MRIs are commonly used in the U.S, more so than in other countries. In many cases, this type of imaging is done as a preventative or diagnostic measure, but in more recent years some people have started to question if it is necessary or even helpful for patients. Beyond the exorbitant cost of excessive diagnostic imaging, some researchers have found that MRIs can bring to light health issues that aren’t problematic but still lead patients to worry and spend money on additional treatments and tests. Moreover, when MRIs pick up incidental problems this can distract from treating the source of pain if it is not structural. So what are the right ways to use MRIs and how can you get a more accurate diagnosis?
What Are MRIs & How Do They Work?
Similar to an X-ray or CT scan, an MRI (magnetic resonance imaging) creates an image of the insides of someone's body. However, unlike an X-ray or CT scan, an MRI uses radio waves, magnets, and a computer to do so, and it doesn’t emit any ionizing radiation (1). For the nitty gritty details about exactly how this works, read here (2).
The test is carried out within a hollow cylinder that is open on both ends. The patient is slid into the machine on a table. Then the intense magnetic field generates multiple pictures that show slices of their body. The test typically takes between 20 and 90 minutes and is painless, but it’s necessary to remain still the entire time. A few days later, the doctor typically explains the results to the patient.
Why Are MRIs Used & What Are The Benefits?
MRIs are used by doctors to diagnose, detect, and monitor injuries and diseases. This type of imaging technology can be performed on many different body parts, including the brain, spinal cord, heart, blood vessels, bones, joints, and organs. A non-invasive method, it produces 3D and cross-sectional images from any direction or orientation without using radiation.
It is particularly useful in capturing images of soft tissues (3). So, in many cases, MRIs are used instead of X-rays and CT scans to view muscles, ligaments, tendons, nerves, the spinal cord, and the brain. MRIs show the contrast of soft tissues better than CT scans, even differentiating between muscle, fat, and water (4). Its images tend to be clear and detailed.
Nowadays, doctors frequently use MRIs to diagnose diseases like strokes, cancer, heart and vascular diseases, and muscle and skeletal disorders. In some instances, MRIs can show if cancer has spread and help determine the type of treatment that should be used (5). However, it’s important to note that many times the area of concern uncovered by an MRI turns out not to be cancer (after a lot of expensive follow-up imaging, biopsies, and even surgery has taken place) (6).
MRIs Are Overused
Although there are many benefits to using MRIs, overusing them can lead to problems like negative outcomes for patients and excessive medical costs. MRIs tend to be overused in certain situations because patients ask for them (37% of the time, according to one study), doctors are worried about litigation, and there's a lack of cost accountability (7).
Multiple studies have investigated the prevalence of MRI usage for diagnostic and/or routine purposes, and their results haven’t been favorable for MRIs. One study in particular uncovered numerous negatives for patients. Perhaps most notably, it found that only 7.8% of patients who had received an MRI (for musculoskeletal issues related to knees, hips, low back, etc.) received appropriate care without needing to be referred to a specialist (8). The vast majority of patients (65.4% or two thirds of imaged patients) were instead sent on to post-MRI referrals that ended up being “ineffective, harmful, or wasteful” (some involving surgery).
The study asserts that most of these unnecessary referrals were the result of patients being mis- and over-diagnosed. In other words, general practitioners are misinterpreting MRI results, which is leading to incorrect patient assessments and treatments. In fact, the same study found that doctors only correctly assessed MRI results a mere 16.7% of the time! With the widespread use of MRIs (10% of all back pain patients receive advanced imaging ), this is a serious problem of real and substantial concern.
Another fascinating takeaway from this same study is that many people who are asymptomatic and pain-free end up with MRI results that show injuries, tears, stress fractures, etc., as a result of age or participation in various activities. Now, they aren’t experiencing any pain, and yet these MRI results frequently cause these same patients to worry and spend money on follow-up visits with other doctors (sometimes even resorting to surgery) to ensure nothing is wrong or to fix something that is incorrectly perceived to be a problem.
Take a look at how common it is for asymptomatic (pain-free) folks to end up with worrisome MRI results:
Other studies offer supporting views. In fact, several of them have found that patients who receive imaging actually have worse pain three months later than people who don’t (9). The study’s participants (patients with back pain) were randomized and those who were imaged were compared to those who weren’t over various periods. The key takeaway? People who have MRIs tend to have worse outcomes. Meanwhile, another study that looked at the use of spine imaging discovered that spine degeneration (that is visible in MRIs) is highly prevalent in people who don’t have any symptoms (10).
Finally, back MRIs have weak predictive power. A study that investigated how various risk factors contribute to serious low back pain discovered that psychosocial variables (e.g., thoughts, stress, work environment, depression, social support, social status, etc.) strongly predicted future back pain, whereas structural findings by MRIs did not (11).
Low Back Pain & MRIs: A Case Study
Consider a recent study that was performed on 44 patients who suffered from low back pain (12).They were randomly put into two groups. One group received a full factual explanation of the causes and effects of the conditions found in their MRI findings, while the others were told that their MRI results were totally normal with only age-related findings. After six weeks the first group was more negative in terms of how they perceived their condition, had experienced less improvement in their pain, and had more trouble functioning than the group who believed their MRI results were normal and healthy. The way in which the findings were conveyed greatly impacted how patients felt and viewed their pain.
The study also looked at how health care professionals (HCPs) were impacted by the way MRI results were reported to them. When the results were reported to them in a scientific and non-catastrophizing manner, the HCPs were more apt to assess the condition less severely and less apt to believe it required an invasive or surgical remedy. In essence, the overuse of MRIs is leading to unnecessary medical and surgical interventions, and the way in which MRI results are currently reported may be exacerbating the problem.
How to Use MRIs Appropriately
When it comes to routine care, MRIs, in general, should not be used. Many times, MRIs pinpoint things (like what appears to be cancer or asymptomatic back conditions) that look serious but turn out to be nothing of concern, which can lead to unnecessary medical and surgical interventions. Other times, MRIs miss things (like cancer) because they are smaller than 1 cm in size (13).
MRIs (as well as X-rays and CT scans) are not useful as predictive scans because they only show what is currently happening. They can't predict what will occur in the future.
A Final Word From Lin
Providing clear, 3D images in a non-invasive manner - without any radiation, MRIs are, without a doubt, of immense value to medical providers and their patients. But despite all of their benefits, in most cases, MRIs shouldn't be used for routine or predictive purposes, since this tends to lead to incorrect diagnoses and other adverse outcomes for patients.
As you move forward with this information, think twice before agreeing to a MRI that has been recommended by your doctor, especially if it's for something routine. And keep in mind the case study above that showed how the pain and recovery levels of patients were impacted by the manner in which MRI results were reported to them. With this knowledge, consider reaching out to Lin today and be paired with your own personal health coach who can help you journey past the pain you feel.