Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.
Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Ann Clin Transl Neurol. 2024 Oct;11(10):2572-2582. doi: 10.1002/acn3.52170. Epub 2024 Jul 30.
We investigated the effects of adding regions to current dissemination in space (DIS) criteria for multiple sclerosis (MS).
Participants underwent brain, optic nerve, and spinal cord MRI. Baseline DIS was assessed by 2017 McDonald criteria and versions including optic nerve, temporal lobe, or corpus callosum as a fifth region (requiring 2/5), a version with all regions (requiring 3/7) and optic nerve variations requiring 3/5 and 4/5 regions. Performance was evaluated against MS diagnosis (2017 McDonald criteria) during follow-up.
Eighty-four participants were recruited (53F, 32.8 ± 7.1 years). 2017 McDonald DIS criteria were 87% sensitive (95% CI: 76-94), 73% specific (50-89), and 83% accurate (74-91) in identifying MS. Modified criteria with optic nerve improved sensitivity to 98% (91-100), with specificity 33% (13-59) and accuracy 84% (74-91). Criteria including temporal lobe showed sensitivity 94% (84-98), specificity 50% (28-72), and accuracy 82% (72-90); criteria including corpus callosum showed sensitivity 90% (80-96), specificity 68% (45-86), and accuracy 85% (75-91). Criteria adding all three regions (3/7 required) had sensitivity 95% (87-99), specificity 55% (32-76), and accuracy 85% (75-91). When requiring 3/5 regions (optic nerve as the fifth), sensitivity was 82% (70-91), specificity 77% (55-92), and accuracy 81% (71-89); with 4/5 regions, sensitivity was 56% (43-69), specificity 95% (77-100), and accuracy 67% (56-77).
Optic nerve inclusion increased sensitivity while lowering specificity. Increasing required regions in optic nerve criteria increased specificity and decreased sensitivity. Results suggest considering the optic nerve for DIS. An option of 3/5 or 4/5 regions preserved specificity, and criteria adding all three regions had highest accuracy.
我们研究了在多发性硬化症（MS）的现行空间传播（DIS）标准中增加区域对其的影响。
参与者接受脑部、视神经和脊髓 MRI 检查。通过 2017 年 McDonald 标准以及包括视神经、颞叶或胼胝体作为第五个区域（需要 2/5）、所有区域的版本（需要 3/7）以及需要 3/5 和 4/5 区域的视神经变化的版本来评估基线 DIS。在随访期间，根据 MS 诊断（2017 年 McDonald 标准）对其进行评估。
共招募了 84 名参与者（53 名女性，年龄 32.8±7.1 岁）。2017 年 McDonald DIS 标准在识别 MS 方面的敏感性为 87%（95%CI：76-94），特异性为 73%（50-89），准确性为 83%（74-91）。视神经改良标准的敏感性提高到 98%（91-100），特异性为 33%（13-59），准确性为 84%（74-91）。包括颞叶的标准敏感性为 94%（84-98），特异性为 50%（28-72），准确性为 82%（72-90）；包括胼胝体的标准敏感性为 90%（80-96），特异性为 68%（45-86），准确性为 85%（75-91）。需要 3/7 个区域（需要 3 个区域）的标准敏感性为 95%（87-99），特异性为 55%（32-76），准确性为 85%（75-91）。当需要 3/5 个区域（视神经为第五个区域）时，敏感性为 82%（70-91），特异性为 77%（55-92），准确性为 81%（71-89）；需要 4/5 个区域时，敏感性为 56%（43-69），特异性为 95%（77-100），准确性为 67%（56-77）。
视神经的纳入增加了敏感性，同时降低了特异性。增加视神经标准中所需的区域会提高特异性并降低敏感性。结果表明考虑 DIS 中的视神经。3/5 或 4/5 个区域的选择保留了特异性，添加所有三个区域的标准具有最高的准确性。
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