Discriminating Multiple Sclerosis from other Diseases of Similar Presentation

Abstract

All patients presenting to an MR Imaging Centre during the periods of study, either in 1988 or 1991, have had their records of signs, symptoms and history prior to scanning reviewed, all abnormal MR images archived and an attempt has been made to follow their subsequent course up to the allocation of a confirmed or working diagnosis by their physicians and surgeons. Using a detailed, menu-driven, computer-based dialogue, abnormal images have been described, blind to all other data, in order to identify image features that may be significant in discriminating between diagnoses. This preliminary study addresses the differential diagnosis of multiple sclerosis from cerebrovascular disease, a problem often confounded by the similar multi-centric, multi-episode clinical presentation. Although the numbers starting with similar clinical presentation, with confirmed or working diagnosis at an acceptable level of certainty, and with completed image descriptions are small (45 Multiple Sclerosis, 6 Cerebrovascular disease), there are strong indications that certain MR image features are more helpful than is generally realised. The association of these features during statistical analysis may improve differential diagnostic certainty. Attention is drawn to the detailed appearances of individual lesions, the prevalence of one or more lesion types in individual patients, the sizes of lesions and the association of lesions affecting arcuate fibres with those affecting grey matter.