These new criteria for DIS can simplify the diagnostic process for MS, while preserving specificity and improving sensitivity.
The presence of both gadolinium-enhancing and nonenhancing lesions on the baseline MRI can substitute for a follow-up scan to confirm DIT, as long as it can be reliably determined that the gadolinium-enhancing lesion is not due to non-MS pathology.
Based on these changes, a diagnosis of MS can be made in some CIS patients on the basis of a single MRI. The panel stated that this change simplifies the diagnostic process without reducing accuracy.
Cerebrospinal Fluid
The panel still agreed that positive cerebrospinal fluid (CSF) findings – elevated immunoglobulin G (IgG) index or two or more oligoclonal bands – can be important to support the inflammatory demyelinating nature of the underlying condition, to evaluate alternative diagnoses, and to predict clinically definite MS. However, when applying the simplified MAGNIMS imaging criteria for DIS and DIT, the panel believes that changing the MRI requirements in CSF-positive patients is not appropriate.
Primary Progressive MS
The panel recommended replacing previous brain imaging criteria for primary progressive MS (PPMS) with the new MAGNIMS criteria for DIS. In addition to 1 year of disease progression, the new criteria for PPMS require two of the following: at least one T2 lesion in at least one area characteristic for MS (periventricular, juxtacortical, or infratentorial); at least two T2 lesions in the cord; or positive CSF (isoelectric focusing evidence of oligoclonal bands with or without an elevated IgG index).
Dr. Polman, Dr. Rudick, and several other panelists reported significant financial relationships with several pharmaceutical companies.