Korteweg Tijmen, Tintoré Mar, Uitdehaag Bernard, Rovira Alex, Frederiksen Jette, Miller David, Fernando Kryshani, Filippi Massimo, Agosta Federica, Rocca Maria, Fazekas Franz, Enzinger Christian, Matthews Paul, Parry Allyson, Polman Chris, Montalban Xavier, Barkhof Frederik
Department of Neuroradiology, VU University Medical Centre, Amsterdam, The Netherlands.
Lancet Neurol. 2006 Mar;5(3):221-7. doi: 10.1016/S1474-4422(06)70353-2.
The McDonald International Panel accepted the Barkhof/Tintoré criteria for providing MRI evidence of dissemination in space to allow a diagnosis of multiple sclerosis in patients with clinically isolated syndromes (CIS). We applied these criteria in a large cohort of patients with CIS, representative of those seen in a general diagnostic setting, to assess their accuracy in predicting conversion to definite multiple sclerosis and to identify factors that affect this risk.
In a collaborative study of seven centres, baseline MRI and clinical follow-up data for 532 patients with CIS were studied, with the development of a second clinical event used as the main outcome. All scans were scored for lesion counts and spatial lesion distribution to assess the fulfilment--ie, at least three out of four--of the Barkhof/Tintoré criteria. We used survival analysis and 2x2 tables to assess the test characteristics of the criteria at baseline.
Overall conversion rate was 32.5% with a median survival time of 85.3 months. Fulfilment of the criteria at baseline showed, after a survival time of 2 years, a conversion rate of about 45% (95% CI 37-53) versus about 10% (6-16) in those with no asymptomatic lesions at baseline (p<0.0001). For patients with a follow-up of at least 2 years, the fulfilment of the MRI criteria showed an accuracy of 68% (sensitivity 49%, specificity 79%) for predicting conversion and an increase in risk of nearly four times for conversion compared with those not fulfilling the criteria (odds ratio 3.7, 95% CI 2.3-5.9; p<0.0001). Cox proportional hazards regression analysis accorded with this increased risk. No effects were recorded on the performance of the criteria by sex, presenting symptoms, or centre. Age at baseline did have a small but significant effect as predictor (hazard ratio 0.97, 0.95-0.99; p=0.002), but did not affect the prognostic value of the MRI criteria.
MRI abnormalities have important prognostic value. The cut-off, based on the Barkhof/Tintoré criteria, as incorporated in the McDonald diagnostic scheme yields acceptable specificity, but could have lower sensitivity than previously reported.
麦当劳国际专家组认可了巴克霍夫/廷托雷标准，该标准用于提供空间播散的MRI证据，以确诊临床孤立综合征（CIS）患者是否患有多发性硬化症。我们将这些标准应用于一大群CIS患者，这些患者代表了一般诊断环境中所见的患者，以评估其预测转化为明确多发性硬化症的准确性，并确定影响这种风险的因素。
在一项由七个中心参与的合作研究中，对532例CIS患者的基线MRI和临床随访数据进行了研究，将出现第二次临床事件作为主要观察指标。对所有扫描结果进行病灶计数和空间病灶分布评分，以评估是否满足巴克霍夫/廷托雷标准（即四项标准中至少三项）。我们使用生存分析和2x2列联表来评估基线时该标准的检测特征。
总体转化率为32.5%，中位生存时间为85.3个月。在基线时满足标准的患者，在生存2年后转化率约为45%（95%CI 37-53），而基线时无无症状病灶的患者转化率约为10%（6-16）（p<0.0001）。对于随访至少2年的患者，MRI标准的满足情况在预测转化方面显示出68%的准确性（敏感性49%，特异性79%），与不满足标准的患者相比，转化风险增加近四倍（优势比3.7，95%CI 2.3-5.9；p<0.0001）。Cox比例风险回归分析与这种增加的风险相符。性别、出现的症状或中心对该标准的性能没有影响。基线年龄作为预测指标有一个小但显著的影响（风险比0.97，0.95-0.99；p=0.002），但不影响MRI标准的预后价值。
MRI异常具有重要的预后价值。基于麦当劳诊断方案中纳入的巴克霍夫/廷托雷标准的截断值具有可接受的特异性，但敏感性可能低于先前报道。
