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PubMed2006

A prospective comparison of 3 new-generation pulse oximetry devices during ambulation after open heart surgery.

OBJECTIVE: To assess the clinical performance of 3 new-generation pulse-oximetry signal-processing software systems (Philips FAST, Masimo SET, and Nellcor N-3000) during ambulation after open-heart surgery. DESIGN: Prospective, convenience sample. SETTING: Cardiac surgical progressive care unit in a 629-bed, not-for-profit, tertiary-care teaching hospital. PATIENTS: Status post-cardiac-surgery patients (n = 36) during their first postoperative ambulation. INTERVENTIONS: None. PROTOCOL: Randomization was used for digit and hand selection, and all 3 devices were used continuously during ambulation. Data on dropouts, false alarms, and correlation with heart rate were recorded. We continuously measured arterial oxygen saturation via pulse oximetry during ambulation with all 3 devices. RESULTS: Pairwise comparisons indicated significant differences among the 3 devices for data dropout and false alarm. In repeated-measures analysis, the Nellcor N-3000 had the greatest likelihood of data dropout (odds ratio of 31.9 to Masimo and 5.6 to Philips, at the 95% confidence interval). However, the converse was true for false alarms; the Masimo had the most false alarms, with an odds ratio of 17.9 to Nellcor and 2.3 to Philips, at the 95% confidence interval. There were also significantly more dropouts with all 3 devices when readings were taken on a hand on an arm from which a radial graft had been taken (p = 0.004). For heart-rate correlation, the mean absolute difference among the 3 devices was similar: Philips = 4.3 beats/min, Masimo = 5.1 beats/min, and Nellcor = 3.0 beats/min. CONCLUSIONS: There are significant differences among the 3 devices with regard to dropout and false alarms. High numbers of dropouts are problematic because no pulse-oximetry patient information is available during dropout. However, false alarms are even more problematic, because they desensitize clinicians to alarms and call into question the accuracy of displayed data. While our data highlight the statistical differences between the studied oximeters, the clinical implications of these differences warrant further study.

Adult↗
PubMed2005

CaSPredictor: a new computer-based tool for caspase substrate prediction.

MOTIVATION: In vitro studies have shown that the most remarkable catalytic features of caspases, a family of cysteineproteases, are their stringent specificity to Asp (D) in the S1 subsite and at least four amino acids to the left of scissile bound. However, there is little information about the substrate recognition patterns in vivo. The prediction and characterization of proteolytic cleavage sites in natural substrates could be useful for uncovering these structural relationships. RESULTS: PEST-like sequences rich in the amino acids Ser (S), Thr (T), Pro (P), Glu or Asp (E/D), including Asn (N) and Gln (Q) are adjacent structural/sequential elements in the majority of cleavage site regions of the natural caspase substrates described in the literature, supporting its possible implication in the substrate selection by caspases. We developed CaSPredictor, a software which incorporated a PEST-like index and the position-dependent amino acid matrices for prediction of caspase cleavage sites in individual proteins and protein datasets. The program predicted successfully 81% (111/137) of the cleavage sites in experimentally verified caspase substrates not annotated in its internal data file. Its accuracy and confidence was estimated as 80% using ROC methodology. The program was much more efficient in predicting caspase substrates when compared with PeptideCutter and PEPS software. Finally, the program detected potential cleavage sites in the primary sequences of 1644 proteins in a dataset containing 9986 protein entries. AVAILABILITY: Requests for software should be made to Dr José E. Belizário SUPPLEMENTARY INFORMATION: Supplementary information is available for academic users at site http://icb.usp.br/~farmaco/Jose/CaSpredictorfiles.

Algorithms↗
PubMed2005

Noninvasive electrocardiographic imaging (ECGI): comparison to intraoperative mapping in patients.

