Contribution Of Cervical Cord MRI And Brain MTI To The Assessment Of Individual Patients With Multiple Sclerosis: A Preliminary Study
Rovaris M, Holtmannspotter M, Rocca MA, Iannucci G, Codella M, Viti B, Campi A, Comi G, Yousry TA, Filippi M
Mult Scler 2002 Feb;8(1):52-8
Scientific Institute and University H San Raffaele, NeuroImaging Research Unit, Milan, Italy
This study was performed to assess how established diagnostic criteria for Brain Magnetic Resonance Imaging (MRI) interpretation in cases of suspected Multiple Sclerosis (MS)
(Fazekas' Criteria) would perform in the distinction of MS from other diseases and whether other MR techniques (Cervical Cord imaging and Brain Magnetization Transfer Imaging [MTI]), might help in the diagnostic work-up of these patients.
We retrospectively identified 64 MS and 59 non-MS patients. The latter group included patients with systemic Immune-Mediated Disorders (SID; n=44) and Migraine (n=15).
All patients had undergone MRI scans of the Brain (dual echo and MTI) and of the Cervical Cord (Fast Short-Tau Inversion Recovery). The number and location of Brain T2-HyperIntense lesions and the number and size of Cervical Cord lesions were assessed.
Brain images were also postprocessed to quantify the Total Lesion Volumes (TLV) and to create Histograms of Magnetization Transfer Ratio (MTR) values from the whole of the Brain tissue.
Barkhof's Criteria correctly classified 108/123 patients, thus showing an accuracy of 87.8%.
"False negative" MS patients were 13, while 2 patients with Systemic Lupus Erythematosus (SLE) were considered as "false positives". Using Brain T2 TLV, nine of the "false negative" patients were correctly classified.
Correct classification of 10 MS patients and both the SLE patients was possible based upon the presence or absence of one Cervical Cord lesion.
Two MS patients with negative Barkhof's Criteria and no Cervical Cord lesions were correctly classified based on their Brain MTR values.
Overall, only one MS patient could not be correctly classified by any of the assessed MR quantities.
These preliminary data support a more extensive use of Cervical Cord MRI and Brain MTI to differentiate between MS and other disorders in case of incondusive findings on T2-weighted MRI scans of the Brain.
Differentiation Of Multiple Sclerosis From Other Inflammatory Disorders And CerebroVascular Disease: Value Of Spinal MR Imaging
Bot JC, Barkhof F, Lycklama a Nijeholt G, van Schaardenburg D, Voskuyl AE, Ader HJ, Pijnenburg JA, Polman CH, Uitdehaag BM, Vermeulen EG, Castelijns JA
Radiology 2002 Apr;223(1):46-56
Vrije Universiteit Medical Centre, MR Center for MS Research, Department of Radiology, PO Box 7057, 1007 MB Amsterdam, the Netherlands
To determine the value of Magnetic Resonance (MR) imaging in the Spinal Cord to differentiate Multiple Sclerosis (MS) from other Inflammatory Disorders and CerebroVascular Diseases (together, Other Neurologic Disease [OND]).
Materials And Methods
The study population included 66 patients with OND and 25 patients with MS, who were matched for age, sex, and symptom duration or severity.
Brain MR imaging included Gadolinium-enhanced T1-weighted and Dual-Echo T2-weighted Spin-Echo sequences to assess the number, size, and appearance of lesions, contrast enhancement, and compatibility with diagnostic criteria for MS.
Spinal cord MR imaging included cardiac-triggered Gadolinium-enhanced sagittal T1-weighted Spin-Echo and Dual-Echo T2-weighted sequences to assess the general appearance (normal, focal lesion, Diffuse abnormality) and number or size of focal lesions.
Images obtained in MS and OND patients were compared. Specificity, sensitivity, accuracy, and positive and negative predictive values with MR images were calculated.
Brain images were abnormal in all MS patients and in 65% of OND patients. Abnormal Cord images were found in 92% of MS and 6% of OND patients.
The combination of Brain and Spinal Cord images increased accuracy of diagnosis compared with use of Brain images alone.
