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Applying the 2024-revised McDonald criteria for multiple sclerosis using conventional diagnostic tools: a single-centre prospective cohort study in Germany

Open access
Konen, Franz Felix, Mahmoudi, Nima, Albers, Lina Marie, Arrambide, Georgina, Streichert, Anna Lena, Haar, Melanie, Soldatov, Alexander, Bucak, Erda +18 more·2026·eClinicalMedicine
DOI 10.1016/j.eclinm.2026.104098PMC PMC13430206
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Abstract

Background: The 2024-revised McDonald criteria may enable earlier diagnosis of multiple sclerosis (MS) through inclusion of optic nerve involvement as fifth neuroanatomical topography, novel MRI biomarkers, cerebrospinal fluid (CSF) kappa free light chains (KFLC), and classification of radiologically isolated syndrome (RIS) as MS. Their applicability in routine practice remained for evaluation. Methods: In this prospective single-centre cohort study in Germany, adults presenting between October 1, 2020, and June 30, 2025, with a first demyelinating event or RIS were screened. Participants underwent conventional diagnostic work-up according to the 2017-revised McDonald criteria, including contrast-enhanced MRI, visual evoked potentials (VEP), and CSF analysis. Novel MRI markers and optical coherence tomography were not systematically available. Primary outcome was the proportion of individuals fulfilling the 2024-revised versus the 2017-revised McDonald criteria at baseline assessment. Findings: Applying the 2024-revised criteria, 201/215 individuals (93.5%) fulfilled diagnostic criteria for MS versus 181/215 (84%) using the 2017 revision (p < 0.0001). Additional diagnoses resulted from optic nerve involvement (55%) and RIS reclassification (35%). VEP identified optic nerve lesions in 89% of cases. Overall, 102/201 (51%) individuals fulfilled diagnostic criteria based on MRI findings alone, whereas 99/201 (49%) additionally required inflammatory CSF findings and dissemination in time. Interpretation: Application of selected components of the 2024-revised McDonald criteria increased the proportion of individuals fulfilling the diagnostic criteria, mainly through inclusion of optic nerve involvement and recognition of RIS. CSF analysis remained important for diagnosis and differential diagnostics. Further studies should evaluate the contribution of novel imaging biomarkers. Funding: No external funding was received.

AI snapshot

Written from the paper’s full text.

TL;DR

In a prospective single-centre German cohort of 215 adults with a first demyelinating event or radiologically isolated syndrome (RIS), applying the 2024-revised McDonald criteria with conventional diagnostics increased MS diagnosis from 84% under the 2017 criteria to 93.5% (p < 0.0001). The increase was driven mainly by optic nerve involvement and RIS reclassification, while CSF analysis remained important for diagnosis.

Key findings

  • Applying the 2024-revised criteria, 201/215 individuals (93.5%) fulfilled diagnostic criteria for MS versus 181/215 (84%) using the 2017 revision (p < 0.0001); among patients with a first demyelinating event, 194/207 (94%) fulfilled 2024 criteria versus 181/207 (87%) under 2017 criteria (p = 0.0002).
  • Of 20 additional MS diagnoses under the 2024 criteria, 55% (11/20) came from considering optic nerve as a fifth topography in CIS, and 35% (7/20) from diagnosing MS in RIS; VEP identified optic nerve lesions in 89% (103/116) of MS patients with optic nerve involvement.
  • Overall, 102/201 (51%) fulfilled 2024 criteria based on MRI dissemination in space alone (≥4/5 topographies), whereas 99/201 (49%) required additional features: 46/99 had dissemination in time plus positive CSF findings, 50/99 had positive CSF findings without DIT, and 3/99 had DIT without inflammatory CSF findings.
  • In hypothetical scenario analyses, excluding CSF results still left 151/201 (75%) fulfilling 2024 criteria, and excluding VEP still left 129/201 (64%) possible; only 1/201 MS diagnosis would have been missed without VEP.

Methods

  • Prospective single-centre cohort at Hannover Medical School, Germany; adults ≥18 years presenting between October 1, 2020, and June 30, 2025, with a first clinical event suggestive of inflammatory demyelinating CNS disease or incidental MRI findings compatible with RIS were screened, with 215 included after exclusions.
  • All participants underwent conventional diagnostic work-up per the 2017-revised McDonald criteria and German guideline: clinical examination, VEP, SEP, contrast-enhanced brain and spinal MRI, and CSF analysis including oligoclonal bands and kappa free light chains; novel MRI markers (central vein sign, paramagnetic rim lesions) and OCT were not systematically available.
  • Primary outcome was the proportion fulfilling 2024-revised versus 2017-revised McDonald criteria at baseline; the 2024 criteria were applied retrospectively as a re-classification analysis using prospectively acquired data, with paired comparisons by McNemar’s exact test and exploratory diagnostic scenario analyses.