OBJECTIVES/BACKGROUND: Cardiac arrhythmias are a leading cause of death and disability. Electrocardiographic imaging (ECGI) is a noninvasive imaging modality that reconstructs potentials, electrograms, and isochrones on the epicardial surface from body surface measurements. We previously demonstrated in animal experiments through comparison with simultaneously measured epicardial data the high accuracy of ECGI in imaging cardiac electrical events. Here, images obtained by noninvasive ECGI are compared to invasive direct epicardial mapping in open heart surgery patients. METHODS: Three patients were studied during sinus rhythm and right ventricular endocardial and epicardial pacing (total of five datasets). Body surface potentials were acquired preoperatively or postoperatively using a 224-electrode vest. Heart-torso geometry was determined preoperatively using computed tomography. Intraoperative mapping was performed with two 100-electrode epicardial patches. RESULTS: Noninvasive potential maps captured epicardial breakthrough sites and reflected general activation and repolarization patterns, localized pacing sites to approximately 1 cm and distinguished between epicardial and endocardial origin of activation. Noninvasively reconstructed electrogram morphologies correlated moderately with their invasive counterparts (cross correlation = 0.72 +/- 0.25 [sinus rhythm], 0.67 +/- 0.23 [endocardial pacing], 0.71 +/- 0.21 [epicardial pacing]). Noninvasive isochrones captured the sites of earliest activation, areas of slow conduction, and the general excitation pattern. CONCLUSIONS: Despite limitations due to nonsimultaneous acquisition of the surgical and noninvasive data under different conditions, the study demonstrates that ECGI can capture important features of cardiac electrical excitation in humans noninvasively during a single beat. It also shows that general excitation patterns and electrogram morphologies are largely preserved in open chest conditions.

Arrhythmias, Cardiac↗
PubMed1999

Evaluation of miniature data loggers for body temperature measurement during sporting activities.

We recorded body temperatures in four runners, two squash players and one swimmer at 1-min intervals using miniature data loggers. These single-channel loggers are small and light (25 g), and were easily carried by the athletes during their sporting activities. Wide-range loggers (-37 degrees C to +46 degrees C), which had a temperature resolution of 0.4 degrees C, were used to measure thigh skin temperature. Auditory canal temperature and rectal temperature were measured with narrow-range loggers (+34 degrees C to + 46 degrees C) which had a considerably higher resolution (0.04 degrees C). With the aid of visual analogue scales subjects reported that the thermometric equipment caused very little discomfort or impairment of exercise performance. Loggers connected to uncoated bead thermistors (used for skin and auditory canal temperatures) had a thermal time constant of 0.4 s, and that of the coated thermistors (rectal probes) was 6 s. We were able to waterproof the equipment and measure rectal temperature in a swimmer. Hot (35 degrees C) or cold (5 degrees C) ambient temperatures had an insignificant effect on the intrinsic accuracy of the data loggers, even when used without recalibration at those temperatures. We believe that miniature temperature loggers are convenient and accurate thermometers for use during sporting activities and may provide new insights into thermoregulation during exercise.

Adult↗
PubMed1996

Measurement of the speed accuracy operating characteristic for visual search.

Making allocation of function decisions in automated inspection systems requires data on the speed accuracy operating characteristic (SAOC) of the human. As the major resource-limited task in inspection is visual search, the SAOC of search tasks is required. A comparison of measurements of the SAOC by the search to completion method and the fixed-time method using twelve practised subjects in a computer-generated search task showed only one significant difference in fifteen comparisons. If the search to completion methodology is used, considerable savings in sample preparation time and subject time are possible.

Adolescent↗
PubMed2005

Use of the CDI blood parameter monitoring system 500 for continuous blood gas measurement during extracorporeal membrane oxygenation simulation.

