Giang D W, Grow V M, Mooney C, Mushlin A I, Goodman A D, Mattson D H, Schiffer R B
Department of Neurology, University of Rochester, NY.
Arch Neurol. 1994 Jan;51(1):61-6. doi: 10.1001/archneur.1994.00540130087016.
Magnetic resonance imaging, computed tomography, cerebrospinal fluid analysis, and evoked potential testing are used to assist in the diagnosis of patients suspected to have multiple sclerosis (MS). The impact of these tests on a clinician's diagnosis of patients suspected to have MS has not been studied systematically.
Clinicians made a diagnosis of each patient following clinical evaluation, again after reviewing the results of magnetic resonance imaging, and finally after reviewing information from other laboratory testing. These diagnoses were compared with the criterion standard of a masked "gold standard" panel reviewing all information after a mean follow-up of 0.9 year.
The General Neurology Clinic and Multiple Sclerosis Clinic of the University of Rochester (NY).
A consecutive sample of 62 patients diagnosed as having either possible or probable MS following clinical evaluation.
Changes in diagnostic certainty of clinicians following incremental presentation of new laboratory data and the accuracy of such diagnoses.
Clinicians used magnetic resonance imaging findings to diagnose definite MS or to eliminate MS from diagnostic consideration in 44% of cases. In these cases, further laboratory testing did not alter clinicians' decisions. In the remaining 56% of cases, in which magnetic resonance imaging did not lead to a diagnosis of definite MS or eliminate MS from diagnostic consideration, further laboratory testing led to such diagnoses in an additional 13% of cases. Gold standard diagnoses were in agreement with the clinician's assessments.
Magnetic resonance imaging aids in the evaluation of patients suspected to have MS; other subsequent studies (computed tomography, cerebrospinal fluid analysis, and evoked potential testing) have less impact. After all studies are performed, about half of such patients still have a tentative diagnosis.
磁共振成像、计算机断层扫描、脑脊液分析及诱发电位测试用于辅助诊断疑似患有多发性硬化症（MS）的患者。尚未系统研究这些检查对临床医生诊断疑似患有MS患者的影响。
临床医生在临床评估后对每位患者进行诊断，再次在查看磁共振成像结果后进行诊断，最后在查看其他实验室检查信息后进行诊断。将这些诊断结果与一个隐蔽的“金标准”小组在平均随访0.9年后审查所有信息的标准进行比较。
纽约罗切斯特大学综合神经科诊所和多发性硬化症诊所。
连续抽取62例经临床评估诊断为可能或疑似患有MS的患者。
随着新实验室数据的逐步呈现，临床医生诊断确定性的变化以及此类诊断的准确性。
临床医生利用磁共振成像结果诊断明确的MS或在44%的病例中排除MS诊断。在这些病例中，进一步的实验室检查并未改变临床医生的决定。在其余56%的病例中，磁共振成像未导致明确的MS诊断或排除MS诊断，进一步的实验室检查在另外13%的病例中得出此类诊断。金标准诊断与临床医生的评估一致。
磁共振成像有助于评估疑似患有MS的患者；其他后续检查（计算机断层扫描、脑脊液分析及诱发电位测试）的影响较小。在所有检查完成后，约一半此类患者仍为暂定诊断。
