Jankowska Anna, Chwojnicki Kamil, Szurowska Edyta
2 Department of Radiology, Medical University of Gdańsk, Poland.
Department of Anaesthesiology and Intensive Care, Medical University of Gdańsk, Poland.
Pol J Radiol. 2023 Dec 12;88:e574-e581. doi: 10.5114/pjr.2023.133677. eCollection 2023.
Multiple sclerosis (MS) is a chronic, demyelinating disease affecting the central nervous system. Diagnosis of MS is based on the proof of disease dissemination in time (DIT) and dissemination in space (DIS) and excluding other disorders that can mimic multiple sclerosis in laboratory tests and clinical manifestation. Over the years the diagnostic criteria have evolved; the introduction of magnetic resonance in the McDonald's 2001 criteria was revolutionary. Since then, the criteria have been modified up to the currently used McDonald 2017. The aim of this review is to analyse the 2017 McDonald criteria, assess what has changed from the 2010 criteria, and present the impact of revised criteria on rapid and accurate diagnosis of MS. The main differences are as follows: inclusion of oligoclonal bands in cerebrospinal fluid as a DIT criterion, and symptomatic and cortical lesions in magnetic resonance imaging are counted in the determination of DIS and DIT. We present also the newest recommendations of the Polish Medical Society of Radiology and the Polish Society of Neurology and international group of North American Imaging in Multiple Sclerosis and Consortium of Multiple Sclerosis Centers, as well as future directions for further investigations. A proper diagnosis is crucial for the patient's quality of life, to give the possibility of early treatment, and to help avoid misdiagnosis and unnecessary therapy.
多发性硬化症（MS）是一种影响中枢神经系统的慢性脱髓鞘疾病。MS的诊断基于疾病时间上的播散（DIT）和空间上的播散（DIS）的证据，并在实验室检查和临床表现中排除其他可模拟多发性硬化症的疾病。多年来，诊断标准不断演变；2001年麦克唐纳标准中引入磁共振成像具有革命性意义。从那时起，该标准不断修订，直至目前使用的2017年麦克唐纳标准。本综述的目的是分析2017年麦克唐纳标准，评估与2010年标准相比有哪些变化，并阐述修订后的标准对MS快速准确诊断的影响。主要差异如下：将脑脊液中的寡克隆带纳入作为DIT标准，磁共振成像中的症状性和皮质病变在DIS和DIT的判定中予以计数。我们还介绍了波兰放射医学学会、波兰神经病学学会以及北美多发性硬化症影像学国际组和多发性硬化症中心联盟的最新建议，以及进一步研究的未来方向。正确的诊断对于患者的生活质量、给予早期治疗的可能性以及帮助避免误诊和不必要的治疗至关重要。
