Although the diagnosis of multiple sclerosis relies on the demonstration of disease dissemination in space and time, the exclusion of other neurological disorders is also essential. The limited specificity of abnormalities disclosed by MRI may increase the likelihood of diagnosis of multiple sclerosis in patients affected by other disorders. The available criteria for diagnosis of multiple sclerosis have not taken advantage of the potential of MRI to detect features "not suggestive" of multiple sclerosis. Recognition of such features in the work-up of patients suspected of having multiple sclerosis may reduce the likelihood of a false positive diagnosis of the disorder in some, while suggesting the correct alternative diagnosis in other patients. On the basis of this, a workshop of the European MAGNIMS (Magnetic Resonance Network in Multiple Sclerosis) was held to define a series of MRI red flags in the setting of clinically suspected multiple sclerosis that is derived from evidence-based findings and educated guesses. The presence of such red flags should alert clinicians to reconsider the differential diagnosis more extensively. In this review we will report on the conclusions of this international consensus, which should represent a first step beyond the concept of "no better explanation", and inform future diagnostic criteria for multiple sclerosis.

译文

:尽管多发性硬化症的诊断依赖于疾病在时空上的传播,但排除其他神经系统疾病也是必不可少的。 MRI揭示的异常特异性有限,可能会增加受其他疾病影响的患者诊断为多发性硬化症的可能性。诊断多发性硬化症的可用标准尚未利用MRI的潜力来检测“不提示”多发性硬化症的特征。在怀疑患有多发性硬化症的患者进行检查时,认识到此类特征可能会减少某些患者对该疾病进行假阳性诊断的可能性,同时建议其他患者进行正确的替代性诊断。在此基础上,召开了欧洲MAGNIMS(多发性硬化症磁共振网络)研讨会,以定义临床可疑的多发性硬化症中的一系列MRI危险信号,这些证据来自循证研究结果和有根据的猜测。此类危险信号的出现应提醒临床医生更广泛地重新考虑鉴别诊断。在这篇综述中,我们将报告这一国际共识的结论,该结论应代表“没有更好的解释”概念之外的第一步,并为将来的多发性硬化症诊断标准提供依据。

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