Accuracy of MRIs

[rhea]

Hi Everyone
I have not been impressed by mris.  I spent 75 mins in that tiny tube getting my ear drums blasted out only to provide my GP with an excuse not to reffer me.  It seems like the last 2 OSs I have seen (and my GP) think that mris are 100% completely accurate.   From the stories I have heard here, I think that is poodle poop.  Anyways, here is a study by AAOS done on the accuracy of MRIs for meniscal tears, plica problems, patellofemoral issues, ACL and OCD lesions and discoid meniscus.  What do you guys think of this?  How many of you have had MRIs giving false results?  

(((Hugs)) 'n healing

rhea

HERE IS THE ARTICLE

Incidence of Pediatric Knee Pathology: A Correlation of Clinical, Arthroscopic and Magnetic Resonance Imaging Findings
Paper No. 16

Thursday February 22, 1996
8:30 AM

Congress Center Rooms 264-265

James S. Marsh, MD, New Haven, CT
John Daigneault, MD, New Haven, CT

One hundred twenty-seven children who failed conservative treatment for knee pain had preoperative magnetic resonance imaging (MRI) scan and subsequent knee arthroscopy. The preoperative clinical findings were correlated with the radiologist's MRI interpretation and compared to the arthroscopic findings. The MRIs were blindly read by a sports medicine physician. Operative findings included meniscal tear (48 patients), plica (47), OCD (42), patellofemoral problems (44), discoid meniscus (, ACL tear (2). MRI accuracy for meniscal tears was 85% (radiologist), 92% (sports physician), 100% for ACL and OCD lesions. Plica diagnosis was missed frequently by MRI. The authors correlate the presence of medial patellar plica and OCD lesions, and note the accuracy and predictive value of the MRI to be less than expected. There were surprisingly few false positive MRI scans.


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Moderator: Vernon T. Tolo, MD, Los Angeles, CA

PEDIATRICS

http://www.aaos.org/wordhtml/anmeet96/sciprog/016.htm

[Iona_-Uk]

Hi Rhea

I am not overly impressed with MRI's myself!.

An incident where I was referrd for a wrist MRI came back negative, when I had a wrist arthroscpy however, I was told I had severe cartilidge tears and congential holes in them as well, the MRI had not picked this up.

I had to wait 14 months for the surgery when if I had been scoped rather than MRI-ed, it would have provided a better end result for me.

Iona

[Tizzy953]

Hi Rhea,
I have had a few MRI's and I have to agree with you.  I didn't have a ligament that developed in my shoulder.  The MRI didn't show that.  The surgeon, when he went in, was expecting stretched ligaments, instead the ligament wasn't even there.  More recently I had an MRI on my knee and it showed and  OCD lesion in the trochlear region of my knee.  The surgeon was expecting to get a biopsy for the carticel procedure but instead found no lesion and a relatively clean area.  So I don't trust the MRI's at all.

Good luck,
KJF

[Heather M.]

I have to join the chorus of disappointed MRI patients...I've had four on my knees, and only one showed any problems. Unfortunately, I've had serious problems that were later documented in each case (usually by surgery).  My favorite is the most recent--I have a lump or cyst or something in the back of my good knee.  It hurts, swells, etc.  My PT, OS and three separate physicians all palpated the area and agreed there was a lump.  One day later the MRI came up perfectly clean, and yet the lump was quite irritated and definitely there to be felt.  Go figure.

I was hoping shoulder MRI's were a little better.  Since I'm going to be doing a lot of stuff that's hard on my shoulder in an effort to baby my knee (biking, swimming), my doctor wants to find out what's going on--it sounds like I have gravel in there when I rotate the shoulder, I can't reach into the back seat of my car any more, and it hurts if I try to do anything like weights or holding my arm out.  Sleeping on it is out of the question, and crutches were torture.  Tentative diagnosis is torn rotator cuff and/or torn labrum (more darn cartilage!!)  My OS is hopeful that the damage will show up on MRI...I'm not so sure.  

Maybe I'll just leave my poor shoulder alone after all....anyone have experience with shoulder MRI?  I know this is the KNEEguru page, but I thought I'd check.

Heather

[rightkneeinjured]

I recently took an MRI and I will get the results tomorrow.. but from these discussions i understand MRI's are not that useful.. moreover i reinjured after taking MRI, so i guess it is a total waste in my case  anyways let you know what it says..

