Isolated demyelinating syndromes: Comparison of different MR imaging criteria to predict conversion to clinically definite multiple sclerosis

BACKGROUND AND PURPOSE: Various authors have developed criteria to classify MR imaging findings that suggest the possibility of multiple sclerosis, Th e purpose of this study was to evaluate and compare the capacity of three s ets of MR imaging criteria for predicting the conversion of isolated demyel inating syndromes to clinically definite multiple sclerosis, METHODS: Seventy patients with clinically isolated neurologic symptoms sugg estive of multiple sclerosis were prospectively studied with MR imaging. Th e MR imaging findings were evaluated by two independent neuroradiologists w ho were blinded to clinical follow-up data. Based on the clinical outcome a t follow-up (presence of a second attack that established clinically defini te multiple sclerosis), the sensitivity, specificity, accuracy, positive pr edictive value, and negative predictive value of the criteria proposed by P aty et al, Fazekas ct al, and Barkhof et al were calculated, RESULTS: Clinically definite multiple sclerosis developed in 22 (31%) patie nts after a mean follow-up time of 28.3 months. The criteria proposed by Pa ty ct al and those proposed by Fazekas et al showed identical results: sens itivity, 86%; specificity, 54%; accuracy, 64%; positive predictive value, 4 6%; and negative predictive value, 89%, The criteria proposed by Barkhof et al showed the following: sensitivity, 73%; specificity, 73%; accuracy, 73% ; positive predictive value, 55%; and negative predictive value, 85%. CONCLUSION: The four dichotomized MR imaging parameters proposed by Barkhof et al are more specific and accurate than the criteria proposed by Paty et al or Fazekas et al for predicting conversion to clinically definite multi ple sclerosis.