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MRI diagnostic ability?

Posted by Gregg W on 1/28/02 at 08:51 (071606)

I'm thinking of having an MRI to help diagnose my foot problems. What percentage of MRI's actually show the inflamation or help diagnose foot problems?

I've heard that sometimes they don't show anything.

Re: MRI diagnostic ability?

paula on 1/28/02 at 09:09 (071609)

i had 2 mri s on same foot. came back with totally different results. i think the folks that read them, same old story. there are doctors and there are doctors i suppose. i'm not sure what kind of doctor reads the report but maybe someone here knows. or even if it is a doctor who makes the report. how do we know we have a report that is worth anything once we pay a fortune for the mri?

Re: MRI diagnostic ability?

cindyp on 1/28/02 at 09:26 (071614)

I don't know maybe it's what you said. I had two done one on good foot one on bad for comparison. You could see my problem right off. But I think they are radiologists? that read them so ?

Re: MRI diagnostic ability?

Ed Davis, DPM on 1/28/02 at 15:25 (071644)

There are big differences on MRI quality. Extremity MRIs are the way to go for the foot and ankle. There are big differences in the training of radiologists pertaining to foot and ankle MRIs.

Most insurance carriers pay a fixed amount for the MRI and a fixed amount for the reading. As such, one might as well go to an extremity MRI and have it read by a radiologist with a foot and ankle subspecialty.
All MRIs that I order are performed on an extremity machine and are read by a subspecialist.
Ed

Re: MRI diagnostic ability?

Gregg W on 1/28/02 at 15:35 (071648)

Thanks. So with the best possible case, using an extremity MRI with a subspecialist reading it, about what percentage detect or help to diagnose the problem? Is it worth the money to get a good MRI done?

Re: MRI diagnostic ability?

cindyp on 1/28/02 at 17:42 (071684)

well money wasn't an issue because v.a. paid for it. but i didn't remember until now that when i went to the foot and ankle reconstructive surgeon his mri guy that he used could't definitively say for sure what the actual problem i had was just a large mass. so i don't know about looking for numbers of success. just hope that you get a good one and a good person reads it. sorry

Re: what is your (suspected) problem?

elliott on 1/28/02 at 18:27 (071698)

If, for example, you show the standard signs of PF, and it is extremely likely that PF is what you have, an MRI may be questionable. But if, say, you have TTS and want to see what's going on there before surgery, that is a very good reason to have one, as it enables the surgeon to see something he might miss. I'll point out that you don't always have to find something for it to be of value; an MRI often helps rules out other things when it doesn't find anything. For example, it would let the surgeon performing a TTS release know that there are (no) other complications. A negative MRI might also be a criterion against surgery.

---

Re: MRI diagnostic ability?

matts on 1/28/02 at 21:17 (071723)

The pod that ordered the mri said it was the gold standard for diagnosis and the ortho said the same thing. However, the radiologist said there was some inflamation on achilles and saw nothing else conclusive, but the problem according to all the other foor drs is the posterial tibial tendon. the pod said there was some fluid maybe, but generally inclusive, but the ortho foot and ankle guy said fluid for sure and located several tender places and the second ortho, also foot and ankle specialist who sees a lot of these showed several places along the tendon that are irritated with fluid. They all were looking at the same mri, so I would say it definitely depends on experience of the dr and the quality of the mri. the radiologist was not a foot specialist, but looks at all kinds of pictures.

Re: MRI diagnostic ability?

Dr. Marlene Reid on 1/28/02 at 23:27 (071741)

I can tell you that the difference is the person reading it. Most MRI's in major medical centers are high enough quality to capture most pathology of the foot and ankle. (I say most because often things like neuromas or small ligament tears are not picked up). It is also better not to get it bilateral, the images are better if they are not. The hospital where I work out of has their radiologists read them and if its not an ankle sprain, they interprete them as negative, no matter what! Now, the MRI center that I send my patients to has a DPM who is probably one of the best in the country at reading foot MRI's. He also likes us to call him after surgery if we found something that he did not see. He continually tries to improve his unique skill. If a patient tells me that they had a negative MRI elsewhere and their clinical symptoms are so pronounced, I usually have them repeat the MRI with my guy and at least half the time, there is pathology.

Re: MRI diagnostic ability?

Dr A K DPM on 1/29/02 at 09:26 (071768)

I agree that MRI quality is pretty good everywhere, but some radiologists are better at reading foot MRI's better than others. If you have a negative MRI, have it read a second time by a foot and ankle specialist.

Re: Does the doctor usually see the MRI or just the report?

Beverly on 1/30/02 at 12:15 (071939)

My MRI was also negative... despite how lifechanging my PF/PTTD/AT has been.
My doctor is an orthopedic surgeon who specializes in foot/ankle.
Do specialists usually read the MRI itself or do they usually depend upon the radiologist's report?
Thanks,
Beverly

Re: MRI diagnostic ability?

D.J. on 1/30/02 at 14:44 (071957)

I received two MRI's that were read by a radiologist, a podiatrist, and an orthopedic foot and ankle specialist (sounds like a good beginning to a bad joke). Noone could see anything abnormal. My podiatrist had a radiologist that he prefers to work with. Although he is trained to read MRI's, the radiologist he works with is more experienced at reading them. I believe he actually looked over the MRI wiht the radiologist present. My pod was somewhat puzzled that nothing showed up but he did point out that although an MRI can show much more detail than other means, it by no means shows everything. I also had a bonescan that was looked at by my orthopedic doctor. He saw nothing abnormal in this either. Thank god I have insurance!

