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¿Influye la Variación Interobservador en la Clasificación Según los Criterios Diagnósticos de Esclerosis Múltiple?
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
Resumen
La concordancia interobservador para la identificación de lesiones de esclerosis múltiple (EM) varía, con mayor consistencia en la aplicación de los criterios diagnósticos que en el recuento de lesiones. Los protocolos estandarizados de RM muestran una concordancia de moderada a sustancial para la presencia de lesiones.
Área de la Ciencia:
- Neurología; Radiología; Imagenología Médica
Sus antecedentes:
- Existen estudios limitados y desactualizados sobre la concordancia interobservador en el análisis de RM para el diagnóstico temprano de esclerosis múltiple (EM).; Este estudio aborda la necesidad de datos actuales sobre la concordancia en la identificación de lesiones por RM.
Objetivo del estudio:
- Evaluar la concordancia interobservador para la identificación de lesiones en el cerebro, nervio óptico y médula espinal en la EM temprana.; Evaluar la variabilidad en la aplicación de los criterios de McDonald de 2017 y 2024 para el diagnóstico de EM.
Principales métodos:
- Setenta y ocho pacientes con un primer episodio clínico sugerente de EM se sometieron a RM estandarizada de 3 Tesla.; Tres lectores con experiencia variada analizaron lesiones en el cerebro, nervios ópticos y médula espinal.; La variabilidad interobservador se cuantificó utilizando el κ de Cohen y el κ de Fleiss.
Principales resultados:
- La concordancia interobservador fue de ligera a regular para el recuento total de lesiones, pero de moderada a sustancial para la presencia de lesiones.; Se observó la mayor concordancia para lesiones de la médula espinal (κ=0,84), lesiones T2 periventriculares (κ=0,70) y lesiones cerebrales con realce (κ=0,75).; Se encontró una concordancia sustancial (κ=0,65) entre las revisiones de los criterios de McDonald de 2017 y 2024.
Conclusiones:
- Los protocolos estandarizados de RM de 3T no mejoraron sustancialmente la concordancia interobservador para el recuento de lesiones en la EM temprana.; La concordancia en la clasificación de lesiones según los criterios diagnósticos se mantuvo constante entre los criterios de McDonald de 2017 y 2024.
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