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How Useful Are MRI Scans And Do I Need One?

Magnetic Resonance Imaging (MRI) scans have been known as the ‘gold standard’ for diagnosing many different pathologies, ever since Larry Minkoff and Michael Goldsmith performed the first MRI scan on a human in 1977. But what exactly is an MRI scan? An MRI scan produces high quality images of the internal structures in a body using radio waves and strong magnetic fields.

A patient will lie on a bed and be conveyed into a tube which uses powerful magnets to produce these detailed images. A patient asking to have an MRI scan is a common occurrence and you are definitely not alone if you’ve even thought about requesting one. But how accurate are they? Would having one change your treatment plan? And does structural damage equate to pain and reduced function? This will all be discussed below.

MRI scans have been shown to have excellent reliability. In research, the term ‘sensitivity’ is defined as the probability of correctly identifying a condition or disease, and ‘specificity’ refers to how well a test correctly identifies those without a condition/disease. For a test to be deemed reliable it must have a high percentage of sensitivity/specificity. Kim, YS et al. (2015) found MRI scans to have a sensitivity of up to 83.6% and specificity of up to 91.7% when detecting anterior talo-fibular ligament (ATFL) injuries in 79 patients. MRI scans have also been found to have excellent sensitivity (95%) and specificity (72.3%) when detecting rotator cuff muscle tears in the shoulder (Apostolopoulos, AP, et al. 2019). So, we now know that MRI scans are untouchable when aiming to detect specific pathologies. However, if an MRI scan did detect a degree of internal structural damage, does this necessarily mean it will affect a patients’ pain or function? DEFINITELY NOT.

Horga, L.M., et al. (2020) performed MRI scans on the knees of 115 uninjured adults. The results exhibited structural abnormalities in 97%of them. This means that nearly all of the patients studied had some sort of structural abnormality despite being pain-free! Similar findings were mirrored when investigating the hips of 45 adults with no history of hip pain. Abnormalities were found in 73% of hips (69% of them being labral tears!) despite all participants being pain-free (Register, B, et al., 2012). The reality is, we all undergo changes as we grow older; the loss of hair and appearance of wrinkles all come with old age, but it is important to note that internal joint changes will occur too. The studies above highlight that although these structural changes do exist, it doesn’t mean they will cause pain or reduce function. Please see ‘Case 1’ below for a real life account of a patient I was seeing in clinic:

Case 1

I was seeing an 80-year-old male patient for lower back pain and I had asked him to bring his MRI scan results to the next session. He did exactly that and the results read that his ‘Sacroiliac (SI) joints are unremarkable’, however he had ‘loss of disc space at levels L2/3’, however the origin of pain was from his SIJ, not levels L2/3. I remember being quite confused, thinking why does this patient have pain coming from his SIJ if the scan results report there are no abnormalities? That is when I started reading into the evidence around scans (as highlighted above) and realised that the abnormal changes a scan shows does not always equate to pain. Two weeks later, the same patient came into my clinic pain free and at full function. This had been achieved through an individualised exercise programme, home management advice & manual therapy. I did not adapt my treatment after I had received the scan results and continued to treat the SIJ, despite the scan reporting abnormal changes in a different part of the lower back.

‘Case 1’just goes to show that for common musculoskeletal (MSK) pathologies such as lower back pain and rotator cuff strains, trying to find the exact structural abnormality through having an MRI will not always make a difference in the treatment needed. Often, a lot of time is wasted through trying to get an MRI scan which only delays the treatment process, reducing the speed of recovery.

Furthermore, when patients do get MRI scans, there have been many times they have come into clinic with knee, shoulder, hip or spinal pain showing me the results which display ‘loss of disc space’ or ‘degenerative changes’ to specific joints, without any explanation to what the results actually mean. A lot of the time it is nothing sinister, but patients become anxious when words like ‘degenerative’ and ‘wear and tear’ are thrown around, and rightly so! As a patient don’t be afraid to ask your Physiotherapist or Doctor if there is anything to be really concerned about, and as clinicians we should be explaining to our patients what their scan results REALLY mean.

To conclude, MRI scans are a very reliable and useful tool in diagnosing many conditions/diseases such as muscle tears, tumours, bone diseases, etc. and have a key role in the world of medical diagnostics. But please don’t lead yourself to believe that ‘nothing can be done until I’ve had an MRI scan’ or ‘I need to know the specific problem before I get treated’, as more often than not the Physiotherapy treatment needed will remain the same and this will just cause a delay in your rehabilitation progress. Most importantly, joint related changes are going to occur as we age, so if you have received scan results showing that you have ‘degenerative joint changes’.... So do I. Most of us will!

References   Apostolopoulos, A., Angelis, S., Yellapragada, R., Khan, S., Nadjafi, J., Balfousias, T. and Selvan, T. (2019). The Sensitivity of Magnetic Resonance Imaging and Ultrasonography in Detecting Rotator Cuff Tears. Horga, L., Hirschmann, A., Henckel, J., Fotiadou, A., Di Laura, A., Torlasco, C., D’Silva, A., Sharma, S., Moon, J. and Hart, A. (2020). Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiology. Kim, Y., Kim, Y., Kim, T., Lee, S., Park, S., Lee, H., Choi, Y. and Koh, Y. (2015). Reliability and Validity of Magnetic Resonance Imaging for the Evaluation of the Anterior Talofibular Ligament in Patients Undergoing Ankle Arthroscopy. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 31(8), pp.1540-1547. Register, B., Pennock, A., Ho, C., Strickland, C., Lawand, A. and Philippon, M. (2012). Prevalence of Abnormal Hip Findings in Asymptomatic Participants. The American Journal of Sports Medicine, 40(12), pp.2720-2724.

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