Comparison of the 2010 and 2005 versions of the McDonald MRI criteria for dissemination-in-time in Taiwanese patients with classic multiple sclerosis

In 2010, the International Panel on the Diagnosis of Multiple Sclerosis revised the 2005 version of the McDonald criteria. The revisions to MRI dissemination-in-time criteria include adoption of a new criterion by demonstration of simultaneous asymptomatic gadolinium-enhancing and nonenhancing lesions on baseline MRI scans. The purpose of this study was to demonstrate the diagnostic validity of the modified MRI dissemination-in-time criteria. We collected 80 patients with an initial clinical attack suggestive of an acute central nervous system demyelinating disease. The patients were followed for at least two years or until the development of definite multiple sclerosis. The nonconverters were taken as negative cases. Their baseline and follow-up brain MRI studies were retrospectively reviewed by two neuroradiologists. The 2010 version had higher sensitivity (68.2% vs. 45.5%), slightly lower specificity (80.6% vs. 83.3%), and higher accuracy (73.8% vs. 62.5%) than the 2005 version, but the differences were without statistical significance. The new criteria are more sensitive and accurate and specific just as the old criteria. They allow the diagnosis of definite multiple sclerosis in 34.1% patients at first presentation of the clinically isolated syndrome.