Multiple sclerosis and related disorders · 2026
Diagnostic yield of the 2022 optic neuritis criteria and an antibody-stratified adjunct in an antibody-predominant Chinese clinical sample.
СтатьяНазвание и аннотация: Перевод в очереди
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Liang Yating, Yang Jun, Luo Wenjing, Wei Siqian, Wang Kelin, Song Ruitong, Fu Renxiu, Zhao Yuanping, Bai Yumin, Du Yi
Аннотация
BACKGROUND: The real-world performance of the 2022 international consensus criteria for optic neuritis (ICON) in antibody-predominant Chinese practice is uncertain. We evaluated diagnostic yield and an antibody-stratified adjunct for settings with high antibody prevalence and timely antibody testing.
METHODS: We retrospectively studied 151 consecutive patients admitted with acute optic neuritis between 2020 and 2023. All cases were reclassified using strict 2022 ICON. We then evaluated an assumed-dyschromatopsia scenario in which dyschromatopsia was assumed unless normal color vision was explicitly documented. On top of that scenario, we applied an antibody-stratified adjunct using aquaporin-4 immunoglobulin G (AQP4-IgG) seropositivity or clear-positive myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG; fixed cell-based assay titer ≥1:100) plus objective optic nerve evidence.
RESULTS: Strict 2022 ICON classified 30/151 (20%) cases as Definite ON, 113/151 (75%) as Possible ON, and 8/151 (5%) as Not ON. Under the assumed-dyschromatopsia scenario, Definite ON increased to 112/151 (74%). With the antibody-stratified adjunct, Definite ON further increased to 124/151 (82%), while Not ON remained 8/151 (5%). Definite ON reached 82/82 (100%) in AQP4-IgG-positive cases, 20/21 (95%) in MOG-IgG-positive cases, 18/37 (49%) in double-seronegative cases, and 4/11 (36%) in cases with incomplete AQP4-IgG/MOG-IgG testing.
CONCLUSIONS: In this antibody-predominant clinical sample, strict 2022 ICON yielded a low Definite ON classification rate, driven largely by incomplete bedside documentation, especially color vision assessment. Assuming complete dyschromatopsia documentation improved yield, and the antibody-stratified adjunct provided further gains without increasing the Not ON category.
METHODS: We retrospectively studied 151 consecutive patients admitted with acute optic neuritis between 2020 and 2023. All cases were reclassified using strict 2022 ICON. We then evaluated an assumed-dyschromatopsia scenario in which dyschromatopsia was assumed unless normal color vision was explicitly documented. On top of that scenario, we applied an antibody-stratified adjunct using aquaporin-4 immunoglobulin G (AQP4-IgG) seropositivity or clear-positive myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG; fixed cell-based assay titer ≥1:100) plus objective optic nerve evidence.
RESULTS: Strict 2022 ICON classified 30/151 (20%) cases as Definite ON, 113/151 (75%) as Possible ON, and 8/151 (5%) as Not ON. Under the assumed-dyschromatopsia scenario, Definite ON increased to 112/151 (74%). With the antibody-stratified adjunct, Definite ON further increased to 124/151 (82%), while Not ON remained 8/151 (5%). Definite ON reached 82/82 (100%) in AQP4-IgG-positive cases, 20/21 (95%) in MOG-IgG-positive cases, 18/37 (49%) in double-seronegative cases, and 4/11 (36%) in cases with incomplete AQP4-IgG/MOG-IgG testing.
CONCLUSIONS: In this antibody-predominant clinical sample, strict 2022 ICON yielded a low Definite ON classification rate, driven largely by incomplete bedside documentation, especially color vision assessment. Assuming complete dyschromatopsia documentation improved yield, and the antibody-stratified adjunct provided further gains without increasing the Not ON category.