How wrong are MRI’s?

If an MRI told you had an ACL tear, you’d probably start looking for a good orthopedic surgeon. And who could blame you? But Steve Ganobcik, a recreational skiier who twisted his knee on the slopes, discovered first hand how MRI’s can be extremely misleading. After visits to two different orthopedists who both determined from MRI’s that he had a fully torn ACL, Steve visited a third orthopedist, Freddie Fu at the University of Pittsburgh, to see what he would recommend for treatment.  What he learned knocked him off his feet.

From the New York Times:

…Dr. Fu told him his ligament was not torn after all. His pain was from a fracture in a long bone in the lower leg that the other doctors had also noticed was broken. An M.R.I. at the University of Pittsburgh confirmed it, showing a perfectly normal A.C.L. (Dr. Fu adds that Mr. Ganobcik’s original scans had an image that was ambiguous. He wanted a better one, to see if Mr. Ganobcik’s ligament had been partly torn and was healing or had never been torn at all. He would not need surgery with a partial tear, but he would need more careful recuperation.)

Two scans. Three doctors. Two doctors convinced he had an ACL tear and only one who figured out with physical examination that a full ACL tear was impossible. Careful rehab was all that was needed.

Another doctor, James Andrews in Gulf Breeze, Florida, has also noticed instances of the unreliability of MRI’s like this in his practice as well, and decided to test the reliability of MRI’s by taking 31 healthy, asymptomatic professional baseball pitchers. None of the pitchers had reported any shoulder pain whatsoever. None.

But the M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,” Dr. Andrews says.

Neither of doctors suggest that MRI’s are not medically useful for serious situations, it’s that they are overused and overtrusted. Just like studies that have shown that MRI’s are not reliable for finding the cause of back pain, Dr. Andrews’ study and Dr. Fu’s experience show that MRI’s are not reliable for figuring out what’s wrong when a shoulder hurts.

This should provide some solace for those out there who think an MRI can tell you why you experience pain. The results are in: they don’t.

Read the full New York Times article to read about another study on MRI’s and find out what makes doctors use MRI’s even when they know they don’t need them.