New diagnostic criteria for multiple sclerosis
New diagnostic criteria for multiple sclerosis
复制标题
多发性硬化症的新诊断标准
DOI：
10.1002/ana.10138
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发表时间：
2002
期刊：
影响因子：
9.9
通讯作者：
Wolf D Heiss
中科院分区：
文献类型：
--
作者：
H. Petereit;Wolf D Heiss
背景：最近制定的MS诊断标准（McDonald标准）表明，在单次脱髓鞘发作（临床孤立综合征[CIS]）的患者中，MRI可能提供空间和时间传播的证据，这是诊断所必需的。目的：评估这些新标准在提示多发性硬化症的CIS患者中的有用性方法：共139例CIS患者，随访中位时间为3年，在首次发作的3个月内和12个月后分别接受了脑部MRI检查。分析基线时病变的数量和位置，随访时新病变的发展情况，以及脑脊液检查结果（如果阳性，则需要较少的MR异常进行诊断）。将新的McDonald诊断标准（包括MRI）与现有的Poser诊断标准进行比较，并评估其准确性。结果：12个月时，根据Poser标准，11%的患者有临床明确的多发性硬化症，而根据McDonald标准，这一比例为37%。80%符合这些新标准的患者在平均49个月的随访期内出现了第二次临床发作。新标准在预测转化为临床明确的多发性硬化症方面的敏感性为74%，特异性为86%，准确性为80%。结论：在症状出现一年后，与旧标准相比，使用包含MRI结果的新诊断标准诊断为多发性硬化症的CIS患者数量增加了三倍以上。然而，所提出的MRI标准需要进一步的前瞻性研究来优化敏感性和特异性。
Background: Recently developed diagnostic criteria for MS (McDonald criteria) indicate that in patients with a single demyelinating episode (clinically isolated syndromes [CIS]), evidence for dissemination in space and time, essential for diagnosis, may be provided by MRI. Objective: To assess the usefulness of these new criteria in patients with CIS suggestive of MS. Methods: A total of 139 patients with CIS followed for a median of 3 years underwent brain MRI within 3 months of their first attack and again 12 months later. The number and location of lesions at baseline, the development of new lesions at follow-up, and the results of CSF examination (which, if positive, requires fewer MR abnormalities for diagnosis) were analyzed. The new McDonald criteria (incorporating MRI) were compared to the existing Poser diagnostic criteria and their accuracy was evaluated. Results: At 12 months, 11% had clinically definite MS according to the Poser criteria compared to 37% with the McDonald criteria. Eighty percent of patients fulfilling these new criteria developed a second clinical episode within a mean follow-up of 49 months. The new criteria showed a sensitivity of 74%, specificity of 86%, and accuracy of 80% in predicting conversion to clinically definite MS. Conclusion: One year after symptom onset, more than three times as many patients with CIS were diagnosed with MS using new diagnostic criteria incorporating MRI results compared to older criteria. However, the proposed MRI criteria require further prospective studies to optimize sensitivity and specificity.