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From the Division of Neurology (Drs. Paty, Oger, Kastrukoff, Hashimoto, Hooge, A. A. Eisen, Purves, and Low, and Ms. Brandejs and K. A. Eisen), Department of Medicine, the Department of Diagnostic Radiology (Drs. Robertson and Li), and the Imaging Research Center, University of British Columbia, Vancouver, British Columbia, Canada.
We compared the diagnostic capabilities of MRI to CT, evoked potentials (EP), and CSF oligoclonal banding analysis in a prospective evaluation of 200 patients with suspected multiple sclerosis (MS). MRI was the best method for demonstrating dissemination in space. An abnormal appropriate EP in monosymptomatic disease was usually supported by MRI and CSF anaylsis as being predictive of MS as a clinical diagnosis. A normal appropriate EP study was not satisfactory because MRI and CSF analysis often did not support a diagnosis of non-MS. When there is agreement between three of these paraclinical studies, the diagnosis of MS is probably unequivocal. For use in research studies, laboratory-supported definite MS (LSDMS) could be diagnosed in 85 patients of the total 200 (42.5%), in 19/38 (50%) of optic neuritis (ON) patients, and in 24/52 (46%) of chronic progressive myelopathy (CPM) patients. MRI was 100% successful in identifying patients who qualified for LSDMS in the ON and CPM groups. In a short follow-up (less than 1 year), 19/200 (10%) went on to develop clinically definite MS (CDMS), and MRI predicted that diagnosis in 18/19 (95%). Only long-term follow-up will show how well these studies and the category of LSDMS predict the development of CDMS. The clinical diagnosis of MS (CDMS), even though only 95% accurate, must remain the gold standard.
Address correspondence and reprint requests to Dr. Paty, Division of Neurology, Vancouver General Hospital, 222–2775 Heather Street, Vancouver, B. C., Canada V5Z 3J5.
Supported by grants from the Medical Research Council of Canada and the Jacob W. Cohen Fund for Research into Multiple Sclerosis.
Presented in part at the thirty-eighth annual meeting of the American Academy of Neurology, New Orleans, LA, April 1986; and the annual meetings of the American Association of Electromyography and Electrodiagnosis, Boston, MA, September 1986; the American EEG Society, Seattle, WA, November 1986; the Society for Magnetic Resonance, Montreal, Canada, 1986; and the NATO MS Workshop, Brussels, Belgium, 1986.
Received March 16, 1987. Accepted for publication in final form May 11, 1987.
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H. McFarland The emerging role of MRI in multiple sclerosis and the new diagnostic criteria Multiple Sclerosis, September 1, 2002; 8(1_suppl): 71 - 72. [PDF]
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M Rovaris, M Holtmannspotter, M A Rocca, G Iannucci, M Codella, B Viti, A Campi, G Comi, T A Yousry, and M Filippi Contribution of cervical cord MRI and brain magnetization transfer imaging to the assessment of individual patients with multiple sclerosis: a preliminary study Multiple Sclerosis, February 1, 2002; 8(1): 52 - 58. [Abstract] [PDF]
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H F McFarland The emerging role of MRI in multiple sclerosis and the new diagnostic criteria Multiple Sclerosis, February 1, 2002; 8(1): 71 - 72. [PDF]
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G. S. Gronseth and E. J. Ashman Practice parameter: The usefulness of evoked potentials in identifying clinically silent lesions in patients with suspected multiple sclerosis (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology Neurology, May 9, 2000; 54(9): 1720 - 1725. [Full Text] [PDF]
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I L Tan, G J L. Nijeholt, C H Polman, H J Ader, F Barkhof, and the 95 Line 146/147 Study Group Linomide in the treatment of multiple sclerosis: MRI results from prematurely terminated phase-III trials Multiple Sclerosis, April 1, 2000; 6(2): 99 - 104. [Abstract] [PDF]
