Accuracy of magnetic resonance imaging for the diagnosis of multiple sclerosis: systematic review
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.38771.583796.7C (Published 13 April 2006) Cite this as: BMJ 2006;332:875
Data supplement
Web Table A: MRI details [As supplied by authors]
MRI Details
Study
Tesla strength (T)
MRI protocol
Gadolinium enhanced?
Cohort studies recruiting patients with suspected MS
Canada 1 w1
0.15
T2 spin echo
-
Canada 2 w3
NR
NR
NR
Canada 3 w5
0.15
T2 spin echo & T1
-
Denmark 1 w6
1.5
T2 & PD spin echo & T1
-
England 1 w7-w11
0.5
T2 & PD spin echo
-
England 2 w12- w 15
1.5
T1, T2 & PD spin echo
+
Holland 1 w16
0.5, 0.6 or 1.5
T1, T2 & PD spin echo
+
Italy 1 w17
0.5
T2 spin echo
-
Italy 2 w18
NR
NR
+
Italy 3 w19
0.5
T2 & PD spin echo
NR
Italy 4 w21
0.5 or 1.5
T2 & PD spin echo
-
Spain 1w 22-w25
1 or 1.5
T1, T2 & PD spin echo
some
Spain 2w26
1 or 1.5
T2 & PD spin echo
-
Swedenw27
1 or 1.5
T2 & PD spin echo
-
Switzerland w28
1.5
T2 spin echo & T1
-
USA & Canada w32
1.5
T2 & PD spin echo & T1
-
USA 1 w29,w30
1.5
T2 (no further details)
-
USA 2 w31
0.15- 1.5
T2 & PD spin echo & T1
-
Studies of other designs
Austria 1 w33
1.5
T2 & PD spin echo
-
Austria 2 w34
1
T1, T2 & PD spin echo
+
Denmark 2 w35
1.5
T2 & PD spin echo & T1
-
Holland 2 w36
0.6
NR
NR
Holland 3 w37
1.5
T2 & PD spin echo
-
Italy 5 w38
1.5
T2 & PD spin echo & T1
-
Italy 6 w39
1.5
T2 spin echo
-
Japan 1 w40
1.5
T1, T2 & PD spin echo
-
USA 3 w41
1.5
T2 & PD spin echo & T1
-
USA 4 w42
0.35, 0.6 or 1.5
T1, T2 & PD spin echo
-
USA 5 w43
1.5
T2 & PD spin echo & T1
-
* Some studies reported in more than one publication had different quality issues, e.g. earlier reports of a study may have included shorter periods of follow-up and so these reports did not include an appropriate reference standard, other quality items relate to reporting which differed between reports of the same studyReferences for Tables 1 and 2 and Web Tables 1 and 2
w1. Lee KH, Hashimoto SA, Hooge JP, Kastrukoff LF, Oger JJ, Li DK, et al. Magnetic resonance imaging of the head in the diagnosis of multiple sclerosis: a prospective 2-year follow-up with comparison of clinical evaluation, evoked potentials, oligoclonal banding, and CT. Neurology 1991;41:657-660.
w2. Schumacher GA, Beebe G, Kebler RF. Problems of experimental trials of therapy in multiple sclerosis. Ann NY Acad Sci 1965;122:552-568.
w3. Ford B, Tampieri D, Francis G. Long-term follow-up of acute partial transverse myelopathy. Neurology 1992;42:250-252.
w4. Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983;13:227-231.
w5. Reese L, Carr TJ, Nicholson RL, Lepp EK. Magnetic resonance imaging for detecting lesions of multiple sclerosis: comparison with computed tomography and clinical assessment. Can Med Assoc J 1986;135:639-643.
w6. Frederiksen, J., Larsson, H. B. W., Henriksen, O., Gonsette, R. E., Delmotte, P. Magnetic resonance imaging is a predictor for later development of multiple sclerosis in acute monosymptomatic optic neuritis. Recent advances in Multiple Sclerosis therapy: proceedings of the Vth Congress of the European Committee for treatment & research in Multiple Sclerosis (ECTRIMS) , 329-330. 1989. (GENERIC)
Ref Type: Conference Proceedingw7. Brex PA, Ciccarelli O, O'Riordan JI, Sailer M, Thompson AJ, Miller DH. A longitudinal study of abnormalities on MRI and disability from multiple sclerosis. NEJM 2002;346:158-164.
