Real-Life Evaluation of the MOGAD Diagnostic Criteria: Application Challenges and Discrepancies.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Carta Sara, Sechi Elia, Dinoto Alessandro, Mancinelli Chiara, Greco Giacomo, Maniscalco Giorgia Teresa, Cornacchini Sara, Giannoccaro Maria Pia, Calabria Francesca, Marziali Alessandro, Masciocchi Stefano, Risi Mario, Cossu Alberto, Volonghi Irene, Cantalupo Gaetano, Zoccarato Marco, Orlandi Riccardo, Del Zotto Elisabetta, Ferraro Diana, Trentinaglia Milena, De Biase Stefano, Grazian Luisa, Caleri Francesca, Bianchi Maria Rachele, Rossi Patrizia, Virgilio Eleonora, Capobianco Marco, Cortese Rosa, Tortorella Carla, Rossi Francesca, De Luca Giovanna, Perelli Anna, Bozzetti Silvia, Zuliani Luigi, Nosadini Margherita, Sartori Stefano, Brambilla Laura, Gajofatto Alberto, Vogrig Alberto, Massacesi Luca, Damato Valentina, Gastaldi Matteo, Mariotto Sara
Аннотация
METHODS: We applied the 2023 MOGAD criteria to patients who tested MOG-Abs positive on cell-based assays and were retrospectively recruited from 29 centers. Detailed clinical and paraclinical data were collected. Patients were classified as true positive/negative (TP/TN) in case of concordance between MOGAD criteria application and enrolling center final diagnosis, as false positive (FP) when MOGAD criteria were fulfilled but final diagnosis was different from MOGAD, and as false negative (FN) when MOGAD criteria were not fulfilled and final diagnosis of MOGAD was confirmed. Central revision of FN and FP cases was performed.
RESULTS: We included 214 patients (median age at onset 38.2 years [interquartile range 25.2-50.7], 60.3% female, 23 pediatric patients). Of these, 168 (78.5%) were classified as TP, 9 (4.2%) as FP, 23 (10.7%) as FN, and 14 (6.5%) as TN. The sensitivity of MOGAD criteria was 87.96% (CI 82.5%-92.2%), specificity 60.9% (CI 38.5%-80.3%), positive predictive value 94.9% (CI 91.8%-96.9%), negative predictive value 37.8% (CI 26.7%-50.2%), and accuracy 85.1% (CI 79.6%-89.5%). In 11 of 32 revised cases, available information did not allow a proper diagnosis. Independent revision changed the diagnosis in 17 of 21 remaining cases, increasing the performance of the MOGAD criteria. Of note, in 3 cases, diagnostic criteria were satisfied only at follow-up. The sensitivity and specificity after independent revision were 98.9% (CI 96%-99.9%) and 91.7% (CI 73%-98.9%), respectively. Moreover, 29 of 214 patients (13.6%) had 1 or more asymptomatic radiologic supportive features, and in 50% (3/6) of FP cases, independent revision did not confirm the presence of supportive features. Patients with clear positive serum titer or CSF-only MOG-Abs were those who received more commonly a MOGAD diagnosis.
DISCUSSION: MOGAD criteria demonstrate a good performance across different centers; however, controversial cases might benefit from collegial discussion and reassessment of MOGAD criteria during the follow-up. Main challenges include availability of proper radiologic data and interpretation of radiologic supportive features.