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M. Tintoré, A. Rovira, M. J. Martínez, J. Rio, P. Díaz-Villoslada, L. Brieva, C. Borrás, E. Grivé, J. Capellades, and X. Montalban Isolated Demyelinating Syndromes: Comparison of Different MR Imaging Criteria to Predict Conversion to Clinically Definite Multiple Sclerosis AJNR Am. J. Neuroradiol., April 1, 2000; 21(4): 702 - 706. [Abstract] [Full Text]
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G. Mastronardo, M. A. Rocca, G. Iannucci, C. Pereira, and M. Filippi A Longitudinal MR Study of the Presymptomatic Phase in a Patient with Clinically Definite Multiple Sclerosis AJNR Am. J. Neuroradiol., August 1, 1999; 20(7): 1268 - 1272. [Abstract] [Full Text]
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F. Fazekas, F. Barkhof, M. Filippi, R. I. Grossman, D. K. B. Li, W. I. McDonald, H. F. McFarland, D. W. Paty, J. H. Simon, J. S. Wolinsky, et al. The contribution of magnetic resonance imaging to the diagnosis of multiple sclerosis Neurology, August 1, 1999; 53(3): 448 - 448. [Abstract] [Full Text] [PDF]
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M. Filippi, M. A. Rocca, L. Minicucci, V. Martinelli, A. Ghezzi, R. Bergamaschi, and G. Comi Magnetization transfer imaging of patients with definite MS and negative conventional MRI Neurology, March 1, 1999; 52(4): 845 - 845. [Abstract] [Full Text]
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M. Sailer, J. I. O'Riordan, A. J. Thompson, D. P. Kingsley, D. G. MacManus, W. I. McDonald, and D. H. Miller Quantitative MRI in patients with clinically isolated syndromes suggestive of demyelination Neurology, February 1, 1999; 52(3): 599 - 599. [Abstract] [Full Text]
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J L Frederiksen Can CSF predict the course of optic neuritis? Multiple Sclerosis, June 1, 1998; 4(3): 132 - 135. [Abstract] [PDF]
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A. Tourbah, A. Clapin, O. Gout, B. Fontaine, R. Liblau, F. Batteux, J.-L. Stievenart, B. Weill, C. Lubetzki, and O. Lyon-Caen Systemic Autoimmune Features and Multiple Sclerosis: A 5-Year Follow-up Study Arch Neurol, April 1, 1998; 55(4): 517 - 521. [Abstract] [Full Text] [PDF]
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 S. J. Khoury and H. L. Weiner Multiple Sclerosis: What Have We Learned From Magnetic Resonance Imaging Studies? Arch Intern Med, March 23, 1998; 158(6): 565 - 573. [Abstract] [Full Text] [PDF]
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J I O'Riordan, N A Losseff, C Phatouros, A J Thompson, I F Moseley, D G MacManus, W I McDonald, and D H Miller Asymptomatic spinal cord lesions in clinically isolated optic nerve, brain stem, and spinal cord syndromes suggestive of demyelination J. Neurol. Neurosurg. Psychiatry, March 1, 1998; 64(3): 353 - 357. [Abstract] [Full Text] [PDF]
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J. L Frederiksen and C. J. Sindic Intrathecal synthesis of virus-specific oligoclonal IgG, and of free kappa and free lambda oligoclonal bands in acute monosymptomatic optic neuritis. Comparison with brain MRI Multiple Sclerosis, February 1, 1998; 4(1): 22 - 26. [Abstract] [PDF]
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C A Davie, G J Barker, A J Thompson, P S Tofts, W I McDonald, and D H Miller 1H magnetic resonance spectroscopy of chronic cerebral white matter lesions and normal appearing white matter in multiple sclerosis J. Neurol. Neurosurg. Psychiatry, December 1, 1997; 63(6): 736 - 742. [Abstract] [Full Text] [PDF]
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F. Thomke, E. Lensch, K. Ringel, and H. C. Hopf Isolated cranial nerve palsies in multiple sclerosis J. Neurol. Neurosurg. Psychiatry, November 1, 1997; 63(5): 682 - 685. [Abstract] [Full Text] [PDF]
