Last year, physicians surveyed about the most important innovations of the last 25 years ranked magnetic resonance imaging (MRI), a diagnostic procedure, ahead of even such interventions as coronary bypass surgery. MRI uses the principles of NMRI (nuclear magnetic resonance imaging) to produce high-resolution images of the human body's tissue. According to Dr. Fleegler, a former professor at the University of Pennsylvania Medical School and the current Medial Director of Disease Control at McKesson Health Services, "If you're looking at diagnostic procedures over the last fifty years, MRI scanning is clearly the most significant."
According to Dr. Fleegler, "To understand the significance of the MRI procedure, you have to know something about medical history." The first MRI exam performed on a human being, conducted on July 3, 1977, took almost five hours to produce an image far inferior to those of today. The original machine, named "Indomitable" by its inventors, is now in the Smithsonian Institute. Today, what used to take hours can be done in seconds. MRI is widely used for determining joint injuries not associated with bone structure, such as injured knees and elbows, where the damage lies primarily in tendons, ligaments, or other tissues of the body. The procedure has also been used to map the functions of various regions of the human brain. Most recently, physicians have begun to use MRI scans to observe key tissue changes during the evolution of a stroke. This allows for physicians to assess the patient's prognosis quickly and non-invasively, which permits much faster response and better chances of successful intervention. In the early 1980s, there were only a few MRI exams being performed each year in the United States. Now there are thousands.
Today, imaging technology continues to develop. The advance of PET scanning has made it possible for physicians to observe the activity of tissue non-invasively, just as MRI scanning makes it possible for physicians to observe the density of tissue. Most recently, researchers have been using it to achieve early diagnosis of Alzheimer's disease. Dr. Fleegler says, "Instead of saying, 'Good news! Your biopsy shoes you don't have cancer,' it would be really nice to say, 'You don't need a biopsy in the first place, because there is no cancer.' But PET scanning won't replace MRI scanning."
Before the advent of MRI technology, Dr. Fleegler said, he studied at the University of Pittsburgh with a renowned diagnostician named Dr. Henry Higman, who would interview patients in class in order to demonstrate the procedure of diagnosis. By analyzing the patient's symptoms, he would determine the placement of a lesion; and "everyone would applaud, and later, his diagnosis would be verified in the patient's surgery. So, then, you had only a pathophysiological approach to diagnosis."
"Before MRI, you had somebody like Henry Higman: a top-notch diagnostician. But there were very few of them. And Henry wasn't always right. He was using deductive logic, and sometimes people present symptoms that aren't easily explained. People with migraines, for example, often present with focal symptoms. In 1972 to '73, CAT scanning was born. It was the first development in imaging with allows 'surgery without surgery.' Then MRI scanning allowed us to tell the density of the tissue: to tell the difference between liquids, solids, and so forth. By doing this kind of 'surgery without surgery,' we're able to focus on the patient's needs. It allows everyone to be a Henry."
