METHOD: Peer reviewed English language publications of human, Therapeutic Studies only – investigating the efficacy of low-field magnetic resonance imaging for extremities vs. high field were evaluated.

The preponderance of studies are favorable and >25% are Level II and are 4:1 vs. unfavorable which are >25% Level II. Neutral studies are least in number and are Level II.

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LOW – FIELD MRI
Studies Favorable: Total 29

Level II: 25 Studies

1. The smallest detectable difference and sensitivity to change of magnetic resonance imaging and radiographic scoring of structural joint damage in rheumatoid arthritis finger, wrist, and toe joints: a comparison of the OMERACT rheumatoid arthritis magnetic resonance imaging score applied to different joint combinations and the Sharp/van der Heijde radiographic score .
Ejbjerg BJ, Vestergaard A, Jacobsen S, Thomsen HS, Østergaard M.
Arthritis Rheum. 2005 Aug;52(8):2300-6.
Prospective non-randomized, comparative study on 35 RA and 9 healthy control patients; low field MRI regardless of method is more sensitive to detecting differences in RA patients than radiography.
Level II – Favorable

2. Diagnostic quality and scoring of synovitis, tenosynovitis and erosions in low-field MRI of patients with rheumatoid arthritis: a comparison with conventional MRI.
Schirmer C, Scheel AK, Althoff CE, Schink T, Eshed I, Lembcke A, Burmester GR, Backhaus M, Hamm B, Hermann KG.
Ann Rheum Dis. 2007 Apr;66(4):522-9. Epub 2006 Oct 26.
Prospective non-randomized, comparative study of 17 patients with RA; Concludes that low-field MRI scanners are clinically useful in evaluating patients with RA.
Level II – Favorable

3. Low field dedicated magnetic resonance imaging in untreated rheumatoid arthritis of recent onset.
Lindegaard H, Vallø J, Hørslev-Petersen K, Junker P, Østergaard M.
Ann Rheum Dis. 2001 Aug;60(8):770-6.
Prospective non-randomized, comparative study on 25 untreated RA patients of recent onset and 3 healthy control patients; low-field MRI is more sensitive to inflammation and destructive changes in RA patients than radiography.
Level II – Favorable

4. Optimised, low cost, low field dedicated extremity MRI is highly specific and sensitive for synovitis and bone erosions in rheumatoid arthritis wrist and finger joints: comparison with conventional high field MRI and radiography.
Ejbjerg BJ, Narvestad E, Jacobsen S, Thomsen HS, Østergaard M.
Ann Rheum Dis. 2005 Sep;64(9):1280-7. Epub 2005 Jan 13.
Prospective non-randomized study on 37 RA patients and 28 healthy control patients; low-field MRI provides high accuracy for detection and grading erosions and synovitis.
Level II – Favorable

5. Results of a prospective multicenter study for evaluation of the diagnostic quality of an open whole-body low-field MRI unit. A comparison with high-field MRI measured by the applicable gold standard.
Merl T, Scholz M, Gerhardt P, Langer M, Laubenberger J, Weiss HD, Gehl HB, Wolf KJ, Ohnesorge I.
Eur J Radiol. 1999 Apr;30(1):43-53.
Prospective non-randomized study on 401 patients with diseases of the kidney, shoulder, spine and cerebrum in four participating center; no statistically relevant difference in high-?eld MRI diagnosis compared to low-?eld MRI diagnostic accuracy measured by clinical or surgical gold standard in three of the four regions examined.
Level II – Favorable

6. Accuracy of imaging the menisci on an in-office, dedicated, magnetic resonance imaging extremity system.
Franklin PD, Lemon RA, Barden HS.
Am J Sports Med. 1997 May-Jun;25(3):382-8.
Prospective, non-randomized study on 35 patients with knee symptoms who subsequently had arthroscopic evaluation; The low-field MRI system specificity and sensitivity equal to or better than previous reports with high-field systems, low-field system eliminated false-positive results that has been found in some studies using high-field systems.
Level II – Favorable

