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Letter
Diagnosis of multiple sclerosis: a multicentre study to compare revised McDonald-2010 and Filippi-2010 criteria
  1. Paolo Preziosa1,2,
  2. Maria A Rocca1,2,
  3. Sarlota Mesaros3,
  4. Alessandro Meani1,
  5. Xavier Montalban4,
  6. Jelena Drulovic3,
  7. Amgad Droby5,
  8. Frauke Zipp5,
  9. Massimiliano Calabrese6,
  10. Jaume Sastre-Garriga4,
  11. Irena Dujmovic-Basuroski3,
  12. Alex Rovira7,
  13. Massimo Filippi1,2
  1. 1 Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
  2. 2 Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
  3. 3 Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  4. 4 Department of Neurology-Neuroimmunology, Cemcat, Vall d’Hebron University Hospital, Barcelona, Spain
  5. 5 Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine-Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
  6. 6 Neurology B, Department of Neurosciences, Biomedicine and Movement, University of Verona, Italy
  7. 7 Section of Neuroradiology (Department of Radiology), Hospital Vall d’Hebron, Autonomous University of Barcelona, Barcelona, Spain
  1. Correspondence to Prof Massimo Filippi, Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina, 60, 20132 Milan, Italy; filippi.massimo{at}hsr.it

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Introduction

MRI has been formally included in the diagnostic work-up of patients with a suspicion of multiple sclerosis (MS) in 2001, to demonstrate disease dissemination in space (DIS) and time (DIT) and to exclude alternative diagnoses.1 Over time, these criteria have been modified to simplify their use and to clarify specific aspects (eg, spinal cord findings).2

One aspect marginally analysed in the diagnostic work-up of patients with clinically isolated syndrome (CIS) is the role of intracortical lesions (ICLs), which are a prominent feature of MS and contribute to disability and cognitive impairment.2 A single-centre study3 showed that inclusion of ICL for the evaluation of DIS in CIS increased the accuracy of MRI diagnostic criteria, with an improvement of specificity.3

The aim of this study was to compare revised McDonald-20101 and Filippi-20103 criteria with respect to development of clinically definite MS (CDMS) in a multicentric cohort of patients with CIS.

Methods

Institutional review board approval and written informed consent were obtained.

Subjects

Consecutive patients with CIS suggestive of MS were prospectively recruited from 2008 to 2013 from five European centres within the MAGNIMS network (http://www.magnims.eu/) (see online supplementary file 1, Supplementary Methods).

Supplementary Material

Supplementary material 1
[SP1.pdf]

Inclusion criteria were a typical CIS syndrome, exclusion of alternative diagnoses and previous events, a baseline brain (including double inversion recovery (DIR)) and spinal cord MRI scan acquired ≤3 months from CIS onset, a follow-up brain scan acquired ≤12 months from CIS onset and a clinical follow-up ≥3 years or until CDMS conversion (defined as occurrence of a second relapse ≥1 month after the first attack) if ≤3 years.

MRI acquisition and analysis

Using 1.5 (two centres) or 3.0 Tesla (three centres) scanners, brain (including DIR) and spinal cord sequences for lesion identification were acquired. Online supplementary material shows parameters and examples of MRI sequences …

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Footnotes

  • Contributors PP: drafting/revising the manuscript and MRI data analysis. MAR: drafting/revising the manuscript, MRI data analysis and interpretation of the data. SM: patients’ recruitment. AM: drafting/revising the manuscript and statistical analysis. XM: patients’ recruitment and drafting/revising the manuscript. JD: patients’ recruitment. AD: patients’ recruitment. FZ: patients’ recruitment and revising the manuscript. MC: patients’ recruitment. JS-G: patients’ recruitment and drafting/revising the manuscript. ID-B: patients’ recruitment. AR: patients’ recruitment and drafting/revising the manuscript. MF: drafting/revising the manuscript, study concept and analysis and interpretation of the data. MF also acted as study supervisor. All the authors gave their approval to the current version of the manuscript.

  • Funding This study was partially supported by a grant from the Ministry of Science, Republic of Serbia (project number 175031).

  • Competing interests PP has received speakers honoraria from Biogen Idec, Novartis and ExceMED. MAR has received speakers honoraria from Biogen Idec, Novartis, Genzyme, Sanofi-Aventis, Teva and Merk Serono and receives research support from the Italian Ministry of Health and Fondazione Italiana Sclerosi Multipla. XM has received speaking honoraria and travel expenses for participation in scientific meetings, has been a steering committee member of clinical trials or participated in advisory boards of clinical trials in the past years with Actelion, Bayer, Biogen, Celgene, Genzyme, Merck, Novartis, Oryzon Genomics, Roche, Sanofi-Genzyme and Teva Pharmaceutical. FZ received funds for consultation or research/symposia from Novartis, Merck Serono, Teva, Ono, Octapharma, Biogen, Genzyme and Sanofi Aventis. MC received funds for consultation or research/symposia from Novartis, Merck Serono, Teva, Biogen, Genzyme and Sanofi Aventis. JS-G has received compensation in the last 12 months for participating on advisory boards, speaking, travel expenses for scientific meetings or research support from Genzyme, Novartis, Biogen, Excemed and Merck. AR serves on scientific advisory boards for Biogen Idec, Novartis, Sanofi-Genzyme, and OLEA Medical; has received speaker honoraria from ExceMED Bayer, Genzyme, Sanofi-Aventis, Bracco, Merck-Serono, Teva Pharmaceutical Industries Ltd, OLEA Medical, Stendhal, Novartis and Biogen Idec; and has research agreements with Siemens AG and Icometrix.MF is Editor-in-Chief of the Journal of Neurology; serves on a scientific advisory board for Teva Pharmaceutical Industries; has received compensation for consulting services and/or speaking activities from Biogen Idec, Merk-Serono, Novartis, and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Teva Pharmaceutical Industries, Novartis, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla (FISM), Cure PSP, Alzheimer’s Drug Discovery Foundation (ADDF), the Jacques and Gloria Gossweiler Foundation (Switzerland), and ARiSLA (Fondazione Italiana di Ricerca per la SLA).

  • Patient consent Obtained.

  • Ethics approval Each participating centre.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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