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Updated: May 22, 2026
Quantitative Magnetic Resonance Imaging of Skeletal Muscle Disease
Published on: December 18, 2016
Prereferral MRI use in patients with musculoskeletal tumors is not excessive
Christopher T Martin1, Jose Morcuende, Joseph A Buckwalter
1Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA. Christopher-T-Martin@uiowa.edu
Background:
Inappropriate MRI use has been targeted as a particular area of concern in orthopaedics, but it is unclear whether and to what extent its use is inappropriate in musculoskeletal oncology.
Questions/Purposes:
We therefore evaluated the incidence and cost of inappropriate prereferral MRI among patients with musculoskeletal tumors.
Methods:
We retrospectively identified 920 patients treated in a musculoskeletal oncology clinic between 2009 and 2010. We accepted as necessary any MRI for a primary bone sarcoma, for biopsy-proven soft tissue sarcomas, for soft tissue masses greater than 5 cm in diameter, for soft tissue masses deep to the fascia, for painful soft tissue masses, and for growing soft tissue masses. Patients without these criteria were reviewed by a team of musculoskeletal oncologists to determine the necessity. The criteria for a repeat MRI were failure to show the tumor, lack of gadolinium contrast, lack of T1 or T2 MRI sequence, or poor image quality. Cost was determined using 2010 Medicare reimbursement rates.
Results:
Of 920 patients, 320 (35%) arrived with a prereferral MRI study. Eight of the 320 (3%) studies were unnecessary, and 12 (4%) were necessary but were repeated. The cost was $11,474, which averages to $574 per study and $36 of waste per patient referred with an MRI study.
Conclusions:
Based on our data, we judged MRI use before referral to our tertiary center as not excessive. This is likely attributable, in part, to the relatively low use of MRI in our referral base. Inappropriate MRI use in patients with tumors may not be as widespread as previously reported.
Level Of Evidence:
Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
Insights
Inappropriate MRI scans for musculoskeletal tumors are not excessive, with only 3% deemed unnecessary. This study suggests that misuse of MRI in oncology may be less common than previously thought.
Area of Science:
- Musculoskeletal Oncology
- Radiology
- Healthcare Economics
Background:
- Inappropriate magnetic resonance imaging (MRI) use is a concern in orthopaedics.
- The extent of inappropriate MRI use in musculoskeletal oncology is unclear.
Purpose of the Study:
- To evaluate the incidence and cost of inappropriate prereferral MRI in patients with musculoskeletal tumors.
Main Methods:
- Retrospective review of 920 patients treated between 2009-2010.
- Defined criteria for necessary MRI (e.g., primary bone sarcoma, biopsy-proven soft tissue sarcoma, masses >5cm, deep masses, painful or growing masses).
- Assessed necessity of repeat MRIs based on image quality and diagnostic information.
Main Results:
- 35% of patients had prereferral MRI studies.
- 3% of these studies were unnecessary.
- 4% of necessary studies were repeated, with an average waste of $36 per referred patient.
Conclusions:
- MRI use before referral to a tertiary center was not excessive.
- Low inappropriate MRI use may be due to reduced utilization in the referral base.
- Inappropriate MRI use in tumor patients may be less prevalent than previously reported.
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