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Medical Imaging News

February 7, 2007

RESULTS WRAP-UP

MRI Changes Management Decisions for Patients With Ankle Pain

In about one third of patients complaining of ankle pain, using MRI had a significant impact on the clinicians' diagnoses and management plans, according to a study conducted by researchers at the Cambridge University Hospitals.

The study included 91 patients and found that there was a significant overall change in diagnostic confidence in 65 (71%) cases when MR was employed. Management plans changed in 32 (35%) of the patients.

"This in itself is significant, but more significant is the fact that before an MRI was done, 65 of the 91 patients were scheduled to undergo surgery. After an MRI was done, nine of those patients were treated nonsurgically," said Philip W.P. Bearcroft, MD, of Cambridge University Hospitals in England.

In fact, in 31% of those patients for whom plans were changed, a less-invasive plan was adopted. In 60 (66%) of the cases, the surgeon believed that an understanding of the patient's disease either depended on MRI or had been substantially improved by it.

The study was conducted as a collaboration between Bearcroft, his colleagues, and an orthopedic foot and ankle surgeon at a regional teaching hospital. The surgeon noted his proposed treatment plan for each patient before and after an MR examination, as well as the potential diagnoses for each injury.

"This study is a bit different than the traditional radiological study," Bearcroft said. "Most studies relate to improving technique, or they look at the accuracy and predictive value of imaging techniques. This one was designed to determine if we really make a difference to the referring physician and the patient. Before an MR examination was done, the surgeon indicated an average 2.3 possible diagnoses per patient. After MRI was performed, the number of diagnoses per patient was reduced to 1.2." He added that MRI increased the referring physician's confidence in his diagnoses.

Titled "MRI of the Ankle: Effect on Diagnostic Confidence and Patient Management", the study appeared in the November 2006 issue of the American Journal of Roentgenology.