SAT0520 Indications and Clinical Impacts of Magnetic Resonance Imaging of The Knee in Older Patients: Are We Choosing Wisely?

Abstract

BackgroundThe use of magnetic resonance imaging (MRI) seems to be increasing in patients with gonalgia. Findings such as osteoarthritis and meniscal damages are very prevalent in older patients, often simultaneously [1–3]. These findings are of undetermined significance, as invasive therapeutic procedures provide no additional benefit [4].ObjectivesThe aim of this study is to analyze MRI indications and clinical impact in this population in our center.MethodsWe retrospectively analyzed 215 medical records of patients older than 50 yo having undergone a knee MRI in 2009. Medical charts were reviewed up to 2014 for: patient characteristics, MRI indication, ordering physician specialty, radiography prior to MRI, MRI findings and clinical impacts of the MRI.ResultsPatient's average age was 60.6±7.5. Main MRI indications were meniscopathy: 148 (68.8%) and chronic pain: 92 (42.8%). Most MRIs were ordered by general practitioners (GP): 148 (68.8%) and orthopedic surgeons (OS): 55 (25.6%). Chronic pain investigation was significantly higher in GPs than in OS (48.0% vs 27.3%, p=0.008). Findings show that 185 (86%) patients had osteoarthritis (OA) and 170 (79.1%) had meniscal lesions. Overall, 87 (40.5%) patients were seen by an OS and 27 (31%) of them underwent an invasive intervention. Among the 81 patients with moderate-to-severe OA on MRI, 36 (46%) had evidence of moderate-to-severe OA on a previous plain radiography, 28 (34.6%) were seen by an OS, and 3 (3,7%) underwent a meniscectomy.ConclusionsOur study reproduces the known association between OA and degenerative meniscal changes in older patients. About half of our cohort could have been appropriately diagnosed and treated based on available radiographic information, thus avoiding the MRI and subsequent OS evaluation. Meniscectomy - an MRI dependent procedure - was rare, particularly in patients with advanced OA. Educational and pragmatic measures must be emphasized to limit the inappropriate use of this costly imaging modality.ReferencesBoden SD, Davis DO, Dina TS, Stoller DW, Brown SD, Vailas JC, et al. A prospective and blinded investigation of magnetic resonance imaging of the knee. Abnormal findings in asymptomatic subjects. Clin Orthop Relat Res. 1992 Sep;(282):177–85.Kornick J, Trefelner E, McCarthy S, Lange R, Lynch K, Jokl P. Meniscal abnormalities in the asymptomatic population at MR imaging. Radiology. 1990 Nov;177(2):463–5.Bhattacharyya T, Gale D, Dewire P, Totterman S, Gale ME, McLaughlin S, et al. The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee. J Bone Joint Surg Am. 2003;85-A:4–9.Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013 May 2;368(18):1675–84.Disclosure of InterestNone declared

Radiographic vs. MRI vs. arthroscopic assessment and grading of knee osteoarthritis - are we using appropriate imaging?

“…It is our view that radiographs are an underrated imaging technique for arthritis of the knee. They are surprisingly underused in the investigation of knee symptoms, despite having been shown to be reliable enough to diagnose OA without the need for further imaging such as MRI scans [ 27 ]. Furthermore, when using a combination of radiograph views, clinicians are even able to accurately predict the suitability of a patient for knee arthroplasty surgery [ 28 ].…”

Characteristics of Non‐Spine Musculoskeletal Ambulatory Care Visits in the United States, 2009‐2016

“…Orthopedic surgeons were the provider specialty seen by the majority of patients with musculoskeletal disorders regardless of body region, with patients with knee symptoms seeking care from orthopedists for 61% of visits. MRI was ordered in 12.5% of shoulder and 11.4% of knee visits despite recent concern and evidence for overuse of advanced imaging in musculoskeletal medicine 19‐21 . Physical therapy was prescribed most commonly for shoulder symptoms.…”

“…MRI was ordered in 12.5% of shoulder and 11.4% of knee visits despite recent concern and evidence for overuse of advanced imaging in musculoskeletal medicine. [19][20][21] Physical therapy was prescribed most commonly for shoulder symptoms. Opioid prescriptions were also prevalent in patients with musculoskeletal disorders (3.2% to 14.8%).…”

Magnetic Resonance Imaging Utilization in Iran

“…Health care providers extensively employ diagnostic methods generally aimed at reducing the risk of medical errors, and thus, the development of induced demand by them has considerably increased the use of MRI services (8). Factors effective in increasing the use of these services can be mentioned as the increased number of doctors and radiologists, easy access to diagnostic and treatment services, increase household income, the patients' expectation for ordering such services, professional uncertainty, and payment systems encouraging doctors to prescribe and order such tests (2,(9)(10)(11)(12)(13)(14). The private system, which constitutes a major part of the health system of countries that allows patients to receive medical care simultaneously from several providers in addition to the ability to freely choose the health care providers, may also provide MRI services without any limitations (2).…”