What are the next steps after receiving an MRI result?

Next Steps After Receiving an MRI Result

The next steps after receiving an MRI result depend entirely on the findings: if normal, reassure the patient and proceed with clinical correlation; if abnormal, initiate appropriate follow-up imaging, specialist referral, or intervention based on the specific pathology identified.

Immediate Post-MRI Actions

Review and Interpretation

• Multisequence evaluation is essential—never rely on a single image type. Review all diffusion-weighted images (DWI), apparent diffusion coefficient (ADC) maps, T1-weighted, T2-weighted, and fat fraction images together using image linking and coregistration tools 1.
• The radiologist should provide a structured report with clear findings and recommendations for next steps 1.

Communication of Results

• Most patients (63%) prefer receiving imaging results from their referring physician rather than directly from the radiologist 2.
• However, 92% of patients want to know if results are normal, and 87% want to know if results are abnormal (including serious findings like cancer), regardless of who delivers the news 3.
• 64% of patients want access to their radiology report, and 85% want to see their images 2.

Clinical Context-Specific Next Steps

For Suspected Infection, Inflammation, or Neoplasm

If MRI is negative:

• Rule out the suspected pathology and avoid further invasive testing 1.
• For diabetic foot osteomyelitis specifically, negative MRI (maintained intramedullary fat signal and intact cortical signal) effectively rules out infection—no biopsy needed 1.

If MRI shows septic joint:

• Immediate surgical debridement and intraoperative cultures are required due to high risk of bacteremia (approximately 70% of cases) 1.

If MRI is positive for osteomyelitis/discitis:

• Check for presence of ulcer or sinus tract 1.
• If ulcer/sinus present: obtain wound cultures from tissues closest to bone (avoid swabs due to contamination risk) 1.
• If no ulcer/sinus: consider percutaneous image-guided biopsy after multidisciplinary discussion 1.

For pediatric back pain with suspected infection/inflammation/tumor:

• Obtain contrast-enhanced MRI if not already done—gadolinium is particularly useful for discitis/osteomyelitis and neoplasm 1.
• Precontrast images must be obtained first to properly assess enhancement 1.
• If multifocal disease suspected, complete spine MRI is indicated rather than targeted imaging 1.

For Myelopathy

If initial MRI shows:

• Vascular malformation: Follow up with MRA to demonstrate abnormal vasculature and guide potential spinal arteriography 1.
• Arachnoid cyst/web or ventral cord herniation: Consider CT myelography for further evaluation 1.
• Positional myelopathy concern: Extension/flexion positional CT myelography may be needed 1.
• Severe canal stenosis: CT myelography can provide additional detail before surgical intervention 1.

For Pituitary Adenomas (Pediatric/Adolescent)

Post-operative surveillance schedule 1:

• MRI at 3 months post-surgery to assess residual tumor
• MRI at 6 months to assess for recurrence
• If stable, MRI at 1,2,3, and 5 years with gradual reduction in frequency thereafter
• Lifelong clinical surveillance for macroadenomas

For incidental findings 1:

• Microincidentalomas: MRI at 12 months, then 1-2 year intervals for 3 years if stable, with gradual reduction thereafter
• Macroincidentalomas: MRI at 6 months, then annually for 3 years if stable, with gradual reduction thereafter (but lifelong surveillance)

For Multiple Sclerosis Monitoring

Treatment response monitoring 1:

• Perform follow-up brain MRI (T2-weighted and contrast-enhanced T1-weighted) at 12 months after starting disease-modifying drugs (DMDs)
• Consider reference scan at 6 months after treatment initiation to account for drug mechanism of action 1
• Compare to baseline pretreatment scan 1

For patients on high-risk immunosuppressive therapy (natalizumab, alemtuzumab, rituximab, dimethyl fumarate):

• Enhanced pharmacovigilance with MRI every 3-4 months to monitor for progressive multifocal leukoencephalopathy (PML) 1
• Use T2-weighted, T2-FLAIR, and diffusion-weighted imaging 1
• Frequency adjusted based on individual PML risk factors (treatment duration, prior immunosuppression, JC virus antibody status) 1

Common Pitfalls to Avoid

• Do not order MRI with contrast only—precontrast images are essential to properly assess enhancement 1.
• Avoid relying on single-sequence interpretation—multisequence evaluation prevents diagnostic errors 1.
• Be aware of false-positive findings: fractures, osteoarthritis, hemangiomas, enchondromas, focal red marrow, and lymphoid tissue hypertrophy can mimic malignancy 1.
• Be aware of false-negative findings: background bone marrow hypercellularity (young age, anemia), sparse tumor infiltration, and areas of body movement can obscure pathology 1.
• Do not delay communication of serious findings—patients want to know abnormal results promptly, even if from the radiologist directly 3.

Documentation and Follow-Up

• Ensure the patient receives a copy of their report if desired (64% want this access) 2.
• Document clinical correlation between MRI findings and patient symptoms 1.
• Schedule appropriate follow-up imaging based on specific pathology and clinical guidelines 1.
• Coordinate with specialists (neurology, orthopedics, infectious disease, oncology) as indicated by findings 1.