The incremental impact of cardiac MRI on clinical decision-making.
OBJECTIVE
Despite a significant expansion in the use of cardiac MRI (CMR), there is inadequate evaluation of its incremental impact on clinical decision-making over and above other well-established modalities. We sought to determine the incremental utility of CMR in routine practice.


METHODS
629 consecutive CMR studies referred by 44 clinicians from 9 institutions were evaluated. Pre-defined algorithms were used to determine the incremental influence on diagnostic thinking, influence on clinical management and thus the overall clinical utility. Studies were also subdivided and evaluated according to the indication for CMR.


RESULTS
CMR provided incremental information to the clinician in 85% of cases, with incremental influence on diagnostic thinking in 85% of cases and incremental impact on management in 42% of cases. The overall incremental utility of CMR exceeded 90% in 7 out of the 13 indications, whereas in settings such as the evaluation of unexplained ventricular arrhythmia or mild left ventricular systolic dysfunction, this was <50%.


CONCLUSIONS
CMR was frequently able to inform and influence decision-making in routine clinical practice, even with analyses that accepted only incremental clinical information and excluded a redundant duplication of imaging. Significant variations in yield were noted according to the indication for CMR. These data support a wider integration of CMR services into cardiac imaging departments.


CONCLUSIONS
These data are the first to objectively evaluate the incremental value of a UK CMR service in clinical decision-making. Such data are essential when seeking justification for a CMR service.
1 Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK.
Adil
http://orcid.org/0000-0002-4196-7205
A
Rajwani
1 Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK.
Michael J
MJ
Stewart
1 Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK.
James D
JD
Richardson
2 Department of Cardiology, University Hospital of North Tees, Stockton-on-Tees, UK.
Nicholas M
NM
Child
1 Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK.
Neil
N
Maredia
D000066491:Clinical Decision-Making; D006331:Heart Diseases / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests