Like the difference between black and white TV and HDTV: Misdiagnosis of an MRI scan

Jim Glanz, the Baghdad bureau chief for the New York Times, was playing touch football in New York in late 2005 when he landed hard while diving to make a catch, both elbows hitting the ground at once. The next day, his fingers and hands hurt so much he couldn't type.

But an MRI showed nothing except some bulging disks in his neck that, he was told, were common in people his age, 50. He was advised to do neck exercises, and eventually he felt better.

About a year later, he fell again while playing football. His symptoms came roaring back.

The worst was when he woke up in the morning, Jim said. The two middle fingers on each hand were so stiff they would not even bend. He would massage his fingers and loosen them, but his hands and knuckles ached all day. He tried ibuprofen, to little avail.

Finally, last spring, he sought help at the NYU Hospital for Joint Diseases, where he had another MRI. It turned out that he had a nerve impingement so serious that he was warned that he risked permanent paralysis if he did not have surgery. So this summer, he had a major operation called a French-door laminoplasty, in which his surgeon opened and widened four or five vertebrae to free the trapped nerves.

How could his MRI’s have come to such different conclusions? MRI machines vary in four ways: First, some use higher quality, more sensitive imaging coils that surround the body parts being scanned. Second, their computer programs vary in the way they form the images. Third, some technicians are much more skilled than others. Fourth, the strength of the machines' magnets varies. The difference can be like the difference between seeing a black-and-white TV versus HDTV, says Dr. John Kennedy of the Hospital for Special Surgery in New York.

Advice to people about to have an MRI: Make sure the radiology center is accredited by the American College of Radiology.

Read another MRI story.

Thanks to Gina Kolata for the source article in Tuesday's New York Times.