Journal of neuroimmunology · 2026
Lesion burden determines the incremental diagnostic value of intrathecal IgG oligoclonal bands synthesis in multiple sclerosis.
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Mauceri Valentina Annamaria, Di Mare Davide, Rinaldi Francesca, Di Paola Alessandro, Zoccarato Marco, Gallo Paolo, Perini Paola, Puthenparampil Marco
Аннотация
BACKGROUND: The 2024 revision of the McDonald criteria allows the diagnosis of multiple sclerosis (MS) based on dissemination in space alone when ≥4 typical lesion locations are present, raising the question of how lesion burden influences the incremental diagnostic value of cerebrospinal fluid (CSF) analysis.
OBJECTIVE: To evaluate the incremental diagnostic value of intrathecal IgG oligoclonal bands (IgGOB) according to lesion burden at MS diagnosis.
METHODS: In this retrospective, cross-sectional, single-centre study, 341 patients undergoing diagnostic evaluation for suspected MS were included. Logistic regression models assessed the associations among lesion burden, intrathecal IgG synthesis and MS diagnosis.
RESULTS: Lesion burden was strongly associated with MS diagnosis (β = 1.55, p < 0.0001). CSF-restricted IgGOB positivity was associated with lesion burden, but not with disease duration. In a multivariable logistic regression model, both lesion burden (p < 0.0001) and CSF-restricted IgGOB (p < 0.0001) remained independently associated with MS diagnosis (AUC = 0.988). The incremental diagnostic contribution of intrathecal IgG synthesis progressively decreased as lesion burden increased.
CONCLUSIONS: The incremental diagnostic value of intrathecal IgG synthesis is strongly influenced by lesion burden. These findings support a context-dependent interpretation of CSF analysis within the 2024 McDonald diagnostic criteria.
OBJECTIVE: To evaluate the incremental diagnostic value of intrathecal IgG oligoclonal bands (IgGOB) according to lesion burden at MS diagnosis.
METHODS: In this retrospective, cross-sectional, single-centre study, 341 patients undergoing diagnostic evaluation for suspected MS were included. Logistic regression models assessed the associations among lesion burden, intrathecal IgG synthesis and MS diagnosis.
RESULTS: Lesion burden was strongly associated with MS diagnosis (β = 1.55, p < 0.0001). CSF-restricted IgGOB positivity was associated with lesion burden, but not with disease duration. In a multivariable logistic regression model, both lesion burden (p < 0.0001) and CSF-restricted IgGOB (p < 0.0001) remained independently associated with MS diagnosis (AUC = 0.988). The incremental diagnostic contribution of intrathecal IgG synthesis progressively decreased as lesion burden increased.
CONCLUSIONS: The incremental diagnostic value of intrathecal IgG synthesis is strongly influenced by lesion burden. These findings support a context-dependent interpretation of CSF analysis within the 2024 McDonald diagnostic criteria.