title: Validation of MRI predictors of multiple sclerosis diagnosis in children with acute CNS demyelination.
abstract: BACKGROUND
  In a recent Canadian prospective study of children with acute demyelinating syndromes (ADS), we demonstrated that the presence of T2 periventricular and T1-hypointense lesions predicted MS diagnosis. We aimed to validate these predictors in a Dutch cohort of children with ADS.
  
  
  METHODS
  Participants with ADS were identified from a prospective cohort or archived dataset. MS was diagnosed based on clinical or MRI evidence of relapsing disease. Baseline MRI scans were evaluated for the presence of the two predictive parameters. Sensitivity, specificity, positive (LR+) and negative likelihood ratios (LR-), and positive (PPV) and negative predictive value (NPV) were calculated to evaluate the performance of the MRI parameters at classifying children as having MS or monophasic demyelination.
  
  
  RESULTS
  Of 115 children identified with ADS between December 1993 and December 2009, MRI scans from 87 children (45 prospective; 47 archived) were evaluated; scans of 28 children were excluded due to incomplete or poor quality imaging. Mean duration of observation was longer in the archived group (7.1 years, SD 3.5) than the prospective cohort (3.3 years, SD 1.4). 30 children were diagnosed with MS. Performance of the parameters was not statistically different between the prospective cohort (sensitivity 93.3% [68.1-99.8]; specificity 86.7% [69.3-96.2]; LR+ 7.0 [2.8-17.6]; LR- 0.08 [0.01-0.5]; PPV 77.8% [52.4-93.6]; NPV 96.3% [81.0-99.9]) and archived group (sensitivity 66.7% [38.4-88.2]; specificity 85.2% [66.3-95.8]; LR+ 4.5 [1.7-11.9]; LR- 0.4 [0.2-0.8]; PPV 71.4% [41.9-91.6]; NPV 82.1% [63.1-93.9]).
  
  
  CONCLUSIONS
  In an independent Dutch cohort, we confirm that the presence of ≥1 T2 periventricular and ≥1 T1-hypointense lesions reliably identifies children with MS.
  
  
  BACKGROUND
  Dutch MS Research Foundation.
authors: Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
authors: L H
authors: LH
authors: Verhey
authors: Department of Neurology, Erasmus MC, Rotterdam, The Netherlands.
authors: E D
authors: ED
authors: van Pelt-Gravesteijn
authors: Department of Neurology, Erasmus MC, Rotterdam, The Netherlands.
authors: I A
authors: IA
authors: Ketelslegers
authors: Department of Pediatric Neurology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors: R F
authors: RF
authors: Neuteboom
authors: Department of Pediatric Neurology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors: C E
authors: CE
authors: Catsman-Berrevoets
authors: Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors: B M
authors: BM
authors: Feldman
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
authors: D L
authors: DL
authors: Streiner
authors: Department of Medical Biophysics, University of Toronto, Toronto, Canada; Program in Physiology & Experimental Medicine, The Hospital for Sick Children, Toronto, Canada.
authors: J G
authors: JG
authors: Sled
authors: Department of Neurology, Erasmus MC, Rotterdam, The Netherlands; Department of Pediatric Neurology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors: R Q
authors: RQ
authors: Hintzen
authors: Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA. Electronic address: banwellb@email.chop.edu.
authors: B
authors: B
authors: Banwell
keywords: Demyelination; Diagnosis; MRI; Multiple sclerosis; Pediatric; Predictors