7. Diagnostic performance of low field MRI in acute knee injuries.
Kinnunen J, Bondestam S, Kivioja A, Ahovuo J, Toivakka SK, Tulikoura I, Karjalainen T.
Magn Reson Imaging. 1994;12(8):1155-60.
Prospective, non-randomized double-blind study among 33 patients with acute knee injuries; low field MRI equalled that reported earlier for high field MRI, the only exception being the sensitivity for lateral meniscus lesions.
Level II – Favorable

8. Comparison of low-field (0.2 Tesla) and high-field (1.5 Tesla) magnetic resonance imaging of the knee joint.
Kladny B, Glückert K, Swoboda B, Beyer W, Weseloh G.
Arch Orthop Trauma Surg. 1995;114(5):281-6.
Prospective, non-randomized study involving 22 patients; The results suggest that both systems are reliable in diagnosing meniscal tears and ruptures of the anterior cruciate ligament; low-field MRI is an alternative to high-field imaging, lowers cost.
Level II – Favorable

9. M.R. imaging of the knee: a prospective trial using a low field strength magnet.
James P, Buirski G.
Australas Radiol. 1990 Feb;34(1):59-63.
Prospective, double blind non-randomized study. 50 patients examined with 0.3 Tesla low field strength scanner to assess the diagnostic accuracy of knee MRI. These results compare favourably with other diagnostic modalities including knee arthroscopy. MR Imaging is good at showing meniscal lesions, cleavage tears, complete cruciate ligament tears.
Level II – Favorable

10. 0.2-Tesla magnetic resonance imaging of internal lesions of the knee joint: a prospective arthroscopically controlled clinical study.
Riel KA, Reinisch M, Kersting-Sommerhoff B, Hof N, Merl T.
Knee Surg Sports Traumatol Arthrosc. 1999;7(1):37-41.
Prospective, non-randomized study comparing low-field MRI imaging with arthroscopy on 244 patients. MRI with a 0.2-T magnet is a safe and valuable adjunct to the clinical examination of the knee and an aid to efficient preoperative planning.
Level II – Favorable

11. Diagnosis of scaphoid fracture and dedicated extremity MRI.
Bretlau T, Christensen OM, Edström P, Thomsen HS, Lausten GS.
Acta Orthop Scand. 1999 Oct;70(5):504-8.
Prospective, non-randomized study; 52 patients with clinical suspicion of a scaphoid fracture and normal initial radiographs; The agreement between the two examiners was high (kappa = 0.8) for E-MRI detection of fractures. E-MRI seems to be better than radiographs in the early diagnosis of occult fractures of the scaphoid bone and the wrist.
Level II – Favorable

12. Low-cost, low-field dedicated extremity magnetic resonance imaging in early rheumatoid arthritis: a 1-year follow-up study.
Lindegaard HM, Vallø J, Hørslev-Petersen K, Junker P, Østergaard M.
Ann Rheum Dis. 2006 Sep;65(9):1208-12. Epub 2006 Mar 15.
Prospective, non-randomized study; 24 previously untreated patients with rheumatoid arthritis; E-MRI at the time of diagnosis of rheumatoid arthritis provides information about the risk of developing irreversible joint damage within the subsequent year.
Level II – Favorable

13. Diagnosis of lumbar disc protrusion. A comparison between magnetic resonance imaging and radiculography.
Szypryt EP, Twining P, Wilde GP, Mulholland RC, Worthington BS.
J Bone Joint Surg Br. 1988 Nov;70(5):717-22.
Prospective, non-randomized comparative study. Forty-two consecutive patients with suspected lumbar disc protrusions were studied with low-field MRI and radiculography. These results indicate that low field strength MRI is slightly better than radiculography in diagnosing lumbar disc protrusions.
Level II – Favorable

