Cote David J, Laws Edward R
Neurosurgery. 2017 May 1;80(5):816-819. doi: 10.1093/neuros/nyw180.
The use of magnetic resonance imaging (MRI) for evaluation of headache remains excessive among physicians across many specialties according to both the American Headache Society and the American College of Radiology, despite recent attempts at limiting overuse of imaging and procedures. As part of the Choosing Wisely campaign, both of these organizations have explicitly recommended against imaging in patients with uncomplicated or typical migraine headaches. Yet, the practice nevertheless remains prevalent, with estimates ranging from 12.4% to 15.9% of patients with uncomplicated headache receiving MRI in outpatient practices. The low prevalence of serious pathological findings on imaging in patients who present without other indicative symptoms and the high cost of such exams necessitates a thorough evaluation of appropriate use of MRI for headache. Here, we debate the problematic use of MRI for uncomplicated headache and put forth a discussion of possible interventions that could promote more efficient use of imaging. Overuse of imaging has the potential to open a box that cannot readily be closed, and physicians upstream of surgical decision making must remain aware of the downstream effects of their clinical choices.
根据美国头痛协会和美国放射学会的说法，尽管最近一直在尝试限制影像学检查和治疗手段的过度使用，但在许多专业的医生中，使用磁共振成像（MRI）来评估头痛的情况仍然过多。作为“明智选择”运动的一部分，这两个组织都明确建议不要对患有单纯性或典型偏头痛的患者进行影像学检查。然而，这种做法仍然很普遍，据估计，在门诊治疗中，12.4%至15.9%的单纯性头痛患者接受了MRI检查。在没有其他指示性症状的患者中，影像学检查发现严重病理结果的比例较低，而且此类检查成本高昂，因此有必要对头痛患者MRI的合理使用进行全面评估。在此，我们对MRI用于单纯性头痛的问题使用进行辩论，并对可能促进更有效利用影像学检查的干预措施展开讨论。影像学检查的过度使用可能会打开一个难以轻易关闭的潘多拉魔盒，手术决策上游的医生必须意识到他们临床选择的下游影响。
