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MR Imaging of the Wrist: Effect on Clinical Diagnosis and Patient Care¹

¹ From the Orthopedic Research Unit (J.L.H., N.R.), Department of Radiology (A.K.D., P.W.P.B., D.J.L.), and Department of Trauma and Orthopedic Surgery (M.H.M.), Box 219, Addenbrooke’s Hospital, Hills Rd, Cambridge CB2 2QQ, England; and the Centre for Applied Medical Statistics, University of Cambridge Institute of Public Health, England (B.D.M.T.). Received August 19, 2000; revision requested September 26; final revision received March 16, 2001; accepted March 23. Supported by research fellowships from the NHSE (Eastern region) research and development directorate and the Royal College of Surgeons of England. The Addenbrooke’s Charities provided a grant to purchase imaging equipment. Address correspondence to A.K.D. (e-mail: akd15@radiol.cam.ac.uk).

PURPOSE: To evaluate the effect of magnetic resonance (MR) imaging of the wrist on clinicians’ diagnoses, diagnostic certainty, and patient care.

MATERIALS AND METHODS: A controlled observational study was performed. Referring clinicians completed questionnaires about diagnosis and intended management before and after wrist MR imaging. One hundred eighteen consecutive patients referred for MR imaging of the wrist were recruited from the MR imaging units at a regional teaching hospital and a large district general hospital. The main measures were changes in the clinicians’ leading and subsidiary diagnoses after MR imaging, their certainty in these diagnoses, and changes in intended patient care.

RESULTS: Questionnaires were incorrectly completed for five patients, questionnaires were not returned for three, appointments were canceled for 10, and two could not tolerate the MR examination. Complete follow-up data were available for 98 patients. The clinical diagnosis changed in 55 of 98 patients; in the remaining 43 patients, diagnostic certainty increased in 23. Clinicians reported that MR imaging had substantially improved their understanding of the disease in 67 of 98 patients. The care plan changed in 45 of 98 patients, with a shift away from surgical treatment. Twenty-eight patients were discharged without further investigation. MR imaging was similarly effective in the regional teaching center and the district general hospital.

CONCLUSION: MR imaging of the wrist influences clinicians’ diagnoses and management plans.

Index terms: Magnetic resonance (MR), utilization • Wrist, injuries, 43.40 • Wrist, MR, 43.121411, 43.121412, 43.121413, 43.121415

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