Publications

Authors:

Cagol, Alessandro; Cortese, Rosa; Barakovic, Muhamed; Schaedelin, Sabine; Ruberte, Esther; Absinta, Martina; Barkhof, Frederik; Calabrese, Massimiliano; Castellaro, Marco; Ciccarelli, Olga; Cocozza, Sirio; De Stefano, Nicola; Enzinger, Christian; Filippi, Massimo; Jurynczyk, Maciej; Maggi, Pietro; Mahmoudi, Nima; Messina, Silvia; Montalban, Xavier; Palace, Jacqueline; Pontillo, Giuseppe; Pröbstel, Anne-Katrin; Rocca, Maria A; Ropele, Stefan; Rovira, Àlex; Schoonheim, Menno M; Sowa, Piotr; Strijbis, Eva; Wattjes, Mike P; Sormani, Maria Pia; Kappos, Ludwig; Granziera, Cristina

Title:

Diagnostic performance of cortical lesions and the central vein sign in multiple sclerosis

Year:

2023

Type of item:

Articolo in Rivista

Tipologia ANVUR:

Articolo su rivista

Language:

Inglese

Format:

Elettronico

Referee:

Sì

Name of journal:

JAMA NEUROLOGY

ISSN of journal:

2168-6149

N° Volume:

First published online: 11 December 2023

Page numbers:

1-11

Keyword:

multiple sclerosis (MS); imaging biomarkers; cortical lesions; central vein sign; diagnosis; accuracy

Short description of contents:

Importance: Multiple sclerosis (MS) misdiagnosis remains an important issue in clinical practice. Objective: To quantify the performance of cortical lesions (CLs) and central vein sign (CVS) in distinguishing MS from other conditions showing brain lesions on magnetic resonance imaging (MRI). Design, setting, and participants: This was a retrospective, cross-sectional multicenter study, with clinical and MRI data acquired between January 2010 and May 2020. Centralized MRI analysis was conducted between July 2020 and December 2022 by 2 raters blinded to participants' diagnosis. Participants were recruited from 14 European centers and from a multicenter pan-European cohort. Eligible participants had a diagnosis of MS, clinically isolated syndrome (CIS), or non-MS conditions; availability of a brain 3-T MRI scan with at least 1 sequence suitable for CL and CVS assessment; presence of T2-hyperintense white matter lesions (WMLs). A total of 1051 individuals were included with either MS/CIS (n = 599; 386 [64.4%] female; mean [SD] age, 41.5 [12.3] years) or non-MS conditions (including other neuroinflammatory disorders, cerebrovascular disease, migraine, and incidental WMLs in healthy control individuals; n = 452; 302 [66.8%] female; mean [SD] age, 49.2 [14.5] years). Five individuals were excluded due to missing clinical or demographic information (n = 3) or unclear diagnosis (n = 2). Exposures: MS/CIS vs non-MS conditions. Main outcomes and measures: Area under the receiver operating characteristic curves (AUCs) were used to explore the diagnostic performance of CLs and the CVS in isolation and in combination; sensitivity, specificity, and accuracy were calculated for various cutoffs. The diagnostic importance of CLs and CVS compared to conventional MRI features (ie, presence of infratentorial, periventricular, and juxtacortical WMLs) was ranked with a random forest model. Results: The presence of CLs and the previously proposed 40% CVS rule had a sensitivity, specificity, and accuracy for MS of 59.0% (95% CI, 55.1-62.8), 93.6% (95% CI, 91.4-95.6), and 73.9% (95% CI, 71.6-76.3) and 78.7% (95% CI, 75.5-82.0), 86.0% (95% CI, 82.1-89.5), and 81.5% (95% CI, 78.9-83.7), respectively. The diagnostic performance of the CVS (AUC, 0.89 [95% CI, 0.86-0.91]) was superior to that of CLs (AUC, 0.77 [95% CI, 0.75-0.80]; P < .001), and was increased when combining the 2 imaging markers (AUC, 0.92 [95% CI, 0.90-0.94]; P = .04); in the random forest model, both CVS and CLs outperformed the presence of infratentorial, periventricular, and juxtacortical WMLs in supporting MS differential diagnosis. Conclusions and relevance: The findings in this study suggest that CVS and CLs may be valuable tools to increase the accuracy of MS diagnosis.

Web page:

https://jamanetwork.com/journals/jamaneurology/fullarticle/2812783

Product ID:

136572

Handle IRIS:

11562/1115570

Last Modified:

February 18, 2024

Bibliographic citation:

Cagol, Alessandro; Cortese, Rosa; Barakovic, Muhamed; Schaedelin, Sabine; Ruberte, Esther; Absinta, Martina; Barkhof, Frederik; Calabrese, Massimiliano; Castellaro, Marco; Ciccarelli, Olga; Cocozza, Sirio; De Stefano, Nicola; Enzinger, Christian; Filippi, Massimo; Jurynczyk, Maciej; Maggi, Pietro; Mahmoudi, Nima; Messina, Silvia; Montalban, Xavier; Palace, Jacqueline; Pontillo, Giuseppe; Pröbstel, Anne-Katrin; Rocca, Maria A; Ropele, Stefan; Rovira, Àlex; Schoonheim, Menno M; Sowa, Piotr; Strijbis, Eva; Wattjes, Mike P; Sormani, Maria Pia; Kappos, Ludwig; Granziera, Cristina, Diagnostic performance of cortical lesions and the central vein sign in multiple sclerosis «JAMA NEUROLOGY» , vol. First published online: 11 December 2023 , 2023 , pp. 1-11

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