MS: Hospital scans usually get it wrong
How do you know if you’ve got the beginnings of multiple sclerosis? Your suspicions may be raised if you suffer two separate – and different – neurological malfunctions, and this is the acid test before deciding to see the doctor.
If this happens to you, your doctor will arrange for you to have a hospital examination, which will be an MRI (magnetic resonance imaging) scan. This is the standard treatment for determining MS cases, as it can detect ‘clinically silent’ lesions in the brain.
Unfortunately, the scan is a hopelessly inaccurate method of detection, and researchers have also discovered that lesions – even lots of them in the brain – don’t necessarily indicate the presence of MS.
This striking piece of new research suggests that medicine doesn’t have any reliable tools at its disposable to detect MS. Worse, it means that many cases of MS aren’t MS at all, and patients and their families go through years of hell when there isn’t much wrong with the person.
The MRC Health Services Research Collaboration in Bristol reviewed 29 studies on MRI and MS, and discovered that the scan could not rule out -or rule in, come to that – the possibility of MS. The presence of brain lesions didn’t indicate MS either. Even patients with 10 or more brain lesions didn’t develop MS, the study found.
(Source: British Medical Journal, 2006; 332: 875-8).
Abstract of this journal article follows …
Accuracy of magnetic resonance imaging for the diagnosis of multiple sclerosis: systemic review, British Medical Journal, 2006; 332: 875-8. Penny Whiting, Roger Harbord, Caroline Main, Jonathan J Deeks, Graziella Filippini, Mathias Egger and Jonathan AC Sterne.
[assumes that any dark spot on MRI is actually a lesion related to disease process …em] … with about a 36% accuracy, magnetic resonance imaging is of limited utility in ruling out the diagnosis of multiple sclerosis … not all patients who experience a first attack will develop the disease and currently no treatment has been shown to delay conversion to clinically definite multiple sclerosis or impact on long term disability. … High quality clinical research based on improved magnetic resonance imaging techniques and measures in combination with a complete description of participants and long term clinical follow-up are needed for qualitative assessment of the clinical efficacy of magnetic resonance imaging in the diagnosis of multiple sclerosis. The disease remains a predominantly clinical diagnosis.
Discrepancies in the interpretation of clinical symptoms and signs in the diagnosis of multiple sclerosis. A proposal for standardization. Mult Scler. 2005 Apr;11(2):227-31. Uitdehaag BM, Kappos L, Bauer L, Freedman MS, Miller D, Sandbrink R, Polman CH.
Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands. firstname.lastname@example.org
The new McDonald diagnostic criteria for multiple sclerosis (MS) incorporate detailed criteria for the interpretation and classification of magnetic resonance imaging (MRI) findings, but, in contrast, provide no instructions for the interpretation of clinical findings(of MRIs) . Because MS according to the McDonald criteria is one of the primary endpoints in a large trial enrolling patients after the first manifestation suggestive for a demyelinating disease (BENEFIT study), it was decided to organize a centralized eligibility assessment for this trial. During this eligibility assessment it was observed that there were marked inconsistencies in the decisions of participating neurologists with respect to the classification of clinical symptoms as being caused by one or more lesions provoking discussions in about one in every five patients. This paper describes these inconsistencies and their sources, and recommends a systematic approach that attempts to reduce the variability in interpreting clinical findings. [Reminder that my MRI has too many spots to count and has been interpreted to emean that I require 24 hoir care! EM]
Beck RW, Trobe JD, Moke PS, Gal RL, Xing D, Bhanti MI et al, High- and low-risk profiles for the development of multiple sclerosis within 10 years after neuritic experience of the optic neuritis treatment trial, Arch Opthalmol 2003, 121:944-9.
Brex PA, Ciccarelli O, O’Riordan JI, Sailer M, Thompson AJ, Miller DH, A longitudinal study of abnormalities on MRI and disability from multiple sclerosis, New England Journal Medicine 2002, 346:158-64.