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When Do I Need A Musculoskeletal Ultrasound Versus MRI?

Theodore Miller, MD, FACR, Chief, Division of Ultrasound at HSS.
Theodore Miller, MD, FACR, Chief, Division of Ultrasound at HSS. Photo Credit: Hospital for Special Surgery

Ultrasound (US) and Magnetic Resonance Imaging (MRI) are advanced imaging modalities that are excellent for evaluating patients with musculoskeletal pain or abnormalities. These imaging studies are often complementary to each other, with MRI providing an unparalleled overview of anatomy including cartilage, bones and soft tissues, while US provides a high resolution focused examination of a particular structure. Additional advantages of MRI are the ability to image large parts of the body and to detect subtle changes in the appearances of the anatomic structures. US can be quickly performed and is not hindered by the presence of orthopedic hardware. Additionally, US can scan in real time, which allows the dynamic assessment of abnormalities or pain that only occur when the patient is moving, and allows the guidance of needle placement for procedures such as steroid injections and aspirations of fluid collections.

At HSS, radiographs (“x-rays”) are usually obtained first in the work-up of a painful or injured body part. If the radiographs are inconclusive or are suggestive of additional abnormalities, the clinician usually requests an MRI for further evaluation. US may be a reasonable alternative for patients with contraindications to MRI such as pacemakers, wire implants and severe claustrophobia. Many conditions demonstrated on MRI, such as arthritis, bursitis or tendonitis, can be treated with conservative measures such as rest, physical therapy or a steroid injection. While some steroid injections are performed blindly by clinicians, the use of US guarantees the correct placement of the needle and assures the steroid is going to the appropriate target.

As leaders in orthopedic and musculoskeletal abnormalities, HSS clinicians are supported by radiologists who are world experts in MR imaging and ultrasound. At the HSS Stamford facility at Chelsea Piers, patients can be assured that they are getting the same world-quality MR imaging and sonography that they would if they traveled to the main campus in New York City. Integration of our imaging modalities allows HSS radiologists and clinicians access to patient’s studies, regardless of which HSS facility in which it was performed. We run an ultrasound schedule on Fridays at HSS Stamford, bringing our expertise from the main hospital to the local community.