Limitations

  • Stated by the authors: single-centre design; lack of systematic assessment of novel diagnostic markers including CVS, PRL, and OCT; relatively short follow-up in some patients; study not designed to formally assess diagnostic specificity or misclassification; tertiary university hospital population may limit generalisability; gender identity, race, and ethnicity were not systematically assessed; some individuals with MRI findings suggestive of inflammatory demyelination might fulfil 2024 criteria but not established RIS criteria and thus would not have been included.
  • Evident from the text: the 2024-revised criteria were applied retrospectively as a re-classification analysis, no formal sample size calculation was performed, and follow-up data were available in only 116/215 (54%) participants over a median of 12 months, limiting longitudinal conclusions.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.eclinm.2026.104098

Cites

43 of 43 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

42 of 53 cited sources checked · 17 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Earlier initiation of DMT is associated with improved long-term outcomes like reduced relapse rates or lower disability accrual.

    “earlier diagnosis enables earlier initiation of DMT, which has been consistently associated with improved long-term outcomes like reduced relapse rates or lower disability accrual.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [5] Tintore, 2021, Effect of changes in MS diagnostic criteria over 25 years on time to treatment and prognosis in patients with clinically isolated syndrome, Neurology source
    • cites [6] Cobo-Calvo, 2023, Association of very early treatment initiation with the risk of long-term disability in patients with a first demyelinating event, Neurology source
  • Premisecitation

    Intrathecal inflammation is associated with a higher risk of conversion to MS.

    “frequently demonstrated intrathecal inflammation, which is associated with a higher risk of conversion to MS.”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites [13] Fissolo, 2025, Prognostic factors for multiple sclerosis symptoms in radiologically isolated syndrome, JAMA Neurol source
    • cites [15] Lebrun-Frénay, 2023, The radiologically isolated syndrome: revised diagnostic criteria, Brain source
    • cites [30] Lebrun-Frenay, 2020, 10-year RISC study group on behalf of SFSEP, OFSEP. Radiologically isolated syndrome: 10-year risk estimate of a clinical event, Ann Neurol source
  • Premisecitation

    The newly introduced MRI biomarkers are not yet readily available in all centres.

    “Particularly, the newly introduced MRI biomarkers are today not yet readily available in all centres and their availability will only increase over time.9”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [9] Barkhof, 2025, Lancet Neurol source
  • Premisecitation

    Oligoclonal bands constitute an independent risk factor for conversion of RIS to MS.

    “the finding that oligoclonal bands constitute an independent risk factor for conversion of RIS to MS.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [30] Lebrun-Frenay, 2020, 10-year RISC study group on behalf of SFSEP, OFSEP. Radiologically isolated syndrome: 10-year risk estimate of a clinical event, Ann Neurol source

      The Procedures section defines positive CSF as either an elevated IgG index or at least two unique oligoclonal bands. The Discussion identifies positive CSF as an independent predictor of a first clinical event in RIS, but the paper does not establish oligoclonal bands alone as an independent predictor of conversion to MS. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Study design and conductcitation

    Some individuals with MRI findings suggestive of inflammatory demyelination might potentially fulfil the 2024-revised McDonald criteria but not the currently established RIS criteria and therefore would not have been included in the present study.

    “Lastly, some individuals with MRI findings suggestive of inflammatory demyelination might potentially fulfil the 2024-revised McDonald criteria but not the currently established RIS criteria and therefore would not have been included in the present study.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [15] Lebrun-Frénay, 2023, The radiologically isolated syndrome: revised diagnostic criteria, Brain source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [16] Okuda, 2009, Incidental MRI anomalies suggestive of multiple sclerosis: the radiologically isolated syndrome, Neurology source
  • Classified as probably not a substantial claim. 31
  • May combine two claims. 37
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The 2024 revision introduces substantial modifications that reflect advances in neuroimaging, neurophysiological assessment, and biomarker discovery.

    “The 2024 revision introduces substantial modifications that reflect advances in neuroimaging, neurophysiological assessment, and biomarker discovery.8”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Montalban, 2025, Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria, Lancet Neurol source

      The available indexed passages identify the paper as addressing the 2024 revisions, but contain only a title, author list, and bibliographic information (labelled Abstract; no page given). Searches for neuroimaging, neurophysiological assessment, and biomarkers found no passage describing the revisions or what informed them, so the claim cannot be checked against our copy. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    MRI acquisition followed the 2021 MAGNIMS-CMSC-NAIMS guidelines and included standard-dose gadolinium enhancement for detection of active inflammatory lesions.

    “MRI acquisition followed the 2021 MAGNIMS-CMSC-NAIMS guidelines and included standard-dose gadolinium enhancement for detection of active inflammatory lesions.21,22”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [21] Wattjes, 2021, Lancet Neurol source
    • cites [22] Mahmoudi, 2025, Added value of optic nerve lesions for multiple sclerosis diagnostic criteria, J Neurol source

  • May combine two claims.

    Premisecitation

    Optic nerve lesions have significant diagnostic yield and improve early classification of MS.

    “recent works that demonstrated that optic nerve lesions have significant diagnostic yield and improve early classification of MS.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [22] Mahmoudi, 2025, Added value of optic nerve lesions for multiple sclerosis diagnostic criteria, J Neurol source
    • cites [29] Vidal-Jordana, 2024, Adding the optic nerve in multiple sclerosis diagnostic criteria: a longitudinal, prospective, multicenter study, Neurology source

  • Classified as probably not a substantial claim.

