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Updated: Dec 26, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Challenges in multiple sclerosis diagnosis: Misunderstanding and misapplication of the McDonald criteria
Andrew J Solomon1, Roman Pettigrew2, Robert T Naismith3
1Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA.
Objective:
To assess comprehension and application of the McDonald criteria.
Background:
Studies suggest that knowledge gaps for specific core elements of the McDonald criteria may contribute to multiple sclerosis (MS) misdiagnosis.
Methods:
Neurology residents (NR) and multiple sclerosis specialists (MSS) in North America completed a web-based survey.
Results:
A total of 160 participants were included: 72 NR and 88 MSS. Syndromes incorrectly identified as typical of MS included: complete transverse myelopathy (35% NR and 15% MSS), intractable vomiting/nausea/hiccoughs (20% NR and 5% MSS), and bilateral optic neuritis/unilateral optic neuritis with poor visual recovery (17% NR and 10% MSS). Periventricular magnetic resonance imaging (MRI) lesions were correctly identified by 39% NR and 52% MSS, and juxtacortical lesions were correctly identified by 28% NR and 53% MSS. The correct definition of "periventricular" was chosen by 38% NR and 61% MSS, and that of "juxtacortical" was chosen by 19% NR and 54% MSS. Regions incorrectly identified for MRI dissemination in space fulfillment included the optic nerve (31% NR and 26% MSS) and the subcortical white matter (11% NR and 18% MSS). The majority of participants assessed previous non-specific neurological symptoms without objective evidence of a central nervous system (CNS) lesion as sufficient for clinical dissemination in time.
Conclusion:
The McDonald criteria are often misunderstood and misapplied. Concerted educational efforts may prevent MS misdiagnosis.
Insights
Neurology residents and multiple sclerosis specialists often misunderstand and misapply the McDonald criteria, potentially leading to multiple sclerosis misdiagnosis. Improved education on these diagnostic criteria is crucial for accurate patient care.
Area of Science:
- Neurology
- Neuroimmunology
- Diagnostic Criteria
Background:
- Knowledge gaps in the McDonald criteria may contribute to misdiagnosis of multiple sclerosis (MS).
- Accurate application of diagnostic criteria is essential for timely and correct MS diagnosis.
Purpose of the Study:
- To assess the comprehension and application of the McDonald criteria among neurology residents and MS specialists.
- To identify specific areas of misunderstanding in the application of MS diagnostic criteria.
Main Methods:
- A web-based survey was administered to neurology residents (NR) and multiple sclerosis specialists (MSS) in North America.
- 160 participants (72 NR, 88 MSS) completed the survey assessing their understanding of MS diagnostic criteria.
Main Results:
- Significant misunderstandings were observed in identifying typical MS syndromes and interpreting MRI findings (e.g., periventricular and juxtacortical lesions).
- Many participants incorrectly identified specific syndromes and MRI lesion locations for dissemination in space.
- A majority incorrectly considered non-specific symptoms sufficient for clinical dissemination in time.
Conclusions:
- The McDonald criteria are frequently misunderstood and misapplied by both residents and specialists.
- Targeted educational interventions are necessary to improve the correct application of the McDonald criteria.
- Addressing these knowledge gaps may help prevent multiple sclerosis misdiagnosis.
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