14. MR imaging of lung parenchyma at 0.2 T: evaluation of imaging techniques, comparative study with chest radiography and interobserver analysis.
Abolmaali ND, Schmitt J, Krauss S, Bretz F, Deimling M, Jacobi V, Vogl TJ.
Eur Radiol. 2004 Apr;14(4):703-8. Epub 2004 Feb 10.
Prospective randomized, comparative study; 101 patients receiving low-field MRI, postero-anterior and lateral chest radiographs of lung parenchyma. Low-field MRI of the lung parenchyma using the CISS sequence is well comparable with chest radiography and demonstrates slight advantages resulting from the cross-sectional imaging technique.
Level II – Favorable

15. Low field strength magnetic resonance imaging of the neonatal brain.
Whitby EH, Paley MN, Smith MF, Sprigg A, Woodhouse N, Griffiths PD.
Arch Dis Child Fetal Neonatal Ed. 2003 May;88(3):F203-8. Erratum in: Arch Dis Child Fetal Neonatal Ed. 2004 Jan;89(1):F40.
Prospective, controlled, non-randomized, double blind comparative study. 134 premature and term babies. Low field strength MR scanning is well tolerated by neonates and provides a valuable additional modality to ultrasound on the neonatal intensive care unit.
Level II – Favorable

16. Mass screening for retrocochlear disorders: low-field-strength (0.2-T) versus high-field-strength (1.5-T) MR imaging.
Dubrulle F, Delomez J, Kiaei A, Berger P, Vincent C, Vaneecloo FM, Lemaitre L.
AJNR Am J Neuroradiol. 2002 Jun-Jul;23(6):918-23.
Prospective, non-randomized comparative study on 287 patients with suspected retrocochlear disease. Patients imaged with high-field MRI and positive patients were then imaged with low-field MRI. MR imaging at 0.2 T provided high sensitivity in detecting vestibular schwannoma of the internal auditory canal or cerebellopontine angle.
Level II – Favorable

17. Magnetic resonance diagnosis of the anterior labrum and capsule. Effect of field strength on efficacy.
Allmann KH, Walter O, Laubenberger J, Uhl M, Buitrago-Tellez CH, Biebow N, Langer M.
Invest Radiol. 1998 Jul;33(7):41520.
Prospective, non-randomized comparative study. 35 patients were examined by both low and high-field MR systems to evaluate shoulder instability. Imaging at 0.2 T does not adversely affect the assessment of shoulder instability when compared with imaging at 1.0 T.
Level II – Favorable

18. Local staging of prostate cancer with 0.2 T body coil MRI.
Deasy NP, Conry BG, Lewis JL, Ford TF, Russell GA, Basu R, Flanagan JJ.
Clin Radiol. 1997 Dec;52(12):933-7.
Prospective non-randomized study. 53 patients with prostate cancer were examined with low-field MRI. It is concluded that a high level of staging accuracy, comparable to that obtained in some published studies using high field strength endorectal coil MRI, can be obtained using 0.2 T body coil MRI.
Levell II – Favorable

19. MRI preferable to diagnostic arthroscopy in knee joint injuries. A double-blind comparison of 47 patients.
Rappeport ED, Wieslander SB, Stephensen S, Lausten GS, Thomsen HS.
Acta Orthop Scand. 1997 Jun;68(3):277-81.
Prospective, non-randomized, double blind comparison study. 47 patients with knee joint injuries. low-field MRI can be used as a first-line diagnostic examination in patients with suspected meniscus or cruciate ligament injuries and thus a substantial number of negative diagnostic arthroscopies can be avoided.
Level II – Favorable

