The Overused and Abused MRI

October 29, 2011 by Mike Axisa 15 Comments

For most of us, an MRI is just some test players go through when they’re hurt. It tells us everything we need to know, no questions asked. Phil Hughes lost some velocity? Send him to the MRI tube. However, as Gina Kolata of The Times writes, MRI’s are often overused and misleading. “An M.R.I. is unlike any other imaging tool we use,” said Dr. Bruce Sangeorzan to Kolata. “It is a very sensitive tool, but it is not very specific. That’s the problem.”

The old refrain is that you can find something wrong with any pitcher if you give them an MRI, but many injuries can be diagnosed through a physical exam and patient history. “I see 300 or 400 new patients a year,” said Dr. Sigvard Hansen. “Out of them, there might be one that has something confusing and might need a scan.” It’s a relatively short but really interesting article, give it a read.

CMP

Problem is when a patient goes to a doctor with pain be it a shoulder or a back, they’re not satisfied unless they’re sent for an MRI and usually will go to another doctor until they get what they think they need. You have the same problem in pediatrics where every mom wants antibiotics for every little cough or sneeze. It’s just our culture.
Plank

It could also be a ‘doctors covering their ass’ thing. If a pitcher goes to the doctor with elbow pain and the doc diagnoses him and is wrong without doing an MRI, they’ll probably be scapegoated and fired. If they order the MRI, they are covering themselves even if they know it won’t reveal anything.
Tom Lin

Good sensitivity plus poor specificity may cause false positive, but at least it won’t cause too many false negative. False positive won’t hurt player’s health while false negative sometimes will cause really serious damage. That’s a guarantee for baseball player’s health.
- http://www.yankeeanalysts.com Eric
  
  False positives could hurt the player’s health, if he gets a surgery that wasn’t necessary for instance.
http://twitter.com/#!/Clay_Bellinger Clay Bellinger

Super interesting read.
Plank

Any predictions for the new CBA?

My guesses:

Luxury threshold raised to $185 million.
No loss of draft picks for signing a type A FA.
New system to determine Elias Rankings.
- Pants Lendelton
  
  That’s wild. None of those 3 will EVER happen including the luxury threshold.
  - Plank
    
    It’s at 178 this year. It was at 170 the year before. That’s a pretty reasonable increase in line with the past increases.
    
    Why does 185 seem unreasonable?
    - Plank
      
      All Luxury Tax Thresholds
      
      2006: 136.5
      2007: 148
      2008: 155
      2009: 162
      2010: 170
      2011: 178
  - Ed
    
    The luxury tax threshold has gone up every year since it was created. That’s probably the safest bet you can make about the new agreement.
    
    Changes to the rankings/compensation system are quite likely too. Especially for dealing with relievers. Probably not a complete overhaul, but something to try to deal with the borderline Type A guys that have trouble getting deals because of their status.
http://Www.or.ly MeGustaMontero (JM)

I’ve gotten several MRIs and let me tell you they are torture.
- Cliff
  
  I love MRIs… I find the vibration very relaxing. I have to resist dozing off.
adeel

As a radiologist, I have to defend my specialty a little bit. Dr. Andrews is an excellent surgeon and can probably read extremity MRI better than most radiologists. The article accurately describes how MRI are very sensitive in picking up abnormalities, and sometimes those abnormalities are not what are causing the symptoms. What Dr. Andrews failed to realize is that just as often MRI can pick up partial tears and effusions BEFORE they become bigger problems. An MRI is more likely to help someone (who is symptomatic) than not help.

Also, Dr. Andrews claims to be able to clinically diagnose sports injuries without imaging. This is below the standard of care and you WILL get sued. Also, Dr. Andrews is HIGHLY specialized so it would make sense that his clinical skills would be above average. But do not expect your orthopod/neurosurgeon to be so skilled; they have a lot more diseases to deal with, and a lot less staff. Also, most doctors can not be as good as Dr. Andrews; so to think that the clinical exam is all you need is ridiculous.

and the ACL tear example they gave was more a case of malpractice than anything else. The radiologist over-called the ACL tear, which might be because it was done on a crappy MRI (like an open one). But that is an example of a Dr. making a mistake; not an indctment against MRI.
- Adam
  
  As another radiologist, let me just point out another hole in the article:
  
  It seems to argue that a there is evidence that performing MRI on asymptomatic patients would lead to unnecessary workup. Well, as the saying goes, “no sh!t, sherlock.” That’s why a good orthopod orders them in symptomatic patients. Bad orthopods, such as those who own their own MRI machine and thus collect reimbursement for every study they order, or have little to no clinical acumen, will order an MRI on everyone. The study author, an orthopod, declines to mention this. Another radiologist said to me: “If you are operating on an athlete based solely on the MRI without correlation with their exam and symptomatology, then I would find a new orthopedic surgeon.”
  
  We’re never going to stop highly paid athletes from getting MRI’s after every little tweak of a muscle or joint. There’s too much money at stake. So yes, some “unnecessary” MRI’s will be done on high-profile athletes, but the quality of the orthopods they see means they will virtually (hopefully) never get a missed diagnosis or unnecessary surgery.
Madefelice

Good article. I was diagnosed and treated for having a herniated disc for three years. When I lost the feeling on the entire left side of my body and was ultimately found to have a completely healthy back, I was then correctly diagnosed with having Multiple Sclerosis. MRIs depend on having someone skilled at reading into the scans.