The Scan That Didn't Scan

The New York Times—October 13, 2008

This is a story about M.R.I.'s, those amazing scans that can show tissue injury and bone damage, inflammation and fluid accumulation. Except when they can't and you think they can.

I found out about magnetic resonance imaging tests when I injured my forefoot running. All of a sudden, halfway through a run, my foot hurt so much that I had to stop.

But an M.R.I. at a local radiology center found nothing wrong.

That, of course, was what I wanted to hear. So I spent five days waiting for it to feel better, taking the anti-inflammatory drugs ibuprofen and naproxen, using an elliptical cross-trainer, and riding my road bike with its clipless pedals that attach themselves to my bicycling shoes. By then, my foot hurt so much I had to walk on my heel. I was beginning to doubt that scan: it was hard to believe nothing was wrong. So I went to Hospital for Special Surgery in New York for a second opinion from Dr. John G. Kennedy, an orthopedist who specializes in sports-related lower-limb injuries. And there I had another M.R.I.

It showed a serious stress fracture, a hairline crack in a metatarsal bone in my forefoot. It was so serious, in fact, that Dr. Kennedy warned that I risked surgery if I continued activities like cycling and the elliptical cross-trainer, which make such injuries worse. And I had to stop taking anti-inflammatory drugs, since they impede bone healing.

How could M.R.I.'s have come to such different conclusions?

I asked Dr. Kennedy the same question and received the same answer. He explained that in my case the quality of the two images was vastly different. "It's like the difference between a black-and-white TV and HDTV," he said.

Read the full story at nytimes.com.