Magnetic resonance imaging or arthrography for shoulder problems: a randomised study

Objective: Diagnostic technologies are often assessed merely by their accur acy, rather than by their impact on diagnosis and patient management. To th is end the authors have undertaken a study to assess the diagnostic and the rapeutic impact of magnetic resonance imaging (MRI) and arthrography of the shoulder for patients referred from a rheumatology clinic. Methods and pat ients: Patients referred from a rheumatology clinic with symptoms warrantin g imaging of the shoulder were randomised to either MRI or arthrography. Da ta on the clinician's diagnostic confidence and management were recorded be fore and after imaging using questionnaires. Patients were followed-up at l east 10 months after imaging to see how management plans evolved, and what proportion of patients required further imaging. Results: Fifty three shoul ders underwent imaging over a year and entered into the study; 29 randomise d to MRI and 24 to arthrography. Both MRI and arthrography had a similar be neficial diagnostic impact in terms of clinical diagnoses (refuted and reta ined) and new diagnoses established. MRI and arthrography had a similar the rapeutic impact, although MRI was associated with a significant shift towar ds surgical intervention. Conclusion: MRI and arthrography a have similar d iagnostic and therapeutic impact. (C) 1999 Elsevier Science Ireland Ltd. Al l rights reserved.