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Old 03-21-2008, 09:11 PM   #1
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McDonald Criteria?

So, I have looked up this McDonald Criteria several times. I guess if it applied to me, I might understand it better.

Can anyone put it simply?

I have numerous MS symptoms. I was told that the MRI was "the" test now for MS, and because my results were:

MR Wet Read
The preliminary interpretation is as follows:
NEGATIVE EXCEPT FOR TWO SMALL FOCCI OF NON-SPECIFIC
T2 HYPERINTENSITY IN THE LOW LEFT FRONTAL LOBE.

I don't have MS, and it must be fibromyalgia.

I would really appreciate any input on what does this MRI show, anything at all?

Thanks,

Tawny

 
Old 03-22-2008, 05:46 PM   #2
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Re: McDonald Criteria?

The criteria was revised in 2005. I was diagnosed with PPMS in 2002 withcriteria matching except for the CSF (LP results) due to the 15% exceptions. The MRI is an excellent tool for MS, BUT it is only one tool. Location of lesions and the extent of the lesions is a factor. I am not a medical doctor; therefore, I would not want to mislead you. You should be tested using all the criteria.

The revised criteria from what I have read:

-For 2 or more attacks with objective clinical evidence of two or more lesions, no additional data are needed for MS diagnosis.
-For 2 or more attacks with objective clinical evidence of one lesion, additional criteria of dissemination in space may include either MRI or 2 or more MRI-detected lesions consistent with MS plus positive CSF findings or waiting for another clinical attack affecting a different clinical site.
-For 1 attack with objective clinical evidence of 2 or more lesions, additional data needed are dissemination in time demonstrated by MRI or second clinical attack.
-For 1 monosymptomatic attack with objective evidence of 1 lesion, additional data required are (1) dissemination in space with positive MRI result or 2 or more MRI-detected lesions consistent with MS plus positive CSF findings; and (2) dissemination in time demonstrated by MRI or second clinical attack.
-For insidious neurologic progression suggestive of MS, additional data needed for diagnosis are 1 year of disease progression and 2 of the following: (1) positive brain MRI findings, (2) positive spinal cord MRI findings, and (3) positive CSF findings.

MRI criteria are as follows:

-The revisions now allow for either contrast-enhancing brain lesions or T2 lesions occurring in the first few weeks after the onset of a first clinical episode to be part of the criterion of dissemination in time.
-T2 lesions occurring within a few weeks of a first attack should not be considered a separate event for the criterion of dissemination in time.
* Any new T2 lesion occurring after the reference scan performed at least 30 days after the onset of the initial clinical event may be useful in meeting diagnostic criteria.
- A new T2 lesion must be sufficient in size and location to reflect one that could not have been previously missed for technical reasons.
-Spinal cord lesions detected by T2 may be helpful in diagnosis if brain imaging does not detect dissemination in space in a patient with suspected MS.
-Spinal cord lesions should be focal.
-For dissemination in space, a spinal cord lesion is equivalent to and can substitute for a brain infratentorial lesion but not for a periventricular or juxtacortical lesion.
-An enhancing spinal cord lesion is equivalent to an enhancing brain lesion.
-Individual spinal cord lesions can contribute together with individual brain lesions to reach the diagnosis of PPMS.
-Repeat spinal cord imaging in the absence of clinical symptomatic myelitis has low yield and should not be performed unless there is clinical evidence of a new spinal cord lesion.

Diagnosis of PPMS

-The 2005 criteria for PPMS are simplified.
-A positive CSF finding is no longer a requirement for the diagnosis of PPMS.
-The criteria now include 1 year of disease progression plus 2 of the following: (1) positive brain MRI results (9 T2 lesions or 4 or more T2 lesions with visual evoked potential), (2) positive spinal cord MRI result (2 focal T2 lesions), and (3) positive CSF findings.

I hope this helps!

 
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Old 03-23-2008, 04:21 PM   #3
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Re: McDonald Criteria?

Thank you, JayHawk. It helps, but I still don't know what most of it means. Like what does "dissemination in space" mean?
I wonder if should have insisted on more spinal MRI's than just the c-spine w/out contrast? I was supposed to be in a 3T machine, but when I mentioned it to the tech, and he told me it was only 1.5T, I was just so anxious to get it over with.
I guess what I am asking more than anything is, do I move on and accept this is not MS, or should I just accecpt that this MRI was negative?
Should I have an LP? I really don't want that, but if it would get to the bottom of things, I would consider it.
I hope it is not MS, but if it is, and I really feel that is the best possibility, I want to be proactive. (At least in avoiding things that can make it worse!)

Thank you so much for all your support and help here!

Happy Easter! I hope you are enjoying the day!

Tawny

 
Old 03-23-2008, 07:53 PM   #4
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Re: McDonald Criteria?

If your MRI was not performed correctly, then you should have it repeated in correct fashion. When I was diagnosed in 2002 with PPMS, the cerebrum was too scarred to detect active lesions and it was not until they moved down that they found the large, active lesions.

Although you do not want a LP, the test works for 85% of MS patients. Prior to the LP, you might want to have an evoked potential run. My Visual Evoked Potential was positive, but my LP was normal. I have had LPs performed twice (1982, 2002). Neither was desired, but I must say, the second one was a breeze.

A happy, blessed Easter to you as well!

 
Old 03-24-2008, 11:01 AM   #5
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Re: McDonald Criteria?

Thank you!

Would you please explain what does "dissemination in space" mean?

 
Old 03-24-2008, 11:25 AM   #6
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Re: McDonald Criteria?

Dissemination in space would be the area of the lesions (distance between them). They also have dissemination in time which is the time between attacks and/or MRIs.

I hope this helps! LOL, I will have to dig into some medical books!!!!

 
Old 03-24-2008, 10:09 PM   #7
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Re: McDonald Criteria?

That does help! I sure can use all the help I can get understanding what is happening to my body and mind.

Oh boy!

 
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