McDonald 2024 diagnostic criteria for multiple sclerosis in a nutshell – a neurologist’s and radiologist’s perspective
Authors:
D. Šťastná 1,2; P. Ryška 3; D. Horáková 1,2; I. Menkyová 1,4; E. Kubala Havrdová 1; J. Mareš 5,6; M. Vaněčková 7
Authors place of work:
Neurologická klinika a Centrum klinických neurověd 1. LF UK a VFN v Praze, ČR
1; Registr ReMuS, ReMuS, nadační fond, Praha, ČR
2; Radiologická klinika LF UK v Hradci Králové a FN Hradec Králové, ČR
3; Neurologická klinika SZU a UNB, Bratislava, Slovensko
4; Neurologická klinika 3. LF UK a FTN, Praha, ČR
5; Neurologická klinika LF UP a FN Olomouc, ČR
6; Oddělení MR, Radiodiagnostická klinika 1. LF UK a VFN v Praze ČR
7
Published in the journal:
Cesk Slov Neurol N 2026; 89(2): 79-86
Category:
Přehledný referát
doi:
https://doi.org/10.48095/cccsnn202679
Summary
The McDonald criteria represent the fundamental diagnostic tool for multiple sclerosis. The 2024 revision enables diagnosis similarly to the 2017 revision, but expands diagnostic options with changes that reflect the current understanding of the disease as a biological continuum. It unifies the diagnostic approach for both relapsing and primary progressive forms, adds the optic nerve as the fifth anatomical location for assessing dissemination in space, and includes the kappa free light chain index as an equivalent alternative to oligoclonal bands. The updated criteria introduce new, highly specific MRI markers – the central vein sign and paramagnetic rim lesions – which improve diagnostic specificity, particularly in atypical populations. However, detection of these new markers is strongly dependent on the MRI sequence used, and their assessment may be time-consuming. The most significant change is the possibility of establishing a diagnosis in the preclinical phase in asymptomatic patients or patients with atypical symptoms. However, the current Czech reimbursement criteria require clinical activity to initiate therapy, which limits therapeutic options in this population and increases pressure to map the epidemiological situation early and negotiate with healthcare payers. Successful implementation of the criteria also depends on standardization of imaging methods, raising awareness in the broader medical community, availability of advanced diagnostics, and close collaboration between neurologists and radiologists. This article aims to provide a practical overview of the changes from the perspective of both neurologist and radiologist, including diagnostic algorithms to facilitate the use of the criteria in routine clinical practice.
Keywords:
Multiple sclerosis – Optic nerve – kappa free light chains – radiologically isolated syndrome – McDonald diagnostic criteria – subclinical multiple sclerosis – central vein sign – paramagnetic rim lesion
Zdroje
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Štítky
Dětská neurologie Neurochirurgie NeurologieČlánek vyšel v časopise
Česká a slovenská neurologie a neurochirurgie
2026 Číslo 2
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