In contrast to MS, Cord lesions are very uncommon in OND. This finding can help differentiate these disorders.
Application Of The New Mcdonald Criteria To Patients With Clinically Isolated Syndromes Suggestive Of Multiple Sclerosis
Dalton CM, Brex PA, Miszkiel KA, Hickman SJ, MacManus DG, Plant GT, Thompson AJ, Miller DH
Ann Neurol 2002 Jul;52(1):47-53
Institute of Neurology, NMR Research Unit, University College London, United Kingdom
Traditionally, Multiple Sclerosis (MS) has been diagnosed on the basis of clinical evidence of dissemination in time and space.
Previously, it could not be diagnosed in patients with single clinical episodes of DeMyelination known as Clinically Isolated Syndromes.
New diagnostic criteria from the International Panel of McDonald and colleagues incorporate MRI evidence of dissemination in time and space to allow a diagnosis of MS in patients with Clinically Isolated Syndromes.
From clinical and MRI examinations performed prospectively at baseline, 3 months, 1 year, and 3 years of follow-up, the frequency of developing MS was ascertained by the application of both the new McDonald Criteria and the Poser Criteria for Clinically Definite MS.
The specificity, sensitivity, positive and negative predictive value, and accuracy of the new criteria for the development of Clinically Definite MS were assessed.
At 3 months, 20 of 95 (21%) patients had MS with the McDonald Criteria, whereas only 7 of 95 (7%) had developed Clinically Definite MS. After 1 year, the corresponding figures were 38 of 79 (48%) and 16 of 79 (20%), and after 3 years, they were 29 of 50 (58%) and 19 of 50 (38%).
The development of MS with the new MRI criteria after 1 year had a high sensitivity (83%), specificity (83%), positive predicative value (75%), negative predictive value (89%), and accuracy (83%) for Clinically Definite MS at 3 years.
Use of the new McDonald Criteria more than doubled the rate of diagnosis of MS within a year of presentation with a Clinically Isolated Syndrome.
The high specificity, positive predictive value, and accuracy of the new criteria for Clinically Definite MS support their clinical relevance.
Isolated DeMyelinating Syndromes: Comparison Of CSF OligoClonal Bands And Different MR Imaging Criteria To Predict Conversion To CDMS
Tintore M, Rovira A, Brieva L, Grive E, Jardi R, Borras C, Montalban X
Mult Scler 2001 Dec;7(6):359-63
Unit of Clinical NeuroImmunology (Department of Neurology), Vall d'Hebron University Hospitals, Barcelona, Spain
Aim Of The Study
To evaluate and compare the capacity of OligoClonal Bands (OB) and three sets of MR imaging criteria to predict the conversion of Clinically Isolated Syndromes (CIS) to Clinically Definite Multiple Sclerosis (CDMS).
Patients And Methods
One hundred and twelve patients with CIS were prospectively studied with MR imaging and determination of OB.
Based on the clinical follow-up (conversion or not conversion to CDMS), we calculated the sensitivity, specificity accuracy, positive and negative predictive value of the OB, and MR imaging criteria proposed by Paty et al, Fazekas' et al and Barkhof et al.
CDMS developed in 26 (23.2%) patients after a mean follow-up of 31 months (range 12-62). OB were positive in 70 (62.5%) patients and were associated with a higher risk of developing CDMS.
OB showed a sensitivity of 81%, specificity of 43%, accuracy of 52%, Positive Predictive Value (PPV) of 30% and negative predictive value (NPV) of 88%.
Paty and Fazekas criteria showed the same results with a sensitivity of 77%, specificity of 51%, accuracy of 57%, positive predictive value of 32% and negative predictive value of 88%.
Barkhof Criteria showed a sensitivity of 65%, specificity of 70%, accuracy of 69%, PPV of 40% and NPV of 87%.
The greatest accuracy was achieved when patients with positive OB and three or four Barkhof's Criteria were selected.
We observed a high prevalence of OB in CIS. OB and MR imaging (Paty's and Fazekas' Criteria) have high sensitivity. Barkhof's Criteria have a higher specificity.
Both OB and MR imaging criteria have a high negative predictive value.