The review included 29 studies: 18 cohort studies and 11 studies of other designs. The total number of participants involved was unclear.
Study quality was generally poor; three items on which studies scored badly were blinding, the use of an appropriate reference standard, and the availability of clinical information.
Cohort studies produced lower estimated sensitivity and specificity than studies of other designs. The pooled DOR was 9 (95% CI: 5, 16) for the cohort studies and 213 (95% CI: 85, 535) for studies of other designs. These were significantly different (P<0.001, permutation test).
Among the 15 cohort studies that used a reference standard of clinically definite MS diagnosed using clinical data alone, it was found that studies with longer follow-up produced higher sensitivity and lower specificity.
The negative likelihood ratios for studies using the Barkhof, Fazekas and Paty criteria ranged from 0.2 to 0.5 and the positive likelihood ratios were all less than 5. This suggested that these criteria are of limited utility for either predicting or ruling out the development of MS (within the 3- to 6-year follow-up duration of these studies). Studies using the McDonald 2001 criteria gave similar negative likelihood ratios (range: 0.1 to 0.5). The positive likelihood ratios ranged from 2.7 to 8.7, suggesting that the combined MRI and clinical criteria have more potential for predicting the development of MS than the MRI criteria alone.
An analysis of the 2 studies with at least 10 years' follow-up suggested that MRI is of limited utility for predicting or ruling out a diagnosis of MS.