Magnetic Resonance Imaging (MRI) for musculoskeletal conditions

Magnetic Resonance Imaging (MRI) is a type of scan that uses a strong magnetic field and radio waves to produce detailed images of the inside of the body.

The conventional MRI is a short cylinder that is open at both ends, you will lie on a motorised bed that is moved inside the scanner. You will enter the scanner either head first or feet first, depending on the part of your body being scanned.

This is a painless procedure that lasts 15-90 minutes depending upon the area to be scanned and how many images to be taken. The MRI scanner makes loud tapping noises at certain times during the procedure, usually, you'll be given earplugs or headphones to wear. The patient is required to stay still/keep the body part being scanned still for the duration of the scan.

You can eat and drink normally. You can drive home afterward and return to work if you need to. There are no known side effects from having an MRI scan. You should try to lie very still to prevent ‘blurred images’ in order to have the required quality images.

Not all patients referred for a specialist opinion require an MRI.  Other investigations may be more appropriate and therefore you need to have an assessment to determine the most appropriate tests for you.  After assessment, a provisional clinical diagnosis will be made.  Further tests may be needed at this point but only in a small number of conditions.

Investigations such as MRI are usually arranged when surgery or other interventions like CT-guided injection or epidural are being considered.  For example, many patients have back pain and it is not necessary to scan the spine to confirm this, however, if it is felt that the problem requires surgery or injection it is important to look at the spine in more detail to make sure surgery or injection could help.  We also arrange MRI if there is suspicion of any serious pathology such as when symptoms suggest that there is pressure on the spinal cord.

We follow Royal College of Radiologist (RCR) guidelines, Back Pain Association, and National Institute of Clinical Excellence (NICE) guidelines to ensure effective, efficient, timely patient-focused care to service users. 

MRI tends to be arranged if symptoms are worsening, or if you have tried a course of exercise or conservative therapy and this has failed.  MRI may also be arranged because we need to see if surgery may help the condition or to clarify which surgery may help.  It is very useful for looking at soft tissue structures, for example muscles and ligaments.

Contra-indications and reasons you may not be able to have an MRI Scan

Before having an MRI scan, you should tell medical staff if:

•         You think you have any metal in your body (see information below)

•         You are pregnant

•         You have a cardiac pacemaker

•         You have had any type of heart surgery

•         You have a cochlear implant, neuro stimulator, or programmable hydrocephalus shunt

•         You have had an injury to your eyes involving metal or metal fragments

•         You have had any operations on your head, eyes, ears or spine

•         You have had any surgery in last 6 weeks.

Metal Implants:

Having something metallic in your body does not necessarily mean you cannot have an MRI scan, but it is important for medical staff carrying out the scan to be aware of it. They can decide on a case–by–case basis if there are any risks, or if further measures need to be taken to ensure the scan is as safe as possible. The section below is a list of the types of metal implants and fragments that may impact on whether you can have a scan:

• pacemaker
• implantable cardioverter defibrillator-ICD
• metal plates, wires, screws or rods
• a nerve stimulator
• a cochlear implant
• a drug pump implant
• brain aneurysm clips
• metallic fragments
• prosthetic artificial heart valves
• penile implants
• eye implants
• intrauterine device (IUD)
• artificial joints
• dental fillings and bridges
• tubal ligation clips, surgical clips, or staples
• some tattoos may also have traces of metal and may affect whether you can have a scan.

Claustrophobia

If you feel you may be claustrophobic, please discuss this with your therapist.  Patients with claustrophobia are advised to try sedation during the procedure to help them to complete the scan.  Your therapist can discuss this with you in more detail.  Once it is agreed that a scan may be appropriate for you they will advise that you speak to your GP well in advance of your MRI scan appointment.  Your GP may prescribe a mild sedative to help you relax during the scan. If you have taken a sedative during the scan, you will need to arrange for a friend or family member to drive you home afterward, as you won’t be able to drive for 24 hours.

We establish whether you need an MRI scan either via our telephone consultation or after the clinical assessment session. If there are no contraindications found for the MRI scan referral this is completed and sent to the scanning Centre/imaging department who will get in touch with you directly to arrange the scan.

You may be asked to change into a gown so you may wish to wear something practical and easy to change out of.

A radiologist will check the scan results shortly after your appointment and will send a report to the referring therapist. At the time of your appointment you'll be told how long this should take (this can range from 4 weeks to 12 weeks). Your follow-up appointment should be arranged, if a follow-up appointment is not already arranged, you will need to contact your Clinician to make an appointment to get your results. The scan can sometimes highlight things we are not expecting and the therapist may be required to inform your GP to look at conditions that are not within our MSK remit.

It is important that you make sure your contact details are up to date so that the imaging team can contact you.  If you have any questions, please speak to your therapist.

Quality statement 2: referral for imaging, LBP and sciatica in over 16s- QS155- (Published July 2017)

www.NoEbackpainprogramme.nhs.uk   (#facts about backs: scans, x-rays, Injections, surgery

NICE guidelines, (NG59) (2016)

Royal College of Radiologist (RCR) Guidelines.