UNLABELLED: The Oximetrix III Opticath (Abbott Critical Care Systems) is used for continuous measurement of venous saturation in a variety of applications, including extracorporeal membrane oxygenation (ECMO), despite clinical reports that have presented data showing poor accuracy of these devices. The CDI Blood Parameter Monitoring System 500 (Terumo) is an inline blood gas monitoring tool commonly used during cardiopulmonary bypass procedures to continuously assess oxygen saturation, blood gases, potassium, and bicarbonate. The purpose of this experiment was to compare the Opticath and the CDI 500 in trending venous blood saturation during a simulation of ECMO. An ECMO simulation circuit consisting of a silicone rubber membrane oxygenator and a stainless steel heat exchanger was constructed, and a standard venous reservoir bag was used to represent the patient. The CDI and the Opticath were incorporated side by side into a shunt that originated just before the oxygenator and returned flow to the venous line. The circuit was primed with fresh porcine blood and conditioned with the addition of CO2 to simulate typical venous blood under ECMO conditions. After an initial calibration procedure, samples were drawn and analyzed by an AVL Opti CCA (Roche/Osmetech) every 4-8 hours for a period of 7 days, with calibration of each device at sample intervals. The data were plotted, and a least squares regression line was calculated. The average error for venous saturation of the CDI and Opticath after 72 hours was 3.86 and 9.51 respectively. At 168 hours, error for the CDI was 8.37, and the Opticath had an error of 14.78. A correlation analysis of the CDI and AVL CCA analyzer yielded a correlation coefficient of r = .88 at 72 hours and r = .84 at 168 hours. Correlation between the Opticath and the AVL CCA yielded a correlation coefficient of r = .77 at 72 hours and r = .55 at 168 hours. Based on these findings, the CDI 500 is an effective tool for monitoring venous blood saturation under simulated conditions of ECMO. KEYWORDS: CDI 500, Opticath, extracorporeal membrane oxygenation, venous saturation.

Blood Gas Analysis↗
PubMed1999

An Analysis of Higher Order Vibration-Torsion-Rotation Interactions and Spectra for a Molecule with an Internal Rotor.

Motivated by attempts to answer the questions (i) if the same order of magnitude is really appropriate for the torsional angular momentum terms P2gamma and the rotational angular momentum term P2 (or P2a), (ii) how to systematically analyze various higher order interaction effects, especially the torsional effects, and (iii) if a reduced Hamiltonian can be used to fit observed spectroscopic data to an accuracy approaching experimental uncertainties over a significant range of quantum states, a detailed discussion is presented on the order of magnitude of a Hamiltonian term Hmln for molecules with an internal rotation. A new scheme of the ordering by magnitude is proposed to analyze the vibration-torsion-rotation (VTR) interactions, in which the importance of the torsional problem is emphasized. The contact transformation technique is applied to the VTR Hamiltonian, which makes it possible to analyze clearly various higher order VTR interactions and their effects in the VTR spectra of the molecule. The resulting formulas are applicable to analyze observed spectra. A reduced torsion-rotation Hamiltonian for the molecule with C3v(M) symmetry is given in the new ordering scheme. As an application, a total of 568 microwave lines with vt </= 3, J </= 42 and K </= 8 for CH318OH have been fitted to 64 molecular constants by using the reduced Hamiltonian with a root mean square (rms) of 0.262 MHz, where the A and E substates are treated simultaneously. About 35 newly assigned lines are added to our former fitting data (M. Ikeda, Y. B. Duan, S. Tsunekawa, and K. Takagi, ApJS, 117, 249 (1998)). Copyright 1999 Academic Press.

Journal Article↗
PubMed2005

From conference abstract to full paper: differences between data presented in conferences and journals.

BACKGROUND: We studied the type and frequency of differences between data presented in conference abstracts and subsequent published papers in the fields of infectious diseases and microbiology. METHODS: We reviewed all abstracts from the first session of 7 of 15 major research categories presented in the 1999 and 2000 Interscience Conference on Antimicrobial Agents and Chemotherapy. For each selected pair of abstract and related published paper, two independent investigators performed a detailed data comparison. RESULTS: From 190 abstracts reviewed, 68 (36%) were subsequently published as full papers by March 2004. Fifty-two pairs referred to the same study population and period. Differences were found in 30 of 51 pairs, which were further analyzed (point estimate=59%, 95% C.I.: 45-73%). The identified differences were related to both the aims and conclusions of the study (3/30), the study conclusions only (2/30), numbers and/or rates of the studied patients (10/30), numbers or rates of microbiological isolates (9/30), MIC values or K(i) values (5/30), other pharmacological properties of antibiotics (2/30), odds ratio (1/30), and duration of observation (1/30). Some differences were considered major. In bivariable associations, time to publication (from presentation in the conference to publication of the full paper) was associated with identifiable differences between the conference abstract and the full paper (OR=1.76, 95% CI 0.95-3.24/year of delay, P=0.07). CONCLUSIONS: It is reassuring that although we identified several reportable differences, only a very small proportion of studies exhibited differences in their aims and/or conclusions. Researchers may benefit from the above findings in improving the accuracy of presented data.

