Limited utility of current MRI criteria for distinguishing multiple sclerosis from common mimickers: Primary and secondary CNS vasculitis, lupus and Sjogren's syndrome

Susan S. Kim, David P Richman, Wesley O. Johnson, John K. Hald, Mark A. Agius

Research output: Contribution to journalArticle

23 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)57-63
Number of pages7
JournalMultiple Sclerosis
Issue number1
StatePublished - Jan 2014



  • autoimmune disorders
  • central nervous system
  • MRI
  • multiple sclerosis
  • Sjogren's syndrome
  • systemic lupus erythematosus
  • vasculitis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

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