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April 09, 2019; 92 (15) Article

How much do periventricular lesions assist in distinguishing migraine with aura from CIS?

Caterina Lapucci, Laura Saitta, Giulia Bommarito, Maria Pia Sormani, Matteo Pardini, Laura Bonzano, Giovanni Luigi Mancardi, Claudio Gasperini, Antonio Giorgio, Matilde Inglese, Nicola De Stefano, Luca Roccatagliata
First published March 8, 2019, DOI: https://doi.org/10.1212/WNL.0000000000007266
Caterina Lapucci
From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (C.L., G.B., M.P., L.B., G.L.M., M.I.), University of Genoa; Departments of Neuroradiology (L.S., L.R.), Health Sciences (M.P.S., L.R.), and Neurology (M.P., G.L.M., M.I.), Ospedale Policlinico San Martino IRCCS, Genoa; Department of Neurosciences (C.G.), S. Camillo-Forlanini Hospital, Rome; and Departments of Medicine, Surgery, and Neuroscience (A.G., N.D.S.), University of Siena, Italy.
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Laura Saitta
From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (C.L., G.B., M.P., L.B., G.L.M., M.I.), University of Genoa; Departments of Neuroradiology (L.S., L.R.), Health Sciences (M.P.S., L.R.), and Neurology (M.P., G.L.M., M.I.), Ospedale Policlinico San Martino IRCCS, Genoa; Department of Neurosciences (C.G.), S. Camillo-Forlanini Hospital, Rome; and Departments of Medicine, Surgery, and Neuroscience (A.G., N.D.S.), University of Siena, Italy.
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Giulia Bommarito
From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (C.L., G.B., M.P., L.B., G.L.M., M.I.), University of Genoa; Departments of Neuroradiology (L.S., L.R.), Health Sciences (M.P.S., L.R.), and Neurology (M.P., G.L.M., M.I.), Ospedale Policlinico San Martino IRCCS, Genoa; Department of Neurosciences (C.G.), S. Camillo-Forlanini Hospital, Rome; and Departments of Medicine, Surgery, and Neuroscience (A.G., N.D.S.), University of Siena, Italy.
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Maria Pia Sormani
From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (C.L., G.B., M.P., L.B., G.L.M., M.I.), University of Genoa; Departments of Neuroradiology (L.S., L.R.), Health Sciences (M.P.S., L.R.), and Neurology (M.P., G.L.M., M.I.), Ospedale Policlinico San Martino IRCCS, Genoa; Department of Neurosciences (C.G.), S. Camillo-Forlanini Hospital, Rome; and Departments of Medicine, Surgery, and Neuroscience (A.G., N.D.S.), University of Siena, Italy.
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Matteo Pardini
From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (C.L., G.B., M.P., L.B., G.L.M., M.I.), University of Genoa; Departments of Neuroradiology (L.S., L.R.), Health Sciences (M.P.S., L.R.), and Neurology (M.P., G.L.M., M.I.), Ospedale Policlinico San Martino IRCCS, Genoa; Department of Neurosciences (C.G.), S. Camillo-Forlanini Hospital, Rome; and Departments of Medicine, Surgery, and Neuroscience (A.G., N.D.S.), University of Siena, Italy.
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Laura Bonzano
From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (C.L., G.B., M.P., L.B., G.L.M., M.I.), University of Genoa; Departments of Neuroradiology (L.S., L.R.), Health Sciences (M.P.S., L.R.), and Neurology (M.P., G.L.M., M.I.), Ospedale Policlinico San Martino IRCCS, Genoa; Department of Neurosciences (C.G.), S. Camillo-Forlanini Hospital, Rome; and Departments of Medicine, Surgery, and Neuroscience (A.G., N.D.S.), University of Siena, Italy.
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Giovanni Luigi Mancardi
From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (C.L., G.B., M.P., L.B., G.L.M., M.I.), University of Genoa; Departments of Neuroradiology (L.S., L.R.), Health Sciences (M.P.S., L.R.), and Neurology (M.P., G.L.M., M.I.), Ospedale Policlinico San Martino IRCCS, Genoa; Department of Neurosciences (C.G.), S. Camillo-Forlanini Hospital, Rome; and Departments of Medicine, Surgery, and Neuroscience (A.G., N.D.S.), University of Siena, Italy.
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Claudio Gasperini
From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (C.L., G.B., M.P., L.B., G.L.M., M.I.), University of Genoa; Departments of Neuroradiology (L.S., L.R.), Health Sciences (M.P.S., L.R.), and Neurology (M.P., G.L.M., M.I.), Ospedale Policlinico San Martino IRCCS, Genoa; Department of Neurosciences (C.G.), S. Camillo-Forlanini Hospital, Rome; and Departments of Medicine, Surgery, and Neuroscience (A.G., N.D.S.), University of Siena, Italy.
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Antonio Giorgio
From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (C.L., G.B., M.P., L.B., G.L.M., M.I.), University of Genoa; Departments of Neuroradiology (L.S., L.R.), Health Sciences (M.P.S., L.R.), and Neurology (M.P., G.L.M., M.I.), Ospedale Policlinico San Martino IRCCS, Genoa; Department of Neurosciences (C.G.), S. Camillo-Forlanini Hospital, Rome; and Departments of Medicine, Surgery, and Neuroscience (A.G., N.D.S.), University of Siena, Italy.
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Matilde Inglese
From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (C.L., G.B., M.P., L.B., G.L.M., M.I.), University of Genoa; Departments of Neuroradiology (L.S., L.R.), Health Sciences (M.P.S., L.R.), and Neurology (M.P., G.L.M., M.I.), Ospedale Policlinico San Martino IRCCS, Genoa; Department of Neurosciences (C.G.), S. Camillo-Forlanini Hospital, Rome; and Departments of Medicine, Surgery, and Neuroscience (A.G., N.D.S.), University of Siena, Italy.
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Nicola De Stefano
From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (C.L., G.B., M.P., L.B., G.L.M., M.I.), University of Genoa; Departments of Neuroradiology (L.S., L.R.), Health Sciences (M.P.S., L.R.), and Neurology (M.P., G.L.M., M.I.), Ospedale Policlinico San Martino IRCCS, Genoa; Department of Neurosciences (C.G.), S. Camillo-Forlanini Hospital, Rome; and Departments of Medicine, Surgery, and Neuroscience (A.G., N.D.S.), University of Siena, Italy.
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Luca Roccatagliata
From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (C.L., G.B., M.P., L.B., G.L.M., M.I.), University of Genoa; Departments of Neuroradiology (L.S., L.R.), Health Sciences (M.P.S., L.R.), and Neurology (M.P., G.L.M., M.I.), Ospedale Policlinico San Martino IRCCS, Genoa; Department of Neurosciences (C.G.), S. Camillo-Forlanini Hospital, Rome; and Departments of Medicine, Surgery, and Neuroscience (A.G., N.D.S.), University of Siena, Italy.
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Citation
How much do periventricular lesions assist in distinguishing migraine with aura from CIS?
Caterina Lapucci, Laura Saitta, Giulia Bommarito, Maria Pia Sormani, Matteo Pardini, Laura Bonzano, Giovanni Luigi Mancardi, Claudio Gasperini, Antonio Giorgio, Matilde Inglese, Nicola De Stefano, Luca Roccatagliata
Neurology Apr 2019, 92 (15) e1739-e1744; DOI: 10.1212/WNL.0000000000007266