w8. Filippi M, Horsfield MA, Morrissey SP, MacManus DG, Rudge P, McDonald WI, et al. Quantitative brain MRI lesion load predicts the course of clinically isolated syndromes suggestive of multiple sclerosis. Neurology 1994;44:635-641.
w9. Miller DH, Ormerod IE, McDonald WI, MacManus DG, Kendall BE, Kingsley DP, et al. The early risk of multiple sclerosis after optic neuritis. J Neurol Neurosurg Psychiatry 1988;51:1569-1571.
w10. Miller DH, Ormerod IE, Rudge P, Kendall BE, Moseley IF, McDonald WI. The early risk of multiple sclerosis following isolated acute syndromes of the brainstem and spinal cord. Ann Neurol 1989;26:635-639.
w11. Sharief MK, Thompson EJ. The predictive value of intrathecal immunoglobulin synthesis and magnetic resonance imaging in acute isolated syndromes for subsequent development of multiple sclerosis. Ann Neurol 1991;29:147-151.
w12. Brex PA, Miszkiel KA, O'Riordan JI, Plant GT, Moseley IF, Thompson AJ, et al. Assessing the risk of early multiple sclerosis in patients with clinically isolated syndromes: the role of a follow up MRI. J Neurol Neurosurg Psychiatry 2001;70:390-393.
w13. Brex PA, O'Riordan JI, Miszkiel KA, Moseley IF, Thompson AJ, Plant GT, et al. Multisequence MRI in clinically isolated syndromes and the early development of MS. Neurology 1999;53:1184-1190.
w14. Dalton CM, Brex PA, Miszkiel KA, Fernando K, MacManus DG, Plant GT, et al. New T2 lesions enable an earlier diagnosis of multiple sclerosis in clinically isolated syndromes. Ann Neurol 2003;53:673-676.
w15. Dalton CM, Brex PA, Miszkiel KA, Hickman SJ, MacManus DG, Plant GT, et al. Application of the new McDonald criteria to patients with clinically isolated syndromes suggestive of multiple sclerosis. Ann Neurol 2002;52:47-53.
w16. Barkhof F, Filippi M, Miller DH, Scheltens P, Campi A, Polman CH, et al. Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis. Brain 1997;120:2059-2069.
w17. Ghezzi A, Martinelli V, Torri V, Zaffaroni M, Rodegher M, Comi G, et al. Long-term follow-up of isolated optic neuritis: the risk of developing multiple sclerosis, its outcome, and the prognostic role of paraclinical tests. J Neurol 1999;246:770-775.
w18. Di Legge S, Piattella MC, Pantano P, Pestalozza IF, Nucciarelli W, Bozzao L, et al. The impact of Revised McDonald Criteria in Predicting Multiple Sclerosis. Neurology 2002;58:A173.
w19. Paolino E, Fainardi E, Ruppi P, Tola MR, Govoni V, Casetta I, et al. A prospective study on the predictive value of CSF oligoclonal bands and MRI in acute isolated neurological syndromes for subsequent progression to multiple sclerosis. J Neurol Neurosurg Psychiatry 1996;60:572-575.
w20. McDonald WI, Halliday AM. Diagnosis and classification of multiple sclerosis. Br Med Bull 1977;33:4-9.
w21. Filippini G, Comi GC, Cosi V, Bevilacqua L, Ferrarini M, Martinelli V, et al. Sensitivities and predictive values of paraclinical tests for diagnosing multiple sclerosis. J Neurol 1994;241:132-137.
w22. Sastre-Garriga J, Tintore M, Rovira A, Nos C, Rio J, Thompson AJ, et al. Specificity of Barkhof criteria in predicting conversion to multiple sclerosis when applied to clinically isolated brainstem syndromes. Arch Neurol 2004;61:222-224.
w23. Sastre-Garriga J, Tintore M, Rovira A, Grive E, Pericot I, Comabella M, et al. Conversion to multiple sclerosis after a clinically isolated syndrome of the brainstem: cranial magnetic resonance imaging, cerebrospinal fluid and neurophysiological findings. Multiple Sclerosis 2003;9:39-43.