Re: MRI diagnostic ability?

paula on 1/28/02 at 09:09 (071609)

i had 2 mri s on same foot. came back with totally different results. i think the folks that read them, same old story. there are doctors and there are doctors i suppose. i'm not sure what kind of doctor reads the report but maybe someone here knows. or even if it is a doctor who makes the report. how do we know we have a report that is worth anything once we pay a fortune for the mri?

Re: MRI diagnostic ability?

cindyp on 1/28/02 at 09:26 (071614)

I don't know maybe it's what you said. I had two done one on good foot one on bad for comparison. You could see my problem right off. But I think they are radiologists? that read them so ?

Re: MRI diagnostic ability?

Ed Davis, DPM on 1/28/02 at 15:25 (071644)

There are big differences on MRI quality. Extremity MRIs are the way to go for the foot and ankle. There are big differences in the training of radiologists pertaining to foot and ankle MRIs.

Most insurance carriers pay a fixed amount for the MRI and a fixed amount for the reading. As such, one might as well go to an extremity MRI and have it read by a radiologist with a foot and ankle subspecialty.
All MRIs that I order are performed on an extremity machine and are read by a subspecialist.
Ed

Re: MRI diagnostic ability?

Gregg W on 1/28/02 at 15:35 (071648)

Thanks. So with the best possible case, using an extremity MRI with a subspecialist reading it, about what percentage detect or help to diagnose the problem? Is it worth the money to get a good MRI done?

Re: MRI diagnostic ability?

cindyp on 1/28/02 at 17:42 (071684)

well money wasn't an issue because v.a. paid for it. but i didn't remember until now that when i went to the foot and ankle reconstructive surgeon his mri guy that he used could't definitively say for sure what the actual problem i had was just a large mass. so i don't know about looking for numbers of success. just hope that you get a good one and a good person reads it. sorry

Re: what is your (suspected) problem?

elliott on 1/28/02 at 18:27 (071698)

If, for example, you show the standard signs of PF, and it is extremely likely that PF is what you have, an MRI may be questionable. But if, say, you have TTS and want to see what's going on there before surgery, that is a very good reason to have one, as it enables the surgeon to see something he might miss. I'll point out that you don't always have to find something for it to be of value; an MRI often helps rules out other things when it doesn't find anything. For example, it would let the surgeon performing a TTS release know that there are (no) other complications. A negative MRI might also be a criterion against surgery.

---

Re: MRI diagnostic ability?

matts on 1/28/02 at 21:17 (071723)

The pod that ordered the mri said it was the gold standard for diagnosis and the ortho said the same thing. However, the radiologist said there was some inflamation on achilles and saw nothing else conclusive, but the problem according to all the other foor drs is the posterial tibial tendon. the pod said there was some fluid maybe, but generally inclusive, but the ortho foot and ankle guy said fluid for sure and located several tender places and the second ortho, also foot and ankle specialist who sees a lot of these showed several places along the tendon that are irritated with fluid. They all were looking at the same mri, so I would say it definitely depends on experience of the dr and the quality of the mri. the radiologist was not a foot specialist, but looks at all kinds of pictures.

Re: MRI diagnostic ability?

Dr. Marlene Reid on 1/28/02 at 23:27 (071741)

I can tell you that the difference is the person reading it. Most MRI's in major medical centers are high enough quality to capture most pathology of the foot and ankle. (I say most because often things like neuromas or small ligament tears are not picked up). It is also better not to get it bilateral, the images are better if they are not. The hospital where I work out of has their radiologists read them and if its not an ankle sprain, they interprete them as negative, no matter what! Now, the MRI center that I send my patients to has a DPM who is probably one of the best in the country at reading foot MRI's. He also likes us to call him after surgery if we found something that he did not see. He continually tries to improve his unique skill. If a patient tells me that they had a negative MRI elsewhere and their clinical symptoms are so pronounced, I usually have them repeat the MRI with my guy and at least half the time, there is pathology.

Re: MRI diagnostic ability?

Dr A K DPM on 1/29/02 at 09:26 (071768)

I agree that MRI quality is pretty good everywhere, but some radiologists are better at reading foot MRI's better than others. If you have a negative MRI, have it read a second time by a foot and ankle specialist.

Re: Does the doctor usually see the MRI or just the report?

Beverly on 1/30/02 at 12:15 (071939)

My MRI was also negative... despite how lifechanging my PF/PTTD/AT has been.
My doctor is an orthopedic surgeon who specializes in foot/ankle.
Do specialists usually read the MRI itself or do they usually depend upon the radiologist's report?
Thanks,
Beverly

Re: MRI diagnostic ability?

D.J. on 1/30/02 at 14:44 (071957)

I received two MRI's that were read by a radiologist, a podiatrist, and an orthopedic foot and ankle specialist (sounds like a good beginning to a bad joke). Noone could see anything abnormal. My podiatrist had a radiologist that he prefers to work with. Although he is trained to read MRI's, the radiologist he works with is more experienced at reading them. I believe he actually looked over the MRI wiht the radiologist present. My pod was somewhat puzzled that nothing showed up but he did point out that although an MRI can show much more detail than other means, it by no means shows everything. I also had a bonescan that was looked at by my orthopedic doctor. He saw nothing abnormal in this either. Thank god I have insurance!