Summary: A revolutionary study has shown that multiple sclerosis (MS) can now be diagnosed with precision with a specialized MRI, eliminating the need for invasive and often painful lumbar perforations. The scan, which takes only 8 minutes, detects brain lesions centered on the veins – a characteristic of MS – using a technique called t2 *.
The researchers introduced a simple diagnostic directive known as the “Six rule”, confirming the MS if lesions centered on six veins are found. This method not only improves patient comfort and reduces diagnostic delays, but could also save millions of health systems by reducing hospital stays and complications from lumbar perforations.
Key facts:
- Non -invasive diagnosis: The 8 -minute MRI replaces the need for painful lumbar perforations.
- ‘Six’ rule: Finding brain lesions centered on six veins confirms the diagnosis of MS.
- Cost and time of savings: Could save the NHS up to 5 million pounds sterling per year and accelerate the diagnosis of 3 months.
Source: University of Nottingham
Experts from the University of Nottingham have proven that multiple sclerosis (MS) can be successfully diagnosed with MRI, which means that patients no longer need to undergo a painful lumbar puncture.
In the new study, published in Neurology Free accessAn official review of the American Academy of Neurology, experts from the School of Medicine revealed that by using a new MRI, they could successfully diagnose the SEP in 8 minutes.
The results could provide the NHS with a scientific approach to diagnosing the MP which is safer, more profitable and, more important, acceptable to patients.
The study was funded by the National Institute for Health and Care Research (NIHR).
SEP is a neurological condition that affects around 150,000 people in the United Kingdom. It is notoriously difficult to diagnose because it has many symptoms, but all people suffering do not experience them all and the disease can progress at different rates.
There is currently no agreement on the best way to diagnose MS. Often, people suspected of having a SEP have a standard MRI and undergo a lumbar puncture, where a thin needle is inserted between the bones in the lower spine.
Patients often point out that they find that it is painful, and this can cause involuntary complications requiring hospitalization or leave to recover. Although the liquid taken during a lumbar puncture can show evidence of illness, this is not always the case.
Anomalies are not found in all those who have a SEP. Some people suffering from conditions that can imitate MS, but who need very different treatment, have similar lumbar puncture anomalies. Both problems can lead to an erroneous diagnosis.
The main author of the study, Professor Nikos Evangelou, professor of clinical neurology at the university, said: “More than half of all people diagnosed with the SEP in the United Kingdom had at least one lumbar perforation, following suspicions of the diagnosis of MS.
The results of our research are particularly exciting because we have now shown that we can give the diagnosis of MS without this painful procedure. »»
The team used a clinical MRI scanner, of the type that all neuroscience centers have, to make a special type of scan called MRI weighted in T2 * which is capable of revealing lesions in the white substance of the brain centered on a vein – A known indicator of MS.
For a conclusive diagnosis of MS, the team developed the “Six rule”, according to which if there were six lesions found with a central vein, this confirmed a diagnosis of MS without having to analyze all the lesions.
The team carried out a prospective study, in Nottingham, Cardiff and London with patients who had a suspected but non -final diagnosis of MS. Each patient received an MRI of 8 minutes and a lumbar puncture and after 18 months, he was able to discover what was the diagnosis and if that corresponded to that of his initial scan.
The results show that the use of T2 * weighted MRI with the “Six rule” supported the diagnosis of MP as an alternative to a lumbar puncture.
Following this study and previous research in Nottingham and the United States, the International Committee for the Diagnosis of MS, recently announced that MRI, as proposed for the first time by the Nottingham research team, was sufficient to diagnose MS. A lumbar puncture is no longer necessary.
Professor Evangelou adds: “Not only will our results have enormous advantages for patients, but this will also mean cost savings for the NHS.
“People with lumbar bites are required to spend at least the most of a day at the hospital, and for a healthy health service, this creates more problems. If there are complications with the lumbar perforation, the stay can be longer. With MRI, it takes 8 minutes, is completely safe, and then you can go home.
“On average, we believe that we will reach the diagnosis three months earlier and the change could allow the NHS up to five million pounds each year, which can be reinvested in better services for our patients with MS.”
About this SP and news from the neuroimages of neuroimaging
Author: Charlotte wall
Source: University of Nottingham
Contact: Charlotte Wall – University of Nottingham
Picture: The image is credited with Neuroscience News
Original search: Open access.
“Comparison of the diagnostic performance of the signs of the central vein and the OLigoclonal strips of the LCR supporting the diagnosis of multiple sclerosis” by Nikos Evangelou et al. Neurology in full access
Abstract
Comparison of the diagnostic performance of the signs of the central vein and the OLIGOCLONALE LCR bands supporting the diagnosis of multiple sclerosis
Context and objectives
The sign of the central vein (CVS) describes the presence of venules in the brain lesions of multiple sclerosis (MS), visible on the weighted MRI *. In the next revision of the SEP diagnostic criteria, the simplified “6th grade” (i.e. the search for 6 lesions with a central vein) can support the diagnosis of SE as an alternative to lumbar puncture (LP).
We have evaluated whether T2 * MRI is more sensitive than oligoclonal bands (OCB) to diagnose MP in presentation with a typical clinically isolated syndrome (CIS). We have also compared the tolerability of the LP and the additional MRI.
Methods
Participants requiring an LP to meet the 2017 McDonald diagnostic criteria for the MS have been entered in this multicenter multicentric diagnostic superiority study of 3 British neuroscience centers.
A sequence weighted in T2 * of six minutes was used to assess the CVS using 2 definitions: a threshold of 40% of all eligible lesions and the rule of 6. These were compared to OCB, using the clinical diagnosis at 18 months as a reference standard.
Results
Out of 113 participants, 99 (average age: 38 years old, woman: 73%) finished all study activities: 80 were diagnosed with MS, 10 remained CIS, 8 had alternative diagnostics and 1 remained without diagnosis. No significant difference in diagnostic sensitivity has been detected between 40% CVS threshold (90% (81% CI -96%)) and OCB tests (84% (74% CI)) (p = 0.332).
The rule of 6 had a sensitivity of 91% (CI 83% to 96%). The side effects were reported by 75% after LP against 9% after MRI. All the participants preferred their MRI on their LP.
Discussion
The CVS and OCB tests are just as sensitive to support the diagnosis of SEP in the typical CI. CVs evaluated using the 40%threshold, and the simpler rule of 6 produces equivalent diagnostic performance.
Compared to OCB tests, CVS tests seem safer and better tolerated by patients. Other studies are necessary to assess the specificity of the CVS, in particular apart from typical cases, as studied here.
Classification of evidence
This study provides class IV evidence as the OCBs of the LCR and the CVS are just as sensitive to support a diagnosis of MS in patients with CIs.
