A RANDOMIZED TRIAL OF TEST RESULT SEQUENCING IN PATIENTS WITH SUSPECTED MULTIPLE-SCLEROSIS

Background and Methods: We performed a randomized trial of the increme ntal impact of high-volume contrast computed tomographic scan of the b rain plus trimodal evoked potentials vs magnetic resonance imaging of the brain on neurologists' diagnostic labeling of patients with suspec ted multiple sclerosis (MS). Two hundred and four patients with suspec ted MS (clinically possible 59% or probable 41%-McAlpine criteria) wer e assessed by two neurologists. Patients were diagnostically categoriz ed after reviewing the results of the tests presented in random order. Results: Most of the change in diagnostic Categorization occurred aft er presenting the first test result irrespective of result sequence (c hi2=0.01, P=.99). The diagnoses became more definitive when all test r esults were available (P<.001). Magnetic resonance imaging and evoked potential were suggestive of MS equally frequently (chi2=0.57, P=.45). Conclusion: In suspected MS, there is no difference in diagnostic eff ect between brain magnetic resonance image scanning and computed tomog raphy plus trimodal evoked potentials.