Appropriateness of the Use of MRI in the Diagnosis and Treatment of Wrist Ligamentous Injury.

Background: When diagnosing wrist ligamentous injury, we hypothesize that MRI is used injudiciously and is associated with unnecessary cost. Methods: A retrospective review was conducted of patients, ages 20-60 years, who underwent an MRI for possible wrist ligamentous injury at a tertiary care center between 2009 and 2014. Treatment recommendation was classified as non-operative, operative, or equivocal. If the MRI-directed treatment recommendation differed from the pre-MRI treatment recommendation, we noted that the MRI influenced patient care (impact study). The cost estimate of an impact study was calculated by dividing the total studies performed by the number of studies that impacted the treatment recommendation and multiplying this value by the institutional wrist MRI cost (USD $2,246, 2016). Results: 140 patients were included. MRI affected treatment recommendation in 28% of patients. Independent predictors of MRI impact on treatment recommendation were: "question specific injury," or "question scapholunate injury." (OR 9.46 (3.18 - 28.16), P