Related Experiment Video
Updated: Jun 6, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Towards a Unified Set of Diagnostic Criteria for Multiple Sclerosis
Wallace J Brownlee1,2, Angela Vidal-Jordana3, Madiha Shatila1
1Queen Square Multiple Sclerosis Center, Department of Neuroinflammation, UCL Institute of Neurology, London, UK.
Objective:
The 2017 McDonald criteria continued the separation of diagnostic criteria for relapsing-remitting multiple sclerosis (RRMS) and primary progressive MS (PPMS) for historical, rather than biological, reasons. We aimed to explore the feasibility of a single, unified set of diagnostic criteria when applied to patients with suspected PPMS.
Methods:
We retrospectively identified patients evaluated for suspected PPMS at 5 European centers. The 2017 McDonald PPMS criteria was the gold standard against which the 2017 McDonald RRMS dissemination in space (DIS) and dissemination in time criteria were evaluated. We also investigated modified RRMS DIS criteria, including: (i) optic nerve lesions; (ii) ≥2 spinal cord lesions; and (iii) higher fulfilment of DIS criteria alone (lesions in ≥3 regions) without dissemination in time/positive cerebrospinal fluid, for a diagnosis of PPMS.
Results:
A total of 282 patients were diagnosed with PPMS using the 2017 McDonald criteria, and 40 with alternate disorders. The 2017 McDonald RRMS DIS criteria and the modified DIS criteria including the optic nerve or ≥2 spinal cord lesions performed well in PPMS diagnosis when combined with dissemination in time/positive cerebrospinal fluid (sensitivity 92.9-95.4%, specificity 95%, accuracy 93.2-95.3%). A diagnosis of PPMS based on high fulfillment of modified RRMS DIS criteria had high specificity, but low sensitivity. A diagnostic algorithm applicable to patients evaluated for suspected MS is proposed.
Interpretation:
The 2017 McDonald RRMS criteria and modifications to DIS criteria, currently under consideration, performed well in PPMS diagnosis. Forthcoming revisions to the McDonald criteria should consider a single, unified set of diagnostic criteria for MS. ANN NEUROL 2025;97:571-582.
Insights
The 2017 McDonald criteria for multiple sclerosis (MS) can be unified. Modified dissemination in space criteria accurately diagnosed primary progressive MS (PPMS), suggesting a single diagnostic approach is feasible.
Area of Science:
- Neurology
- Clinical Diagnostics
- Neuroimmunology
Background:
- The 2017 McDonald criteria separate diagnostic criteria for relapsing-remitting MS (RRMS) and primary progressive MS (PPMS).
- This separation is based on historical rather than biological distinctions.
- Investigating unified criteria could streamline MS diagnosis.
Purpose of the Study:
- To explore the feasibility of a single, unified set of diagnostic criteria for MS.
- To evaluate the performance of 2017 McDonald RRMS criteria and modified criteria in diagnosing PPMS.
Main Methods:
- Retrospective analysis of patients suspected of having PPMS across 5 European centers.
- Evaluation of 2017 McDonald RRMS dissemination in space (DIS) and dissemination in time criteria against the 2017 McDonald PPMS criteria.
- Investigation of modified RRMS DIS criteria (optic nerve lesions, ≥2 spinal cord lesions, or higher fulfillment) for PPMS diagnosis.
Main Results:
- 282 patients were diagnosed with PPMS, and 40 with other disorders.
- 2017 McDonald RRMS DIS criteria and modified DIS criteria (optic nerve/≥2 spinal cord lesions) showed high sensitivity (92.9-95.4%) and specificity (95%) for PPMS when combined with dissemination in time/CSF.
- High fulfillment of modified RRMS DIS criteria alone demonstrated high specificity but low sensitivity for PPMS.
Conclusions:
- The 2017 McDonald RRMS criteria and proposed DIS modifications are effective for PPMS diagnosis.
- A unified diagnostic criterion for MS should be considered in future revisions.
- A diagnostic algorithm for suspected MS cases is proposed.
