Beer S, Rösler K M, Hess C W
Department of Neurology, University of Bern, Inselspital, Switzerland.
J Neurol Neurosurg Psychiatry. 1995 Aug;59(2):152-9. doi: 10.1136/jnnp.59.2.152.
The yield of paraclinical tests was evaluated in a prospective study of 189 consecutive patients referred for suspected multiple sclerosis (142 patients with multiple sclerosis, 47 non-multiple sclerosis patients on discharge). Patients were first classified according to the Poser criteria by the clinical findings. Subsequently, the results of paraclinical tests (cranial MRI, visually evoked potentials (VEPs), somatosensory evoked potentials by tibial nerve stimulation (SSEPs), motor evoked potentials (MEPs), and analysis of CSF for oligoclonal banding and IgG-index (CSF)) were taken into account. The percentage of reclassified patients (reclassification sensitivity, RS) was always lower than the percentage of abnormal results (diagnostic sensitivity, DS), and the divergence of RS v DS differed between the tests (60% v 84% in MRI, 31% v 77% in CSF, 29% v 37% in VEPs, 20% v 68% in MEPs, and 12% v 46% in SSEPs respectively). False reclassifications of non-multiple sclerosis patients to multiple sclerosis would have occurred with all tests (MRI: six of 47 patients, (reclassification specificity 88%); CSF: one (98%); VEPs: two (96%); MEPs: two (96%); SSEPs: four (91%); P < 0.05). Although MRI had superior diagnostic capacity, 57 of the 142 patients with multiple sclerosis were not reclassified by the MRI result, 12 of whom were reclassified by CSF and 18 by one of the evoked potential (EP) studies. Of the 98 patients not reclassified by CSF, 53 were reclassified by MRI and 39 by EPs. The results suggest that for the evaluation of paraclinical tests in suspected multiple sclerosis, comparison of diagnostic sensitivities is inappropriate. In general, a cranial MRI contributes most to the diagnosis; however, due to its comparatively low specificity and its considerable number of negative results, EP or CSF studies are often useful to establish the diagnosis of multiple sclerosis.
在一项对189例因疑似多发性硬化症转诊的连续患者进行的前瞻性研究中，评估了临床旁检查的结果（142例多发性硬化症患者，47例出院时诊断为非多发性硬化症的患者）。首先根据临床发现按照波塞尔标准对患者进行分类。随后，考虑临床旁检查的结果（头颅磁共振成像（MRI）、视觉诱发电位（VEP）、胫神经刺激体感诱发电位（SSEP）、运动诱发电位（MEP）以及脑脊液寡克隆带和IgG指数分析（CSF））。重新分类患者的百分比（重新分类敏感性，RS）始终低于异常结果的百分比（诊断敏感性，DS），并且RS与DS之间的差异在不同检查中有所不同（MRI分别为60%对84%，CSF为31%对77%，VEP为29%对37%，MEP为20%对68%，SSEP为12%对46%）。所有检查均会出现将非多发性硬化症患者误重新分类为多发性硬化症的情况（MRI：47例患者中有6例，（重新分类特异性88%）；CSF：1例（98%）；VEP：2例（96%）；MEP：2例（96%）；SSEP：4例（91%）；P<0.05）。虽然MRI具有更高的诊断能力，但142例多发性硬化症患者中有57例未根据MRI结果重新分类，其中12例通过CSF重新分类，18例通过一项诱发电位（EP）研究重新分类。在98例未通过CSF重新分类的患者中，53例通过MRI重新分类，39例通过EP重新分类。结果表明，对于疑似多发性硬化症患者的临床旁检查评估，比较诊断敏感性是不合适的。一般来说，头颅MRI对诊断贡献最大；然而，由于其相对较低的特异性和相当数量的阴性结果，EP或CSF研究对于确立多发性硬化症的诊断通常很有用。
