Three MRI Criteria In The Diagnostic Value Of Pediatric Multiple Sclerosis In The First Attack: A Meta-Analysis

Objective : To systematically review the diagnostic value of different standard of brain magnetic resonance imaging(KIDMUS criteria,Callen diagnostic MS criteria and Callen MS-ADEM criteria)for pediatric multiple sclerosis who had a first attack.Methods : We electronically searched CNKI,Wan Fang Data,VIP,Pub Med,CENTRAL and EMbase from inception to June,2016,to collect the literature about the diagnostic value of different standard of brain magnetic resonance imaging for pediatric multiple sclerosis who had a first event.Two reviewers screened literature according to the inclusion and exclusion criteria,extracted data,and assessed the quality of included studies.Meta Di Sc 1.4 were used to conduct the meta-analysis.Pooled sensitivity(SEN),specificity(SPE),positive likelihood ratio(+LR),negative likelihood ratio(–LR),diagnostic odds ratio(DOR),and area under the curve(AUC)of summary receiver operating characteristic curve(SROC)were calculated to assess the diagnostic value of individual diagnostic tests.Results:We primary retrieved 426 references,seven studies involving 660 patients were finally included.The results of meta-analysis showed that for the KIDMUS criteria,Callen diagnostic MS criteria and Callen MS-ADEM criteria,the results of Spearman respectively were 0.714,0.714 and-0.10,which suggested the threshold effect was absent.1)For the KIDMUS criteria,the pooled SEN,SPE,+LR,–LR,and DOR were 0.40[95%CI(0.33,0.47)]?0.98[95%CI(0.96,0.99)]?11.36[95%CI(6.39,20.20)]?0.67[95%CI(0.52,0.87)]?20.76[95%CI(10.78,39.95)],AUC=0.92.2)For Callen diagnostic MS criteria,the pooled SEN,SPE,+LR,–LR,and DOR were 0.80[95%CI(0.73,0.86)]?0.90[95%CI(0.86,0.93)]?7.7[95%CI(4.79,12.39)]?0.24[95%CI(0.11,0.55)]?38.77[95%CI(11.07,135.75)],AUC=0.96.3)For Callen MS-ADEM criteria,the pooled SEN,SPE,+LR,–LR,and DOR were 0.80[95%CI(0.73,0.86)],0.90[95%CI(0.86,0.93)],7.7[95%CI(4.79,12.39)],0.24[95%CI(0.11,0.55)],and 38.77[95%CI(11.07,135.75)],AUC was 0.96.Conclusions : Current evidence indicates that KIDMUS criteria and Callen MS-ADEM criteria are of great diagnostic value for pediatric multiple sclerosis who had a first demyelinating event,and the value of Callen diagnostic MS criteria is middling.But due to the limited quality,exclusion of the suspected patients and quantity of the included studies,the abovementioned conclusion still needs to be verified by conducting more high quality studies.