Appropriateness of the Use of Magnetic Resonance Imaging in the Diagnosis and Treatment of Wrist Soft Tissue Injury

Michelotti, Brett; Mathews, Alexandra L.; Chung, Kevin C.

doi:10.1097/prs.0000000000004023

Cited by 10 publications

(7 citation statements)

References 27 publications

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“…Further, orthopedic trauma, post-op, or post-splinting X-ray gave little to no change in management [ 162 – 169 ]. MRI of the wrist in ligamentous injury changed the surgical plan in 28% of patients and was thus low-value for many patients [ 170 ]. On general use of imaging in the musculoskeletal system, four studies showed that skeletal CT for peri-articular fractures (post-op) [ 171 ], and long bone cartilaginous lesions (also MRI) [ 172 ] were of low-value.…”

Section: Resultsmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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Background Inappropriate and wasteful use of health care resources is a common problem, constituting 10–34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging—in which the diagnostic test confers little to no clinical benefit—is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. Methods A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. Results A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. Conclusions A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. Systematic review registration: PROSPERO: CRD42020208072.

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Section: Resultsmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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“…This phenomenon may be beneficial to patients and the health care system as a whole, because MRI studies ordered by orthopedic surgeons are more likely to be cost-effective and positively influence their ultimate treatment plans. 15 Better knowledge of wrist anatomy and pertinent physical examination findings may also explain the higher utilization of arthrograms among orthopedic and hand surgeons. Surgeons are more inclined to use MRI to confirm a specific injury than to use it as a screening tool for wrist pain, 15 and an arthrogram may better help the surgeon delineate whether a patient requires operative treatment.…”

Section: Discussionmentioning

confidence: 99%

“…15 Better knowledge of wrist anatomy and pertinent physical examination findings may also explain the higher utilization of arthrograms among orthopedic and hand surgeons. Surgeons are more inclined to use MRI to confirm a specific injury than to use it as a screening tool for wrist pain, 15 and an arthrogram may better help the surgeon delineate whether a patient requires operative treatment. Additionally, negative results on a highly sensitive test such as an MRA may be helpful in avoiding unnecessary operations.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Arthrography of the Wrist: The Impact on Operative Management of Wrist Injuries

et al. 2021

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Background There is no consensus on the utility of arthrography in the evaluation of wrist injuries. This study evaluates ordering trends of different types of magnetic resonance imaging (MRI) of the wrist and compares rates of surgery following these imaging modalities. Methods A national claims-based database was used to identify patients who underwent MRI within 90 days of a first-instance diagnosis of wrist injury from 2010 to 2018. The utilization of MRI without intravenous (IV) contrast, MRI with IV contrast, and MRI with arthrogram was investigated. The instances of operative procedures of the wrist within 1 year of MRI study were recorded. Patient demographics, comorbidities, type of operative procedure, and ordering physician specialty were obtained. Logistic regression analysis was used to evaluate the utilization of MRI and subsequent 1-year operative intervention rates as well as association of patient-related factors. Results Magnetic resonance arthrography use was associated with higher rates of subsequent operative treatment. Surgeons were more likely to order an arthrogram at the time of MRI. Younger patients were more likely to undergo MRI-based advanced imaging. Conclusion Surgeons may perceive MRA of the wrist to play an important role in operative decision-making following wrist injury. Level of Evidence This is a Level III, retrospective cohort study.

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“…Specialized clinical evaluation and a multidisciplinary, multimodality approach are proven to enhance the positive predictive value and cost effectiveness of MRI in postoperative settings of the wrist and hand. 72 In the presence of orthopaedic implants, basic and advanced metal artifact reduction techniques improve the image quality. 2,[36][37][38][39]73,74 Fig.…”

Section: Postoperative Mrimentioning

confidence: 99%

3D MRI of the Hand and Wrist: Technical Considerations and Clinical Applications

Dalili

Fritz

Isaac

2021

Semin Musculoskelet Radiol

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In the last few years, major developments have been observed in the field of magnetic resonance imaging (MRI). Advances in both scanner hardware and software technologies have witnessed great leaps, enhancing the diagnostic quality and, therefore, the value of MRI. In musculoskeletal radiology, three-dimensional (3D) MRI has become an integral component of the diagnostic pathway at our institutions. This technique is particularly relevant in patients with hand and wrist symptoms, due to the intricate nature of the anatomical structures and the wide range of differential diagnoses for most presentations. We review the benefits of 3D MRI of the hand and wrist, commonly used pulse sequences, clinical applications, limitations, and future directions. We offer guidance for enhancing the image quality and tips for image interpretation of 3D MRI of the hand and wrist.

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Appropriateness of the Use of Magnetic Resonance Imaging in the Diagnosis and Treatment of Wrist Soft Tissue Injury

Cited by 10 publications

References 27 publications

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Magnetic Resonance Arthrography of the Wrist: The Impact on Operative Management of Wrist Injuries

3D MRI of the Hand and Wrist: Technical Considerations and Clinical Applications

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