Search

Purpose: To improve the cost efficiency of the imaging evaluation of clinically suspected pheochromocytoma by using 24-hour fractionated urine metanephrine (FUM) results. Methods: A retrospective review of 1-123 meta-iodo-benzy1-guanidine single photon emission tomography (SPECT) computed tomography (CT) studies performed at our institution between January 2007 and February 2011 for clinically suspected pheochromocytoma was performed. SPECT-CT results from 70 patients were compared with results from 24-hour FUM analysis (within 2 months of SPECT-CT) and with relevant CT or magnetic resonance imaging studies (within 6 months of SPECT-CT). An imaging algorithm was developed to maximize cost efficiency without altering the final imaging interpretation. Actual imaging costs for the studied cohort were compared with the expected costs if this algorithm had been applied. Results: If the 24-hour FUMs were normal, then all the SPECT-CT studies were negative (16/70). Eighty-seven percent of patients with abnormal total metanephrine had a positive SPECT-CT. If the total metanephrine was normal but 1 or more of the metanephrine fractions were abnormal, then 39%-58% of the SPECT-CT studies were positive. Within this subgroup, none had a positive SPECT-CT if a CT or magnetic resonance image was negative or benign. The actual imaging costs averaged CADS2833.19 per patient for this cohort. Applying a streamlined imaging algorithm guided by 24-hour FUM analysis would result in an average imaging cost of CADS 1225.97 per patient without an expected change in the final imaging impression. Conclusion: By using 24-hour FUM results to streamline imaging, considerable cost savings per patient (56.7%) can be attained without a change in the final overall imaging interpretation. [ABSTRACT FROM AUTHOR]

Purpose: To assess ultrasound intrascan variability and the potential error rate of serial ultrasounds in the diagnosis of deep venous thrombosis in children. Methods: A retrospective cohort review of imaging results of children having at least 3 serial ultrasound examinations of the same region within a 2-month period. The results were interpreted as either (1) inadequately visualized or (2) the absence or presence of deep venous thrombosis, and were categorized by location. Serial imaging findings then were further categorized based on results and clinical information. Results: Sixty-four patients and 157 vessel segments were included in the study. Deep venous thrombosis was documented in 58 patients. Concordant results were observed in 26 patients (40.1%), clot resolution in 17 patients (26.6%), clot formation in 12 patients (18.8%), and discordant results in 9 patients (14%). Twenty-one of 64 patients (32.8%) had at least 1 vessel inadequately imaged. Conclusions: The inconsistency of serial ultrasound results in up to 25% of patients calls attention to the potential inaccuracy of ultrasound for diagnosis and follow-up of deep venous thrombosis in children. The high proportion of patients with at least 1 inadequately visualized vessel also highlights the limitation of ultrasound in the diagnosis of pediatric deep venous thrombosis. [ABSTRACT FROM AUTHOR]