Overdiagnosis of multiple sclerosis and magnetic resonance imaging criteria
Open accessAbstract
Retrospectively, we assessed the specificity of two proposed magnetic resonance imaging (MRI) criteria for multiple sclerosis (MS) in patients suspected to have MS but who ultimately receive another diagnosis. Brain MRIs of 28 patients mixed with 28 MRIs of MS patients from the same cohort of 377 consecutively referred patients were scored by a neuroradiologist masked to the final diagnosis. The criteria for dissemination in space incorporated in the McDonald International Panel showed good specificity (89%). However, the more sensitive criteria proposed by a Subcommittee of the American Academy of Neurology resulted in a lower specificity (29%), indicating an increased risk of a false‐positive diagnosis. Ann Neurol 2005;58:781–783
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Of these patients, 29 (25%) had another neurological disease, none of whom had FND or psychiatric disorders.
“Of these patients, 29 (25%) had another neurological disease, none of whom had FND or psychiatric disorders (although five “single diagnoses” were not specified).”
From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [22]
In a Dutch retrospective review from 1998 to 2001, 116 out of 377 (31%) consecutive patients referred for a second opinion to a tertiary MS center had diagnoses other than MS or demyelinating disease.
“Conversely, there were no diagnoses of FND or psychiatric disorders in a Dutch retrospective review from 1998 to 2001, where 116 out of 377 (31%) consecutive patients referred for a second opinion to a tertiary MS center had diagnoses other than MS or demyelinating disease [22].”
From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [22]
In that Dutch study, there were no diagnoses of FND or psychiatric disorders.
“Conversely, there were no diagnoses of FND or psychiatric disorders in a Dutch retrospective review from 1998 to 2001, where 116 out of 377 (31%) consecutive patients referred for a second opinion to a tertiary MS center had diagnoses other than MS or demyelinating disease [22].”
From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [22]
MRI in patients with small-vessel cerebrovascular disease, other inflammatory and noninflammatory disorders affecting white matter, and even in healthy subjects (especially in older age groups), may show brain lesions that fulfil MRI criteria for MS.
“MRI in patients with small-vessel cerebrovascular disease, other inflammatory and noninflammatory disorders affecting white matter (see examples in Tables 2 & 3), and even in healthy subjects (especially in older age groups), may show brain lesions that fulfil MRI criteria for MS [21][22][23][24]”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [22]
Cites
A longitudinal study of abnormalities on MRI and disability from multiple sclerosis
Brex, P. A., Ciccarelli, O., O'Riordan, J. I., Sailer, M., Thompson, A. J., & Miller, D. H. (2002) · New England Journal of Medicine · doi:10.1056/nejmoa011341 · Cited by 861 · see citing works
Bot, J. C. J., Barkhof, F., à Nijeholt, G. L., van Schaardenburg, D., Voskuyl, A. E., Ader, H. J., Pijnenburg, J. A. L., Polman, C. H., Uitdehaag, B. M. J., Vermeulen, E. G. J., et al. (2002) · Radiology · doi:10.1148/radiol.2231010707 · Cited by 168 · see citing works
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Diagnosis of multiple sclerosis: progress and challenges
Brownlee, W. J., Hardy, T. A., Fazekas, F., & Miller, D. H. (2017) · The Lancet · doi:10.1016/s0140-6736(16)30959-x · Cited by 701 · see citing works
MRI criteria for MS in patients with clinically isolated syndromes
Montalban, X., Tintoré, M., Swanton, J., Barkhof, F., Fazekas, F., Filippi, M., Frederiksen, J., Kappos, L., Palace, J., Polman, C., et al. (2010) · Neurology · doi:10.1212/wnl.0b013e3181cec45c · Cited by 252 · see citing works
Self-citationWalzl, D., Solomon, A. J., & Stone, J. (2022) · Journal of Neurology · doi:10.1007/s00415-021-10436-6 · Cited by 62 · see citing works
Aldraihem, M., Alyami, W., AlQahtani, E., Saeed, L., AlDosary, R., Altowaijri, G., & Almutlaq, A. (2025) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2025.106779
- Authors
- Nielsen, J. M., Korteweg, T., Barkhof, F., Uitdehaag, B. M. J., & Polman, C. H.
- Affiliations
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Corresponding author
- Nielsen, Jessica M.
- Venue
- Annals of Neurology
- Publisher
- Wiley
- Published
- 2005-10-20
- Volume
- 58
- Issue
- 5
- Pages
- 781-783
- ISSN
- 0364-5134 (ISSN-L)
- 1531-8249
- OpenAlex
- W1987869280
- Cited by
- 72
- References
- 2
- Citations by year
- 2025: 2 · 2022: 1 · 2021: 7 · 2020: 3 · 2019: 3 · 2018: 3 · 2017: 7 · 2016: 5 · 2015: 4 · 2014: 4 · 2013: 1 · 2012: 2
- FWCI
- 4.68
- Type
- journal article
- Language
- en
- Open access
- green
- research.vumc.nl
- Licence
- Locations
- Annals of Neurology (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Neurology › Peripheral Neuropathies and Disorders
- Keywords
- multiple sclerosis, overdiagnosis, dissemination in space, McDonald criteria, diagnostic specificity, false-positive diagnosis
- MeSH terms
- Adult, Diagnosis, Differential, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis, Reference Standards, Sensitivity and Specificity
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