Accuracy of magnetic resonance imaging for the diagnosis of multiple sclerosis: systematic review.
OBJECTIVE
To determine the accuracy of magnetic resonance imaging criteria for the early diagnosis of multiple sclerosis in patients with suspected disease.


METHODS
Systematic review.


METHODS
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 than 10 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.
MRC Health Services Research Collaboration, Department of Social Medicine, Bristol BS8 2PR. penny.whiting@bristol.ac.uk
Penny
P
Whiting
Roger
R
Harbord
Caroline
C
Main
Jonathan J
JJ
Deeks
Graziella
G
Filippini
Matthias
M
Egger
Jonathan A C
JA
Sterne
D016022:Case-Control Studies; D015331:Cohort Studies; D042241:Early Diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards*; D009103:Multiple Sclerosis / Q000175:diagnosis*; D012680:Sensitivity and Specificity