w24. Tintore M, Rovira A, Brieva L, Grive E, Jardi R, Borras C, et al. Isolated demyelinating syndromes: comparison of CSF oligoclonal bands and different MR imaging criteria to predict conversion to CDMS. Multiple Sclerosis 2001;7:359-363.
w25. Tintore M, Rovira A, Rio J, Nos C, Grive E, Sastre-Garriga J, et al. New diagnostic criteria for multiple sclerosis: application in first demyelinating episode. Neurology 2003;60:27-30.
w26. Rio J, Nos C, Rovira A, Tintore M, Codina A, Montalban X. [The development of multiple sclerosis following an isolated episode of optic neuritis. Magnetic resonance study]. Med Clin (Barc) 1997;109:370-372.
w27. Soderstrom M, Ya-Ping J, Hillert J, Link H. Optic neuritis: prognosis for multiple sclerosis from MRI, CSF, and HLA findings. Neurology 1998;50:708-714.
w28. Beer S, Rosler KM, Hess CW. Diagnostic value of paraclinical tests in multiple sclerosis: relative sensitivities and specificities for reclassification according to the Poser committee criteria. J Neurol Neurosurg Psychiatry 1995;59:152-159.
w29. Beck RW, Trobe JD, Moke PS, Gal RL, Xing D, Bhatti MT, et al. High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial. Arch Ophthalmol 2003;121:944-949.
w30. Tumani H, Tourtellotte WW, Peter JB, Felgenhauer K. Acute optic neuritis: combined immunological markers and magnetic resonance imaging predict subsequent development of multiple sclerosis. The Optic Neuritis Study Group. J Neurol Sci 1998;155:44-49.
w31. Jacobs LD, Kaba SE, Miller CM, Priore RL, Brownscheidle CM. Correlation of clinical, magnetic resonance imaging, and cerebrospinal fluid findings in optic neuritis. Ann Neurol 1997;41:392-398.
w32. Mushlin AI, Detsky AS, Phelps CE, O'Connor PW, Kido DK, Kucharczyk W, et al. The accuracy of magnetic resonance imaging in patients with suspected multiple sclerosis. The Rochester-Toronto Magnetic Resonance Imaging Study Group. JAMA 1993;269:3146-3151.
w33. Offenbacher H, Fazekas F, Schmidt R, Freidl W, Flooh E, Payer F, et al. Assessment of MRI criteria for a diagnosis of MS. Neurology 1993;43:905-909.
w34. Fazekas F, Offenbacher H, Fuchs S, Schmidt R, Niederkorn K, Horner S, et al. Criteria for an increased specificity of MRI interpretation in elderly subjects with suspected multiple sclerosis. Neurology 1988;38:1822-1825.
w35. Ravnborg M, Liguori R, Christiansen P, Larsson H, Sorensen PS. The diagnostic reliability of magnetically evoked motor potentials in multiple sclerosis. Neurology 1992;42:1296-1301.
w36. Van Der Eerden HAM, Koetsier JC, Polman CH. Making a diagnosis in patients with an isolated spinal cord syndrome. Acta Neurol Scand 1990;81:205-208.
w37. Bot JC, Barkhof F, Nijeholt G, van SD, Voskuyl AE, Ader HJ, et al. Differentiation of multiple sclerosis from other inflammatory disorders and cerebrovascular disease: value of spinal MR imaging. Radiology 2002;223:46-56.
w38. Rovaris M, Holtmannspotter M, Rocca MA, Iannucci G, Codella M, Viti B, et al. Contribution of cervical cord MRI and brain magnetization transfer imaging to the assessment of individual patients with multiple sclerosis: a preliminary study. Multiple Sclerosis 2002;8:52-58.
w39. Rovaris M, Viti B, Ciboddo G, Capra R, Filippi M. Cervical cord magnetic resonance imaging findings in systemic immune-mediated diseases. J Neurol Sci 2000;176:128-130.
w40. Kuroda Y, Matsui M, Yukitake M, Kurohara K, Takashima H, Takashima Y, et al. Assessment of MRI criteria for MS in Japanese MS and HAM/TSP. Neurology 1995;45:30-33.
w41. Palmer S, Bradley WG, Chen DY, Patel S. Subcallosal striations: early findings of multiple sclerosis on sagittal, thin-section, fast FLAIR MR images. Radiology 1999;210:149-153.
w42. Gean-Marton AD, Vezina LG, Marton KI, Stimac GK, Peyster RG, Taveras JM, et al. Abnormal corpus callosum: a sensitive and specific indicator of multiple sclerosis. Radiology 1991;180:215-221.
w43. Yetkin FZ, Haughton VM, Papke RA, Fischer ME, Rao SM. Multiple sclerosis: specificity of MR for diagnosis. Radiology 1991;178:447-451.
