Unidentified Bright Objects

A recent article in the New York Times discussing the use of MRIs in orthopedics caught my attention.
 
The article mentions a study where 31 healthy baseball pitchers received MRIs of their shoulders. According to the study, “The pitchers were not injured and had no pain. But the MRI’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent." One doctor mentioned in the article commented, “It is very rare for an MRI to come back with the words ‘normal study.' I can’t tell you the last time I’ve seen it.” The article mentioned another study, which found that with regards to patients with foot and ankle injuries who received MRIs, “Nearly 90 percent of those scans were unnecessary and half had interpretations that either made no difference to the patient’s diagnosis or were at odds with the diagnosis.”
 
Although the reason I am mentioning this article in a blog about MS might not be obvious to patients with MS, the relevance would certainly be clear to any neurologist who treats patients with MS. Every month, several patients are referred to our office for an evaluation of MS who have received an MRI for some nebulous reason. My experience is very similar to the sports medicine doctor quoted above is that quite often, an MRI is not “normal.”
 
Many perfectly healthy people will have abnormalities on their MRI that are of no clinical significance. Often, these abnormalities can be mistaken for the lesions of MS.  In fact, they are so common that radiologists informally call them UBOs or “unidentified bright objects.” Sometimes, patients have many UBOs, and we have no idea why or what they mean. When confronted with this picture, the radiologist will often give a long list of possibilities that the lesions could be. Many patients are naturally frightened when the radiologist’s report says that these lesions could be “ischemic, infectious, vasculitis, demyelinating, or due to migraine.”
 
So how should neurologists and patients handle such cases? The MRI is an extraordinarily powerful machine. I always tell my patients that if I examined their skin with a magnifying glass, I could probably find dozens of "lesions." This does not mean they have a dermatological problem. Neurologists pride themselves on being some of the last batch of doctors who believe the best way to evaluate their patients is to talk to and examine their patients. Occasionally, I have met patients who have been improperly diagnosed with MS, I believe, and have taken burdensome medicines and lived with a worrisome diagnosis for many years. Yes, the MRI is incredibly valuable in MS and other neurological illness. However, abnormalities found on the MRI must be interpreted in the proper context. It should not take the place of a careful examination of the patient.