2017修订版McDonald多发性硬化诊断标准解读

2010修订版McDonald多发性硬化(multiple sclerosis,MS)诊断标准被广泛应用于研究和临床实践。结合近年来的科学研究进展,MS诊断国际专家组在2010修订版McDonald MS诊断标准的基础上,提出了新的2017修订版McDonald MS诊断标准。主要修订内容包括:典型的临床孤立综合征(clinically isolated syndrome,CIS)患者,如已有临床或磁共振成像(magnetic resonance imaging,MRI)的空间多发证据,且脑脊液(cerebrospinal fluid,CSF)特异的寡克隆区带阳性,即允许MS诊断成立;在幕上和幕下病灶或脊髓综合征患者中,症状性病灶可用于空间和时间多发证据;皮质病灶可用于空间多发证据。2017修订版McDonald MS诊断标准更加简化和明晰,有利于MS的早期诊断;同时保留了2010修订版的特异性,旨在促进其在不同人群中的合理应用以降低误诊率。本文对2017修订版McDonald MS诊断标准的要点进行解读和评论。     

多发性硬化的McDonald诊断标准评价情况

1983年,Poser等[1]提出了由临床、亚临床(诱发电位)和脑脊液(CSF)异常组成的多发性硬化(multiple sclerosis,MS)诊断标准(简称旧标准),在国内一直沿用至今。其中并没有把磁共振成像(MRI)异常作为诊断依据(直到1988年对该诊断标准的进一步完善),这很大程度上是因为当时MRI处于发展的早期,尚未普及。近年来,MRI已经成为诊断和鉴别诊断MS必不可少的手段之一。2002年国外研究表明,大约95%的临床确诊MS患者以及约2/3的临床孤立综合征(CIS)患者MRI的T2像或质子像会出现异常[2]。2001年国际MS诊断专家组在重新复习Poser诊断标准,并考虑…     

McDonald多发性硬化诊断标准的应用性评价

多发性硬化（multiple sclerosis，MS）的诊断主要基于中枢神经系统病灶在时间上和空间上多发性的临床证据，且需除外可引起这些损害的其他疾病。目前被广泛应用的诊断标准有两种，即1983年提出的Poser标准和2001年提出的McDonald标准。McDonald标准 ^[1]是建立在Poser标准基础上，但更注意利用包括MRI在内的相关实验室检查来证明多发性硬化在时间和空间上的多发性，     

多发性硬化的诊断标准

多发性硬化是中枢神经系统炎症性脱髓鞘性自身免疫性疾病。自1968年Charcot首次描述多发性硬化诊断标准以来,先后出现了多个诊断标准。本文简述了多发性硬化诊断标准的历史演变,着重介绍了国际多发性硬化诊断专家组新的诊断标准。     

多发性硬化的诊断和分类标准

对研究多发性硬化的本质来说,了解其病程,类型和诊断标准等能达到统一至关重要。结合文献和我们临床实践提出了北京地区多发性硬化研究组的诊断和分类标准,供国内同道们研究、参考。     

多发性硬化诊断标准的进展

2005年新修订的McDonald诊断标准在多发性硬化（MS）诊断方面强调了MRI检查T2相病变能更早地提示病变在时间上的多发性，在距第1次发病至少30d后进行MRI扫描所发现的新T2相病变均可用于影像学标准说明病变在时间上的多发性；将脊髓病变整合进影像诊断要求中，对MS鉴别诊断具有极大的实用性。新研究结果显示，在缺乏阳性脑脊液检查结果时仍然可对原发进展型MS（PPMS）做出可靠诊断（至少要有典型头颅MRI改变出现），2005年新修订标准基于此研究结果简化了PPMS诊断标准，并对MRI所见的脑部和脊髓病理变化进行了更为详细的说明。     

两种多发性硬化诊断标准的比较

目的 针对诊断多发性硬化（MS）的McDonald标准、Poser标准的有效性做比较。方法 按中枢神经系统（CNS）受累的临床表现将35例MS患者分为脊髓型和非脊髓型两个亚组,并对部分患者进行了随访观察,用卡方检验对两种诊断标准进行比较分析。结果 两种诊断标准对脊髓型、非脊髓型MS的诊断阳性率接近（P＞0．05）,但McDonald标准中诊断不能的例数相对较多（P＜0．05）,经随访观察均证实为MS。结论 Poser标准对MS诊断的有效性优于McDonald标准,但对其在诊断进展型MS时的MS时的病程规定有待于进行改良或者灵活运用。MS诊断的有效性优于McDonald标准,但对其在诊断进展型MS时的病程规定有待于进行改良或者灵活运用。     

2010版多发性硬化McDonald诊断标准

多发性硬化(MS)作为一种中枢神经系统(CNS)炎性脱髓鞘疾病,其诊断主要依靠临床表现和实验室检查,强调空间和时间的多发性。MRI已成为协助诊断MS的一项重要手段,主要采用McDonald诊断标准。该标准于2001年由MS诊断国际专家组制定,并在2005年进行了首次修     

