MAGNETIC RESONANCE IMAGING NOT SUFFICIENT FOR MS DIAGNOSIS

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MAGNETIC RESONANCE IMAGING NOT SUFFICIENT FOR MS DIAGNOSIS
03 April 2007 - University of Bristol

The accuracy of magnetic resonance imaging is not sufficient to rule in or rule out a diagnosis of multiple sclerosis with a high degree of certainty, according to new research from Bristol University’s Department of Social Medicine, published online by the BMJ.

MRI has been adopted in England and Wales by the National Institute for Health and Clinical Excellence 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 per cent probability of developing MS, this is increased to between 75 and 84 per cent in those with a positive MRI scan and decreased to between 43 and 57 per cent 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.

Penny Whiting said: “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.”

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

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About: University of Bristol
The University College of Bristol opened in 1876, after six years of discussions and controversy, in a bid to bring university culture to the provinces. It was the first college in the country to admit men and women on an equal footing.

The University’s Research and Enterprise Development (RED) division was launched in 2000 to stimulate and support an entrepreneurial culture and encourage the growth of technology-based business.

2003 saw the completion of the Dorothy Hodgkin building, named after the University’s fifth Chancellor. The £18 million building is dedicated to research in neuroendocrinology. 2003 also saw the opening of the University’s £5 million Centre for Sport, Exercise and Health.

Work on a new, state-of-the-art engineering building is due to be completed in early 2004. The £20 million BLADE project (Bristol Laboratory for Advanced Dynamics Engineering) will bring together the Engineering Faculty’s six departments to establish Europe’s most advanced dynamics engineering research facilities.

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