MRI and Cartilage Repair

Patients in general come asking for MRI exams, are seduced by the technology, and impute too much value to the interpretation.

This is not limited to patients; I have run into some of the same issues when using MRI for a clinical trial; what does the “reading” mean? Is there a quantitative scale that can be used instead of someone’s opinion? Are all MRI scanners the same (emphatically NO!)? Do you want to bet the ranch on an MRI when it comes to cartilage repair? (also, NO!)

The first thing to know is that no one ever got better by getting an MRI. This is a diagnostic test and does not convey any therapy.

So the use of these images need to be in a certain context in order to be helpful, and not just a distraction.¬† One of the root problems in today’s medical care is that it becomes easy to focus upon distractions, and it sure costs a lot. For this reason patients should not order or insist upon¬† their own MRIs in the belief that it could not hurt. This is even more true because many MRIs are of poor quality or insufficient field strength to deliver a good picture. And by the way, the poor quality MRis cost just as much as the high definition ones. Do you want to watch a vintage TV set or a new HDTV?

For cartilage repair, I have never seen a so called “open” MRI give quality images.

Having said the above, I use MRI technology quite a bit. I have excellent consulting radiologists, we meet frequently to discuss new techniques and computer programs that run the MRI machine, and if there is a question, they call me. In addition, I look at all of the scans myself, and yes, sometimes there is a difference of opinion.

The nature of the difference may surprise you. I am far more critical of cartilage repair- even my own cartilage repair- than the average radiologist. That is because I know from experience, that when you scope the knee the problem is always worse than you think, and worse than the images convey. There are technical reasons for this that are inherent in the method.

The best MRI at present in clinical use is a 3 Tesla machine; in the near future we will be able to look at the actual molecules that make up the cartilage. This will no doubt lead to earlier diagnosis of cartilage problems that will enable the new repair technologies to work even better.