Caterina Lapucci1, Laura Saitta2, Giulia Bommarito2, Maria Pia Sormani2, Matteo Pardini2, Laura Bonzano2, Giovanni Luigi Mancardi2, Claudio Gasperini2, Antonio Giorgio2, Matilde Inglese2, Nicola De Stefano2, Luca Roccatagliata2. 1. From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (C.L., G.B., M.P., L.B., G.L.M., M.I.), University of Genoa; Departments of Neuroradiology (L.S., L.R.), Health Sciences (M.P.S., L.R.), and Neurology (M.P., G.L.M., M.I.), Ospedale Policlinico San Martino IRCCS, Genoa; Department of Neurosciences (C.G.), S. Camillo-Forlanini Hospital, Rome; and Departments of Medicine, Surgery, and Neuroscience (A.G., N.D.S.), University of Siena, Italy. lapuccicate@gmail.com. 2. From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (C.L., G.B., M.P., L.B., G.L.M., M.I.), University of Genoa; Departments of Neuroradiology (L.S., L.R.), Health Sciences (M.P.S., L.R.), and Neurology (M.P., G.L.M., M.I.), Ospedale Policlinico San Martino IRCCS, Genoa; Department of Neurosciences (C.G.), S. Camillo-Forlanini Hospital, Rome; and Departments of Medicine, Surgery, and Neuroscience (A.G., N.D.S.), University of Siena, Italy.
Abstract
OBJECTIVE: To evaluate in clinically isolated syndrome (CIS) and migraine with aura (MA) how the number of periventricular lesions (PVLs) detected at MRI influences diagnostic performance when the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) or the 2017 revised criteria are applied. METHODS: In this retrospective study, white matter hyperintensities (WMH) of 84 patients with MA and 79 patients with CIS were assessed using manual segmentation technique. Lesion probability maps (LPMs) and voxel-wise analysis of lesion distribution by diagnosis were obtained. Furthermore, we performed a logistic regression analysis based on lesion locations and volumes. RESULTS: Compared to patients with MA, patients with CIS showed a significant overall higher T2 WMH mean number and volume (17.9 ± 16.9 vs 6.2 ± 11.9 and 3.1 ± 4.2 vs 0.3 ± 0.6 mL; p < 0.0001) and a significantly higher T2 WMH mean number in infratentorial, periventricular, and juxtacortical areas (p < 0.0001). LPMs identified the periventricular regions as the sites with the highest probability of detecting T2 WMH in patients with CIS. Voxel-wise analysis of lesion distribution by diagnosis revealed a statistically significant association exclusively between the diagnosis of CIS and the PVLs. MAGNIMS criteria demonstrated the highest specificity in differentiating patients with CIS from patients with MA (100% vs 87%) against a predictable lower sensitivity (63% vs 72%). CONCLUSIONS: PVLs play a key role in the differential diagnosis between MA and CIS, particularly when there are more than 3. Future studies on multiple sclerosis criteria might reconsider the 3 PVLs to minimize the risk of misdiagnosis. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that the presence at least 3 PVLs increases the specificity in distinguishing MA from CIS.
OBJECTIVE: To evaluate in clinically isolated syndrome (CIS) and migraine with aura (MA) how the number of periventricular lesions (PVLs) detected at MRI influences diagnostic performance when the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) or the 2017 revised criteria are applied. METHODS: In this retrospective study, white matter hyperintensities (WMH) of 84 patients with MA and 79 patients with CIS were assessed using manual segmentation technique. Lesion probability maps (LPMs) and voxel-wise analysis of lesion distribution by diagnosis were obtained. Furthermore, we performed a logistic regression analysis based on lesion locations and volumes. RESULTS: Compared to patients with MA, patients with CIS showed a significant overall higher T2 WMH mean number and volume (17.9 ± 16.9 vs 6.2 ± 11.9 and 3.1 ± 4.2 vs 0.3 ± 0.6 mL; p < 0.0001) and a significantly higher T2 WMH mean number in infratentorial, periventricular, and juxtacortical areas (p < 0.0001). LPMs identified the periventricular regions as the sites with the highest probability of detecting T2 WMH in patients with CIS. Voxel-wise analysis of lesion distribution by diagnosis revealed a statistically significant association exclusively between the diagnosis of CIS and the PVLs. MAGNIMS criteria demonstrated the highest specificity in differentiating patients with CIS from patients with MA (100% vs 87%) against a predictable lower sensitivity (63% vs 72%). CONCLUSIONS: PVLs play a key role in the differential diagnosis between MA and CIS, particularly when there are more than 3. Future studies on multiple sclerosis criteria might reconsider the 3 PVLs to minimize the risk of misdiagnosis. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that the presence at least 3 PVLs increases the specificity in distinguishing MA from CIS.
Authors: Andrew J Solomon; Georgina Arrambide; Wallace Brownlee; Anne H Cross; María I Gaitan; Fred D Lublin; Naila Makhani; Ellen M Mowry; Daniel S Reich; Àlex Rovira; Brian G Weinshenker; Jeffrey A Cohen Journal: Neurol Clin Pract Date: 2022-06
Authors: Antonio Giorgio; Marco Battaglini; Giordano Gentile; Maria Laura Stromillo; Claudio Gasperini; Andrea Visconti; Andrea Paolillo; Nicola De Stefano Journal: Front Neurol Date: 2020-11-20 Impact factor: 4.003