CLINICAL-DIAGNOSIS OF MULTIPLE-SCLEROSIS - THE IMPACT OF MAGNETIC-RESONANCE-IMAGING AND ANCILLARY TESTING

Objective: Magnetic resonance imaging, computed tomography, cerebrospi nal fluid analysis, and evoked potential testing are used to assist in the diagnosis of patients suspected to have multiple sclerosis (MS). The impact of these tests on a clinician's diagnosis of patients suspe cted to have MS has not been studied systematically. Design: Clinician s made a diagnosis of each patient following clinical evaluation, agai n after reviewing the results of magnetic resonance imaging, and final ly after reviewing information from other laboratory testing. These di agnoses were compared with the criterion standard of a masked ''gold s tandard'' panel reviewing all information after a mean follow-up of 0. 9 year. Setting: The General Neurology Clinic and Multiple Sclerosis C linic of the University of Rochester (NY). Patients: A consecutive sam ple of 62 patients diagnosed as having either possible or probable MS following clinical evaluation. Main Outcome Measure: Changes in diagno stic certainty of clinicians following incremental presentation of new laboratory data and the accuracy of such diagnoses. Results: Clinicia ns used magnetic resonance imaging findings to diagnose definite MS or to eliminate MS from diagnostic consideration in 44% of cases. In the se cases, further laboratory testing did not alter clinicians' decisio ns. In the remaining 56% of cases, in which magnetic resonance imaging did not lead to a diagnosis of definite MS or eliminate MS from diagn ostic consideration, further laboratory testing led to such diagnoses in an additional 13% of cases. Gold standard diagnoses were in agreeme nt with the clinician's assessments. Conclusions: Magnetic resonance i maging aids in the evaluation of patients suspected to have MS; other subsequent studies (computed tomography, cerebrospinal fluid analysis, and evoked potential testing) have less impact. After all studies are performed, about half of such patients still have a tentative diagnos is.