Intracortical lesions: Relevance for new MRI diagnostic criteria for multiple sclerosis
Abstract
Objective To generate and validate new MRI diagnostic criteria for multiple sclerosis (MS) taking into account not only white matter lesions but also intracortical lesions (ICLs). Methods Brain double inversion recovery and brain and cord T2- and postcontrast T1-weighted scans were acquired in a training (80 patients with clinically isolated syndromes [CIS], median follow-up = 55.3 months) and a validation (39 patients with CIS, median follow-up = 28.0 months) sample. In the training sample, regression analysis and Cox proportional hazard model were used to identify MRI variables independently predicting the evolution to clinically definite (CD) MS. The best criterion selected was then validated. The performance of the new and previously available MRI criteria for disease dissemination in space (DIS) and time (DIT) were tested. Results The final multivariate model showed that ≥1 ICL (p Conclusions The accuracy of MRI diagnostic criteria for MS is increased when considering the presence of ICLs on baseline scans from patients at presentation with CIS suggestive of MS. If confirmed by other studies, ICL detection might be considered in future diagnostic algorithms for MS.
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A recent multicenter case series demonstrated that a wide range of conditions can be mistaken for MS.
“A recent multicenter case series demonstrated that a wide range of conditions can be mistaken for MS. 11”
From Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria (2018) · cites this paper as [11]
Misdiagnosis of MS remains an issue in clinical practice.
“Misdiagnosis of MS remains an issue in clinical practice. 8-11”
From Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria (2018) · cites this paper as [11]
Misdiagnosis had harmful consequences in some patients.
“Misdiagnosis had harmful consequences in some patients, emphasizing the importance of appropriate application of the McDonald Criteria (Panel 3).”
From Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria (2018) · cites this paper as [11]
Aside from NMOSD, the most frequent reason for misdiagnosis as MS was misinterpretation of nonspecific symptoms, neurologic signs, or MRI findings in common disorders (for example, migraine), which when reviewed carefully, in most patients, would not fulfill the 2010 McDonald Criteria.
“Aside from NMOSD, the most frequent reason for misdiagnosis as MS was misinterpretation of nonspecific symptoms, neurologic signs, or MRI findings in common disorders (for example, migraine), which when reviewed carefully, in most patients, would not fulfill the 2010 McDonald Criteria.”
From Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria (2018) · cites this paper as [11]
Cortical lesions are better seen using double inversion recovery (DIR) or phase-sensitive inversion recovery (PSIR) techniques.
“are better seen using double inversion recovery (DIR) or phase-sensitive inversion recovery (PSIR) techniques.73,75”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [73]
Cortical lesions are rarely visualised on conventional MRI sequences.
“cortical lesions are rarely visualised on conventional MRI sequences”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [73]
Cortical grey matter lesions may be helpful in making a diagnosis of MS.
“Cortical grey matter lesions may be helpful in making a diagnosis of MS 68,73”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [73]
Some of these recommendations are evidence-based and others are based on expert consensus.
“Some of these recommendations are evidence-based 73,74 and others are based on expert consensus.”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [73]
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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
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Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria
Polman, C. H., Reingold, S. C., Banwell, B., Clanet, M., Cohen, J. A., Filippi, M., Fujihara, K., Havrdova, E., Hutchinson, M., Kappos, L., et al. (2011) · Annals of Neurology · doi:10.1002/ana.22366 · Cited by 9,802 · see citing works
Self-citationDiagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria
Thompson, A. J., Banwell, B. L., Barkhof, F., Carroll, W. M., Coetzee, T., Comi, G., Correale, J., Fazekas, F., Filippi, M., Freedman, M. S., et al. (2018) · The Lancet Neurology · doi:10.1016/s1474-4422(17)30470-2 · Cited by 8,167 · see citing works
Self-citationInflammatory cortical demyelination in early multiple sclerosis.
Lucchinetti, C. F., Popescu, B. F. G., Bunyan, R. F., Moll, N. M., Roemer, S. F., Lassmann, H., Brück, W., Parisi, J. E., Scheithauer, B. W., Giannini, C., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1100648 · Cited by 1,103 · see citing works
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
- Authors
- Filippi, M., Rocca, M. A., Calabrese, M., Sormani, M. P., Rinaldi, F., Perini, P., Comi, G., & Gallo, P.
- Affiliations
- IRCCS Ospedale San Raffaele (IT)
- Venue
- Neurology
- Published
- 2010-11-30
- Volume
- 75
- Issue
- 22
- Pages
- 1988-1994
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- OpenAlex
- W1964519292
- Cited by
- 172
- References
- 3
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 7 · 2023: 7 · 2022: 4 · 2021: 7 · 2020: 8 · 2019: 8 · 2018: 12 · 2017: 21 · 2016: 18 · 2015: 10 · 2014: 16 · 2013: 11 · 2012: 23
- FWCI
- 10.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Oncology › Polyomavirus and related diseases
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- intracortical lesions, multiple sclerosis, clinically isolated syndrome, MRI diagnostic criteria, clinically definite multiple sclerosis, infratentorial lesions, spinal cord lesions, gadolinium-enhancing lesions
- MeSH terms
- Adult, Cerebral Cortex, Female, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis, Nerve Fibers, Myelinated, Predictive Value of Tests, Prognosis, Regression Analysis, Sensitivity and Specificity, Spinal Cord, Proportional Hazards Models, Disease Progression, Kaplan-Meier Estimate
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