Validation of MRI predictors of multiple sclerosis diagnosis in children with acute CNS demyelination

L. H. Verhey, E. D. Van Pelt-Gravesteijn, I. A. Ketelslegers, R. F. Neuteboom, C. E. Catsman-Berrevoets, B. M. Feldman, D. L. Streiner, J. G. Sled, R. Q. Hintzen, B. Banwell*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademic

8 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)193-199
Number of pages7
JournalMultiple Sclerosis and Related Disorders
Volume2
Issue number3
DOIs
Publication statusPublished - Jul 2013

Bibliographical note

Funding Information:
The Dutch Study Group for Pediatric MS is funded under a grant from the Dutch MS Research Foundation . Funding for the current analysis was provided by direct donations to MS research at The Hospital for Sick Children (Toronto, Canada). The authors thank the participating children and their families for their cooperation and commitment to the research program.

Funding Information:
LHV receives studentship support from the Canadian Institutes of Health Research (CIHR) Frederick Banting and Charles Best Master's and Doctoral Canada Graduate Scholarships: 201010GSD-249751-175560 and 200802CGM-186751-175560, Multiple Sclerosis Society of Canada (MSSC) Master's Award, and The Hospital for Sick Children Foundation Research Training Award. EDvP-G, IAK, RFN, CEC-B, BMF, DLS, JGS and RQH report no disclosures. BB has received speaker's honoraria from Merck-Serono, Biogen-IDEC, Bayer Healthcare, and Teva Neuroscience. BB serves as an advisor on pediatric therapies for Biogen-IDEC, Merk-Serono, and Genzyme. BB is supported by the MSSC, the Canadian Multiple Sclerosis Scientific Research Foundation, and by a New Emerging Team Grant in Autoimmunity supported by the CIHR and MSSC.

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