Department of Neurology, Zealand University Hospital, Roskilde, Denmark; Department of Neurology, Herlev Hospital, Denmark.
Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark.
Mult Scler Relat Disord. 2022 Jun;62:103738. doi: 10.1016/j.msard.2022.103738. Epub 2022 Mar 12.
MRI of the nervous system is the critical in distinguishing pediatric MS from acute disseminated encephalomyelitis (ADEM). Our aim was to propose MRI criteria to distinguish MS from monophasic ADEM based on the first MRI and to validate previously proposed MRI criteria.
A neuroradiologist undertook retrospective evaluation of the MRI at the first demyelinating event in children (<18 years) with medical record-validated MS and ADEM in Denmark during 2008-15. We used forward stepwise logistic regression to identify MRI categories that differed significantly between MS and ADEM. We estimated accuracy statistics for all MRI criteria to distinguish MS from ADEM.
The monophasic ADEM cohort (n=46) was nationwide and population-based during 2008-15; the median age at onset of 5.3 years (range 0.8‒17.2) and children had at least five years of follow-up to ensure a monophasic disease course. Children with MS (n=67) had a median age at onset of 16.3 years (range 3.3‒17.9). Having at least two categories best distinguished MS from monophasic ADEM by an area under the curve of 83% to 89%: (a) corpus callosum long axis perpendicular lesion; (b) only well-defined lesions; (c) absence of basal ganglia or thalamus lesion OR, (a) corpus callosum long axis perpendicular lesion; (b) only well-defined lesions; (c) absence of diffuse large lesions; (d) black holes. The Callen, KIDMUS, and IPMSSG criteria performed well. The McDonald 2017, Barkhof, MAGNIMS, and Verhey criteria had poorer performance.
This study provides Class II evidence that MRI has good performance in differentiating MS from monophasic ADEM at onset.
磁共振成像（MRI）对区分儿科多发性硬化症（MS）和急性播散性脑脊髓炎（ADEM）至关重要。我们的目的是基于首发 MRI 提出用于区分 MS 和单相 ADEM 的 MRI 标准，并验证之前提出的 MRI 标准。
神经放射科医生对丹麦 2008-15 年期间经病历证实的 MS 和 ADEM 患儿首次脱髓鞘事件的 MRI 进行了回顾性评估。我们使用向前逐步逻辑回归来确定 MS 和 ADEM 之间存在显著差异的 MRI 类别。我们估计了所有 MRI 标准用于区分 MS 和 ADEM 的准确性统计数据。
单相 ADEM 队列（n=46）为 2008-15 年全国范围内的人群研究；发病中位年龄为 5.3 岁（范围 0.8-17.2 岁），所有患儿均有至少 5 年的随访，以确保疾病为单相病程。MS 患儿（n=67）的发病中位年龄为 16.3 岁（范围 3.3-17.9 岁）。通过曲线下面积为 83%-89%，具有至少两个类别可以最佳地区分 MS 和单相 ADEM：（a）胼胝体长轴垂直病变；（b）仅存在明确病变；（c）无基底节或丘脑病变或（a）胼胝体长轴垂直病变；（b）仅存在明确病变；（c）无弥漫性大病变；（d）黑洞。Callen、KIDMUS、和 IPMSSG 标准表现良好。McDonald 2017、Barkhof、MAGNIMS 和 Verhey 标准的表现较差。
本研究提供了 II 级证据，表明 MRI 在区分首发 MS 和单相 ADEM 方面具有良好的性能。
