Is My MRI Reliable? Or Even Accurate?

Traditionally, we have all taken for granted that MRI findings are reliable and accurate. After all, isn’t that why we get imaging in the first place? We want to know what is going on beneath the surface! But, what if MRI findings are unreliable or even inaccurate? The sheer volume of options for receiving an MRI in Atlanta is daunting. You have hospital-based, orthopedic offices, or standalone independent MRI clinics. Are they all of the same caliber and worth your (many) dollars? If the information we receive is inaccurate or unreliable is an MRI even useful? We have documented before that an MRI for back pain is questionable at best, and perhaps downright harmful (check it out here). But we haven’t addressed the reliability and accuracy of MRIs themselves, yet.

In a study published in 2016, some researchers set out to investigate if MRI findings were consistent between MRI centers and radiologists. So, they recruited a single female patient with a history of back pain and sent her to 10 different MRI clinics over a span of 3 weeks to see what was found. I’m certainly an MRI skeptic but even these results shocked me!

Guess how many MRI reports had one interpretation in common? Zero. Not a single interpretation was the same across all 10 reports. In fact, there were 49 distinct findings across the reports and only one was consistent across 9 out of the 10. 32.7% of all findings appeared only once!

Now, before we throw all MRIs out the window, we should take a moment to critically assess this paper. The original intent of the authors was to illustrate that it does matter where you receive your MRI and the radiologist reading it matters. However, the findings would indicate poor agreement between 10 different radiologists. You would certainly hope that not all of these radiologists are uneducated of negligent. And I don’t believe that is the case. The problem with an MRI is that it is so incredibly detailed it can be very challenging to find the relevant pathologies. It would be as if you have needles in a haystack that could be both needles or hay! How do you know what is relevant and what is within the spectrum of normal? Or another analogy, you are sitting in the International Space Center and you are looking at weather patterns trying to discern the cause of a heat wave in Atlanta. The picture is much too complex for a single image to convey. The same is the case with our bodies. That butterfly flapping it’s wings in South America could be causing the hurricane thousands of miles away – or it could just be flitting over to the next flower. Interpretation matters.

Additionally, this study concerns and MRI of the spine which is notoriously the most difficult to assess and interpret. But, the scary part about this is people make life-altering decisions based solely on an MRI report. Again, I’m not saying all MRIs are useless, but we need to be very, very careful on how we use them. Deciding what you should do with an injury or pain should involve multiple practitioners, multiple opinions, and should reflect your symptoms and take into account normal aspects of aging.

If anything at all, I hope this blog post gives you pause when considering that several page MRI report you just received. Is it a hurricane-causing-butterfly?

Or is it just an innocent butterfly?

Thanks for reading,

Ryan

Source: Herzog, R., Elgort, D. R., Flanders, A. E., & Moley, P. J. (2017). Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period. The Spine Journal, 17(4), 554-561.