The Magnetic Resonance Imaging (MRI) scanner is used to take images of any part of the body (e.g., head, joints, abdomen, legs, etc.), in any imaging direction. MRI provides better soft tissue contrast than CT and can differentiate better between fat, water, muscle, and other soft tissue than CT (CT is usually better at imaging bones). MRI scans are ideal for getting a detailed, in-depth look at your tissues or organs. These images provide information to physicians and can be useful in diagnosing a wide variety of diseases and conditions. However, there is an increasing concern from healthcare organizations towards the utility and associated costs of imaging. This blog will explain what is the value of MRI scans and gives some insights and practical examples of how the value of MRI can be increased.
MRI plays an integral part in the management of many diseases. MRI doesn't use X-rays, so there's no radiation exposure. It provides multimodal information on metabolism, function, and molecular structure, and this has extended its use in many fields including completely new arenas, such as quantitative MRI in precision medicine, functional MRI, and fiber tracking in neuroradiology, and psychoradiology.
The value of an MRI exam can be defined as the sum of measures of the actionable diagnostic information provided by the exam, safety, and service, all divided by costs.
It is well established that breast MRI is by far the most powerful method for breast cancer diagnosis as well as for screening. Overdiagnosis is evident by cancer epidemiology. Underdiagnosis is evident through the high number of cancers that remain undetected by mammographic screening, and are diagnosed because they become clinically palpable after a normal screening mammogram: the so-called “interval cancers.” Breast MRI thus promises to correct the major shortcomings of screening mammography, and will be a major milestone regarding the further reduction of breast cancer mortality.
MRI is routinely and increasingly used for screening patients with cirrhosis, who are at elevated risk of developing hepatocellular carcinoma (HCC). It is key to assessing the increasingly prevalent nonalcoholic fatty liver disease (NAFLD) and viral-associated cirrhosis.
Pulmonary embolism (PE) is a common and potentially life-threatening clinical conundrum and imaging is key for diagnostic management. Currently, CT angiography (CTA) is the reference standard for the diagnosis of PE. Recently, the use of pulmonary MRA was demonstrated to be a safe and viable alternative to CTA for the diagnosis and exclusion of PE, without the need for ionizing radiation.
Rapid protocols in musculoskeletal (MSK) MRI have been used to rule out occult fractures of the hip and wrist in the emergency setting. When negative, MRI can exclude a fracture with rapidity and certainty, avoiding further testing. When positive, MR can lead to rapid treatment, avoiding complications. While typical MSK MRI protocols for joints are up to 30 minutes long, 3D methods with isotropic resolution can cut the exam time to as little as 5 minutes.
Multiparametric (MP) MRI has gained increasing relevance for the detection and characterization of intraglandular prostate cancer. Currently, prostate cancer remains the last cancer in the body to be diagnosed by random sampling of the gland. Multiple studies have shown the increased yield of clinically significant prostate cancer using the MRI-guided targeted prostate biopsies.
Neurological imaging is one of the commonest MRI exams and there are multiple neurological applications of rapid MR protocols. These include a single-shot T2-weighted fast spin echo (FSE) sequence, which takes 3 minutes of exam time, for assessing hydrocephalus and shunt tip location in children. Direct comparison to CT shows noninferiority of the MR-based protocols to CT scanning, allowing rapid adoption of the MRI approach. While CT is currently the main imaging modality in acute stroke in many countries, MRI has been widely utilized for rapid assessment of stroke.
Even in the wealthiest of societies, healthcare costs are rapidly becoming unsustainable. Costs of delivering MR scans are easier to capture, but vary globally across different healthcare systems. Costs may be fixed (such as the cost of MRI systems [initial capital, depreciation, and upgrades, service contracts, staff costs] or variables [eg, contrast and consumables]). Further, the “costs” will also vary depending on perspective, eg, reducing exam time may reduce the healthcare system cost, but the patient charge may remain unaltered.
Consequently, the costs of imaging have to be controlled and rationalized; demonstrating and increasing “MR Value” is a global necessity. Thus, optimized arrangements of MRI systems and new techniques are important to save resources, while improving effectiveness. Improved diagnostic certainty, replacement of invasive procedures, standardized reporting, and development of quantitative measures can all enhance the value of MRI. Furthermore, focused optimized MRI protocols will trim exam times, improving efficiency of scanner use.
The requirement to address the unsustainable rise in healthcare costs is both a tremendous challenge and a matter of critical importance, both for society in general, and for MRI in particular. People want evidence that an MRI study adds clinical value for the patient, or avoids unnecessary surgery or other costs. Hospitals want to know that their equipment is utilized efficiently, especially if the MRI examination is performed in the setting of an accountable care organization or cost-center. The imperative to prove the value of MRI, moreover, goes beyond economics alone. Patients certainly want to know that any imaging test they undergo is necessary and helpful for their care.
In the rapidly evolving global healthcare landscape, these challenges will continue to rise for traditional imaging enterprises. Along with these challenges, however, come enormous opportunities for the development of technology and practice. Since MRI is utilized at the front end of patient management, during therapy, as well as in prognosis, it can be leveraged in numerous ways to better direct patients to the optimal therapy for the best outcome, coupled with substantial benefits in economic value and patient satisfaction.
Better value in MRI, with improved patient outcomes at a lower cost to the health system, is good for everyone. It will benefit the entire imaging community to use the drive for increased value to build better bridges between clinical practitioners, comparative effectiveness and outcomes researchers, and clinical, scientific, and technical innovators.
Magnetic resonance imaging (MRI) is a pivotal, diverse modality, used to evaluate a range of morphological and functional targets. It is a highly versatile diagnostic tool and is an information-rich research tool for studying the mechanistic underpinning of body function and dysfunction.
There is little doubt that MRI is one of the most powerful diagnostic tools in contemporary clinical medicine, while offering highly advanced research opportunities and studies of (patho) physiological processes. Unfortunately, it is also perceived (rightly or wrongly) as a cost-intensive method and an important driver of overall healthcare costs. Thus, there is a critical need to prove its effectiveness in terms of clinical outcomes, within the context of noninvasive diagnosis and minimally invasive therapy.