Evaluation of the contribution of radiological imaging to the final diagnosis in medical case reports.

Purpose: To evaluate the clinical value and impact of radiological imaging in published medial case reports.

Methods: We analysed 671 consecutively published case reports of a peer-reviewed medical journal for case reports. The general use of radiological imaging as well as the specific imaging modality used in each case (ultrasound, x-ray, fluoroscopy, CT, MRI) was documented, and most importantly the 'final problem solver', i.e. the diagnostic modality giving the final clue to the patient's diagnosis, was identified.

Results: In 511 of 671 (76.1 %) analysed case reports at least one radiological modality was used in the diagnostic cascade. In 28.6% of all cases the final diagnosis was achieved by radiological imaging. All other cases were solved by the patient's history and physical examination (15.2%), histology (12.4%), and blood analysis (9.6%). When radiology was the 'final problem solver', it was mainly CT (51.6%) and MRI (30.6%). In 52.2% of the case reports the radiological image was included in the article.

Conclusion: In case reports published in a prominent general medical journal radiological imaging is an important key player in the diagnostic process. In many cases, it is also the diagnostic tool which ultimately leads to determining the final diagnosis.

Key Points: • Radiology was the most important specialty for finding the final diagnosis. • CT was the most successful problem-solving imaging modality followed by MRI. • MRI and CT had the best solution rates of more than 30%.