Diagnostic performance of the 2010, 2017, and 2024 McDonald criteria: clinical implications in multiple sclerosis.

IF 4.6 2区医学 Q1 CLINICAL NEUROLOGY

Journal of Neurology Pub Date : 2025-09-20 DOI:10.1007/s00415-025-13395-4

Mario Habek, Ivan Adamec, Tereza Gabelić, Barbara Barun, Magdalena Krbot Skorić

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引用次数: 0

Abstract

Objective: To compare the sensitivity, specificity, predictive value, and accuracy of the 2010, 2017, and 2024 revisions of the McDonald criteria in a cohort of patients who have experienced their first demyelinating event suggestive of MS.

Methods: We included 118 participants (mean age 32.21 years, 71.2% female) with an average follow-up of 7.89 ± 2.65 years. The primary outcomes were to assess the sensitivity, specificity, predictive value, and accuracy of the 2010, 2017, and 2024 revisions of the McDonald criteria and to compare the effectiveness of these three sets of criteria in diagnosing MS.

Results: The 2024 revision demonstrated higher sensitivity (90% vs. 86% vs 32% and 87% vs. 79% vs. 37%) and lower specificity (35% vs. 47% vs. 69% and 54% vs. 63% vs 92%) when compared to the 2017 and 2010 revisions, for the development of a relapse and new MRI lesion, respectively. The hazard of relapse and EDSS worsening for participants meeting the 2024 McDonald criteria was 3.464 times (95% CI 1.492-8.046), p = 0.004, and 3.395 times (95% CI 1.043-11.049), p = 0.042, higher compared to participants who did not meet the criteria. After adjusting for age, sex, and EDSS, the hazard of switching to HET for participants meeting the 2024 McDonald criteria was 4.617 times greater than that of participants not meeting the criteria.

Conclusion: The findings indicate that the 2024 criteria have the highest sensitivity while retaining clinical applicability, especially in identifying disease activity through new MRI lesions.

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2010年、2017年和2024年麦当劳标准的诊断表现：多发性硬化症的临床意义

目的：比较2010年、2017年和2024年修订的McDonald标准对首次脱髓鞘事件提示多发性硬化患者的敏感性、特异性、预测值和准确性。方法：纳入118名参与者（平均年龄32.21岁，71.2%为女性），平均随访时间为7.89±2.65年。主要结果是评估2010年、2017年和2024年修订的麦当劳标准的敏感性、特异性、预测值和准确性，并比较这三套标准诊断多发性硬化的有效性。与2017年和2010年的修订相比，2024年的修订分别对复发和新的MRI病变的发展表现出更高的敏感性（90%对86%对32%，87%对79%对37%）和更低的特异性（35%对47%对69%，54%对63%对92%）。符合2024年McDonald标准的参与者的复发和EDSS恶化的风险是3.464倍（95% CI 1.492-8.046）， p = 0.004, 3.395倍（95% CI 1.043-11.049）， p = 0.042，高于不符合标准的参与者。在调整了年龄、性别和EDSS后，符合2024年麦当劳标准的参与者切换到HET的风险是不符合标准的参与者的4.617倍。结论：2024标准在保留临床适用性的同时具有最高的敏感性，特别是在通过MRI新发病变识别疾病活动性方面。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neurology 医学-临床神经学

CiteScore

10.00

自引率

5.00%

发文量

558

审稿时长

1 months

期刊介绍： The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field. In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials. Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.