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Surgeons more likely to alter diagnosis after MRI for knee lateral joint problems
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SAN FRANCISCO — MRI results often change a diagnosis for knee lateral joint line pain, even when a trained surgeon performs the pre-image clinical examination, according to a study by researchers from Ohio.
“MRI frequently changes clinical diagnosis, improves diagnostic confidence and frequently changes planned management,” Sunny Patel, BA, stated in his presentation at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting, here. He noted that a diagnosis was changed most often when lateral joint line pain, tenderness or lateral meniscal tears were present.
The imaging helped surgeons identify the need for surgery in 14% of cases, but changed the type of surgery in 20% of cases, Patel said. MRI results also changed a diagnosis from non-surgical to needing surgical intervention in over one-third of cases, he added.
“When the diagnosis stayed the same, confidence increased by 8.7%,” Patel said. “When the primary diagnosis changed after the MRI, confidence in the new diagnosis increased by about 16%, [while] the confidence in the old diagnosis decreased by 62%.”
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Patel and colleagues also found that MRI results changed planned management in 25% of cases.
“Clinical examinations were performed by highly specialized physicians and it is important to remember that MRI would change these diagnosis and management more frequently if MRIs were ordered by non-specialists,” he said.
Patel also noted that the next step in the study is to develop “evidence-based guidelines to optimize MRI utilization.”
Reference:
Patel S, Subhas N, Obuchowski NA, et al. Value of knee magnetic resonance imaging (MRI) in the diagnosis and management of knee disorders. Paper #337. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
