A comparison of MRI criteria for diagnosing pediatric ADEM and MS
A comparison of MRI criteria for diagnosing pediatric ADEM and MS
复制标题
DOI：
10.1212/wnl.0b013e3181dc138b
复制
发表时间：
2010-05-04
期刊：
影响因子：
9.9
通讯作者：
Hintzen, R. Q.
中科院分区：
文献类型：
--
作者：
Ketelslegers, I. A.;Neuteboom, R. F.;Hintzen, R. Q.
背景：脑MRI是诊断儿童炎性脱髓鞘疾病的有用工具。然而，目前尚不清楚哪些是区分多发性硬化症（MS）和急性播散性脑脊髓炎（ADEM）等多发性神经系统疾病的最可靠标准。因此，我们比较了目前的4套MRI标准在我们的荷兰儿科队列，并确定哪些是最有用的在临床实践中区分ADEM从MS。方法：我们包括49名儿童谁有脱髓鞘事件和MRI扫描2个月内，他们的第一次临床发作。21例患者患有ADEM，并在至少2年的随访后保持无复发。28例患者确诊为MS。我们评估了以下MRI标准的敏感性和特异性：Barkhof标准、KIDMUS标准、Callen MS-ADEM标准和Callen诊断MS标准。结果：Callen MS-ADEM标准具有最佳的敏感性（75%）和特异性（95%）组合。KIDMUS标准具有较高的特异性（100%），但敏感性低得多（11%）。Barkhof标准的敏感性为61%，特异性为91%。Callen诊断MS的标准是最敏感的（82%），但只有52%的具体区分首次发作的MS ADE.Conclusions：在我们的队列的结果表明，新的Callen标准多发性硬化急性播散性脑脊髓炎（MS-ADEM）是最有用的区分首次发作的MS从单相ADEM。虽然Callen诊断MS标准更敏感，但它们缺乏区分MS和ADEM所需的特异性。神经病学（R）2010; 74：1412-1415
Background: Brain MRI is a useful tool for diagnosing inflammatory demyelinating disorders in children. However, it remains unclear which are the most reliable criteria for distinguishing multiple sclerosis (MS) from monophasic disorders such as acute disseminated encephalomyelitis (ADEM). We therefore compared the 4 current sets of MRI criteria in our Dutch pediatric cohort and determined which are the most useful in clinical practice for distinguishing ADEM from MS.Methods: We included 49 children who had had a demyelinating event and an MRI scan within 2 months of their first clinical attack. Twenty-one patients had ADEM and remained relapse-free after at least 2 years of follow-up. Twenty-eight patients had a definitive diagnosis of MS. We assessed the sensitivity and specificity of the following MRI criteria: Barkhof criteria, KIDMUS criteria, Callen MS-ADEM criteria, and Callen diagnostic MS criteria.Results: The Callen MS-ADEM criteria had the best combination of sensitivity (75%) and specificity (95%). The KIDMUS criteria had higher specificity (100%), but much lower sensitivity (11%). The Barkhof criteria had a sensitivity of 61% and a specificity of 91%. The Callen diagnostic MS criteria were the most sensitive (82%), but were only 52% specific for distinguishing a first attack of MS from ADEM.Conclusions: The results in our cohort demonstrate that the new Callen criteria for multiple sclerosis-acute disseminated encephalomyelitis (MS-ADEM) are the most useful for differentiating a first attack of MS from monophasic ADEM. Although the Callen diagnostic MS criteria are more sensitive, they lack the specificity necessary to differentiate MS from ADEM. Neurology (R) 2010; 74: 1412-1415