Abstract
Background
In a recent Canadian prospective study of children with acute demyelinating syndromes
(ADS), we demonstrated that the presence of T2 periventricular and T1-hypointense
lesions predicted MS diagnosis. We aimed to validate these predictors in a Dutch cohort
of children with ADS.
Methods
Participants with ADS were identified from a prospective cohort or archived dataset.
MS was diagnosed based on clinical or MRI evidence of relapsing disease. Baseline
MRI scans were evaluated for the presence of the two predictive parameters. Sensitivity,
specificity, positive (LR+) and negative likelihood ratios (LR−), and positive (PPV)
and negative predictive value (NPV) were calculated to evaluate the performance of
the MRI parameters at classifying children as having MS or monophasic demyelination.
Findings
Of 115 children identified with ADS between December 1993 and December 2009, MRI scans
from 87 children (45 prospective; 47 archived) were evaluated; scans of 28 children
were excluded due to incomplete or poor quality imaging. Mean duration of observation
was longer in the archived group (7.1 years, SD 3.5) than the prospective cohort (3.3
years, SD 1.4). 30 children were diagnosed with MS. Performance of the parameters
was not statistically different between the prospective cohort (sensitivity 93.3%
[68.1–99.8]; specificity 86.7% [69.3–96.2]; LR+ 7.0 [2.8–17.6]; LR− 0.08 [0.01–0.5];
PPV 77.8% [52.4–93.6]; NPV 96.3% [81.0–99.9]) and archived group (sensitivity 66.7%
[38.4–88.2]; specificity 85.2% [66.3–95.8]; LR+ 4.5 [1.7–11.9]; LR− 0.4 [0.2–0.8];
PPV 71.4% [41.9–91.6]; NPV 82.1% [63.1–93.9]).
Interpretation
In an independent Dutch cohort, we confirm that the presence of ≥1 T2 periventricular
and ≥1 T1-hypointense lesions reliably identifies children with MS.
Funding
Dutch MS Research Foundation.
Highlights
- We validate MRI parameters for predicting MS diagnosis in children.
- T2 periventricular and T1-hypointense lesions are associated with MS diagnosis.
- Prompt diagnosis of children with MS aids in counseling and management.
- The MRI parameters may identify participants for clinical trials.
Keywords
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Article info
Publication history
Published online: February 04, 2013
Accepted:
December 11,
2012
Received in revised form:
December 5,
2012
Received:
October 19,
2012
Identification
Copyright
© 2012 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
