MS, MRI, and the 2010 McDonald criteria: A Canadian expert commentary
Abstract
Since the first development of diagnostic criteria for multiple sclerosis (MS), there have been regular revisions of disease definitions and diagnostic thresholds aimed at improving specificity while maintaining sensitivity. The central requirements for diagnosis of MS are dissemination in space (DIS) and dissemination in time (DIT) of lesions in the CNS, with the proviso that there should be no alternate diagnosis that better explains the clinical presentation. The most definitive diagnosis is the purely clinical one, with 2 separate attacks of symptoms (fulfilling DIT criteria) involving at least 2 different areas of the CNS (fulfilling DIS criteria). In patients who have had a first but not a second clinical attack, the McDonald criteria provide guidance on how paraclinical evidence can be used to support a diagnosis of MS. Recently, the McDonald criteria were revised and new definitions for DIS and DIT proposed. In response to that revision, a panel of Canadian MS neurologists and one neuroradiologist created this commentary regarding the clinical implications and applications of the 2010 McDonald criteria.
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The McDonald MRI criteria were developed and tested in CIS patients with symptoms typical of MS and they should not be applied to patients with non-specific neurological symptoms such as paraesthesia, dizziness or headache, in which the diagnosis is much less likely.
“The McDonald MRI criteria were developed and tested in CIS patients with symptoms typical of MS (e.g.unilateral optic neuritis) and they should not be applied to patients with non-specific neurological symptoms such as paraesthesia, dizziness or headache, in which the diagnosis is much less likely.23”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [23]
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 [23]
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Confavreux, C., & Compston, A. (2006) · McAlpine's Multiple Sclerosis · doi:10.1016/b978-0-443-07271-0.50006-9 · Cited by 166 · 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
The contemporary spectrum of multiple sclerosis misdiagnosis
Solomon, A. J., Bourdette, D. N., Cross, A. H., Applebee, A., Skidd, P. M., Howard, D. B., Spain, R. I., Cameron, M. H., Kim, E., Mass, M. K., et al. (2016) · Neurology · doi:10.1212/wnl.0000000000003152 · Cited by 334 · see citing works
- Authors
- Selchen, D., Bhan, V., Blevins, G., Devonshire, V., Duquette, P., Grand’Maison, F., Kremenchutzky, M., Lapierre, Y., Li, D., von Riedemann, S. J., & Freedman, M.
- Affiliations
- Western University (CA)
- From the Division of Neurology (D.S.), St. Michael's Hospital, University of Toronto; Dalhousie University (V.B.); Division of Neurology (G.B.), University of Alberta; University of British Columbia (V.D.); CHUM Notre-Dame (P.D.); Department of Medicine (F.G.), Hôpital Charles LeMoyne, Université de Sherbrooke; Clinical Neurosciences Department (M.K.), The University of Western Ontario; Neurology/Neurosurgery Department (Y.L.), McGill University; MS Clinic (Y.L.), MNH/MNI, McGill; Department of...
- ORCID
- Venue
- Neurology
- Published
- 2012-12-04
- Volume
- 79
- Issue
- 23_supplement_2
- Pages
- S1-15
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- OpenAlex
- W2048910666
- Cited by
- 25
- References
- 1
- Citations by year
- 2026: 1 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 5 · 2016: 4 · 2015: 5 · 2014: 2 · 2013: 3
- FWCI
- 2.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- 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, magnetic resonance imaging, magnetic resonance spectroscopy, dissemination in space, dissemination in time, diagnostic criteria, central nervous system lesions
- MeSH terms
- Age Factors, Brain, Canada, Humans, Magnetic Resonance Imaging, Multiple Sclerosis, Sensitivity and Specificity
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