S. Gayathri, Presenter: Nothing to Disclose

B.P. Baruah MBBS, MD, Abstract Co-Author: Nothing to Disclose

We conducted a cost effective analysis in patients with rotator cuff disease (>45 years) undergoing USG and MRI and determined if MRI changes clinical and / or therapeutic decision (Conservative vs. surgical) significantly.

92 consecutive patients above 45years of age, who presented to orthopedic department with shoulder pain and clinical examination suggestive of rotator cuff tear/ impingement were selected. All patients underwent USG evaluation and MRI examination within one week of diagnosis. USG and MRI were reported by 2 different radiologists separately. Orthopedicians were first provided with USG report only based on which clinical management was planned. Two days later MR results were made available and change in therapeutic plan was assessed.

We found that USG and MRI detected similar lesions and provided the same diagnosis in 68 patients (35full thickness tears , 20 partial tears and 7 tendinopathy and 6 normal reports). Of the remaining cases ultrasound was found to underestimate the size of tear in 12 cases, USG missed 4 Subscapularis partial tears , missed four labral pathologies and 4 cases of partial tear reported on USG were not detected on MRI. OF these 24 cases therapeutic decision was changed in only 3 cases (12.5%) in 2patients with labral tears and 1 with massive tear. In all other cases clinical diagnosis, symptom severity, patient desire, and USG findings were deemed sufficient for clinical decision making as well as considered adequate for pre surgical evaluation. In the 20 cases that underwent surgery (out of 92) 17 patients had a full thickness tear and 3 cases had labral pathology which was not detected on USG but was picked up on MRI only.

Cost effectiveness of MRI vs. USG revealed that MR with USG costs 400% more than USG alone. And the benefit of MRI was trivial in view of the large costs incurred. We conclude that including MRI in the diagnostic workup of patients with rotator cuff disease in pts >45yrs adds to total health care expenditure with minimal benefit if any in this age group.

MRI for rotator cuff pathology is patients above 45 years is a sheer waste of health care expenditure and may at best be avoided unless diagnosis is uncertain after USG and physical examination.

Gayathri, S, Baruah, B, Cost-effectiveness of MRI of Rotator Cuff in Elderly: Study in a Developing Country.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8009203.html