MR Takes Hit From Physician Group Critical of Neuro-MRI Research

ACP report highlights need for outcomes researchMRI suffered anothersetback last month in the form of a study published in the Annalsof Internal Medicine that claims there is a lack of quality researchsupporting the use of MRI in the brain and spine. Neuroradiologistswere quick to leap to MRI's defense, but the study received extensivecoverage in the mainstream news media, including an article inthe Wall Street Journal.

The study, which was commissioned by the American College ofPhysicians as part of its ongoing technology assessment effort,consisted of a literature review of more than 3000 published citationson MRI, according to Dr. Daniel Kent, lead author of the study.

Kent is a clinical associate professor of medicine at the Universityof Washington and medical director of Seattle-based PacifiCareof Washington, a managed-care plan.

After technical reviews, case reports and other nonacademiccitations were screened out, researchers were left with 285 studiesfor review. These studies were graded on an A-B-C-D scale, basedon their sample size, methodology, use of high-quality equipmentand other academic criteria.

Most of the studies received C or D grades, and only one, astudy of the accuracy of MRI in patients with suspected multiplesclerosis, received an A rating, Kent said. That study was publishedin the June 23, 1993, issue of the Journal of the American MedicalAssociation.

While the authors of the ACP study acknowledged that MRI yieldshigh-quality images, they claimed that their research indicatesthere are few large-scale quantitative studies to support theuse of the modality in neurology.

"Despite the installation of more than 2000 magnetic resonancescanners and the appearance of more than 5000 citations aboutneuroimaging with MRI, fewer than 30 studies are prospective controlledcomparisons of diagnostic accuracy or changes in therapeutic choices,"the authors stated. "No study documents a change in patientoutcomes."

The study comes at a bad time for MRI and could be particularlydamaging if it leads to restrictions or cutbacks in reimbursementamong third-party payors. Radiologists concede that the ACP studyunderlines the need for the medical imaging community to supportoutcomes studies to counter barbs launched from outside the specialty.

Indeed, the imaging industry is realizing that outcomes researchis necessary to support new product introductions and clinicalapplications (SCAN 5/18/94). Few companies or clinicians, however,believe that MRI must prove itself to support applications thatare already accepted by the medical community.

Neuroradiologist Dr. William Bradley, director of MRI and radiologyresearch at Long Beach Memorial Medical Center in Long Beach,CA, believes that a large-scale outcomes study of the type recommendedby the ACP study would be a waste of time and money.

"If I had to put a certain number of dollars into establishingthe worth of MRI, it would be to show where MRI replaces otherexpensive tests, including diagnostic surgery or laparoscopy,"Bradley said. "I wouldn't waste my money proving the obvious.I know (MRI) is better, and my clinicians know it's better. Idon't need to prove it."