Multiple sclerosis diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
Diagnostic Study of Choice
Study of choice
- Before MRI becomes a common imaging technique for diagnosis MS, clinical presentation was the only tool. Nowadays, new diagnostic criteria (mcDonald criteria) are focusing on MRI finding in addition to clinical presentation of patients.[1] MRI can show lesions better than CTscan. We can find typical white matter lesion in most of the MS patients. These findings alone can’t confirm the diagnosis since there are so many conditions mimicing MS imaging especially ischemic lesions in patients more than 50 years old.[2]
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
OR
The following result of [gold standard test] is confirmatory of [disease name]:
- [Result 1]
- [Result 2]
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[Name of the investigation] must be performed when:
- The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
- A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
OR
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
OR
The diagnostic study of choice for [disease name] is [name of the investigation].
OR
There is no single diagnostic study of choice for the diagnosis of [disease name].
OR
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
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[Disease name] is primarily diagnosed based on the clinical presentation.
OR
Investigations:
- Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
- Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
- Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
The comparison of various diagnostic studies for [disease name]
[Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity
Diagnostic results
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
- cerebral plaques which are demyelinating areas.[3]
- An elevated concentration of CSF oligoclonal bands is diagnostic of multiple sclerosis and can be seen in more than 95% of these patients.[1][4][5]
Sequence of Diagnostic Studies
- History and physical examination
- Imaging
- CSF analysis
McDonald criteria
| Clinical presentation | Additional Data Needed |
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Dissemination in space, demonstrated by:
New criteria: Dissemination in Space (DIS) can be demonstrated by the . |
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Dissemination in time (DIT), demonstrated by:
New criteria: No longer a need to have separate MRIs run; Dissemination in time, demonstrated by: Simultaneous presence of asymptomatic gadolinium-enhancing and nonenhancing lesions at any time; or A new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, irrespective of its timing with reference to a baseline scan; or Await a second clinical attack. [This allows for quicker diagnosis without sacrificing specificity, while improving sensitivity.] |
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New criteria: Dissemination in space and time, demonstrated by:
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New criteria: One year of disease progression (retrospectively or prospectively determined) and two or three of the following:
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References
- ↑ 1.0 1.1 McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinshenker BY, Wolinsky JS (July 2001). "Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis". Ann. Neurol. 50 (1): 121–7. PMID 11456302.
- ↑ Offenbacher H, Fazekas F, Schmidt R, Freidl W, Flooh E, Payer F, Lechner H (May 1993). "Assessment of MRI criteria for a diagnosis of MS". Neurology. 43 (5): 905–9. PMID 8274173.
- ↑ Trapp BD, Peterson J, Ransohoff RM, Rudick R, Mörk S, Bö L (January 1998). "Axonal transection in the lesions of multiple sclerosis". N. Engl. J. Med. 338 (5): 278–85. doi:10.1056/NEJM199801293380502. PMID 9445407.
- ↑ Dobson R, Ramagopalan S, Davis A, Giovannoni G (August 2013). "Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes: a meta-analysis of prevalence, prognosis and effect of latitude". J. Neurol. Neurosurg. Psychiatry. 84 (8): 909–14. doi:10.1136/jnnp-2012-304695. PMID 23431079.
- ↑ McLean BN, Luxton RW, Thompson EJ (October 1990). "A study of immunoglobulin G in the cerebrospinal fluid of 1007 patients with suspected neurological disease using isoelectric focusing and the Log IgG-Index. A comparison and diagnostic applications". Brain. 113 ( Pt 5): 1269–89. PMID 2245296.
- ↑ Gobbin F, Zanoni M, Marangi A, Orlandi R, Crestani L, Benedetti MD, Gajofatto A (January 2019). "2017 McDonald criteria for multiple sclerosis: Earlier diagnosis with reduced specificity?". Mult Scler Relat Disord. 29: 23–25. doi:10.1016/j.msard.2019.01.008. PMID 30658260.
- ↑ McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinshenker BY, Wolinsky JS (July 2001). "Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis". Ann. Neurol. 50 (1): 121–7. PMID 11456302.