    Premisecitation

    The optic nerve is incorporated as the fifth neuroanatomical topography for establishing DIS in the 2024-revised McDonald criteria.

    “The optic nerve is incorporated as the fifth neuroanatomical topography for establishing DIS, complementing periventricular, (juxta-)cortical, infratentorial, and spinal cord regions.8, 9, 10”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites [8] Montalban, 2025, Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria, Lancet Neurol source
    • cites [9] Barkhof, 2025, Lancet Neurol source
    • cites [10] Saidha, 2025, The use of optical coherence tomography and visual evoked potentials in the 2024 McDonald diagnostic criteria for multiple sclerosis, Lancet Neurol source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The 2024-revised criteria permit a diagnosis of MS in individuals with RIS and in people with non-specific presentations.

    “Lastly, the criteria now permit a diagnosis of MS in individuals with incidental MRI findings suggestive of chronic inflammatory demyelination (RIS: radiologically isolated syndrome) and in people with non-specific presentations.8,13”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [8] Montalban, 2025, Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria, Lancet Neurol source

      The supplied passages contain bibliographic information, and searches for radiologically isolated syndrome, nonspecific symptoms, and incidental MRI findings returned no relevant full-text section or page. The only passage addressing diagnosis in these groups is labelled Abstract, which is not admissible evidence under the stated rubric. (LLM, conf=0.65)

      Experimental — accuracy not yet measured
    • cites [13] Fissolo, 2025, Prognostic factors for multiple sclerosis symptoms in radiologically isolated syndrome, JAMA Neurol source

      The Discussion (page unavailable) says the forthcoming 2024 McDonald criteria will classify many people with RIS who meet the 2017 dissemination-in-space criteria as having MS. The paper’s introductory passage says RIS can include nonspecific symptoms, but it does not say the revised criteria permit MS diagnosis in people with nonspecific presentations more generally. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Overall evidence remains limited and the relative importance of different diagnostic tools within the revised framework has not yet been systematically evaluated.

    “However, overall evidence remains limited and the relative importance of different diagnostic tools within the revised framework has not yet been systematically evaluated.14”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [14] Brownlee, 2026, Performance of the 2024 McDonald criteria in patients under evaluation for suspected multiple sclerosis, Neurology source

      The Introduction (page unavailable) says elements of the revised criteria had been tested in isolation rather than in aggregate, supporting the statement that evidence was limited. But this paper’s Results assess how several changes affected diagnoses and compare outcomes by availability of paraclinical tests. The Discussion notes that some new tools were not assessed, so the claim that the relative importance of different tools had not been systematically evaluated is too broad. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent studies have provided initial evidence for the diagnostic performance of individual components of the revised criteria, suggesting high sensitivity and accuracy of certain approaches.

    “Recent studies have provided initial evidence for the diagnostic performance of individual components of the revised criteria, suggesting high sensitivity and accuracy of certain approaches.14”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] Brownlee, 2026, Performance of the 2024 McDonald criteria in patients under evaluation for suspected multiple sclerosis, Neurology source

      The Introduction (page unavailable) says earlier studies tested elements of the revised criteria in isolation. The Results (page unavailable) report high sensitivity and accuracy for the 2024 criteria as a whole, not for individual components; the paper therefore does not establish that those components had high sensitivity and accuracy. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Under the 2024-revised criteria, MS can be diagnosed when ≥4 typical topographies are affected.

    “MS can be diagnosed when ≥4 typical topographies are affected.8, 9, 10”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites [8] Montalban, 2025, Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria, Lancet Neurol source

      The passages available from our copy contain bibliographic information, but no diagnostic rule. Searches for four typical topographies and for four of five anatomical locations found no passage addressing the claimed threshold, so our copy cannot verify it. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
    • cites [9] Barkhof, 2025, Lancet Neurol source
    • cites [10] Saidha, 2025, The use of optical coherence tomography and visual evoked potentials in the 2024 McDonald diagnostic criteria for multiple sclerosis, Lancet Neurol source

      The Summary (p. 4) and Conclusions (p. 12) say that involvement of at least two of five anatomical regions meets the revised dissemination-in-space criterion, so four affected regions would meet that criterion. They do not state that four affected regions alone are sufficient to diagnose MS. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The 2024 revisions aim to increase diagnostic sensitivity while incorporating additional features intended to preserve, even increase, diagnostic specificity, thereby enabling an earlier and more accurate diagnosis of MS.

    “These revisions aim to increase diagnostic sensitivity while incorporating additional features intended to preserve, even increase, diagnostic specificity, thereby enabling an earlier and more accurate diagnosis of MS.8”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] Montalban, 2025, Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria, Lancet Neurol source

      The indexed Abstract says the 2024 criteria should expedite MS diagnosis while maintaining specificity, and identifies additional features that can confer specificity in specific situations. It does not say that the revisions aim to increase specificity or explicitly claim increased diagnostic sensitivity or accuracy. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Optic nerve involvement can be substantiated by VEP, OCT, or MRI in the 2024-revised criteria.

