Prevalence of brain MRI meeting Barkhof and McDonald criteria for dissemination in space among headache patients

This study looked at brain MRIs performed for the clinical indication of headaches in order to assess the prevalence of radiologic white matter hyperintensities (WMH) meeting the Barkhof and 2010 McDonald dissemination in space (DIS) criteria in this population. The researchers also looked at whether the prevalence is changed if different definitions of periventricular and juxtacortical lesions are used.

Headache patients have asymptomatic T2 WMHs on MRI at a higher frequency than the general population. A total of 326/564 (58%) patients had enhanced brain MRI studies meeting criteria for inclusion.

The prevalence of Barkhof criteria fulfilment in the headache patients ranged from 2.4% to 7.1%. When the revised McDonald criteria were applied, the number of radiologically positive cases was significantly higher, ranging from 24.4% to 34.5%.

Barkhof ‘touching’ criteria were met in 2.4% and in 7.1% of the 3mm group, while the McDonald criteria were met in 24.4% for ‘touching’ and 34.5% for 3mm respectively.

Therefore, the authors conclude that the significance of asymptomatic radiographic abnormalities such as radiologically isolated syndrome (RIS) remains unknown and would markedly increase if the newly revised 2010 McDonald criteria are applied. The natural history of these findings should be better studied before prudent therapeutic recommendations can be advocated.

Authors: Liu S, Kullnat J, Bourdette D

Source: MultScler. 2013 Feb 4. [Epub ahead of print]

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