN pipeline for the automated segmentation of cortical, in addition to WM, lesions at 3T, using T2-weighted FLAIR and T1-weighted MP2RAGE contrasts as input images. Cortical lesions are an accurate biomarker for MS diagnosis ( Filippi et al, 2021b ), and they provide important pieces of information for prognosis and treatment decision ( Haider et al, 2021 , Rotstein and Montalban, 2019 ). Another innovation was the application of AI for the automated assessment of the central vein sign (CVS) in WM lesions, which is an accurate tool for distinguishing MS from other conditions characterized by WM lesions on MRI ( Bendfeldt et al, 2019 ).…”

Section: Technical Applications Of Ai For Mri Acquisition and Analysismentioning

confidence: 99%

“…MRI has revolutionized the approach to MS, playing a major role in early diagnosis, differential diagnosis, prognostication, treatment and disease monitoring ( Filippi et al, 2021b , Sastre-Garriga et al, 2020 , Wattjes et al, 2021 ). Increasing knowledge and expansion of the availability of advanced MRI techniques are requiring more and more time, resources and expertise, which conflicts with the clinical applications of these tools.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Role of artificial intelligence in MS clinical practice

Bonacchi

Filippi

Rocca

2022

NeuroImage: Clinical

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Section: Clinical Applications Of Aimentioning

confidence: 99%

Section: Clinical Applications Of Aimentioning

confidence: 99%

Section: Technical Applications Of Ai For Mri Acquisition and Analysismentioning

confidence: 99%

Section: Technical Applications Of Ai For Mri Acquisition and Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Role of artificial intelligence in MS clinical practice

Bonacchi

Filippi

Rocca

2022

NeuroImage: Clinical

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Diagnostic Performance of Cortical Lesions and the Central Vein Sign in Multiple Sclerosis

Cagol,

Cortese,

Barakovic

et al. 2024

JAMA Neurol

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ImportanceMultiple sclerosis (MS) misdiagnosis remains an important issue in clinical practice.ObjectiveTo quantify the performance of cortical lesions (CLs) and central vein sign (CVS) in distinguishing MS from other conditions showing brain lesions on magnetic resonance imaging (MRI).Design, Setting, and ParticipantsThis was a retrospective, cross-sectional multicenter study, with clinical and MRI data acquired between January 2010 and May 2020. Centralized MRI analysis was conducted between July 2020 and December 2022 by 2 raters blinded to participants’ diagnosis. Participants were recruited from 14 European centers and from a multicenter pan-European cohort. Eligible participants had a diagnosis of MS, clinically isolated syndrome (CIS), or non-MS conditions; availability of a brain 3-T MRI scan with at least 1 sequence suitable for CL and CVS assessment; presence of T2-hyperintense white matter lesions (WMLs). A total of 1051 individuals were included with either MS/CIS (n = 599; 386 [64.4%] female; mean [SD] age, 41.5 [12.3] years) or non-MS conditions (including other neuroinflammatory disorders, cerebrovascular disease, migraine, and incidental WMLs in healthy control individuals; n = 452; 302 [66.8%] female; mean [SD] age, 49.2 [14.5] years). Five individuals were excluded due to missing clinical or demographic information (n = 3) or unclear diagnosis (n = 2).ExposuresMS/CIS vs non-MS conditions.Main Outcomes and MeasuresArea under the receiver operating characteristic curves (AUCs) were used to explore the diagnostic performance of CLs and the CVS in isolation and in combination; sensitivity, specificity, and accuracy were calculated for various cutoffs. The diagnostic importance of CLs and CVS compared to conventional MRI features (ie, presence of infratentorial, periventricular, and juxtacortical WMLs) was ranked with a random forest model.ResultsThe presence of CLs and the previously proposed 40% CVS rule had a sensitivity, specificity, and accuracy for MS of 59.0% (95% CI, 55.1-62.8), 93.6% (95% CI, 91.4-95.6), and 73.9% (95% CI, 71.6-76.3) and 78.7% (95% CI, 75.5-82.0), 86.0% (95% CI, 82.1-89.5), and 81.5% (95% CI, 78.9-83.7), respectively. The diagnostic performance of the CVS (AUC, 0.89 [95% CI, 0.86-0.91]) was superior to that of CLs (AUC, 0.77 [95% CI, 0.75-0.80]; P &lt; .001), and was increased when combining the 2 imaging markers (AUC, 0.92 [95% CI, 0.90-0.94]; P = .04); in the random forest model, both CVS and CLs outperformed the presence of infratentorial, periventricular, and juxtacortical WMLs in supporting MS differential diagnosis.Conclusions and RelevanceThe findings in this study suggest that CVS and CLs may be valuable tools to increase the accuracy of MS diagnosis.

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The diagnostic value of the central vein sign in radiologically isolated syndrome

Landes‐Chateau,

Levraut,

Okuda

et al. 2024

Ann Clin Transl Neurol

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ObjectiveThe radiologically isolated syndrome (RIS) represents the earliest detectable preclinical phase of multiple sclerosis (MS). Increasing evidence suggests that the central vein sign (CVS) enhances lesion specificity, allowing for greater MS diagnostic accuracy. This study evaluated the diagnostic performance of the CVS in RIS.MethodsPatients were prospectively recruited in a single tertiary center for MS care. Participants with RIS were included and compared to a control group of sex and age‐matched subjects. All participants underwent 3 Tesla magnetic resonance imaging, including postcontrast susceptibility‐based sequences, and the presence of CVS was analyzed. Sensitivity and specificity were assessed for different CVS lesion criteria, defined by proportions of lesions positive for CVS (CVS+) or by the absolute number of CVS+ lesions.Results180 participants (45 RIS, 45 MS, 90 non‐MS) were included, representing 5285 white matter lesions. Among them, 4608 were eligible for the CVS assessment (970 in RIS, 1378 in MS, and 2260 in non‐MS). According to independent ROC comparisons, the proportion of CVS+ lesions performed similarly in diagnosing RIS from non‐MS than MS from non‐MS (p = 0.837). When a 6‐lesion CVS+ threshold was applied, RIS lesions could be diagnosed with an accuracy of 87%. MS could be diagnosed with a sensitivity of 98% and a specificity of 83%. Adding OCBs or Kappa index to CVS biomarker increased the specificity to 100% for RIS diagnosis.InterpretationThis study shows evidence that CVS is an effective imaging biomarker in differentiating RIS from non‐MS, with similar performances to those in MS.

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Performance of the 2017 and 2010 Revised McDonald Criteria in Predicting MS Diagnosis After a Clinically Isolated Syndrome

Cited by 45 publications

References 51 publications

Role of artificial intelligence in MS clinical practice

Role of artificial intelligence in MS clinical practice

Diagnostic Performance of Cortical Lesions and the Central Vein Sign in Multiple Sclerosis

The diagnostic value of the central vein sign in radiologically isolated syndrome

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