Week 2.2 Limitations of Imaging

Question 1

diagnostic imaging reveals pathology, but what provides the relevance

Answer 1

the history and physical exam

Question 2

what do we see in healthy overhead athletes

Answer 2

40% of them have partial or full thickness RTC tear that are asymptomatic, and even at 5year follow up, no symptoms of any treatment. this is normal

Question 3

what about healthy college basketball players and knee MRIs

Answer 3

41% had bone marrow edema
41% had abnormal articular cartilage signal
35% had joint effusion
24% had tendinopathy

Question 4

what about the lumbar spines of asymptomatic workers

Answer 4

50% had an abnormality like a disc or spinal canal, mild stenosis, disc degeneration or bulging or herniated discs.
27% had disc protrusion
38% had annular tears

Question 5

TF: findings always predict the development of LBP

Answer 5

false

Question 6

what is the sensitivity of imaging and radiographs on the wrist, lumbar spine, bone metastasis, partial RTC tear and MRI, and stress fractures

Answer 6

low! not that great, and you cannot rule things out because there is a low sensitivity

Question 7

like special test, imaging has limitations, so you must know that they do not have high sensitivity. why is this important

Answer 7

a stress fracture may take 4-6 weeks to show up, so you cannot send your foot pain right back to running, just because the first image was negative, or no finding.

Question 8

what was the Herzog 2017 article highlighting

Answer 8

there was a 63 y/o female with right L5 radicular pain, and she had 12 MRI done at 10 centers over 3 weeks. 49 distinct findings were noted from her scans, and none were unanimously reported. only one finding was reported by 9/10 doctors, and 33% only appeared once. So overall there was NOT good agreement. Kappa was only 0.2

Question 9

so what are some cautions we need to take into account when we talk about imaging reports

Answer 9

the reports are not always correct, or there is often missing information, or too much, so always look at the image when you can

Question 10

what is the idea between trusts but verify

Answer 10

think about the report, but always try to look, because the image may be real blurry or may have artifact or may be reflective, and its just not very clear.

Question 11

why can’t we dismiss imaging if they are negative

Answer 11

because the patient may still be having signs and symptoms that lead you to the same conclusion, and that really impact the patient.