[Shazinoz]

I too join the ranks of useless MRI's I had one a few weeks ago after bending my knee (ACL reoc'd 2x last time 1998) and my knee exploding (literally). The MRI showed absolutely nothing at all (My GP says he doesn't know how my OS could say that my ACL etc was fine by this MRI as it was so bad (Interference from screw and staples and poorly done) that you couldn't even see the ACL.
My GP sent me for a bone scan as a HUGE lump has come up on medial side of tibia from knee to about 5+cm below. The Bone scan showed lots (but the radiologist thinks it is probably (don't you just love that word) from my recent (recent ? yeah 4 yrs ago) surgeries . But these changes didn't show on a bone scan 13 months before. But the radiologists answer is it is a different kind of Bone Scan (SPECT ) and the results are still true. My GP on the other hand says this is $%#&% and it is from this recent injury and I have partially torn my ACL graft out of the bone at each end (fractured it a bit from the bone) and that I have stretched the graft AGAIN (it is now 1/2 as wide and 2x as long). I am not allowed to put ANY stress on my ACL therefore I am to be in an immobiliser (ROM brace) locked between 15 to 45 degrees as between these there is no stress on the ACL I am also supposed to be non weightbearing but as I had my right shoulder reconstructed last August this is TOTALLY out of the question. So I use 1 crutch with left arm when I am doing a lot and most of the time no crutches and just try to limit my walking.

[rhea]

Well this is certainly interesting!!   Here my GP and last 2 OS are talking like the MRI is 100% accurate, completely fool proof, absolutely no chance of it being inaccurate!  I'd like to take all you people with me back to my GP and last 2 OSs and we could BLAST them.  Let them know our experiences with this so called modern "advance" in technology.  Advance smanche.....in my case this mri has just provided my Drs with an excuse not to help me.  Forgive me for this bitterness, but I am having a rough night and haven't ranted for at least a fortnight.  A pox on all of those uncaring, don't give a poodle poop, surgeons!!  

Would anyone mind if I printed off all of your responses?  I'd like to add them to my knee file and use them as ammo if I need to at my next GP appt for painkillers.

Thank you again for your replies everyone!!  

(((hugs))) n' healing to you all.

rhea

[Shazinoz]

feel free to print my responses and if you want more ammo then i can fire anytime  

[Linds]

  Hey Rhea you know about me and MRI's but I just thought I would share...only because I love testing out hte new forum.  I had three MRI's in which nothing was out of place...or different then a perfectly healthy knee. I however after have had a scope in 97 and LR and subsequent scope in April of this year have been diagnosed with CMP and Patella Femoral Syndrome. But in my not proffesional opinion the MRI is farely useless at diagnosing alignment/mechanical problem, unless it is one of those ones they take while you are moving because your leg is just plain straight....my knees are perfectly aligned when my leg is straight! Ohwell....Hope all is well
Linds

[Iona_-Uk]

No problem printing mine off Rhea, give those dr's what for Rhea!

iona

[ellynno]

HeY! This is my very first post! I'm so glad to have found this site, but I feel so sorry for all of you who have had so much misery with knees.
I have had pain, achy swelling and hot spots in my left knee for 3 years off and on. I've had two MRIs--one just last week. The first one, done in 1999, showed nothing. My family doctor sent me to a physical therapist who decided I had a trapped nerve, and charged my insurance company a lot of money to have me do some really lame (no pun) exercises.
My knee did seem to improve, but started in again last fall. It seemed like my whole leg would swell, and hurt from my hip to my ankle. I went to a Rheumatologist--I don't have to have a referral to see specialists--because I've had other symptoms which could be arthritis or fibromyalgia or WHAT? He sent me to a GP who sent me for another MRI. I love doctors-- they spend your money. It's so much easier than maybe trying to diagnose by, say, touching the patient! My husband knows some people who own an imaging center, and they sent me the radiologist's report. The MRI showed no meniscus tears, no bony changes, a little swelling AND a "small to moderate popliteal cyst." A few days later, the doctor's office called me and said "there were no abnormalities"!!! So does everyone have cysts in their knees? I was so mad. The doctor wouldn't even take the time to explain what a popliteal cyst is! Of course, the doctor doesn't know I have a copy of the report. I have been searching everywhere to find out what it means to have a "politeal", "Baker's" or mensical cyst. All I know is I have had to stop exercising, which I have done for over 20 years, and never know what is going to make my knee go beserko. The doctor offered to give me a cortisone shot in my knee (even though there's nothing supposedly wrong with it)  or I could go to an orthopedic specialist. I suspect that what she really wants me to do is shut up and go away.
I live in rural Florida where everything is a long trip.
So is this congenital, or what? Any insight would be greatly appreciated. Thanks for listening!

