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Magnetic Resonance Imaging of the Brain and Spine: A Revised Statement
- American College of Physicians*
- *This guideline was authored by Daniel L. Kent, MD, David R. Haynor, MD, W.T. Longstreth, Jr., MD, MPH, and Eric B. Larson, MD, MPH, and was developed for the Health and Public Policy Committee by the Clinical Efficacy Assessment Subcommittee: Ernest L. Mazzaferri, MD, Chair; John R. Feussner, MD; Edward J. Huth, MD; Gerald R. Kerby, MD; Francis J. Klocke, MD; Col. Michael J. Kussman, MD; Albert G. Mulley, Jr., MD; and George E. Thibault, MD. Members of the Health and Public Policy Committee were: Clifton R. Cleaveland, MD, Chair; Cecil O. Samuelson, Jr., MD, Vice-Chair; Whitney Addington, MD; Robert A. Berenson, MD; Christine K. Cassel, MD; John M. Eisenberg, MD; Nancy E. Gary, MD; David J. Gullen, MD; Ernest L. Mazzaferri, MD; P. Preston Reynolds, MD, PhD; Gerald E. Thomson, MD; Mack V. Traynor, Jr., MD; Quentin D. Young, MD. The guideline was approved by the Board of Regents on 18 July 1993. Requests for Reprints: Linda Johnson White, Director, Department of Scientific Policy, American College of Physicians, Independence Mall West, Sixth Street at Race, Philadelphia, PA 19106-1572.
The numbers in square brackets correspond to numbered paragraphs in the review article “The Clinical Efficacy of Magnetic Resonance Imaging in Neuroimaging” (see pages 856-871), which support statements made here.
Magnetic resonance imaging (MRI) is now widely accepted as an important diagnostic technology. Use of MRI to image blood vessels (magnetic resonance angiography) is increasing rapidly. From a rigorous review of the extensive published literature on MRI for neuroimaging, the American College of Physicians has updated its 1987 policy statement about MRI of the brain and spine.
Technical Advantages and Disadvantages of Magnetic Resonance Imaging
Three Advantages
Soft tissue contrast is better with MRI than other imaging techniques. Magnetic resonance images can be acquired with equal clarity in any orientation: axial, sagittal, coronal, or oblique. Image artifacts from bone are absent with MRI.
Magnetic resonance imaging does not involve exposure to ionizing radiation and has no known significant clinical side effects [3.1]. Magnetic resonance imaging without contrast can be done during pregnancy if necessary [3.1].
Magnetic resonance imaging does not require contrast in most situations, so it can replace computed tomography (CT) when the risk for an adverse reaction to iodinated contrast agents is high [3.1]. Paramagnetic contrast agents also are safer than iodinated contrast agents, although both usually are contraindicated in pregnancy [3.1].
Four Disadvantages
Magnetic resonance scanners are costly to install and operate [3.4].
Magnetic resonance imaging shows incidental anatomic abnormalities or anomalies that can be misinterpreted as causing a patient's symptoms [3.3]. Prominent examples are nonspecific white matter abnormalities [7.1, 12.2] or incidental spinal column abnormalities [13.6] whose prevalence increases with age.
Magnetic resonance imaging requires more patient cooperation than does CT [3.1]. Life support for medically unstable patients must be compatible with strong magnetic fields.
Metallic objects in the body may be contraindications for MRI. Most intracerebral aneurysm clips, intracranial or intraocular metal, and cochlear implants are absolute …
This 100-word excerpt has been provided in the absence of an abstract.
