Tintoré M, Rovira A, Río J, Nos C, Grivé E, Sastre-Garriga J, Pericot I, Sánchez E, Comabella M, Montalban X
Clinical Neuroimmunology Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Neurology. 2003 Jan 14;60(1):27-30. doi: 10.1212/wnl.60.1.27.
Recently developed diagnostic criteria for MS (McDonald criteria) indicate that in patients with a single demyelinating episode (clinically isolated syndromes [CIS]), evidence for dissemination in space and time, essential for diagnosis, may be provided by MRI.
To assess the usefulness of these new criteria in patients with CIS suggestive of MS.
A total of 139 patients with CIS followed for a median of 3 years underwent brain MRI within 3 months of their first attack and again 12 months later. The number and location of lesions at baseline, the development of new lesions at follow-up, and the results of CSF examination (which, if positive, requires fewer MR abnormalities for diagnosis) were analyzed. The new McDonald criteria (incorporating MRI) were compared to the existing Poser diagnostic criteria and their accuracy was evaluated.
At 12 months, 11% had clinically definite MS according to the Poser criteria compared to 37% with the McDonald criteria. Eighty percent of patients fulfilling these new criteria developed a second clinical episode within a mean follow-up of 49 months. The new criteria showed a sensitivity of 74%, specificity of 86%, and accuracy of 80% in predicting conversion to clinically definite MS.
One year after symptom onset, more than three times as many patients with CIS were diagnosed with MS using new diagnostic criteria incorporating MRI results compared to older criteria. However, the proposed MRI criteria require further prospective studies to optimize sensitivity and specificity.
最近制定的多发性硬化症诊断标准（麦克唐纳标准）表明，对于单次脱髓鞘发作的患者（临床孤立综合征[CIS]），磁共振成像（MRI）可提供诊断所必需的空间和时间上的播散证据。
评估这些新标准对疑似多发性硬化症的临床孤立综合征患者的实用性。
139例临床孤立综合征患者，中位随访时间为3年，在首次发作后3个月内及12个月后分别接受脑部MRI检查。分析基线时病灶的数量和位置、随访中新发病灶的情况以及脑脊液检查结果（脑脊液检查若呈阳性，则诊断所需的MRI异常较少）。将新的麦克唐纳标准（纳入MRI）与现有的波泽诊断标准进行比较，并评估其准确性。
12个月时，根据波泽标准，11%的患者患有临床确诊的多发性硬化症，而根据麦克唐纳标准这一比例为37%。符合这些新标准的患者中，80%在平均49个月的随访期内出现了第二次临床发作。新的标准在预测转化为临床确诊的多发性硬化症方面，敏感性为74%，特异性为86%，准确性为80%。
症状出现一年后，与旧标准相比，采用纳入MRI结果的新诊断标准诊断出的临床孤立综合征患者中，被诊断为多发性硬化症的人数多出三倍多。然而，所提出的MRI标准需要进一步的前瞻性研究以优化敏感性和特异性。
