MRI for the Evaluation of Knee Pain

Roberts, Timothy T.; Singer, Natalie V.; Hushmendy, Shazaan; Dempsey, Ian; Roberts, Jared; Uhl, Richard L.; Johnson, Paul E.

doi:10.2106/jbjs.n.00947

Cited by 30 publications

(21 citation statements)

References 1 publication

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“…Debaters against GP direct access MRI pathways often identify situations where GPs lack dedicated pre-use training and quality assurance, and operate within an unlimited condition open access environment, factors which are critical to success. 10,24 These studies contrast with findings from The Netherlands, indicating changes in GP referral patterns following MRI referrals. 25 Roberts et al 24 admit to the value of an educational primer as testament to effectiveness of careful clinical evaluation and prudent MRI use.…”

Section: Comparison With Existing Literaturementioning

confidence: 61%

“…10,24 These studies contrast with findings from The Netherlands, indicating changes in GP referral patterns following MRI referrals. 25 Roberts et al 24 admit to the value of an educational primer as testament to effectiveness of careful clinical evaluation and prudent MRI use. Other studies support educational interventions and patient pre-selection as means of preventing increases in GP referral rates.…”

Section: Comparison With Existing Literaturementioning

confidence: 61%

“…However, this did result in an effective use of public resources through providing a small, but significant, improvement in patient quality-of-life measures. In a retrospective chart review, Roberts et al 24 found specialist-generated MRI resulted in more appropriate interventions for symptomatic patients and more surgically amenable pathology compared to GPs. Debaters against GP direct access MRI pathways often identify situations where GPs lack dedicated pre-use training and quality assurance, and operate within an unlimited condition open access environment, factors which are critical to success.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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Corrigendum to: Guidelines, training and quality assurance: influence on general practitioner MRI referral quality

Kara¹,

Smart²,

Officer³

et al. 2019

J Prim Health Care

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INTRODUCTIONMagnetic resonance imaging (MRI) is an accurate diagnostic test used mainly in secondary care. Uncertainty exists regarding the ability of general practitioners (GPs) to use direct access high-tech imaging pathways appropriately when managing musculoskeletal injury. AIMTo evaluate the use of primary care-centric guidelines, training and quality assurance on the appropriateness of GP MRI referrals for patients with selected musculoskeletal injuries. METHODSThis is an 18-month primary care retrospective study. GPs participated in clinical musculoskeletal training, enabling patient referral for MRI on four body sites. Two reviewers categorised referral appropriateness independently, and reviewer inter-rater agreement between categorisations was measured. MRI results and patient management pathways were described. Associations of scan status and patient management were examined using logistic regression. RESULTSIn total, 273 GPs from 72 practices attended training sessions to receive MRI referral accreditation. Of these, 150 (55%) GPs requested 550 MRI scans, with 527 (96%) eligible for analysis, resulting in 86% considered appropriate; 79% consistent with guidelines and 7% clinically useful but for conditions outside of guidelines. Inter-rater agreement was 75%. Cohen's weighted kappa statistic was 0.38 (95% CI: 0.28–0.48). MRI referrals consistent with guidelines were more likely to show pathology requiring specialist intervention (reviewer 1: odds ratio=2.64, 95% CI 1.51–4.62; reviewer 2: odds ratio=4.44, 95% CI 2.47–7.99), compared to scan requests graded not consistent. DISCUSSIONStudy findings indicate GPs use decision support guidance well, and this has resulted in appropriate MRI referrals and higher specialist intervention rates for selected conditions.