Additional details to go on the website
Web Box 1: QUADAS items and review specific details of criteria for scoring studies (general scoring criteria are provided in the QUADAS background document)
QUADAS item
When to score as "yes"
1. Was the spectrum of patients representative of the patients who will receive the test in practice? (patient spectrum)
Patient with suspected MS enrolled prospectively
2. Were selection criteria clearly described? (selection criteria)
Enough details reported so that selection process could be replicated.
3. Is the reference standard likely to correctly classify the target condition? (reference standard)
Mean clinical follow-up ≥10 years. Studies that classified patients with clinically possible or probably MS as having MS were scored no.
4. Did the whole sample or a random selection of the sample, receive verification using a reference standard of diagnosis? (partial verification)
Whole sample or a random selection received a reference standard.
5. Did patients receive the same reference standard regardless of the index test result? (differential verification)
All patients received same reference standard.
6. Was the reference standard independent of the index test (i.e. the index test did not form part of the reference standard)? (incorporation)
Index test results did not form part of reference standard
7. Was the execution of the index test described in sufficient detail to permit replication of the test? (test details)
Sufficient details of MRI reported to complete all details on data extraction form
8. Was the execution of the reference standard described in sufficient detail to permit its replication? (reference standard details)
Report duration of follow-up and criteria used to diagnose MS
9. Were the index test results interpreted without knowledge of the results of the reference standard? (test bias)
Index test was interpreted without knowledge of reference standard results and vice versa, or test was clearly interpreted before results of other test were available
10. Were the reference standard results interpreted without knowledge of the results of the index test? (review bias)
11. Were the same clinical data available when test results were interpreted as would be available when the test is used in practice? (clinical data)
Data on patient age, gender and presenting symptoms available
12. Were uninterpretable/ intermediate test results reported? (uninterpretable results)
Results available for all patients who entered the study
13. Were withdrawals from the study explained? (withdrawals)
Reasons why results were not available for all patients who entered the trial reported or results available for all patients
Web Appendix 1: Details of duplicate reports, data from which was not extracted separately
Study
Duplicate Publication(s)
Canada 1
Paty (1988)1
Denmark 1
Frederiksen (1989)2
England 2
O'Riordan (1998)3
Morrissey (1993)4
Sailer (1999)5
O'Riordan (1996)6
Dalton (2002)7
Dalton (2002)8
Holland 1
Tas (1995)9
Barkhof (1995)10
Italy 1
Ghezzi (1996)11
Italy 6
Rovaris (2000)12
Spain 1
Tintore (2000)13
Tintore (2000)14
Tintore (2002)15
Sweden
Jin (2003)16
USA & Canada
O'Connor (1996)17
Mushlin (1993)18
USA 1
Beck (1997)19
Beck (1993)20
USA 2
Jacobs (1991)21
References of duplicate publications
1. Paty DW, Oger JJ, Kastrukoff LF, Hashimoto SA, Hooge JP, Eisen AA, et al. MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding, and CT. Neurology 1988;38:180-185.
2. Frederiksen JL, Larsson HB, Henriksen O, Olesen J. Magnetic resonance imaging of the brain in patients with acute monosymptomatic optic neuritis. Acta Neurol Scand 1989;80:512-517.
3. O'Riordan JI, Thompson AJ, Kingsley DP, MacManus DG, Kendall BE, Rudge P, et al. The prognostic value of brain MRI in clinically isolated syndromes of the CNS. A 10-year follow-up. Brain 1998;121:495-503.
4. Morrissey SP, Miller DH, Kendall BE, Kingsley DP, Kelly MA, Francis DA, et al. The significance of brain magnetic resonance imaging abnormalities at presentation with clinically isolated syndromes suggestive of multiple sclerosis. A 5-year follow-up study. Brain 1993;116:135-146.
