Draft Key Questions
Disposition of Comments Report
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Musculoskeletal conditions are the most common cause of disability in the United States. The differential diagnosis of nonspecific musculoskeletal complaints is challenging and the use of imaging modalities, such as magnetic resonance imaging (MRI), is often required to establish a diagnosis, determine treatment, or monitor disease progression. Although MRI is widely used in medicine today, there remains considerable uncertainty as to the optimal imaging approach for most musculoskeletal conditions.
To describe the current state of application, enumerate the potential benefits and harms of emerging MRI technologies for imaging under loading stress (for example, weight-bearing or simulated weight-bearing conditions) used in the diagnosis and management of patients with musculoskeletal disorders, and to summarize the state of current research.
A search of the published literature, interviews with selected Key Informants, a structured review of grey literature, and an evidence map(i.e., a systematic description of the characteristics of the published studies) of MEDLINE-indexed original research publications (last search: September 2010).
There exists a rapidly expanding array of MRI technologies designed to employ weight-bearing, stress-loading, or positioning protocols to more accurately diagnose musculoskeletal disorders. Often novel MRI devices have low magnetic field strength, which may adversely impact image quality. The diagnostic accuracy of the available technologies has not been investigated in well designed studies; thus, considerable uncertainty remains regarding the impact of these techniques and technologies on physicians' diagnostic thinking and decision making with regards to treatment. Furthermore, potential subgroups of patients that may particularly benefit from loading stress MRI cannot be identified with certainty. Most importantly, there are as yet no trials that compare the impact of these technologies on patient outcomes with conventional MRI. Therefore, the relative benefits and harms of different imaging technologies remain unclear. Future studies should address the prevalent methodological limitations in the existing literature, regarding participant selection, outcomes investigated, and statistical analyses performed, to identify the imaging modalities and protocols with the highest clinical utility.