Lesion topographies in multiple sclerosis diagnosis: A reappraisal. (5th December 2017)

• Record Type: Journal Article
• Authors: Arrambide, Georgina; Tintore, Mar; Auger, Cristina; Río, Jordi; Castilló, Joaquín; Vidal-Jordana, Angela; Galán, Ingrid; Nos, Carlos; Comabella, Manuel; Mitjana, Raquel; Mulero, Patricia; de Barros, Andrea; Rodríguez-Acevedo, Breogán; Midaglia, Luciana; Sastre-Garriga, Jaume; Rovira, Alex; Montalban, Xavier
• Is Part Of: Neurology. Volume 89:Number 23(2017)
• Publication Date: 2017-12-05
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000004715
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Objectives: To assess the contributions of cortico-juxtacortical and corpus callosum lesions to multiple sclerosis diagnosis and to compare the value of ≥1 vs ≥3 periventricular lesions in clinically isolated syndromes (CIS). Methods: Step 1: We evaluated lesion topography classifications in 657 patients with CIS with stepwise Cox proportional hazards regression models considering second attack as the outcome. Step 2: We established 2 dissemination in space (DIS) versions according to the periventricular lesion cutoffs of ≥1 and ≥3 and assessed their performance at 10 years with second attack as the outcome, first individually and then combined with dissemination in time (DIT) in all cases (n = 326), by age, and by CIS topography. Results: Step 1: The models (hazard ratios [95% confidence interval]) favored ≥1 over ≥3 periventricular lesions (2.5 [1.7–3.6]) and cortico-juxtacortical over juxtacortical lesions (1.4 [1.0–1.8]). Callosal lesions were not selected. Step 2: DIS specificity with ≥1 periventricular lesions was slightly lower than with ≥3 (59.1 vs 61.4) and the same after adding DIT (88.6). Regarding age, ≥3 periventricular lesions improved DIS specificity over ≥1 lesions in the 40–49 years of age bracket (66.7 vs 58.3). This difference disappeared when adding DIT (83.3). Optic neuritis had a similar pattern when evaluating CIS topographies. Conclusions: Our results comply with the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) consensus recommendation of combining cortical and juxtacortical lesions into a single term when possible. Concerning periventricular lesions, maintaining the current ≥1 cutoff in the McDonald criteria does not compromise specificity in typical CIS cases, but attention should be paid to older patients or optic neuritis cases.