    “Optic nerve involvement can be substantiated by visual evoked potentials (VEP), optical coherence tomography (OCT), or MRI thus formally integrating visual pathway assessment into the diagnostic framework.8, 9, 10”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites [8] Montalban, 2025, Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria, Lancet Neurol source

      The supplied passages and indexed results contain bibliographic information, not the criteria's provisions on optic nerve involvement. Searches for visual evoked potentials, optical coherence tomography, MRI, and optic nerve involvement returned no passage addressing whether these methods substantiate involvement under the 2024 revisions. (LLM, conf=0.73)

      Experimental — accuracy not yet measured
    • cites [9] Barkhof, 2025, Lancet Neurol source
    • cites [10] Saidha, 2025, The use of optical coherence tomography and visual evoked potentials in the 2024 McDonald diagnostic criteria for multiple sclerosis, Lancet Neurol source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In CSF, intrathecal inflammation can be demonstrated by oligoclonal bands (OCB) or by kappa free light chains (KFLC).

    “in CSF, intrathecal inflammation can be demonstrated by oligoclonal bands (OCB) or by kappa free light chains (KFLC), which represent a complementary biomarker.8, 9, 10, 11, 12”
    Quote in the paperNot a substantial claim5 of 5 sources checked
    • cites [8] Montalban, 2025, Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria, Lancet Neurol source

      The available indexed passages contain bibliographic information but no discussion of CSF biomarkers. Searches for oligoclonal bands, kappa free light chains, and intrathecal antibody synthesis found no passage that addresses the claim. (LLM, conf=0.70)

      Experimental — accuracy not yet measured
    • cites [9] Barkhof, 2025, Lancet Neurol source

      The section ‘The use of MRI in the 2024 McDonald diagnostic criteria for multiple sclerosis’ mentions CSF findings as possible diagnostic evidence, but does not identify the CSF markers. Searches for oligoclonal bands, kappa free light chains, and intrathecal inflammation found no passage in our copy addressing whether either marker demonstrates intrathecal inflammation. No page number was available for the indexed passage. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
    • cites [10] Saidha, 2025, The use of optical coherence tomography and visual evoked potentials in the 2024 McDonald diagnostic criteria for multiple sclerosis, Lancet Neurol source

      The Summary (p. 4) and Conclusions (p. 12) discuss OCT and visual evoked potentials for detecting optic nerve involvement, not CSF markers of intrathecal inflammation. Searches for kappa free light chains, CSF, and oligoclonal bands found only references mentioning oligoclonal banding (pp. 30–31), with no passage establishing the claimed OCB-or-KFLC relationship. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
    • cites [11] Deisenhammer, 2025, Positive cerebrospinal fluid in the 2024 McDonald criteria for multiple sclerosis, eBioMedicine source
    • cites [12] Konen, 2025, German Society for Cerebrospinal Fluid Diagnostics and Clinical Neurochemistry (DGLN e.V.). Oligoclonal bands and kappa free light chains: competing parameters or complementary biomarkers?, Autoimmun Rev source

  • May combine two claims.

    Interpretationcitation

    When applying the published diagnostic sensitivity of the select-6∗ methods of 82%-89%, hypothetically some of the missed MS diagnoses could have been made, possibly reaching a similar proportion of MS diagnosis as compared with detection of KFLC.

    “When applying the published diagnostic sensitivity of the select-6∗ methods of 82%–89%, hypothetically some of the missed MS diagnoses could have been made, possibly reaching a similar proportion of MS diagnosis as compared with detection of KFLC.”
    Quote in the paperSubstantial claim3 of 4 sources checked
    • cites [11] Deisenhammer, 2025, Positive cerebrospinal fluid in the 2024 McDonald criteria for multiple sclerosis, eBioMedicine source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [12] Konen, 2025, German Society for Cerebrospinal Fluid Diagnostics and Clinical Neurochemistry (DGLN e.V.). Oligoclonal bands and kappa free light chains: competing parameters or complementary biomarkers?, Autoimmun Rev source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [32] Borrelli, 2024, Central vein sign, cortical lesions, and paramagnetic rim lesions for the diagnostic and prognostic workup of multiple sclerosis, Neurol Neuroimmunol Neuroinflamm source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [33] Toljan, 2025, Central vein sign and paramagnetic rim lesion abbreviated counting methods for diagnosis of multiple sclerosis: a systematic review and meta-analysis, Clin Radiol source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    OCT is emerging as a robust prognostic biomarker in MS and was also suggested to be applicable for treatment decisions and differential diagnosis.

