Effect of foot and ankle MR imaging on clinical decision making.

Abstract

To evaluate the effect of magnetic resonance (MR) imaging of the ankle and hindfoot on clinical decision making. Eighty-one consecutive patients were prospectively examined with MR imaging of the foot and ankle. The referring clinician (one of two orthopedic surgeons or one of two podiatrists) assigned a clinical diagnosis (with a corresponding confidence score of 1-5) and a tentative treatment plan before and after the MR imaging examination and reading. A two-tailed, paired Student t test was used to determine the effects of MR imaging on the diagnosis and treatment. Of the 81 patients examined, 38 (47%) had a post-MR imaging diagnosis that differed from the pre-MR imaging diagnosis (P < .001). Treatment plans were subsequently changed in 28 patients (34%) (P < .001). MR imaging had a statistically significant effect regardless of the assigned, pre-MR imaging clinical confidence rating. MR imaging was also noted to play a key role in surgical planning regardless of the effect on diagnosis. MR imaging of the foot and ankle has an effect on clinical decision making. Regardless of the clinician's confidence in diagnosis, MR imaging consistently plays a central role in further defining the diagnosis and treatment.