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F. Barkhof Imaging of remyelination Multiple Sclerosis, April 1, 1997; 3(2): 129 - 132. [Abstract] [PDF]
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 {blacktriangledown}Interferon beta-1b - hope or hype? DTB, February 1, 1996; 34(2): 9 - 11. [Abstract] [Full Text] [PDF]
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M Soderstrom, J Hillert, J Link, V Navikas, S Fredrikson, and H Link Expression of IFN-{gamma}, IL-4, and TGF-{beta} in multiple sclerosis in relation to HLA-Dw2 phenotype and stage of disease Multiple Sclerosis, November 1, 1995; 1(3): 173 - 180. [Abstract] [PDF]
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M. P. Amato, G. Ponziani, G. Pracucci, L. Bracco, G. Siracusa, and L. Amaducci Cognitive Impairment in Early-Onset Multiple Sclerosis: Pattern, Predictors, and Impact on Everyday Life in a 4-Year Follow-up Arch Neurol, February 1, 1995; 52(2): 168 - 172. [Abstract] [PDF]
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D. E. Goodkin, R. A. Rudick, and J. S. Ross The Use of Brain Magnetic Resonance Imaging in Multiple Sclerosis Arch Neurol, May 1, 1994; 51(5): 505 - 516. [Abstract] [PDF]
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P. O'Connor, C. Tansey, W. Kucharczyk, A. S. Detsky, and Rochester-Toronto MRI Study Group A Randomized Trial of Test Result Sequencing in Patients With Suspected Multiple Sclerosis Arch Neurol, January 1, 1994; 51(1): 53 - 59. [Abstract] [PDF]
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D. W. Giang, V. M. Grow, C. Mooney, A. I. Mushlin, A. D. Goodman, D. H. Mattson, R. B. Schiffer, and Rochester-Toronto Magnetic Resonance Study Group Clinical Diagnosis of Multiple Sclerosis: The Impact of Magnetic Resonance Imaging and Ancillary Testing Arch Neurol, January 1, 1994; 51(1): 61 - 66. [Abstract] [PDF]
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R. W. Beck, J. Arrington, F. R. Murtagh, P. A. Cleary, D. I. Kaufman, and Optic Neuritis Study Group Brain Magnetic Resonance Imaging in Acute Optic Neuritis: Experience of the Optic Neuritis Study Group Arch Neurol, August 1, 1993; 50(8): 841 - 846. [Abstract] [PDF]
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A. I. Mushlin, A. S. Detsky, C. E. Phelps, P. W. O'Connor, D. K. Kido, W. Kucharczyk, D. W. Giang, C. Mooney, C. M. Tansey, W. J. Hall, et al. The Accuracy of Magnetic Resonance Imaging in Patients With Suspected Multiple Sclerosis JAMA, June 23, 1993; 269(24): 3146 - 3151. [Abstract] [PDF]
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 K. Syndulko, W. W. Tourtellotte, R. W. Baumhefner, G. W. Ellison, L. W. Myers, G. Belendiuk, and G. V. Kondraske Neuroperformance Evaluation of Multiple Sclerosis Disease Progression in a Clinical Trial: Implications for Neurological Outcomes Neurorehabil Neural Repair, January 1, 1993; 7(3-4): 153 - 176. [PDF]
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 A. Gessain and O. Gout Chronic Myelopathy Associated with Human T-Lymphotropic Virus Type I (HTLV-I) Ann Intern Med, December 1, 1992; 117(11): 933 - 946. [Abstract] [PDF]
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R. A. Rudick The Value of Brain Magnetic Resonance Imaging in Multiple Sclerosis Arch Neurol, July 1, 1992; 49(7): 685 - 686. [Abstract] [PDF]
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M. Ramirez-Lassepas, J. W. Tulloch, M. R. Quinones, and B. D. Snyder Acute Radicular Pain as a Presenting Symptom in Multiple Sclerosis Arch Neurol, March 1, 1992; 49(3): 255 - 258. [Abstract] [PDF]
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D. E. Goodkin, T. H. Doolittle, S. S. Hauser, R. M. Ransohoff, A. D. Roses, and R. A. Rudick Diagnostic Criteria for Multiple Sclerosis Research Involving Multiply Affected Families Arch Neurol, August 1, 1991; 48(8): 805 - 807. [Abstract] [PDF]
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