Current imaging criteria for the diagnosis of multiple sclerosis could be leaving many children behind, according to new research.
MR imaging is the standard for diagnosing MS. In some cases, signs indicative of MS show up before any actual symptoms do; this is known as radiologically isolated syndrome (RIS). Radiologists use McDonald or Barkhof criteria to classify RIS, but a recent analysis published in Multiple Sclerosis and Related Disorders found that these criteria often exclude children who display suspicious findings on imaging.
“In our study, not all patients met the McDonald or Barkhof criteria [the current standard for diagnosing adult RIS], yet some went on to develop MS,” explained lead author of the study Vikram Bhise, director of Child Neurology and Developmental Disabilities at Rutgers Robert Wood Johnson Medical School. “This suggests that the criteria used to characterize RIS in adults might be insufficient for the younger population.”
Experts used the U.S. Network of Pediatric Multiple Sclerosis Centers and Rutgers Robert Wood Johnson Medical School databases to identify children with suspected demyelination on imaging. This resulted in a total of 38 participants between the ages of 7.6 and 17.8 years old.
At the time of their initial MRI, none of the children displayed any neurological symptoms of MS—most were initially screened due to headaches, according to experts involved in the study. Patients were monitored for symptoms and/or changes on imaging for a mean duration of 3.7 years.
During that time, 40% of patients experienced the onset of symptoms or their first MS attack and 73% exhibited new lesions on imaging.
When experts used McDonald or Barkhof criteria on the cohort’s imaging, many of the children did not meet the criteria for an MS diagnosis, although they did eventually go on to develop MS.
Although their study was small, the authors maintain that their findings are worth investigating further to determine whether diagnostic criteria for MS in adults are suitable in pediatric settings when symptoms are not yet present, as earlier diagnosis would trigger earlier interventions.
“Finding MS early can help a doctor knock out a whole bunch of future problems for their patients,” Bhise said. “But that can only happen with accurate diagnostic tools.”
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.