Division of Clinical Neurology, Queen's Medical Centre, University of Nottingham, England.
JAMA Neurol. 2013 May;70(5):623-8. doi: 10.1001/jamaneurol.2013.1405.
There is no single test that is diagnostic for multiple sclerosis (MS), and existing diagnostic criteria are imperfect. This can lead to diagnostic delay. Some patients require multiple (sometimes invasive) investigations, and extensive clinical follow-up to confirm or exclude a diagnosis of MS. A diagnostic biomarker that is pathologically specific for the inflammatory demyelination in MS could overhaul current diagnostic algorithms.
To prospectively assess the diagnostic value of visualizing central veins in brain lesions with magnetic resonance imaging (MRI) for patients with possible MS for whom the diagnosis is uncertain.
Prospective longitudinal cohort study. The reference standard is a clinical diagnosis that is arrived at (after a mean follow-up of 26 months) by the treating neurologist with a specialist interest in MS. The 7-T MRI scans were analyzed at baseline, by physicians blinded to the clinical data, for the presence of visible central veins.
Academic MS referral center.
A consecutive sample of 29 patients referred with possible MS who had brain lesions detected on clinical MRI scans but whose condition remained undiagnosed despite expert clinical and radiological assessments.
Seven-Tesla MRI using a T2*-weighted sequence.
The proportion of patients whose condition was correctly diagnosed as MS or as not MS, using 7-T MRI at study onset, compared with the eventual diagnosis reached by treating physicians blinded to the result of the MRI scan.
Of the 29 patients enrolled and scanned using 7-T MRI, so far 22 have received a clinical diagnosis. All 13 patients whose condition was eventually diagnosed as MS had central veins visible in the majority of brain lesions at baseline. All 9 patients whose condition was eventually not diagnosed as MS had central veins visible in a minority of lesions.
In our study, T2*-weighted 7-T MRI had 100% positive and negative predictive value for the diagnosis of MS. Clinical application of this technique could improve existing diagnostic algorithms.
目前尚无单一测试可用于多发性硬化症（MS）的诊断，且现有的诊断标准并不完善。这可能导致诊断延误。有些患者需要进行多次（有时是侵入性的）检查，并进行广泛的临床随访，以确认或排除 MS 的诊断。一种对 MS 炎症性脱髓鞘具有病理特异性的诊断生物标志物可以彻底改变当前的诊断算法。
前瞻性评估对疑似 MS 患者的脑内病变进行磁共振成像（MRI）显示中央静脉，对这些患者的诊断不确定时，该检测的诊断价值。
前瞻性纵向队列研究。参考标准是由对 MS 有专门研究兴趣的主治神经病学家在平均 26 个月的随访后得出的临床诊断。由对临床数据不知情的医生在基线时对 7-T MRI 扫描进行分析，以评估是否存在可见中央静脉。
学术性 MS 转诊中心。
连续纳入 29 例疑似 MS 患者，这些患者的脑部病变在临床 MRI 扫描中被发现，但尽管经过专家临床和影像学评估，其病情仍未得到诊断。
使用 T2*-加权序列进行 7-T MRI。
在研究开始时，使用 7-T MRI 对患者的病情进行诊断，与治疗医生在未获知 MRI 扫描结果的情况下对患者的最终诊断进行比较，评估患者病情被正确诊断为 MS 或非 MS 的比例。
在已入组并接受 7-T MRI 扫描的 29 例患者中，目前已有 22 例患者获得了临床诊断。最终被诊断为 MS 的 13 例患者，其脑内病变在基线时多数可见中央静脉。最终被诊断为非 MS 的 9 例患者，其脑内病变在少数病灶中可见中央静脉。
在我们的研究中，T2*-加权 7-T MRI 对 MS 的诊断具有 100%的阳性和阴性预测值。该技术的临床应用可能会改进现有的诊断算法。