5. Sailer M, O'Riordan JI, Thompson AJ, Kingsley DP, MacManus DG, McDonald WI, et al. Quantitative MRI in patients with clinically isolated syndromes suggestive of demyelination. Neurology 1999;52:599-606.
6. O'Riordan JI, McDonald WI, Miller DH. The predictive value of MRI in clinically isolated syndromes suggestive of demyelination. Multiple Sclerosis 1996;2:4.
7. Dalton C, Brex P, Miszkiel K, Fernando K, Plant G, Thompson A, et al. Clinically isolated syndromes (CIS) and new T2 lesions on early MRI follow up: a better predictor for clinically definite MS (CDMS) than the new diagnostic (McDonald) criteria? J Neurol 2002;249:I/38.
8. Dalton CM, Brex PA, Miszkiel KA, Plant GT, Thompson AJ, Miller DH. Validation of the McDonald Criteria in Patients with Clinically Isolated Syndromes Suggestive of Multiple Sclerosis. Neurology 2002;58:A172.
9. Tas MW, Barkhol F, van Walderveen MA, Polman CH, Hommes OR, Valk J. The effect of gadolinium on the sensitivity and specificity of MR in the initial diagnosis of multiple sclerosis. Am J Neurorad 1995;16:259-264.
10. Barkhof F, Filippi M, Horsfield MA, Losseff N, Tas MW, Comi GC, et al. Towards Specific Magnetic-Resonance-Imaging Criteria in the Early Diagnosis of Multiple-Sclerosis. Neurology 1995;45:A398.
11. Ghezzi A, Torri V, Zaffaroni M. Isolated optic neuritis and its prognosis for multiple sclerosis: a clinical and paraclinical study with evoked potentials. CSF examination and brain MRI. Ital J Neurol Sci 1996;17:325-332.
12. Rovaris M, Viti B, Ciboddo G, Gerevini S, Capra R, Iannucci G, et al. Brain involvement in systemic immune mediated diseases: magnetic resonance and magnetisation transfer imaging study. J Neurol Neurosurg Psychiatry 2000;68:170-177.
13. Tintore M, Rovira A, Martinez MJ, Rio J, az-Villoslada P, Brieva L, et al. Isolated demyelinating syndromes: comparison of different MR imaging criteria to predict conversion to clinically definite multiple sclerosis. Am J Neurorad 2000;21:702-706.
14. Tintore, M., Jardi, J., No, C., Diaz, P., Rovira, A., Montalban, X. The predictive value of oligoclonal bands and MRI in patients with isolated demyelinating syndromes. 3S142. 2000. Masson; 2000. European Committee for Treatment and Research in Multiple Sclerosis. 2000.
15. Tintore M, Rovira A, Rio J, Nos C, Grive E, Sastre-Garriga J, et al. Application of the New McDonald's Diagnostic Criteria in a Cohort of Patients with Clinically Isolated Syndromes. Neurology 2002;58:A211.
16. Jin YP, de Pedro-Cuesta J, Huang YH, Soderstrom M. Predicting multiple sclerosis at optic neuritis onset. Multiple Sclerosis 2003;9:135-141.
17. O'Connor PW, Tansay CM, Detsky AS, Mushlin AI, Kucharczyk W. The effect of spectrum bias on the utility of magnetic resonance imaging and evoked potentials in the diagnosis of suspected multiple sclerosis. Neurology 1996;47:140-144.
18. Mushlin AI, Phelps CE, Hall WJ, Kido D, Mooney C, Giang D, et al. The Accuracy of Mri in Patients with Suspected Multiple- Sclerosis. Med Decis Making 1991;11:328.
19. Anonymous. The 5-year risk of MS after optic neuritis. Experience of the optic neuritis treatment trial. Optic Neuritis Study Group. Neurology 1997;49:1404-1413.
20. Beck RW, Arrington J, Murtagh FR, Cleary PA, Kaufman DI. Brain magnetic resonance imaging in acute optic neuritis. Experience of the Optic Neuritis Study Group. Arch Neurol 1993;50:841-846.
21. Jacobs L, Munschauer FE, Kaba SE. Clinical and magnetic resonance imaging in optic neuritis. Neurology 1991;41:15-19.
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