1. PET/MRI versus PET/CT in oncology: a prospective single-center study of 330 examinations focusing on implications for patient management and cost considerations.
- Author
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Mayerhoefer, Marius E., Prosch, Helmut, Beer, Lucian, Tamandl, Dietmar, Beyer, Thomas, Hoeller, Christoph, Berzaczy, Dominik, Raderer, Markus, Preusser, Matthias, Hochmair, Maximilian, Kiesewetter, Barbara, Scheuba, Christian, Ba-Ssalamah, Ahmed, Karanikas, Georgios, Kesselbacher, Julia, Prager, Gerald, Dieckmann, Karin, Polterauer, Stephan, Weber, Michael, and Rausch, Ivo
- Subjects
POSITRON emission tomography computed tomography ,COST control ,LONGITUDINAL method ,LIVER metastasis ,BRAIN metastasis ,ONCOLOGY ,HOSPITAL central service departments - Abstract
Purpose: PET/MRI has recently been introduced into clinical practice. We prospectively investigated the clinical impact of PET/MRI compared with PET/CT, in a mixed population of cancer patients, and performed an economic evaluation of PET/MRI. Methods: Cancer patients referred for routine staging or follow-up by PET/CT underwent consecutive PET/CT and PET/MRI, using single applications of [
18 F]FDG, [68 Ga]Ga-DOTANOC, or [18 F]FDOPA, depending on tumor histology. PET/MRI and PET/CT were rated separately, and lesions were assessed per anatomic region; based on regions, per-examination and per-patient accuracies were determined. A simulated, multidisciplinary team meeting served as reference standard and determined whether differences between PET/CT and PET/MRI affected patient management. The McNemar tests were used to compare accuracies, and incremental cost-effectiveness ratios (ICERs) for PET/MRI were calculated. Results: Two hundred sixty-three patients (330 same-day PET/CT and PET/MRI examinations) were included. PET/MRI was accurate in 319/330 examinations and PET/CT in 277/330 examinations; the respective accuracies of 97.3% and 83.9% differed significantly (P < 0.001). The additional findings on PET/MRI—mainly liver and brain metastases—had implications for patient management in 21/263 patients (8.0%). The per-examination cost was 596.97 EUR for PET/MRI and 405.95 EUR for PET/CT. ICERs for PET/MRI were 14.26 EUR per percent of diagnostic accuracy and 23.88 EUR per percent of correctly managed patients. Conclusions: PET/MRI enables more appropriate management than PET/CT in a nonnegligible fraction of cancer patients. Since the per-examination cost is about 50% higher for PET/MRI than for PET/CT, a histology-based triage of patients to either PET/MRI or PET/CT may be meaningful. [ABSTRACT FROM AUTHOR]- Published
- 2020
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