BMJ, 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 ^1*, Roger Harbord ¹, Caroline Main ², Jonathan J Deeks ³, Graziella Filippini ⁴, Matthias Egger ⁵, Jonathan A C Sterne ¹

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: penny.whiting{at}bristol.ac.uk.

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.

---

(Accepted 2 February 2006)
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Role of MRI in diagnosing multiple sclerosis: Magnetic resonance imaging is valuable

David H Miller
BMJ 2006 332: 1034. [Extract] [Full Text]

Role of MRI in diagnosing multiple sclerosis: Early diagnosis using MRI and early treatment delays disease conversion

Bharani Padmanabhan
BMJ 2006 332: 1034-1035. [Extract] [Full Text]

Caution needed over role of MRI in diagnosing multiple sclerosis
BMJ 2006 332: 0. [Full Text] [PDF]

Medical academia is failing patients and clinicians

Peter M Rothwell
BMJ 2006 332: 863-864. [Extract] [Full Text] [PDF]

Diagnostic tests 4: likelihood ratios

Jonathan J Deeks and Douglas G Altman
BMJ 2004 329: 168-169. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Minneboo, A, Jasperse, B, Barkhof, F, Uitdehaag, B M J, Knol, D L, de Groot, V, Polman, C H, Castelijns, J A (2008). Predicting short-term disability progression in early multiple sclerosis: added value of MRI parameters. J. Neurol. Neurosurg. Psychiatry 79: 917-923 [Abstract] [Full text]  
• (2006). Is MRI an Accurate Tool in the Diagnosis of Multiple Sclerosis?. JWatch Neurology 2006: 3-3 [Full text]  
• Weinshenker, B. G (2006). Review: magnetic resonance imaging alone is of limited usefulness in diagnosing multiple sclerosis. Evid. Based Med. 11: 155-155 [Full text]  
• (2006). CARPHOLOGY by Rajendra. PN 6: 268-268 [Full text]  
• (2006). Is MRI Useful for Diagnosing Multiple Sclerosis?. JWatch General 2006: 3-3 [Full text]  
• Miller, D. H (2006). Role of MRI in diagnosing multiple sclerosis: magnetic resonance imaging is valuable.. BMJ 332: 1034-1034 [Full text]  
• Padmanabhan, B. (2006). Role of MRI in diagnosing multiple sclerosis: early diagnosis using MRI and early treatment delays disease conversion.. BMJ 332: 1034-1035 [Full text]  
• Rothwell, P. M (2006). Medical academia is failing patients and clinicians.. BMJ 332: 863-864 [Full text]  

Rapid Responses:

Read all Rapid Responses

The clinical value of magnetic resonance imaging for the diagnosis of multiple sclerosis

Chris H Polman, et al.
bmj.com, 31 Mar 2006 [Full text]

MRI is valuable in the diagnosis of multiple sclerosis

David H Miller, et al.
bmj.com, 5 Apr 2006 [Full text]

Early diagnosis using MRI and early treatment definitely delays conversion to clinically definite MS

Bharani Padmanabhan
bmj.com, 14 Apr 2006 [Full text]

"Overdiagnoses"

David Carvel
bmj.com, 16 Apr 2006 [Full text]

Magnetic resonance imaging for the diagnosis of multiple sclerosis

Jonathan A.C. Sterne, et al.
bmj.com, 22 Apr 2006 [Full text]

Meta-analysis for the sake of meta-analysis?

Gavin Giovannoni
bmj.com, 22 Apr 2006 [Full text]

MRi in the diagnosis of MS

Douglas S. Goodin, et al.
bmj.com, 22 Nov 2006 [Full text]