Predicting MS in Patients With Clinically Isolated Syndrome: MAGNIMS vs McDonald Criteria

The 2016 Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) criteria demonstrates similar accuracy compared with the 2010 McDonald criteria for predicting multiple sclerosis (MS) in patients with clinically isolated syndrome (CIS), according to the results of a recent multicenter retrospective cohort study published in Lancet Neurology.

The researchers proposed several modifications to the existing magnetic resonance imaging (MRI) criteria for defining dissemination in space (DIS) and dissemination in time (DIT) for diagnosing MS in patients with CIS, including: (1) removal of the distinction between symptomatic and asymptomatic lesions; (2) increasing the number of lesions needed to define periventricular involvement from 1 to 3, in order to improve specificity; (3) combining cortical and juxtacortical lesions; and (4) inclusion of optic nerve assessment.

The study used brain and spinal cord MRI and optic nerve evaluations from patients with typical CIS suggestive of MS that were performed <3 months from clinical onset of disease at 8 European MS centers. All eligible patients were age 16 to 60 and had experienced a first CIS suggestive of central nervous system demyelination and typical of relapsing-remitting MS. The occurrence of a second clinical attack (ie, clinically definite MS) was recorded at 36 and 60 months.

A total of 571 patients with CIS were screened between June 16, 1995, and January 27, 2017, with 368 patients meeting all inclusion criteria. At the last assessment (median, 50 months), 51% (189 of 368) of patients had developed clinically definite MS, having experienced a second clinical episode, and 50% (184 of 368) had developed new T2 or gadolinium-enhancing lesions. At 36 months, with respect to DIS alone, both the 2010 McDonald and the 2016 MAGNIMS criteria demonstrated high sensitivity (0.91; 95% CI, 0.85-0.94 and 0.93; 95% CI, 0.88-0.96, respectively), similar specificity (0.33; 95% CI, 0.25-0.42 and 0.32; 95% CI, 0.24-0.41, respectively), and similar area under the curve (AUC) values (0.62; 95% CI, 0.57-0.67 and 0.63; 95% CI, 0.58-0.67, respectively).

Performance was not affected by the inclusion of symptomatic lesions (sensitivity: 0.92; 95% CI, 0.87-0.96; specificity: 0.31; 95% CI, 0.23-0.40; and AUC: 0.62; 95% CI, 0.57-0.66) or cortical lesions (sensitivity: 0.92; 95% CI, 0.87-0.95; specificity: 0.32; 95% CI, 0.24-0.41; and AUC: 0.62; 95% CI, 0.57-0.67). The use of 3 periventricular lesions was associated with slightly lower sensitivity (0.85; 95% CI, 0.78-0.90); slightly higher specificity (0.40; 95% CI, 0.32-0.50), and similar AUC (0.63; 95% CI, 0.57-0.68). When optic nerve evaluation was included, the sensitivity was similar (0.92; 95% CI, 0.87-0.96), the specificity was slightly lower (0.26; 95% CI, 0.18-0.34), and the AUC was also slightly lower (0.59; 95% CI, 0.55-0.64).

The investigators concluded that additional efforts should be undertaken to improve cortical lesion assessment in patients with MS. Moreover, further studies are warranted to evaluate the impact of including optic nerve assessment as an additional DIS criterion.

Reference

Filippi M, Preziosa P, Meani A, et al. Prediction of a multiple sclerosis diagnosis in patients with clinically isolated syndrome using the 2016 MAGNIMS and 2010 McDonald criteria: a retrospective study [published online December 21, 2017]. Lancet Neurol. doi:10.1016/S1474-4422(17)30469-6