MR imaging of the wrist: Effect on clinical diagnosis and patient care

PURPOSE: To evaluate the effect of magnetic resonance (MR) imaging of the w rist on clinicians' diagnoses, diagnostic certainty, and patient care. MATERIALS AND METHODS: A controlled observational study was performed. Refe rring clinicians completed questionnaires about diagnosis and intended mana gement before and after wrist MR imaging. One hundred eighteen consecutive patients referred for MR imaging of the wrist were recruited from the MR im aging units at a regional teaching hospital and a large district general ho spital. The main measures were changes in the clinicians' leading and subsi diary diagnoses after MR imaging, their certainty in these diagnoses, and c hanges in intended patient care. RESULTS: Questionnaires were incorrectly completed for five patients, quest ionnaires were not returned for three, appointments were canceled for 10, a nd two could not tolerate the MR examination. Complete follow-up data were available for 98 patients. The clinical diagnosis changed in 55 of 98 patie nts; in the remaining 43 patients, diagnostic certainty increased in 23. Cl inicians reported that MR imaging had substantially improved their understa nding of the disease in 67 of 98 patients. The care plan changed in 45 of 9 8 patients, with a shift away from surgical treatment. Twenty-eight patient s were discharged without further investigation. MR imaging was similarly e ffective in the regional teaching center and the district general hospital. CONCLUSION: MR imaging of the wrist influences clinicians' diagnoses and ma nagement plans.