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Section: Comparison With Existing Literaturementioning

confidence: 61%

Section: Comparison With Existing Literaturementioning

confidence: 61%

Section: Comparison With Existing Literaturementioning

confidence: 99%

See 1 more Smart Citation

Corrigendum to: Guidelines, training and quality assurance: influence on general practitioner MRI referral quality

Kara¹,

Smart²,

Officer³

et al. 2019

J Prim Health Care

View full text Add to dashboard Cite

show abstract

“…Moreover, some authors suggest that an MRI examination prior to the planned arthroscopic surgery does not change the treatment strategy [19]. The findings are supported by other researchers [49], however, if the MRI is ordered by an orthopaedic surgeon, it has a greater impact on the planned treatment [50] compared to a primary care physician. The accurate referral may incline the usage of cartilage dedicated sequences, which improves the overall diagnostic accuracy [51].…”

Section: Discussionmentioning

confidence: 81%

Knee MRI Underestimates the Grade of Cartilage Lesions

et al. 2021

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Purpose: This study was conducted in order to evaluate the clinical utility of MRI in detecting cartilage lesions and its dependence on anatomical location and lesion grade. Methods: A retrospective analysis of MRI reports and arthroscopic findings was performed on 190 consecutive patients treated in one orthopaedic department. MRI protocols were prepared by 18 radiologists from 10 different MRI centers with the use of 1.5 T magnets. The image protocols were selected by reading radiologists. Four hundred and fifty-three chondral lesions in five anatomic locations were identified during this study and graded according to the ICRS classification. Sensitivity, specificity, receiver operating characteristic (ROC), and Bangdiwala’s observer agreement charts were utilized to evaluate the diagnostic performance. Results: Only approximately 30% of MRI showed an adequate cartilage status in all anatomical locations. The sensitivity ranged from 92% in healthy cartilage to 5% in grade I lesions. The specificity differed also grossly depending on the lesion grade, reaching 96.5% in grade four lesions and 38% in healthy cartilage. The medial compartment Bangdiwala’s observer agreement charts show a gross underestimation of cartilage lesions, and the area under the curve (AUC) of ROC surpasses 0.7 only in the medial femoral condyle and patella-femoral joint. Overall, the medial compartment accuracy was significantly higher than the lateral compartment. The MRI showed correspondence of its diagnostic performance with cartilage lesion severity. Conclusion: MRI underestimates the extent of cartilage injury and evaluation of cartilage defects based on MRI should be taken with caution by orthopaedic surgeons in planning surgery. Surgical planning on MRI should take cartilage lesions under consideration, even if no cartilage lesions are reported on the MRI.

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“…Researchers demonstrated that MRI studies that were ordered by orthopedic surgeons versus non-orthopedic physicians were more likely to be associated with a specific diagnosis, impact patient treatment, and result in surgery that was of benefit to the patient. 9,10,12 Additionally, when used as a screening tool for non-specific hip pain, Keeney et al calculated a cumulative institutional cost for obtaining a single study that impacted a patient’s treatment of $59,296. When the study cost was compared between providers, they found that the cost of obtaining a study that impacted a patient’s treatment was three-times greater when the ordering physician was a non-orthopedic provider ($7,804 versus $2,834) suggesting that education of referring physicians is paramount to reducing healthcare costs.…”

mentioning

confidence: 99%

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

Michelotti

Mathews

Chung

2018

Plastic &Amp; Reconstructive Surgery

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The provider must carefully consider the pretest probability of ordering a study that will affect treatment recommendation. Injudicious screening with magnetic resonance imaging ($15,565) incurred a cost nearly seven times the cost of the one imaging scan ($2246) before impacting one treatment recommendation. In the current era of cost containment and bundled payment, diagnostic test probability must be appreciated to guide physician ordering practices.

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MRI for the Evaluation of Knee Pain

Abstract: MRI utilization by orthopaedic surgeons results in more appropriate interventions for patients with symptoms and findings most amenable to surgical intervention.

Cited by 30 publications

References 1 publication

Corrigendum to: Guidelines, training and quality assurance: influence on general practitioner MRI referral quality

Corrigendum to: Guidelines, training and quality assurance: influence on general practitioner MRI referral quality

Knee MRI Underestimates the Grade of Cartilage Lesions

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

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