    “Further, OCT is emerging as a robust prognostic biomarker in MS and was also suggested to be applicable for treatment decisions and differential diagnosis.”
    Quote in the paperNot a substantial claim5 of 5 sources checked
    • cites [10] Saidha, 2025, The use of optical coherence tomography and visual evoked potentials in the 2024 McDonald diagnostic criteria for multiple sclerosis, Lancet Neurol source

      The section ‘Optical coherence tomography and visual evoked potentials’ (p. 6) says OCT may show patterns that help distinguish NMOSD- or MOGAD-related optic neuritis, supporting a role in differential diagnosis. The paper chiefly addresses OCT for MS diagnosis; its discussion of relapse risk (p. 9) does not establish OCT as a robust prognostic biomarker, and the searched passages do not suggest using it for treatment decisions. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [17] Petzold, 2022, Diagnosis and classification of optic neuritis, Lancet Neurol source

      The Paraclinical criteria (p. 11) include OCT findings as evidence for diagnosing optic neuritis, supporting a diagnostic role. The available passages do not describe OCT as a robust prognostic biomarker in MS or suggest its use for treatment decisions; they also do not establish its use to distinguish among diagnoses. (LLM, conf=0.80)

      Experimental — accuracy not yet measured
    • cites [38] Oertel, 2023, Visually evoked potential as prognostic biomarker for neuroaxonal damage in multiple sclerosis from a multicenter longitudinal cohort, Neurol Neuroimmunol Neuroinflamm source

      The Background and Objectives and Methods sections describe OCT as a measure of retinal neurodegeneration, while the Discussion evaluates VEP latency—not OCT—as a prognostic marker. Searches for OCT prognosis, treatment decisions, and differential diagnosis found no passage in our copy addressing those claimed uses of OCT. Page numbers were not available. (LLM, conf=0.75)

      Experimental — accuracy not yet measured
    • cites [39] Paul, 2021, Optical coherence tomography in multiple sclerosis: a 3-year prospective multicenter study, Ann Clin Transl Neurol source

      The Conclusion reports highly reproducible OCT measurements and describes their potential for monitoring MS progression, supporting the claim that OCT is an emerging biomarker. The Introduction suggests OCT could assess treatment effects, but neither it nor the Conclusion proposes using OCT to make treatment decisions or for differential diagnosis. The paper also frames OCT’s clinical role as a potential rather than an established robust prognostic tool. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [40] Mauceri, 2025, Optic nerve as a 5th location in the revised McDonald diagnostic criteria for multiple sclerosis: limitations of OCT in the acute phase, BMJ Neurol Open source

      The Discussion describes OCT as a tool for MS diagnosis and disease monitoring, and notes that optic neuritis from different causes may follow distinct structural trajectories. It does not establish OCT as a robust prognostic biomarker or suggest its use for treatment decisions; it also cautions against applying MS-specific diagnostic cut-offs during the acute phase. No page numbers are provided in our copy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Studies employing the select-6∗ methodology for CVS have reported high sensitivity and specificity for distinguishing MS from mimics.

    “studies employing the select-6∗ methodology for CVS have reported high sensitivity and specificity for distinguishing MS from mimics”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [32] Borrelli, 2024, Central vein sign, cortical lesions, and paramagnetic rim lesions for the diagnostic and prognostic workup of multiple sclerosis, Neurol Neuroimmunol Neuroinflamm source
    • cites [33] Toljan, 2025, Central vein sign and paramagnetic rim lesion abbreviated counting methods for diagnosis of multiple sclerosis: a systematic review and meta-analysis, Clin Radiol source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    CSF analysis in general and detection of CSF-restricted oligoclonal bands in special are pivotal for differential diagnosis beyond the diagnostic contribution, helping to exclude mimics and provide additional diagnostic information such as the clonality of IgG.

    “CSF analysis in general and detection of CSF-restricted oligoclonal bands in special are pivotal for differential diagnosis beyond the diagnostic contribution, helping to exclude mimics and provide additional diagnostic information such as the clonality of IgG.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [12] Konen, 2025, German Society for Cerebrospinal Fluid Diagnostics and Clinical Neurochemistry (DGLN e.V.). Oligoclonal bands and kappa free light chains: competing parameters or complementary biomarkers?, Autoimmun Rev source
    • cites [36] Konen, 2021, The increasing role of Kappa free light chains in the diagnosis of multiple sclerosis, Cells source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [37] Hannich, 2024, Implications of monoclonal gammopathy and isoelectric focusing pattern 5 on the free light chain kappa diagnostics in cerebrospinal fluid, Clin Chem Lab Med source

  • May combine two claims.

    Findingown data

    Of the 20 additional MS diagnoses under the 2024-revised criteria compared with the 2017 criteria, 13/20 (65%) derived from patients with CIS and 7/20 (35%) from individuals with RIS.

    “Of the 20 additional MS diagnoses according to the 2024-revised McDonald criteria compared with the 2017 revised McDonald criteria, 65% (13/20) derived from patients with CIS, which were mainly diagnosed (11/13, 85%) due to consideration of the optic nerve as fifth neuroanatomical topography (Table 2).”
    • Also stated in: § Results · plain
      “35% (7/20) of the additional MS diagnoses according to the 2024-revised McDonald criteria derived from consideration of individuals with RIS (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All participants underwent spinal cord MRI and spinal cord lesions were identified in 140/215 (65%) individuals, including 20/215 (9%) with gadolinium-enhancing lesions.

