MRI diagnostic criteria for multiple sclerosis: an update

MRI diagnostic criteria for multiple sclerosis: an update Poster No.: C-0285 Congress: ECR 2013 Type: Educational Exhibit Authors: L. Valls Masot, A. M. Quiles Granado, J. Puig Alcántara, L. RamióTorrentà, S. Pedraza Gutiérrez; Girona/ES Keywords: Inflammation, Edema, Diagnostic procedure, Education, MR, Neurorradiología, columna dorsolumbar, Neuroradiology peripheral nerve, Neuroradiology brain DOI: 10.1594/ecr2013/C-0285 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 26

Learning objectives 1. To exhibit the new 2010 revised McDonald criteria emphasizing changes over time as well as their impact on the diagnostic management of patients with multiple sclerosis (MS). 2. To establish the differential diagnosis with Devic's optic neuromyelitis (NMO) and with acute disseminated encephalitis (ADEM) and to illustrate them. Background The 2005 McDonald criteria, based on the Barkhof-Tintoré criteria for establishing dissemination in space of lesions in the central nervous system, were the best-known criteria in the diagnosis of patients with MS. However, they have been recently revised and modified so that new 2010 McDonald criteria are currently used. The analysis of diagnostic criteria evolution on MRI evidence: a) An effort to simplify the demonstration of the dissemination in space. b) A clear intention to reduce the number of MRI required establishing existence of disseminations in time. All these changes have increased sensitivity in the early diagnosis of MS patients, with preservation of accuracy and specificity. At the same time, it has been managed to standardise their application across different populations as well as to achieve consensus on their usage among neuroradiologists. Imaging findings OR Procedure details See sidebar presentation Images for this section: Page 2 of 26

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Fig. 18: Fig. MRI images of two different patients (a and b) and (c, d and e) with MS compatible lesions. Axial (a), sagittal (b), axial (c) and sagittal (e) fluid -attenuated inversion recovery images, and double inversion-recovery sequence (d). There are multiple demyelinating plaques in the MS-typical regions including periventricular (yellow arrows) and juxtacortical white matter, and infratentorial (orange arrow) lesions. There are also subcortical white matter lesions (red arrows) and involvement of the corpus callosum with atrophy and lesions on the calloseptal surface (blue arrows) Page 20 of 26

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Fig. 20: Fig. Axial (a) and sagittal (b) fluid-attenuated inversion recovery images of brain without evidence of lesions. Sagittal (c), and axial (d) T2-weighted images and show large and ill-defined lesions of the central portion of the spinal cord, extending over 3 vertebral segments. A postcontrast sagittal T1-weighted image (e) demonstrates a mild heterogeneous enhancement of the spinal cord lesions. These findings were consistent with Devic's optic neuromyelitis (NMO) disease Page 22 of 26

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Fig. 22: Fig. Axial FLAIR (a), sagittal FLAIR (b) and axial T1-weighted postcontrast (c) images that show an ADEM. Large lesions can be observed in the periventricular, subcortical and juxtacortical white matter, as wll as in the corpus callosum, with a nodular enhancement pattern(c) Page 24 of 26

Conclusion MRI is a highly sensitive and relatively specific technique for the identification of CNS demyelinating lesions The MAGNIMS group has validated the 2010 McDonald criteria to simplify the early diagnosis of CDMS and PPMS, with preservation of accuracy and specificity They have been validated in patients with a typical CIS or suspected PPMS. The NMO in Asian and Latin American adult populations and ADEM in children must be excluded References Chris H. Polman PhD, Stephen C. Reingold Phd, Brenda Banwell MD et al. Diagnostic Criteria for Multiple Sclerosis: 2010 Revisions to the McDonald Criteria. ANN NEUROL 2011;69:292-302 D. J. Rigotti PhD, O. Gonen PhD. Is "Benign Multiple Sclerosis" really benign?. REVISTA ESPAÑOLA DE ESCLEROSIS MÚLTIPLE Nº 14 - Junio de 2010 Polman CH, Reingold SC, Edan G, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the ''McDonald Criteria.'' Ann Neurol 2005;58:840-846 Ketelslegers IA, Neuteboom RF, Boon M, et al. A comparison of MRI criteria for diagnosing pediatric ADEM and MS. Neurology. 2010;74:1412-1415 Àlex Rovira et Al. A Single, Early Magnetic Resonance Imaging Study in the Diagnosis of Multiple Sclerosis. Arch Neurol. 2009;66(5):587-592 McDonaldWI, Compston A, Edan G, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 2001;50:121-127 Miller DH, Weinshenker BG, Filippi M, et al. Differential diagnosis of suspected multiple sclerosis: a consensus approach. Mult Scler 2008;14:1157-1174 Rovira A, Swanton J, Tintore M, et al. A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis. Arch Neurol 2009;5:287-292 Montalban X, Tintoré, M, Swanton J, et al. MRI criteria for MS in patients with clinically isolated syndromes. Neurology 2010;74: 427-434 A. Rovira, M. Tintoré,et Al. Recomendaciones para la utilización e interpretación de los estudios de resonancia magnética en la esclerosis múltiple. Neurología. 2010;25(4):248-265 Page 25 of 26

Callen DJA, Shroff MM, Branson HM, et al. MRI in the diagnosis of pediatric multiple sclerosis. Neurology 2009;72:961-967 Filippi M, Rocca MA, et al. Correlations between structural CNS damage and functional MRI changes in primary progressive multiple sclerosis. Neuroimage 2002; 15:537-46 Brex PA, Ciccarelli O, et al. Longitudinal study of abnormalities on MRI and disability from multiple sclerosis. N Engl J Med 2002; 346: 158-64 Fazekas F, et al. Histopathologic analysis of foci of signal loss on gradientecho T2-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds. Am JNeuroradiol, l999, 20 : 637-642. Personal Information vallslaia@hotmail.com Page 26 of 26