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Abstract
Objective To evaluate in clinically isolated syndrome (CIS) and migraine with aura (MA) how the number of periventricular lesions (PVLs) detected at MRI influences diagnostic performance when the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) or the 2017 revised criteria are applied.
Methods In this retrospective study, white matter hyperintensities (WMH) of 84 patients with MA and 79 patients with CIS were assessed using manual segmentation technique. Lesion probability maps (LPMs) and voxel-wise analysis of lesion distribution by diagnosis were obtained. Furthermore, we performed a logistic regression analysis based on lesion locations and volumes.
Results Compared to patients with MA, patients with CIS showed a significant overall higher T2 WMH mean number and volume (17.9 ± 16.9 vs 6.2 ± 11.9 and 3.1 ± 4.2 vs 0.3 ± 0.6 mL; p < 0.0001) and a significantly higher T2 WMH mean number in infratentorial, periventricular, and juxtacortical areas (p < 0.0001). LPMs identified the periventricular regions as the sites with the highest probability of detecting T2 WMH in patients with CIS. Voxel-wise analysis of lesion distribution by diagnosis revealed a statistically significant association exclusively between the diagnosis of CIS and the PVLs. MAGNIMS criteria demonstrated the highest specificity in differentiating patients with CIS from patients with MA (100% vs 87%) against a predictable lower sensitivity (63% vs 72%).
Conclusions PVLs play a key role in the differential diagnosis between MA and CIS, particularly when there are more than 3. Future studies on multiple sclerosis criteria might reconsider the 3 PVLs to minimize the risk of misdiagnosis.
Classification of evidence This study provides Class IV evidence that the presence at least 3 PVLs increases the specificity in distinguishing MA from CIS.
Glossary
- CIS=
- clinically isolated syndrome;
- DIS=
- dissemination in space;
- FLAIR=
- fluid-attenuated inversion recovery;
- LPM=
- lesion probability map;
- MA=
- migraine with aura;
- MAGNIMS=
- Magnetic Resonance Imaging in Multiple Sclerosis;
- MS=
- multiple sclerosis;
- PVL=
- periventricular lesion;
- WMH=
- white matter hyperintensities
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Class of Evidence: NPub.org/coe
Podcast: NPub.org/54kjls
CME Course: NPub.org/cmelist
- Received July 24, 2018.
- Accepted in final form December 7, 2018.
- © 2019 American Academy of Neurology
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