    “All participants underwent spinal cord MRI and spinal cord lesions were identified in 140/215 (65%) individuals, including 20/215 (9%) with gadolinium-enhancing lesions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    According to the 2024-revised McDonald criteria, 3/4 patients with CIS and 2/2 individuals with RIS could have been diagnosed with MS after initial diagnostic work-up, leading to a median diagnostic delay of 16 months for CIS and 11 months for RIS.

    “According to the 2024-revised McDonald criteria 3/4 patients with CIS and 2/2 individuals with RIS could have been diagnosed with MS after initial diagnostic work-up, leading to a median diagnostic delay of 16 months for CIS (IQR: 10–19) and 11 months for individuals with RIS (IQR: 9–13).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    During follow-up, 4/16 (25%) patients with CIS and 2/6 (33%) individuals with RIS fulfilled the 2017-revised McDonald criteria for MS.

    “During follow-up, 4/16 (25%) patients with CIS and 2/6 (33%) individuals with RIS fulfilled the 2017-revised McDonald criteria for MS.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Optic nerve involvement was present in 116/201 patients with MS (58%) and was predominantly identified by VEP (103/116, 89%).

    “VEP identified optic nerve lesions in 89% of cases.”
    • Also stated in: § Results · plain
      “Optic nerve involvement was present in 116/201 patients with MS (58%) and was predominantly identified by VEP (103/116, 89%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Applying the 2017-revised McDonald criteria, 181/215 (84%) were diagnosed with MS, 26/215 (12%) remained CIS, and 8/215 (4%) remained RIS.

    “Applying the 2017-revised McDonald criteria after initial diagnostic work-up, 181/215 (84%) of the included patients were diagnosed with MS, whereas 26/215 (12%) remained as CIS and 8/215 (4%) as RIS.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among the 8 individuals with RIS, 7 (88%) fulfilled the 2024-revised criteria for MS and 1 (12%) remained classified as RIS (p = 0.016 vs 2017).

    “Among the 8 individuals with RIS, 7 (88%) fulfilled the 2024-revised criteria for MS and 1 (12%) remained classified as RIS (compared to 2017-revised McDonald criteria p = 0.016).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Of the 11 CIS diagnosed due to optic nerve involvement, it was demonstrated by MRI and VEP in 6/11, VEP only in 1/11, and MRI only in 4/11.

    “Involvement of the optic nerve was demonstrated with MRI and VEP in 6/11, VEP only in 1/11 or MRI only in 4/11.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among the 129 patients in whom MS diagnosis remained possible without optic nerve topography, 44/129 fulfilled DIS in 5/5 neuroanatomical topographies by MRI only and 85/129 had no evidence of optic nerve involvement on either VEP or MRI.

    “This group comprised 44/129 patients fulfilling DIS in 5/5 neuroanatomical topographies by MRI only and 85/129 patients without evidence of optic nerve involvement on either VEP or MRI.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Among patients presenting with a first demyelinating event, 194/207 (94%) fulfilled the 2024-revised McDonald criteria for MS versus 181/207 (87%) under the 2017-revised criteria (p = 0.0002).

    “Among patients presenting with a first demyelinating event, 194/207 (94%) fulfilled the 2024-revised McDonald criteria for MS, whereas 13/207 (6%) remained classified as CIS (compared with 2017-revised McDonald criteria p = 0.0002).”
    • Also stated in: § Results · plain
      “Among patients presenting with a first demyelinating event, 181/207 (87%) fulfilled the 2017-revised McDonald criteria for MS, whereas 26/207 (13%) remained classified as CIS.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among patients presenting with a first demyelinating event, 181/207 (87%) fulfilled the 2017-revised McDonald criteria for MS and 26/207 (13%) remained classified as CIS.

    “Among patients presenting with a first demyelinating event, 181/207 (87%) fulfilled the 2017-revised McDonald criteria for MS, whereas 26/207 (13%) remained classified as CIS.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Of the included patients, 135/215 (63%) were female, with a median age at diagnosis of 34 years (IQR: 27-45).

    “Of the included patients, 135/215 (63%) were female, with a median age at diagnosis of 34 years (IQR: 27–45).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    None of the diagnosed patients with MS presented without DIS, thus evidence of PRL or CVS was not needed.

    “None of the diagnosed patients with MS presented without DIS, thus evidence of PRL or CVS was not needed.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    A subset of patients presenting with CIS or RIS at baseline remained undiagnosed even with the updated criteria, despite some progressing to clinically definite MS during follow-up.

    “Nevertheless, a subset presenting with CIS or RIS at baseline remained undiagnosed even with the updated criteria, despite some of them progressing to clinically definite MS during follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Thirteen patients with neurological symptoms who did not fulfil diagnostic criteria for MS were classified as CIS, and one asymptomatic patient was classified as RIS.

    “Thirteen patients with neurological symptoms who did not fulfil the diagnostic criteria for MS were classified as CIS, whereas one asymptomatic patient was classified as RIS.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In patients with DIS in only 2/5 neuroanatomical topographies, inflammatory CSF findings were present in all cases and optic nerve involvement could additionally be demonstrated by MRI in most patients.

