From the Queen Square Multiple Sclerosis Centre (W.J.B., C.T., D.H.M., O.C.), Department of Neuroinflammation, UCL Institute of Neurology; Lysholm Department of Neuroradiology (K.A.M., F.B.), National Hospital for Neurology and Neurosurgery; UCL Institute of Healthcare Engineering (F.B.), London, UK; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; and NIHR University College London Hospitals Biomedical Research Centre (F.B., O.C.), UK.
Neurology. 2018 Sep 18;91(12):e1130-e1134. doi: 10.1212/WNL.0000000000006207. Epub 2018 Aug 17.
To investigate the effect of including optic nerve involvement in dissemination in space (DIS) criteria for diagnosis of multiple sclerosis (MS) in patients with clinically isolated syndrome (CIS).
We studied 160 patients with CIS: 129 with optic neuritis (ON) and 31 with non-ON CIS. MRI brain/spinal cord was done at the time of presentation and a follow-up MRI brain after 3-12 months. We evaluated optic nerve involvement clinically or with visual evoked potentials (VEPs, n = 42). We investigated the performance of the McDonald 2017 DIS criteria and modified DIS criteria including optic nerve involvement for development of clinically definite MS after ∼15 years.
In the ON group, including symptomatic optic nerve involvement identified an additional 15 patients with DIS. The modified DIS criteria that included optic nerve involvement were more sensitive (95% vs 83%) and more accurate (81% vs 78%) than the McDonald 2017 DIS criteria, but less specific (57% vs 68%). In combination with dissemination in time criteria, the modified DIS criteria remained more sensitive (83% vs 74%) and accurate (81% vs 75%), and the specificity was the same (77%). Including asymptomatic optic nerve involvement in DIS the non-ON group did not identify any additional patients and the performance of the McDonald 2017 criteria and the modified criteria was the same.
The inclusion of symptomatic optic nerve involvement in DIS in patients with ON improved the overall performance of MS diagnostic criteria. Including asymptomatic optic nerve involvement in DIS in patients with a non-ON CIS may be of limited value.
This study provides Class III evidence that for patients with suspected MS, inclusion of symptomatic optic nerve involvement in DIS criteria improves the overall performance of diagnostic criteria for MS.
探讨在诊断临床孤立综合征（CIS）患者的多发性硬化（MS）时，将视神经受累纳入弥散空间（DIS）标准的影响。
我们研究了 160 例 CIS 患者：129 例视神经炎（ON）和 31 例非 ON CIS。在发病时进行了脑/脊髓 MRI，3-12 个月后进行了脑 MRI 随访。我们通过临床或视觉诱发电位（VEPs，n = 42）评估视神经受累情况。我们研究了 McDonald 2017 年 DIS 标准和包括视神经受累的改良 DIS 标准在约 15 年后发展为临床确诊 MS 的性能。
在 ON 组中，包括症状性视神经受累，发现了另外 15 例 DIS 患者。改良的 DIS 标准，包括视神经受累，更敏感（95%对 83%）和更准确（81%对 78%），但特异性较低（57%对 68%）。与时间弥散标准相结合，改良的 DIS 标准仍具有较高的敏感性（83%对 74%）和准确性（81%对 75%），特异性相同（77%）。在非 ON 组中，将无症状的视神经受累纳入 DIS 并没有识别出任何额外的患者，并且 McDonald 2017 标准和改良标准的性能相同。
在 ON 患者中，将症状性视神经受累纳入 DIS 可提高 MS 诊断标准的整体性能。将无症状的视神经受累纳入非 ON CIS 患者的 DIS 可能价值有限。
本研究提供了 III 级证据，对于疑似 MS 的患者，将症状性视神经受累纳入 DIS 标准可提高 MS 诊断标准的整体性能。
