Accuracy of MRI in Diagnosing MS
 

This is slightly dated, but I think the info is good to share anyway:

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

This 'smells' very much to me, as propaganda the British 'penny pinching' health system is putting out to avoid the expense of doing MRI's on suspected MS patients and thereby avoiding having to give people the CRABS!

That's an interesting way to look at it, Chez.

I guess I was thinking more along the lines of people NOT getting the proper dx of MS because the MRI didn't show enough accuracy of information.

There was a study done with that focus, and it was determined that very few lesions were visible on an MRI, in certain parts of the brain. They were able to confirm this by reviewing the MRI's (taken prior to death) to the autopsy results.

http://www.ajnr.org/cgi/content/abstract/26/3/572

Cherie

Since I am not a scientist, I don't pretend to understand most of the articles I read.

What I am looking for is how they dx the 5% of MSers who don't show lesions. I kind of wonder if it isn't more than 5%. One never sees articles on MSers who don't show lesions, just atrophy.

Limboland is he^^. Having an MS dx recinded must be much worse though. If the bathtub test was the only criteria then some of us would be out of limboland for sure. :rolleyes:

good thread
 

cricket,

They can give a clinical diagnosis in someone who has no lesions on MRI. I have been told that I fulfill the clinical criteria for definite MS.

A clinical diagnosis can be established if their is evidence for lesions disseminated in space and time. They tend to rely heavilly on things that aren't fakeable. They worry way too much about people faking symptoms.

My eyes, for example, show clinical evidence of lesions disseminated in space and time. I developed optic disc pallor a number of years after I developed an eye-traction problem (bilateral INO). The optic disc pallor indicates an optic nerve lesion. The eye traction indicates a brainstem lesion. So, there are lesions in two different locations, and they happened at different times.

There is a lot of caution out there against giving a definite diagnosis to someone in whom all of the tests have been negative. It's really up to the doctor what tests they need to show positive for a definite diagnosis if the person has shown clinical evidence of lesions disseminated in space and time.

There seems to be such conflict between giving an early diagnosis and doing the 'watching and waiting' thing to see what develops. It really seems to be random who gets the diagnosis and who has to wait. This might be why people neuro-shop because we hear stories of people waiting a loooong time without any diagnosis whereas others with seemingly identical circumstances get one right away. Just different doctors, that's the only difference.

Here is the full BMJ article that Cherie's article stems from.

http://bmj.bmjjournals.com/cgi/conte...urcetype=HWCIT

What wannabe said. It seems so arbitrary.

Is a poor patient to believe the "Early Diagnosis and Treatment" mantra you hear almost everywhere in MS Officialdom?

Or is the poor patient to believe the conflicting, seemingly arbitrary, blase, AND/OR dismissive attitudes of many doctors toward those without MRI evidence that screams MS?

(Picture the neurologist leaving the room making the Valley Girl "W" sign... "Whatever!")

Nancy

Early DX and TX, I laugh when I hear those words in reference to any disease. That is what is promoted by hospitals and insurance, but they don't practice it, it's just a media thing.

I've had MRI's showing multiple lesions and progression, and many tests that show some sort of abnormalities, but since I don't show "O" bands I'm dismissed and told I am healthy.

When I stumble, have to push myself to walk a block and have to think about every step I take, and my legs twitch and spasm all day long, well all I can do is shake my head.

Something is wrong, hopefully the Cleveland clinic will be willing to figure out what is wrong.
Pat

Matt:

I had to look up INO. :)

The only eye problems I have is jerkiness of pursuit. Police officers watch for that when they test drunk drivers. I don't drink. I have oscillopsia, double and blurred vision. My optic discs are perfect. Neurogenic bladder, bowel motility problems, spasticity, clonus, slight loss of sensation, fatigue, wide gait, can't do tandem walk, use a cane for distances, ocassional weakness, brain atrophy, normal EVP's - which all add up on clinical exam to soft neurological signs. Yep - great MS mimicker. No lesions. When my leg reflexes tested 4+ I got considerable enjoyment from the look on my PCP's face.

Quality of life seems to be the goal for those with early symptoms. Pain management shouldn't be ignored. In the end, you cannot replace a good MS specialist vs. a 'normal' neuro. Well, at least that is my experience and story and I'm stickin to it. :D


Whatever happened to that promising blood test for MS? It seems to have disappeared from the literature.