20. Low-field compact magnetic resonance imaging system for the hand and wrist in rheumatoid arthritis.
Yoshioka H, Ito S, Handa S, Tomiha S, Kose K, Haishi T, Tsutsumi A, Sumida T.
J Magn Reson Imaging. 2006 Mar;23(3):370-6.
Prospective, non-randomized study; 13 patients with hand and wrist pains (including pain from RA) and 13 healthy controls with no clinical symptoms of arthritis; RA was correctly evaluated, and early RA could be identified with the compact MRI system but with limitations.
Level II – Favorable

21. The influence of MR field strength on the detection of focal liver lesions with superparamagnetic iron oxide.
Deckers F, Corthouts B, Nackaerts Y, Ozsarlak O, Parizel PM, De Schepper AM.
Eur Radiol. 1997;7(6):887-92.
Prospective, non-randomized comparative study. 20 patients with focal liver lesions on CT or US, or strong clinical suspicion of focal liver disease. Although subjective image quality is significantly better on the high-field system, this does not result in better lesion detection or better lesion conspicuity.
Level II – Favorable

22. MR equipment acquisition strategies: low-field or high-field scanners.
Martí-Bonmatí L, Kormano M.
Eur Radiol. 1997;7 Suppl 5:263-8. Review.
Literature review containing 4 star prospective studies on comparisons of high and low-field MRI. Concludes the difference between low and high-field MRI is lower than clinicians and radiologists tend to believe.
Level II – Favorable

23. Anterior cruciate ligament tear: prospective evaluation of diagnostic accuracy of middle- and high-field-strength MR imaging at 1.5 and 0.5 T.
Vellet AD, Lee DH, Munk PL, Hewett L, Eliasziw M, Dunlavy S, Vidito L, Fowler PJ, Miniaci A, Amendola A.
Radiology. 1995 Dec;197(3):826-30.
Prospective, non-randomized comparative study. 205 patients with suspected diagnosis of ACL tear or knee abnormalities. Higher field strength does not confer higher accuracy in the diagnosis of ACL tears at MR imaging.
Level II – Favorable

24. MR imaging field strength: prospective evaluation of the diagnostic accuracy of MR for diagnosis of multiple sclerosis at 0.5 and 1.5 T.
Lee DH, Vellet AD, Eliasziw M, Vidito L, Ebers GC, Rice GP, Hewett L, Dunlavy S.
Radiology. 1995 Jan;194(1):257-62.
Prospective, non-randomized comparative study. 132 patients with suspected multiple sclerosis underwent MRI imaging. Higher field strength does not confer higher accuracy in the diagnosis of multiple sclerosis with current-generation MR imagers.
Level II – Favorable

25. Postoperative pulmonary vascular supply in congenital heart disease evaluated with MR imaging at 0.3 T.
Malmgren N, Brockstedt S, Johansson J, Björkhem G.
Acta Paediatr Suppl. 1995 Aug;410:63-8.
27 patients operated for complex congenital heart disease underwent cardiac MR imaging. MR imaging at 0.3 T is an effective non-invasive tool for postoperative evaluation of pulmonary arteries.
Level II – Favorable

Level III: 3 Studies

1. Low-field MR arthrography of the shoulder joint: technique, indications, and clinical results.
Kreitner KF, Loew R, Runkel M, Zöllner J, Thelen M.
Eur Radiol. 2003 Feb;13(2):320-9. Epub 2002 Aug 28.
Level III – Favorable

2. A retrospective analysis of low-field strength magnetic resonance imaging and the management of patients with rheumatoid arthritis.
Schiff MH, Hobbs KF, Gensler T, Keenan GF.
Curr Med Res Opin. 2007 May;23(5):961-8.
Retrospective comparative study of 300 RA patients that underwent in-office MRI scans; There was an association of MRI detection of joint space narrowing, erosion, and/or bone edema and change in therapeutic management due to MRI findings.
Level III – Favorable