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Abstract

Objective To evaluate in clinically isolated syndrome (CIS) and migraine with aura (MA) how the number of periventricular lesions (PVLs) detected at MRI influences diagnostic performance when the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) or the 2017 revised criteria are applied.

Methods In this retrospective study, white matter hyperintensities (WMH) of 84 patients with MA and 79 patients with CIS were assessed using manual segmentation technique. Lesion probability maps (LPMs) and voxel-wise analysis of lesion distribution by diagnosis were obtained. Furthermore, we performed a logistic regression analysis based on lesion locations and volumes.

Results Compared to patients with MA, patients with CIS showed a significant overall higher T2 WMH mean number and volume (17.9 ± 16.9 vs 6.2 ± 11.9 and 3.1 ± 4.2 vs 0.3 ± 0.6 mL; p < 0.0001) and a significantly higher T2 WMH mean number in infratentorial, periventricular, and juxtacortical areas (p < 0.0001). LPMs identified the periventricular regions as the sites with the highest probability of detecting T2 WMH in patients with CIS. Voxel-wise analysis of lesion distribution by diagnosis revealed a statistically significant association exclusively between the diagnosis of CIS and the PVLs. MAGNIMS criteria demonstrated the highest specificity in differentiating patients with CIS from patients with MA (100% vs 87%) against a predictable lower sensitivity (63% vs 72%).

Conclusions PVLs play a key role in the differential diagnosis between MA and CIS, particularly when there are more than 3. Future studies on multiple sclerosis criteria might reconsider the 3 PVLs to minimize the risk of misdiagnosis.

Classification of evidence This study provides Class IV evidence that the presence at least 3 PVLs increases the specificity in distinguishing MA from CIS.

Glossary

CIS=
clinically isolated syndrome;
DIS=
dissemination in space;
FLAIR=
fluid-attenuated inversion recovery;
LPM=
lesion probability map;
MA=
migraine with aura;
MAGNIMS=
Magnetic Resonance Imaging in Multiple Sclerosis;
MS=
multiple sclerosis;
PVL=
periventricular lesion;
WMH=
white matter hyperintensities

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Class of Evidence: NPub.org/coe

  • Podcast: NPub.org/54kjls

  • CME Course: NPub.org/cmelist

  • Received July 24, 2018.
  • Accepted in final form December 7, 2018.
  • © 2019 American Academy of Neurology
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