BMJ  2006;332:875-884 (15 April), doi:10.1136/bmj.38771.583796.7C (published 24 March 2006)

Research

Accuracy of magnetic resonance imaging for the diagnosis of multiple sclerosis: systematic review

Penny Whiting, research fellow1, Roger Harbord, research associate1, Caroline Main, research fellow2, Jonathan J Deeks, senior medical statistician3, Graziella Filippini, head4, Matthias Egger, professor of epidemiology and public health5, Jonathan A C Sterne, reader in medical statistics and epidemiology1

1 MRC Health Services Research Collaboration, Department of Social Medicine, Bristol BS8 2PR, 2 Centre for Reviews and Dissemination, University of York, 3 Centre for Statistics in Medicine, Wolfson College, Oxford, 4 Unit of Neuroepidemiology, Istituto Nazionale Neurologico "Carlo Besta," Milan, Italy, 5 Department of Social and Preventive Medicine, University of Bern, Switzerland

Correspondence to: P Whiting penny.whiting{at}bristol.ac.uk

Abstract

Objective To determine the accuracy of magnetic resonance imaging criteria for the early diagnosis of multiple sclerosis in patients with suspected disease.

Design Systematic review.

Data sources 12 electronic databases, citation searches, and reference lists of included studies.

Review methods Studies on accuracy of diagnosis that compared magnetic resonance imaging, or diagnostic criteria incorporating such imaging, to a reference standard for the diagnosis of multiple sclerosis.

Results 29 studies (18 cohort studies, 11 other designs) were included. On average, studies of other designs (mainly diagnostic case-control studies) produced higher estimated diagnostic odds ratios than did cohort studies. Among 15 studies of higher methodological quality (cohort design, clinical follow-up as reference standard), those with longer follow-up produced higher estimates of specificity and lower estimates of sensitivity. Only two such studies followed patients for more than10 years. Even in the presence of many lesions (> 10 or > 8), magnetic resonance imaging could not accurately rule multiple sclerosis in (likelihood ratio of a positive test result 3.0 and 2.0, respectively). Similarly, the absence of lesions was of limited utility in ruling out a diagnosis of multiple sclerosis (likelihood ratio of a negative test result 0.1 and 0.5).

Conclusions Many evaluations of the accuracy of magnetic resonance imaging for the early detection of multiple sclerosis have produced inflated estimates of test performance owing to methodological weaknesses. Use of magnetic resonance imaging to confirm multiple sclerosis on the basis of a single attack of neurological dysfunction may lead to over-diagnosis and over-treatment.


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