What does 'suggestive' mean in the context of Magnetic Resonance Imaging (MRI) findings?

Understanding "Suggestive" in MRI Terminology

In MRI reporting, "suggestive" means the imaging findings raise suspicion for a particular diagnosis but are not definitive or confirmatory—they require correlation with clinical findings, additional testing, or follow-up imaging to establish a diagnosis.

Clinical Meaning and Diagnostic Framework

The term "suggestive" in radiology represents a middle ground between confirmatory and normal findings:

• Suggestive findings indicate increased probability of disease but lack the specificity to make a definitive diagnosis on imaging alone 1
• These findings must be interpreted alongside clinical signs, laboratory markers, and sometimes tissue sampling to reach a final diagnosis 1
• Radiologists use "suggestive" when imaging features are compatible with a condition but could also represent alternative diagnoses or normal variants 1

Practical Examples from Clinical Guidelines

In Fracture-Related Infection

• Radiological signs like implant loosening, bone lysis, or periosteal bone formation are categorized as "suggestive" rather than confirmatory criteria 1
• Even nuclear imaging with high diagnostic accuracy remains "suggestive" and cannot alone establish the presence of infection 1
• Confirmatory diagnosis requires microbiological evidence (pathogens from multiple tissue specimens) or histopathology, not imaging alone 1

In Autoimmune Encephalitis

• MRI findings must show focal or multifocal brain pathology "suggestive of" autoimmune encephalitis before proceeding with confirmatory testing 1
• The diagnostic algorithm explicitly requires confirmation through CSF analysis and antibody testing, as imaging alone is insufficient 1

In Axial Spondyloarthritis

• Radiologists should state whether findings are "compatible with" or "suggestive of" the condition rather than making the final diagnosis 1
• The conclusion should communicate uncertainty clearly when findings are equivocal, avoiding vague terms like "likely" or "suspicion of" 1

Critical Pitfalls to Avoid

• Do not treat "suggestive" findings as diagnostic—they require clinical correlation and often additional testing 1
• MRI abnormalities may be present in asymptomatic patients; abnormal imaging does not always correspond to clinical symptoms 1, 2
• In cervical spine imaging, abnormal MRI levels frequently do not match clinical examination findings, emphasizing the need for correlation 1, 2
• A negative or equivocal MRI does not exclude disease—clinical suspicion should guide further workup 1

When Additional Imaging or Testing Is Needed

• If MRI findings are suggestive but inconclusive, radiologists should recommend further imaging modalities based on clinical context 1
• For suspected autoimmune encephalitis with negative MRI, brain PET scanning can confirm focal or multifocal abnormalities 1
• In fracture-related infection, tissue culture from multiple deep specimens is required despite suggestive imaging 1
• Follow-up imaging may be necessary to determine if suggestive lesions progress, remain stable, or resolve 1

Communication in Radiology Reports

• The conclusion should clearly state the degree of confidence in interpretation and whether findings are suggestive versus confirmatory 1
• Differential diagnoses should be listed with their relative probabilities, especially if more likely than the suspected condition 1
• Any uncertainty in image quality or interpretation must be communicated to help clinicians contextualize divergent clinical findings 1
• Reports should avoid ambiguous language and instead use clear, unequivocal statements about the level of diagnostic certainty 1