Abstracting and Indexing↗
PubMed2003

In vivo alanine/EPR dosimetry in daily clinical practice: a feasibility study.

PURPOSE: The objective of this study was evaluation of accuracy of in vivo dosimetry using electron paramagnetic resonance (EPR) in alanine. Additionally, we aimed to identify sources of uncertainty in dose determination and quantitative assessment of physical factors that may result in discrepancies between the measured and planned single-fraction doses. METHODS AND MATERIALS: The measurements were performed using detectors in a form of 1.6 cm x 1.6 cm polyethylene sachets filled with powdered L-alanine. The detectors were taped to the patient's skin and measured the entrance doses for (60)Co and electron beams. Some detectors were covered with buildup material, and some measured the "skin dose." The EPR measurements were performed with a Varian E-4 spectrometer. RESULTS: The calculated uncertainty of EPR measured doses was dependent on measured doses and varied from 6.6% for 0.5 Gy to 3.2% for 2 Gy. The calculated uncertainty was in concordance with experimentally determined reproducibility of EPR signals. However, the deviations between measured and planned doses exceeded the uncertainty range of EPR measurements, which can be attributed to uncertainty in determination of actually delivered doses to the detectors, on the basis of treatment planning data. CONCLUSION: The accuracy of dose determination by EPR measurements was shown to be achievable within the 5% limit recommended by the ICRU for doses above 0.7 Gy. The accuracy of in vivo verification of radiotherapy doses by in vivo EPR dosimetry can be improved by meticulous selection of measurement conditions, i.e., radiation fields and detector positions, ensuring accurate calculation of doses delivered to the dosimeters.

Alanine↗
PubMed1980

Comparison of endocardial catheter mapping with intraoperative mapping of ventricular tachycardia.

To validate the accuracy of catheter endocardial mapping to localize the origin of ventricular tachycardia (VT), we compared cathether endocardial mapping with intraoperative epicardial and endocardial mapping of 24 morphologically distinct VTs in 18 patients undergoing surgery. Twelve had VT with left bundle branch block morphology and 12 had VT with right bundle branch block morphology. Catheter endocardial mapping localized 23 VT morphologies to the border of a left ventricular aneurysm or myocardial infarction and one VT to a right ventriculotomy scar. Intraoperative epicardial mapping showed epicardial breakthrough on the right ventricle in 10 VTs with left bundle branch block morphology and on the left ventricle in two. In 12 VTs with right bundle branch block morphology, intraoperative epicardial mapping revealed the earliest site of VT with left bundle branch block morphology (11 patients) and VT with right bundle branch block morphology (12 patients) at the border of a left ventricular aneurysm, and one VT with left bundle branch block morphology in the right ventricle. Catheter endocardial mapping predicted the origin of VT within 4--8 cm2 of that determined by intraoperative endocardial mapping, which always identified the earliest site. These data validate the accuracy of catheter endocardial mapping in localizing the origin of VT.

Adult↗
PubMed2005

Monitoring respiratory mechanics during mechanical ventilation: where do the signals come from?

Graphical patient data have become essential to the understanding and management of ventilator-dependent patients. These electronically generated data often reveal clues to subtle complications that, if corrected, could lead to improved patient-ventilator harmony. The apparent precision of the waveforms and the 3- or 4-place display of numeric data imply high accuracy. Laboratory devices and equipment, with their required certification, generally exhibit accuracies of approximately 2% for flow and significantly less than 1% for pressure. But the cost constraints placed on hospital-grade medical equipment dictate the use of commercial sensors-transducers, which means that pressure measurements will range between 3% and 5% of reading, and flow measurements will range between 6% and 10% (+/- 3 standard deviations of the mean). Other direct and indirect influences, such as temperature, humidity, absolute pressure, system pressure, type of gas, contamination, and myriad additional effects further interfere with the transformation of the variable of interest into an electrically equivalent signal. The abundance of viewable information pertinent to the management of the ventilated patient can be traced to the availability of the many types of transducers combined with microprocessor electronics. The process of capturing a variable of interest (sensing and signal transduction), converting it to a digitized electronic signal (analog-to-digital-conversion), operating on that signal (such as for control of the breathing algorithm and checking for violation of alarm thresholds), and finally converting it back to an analog signal that appears on a monitor generally receives scant appreciation. The process, however, lies at the core of data management in modern ICU ventilators.