3. Evaluation of the rotator cuff and glenoid labrum using a 0.2-Tesla extremity magnetic resonance (MR) system: MR results compared to surgical findings.
Shellock FG, Bert JM, Fritts HM, Gundry CR, Easton R, Crues JV 3rd.
J Magn Reson Imaging. 2001 Dec;14(6):763-70.
Retrospective comparative study, 47 patients that underwent MRI using a 0.2-Tesla extremity MR system (E-scan) to the surgical findings; good agreement comparing the MR results obtained using the low-field extremity MR system to the surgical findings for determination of lesions of the rotator cuff and glenoid labrum. Notably, the statistical values determined for the use of this MR system were comparable.
Level III – Favorable

Level V: 1 Study

1. Utilization of low-field MR scanners.
Hayashi N, Watanabe Y, Masumoto T, Mori H, Aoki S, Ohtomo K, Okitsu O, Takahashi T.
Magn Reson Med Sci. 2004 Apr 1;3(1):27-38. Review.
Level V – Favorable
Opinion.

LOW – FIELD MRI
Studies Unfavorable: Total 8

Level I: 1 Study

1. Acute wrist trauma: value of a short dedicated extremity MR imaging examination in prediction of need for treatment.
Nikken JJ, Oei EH, Ginai AZ, Krestin GP, Verhaar JA, van Vugt AB, Hunink MG.
Radiology. 2005 Jan;234(1):116-24.
Prospective, randomized, controlled study; 87 patients with acute wrist trauma; short MR imaging examination with a low-field-strength MR imaging system in the initial work-up of all patients with acute wrist trauma has additional value in the prediction of the need for treatment, but it does not have value in the identification of patients who can be discharged without follow-up. A short MR imaging examination in all patients with acute wrist trauma is, therefore, not recommended.
Level I – Unfavorable

Level II: 5 Studies

1. Endoluminal ultrasound and low-field magnetic resonance imaging are superior to clinical examination in the preoperative staging of rectal cancer.
Starck M, Bohe M, Fork FT, Lindström C, Sjöberg S.
Eur J Surg. 1995 Nov;161(11):841-5.
Prospective, comparative study. 35 patients with rectal cancer underwent endoluminal ultrasound and low-field MRI imagine. LU is superior in staging tumors confined to the rectal wall, and could be of value in the selection of patients whose tumors were suitable for local excision. None of these techniques, however, can reliably identify the extent of lymph node involvement.
Level II – Unfavorable

2. Assessment of cervical lymph node status in head and neck cancer patients: palpation, computed tomography and low field magnetic resonance imaging compared with ultrasound-guided fine-needle aspiration cytology.
Atula TS, Varpula MJ, Kurki TJ, Klemi PJ, Grénman R.
Eur J Radiol. 1997 Sep;25(2):152-61.
Prospective, non-randomized comparative study on 105 consecutive patients with a primary cancer in the head and neck region. CT is superior to low field MRI in depicting small pathologic lymph nodes.
Level II – Unfavorable

3. Low field-low cost: can low-field magnetic resonance systems replace high-field magnetic resonance systems in the diagnostic assessment of multiple sclerosis patients?
Ertl-Wagner BB, Reith W, Sartor K.
Eur Radiol. 2001;11(8):1490-4.
Prospective, non-randomized comparative study 20 patients with clinically proven multiple sclerosis were examined with high and low-field MRI. Significantly lower lesion load is identified in low-field MR imaging than in high-field MR imaging, and blood-brain barrier disruption is frequently missed, caution must be exercised in interpreting a normal low-field MR imaging scan in a patient with clinical signs of multiple sclerosis.
Level II – Unfavorable

4. MRI of the foot and ankle: diagnostic performance and patient acceptance of a dedicated low field MR scanner.
Verhoek G, Zanetti M, Duewell S, Zollinger H, Hodler J.
J Magn Reson Imaging. 1998 May-Jun;8(3):711-6.
Prospective, non-randomized study on 41 patients; compares low and high-field imaging; Image quality of low field system was inferior to the 1.0-T system using objective parameters, patients did not prefer the low field system. low field MR system can only be recommended when funding is limited and the available space is limited.
Level II – Unfavorable

