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MRI in the diagnosis of MS
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1988
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When agreement exists among three paraclinical studies, the diagnosis of MS is probably unequivocal. The study compared MRI, CT, evoked potentials, and CSF oligoclonal banding analysis in 200 suspected MS patients and seeks to determine how well these tests and the LSDMS category predict clinically definite MS over long‑term follow‑up. The authors prospectively evaluated 200 suspected MS patients, comparing MRI, CT, EP, and CSF oligoclonal banding analysis. MRI proved superior, correctly demonstrating dissemination in space, identifying all LSDMS cases in optic neuritis and chronic progressive myelopathy, and predicting clinically definite MS in 95 % of patients who later developed the disease, although the clinical diagnosis remains the gold standard.
We compared the diagnostic capabilities of MRI to CT, evoked potentials (EP), and CSF oligoclonal banding analysis in a prospective evaluation of 200 patients with suspected multiple sclerosis (MS). MRI was the best method for demonstrating dissemination in space. An abnormal appropriate EP in monosymptomatic disease was usually supported by MRI and CSF anaylsis as being predictive of MS as a clinical diagnosis. A normal appropriate EP study was not satisfactory because MRI and CSF analysis often did not support a diagnosis of <i>non-MS</i>. When there is agreement between three of these paraclinical studies, the diagnosis of MS is probably unequivocal. For use in research studies, laboratory-supported definite MS (LSDMS) could be diagnosed in 85 patients of the total 200 (42.5%), in 19/38 (50%) of optic neuritis (ON) patients, and in 24/52 (46%) of chronic progressive myelopathy (CPM) patients. MRI was 100% successful in identifying patients who qualified for LSDMS in the ON and CPM groups. In a short follow-up (less than 1 year), 19/200 (10%) went on to develop clinically definite MS (CDMS), and MRI predicted that diagnosis in 18/19 (95%). Only long-term follow-up will show how well these studies and the category of LSDMS predict the development of CDMS. The clinical diagnosis of MS (CDMS), even though only 95% accurate, must remain the gold standard.