Algorithms↗
PubMed2001

Potential accuracy of genetic evaluation for calving difficulty with incomplete data on calving difficulty and/or birth weight using a bivariate threshold-linear animal model.

The purpose of this study was to evaluate the potential loss of accuracy in direct and maternal predicted breeding values (PBV) for calving difficulty (CD) with different levels of missing records of CD and/or birth weight (BW), using a bivariate threshold-linear animal model. Data obtained from the American Gelbvieh Association included 84,420 first-parity records with both CD and BW available. The final pedigree file included 178,858 animals. The model included fixed calf-sex-dam-age, random herd-year-season, and animal direct and maternal effects. Different levels of missing observations for CD and BW were obtained by randomly deleting 0, 25, 50, 75, and 100% of records for both traits in various combinations. Correlation estimates between PBV for CD obtained with complete and incomplete data were used to measure the changes in PBV for different levels of missing records. Reported correlations are means of three replicates. The results suggest that the information on direct and maternal PBV provided by CD records is more reliable than the information provided by BW records. The difference was especially large when a high proportion of CD records were missing. Correlations above 0.96 and 0.95 for direct and maternal PBV, respectively, when missing 25% or 0% of the CD or BW records suggest that small changes would be predicted with a low proportion incomplete data. For genetic prediction of popular sires (with > 100 pogeny), a higher proportion of missing records could be tolerated. The results suggest that the bivariate threshold-linear animal model is useful for routine genetic evaluation of CD with incomplete field data.

Journal Article↗
PubMed1996

Evaluating data acquisition and smoothing functions of currently available videokeratoscopes.

PURPOSE: To compare the accuracy of computerized videokeratography systems using identical, calibrated test objects. SETTING: Lions Eye Institute, Albany, New York. METHODS: We evaluated the accuracy and smoothing of raw data acquisition (axial solution) of seven commercially available videokeratoscopes: Alcon EyeMap, Computed Anatomy TMS, EyeSys CAS, Humphrey MasterVue, Topcon CM-1000, Optikon Keratron, and TechnoMed C-Scan. We used six calibrated test objects to simulate clinical settings: spherical, spherocylindrical, simulated myopic ablation, hyperopic ablation, and a simulated central island. RESULTS: None of the systems accurately imaged all objects. Although all systems imaged spherical objects with reasonable accuracy, errors greater than 4.0 diopters (D) frequently occurred in the central 6.0 mm optical zone (maximum error 10.0 D) Sources of error included excessive raw data smoothing, inability to read large transitions, loss of accuracy in the periphery, and poor central coverage. CONCLUSION: The clinician should be aware of the potential limitations of corneal topography when making clinical decisions.

Cornea↗
PubMed2004

Estrogen receptor-alpha polymorphism in a Taiwanese clinical breast cancer population: a case-control study.

