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Updated: Jan 24, 2026

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Does Interrater Variation Influence the Classification According to the Diagnostic Criteria for Multiple Sclerosis?

Nima Mahmoudi1,2, Julius Renne2, Franz Felix Konen3

  • 1Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.

European Journal of Neurology
|January 23, 2026
PubMed
Abstract

Insights

Interrater agreement for multiple sclerosis (MS) lesion identification varies, with higher consistency in applying diagnostic criteria than in lesion counts. Standardized MRI protocols show moderate to substantial agreement for lesion presence.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Limited and outdated studies exist on interrater agreement in MRI analysis for early multiple sclerosis (MS) diagnosis.
  • This study addresses the need for current data on MRI lesion identification agreement.

Purpose of the Study:

  • To evaluate interrater agreement for brain, optic nerve, and spinal cord lesion identification in early MS.
  • To assess variability in applying the 2017 and 2024 McDonald criteria for MS diagnosis.

Main Methods:

  • Seventy-eight patients with a first clinical episode suggestive of MS underwent standardized 3 Tesla MRI.
  • Three readers with varied expertise analyzed lesions in the brain, optic nerves, and spinal cord.
  • Interrater variability was quantified using Cohen's κ and Fleiss κ.

Main Results:

  • Interrater agreement was slight to fair for total lesion counts but moderate to substantial for lesion presence.
  • Highest agreement observed for spinal cord lesions (κ=0.84), periventricular T2 lesions (κ=0.70), and enhancing brain lesions (κ=0.75).
  • Substantial agreement (κ=0.65) was found between the 2017 and 2024 McDonald criteria revisions.

Conclusions:

  • Standardized 3T MRI protocols did not substantially improve interrater agreement for lesion counts in early MS.
  • Agreement in classifying lesions based on diagnostic criteria remained consistent between the 2017 and 2024 McDonald criteria.
Keywords:
MR imagingMcDonald criteriademyelinationmultiple sclerosisoptic nerveoptic nerve imaging

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