A randomized trial of test result sequencing in patients with suspected multiple sclerosis. Rochester-Toronto MRI Study Group.

ABSTRACT

BACKGROUND AND METHODS: We performed a randomized trial of the incremental impact of high-volume contrast computed tomographic scan of the brain plus trimodal evoked potentials vs magnetic resonance imaging of the brain on neurologists' diagnostic labeling of patients with suspected multiple sclerosis (MS). Two hundred and four patients with suspected MS (clinically possible 59% or probable 41%-McAlpine criteria) were assessed by two neurologists. Patients were diagnostically categorized after reviewing the results of the tests presented in random order. RESULTS: Most of the change in diagnostic categorization occurred after presenting the first test result irrespective of result sequence (chi 2 = 0.01, P = .99). The diagnoses became more definitive when all test results were available (P < .001). Magnetic resonance imaging and evoked potential were suggestive of MS equally frequently (chi 2 = 0.57, P = .45). CONCLUSION: In suspected MS, there is no difference in diagnostic effect between brain magnetic resonance image scanning and computed tomography plus trimodal evoked potentials.