Year: 2011
Type: dissertation
Study design: Observational Study
Abstract: The McDonald International Panel accepted the Barkhof/Tintoré criteria for providing MRI evidence of dissemination in space to allow a diagnosis of multiple sclerosis in patients with clinically isolated syndromes (CIS).We applied these criteria in a large cohort of patients with CIS, representative of those seen in a general diagnostic setting, to assess their accuracy in predicting conversion to definite multiple sclerosis and to identify factors that affect this risk. MethodsIn a collaborative study of seven centres, baseline MRI and clinical follow-up data for 532 patients with CIS were studied, with the development of a second clinical event used as the main outcome.All scans were scored for lesion counts and spatial lesion distribution to assess the fulfilmentie, at least three out of four-of the Barkhof/Tintoré criteria.We used survival analysis and 2X2 tables to assess the test characteristics of the criteria at baseline. FindingsOverall conversion rate was 32•5% with a median survival time of 85•3 months.Fulfilment of the criteria at baseline showed, after a survival time of 2 years, a conversion rate of about 45% (95% CI 37-53) versus about 10% (6-16) in those with no asymptomatic lesions at baseline (p 0•0001).For patients with a follow-up of at least 2 years, the fulfilment of the MRI criteria showed an accuracy of 68% (sensitivity 49%, specificity 79%) for predicting conversion and an increase in risk of nearly four times for conversion compared with those not fulfilling the criteria (odds ratio 3•7, 95% CI 2•3-5•9; p 0•0001).Cox proportional hazards regression analysis accorded with this increased risk.No effects were recorded on the performance of the criteria by sex, presenting symptoms, or centre.Age at baseline did have a small but significant effect as predictor (hazard ratio 0•97, 0•95-0•99; p=0•002), but did not affect the prognostic value of the MRI criteria.Interpretation MRI abnormalities have important prognostic value.The cut-off, based on the Barkhof/ Tintoré criteria, as incorporated in the McDonald diagnostic scheme yields acceptable specificity, but could have lower sensitivity than previously reported.
Author: Korteweg, T.
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Biogen, Vrije Universiteit Amsterdam
OpenAlex ID: W1549319953