INTRODUCTION: Receptor-mediated estrogen activation participates in the development and progression of breast cancer. Estrogen receptor (ER)-alpha polymorphism has been found to be associated with breast cancer and clinical features of the disease in Caucasians. Epidemiologic studies have revealed that age-incidence patterns of breast cancer in Asians differ from those in Caucasians. Genomic data for ER-alpha in either population is therefore of value in the clinical setting for that ethnic group. METHODS: A case-control study was conducted to establish a database of ER-alpha polymorphisms in a Taiwanese population in order to compare Western and Taiwanese (Asian) distributions and to evaluate ER-alpha polymorphism as an indicator of clinical outcome. The ER-alpha gene was scanned in a Taiwanese clinical breast cancer group (189 patients) and in healthy individuals (177 healthy control individuals). PCR single-strand conformation polymorphism technology was employed and real-time PCR melting curve analysis was performed. RESULTS: Three sites of silent single nucleotide polymorphism (SNPs) were found, as reported previously in Western studies, but at significantly different frequencies. Among the three SNPs, the frequency of allele 1 (TCT --> TCC) in codon 10 was significantly lower in breast cancer patients (32.0%) than in control individuals (40.4%; P = 0.018). We found that allele 1 (ACG --> ACA) in codon 594 was less common in breast cancer patients with a family history of breast cancer (5.9%) than in those without such a history (19.6%; P = 0.049). Individually, both allele 1 in codon 325 (CCC --> CCG) and allele 1 in codon 594 exhibited a reverse association with the occurrence of lymph node metastasis. Furthermore, incorporation of both SNP markers further increased predictive accuracy. CONCLUSIONS: Our data suggest that ER-alpha polymorphisms are correlated with various aspects of breast cancer in Taiwan. ER-alpha genotype, as determined during presurgical evaluation, might represent a surrogate marker for predicting breast cancer lymph node metastasis.

Adult↗
PubMed2004

Automated eye tracking system calibration using artificial neural networks.

The electro-oculogram (EOG) continues to be widely used to record eye movements especially in clinical settings. However, an efficient and accurate means of converting these recordings into eye position is lacking. An artificial neural network (ANN) that maps two-dimensional (2D) eye movement recordings into 2D eye positions can enhance the utility of such recordings. Multi-layer perceptrons (MLPs) with non-linear activation functions and trained with back propagation proved to be capable of calibrating simulated EOG data to a mean accuracy of 0.33 degrees . Linear perceptrons (LPs) were only nearly half as accurate. For five subjects, the mean accuracy provided by the MLPs was 1.09 degrees of visual angle ( degrees ) for EOG data, and 0.98 degrees for an infrared eye tracker. MLPs enabled calibration of 2D saccadic EOG to an accuracy not significantly different from that obtained with the infrared tracker. Using initial weights trained on another person reduced MLP training time, reaching convergence in as little as 20 iterations.

Automation↗
PubMed1980

Verification and standardization of cephalometric coordinate data.

This paper presents the details and logic of the FORTRAN computer programs designed to verify the accuracy of digitized coordinate data arising form cephalometric radiographs, prior to entry into a databank. In addition, the software accounts for varying magnifications of the radiographs which result from the use of different cephalometers, Finally, data from all records are oriented in the same coordinate system, thus standardization of the data has been accomplished. As a result of the two programs, the user may be guaranteed accurate and comparable data for any or all records contained in the databank.

Cephalometry↗
PubMed1998

The clinical diagnosis of deep venous thrombosis: integrating incidence, risk factors, and symptoms and signs.

Symptoms and clinical signs suggestive of deep venous thrombosis (DVT) are common and have numerous possible causes. Studies have shown that symptoms and clinical signs in themselves are inaccurate for the diagnosis of DVT. However, clinicians have other information at hand, such as data on risk factors for DVT, that may help improve their ability to predict a diagnosis of DVT in the individual patient. Epidemiological data on DVT incidence and risk factors were reviewed, as were published data on the accuracy of clinical diagnosis of DVT, with the use of both symptoms and signs in isolation and symptoms and signs combined with other clinical information in the form of clinical prediction indexes. Symptoms and clinical signs, when combined with other patient information such as the presence or absence of known risk factors for DVT, can improve clinical prediction considerably. Further study is needed to determine whether clinical prediction indexes have a role in improving the diagnostic process in patients with suspected DVT.

Diagnosis, Differential↗
PubMed1994

Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group.

OBJECTIVE: 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. DESIGN: 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. SETTING: The General Neurology Clinic and Multiple Sclerosis Clinic of the University of Rochester (NY). PATIENTS: A consecutive sample of 62 patients diagnosed as having either possible or probable MS following clinical evaluation. MAIN OUTCOME MEASURE: Changes in diagnostic certainty of clinicians following incremental presentation of new laboratory data and the accuracy of such diagnoses. RESULTS: 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. CONCLUSIONS: 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.

Adult↗