title: Limited utility of current MRI criteria for distinguishing multiple sclerosis from common mimickers: primary and secondary CNS vasculitis, lupus and Sjogren's syndrome.
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) criteria play an important role in making an earlier diagnosis of multiple sclerosis (MS) in patients presenting with clinically isolated syndrome.
  
  
  OBJECTIVE
  The objective of this paper is to determine whether MRI criteria may be used to distinguish MS from primary and secondary central nervous system (CNS) vasculitis, lupus, and Sjogren's syndrome.
  
  
  METHODS
  MRI criteria were applied retrospectively to images for patients with clinically definite MS (CDMS), primary CNS vasculitis, secondary CNS vasculitis, and autoimmune disorders including systemic lupus erythematosus (SLE) and Sjogren's syndrome. Classical statistics and Bayesian analyses were performed.
  
  
  RESULTS
  Overall modified Barkhof's MRI criteria were statistically significant in distinguishing CDMS (60%) from SLE/Sjogren's syndrome (17%, p = 0.0173) but not in distinguishing CDMS from primary CNS vasculitis (50%, p = 0.7376) or secondary CNS vasculitis (58%, p = 1.0000). Four of the five other MRI criteria tested were demonstrated to be superior to modified Barkhof's criteria in predicting MS: nine or more T2 lesions (a component of Barkhof's criteria), one or more ovoid periventricular T2 lesions, one or more perpendicular periventricular T2 lesions, and one or more T2 lesions larger than 6 mm.
  
  
  CONCLUSIONS
  MRI criteria, including the modified Barkhof's criteria, were unsuccessful in distinguishing MS from primary CNS vasculitis or secondary CNS vasculitis and mildly successful in distinguishing MS from SLE/Sjogren's syndrome.
authors.affiliation: Neurology Service, VANCHCS, Sacramento VA Medical Center, Department of Veterans Affairs, USA.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Kim
authors.forename: David P
authors.initials: DP
authors.lastname: Richman
authors.forename: Wesley O
authors.initials: WO
authors.lastname: Johnson
authors.forename: John K
authors.initials: JK
authors.lastname: Hald
authors.forename: Mark A
authors.initials: MA
authors.lastname: Agius
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis*; D012189:Retrospective Studies; D012859:Sjogren's Syndrome / Q000175:diagnosis*; D020293:Vasculitis, Central Nervous System / Q000175:diagnosis*; D055815:Young Adult
keywords: MRI; Sjogren’s syndrome; autoimmune disorders; central nervous system; multiple sclerosis; systemic lupus erythematosus; vasculitis