Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
To determine whether magnetic resonance imaging (MRI) is necessary for a patient with suspected musculoskeletal disorders, consider the following key points:
- Suspected spinal metastases or metastatic spinal cord compression (MSCC): Offer an MRI scan urgently if there is clinical suspicion of MSCC, to be performed as soon as possible and within 24 hours at a local hospital with imaging facilities. For suspected spinal metastases without MSCC suspicion, offer MRI within 1 week to guide treatment options NICE NG234.
- Myeloma suspicion: Offer imaging to all people with a plasma cell disorder suspected to be myeloma, with whole-body MRI considered as first-line imaging NICE NG35.
- Neurological symptoms suggestive of multiple sclerosis (MS): MRI is part of the diagnostic process combined with history, examination, and laboratory findings, especially when neurological symptoms consistent with MS are present NICE NG220.
- Contraindications and alternatives: If MRI is contraindicated, consider CT scanning for suspected spinal metastases or MSCC NICE NG234.
- Do not use plain X-rays to diagnose or rule out spinal metastases or MSCC as they are not appropriate for this purpose NICE NG234.
In general, MRI is necessary when clinical features suggest serious underlying pathology such as spinal metastases, MSCC, myeloma-related bone disease, or neurological conditions like MS. The decision should be guided by clinical suspicion, urgency of diagnosis, and availability of imaging modalities.