多发性硬化诊断标准现状与进展

2010年爱尔兰都柏林国际多发性硬化(MS)诊断会议推出最新MS诊断标准,主要修订为:规定在2～4个MS相关特征性部位(靠近皮质部位、脑室周围、幕下和脊髓)中每个至少存在1个T2相病灶可以提示病变存在空间多发性,与首次发病期MRI比较出现新的T2相病灶可以提示病变存在时间多发性;进一步探讨脑脊液检查的诊断价值,并将新研究结果整合进去;进一步简化原发性进行性MS(PPMS)的诊断流程;对该标准在不同人群中的应用进行详细说明。     

多发性硬化的临床表现及MRI诊断

目的 提高对多发性硬化的临床MRI表现的认识.方法 回顾性分析58例多发硬化病例的临床及MRI表现.结果 临床上均具有反复发作病史.病灶分布于大脑半球皮质下白质区、半卵圆中心、侧脑室旁34例,其中垂直于侧脑室分布30例,脊髓颈段、中上胸段19例;其它部位单位发5例.病灶直径从3mm～5cm;病灶形态是团块样41例,条带状17例;病灶呈长T1长T2信号,新发病灶及活动期病灶增强后均见强化,呈斑片状、环状或线状强化,陈旧性病灶不强化.结论根据典型的临床表现和MRI特征,可对多发性硬化病例进行明显诊断及有效治疗.     

Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria

New evidence and consensus has led to further revision of the McDonald Criteria for diagnosis of multiple sclerosis. The use of imaging for demonstration of dissemination of central nervous system lesions in space and time has been simplified, and in some circumstances dissemination in space and time can be established by a single scan. These revisions simplify the Criteria, preserve their diagnostic sensitivity and specificity, address their applicability across populations, and may allow earlier diagnosis and more uniform and widespread use.     

诊断多发性硬化的Poser标准与McDonald新标准的比较

目的 比较诊断多发件硬化(multiple sclerosis,MS)的Poser标准和McDonald新标准.方法 将Poser标准和McDonald新标准回顾性应用于临床表现提示为MS的67例患者,采用Fisher精确枪验对两种诊断标准进行比较分析.结果 符合Poser临床和实验室确诊者分别为34例和24例,可能MS者9例,符合McDonald标准的MS确诊者36例,可能MS者31例,两种标准的诊断阳性率差异有统计学意义(OR=5.549,95%CI 2.37～13.00,P<0.01).结论 两种标准住诊断MS,尤其在确诊MS时有明显差异,这可能主要与Poser标准更多地依赖各种亚临床证据,而McDonald标准采用了更为严格的MRI规定有关,脑脊液分析可能在一定程度上有助于提高MS的确诊率和MRI异常的病理特异性.     

2010 McDonald criteria for diagnosing pediatric multiple sclerosis

OBJECTIVE: The diagnosis of multiple sclerosis (MS) rests on confirmation of central nervous system inflammatory disease that is disseminated in space and time, as evidenced clinically or by magnetic resonance imaging (MRI). The 2010 McDonald criteria simplified MRI requirements, and newly proposed that the criteria are also suitable for the diagnosis of pediatric MS. METHODS: In a national prospective incident cohort study of children with acute demyelination observed for a minimum of 24 months, baseline and serial clinical and MRI examinations were used to retrospectively evaluate the 2010 and 2005 McDonald criteria using clinically relapsing disease as the gold standard. RESULTS: Of 212 eligible participants, 34 experienced 2 or more clinical attacks, 58 met the 2010 criteria, and 42 met 2005 McDonald criteria. The 2010 criteria demonstrated high sensitivity (100%), specificity (86%), positive predictive value (76%), and negative predictive value (100%) for children older than 11 years with non-acute disseminated encephalomyelitis (ADEM) presentations, as did the 2005 McDonald criteria. In younger children with a non-ADEM presentation, PPV of the 2010 criteria was only 55%. None of the 50 children with ADEM met clinical criteria for MS, but 10 met 2010 and 4 met 2005 criteria. INTERPRETATION: Both 2005 and 2010 McDonald criteria identify children with relapsing-remitting MS, although caution is suggested when applying these criteria in younger children. The 2010 McDonald criteria are simple and enable an early diagnosis of MS, but are not suited for application in the context of ADEM-like presentations. ANN NEUROL 2012;72:211-223.     

Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria"

New diagnostic criteria for multiple sclerosis integrating magnetic resonance image assessment with clinical and other paraclinical methods were introduced in 2001. The "McDonald Criteria" have been extensively assessed and used since 2001. New evidence and consensus now strengthen the role of these criteria in the multiple sclerosis diagnostic workup to demonstrate dissemination of lesions in time, to clarify the use of spinal cord lesions, and to simplify diagnosis of primary progressive disease. The 2005 Revisions to the McDonald Diagnostic Criteria for MS should simplify and speed diagnosis, whereas maintaining adequate sensitivity and specificity.     