    “In patients with DIS in only 2/5 neuroanatomical topographies, inflammatory CSF findings were present in all cases and optic nerve involvement could additionally be demonstrated by MRI in most patients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Pathological VEP findings were present in a substantially larger proportion of patients, but VEP rarely represented the sole diagnostic feature required to establish MS.

    “Although pathological VEP findings were present in a substantially larger proportion of patients, VEP rarely represented the sole diagnostic feature required to establish MS.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The application of the 2024-revised McDonald criteria was performed retrospectively as a re-classification analysis using prospectively acquired clinical, MRI, VEP, and CSF data.

    “The application of the 2024-revised McDonald criteria was performed retrospectively as a re-classification analysis using the prospectively acquired clinical, MRI, VEP, and CSF data.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This study followed the STROBE reporting guideline.

    “This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Follow-up data were available in 116/215 (54%) participants.

    “Follow-up data were available in 116/215 (54%) participants.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Application of selected components of the 2024-revised McDonald criteria increased the proportion of individuals fulfilling the diagnostic criteria, mainly through inclusion of optic nerve involvement and recognition of RIS.

    “Application of selected components of the 2024-revised McDonald criteria increased the proportion of individuals fulfilling the diagnostic criteria, mainly through inclusion of optic nerve involvement and recognition of RIS.”
    • Also stated in: § Results · plain
      “The flow diagram highlights that the increase in MS diagnoses under the 2024-revised criteria is primarily driven by incorporation of optic nerve involvement and by allowing diagnosis in patients with limited DIS when supported by additional diagnostic features.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study was conducted according to a prespecified study protocol.

    “The study was conducted according to a prespecified study protocol, which is provided as a Supplementary Appendix.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    No baseline data required for diagnostic classification were missing.

    “No baseline data required for diagnostic classification were missing.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Ethical approval was obtained from the Ethics Committee of Hannover Medical School (No. 8819_BO_S_2019).

    “Ethical approval was obtained from the Ethics Committee of Hannover Medical School (MHH), Hannover, Germany (No. 8819_BO_S_2019).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Written informed consent was obtained from all participants.

    “Written informed consent for study participation, collection of clinical and paraclinical data, and their use for scientific analyses and publication was obtained from all participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    No formal sample size calculation was performed because all consecutive eligible individuals presenting during the study period were included and the study was exploratory and hypothesis-generating.

    “No formal sample size calculation was performed because all consecutive eligible individuals presenting during the study period were included and this study was rather exploratory and hypothesis-generating.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Conventional diagnostic tools including MRI, CSF, and VEP remain highly informative and allow most diagnoses to be established without the need for novel imaging markers.

    “Conventional diagnostic tools including MRI, CSF, and VEP remain highly informative and allow most diagnoses to be established without the need for novel imaging markers.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The 2024-revised McDonald criteria can be validly applied using only conventional diagnostic tools (MRI, CSF, VEP) without novel imaging biomarkers.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The primary and secondary outcomes were prespecified in the study protocol.

    “The primary and secondary outcomes were prespecified in the study protocol.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Exploratory diagnostic scenario analyses and theoretical evaluations of additional biomarkers (CVS, PRL, and OCT) were performed post hoc.

    “Exploratory diagnostic scenario analyses and theoretical evaluations of additional biomarkers (CVS, PRL, and OCT) were performed post hoc.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    In this subgroup, the presence of CVS lesions would theoretically allow fulfilment of the diagnostic criteria for MS according to the 2024-revised McDonald criteria.

    “In this subgroup, the presence of CVS lesions would theoretically allow fulfilment of the diagnostic criteria for MS according to the 2024-revised McDonald criteria.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The present study's findings are limited to the diagnostic components available in the cohort.

    “the findings presented should be interpreted in the context of the diagnostic components that were available in this cohort.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisereasoning

    The extent to which the revised framework increases diagnostic yield when applied using conventional diagnostic work-up has not yet been systematically evaluated.

    “In particular, the extent to which the revised framework increases diagnostic yield when applied using conventional diagnostic work-up has not yet been systematically evaluated.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    During a median follow-up of nine months (IQR 6-13), follow-up was available in 12/14 patients (86%), with two lost to follow-up.

    “During a median follow-up of nine months (IQR: 6–13), available in 12/14 patients (86%; two lost to follow-up)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The 2024 criteria may capture high-risk RIS cases earlier, potentially influencing surveillance and treatment strategies.

    “this suggests that the 2024 criteria may capture high-risk RIS cases earlier, potentially influencing surveillance and treatment strategies.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisenone given

    Available evidence mainly consists of expert consensus papers describing the proposed criteria and studies evaluating individual biomarkers, whereas prospective real-world studies assessing the overall diagnostic impact of the revised criteria remain scarce.

    “Available evidence mainly consists of expert consensus papers describing the proposed criteria and studies evaluating individual biomarkers, whereas prospective real-world studies assessing the overall diagnostic impact of the revised criteria remain scarce.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Novel MRI markers (CVS, PRL) and OCT-based assessment of optic nerve involvement were not systematically acquired and could not be comprehensively evaluated.

