MRI as a Diagnostic Tool

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Questions Over Accuracy of MRI in Diagnosing Multiple Sclerosis (press release)

Posted Monday, August 14, 2006 by NewsTarget, Key concepts

Questions over accuracy of MRI in diagnosing multiple sclerosis
Accuracy of magnetic resonance imaging for the diagnosis of multiple sclerosis: systematic review BMJ Online First

The accuracy of magnetic resonance imaging (MRI) is not sufficient to rule in or rule out a diagnosis of MS with a high degree of certainty, finds a study published online by the BMJ today.

MRI has been adopted in England and Wales by the National Institute for Health and Clinical Excellence (NICE) as part of the recommended criteria for diagnosing multiple sclerosis. Although its accuracy has been assessed, the evidence has not previously been systematically assessed.

Researchers analysed 29 studies to assess the accuracy of magnetic resonance imaging criteria for the early diagnosis of multiple sclerosis in patients with suspected disease. Each study compared MRI criteria to a reference standard for the diagnosis of multiple sclerosis. The average duration of follow-up ranged from seven months to 14 years.

Considerable weaknesses existed in the studies included in the review, and studies with methodological flaws overestimated the diagnostic accuracy of MRI.

Only two studies followed patients for more than 10 years, and these suggested that the role of magnetic resonance imaging either in ruling in or ruling out multiple sclerosis is limited. Patients with a first attack suggestive of MS have around a 60% probability of developing MS, this is increased to between 75 and 84% in those with a positive MRI scan and decreased to between 43 and 57% in those with a negative scan over 10-14 years.

The results suggest that 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.

“There is a real danger of giving patients a serious diagnosis which will affect their lives but may turn out to be incorrect later on,” says Penny Whiting.

Dr Jonathan Sterne adds: “Neurologists should discuss potential consequences of false positive and false negative magnetic resonance imaging results with their patients.”

http://www.newstarget.com/019977.html
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You can tell whether a man is clever by his answers.
You can tell whether a man is wise by his questions.
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[cricket52]

Thank goodness I have a very humble MS neuro who doesn't think lesions are absolutely necessary for classification and treatment. Her response to the three 'negative' (except for CC and cerebral atropy) MRI's over the past 10 years is "we are humbled by what we don't know".

Even if I did show lesions I seriously doubt at this stage of my life I would consider CRABS. I'm happy enough with the symptomatic treatment and support the MS clinic offers.
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Cricket

[Matt]

I'm glad you are getting the level of treatment you need. Wow, you've been in limboland for 10 years. Holy Cow.

[agate]

I'm with you, cricket52! I'm not very concerned about not taking any ABCRs. I don't want any more of my life gummed up if I can help it, after already having it gummed up by MS for quite a number of years.

Avonex gave me all too many down days during the 3 years I was on it.

[cricket52]

Actually Matt I think I have set the record for limbolanders. My first symptoms were over 30 years ago.

If it is MS (and I think it is), then I am very very blessed. I was able to work until 10 years ago, only the last 4 years have been problematic.

What I hated the most was being called hysterical, depressed (not that I wasn't), my complaints were functional, I was malingering, yada yada yada.

When I was hospitalized in 2001 with neurogenic pain, bladder and bowel shutdown and weakness, the dx was shingles without a rash, the differential dx was hysteria. I was furious. To this day I haven't been able to find out if shingles pain is constant or if it comes and goes. I don't think for a second it was shingles, but then, I am not a doctor, I don't even play one online.

I read an abstract that agate posted that men are usually referred to an orthopedic surgeon when they first present with MS symptoms, women are sent to a psychiatrist. My psychiatrist set my PCP straight a few years ago, as did my physiotherapist. It was my optician who sent me to the Ottawa Eye Clinic who in turn sent me to a neuro-opthalmologist/neurologist at the MS clinic there. I can't say enough good about them. They believed me and treat me with respect and kindness. Nice change.
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Cricket

[Matt]

I was also accused of psychosomatic disorder early on. The biggest problem with diagnosing psychosomatic disorder is that the person can't easilly turn to a psychiatrist and discuss how traumatic it is to have hasty symptoms come and then go and then be falsely accused of making up the symptoms, like as if we always wanted a horrible neurodegenerative illness.

[agate]

cricket, although I don't recall posting an abstract about women being sent to a psychiatrist and men to an orthopedist, I ran across this article, which Matt here just posted on another board, and it states the same thing:

http://tinyurl.com/f25af

It's a very interesting article anyway. Matt, thanks for bringing it to people's attention.