The problem is that most patients and many doctors still perceive MRIs as an easily accessible commodity that will provide the answers as to where the pain has come from, and therefore the solution to getting rid of the pain. However, this relies on two massive assumptions:
Assumption 1: MRI scans are always accurate
The Truth? MRI scans are surprisingly difficult to read, and different radiographers looking at the same scan will often report different findings!
Assumption 2: MRI scans’ findings are always related to the problem
The Truth? Issues found by an MRI scan are often completely misleading, can have nothing to do with the pain you are feeling, and can be a completely normal part of ageing.
Let’s dig a little bit deeper.
So how accurate are MRI scans?
A very recent study conducted by Herzog et al, published in the Spine Journal in April 2017 assessed the accuracy of MRI imaging and reporting, by asking a 63 year old patient with current pain, and a long history of lower back problems to visit ten different MRI centres in succession, and get a report from each one. The results?
10 MRI Scans
49 different ‘issues’ reported
0 of these ‘issues’ seen across all 10 scans.
This is a scarily clear demonstration that MRIs are not the clear snapshot that patients often believe that they are.
So why is there a difference between different MRI centres? First of all, like with physiotherapists, you can get good, skilled radiographers, and you can get inexperienced or under-skilled radiographers.
Secondly, just like your TV and computer, imaging technology is constantly changing and improving. So an Ultrasound or MRI machine from 10 years ago is going to be very low quality compared to a machine produced in the last two years.
Finally, an uncomfortable aspect of the medical industry: many doctors now own their own imaging machines, and will charge a premium for potentially unnecessary scans to ‘confirm’ their diagnosis. Is there anything a patient can do about this? Not much besides trusting your doctor to refer you to a trusted imaging centre, and hoping for the best.
Are MRI scans even relevant?
In most cases, no. A large systematic review conducted by Brinjikji et al, in 2014, assessed the MRI findings of 3,110 people with No Reported Back Pain. The findings? A significant number of these perfectly fine people were found to have problems, issues, or ‘degradation’ within their spines, which became more common as they got older.