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Emerging MRI Technologies for Imaging Musculoskeletal Disorders Under Loading Stress

Comparative Effectiveness Technical Briefs, No. 7

Investigators: , PhD, MPH, , MD, , MS, , MA, , BA, , MD, PhD, and , MD.

Author Information and Affiliations
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 11-EHC024-EF

Structured Abstract

Background:

Musculoskeletal conditions are the most common cause of disability in the United States. The differential diagnosis of nonspecific musculoskeletal complaints is challenging and the use of imaging modalities, such as magnetic resonance imaging (MRI), is often required to establish a diagnosis, determine treatment, or monitor disease progression. Although MRI is widely used in medicine today, there remains considerable uncertainty as to the optimal imaging approach for most musculoskeletal conditions.

Purpose:

To describe the current state of application, enumerate the potential benefits and harms of emerging MRI technologies for imaging under loading stress (for example, weight-bearing or simulated weight-bearing conditions) used in the diagnosis and management of patients with musculoskeletal disorders, and to summarize the state of current research.

Methods:

A search of the published literature, interviews with selected Key Informants, a structured review of grey literature, and an evidence map(i.e., a systematic description of the characteristics of the published studies) of MEDLINE-indexed original research publications (last search: September 2010).

Findings:

There exists a rapidly expanding array of MRI technologies designed to employ weight-bearing, stress-loading, or positioning protocols to more accurately diagnose musculoskeletal disorders. Often novel MRI devices have low magnetic field strength, which may adversely impact image quality. The diagnostic accuracy of the available technologies has not been investigated in well designed studies; thus, considerable uncertainty remains regarding the impact of these techniques and technologies on physicians’ diagnostic thinking and decision making with regards to treatment. Furthermore, potential subgroups of patients that may particularly benefit from loading stress MRI cannot be identified with certainty. Most importantly, there are as yet no trials that compare the impact of these technologies on patient outcomes with conventional MRI. Therefore, the relative benefits and harms of different imaging technologies remain unclear. Future studies should address the prevalent methodological limitations in the existing literature, regarding participant selection, outcomes investigated, and statistical analyses performed, to identify the imaging modalities and protocols with the highest clinical utility.

Contents

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10055-I, Prepared by: Tufts Evidence-based Practice Center, Boston, MA

Suggested citation:

Chung M, Dahabreh IJ, Hadar N, Gaylor JM, Ratichek SJ, Trikalinos TA, Lau J. Emerging MRI Technologies for Imaging Musculoskeletal Disorders Under Loading Stress. Technical Brief No. 7. (Prepared by the Tufts Evidence-based Practice Center under Contract No. HHSA 290-2007-100551.) AHRQ Publication No. 11-EHC024-EF. Rockville, MD: Agency for Healthcare Research and Quality. November 2011. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm.

This report is based on research conducted by the Tufts Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10055-I). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, that is, in the context of available resources and circumstances presented by individual patients.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators has any affiliation or financial involvement that conflicts with the material presented in this report.

1

540 Gaither Road, Rockville, MD 20850; www‚Äč.ahrq.gov

Bookshelf ID: NBK82287PMID: 22191119

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