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Study Says MRI Overused As Neuropathy Test

January 24, 2012
Written by: , Filed in: Diagnostic Imaging, Neuroradiology
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How do physicians go about diagnosing peripheral neuropathy? There are almost countless ways, says a new study by researchers at the University of Michigan. The researchers suggest some standardization is in order.

“Currently no standard approach to the evaluation of peripheral neuropathy exists,” said Brian Callaghan, MD, assistant professor of neurology at the University of Michigan Medical School. “We need more research to determine an optimal approach. We do a lot of tests that cost a lot of money, and there’s no agreement on what we’re doing.”

Dr. Callaghan led the research. He was quoted in a University of Michigan Health System news release.

The study was published Monday in Archives of Internal Medicine. It examined the use of 15 “relevant” tests in diagnosing the disorder. The closest thing to a standard approach right now is an MRI of the brain or spine, which was used for 23.2 percent of the patients studied.

Unfortunately, the researchers think that’s a bad idea. They’d prefer a glucose tolerance test, which was used for only 1 percent of the patients. Here’s how the study puts it:

Almost one-quarter of patients receiving neuropathy diagnoses undergo high-cost, low-yield magnetic resonance imaging, whereas few receive low-cost, high-yield glucose tolerance tests.

The most common cause of the nerve dysfunction that characterizes peripheral neuropathy is diabetes. Hence the efficacy of a glucose tolerance test.

Of course, there can be a lot of other causes too, some of which MRI does detect well. However, expect health care’s cost-cutting forces to target its use, at least as a first option. As Dr. Callaghan put it: “Our findings, that MRIs were frequently ordered by physicians but a lower-cost glucose tolerance test was rarely ordered, show that there is substantial opportunity to improve efficiency in the evaluation of peripheral neuropathy.”

Related seminar: Diagnostic Imaging Review: For Residents, Fellows and Radiologists


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