Utility of magnetic resonance imaging obtained before evaluation by the hand surgeon

The objective of this study was to assess prospectively the utility of magnetic resonance imaging (MRI) obtained before evaluation by a hand surgeon. Over a 4-week period, the hand surgeon documented the type of imaging used in each encounter, which prereferral MRIs were useful, and if he agreed with the radiologist's interpretation. Of 396 consecutive patients, 14 (4%) presented with an MRI. Of those MRIs, 10 were found to be useful. The hand surgeons agreed with the radiologist's interpretation on 13 of the 14. Eleven patients presented with only an MRI, and 10 of those were helpful. In contrast, none (0 of 3) of the MRIs of patients who presented with both radiographs and an MRI were useful (p = .01). These results suggest that previous retrospective studies may be confounded by recall bias. The data support the selective ordering of MRIs by referring physicians; however, ordering more than one imaging modality is less likely to be helpful.