Department of Neurology, Zealand University Hospital, Vestermarksvej 11, Roskilde 4000, Denmark.
Department of Radiology, Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Mult Scler Relat Disord. 2022 Oct;66:104008. doi: 10.1016/j.msard.2022.104008. Epub 2022 Jul 3.
Our aim was to propose criteria to distinguish multiple sclerosis (MS) from acute disseminated encephalomyelitis (ADEM) at onset based on age at onset, sex, cerebrospinl fluid (CSF)-specific oligoclonal bands, and MRI.
A neuroradiologist undertook retrospective evaluation of the baseline magnetic resonance imaging (MRI) in a nationwide cohort of children with medical record-validated MS (n = 67) and monophasic ADEM (n = 46). Children with ADEM had at least 5 years of follow-up for relapse. We used forward stepwise conditional logistic regression to develop our criteria based on age at onset, sex, CSF-specific oligoclonal bands, and MRI. We undertook sensitivity analyses using children with ADEM including encephalopathy and polyfocal neurological deficits and in those with onset between 11 and 17 years of age. We estimated accuracy statistics from our criteria and all previously proposed MRI criteria to distinguish MS and ADEM.
The best performing criteria to differentiate MS from ADEM were scoring at least three points in the following categories: presence of CSF-specific oligoclonal bands (2 points), occipital lesion (1 point), age 11-17 years (1 point), female sex (1 point). These criteria gave highly reliable discrimination with sensitivity of 95% (95% CI=89%-100%), specificity of 100% (95% CI=100%-100%), and area under the curve of 98% (95% CI=95%-100%). The best performing MRI criteria had area under the curve of 84% (95% CI=78%-91%). Previously proposed MRI criteria had the following areas under the curve: Callen (75%), KIDMUS (82%), and McDonald 2017 criteria (68%).
Combining sex, age at onset, CSF-specific oligoclonal bands, and MRI gives highly reliable differentiation between pediatric MS and monophasic ADEM at onset.
我们的目的是基于发病年龄、性别、脑脊液(CSF)特异性寡克隆带和磁共振成像(MRI),提出用于鉴别多发性硬化(MS)和急性播散性脑脊髓炎(ADEM)的鉴别标准。
一位神经放射科医生对经病历证实的儿童 MS(n=67)和单相 ADEM(n=46)全国性队列的基线 MRI 进行了回顾性评估。ADEM 患儿至少随访 5 年以了解是否复发。我们使用向前逐步条件逻辑回归,根据发病年龄、性别、CSF 特异性寡克隆带和 MRI 来制定我们的标准。我们使用包括脑病和多灶性神经功能缺损在内的 ADEM 患儿和发病年龄在 11-17 岁之间的患儿进行了敏感性分析。我们根据标准和所有先前提出的 MRI 标准来估计鉴别 MS 和 ADEM 的准确性统计数据。
区分 MS 和 ADEM 的最佳标准是在以下类别中至少得 3 分:CSF 特异性寡克隆带阳性(2 分)、枕部病变(1 分)、11-17 岁发病(1 分)、女性(1 分)。这些标准的敏感性为 95%(95%CI=89%-100%)、特异性为 100%(95%CI=100%-100%)、曲线下面积为 98%(95%CI=95%-100%),具有高度可靠的鉴别能力。最佳的 MRI 标准的曲线下面积为 84%(95%CI=78%-91%)。先前提出的 MRI 标准的曲线下面积分别为:Callen(75%)、KIDMUS(82%)和 McDonald 2017 标准(68%)。
将性别、发病年龄、CSF 特异性寡克隆带和 MRI 相结合,可以高度可靠地区分儿科 MS 和单相 ADEM。