[ellynno]

The way health care care works in the US is this: if you have insurance, no one will even tell you how much things cost because they over-bill the insurance company in order to get every last dollar the insurance may cover. Good luck if you want to pay cash. If you don't have insurance and you qualify as being low-income, you have to get into the government's system, which is okay because you don't have to pay for anything but is bad because you have to go where they will take you as a patient.
In my case, I have a $1000 deductible which I haven't met so I have to pay for the MRI. I called a couple of different places to get an "estimate" for an MRI on one knee. One place was going to charge me $2,045. The place my husband found said $900. My husband is a veterinarian so I understand well the costs involved in operating a medical facility. But how could there be such a difference in the price of the same procedure?
An MRI is just a test. No test is perfect. I think the frustration we are feeling is because MRIs are built up to be the key to every diagnosis. Plus they cost so much!!! Then you still don't know???
But what else can you do? I still don't know what's wrong with my knee. Did the MRI miss something (twice) ? This has really affected my life because I can't walk right. It makes my other hip hurt. Then I really get crabby. I'm 51 years old and I don't think that's old. I get so sick of hearing about "falling apart" and how "gettting on" sucks for everyone.
But you poor thing! You have a very strange lump! Something everyone can see! By anyone's standards this is not right.
I had a big lumpy swollen thing on my little finger way back in 1979. I went to the doctor who decided it was a "ganglion". He sent me to a hand surgeon who cut open my finger (boy was he happy to have a little finger to cut open) and guess what? There was no ganglion, which is when the synovial fluid leaks out of the joint. I had something torn, which he sewed down, but he said that wasn't the cause of the lump.
For a year I had a purple, sore, stiff little finger that ached in the cold and didn't move right. Then the lump came back. I went back to the doctor, who wanted to cut open my finger AGAIN. I walked out the door and never went back.
Fingers, knees, who knows.
Good luck.  (And thanks for listening to my ranting.)

[Heather M.]

Hey Nouse,

Thought I would reply to a couple of things--I've had four MRIs, and the ONLY thing that was ever picked up was my meniscal cyst and the tear causing it.  It was SOOOO big, it was impossible to miss.  But if I were you, I'd wait and see what the private OS says--you may not need an MRI with that big old lump on your knee.  My MRI's have ranged from $1200-$2200, depending on the facility.

As for costs, here's my little anecdote about the US healthcare system.  I had my first surgery as a private patient, because my insurance only covered another physician (in their network) who told me if my knee hurt when I hiked and used exercise equipment, I shouldn't do it.  For my surgery with my current OS, the bill for his time was $4500 and for the operating theater was another $3800.  YIKES!  But when I came back for another surgery I had different insurance, so I was covered this time.  I saw that for the 2nd surgery, the amount billed was the same, but the amount my insurance reimbursed my doctor and the surgery center was a mere $450.  That's reimbursement of .10 cents on the dollar--not a bad scam, eh?  

They absolutely rip off private patients here, hope it's better in the UK.

Heather

PS My insurance coverage ends in December...looks like I'm sunk.

[Heather M.]

Actually, what our insurance system has done here is to make it necessary for doctors to have several layers of administrative bureaucracy to deal with the insurance companies.  I doubt you could find a doctor today who even KNEW what his charges were...the admin handles that.  My doctor, who works in a large practice with 4 other surgeons, has a full-time employee whose sole purpose is to type and file insurance claims.  Another calls companies all day to get required pre-authorizations for surgical procedures...yet another handles the surgical scheduling, booking the anesthesiologist, nurses, rooms, etc.  In a way, it's good that the doctors are focusing soley on medicine, but for surgeons in small practices I hate to think of what happens!

Stay with your endocrinologist, he sounds like he's worth his weight in gold.  I feel the same way about my surgeon.

Heather

[ellynno]

 
I told you my husband is a veterinarian--the other day someone asked me if we took pet insurance. Insurance? I said yeah RIGHT. Be glad we don't.  I chose the most recent doctor because one, she was close, and two, the office knows how to effectively file insurance claims. Pretty funny, huh. My mistake. She has proven herself to be a dud. She also wouldn't discuss the bloodwork I had done, even though it came back with an elevated value for a thyroid test. How hard is it to talk to a patient? Isn't that what doctors are supposed to do? I don't like being treated like a child or an idiot.
The bottom line is what you were saying, it's not easy to find a good doctor. It's downright unusual. Isn't that sad?
By the way, our insurance premiums are outrageous. Even with high deductibles. And now I sure hope I don't have to change companies (again) because I've gone to the doctor.

Noueuse, just lay your knee down here and I'll hit it with my Internal Medicine book (that I bought at a Barnes and Noble book store) which is HUGE and has proven to be way more useful than doctors.