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The Impact of Magnetic Resonance Imaging and Ancillary Testing

Daniel W. Giang, MD; Virginia M. Grow, MA; Cathleen Mooney, MS, RN; Alvin I. Mushlin, MD, MSc; Andrew D. Goodman, MD; David H. Mattson, MD, PhD; Randolph B. Schiffer, MD; Rochester-Toronto Magnetic Resonance Study Group

Arch Neurol. 1994;51(1):61-66.

Abstract
Objective
Magnetic resonance imaging, computed tomography, cerebrospinal fluid analysis, and evoked potential testing are used to assist in the diagnosis of patients suspected to have multiple sclerosis (MS). The impact of these tests on a clinician's diagnosis of patients suspected to have MS has not been studied systematically.

Design
Clinicians made a diagnosis of each patient following clinical evaluation, again after reviewing the results of magnetic resonance imaging, and finally after reviewing information from other laboratory testing. These diagnoses were compared with the criterion standard of a masked "gold standard" panel reviewing all information after a mean follow-up of 0.9 year.

Setting
The General Neurology Clinic and Multiple Sclerosis Clinic of the University of Rochester (NY).

Patients
A consecutive sample of 62 patients diagnosed as having either possible or probable MS following clinical evaluation.

Main Outcome Measure
Changes in diagnostic certainty of clinicians following incremental presentation of new laboratory data and the accuracy of such diagnoses.

Results
Clinicians used magnetic resonance imaging findings to diagnose definite MS or to eliminate MS from diagnostic consideration in 44% of cases. In these cases, further laboratory testing did not alter clinicians' decisions. In the remaining 56% of cases, in which magnetic resonance imaging did not lead to a diagnosis of definite MS or eliminate MS from diagnostic consideration, further laboratory testing led to such diagnoses in an additional 13% of cases. Gold standard diagnoses were in agreement with the clinician's assessments.

Conclusions
Magnetic resonance imaging aids in the evaluation of patients suspected to have MS; other subsequent studies (computed tomography, cerebrospinal fluid analysis, and evoked potential testing) have less impact. After all studies are performed, about half of such patients still have a tentative diagnosis.

Author Affiliations
From the Departments of Neurology (Drs Giang, Goodman, Mattson, and Schiffer), Community and Preventive Medicine (Mss Grow and Mooney and Dr Mushlin), Medicine (Dr Mushlin), and Psychiatry (Dr Schiffer), University of Rochester (NY).

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