Diagnostic criteria for multiple sclerosis

Over a hundred years ago, Charcot set down what he considered to be some of the clinical characteristics of multiple sclerosis (MS). His triad was not specific but it was the first attempt to separate this disease from the many others affecting the nervous system. The history of clinical diagnostic criteria demonstrates the evolution from rather tentative classifications of restricted value to the more elaborate 1983 scheme which incorporates some laboratory procedures under the rubric paraclinical tests, considered to be extensions of the neurological examination, as well as a new category based on the presence of specific abnormalities of the cerebrospinal fluid (CSF). It is curious that until then the term definite MS had been avoided except for autopsy-proven cases, perhaps a wise move, since exact diagnosis may require long term observation. All the proposed schemes have been based on the twin principles of dissemination in both time and space. The diagnosis of MS must remain a clinical one, supported but not supplanted by the increasingly popular magnetic resonance imaging, which is non-specific and is frequently overinterpreted by radiologists lacking appropriate clinical information. Reliance on the MRI as the principal if not exclusive basis for the diagnosis leads to error in as many as one third of cases. This assumes a great deal of importance considering that such non-MS patients may be counted in epidemiological surveys and included in therapeutic trials for disease-modifying drugs, or eventually treated with these very expensive drugs with still controversial long term efficacy. Not surprisingly, attempts to develop reliable criteria for the MRI diagnosis of MS have been unsuccessful in view of the lack of specificity of that procedure. Great care should be taken to exclude the presence of extrinsic cervical spine lesions which might impinge on the cord, leading to the formation of plaques, or mimic the course of MS. An MRI of the cervical spine is recommended in all patients suspected of having MS who have symptoms suggestive of spinal cord involvement.The diagnosis of MS is, and will remain, based on clinical criteria which codify the characteristic dissemination in time and space of MS.     

Paediatric multiple sclerosis: examining utility of the McDonald 2010 criteria

The new McDonald 2010 criteria have been recommended in paediatric multiple sclerosis (PMS). We aimed to assess the utility of McDonald 2010 criteria in comparison with 2007 International Paediatric Multiple Sclerosis Study Group (IPMSSG)-recommended criteria for PMS diagnosis. Retrospective analysis of 38 PMS cases from three UK demyelination clinics was conducted. Dissemination in space (DIS) and time (DIT) for both McDonald and IPMSSG criteria were noted on initial and follow-up magnetic resonance imaging (MRI). At first MRI scan, IPMSSG DIS criteria were fulfilled in 68% of scans and McDonald DIS criteria in 84%. In total, 11/18 children given gadolinium contrast fulfilled both McDonald DIS and DIT criteria on initial scan. The 2010 McDonald criteria appear more sensitive than IPMSSG and may allow PMS diagnosis at first presentation of CIS in at least a half of cases.     

Diagnosis of multiple sclerosis: comparison of the Poser criteria and the new McDonald criteria

OBJECTIVES: A confident and accurate diagnosis of multiple sclerosis (MS) is important, but a specific diagnostic test for the disease does not exist. The traditional diagnostic criteria of Poser et al. were published in 1983, and recently, McDonald et al. recommended new criteria for the diagnosis of MS. PATIENTS AND METHODS: In this study these two diagnostic schemes were compared by prospectively applying both of them to 76 patients with clinical features suggesting a new diagnosis of MS. RESULTS: Using the Poser criteria, 29 patients (38%) were classified as clinically definite and 35 patients (46%) as laboratory definite MS. According to the new McDonald criteria, MS was diagnosed in 39 (52%) patients, 37 patients (48%) had 'possible MS'. All patients with a clinically definite MS with the Poser criteria were also given the diagnosis of MS as recommended by McDonald et al. Of those 35 patients with laboratory definite MS according to Poser et al., four patients could be classified as having MS with the McDonald criteria, 89% of them had 'possible MS'. Conversely, 75% of the 39 patients, who fulfilled the new McDonald criteria for MS were assigned to the category of clinically definite MS according to the Poser criteria, and 83% of the patients with a 'possible MS' using the McDonald criteria, had a laboratory definite MS with the Poser criteria. CONCLUSION: MS according to the McDonald criteria was diagnosed more often than 'clinically definite MS' according to Poser et al., but combining the categories of clinically and laboratory definite MS, the diagnosis of MS could clearly be established more frequently using the Poser criteria.     

Diagnostic criteria for multiple sclerosis: an historical review

Starting with Charcot, diagnostic criteria for multiple sclerosis (MS) have evolved to reflect advances in our understanding of the disease and the development of new diagnostic techniques, and from purely clinical considerations to increasing dependency upon imaging of the central nervous system. The MS diagnostic process was revolutionized by the 1981 introduction of magnetic resonance imaging (MRI), but the increasing reliance upon this technique has led to a surge in erroneous diagnoses, mostly because of the failure to distinguish between MS and disseminated encephalomyelitis (DEM), as well as mounting disregard for the data obtained from the traditional history and physical examination. The most recent scheme of McDonald et al. incorporated quantitative MRI criteria of dubious origin and reliability, but failed to provide qualitative, illustrative ones that would help differentiate between MS and DEM. The choice will have to be made by the neurological community between basing the diagnosis of MS on the MRI alone, or to use it as one aspect of a comprehensive clinical diagnostic algorithm. There will never be a substitute for the experienced and astute clinician's 'feel' for the patient.