5. Comparison of high-field-strength versus low-field-strength MRI of the shoulder.
Magee T, Shapiro M, Williams D.
AJR Am J Roentgenol. 2003 Nov;181(5):1211-5.
Prospective non-randomized study interpreted shoulder MRIs from 40 patients who had a complete shoulder MRI examination on a 0.2-T system and limited imaging on a 1.5-T unit; High-field-strength MRI units provide better spatial and contrast resolution and allow more accurate interpretations than low-field-strength units, these findings may affect clinical treatment.
Level II – Unfavorable

Level III: 2 Studies

1. High-field and low-field MR imaging of superior glenoid labral tears and associated tendon injuries.
Tung GA, Entzian D, Green A, Brody JM.
AJR Am J Roentgenol. 2000 Apr;174(4):1107-14.
Retrospective comparative study, MR imaging was performed on 41 patients with SLAP tears and 26 patients with normal superior labra; The performance characteristics of high-?eld MR imaging are superior to those of low-?eld MR imaging for the diagnosis of a superior labral tear.
Level III – Unfavorable

2. Low-Field Musculoskeletal MRI.
Ghazinoor S, Crues J, Crowley C.
J Magn Reson Imaging. 2007 Feb;25(2):234-44. Review.
Literature review containing 4 star prospective studies and 3 star retrospective studies on the sensitivity and specificity levels detected with low-field MRI. Neutral. Concludes low-field MRI is invaluable for patient diagnosis but highly subjective depending application and level of expertise of the user.
Level III – Unfavorable

LOW – FIELD MRI
Studies Neutral: Total 3

Level III: 1 Study

1. Acute peripheral joint injury: cost and effectiveness of low-field-strength MR imaging–results of randomized controlled trial.
Nikken JJ, Oei EH, Ginai AZ, Krestin GP, Verhaar JA, van Vugt AB, Hunink MG.
Radiology. 2005 Sep;236(3):958-67.
Prospective, randomized, controlled study; 500 patients with acute wrist, knee or ankle injuries; ‘Compared with radiography, MR imaging in patients with acute wrist or ankle injuries is neither cost saving nor effective in expediting diagnostic work-up or improving quality of life. In patients with knee injuries, a short MR imaging examination shortens the time to completion of diagnostic work-up, reduces the number of additional diagnostic procedures, improves quality of life in the first 6 weeks, and may reduce costs associated with lost productivity’.
Level I – Neutral

Level II: 1 Study

1. Staging uterine cervical carcinoma with low-field MR imaging.
Hansen MA, Pedersen PH, Andreasson B, Bjerregaard B, Thomsen HS.
Acta Radiol. 2000 Nov;41(6):647-52.
Prospective, non-randomized comparative study. 95 women entered the study over a 3-year period to determine if low-field MRI is able to correctly stage uterine cervical carcinoma. clinical assessment was superior to low-field MR in staging cervical cancer. When using contrast enhancement, the staging accuracies of low-field MR were comparable to the ones reported for techniques with higher tesla values, whereas the specificity and reproducibility errors were lower. The method, therefore, needs to be optimized.
Level II – Neutral

Level III: 1 Study

1. Assessment of the rotator cuff and glenoid labrum using an extremity MR system: MR results compared to surgical findings from a multi-center study.
Zlatkin MB, Hoffman C, Shellock FG.
J Magn Reson Imaging. 2004 May;19(5):623-31.
Retrospective, comparative, multicenter study was performed involving 160 patients; MR results compared to surgical findings; good agreement when MR results obtained using the extremity MR system were compared to surgical findings for rotator cuff tears, while the sensitivity of MR imaging for determining labral tears was relatively poor; Favorable and Unfavorable for Low-field MRI; study rated neutral overall.
Level III – Neutral

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