Tena-Cucala Raquel, Naval-Baudin Pablo, Martínez-Yélamos Antonio, León Isabel, Muñoz-Vendrell Albert, Bau Laura, Matas Elisabet, Arroyo-Pereiro Pablo, Puchades Alejandro Caravaca, Morandeira Francisco, Mas Virginia, Martínez-Yélamos Sergio, Romero-Pinel Lucía
Department of Neurology, Hospital de Tortosa Verge de la Cinta, Institut Català de la Salut, Tortosa, Spain; Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus/Tarragona, Spain; Departament de Ciències Clíniques, Facultat de Medicina I Ciències de La Salut, Universitat de Barcelona (UB), Carrer de Casanova 143, 08036, Barcelona, Spain.
Departament de Ciències Clíniques, Facultat de Medicina I Ciències de La Salut, Universitat de Barcelona (UB), Carrer de Casanova 143, 08036, Barcelona, Spain; Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de Feixa Llarga SN, 08907, Barcelona, Spain; Institut de Diagnòstic Per La Imatge (IDI), L'Hospitalet de Llobregat, Centre Bellvige, Carrer de Feixa Llarga SN, 08907, Barcelona, Spain; Translational Imaging Biomarkers Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Mult Scler Relat Disord. 2025 Jul 29;103:106658. doi: 10.1016/j.msard.2025.106658.
The 2024 revision of the McDonald criteria introduces specific recommendations for diagnosing late-onset multiple sclerosis (LOMS). One of the following criteria must be met: spinal cord lesions, positive cerebrospinal fluid (CSF) findings, or fulfilment of the Select-6 criteria (i.e., six or more central vein signs on brain magnetic resonance imaging (MRI)).
To evaluate the sensitivity of the 2024 McDonald criteria in patients with LOMS and to identify the most sensitive diagnostic test.
This cross-sectional, observational, retrospective study included patients diagnosed with LOMS (onset ≥50 years of age) who were followed at the Multiple Sclerosis Clinic of Bellvitge University Hospital. Clinical records, MRI scans, and CSF analyses were reviewed to assess the presence of spinal cord lesions, central vein signs and oligoclonal bands (OCBs). The sensitivity of the 2024 recommended LOMS criteria was analysed.
115 patients met at least one of the proposed 2024 LOMS diagnostic criteria, resulting in a sensitivity of 100 %. Of these, 10.4 % fulfilled all three criteria, 52.1 % met two criteria (most commonly OCBs and spinal lesions). The remaining 37.4 % met only one: 53.5 % had spinal lesions, 46.5 % were positive for OCBs, and none met only the Select-6 criterion. The difference between the proportions meeting the OCB and spinal cord lesion criteria was not statistically significant (p = 0.581), but both were significantly more common than meeting the Select-6 criterion (p < 0.001).
The 2024 McDonald criteria maintain high sensitivity for diagnosing LOMS. CSF analysis and spinal MRI are the most valuable tools, whereas the Select-6 criteria exhibited a lower diagnostic value.
2024年修订的麦克唐纳标准引入了诊断晚发性多发性硬化症（LOMS）的具体建议。必须满足以下标准之一：脊髓病变、脑脊液（CSF）检查结果阳性或满足Select-6标准（即脑磁共振成像（MRI）上有六个或更多中央静脉征）。
评估2024年麦克唐纳标准对LOMS患者的敏感性，并确定最敏感的诊断测试。
这项横断面、观察性、回顾性研究纳入了在贝尔维奇大学医院多发性硬化症诊所接受随访的诊断为LOMS（发病年龄≥50岁）的患者。回顾临床记录、MRI扫描和CSF分析，以评估脊髓病变、中央静脉征和寡克隆带（OCB）的存在情况。分析2024年推荐的LOMS标准的敏感性。
115例患者至少符合2024年提出的一项LOMS诊断标准，敏感性为100%。其中，10.4%的患者符合所有三项标准，52.1%的患者符合两项标准（最常见的是OCB和脊髓病变）。其余37.4%的患者仅符合一项标准：53.5%有脊髓病变，46.5%的OCB呈阳性，没有患者仅符合Select-6标准。符合OCB和脊髓病变标准的比例之间的差异无统计学意义（p = 0.581），但两者均比符合Select-6标准更为常见（p < 0.001）。
2024年麦克唐纳标准对诊断LOMS保持高敏感性。CSF分析和脊髓MRI是最有价值的工具，而Select-6标准的诊断价值较低。
