Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, Canada.
Neurology. 2012 Dec 4;79(23 Suppl 2):S1-15. doi: 10.1212/WNL.0b013e318277d144.
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.
自多发性硬化症 (MS) 的诊断标准首次制定以来，一直定期对疾病定义和诊断阈值进行修订，旨在提高特异性的同时保持敏感性。MS 诊断的核心要求是中枢神经系统 (CNS) 病变的空间弥散 (DIS) 和时间弥散 (DIT)，前提是没有更好地解释临床表现的其他诊断。最明确的诊断是纯粹的临床诊断，有 2 次不同的症状发作（符合 DIT 标准），涉及至少 2 个不同的 CNS 区域（符合 DIS 标准）。在首次发作但没有第二次临床发作的患者中，麦当劳标准为如何使用临床证据来支持 MS 的诊断提供了指导。最近，麦当劳标准进行了修订，并提出了 DIS 和 DIT 的新定义。针对这一修订，一组加拿大 MS 神经病学家和一名神经放射学家就此发表了评论，讨论了 2010 年麦当劳标准的临床意义和应用。
