Musculoskeletal magnetic resonance imaging: Importance of radiography

Objective: To determine the usefulness of radiography for interpretation of musculoskeletal (MSK) magnetic resonance imaging (MRI) studies. Designs and Patients: In a 1-year period, 1,030 MSK MRI studies were performed in 1,002 patients in our institution. For each study, the interpreting radiologist completed a questionnaire regarding the availability and utility of radiographs, radiological reports and clinical information for the interpretation of the MRI study. Results: Radiographs were essential, very important or added information in 61-75% of all MSK MRI cases. Radiographs were judged as essential for reading of MRI studies more often for trauma, infection/inflammation and tumors than for degenerative and miscellaneous/normal diagnoses (χ²=60.95, df=16, P<0.0001). The clinical information was rated as "essential" or "useful" significantly more often than not (χ²=93.07, df=16, P<0.0001). The clinical and MRI diagnoses were the same or partially concordant significantly more often for tumors than for trauma, infection/inflammation and degenerative conditions, while in the miscellaneous/normal group they were different in 64% of cases. When the diagnoses were different, there were more instances in which radiographs were not available. Conclusions: Radiographs are an important, and sometimes essential, initial complementary study for reading of MSK MRI examinations. It is highly recommended that radiographs are available when MSK MRI studies are interpreted.