    “these markers were not systematically acquired and therefore could not be comprehensively evaluated.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Gender identity, race and ethnicity were not systematically assessed and therefore sex-specific, gender-related, or race-/ethnicity-associated effects could not be evaluated.

    “Further, gender identity, race and ethnicity were not systematically assessed and therefore sex-specific, gender-related, or race-/ethnicity-associated effects could not be evaluated.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Follow-up duration was relatively short in some patients.

    “However, follow-up duration was relatively short in some patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    VEP retains its high clinical value due to rapid execution, cost-effectiveness, and applicability compared to orbital MRI, which is associated with a longer scan duration.

    “Therefore, VEP retains its high clinical value due to rapid execution, cost-effectiveness, and applicability compared to orbital MRI, which is associated with a longer scan duration.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    CSF analysis enables diagnosis in a high number of patients, providing both high diagnostic yield and essential differential diagnostic information.

    “CSF analysis enables diagnosis in a high number of patients, providing both high diagnostic yield and essential differential diagnostic information.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study had a single-centre design.

    “Limitations of the present study include its single-centre design”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Application of the routinely available components of the 2024-revised McDonald criteria enhances diagnostic sensitivity and allows for earlier MS diagnosis primarily through inclusion of optic nerve involvement and recognition of high-risk RIS cases.

    “In conclusion, application of the routinely available components of the 2024-revised McDonald criteria enhances diagnostic sensitivity and allow for earlier MS diagnosis primarily through inclusion of optic nerve involvement and recognition of high-risk RIS cases.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    OCT would also be applicable in a subset of patients to demonstrate optic nerve involvement.

    “Despite the high proportion of pathological VEP, OCT would also be applicable in a subset of patients to demonstrate optic nerve involvement.”
    Quote in the paperNot a substantial claim
58 of 58

  • The paper relies on this without support.

    The single-centre cohort is representative of routine clinical practice.

    “in a real-world setting using conventional and well-established MRI markers and CSF diagnostic methods already available”
    “in routine clinical practice”

  • The paper relies on this without support.

    The 2024-revised McDonald criteria can be validly applied using only conventional diagnostic tools (MRI, CSF, VEP) without novel imaging biomarkers.

    “Applying the 2024-revised McDonald criteria for multiple sclerosis using conventional diagnostic tools: a single-centre prospective cohort study in Germany”
    “using conventional and well-established MRI markers and CSF diagnostic methods already available (paraclinical tools as per 2017-revised McDonald criteria)”

  • The authors state this as an assumption.

    In the hypothetical analysis, CSF results were assumed to be absent.

    “Under this assumption, 99/201 MS diagnoses (49%) would be affected”
    “in the hypothetical absence of CSF results”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Abstract says all 99 additional diagnoses required both CSF findings and dissemination in time

    Minor

    The abstract says the 99 diagnoses required inflammatory CSF findings and dissemination in time. The Results instead classify 50 as having positive CSF findings without dissemination in time and three as having dissemination in time without inflammatory CSF findings.

1 of 1

Cites

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Related

Authors
Konen, F. F., Mahmoudi, N., Albers, L. M., Arrambide, G., Streichert, A. L., Haar, M., Soldatov, A., Bucak, E., Jendretzky, K. F., Nay, S., Grote-Levi, L., Hegelmaier, T., Trebst, C., Schwenkenbecher, P., Hümmert, M. W., Pawlitzki, M., Sühs, K.-W., Khalil, M., Framme, C., Petzold, A., Meuth, S. G., Wattjes, M. P., Haghikia, A., Montalban, X., Renne, J., & Skripuletz, T.
Affiliations
  • Medizinische Hochschule Hannover (DE)
  • Humboldt-Universität zu Berlin (DE)
  • Universitat de Vic - Universitat Central de Catalunya (ES)
  • University of Münster (DE)
  • Medical University of Graz (AT)
  • Moorfields Eye Hospital (GB)
Corresponding author
Skripuletz, Thomas
ORCID
Venue
eClinicalMedicine
Publisher
Elsevier BV
Published
2026-08
Volume
98
Pages
104098
ISSN
2589-5370 (ISSN-L)
DOI
10.1016/j.eclinm.2026.104098
PMC
PMC13430206
OpenAlex
W7171191516
Semantic Scholar
b901d3930ec6c5cea3acbcdba5bd6c06a441789e
Cited by
0
References
41
FWCI
0.00
Type
journal article
Language
en
Open access
Licence
Locations
  • EClinicalMedicine (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • PubMed Central (submittedVersion, cc-by)
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 › Oncology › Polyomavirus and related diseases
Keywords
multiple sclerosis, radiologically isolated syndrome, optic nerve involvement, visual evoked potentials, cerebrospinal fluid analysis, MRI biomarkers, early diagnosis, demyelinating disease, dissemination in time

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-22.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-22.

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Statistics and arithmetic are recomputed, not judged.

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