MRI criteria for MS in patients with clinically isolated syndromes

University of Milan, Milano, Lombardy, Italy
Neurology (Impact Factor: 8.29). 02/2010; 74(5):427-34. DOI: 10.1212/WNL.0b013e3181cec45c
Source: PubMed


In recent years, criteria for the diagnosis of multiple sclerosis (MS) have changed, mainly due to the incorporation of new MRI criteria. While the new criteria are a logical step forward, they are complex and-not surprisingly-a good working knowledge of them is not always evident among neurologists and neuroradiologists. In some circumstances, several MRI examinations are needed to achieve an accurate and prompt diagnosis. This provides an incentive for continued efforts to refine the incorporation of MRI-derived information into the diagnostic workup of patients presenting with a clinically isolated syndrome. Within the European multicenter collaborative research network that studies MRI in MS (MAGNIMS), a workshop was held in London in November 2007 to review information that may simplify the existing MS diagnostic criteria, while maintaining a high specificity that is essential to minimize false positive diagnoses. New data that are now published were reviewed and discussed and together with a new proposal are integrated in this position paper.

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Available from: Jette Frederiksen, Nov 11, 2014
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    • "A new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, with reference to a baseline scan, irrespective of the timing of the baseline MRI 2. Simultaneous presence of asymptomatic gadolinium-enhancing and nonenhancing lesions at any time MRI, magnetic resonance imaging; DIT, lesion dissemination in time. Based on Montalban et al. 2010. Adapted from Polman et al. (2011). "
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    ABSTRACT: Background Multiple sclerosis is an acquired demyelinating disease of the central nervous system. It is the second most common cause of disability in adults in United States after head trauma.DiscussionThe etiology of MS is probably multifactorial, related to genetic, environmental, and several other factors. The pathogenesis is not fully understood but is believed to involve T-cell-mediated inflammation directed against myelin and other related proteins with a possible role for B cells. The McDonald criteria have been proposed and revised over the years to guide the diagnosis of MS and are based on clinical presentation and magnetic resonance imaging (MRI) of the brain and spinal cord to establish dissemination in time and space. The treatment of MS includes disease modification with immunomodulator drugs and symptom management to address the specific symptoms such as fatigue, spasticity, and pain.Conclusion An update on etiology, pathogenesis, diagnosis, and immunomodulatory treatment of MS is presented.
    Full-text · Article · Jul 2015 · Brain and Behavior
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    • "For CIS, on T2-weighted MRI, 50–70% of adults show white matter brain lesions, suggesting demyelination [2]. The McDonald criteria used for the diagnosis of MS applies to typically presenting cases of CIS, yet its utility in atypical presentations has not been determined [3,14]. It has been reported that in a patient with suspected CIS, the presence of abnormal lesions on a T2-weighted MRI may predict a long-term 60–80% risk for clinically definite MS [2]. "
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    ABSTRACT: Background There are several categories of primary inflammatory demyelinating disorders, which comprise clinically similar neurologic sequelae. Of interest, clinically isolated syndrome (CIS) and acute disseminated encephalomyelitis (ADEM) are 2 demyelinating conditions of the central nervous system (CNS), whose clinical similarity pose a significant challenge to definitive diagnosis. Yet, both remain important clinical considerations in patients with neurologic signs and symptoms in the context of recent vaccination. Case Report We report a case of a 50-year-old Caucasian male with a course of progressive, focal, neurologic deficits within 24 h after receiving the influenza vaccine. Subsequent work-up revealed the possibility of an acute central nervous system (CNS) demyelinating episode secondary to the influenza vaccine, best described as either CIS or ADEM. Conclusions Case reports of CNS demyelination following vaccinations have been previously noted, most often occurring in the context of recent influenza vaccination. This report serves to document a case of CNS demyelination occurring 24 h after influenza vaccination in a middle-aged patient, and will describe some salient features regarding the differential diagnosis of CIS and ADEM, as well as their potential management.
    Preview · Article · Aug 2014 · American Journal of Case Reports
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    • "Magnetic resonance sequences included conventional T1-weighted imaging, T2-weighted imaging, fluid-attenuated inversion recovery (FLAIR) sequence and diffusion-weighted imaging (DWI). The MRI diagnostic criteria for MS were those recommended in the European Magnetic Resonance Imaging in MS (MAGNIMS) proposal [14]. This required intravenous administration of a gadolinium-containing MR contrast agent, such as gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA), followed by dynamic contrast-enhanced MR imaging (DCE-MRI) of the brain or spinal cord. "
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    ABSTRACT: Reports in Asian populations suggest that ethnic and geographical differences may influence susceptibility to multiple sclerosis (MS) and its clinical behaviors. Here, we sought to retrospectively survey clinical characteristics and MRI data in Chinese subjects with MS. We conducted a retrospective analysis in 117 patients with MS. The patients were divided into subgroups with optic-spinal form of multiple sclerosis (OSMS; n = 42) and classical multiple sclerosis (CMS; n = 75). Clinical characteristics, MRI finding and expanded disability status scale (EDSS) score were compared between the two groups. In 117 MS patients, 64.1% patients were classified as having CMS and 35.9% OSMS forms. White blood cell counts of OSMS patients were significantly higher than those of CMS patients (P <0.05). The longitudinal fusion lesions of spinal cord on MRI were statistically significant between groups (P <0.05). Spinal cord MRI showed that MS lesions were longer, and revealed spinal cord swelling in patients with CMS, but atrophy in patients with OSMS. The EDSS score at five years was significantly higher in patients with OSMS than in those with CMS (P <0.05). Relapse rates of patients with OSMS were also higher than those of patients with CMS (P <0.01) within one to three years. OSMS accounts for a higher proportion of MS populations in Northern China than in Western countries. MRI showed a longitudinally extensive spinal cord lesion in patients with OSMS and spinal cord swelling at onset.
    Full-text · Article · Apr 2014
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