An assessment of the effectiveness of magnetic resonance imaging of the shoulder: literature review

Objective. To analyse and compare all papers published to date (August 2000 ) that quantify I:he effectiveness, defined as the impact of clinician's di agnosis or management plans, or patient outcome, of MF:I of the shoulder. Design. A computerised search of Index Medicus with a broad search strategy relating to shoulder MRI was performed. Manual assessment of all papers li sted was undertaken with classification of each paper depending on whether it addressed questions of (1) technical performance, (2) diagnostic perform ance or (3) outcome. Results. Four of 265 qualifying papers addressed aspects of effectiveness a nd these were reviewed. The impact on the clinician's diagnosis varied wide ly between papers: the primary diagnosis was altered in 23% to 68% of cases , and the management plans were subsequently changed in 15% to 61% of cases . Only one paper addressed the impact on patient health. Conclusions. The effectiveness of MRI of the shoulder depends on the clinic al skills of the referring clinician and prevalence of disease in the study population. This will have implications when the effectiveness of an imagi ng technique between different institutions is compared, and this in turn w ill influence any comparisons of cost-effectiveness.