gadoxetic-acid-disodium and Rectal-Neoplasms

Topics: Ablation Techniques; Adult; Anti-Bacterial Agents; Cholangiopancreatography, Endoscopic Retrograde; Contrast Media; Drainage; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Microwaves; Pleural Effusion; Rectal Neoplasms; Thoracentesis

To compare the direct costs of two diagnostic algorithms for pretherapeutic TNM staging of rectal cancer.. In a study including 33 patients (mean age: 62.5 years), the direct fixed and variable costs of a sequential multimodal algorithm (rectoscopy, endoscopic and abdominal ultrasound, chest X-ray, thoracic/abdominal CT in the case of positive findings in abdominal ultrasound or chest X-ray) were compared to those of a novel algorithm of rectoscopy followed by MRI using a whole-body scanner. MRI included T 2w sequences of the rectum, 3D T 1w sequences of the liver and chest after bolus injection of gadoxetic acid, and delayed phases of the liver. The personnel work times, material items, and work processes were tracked to the nearest minute by interviewing those responsible for the process (surgeon, gastroenterologist, two radiologists). The costs of labor and materials were determined from personnel reimbursement data and hospital accounting records. Fixed costs were determined from vendor pricing.. The mean MRI time was 55 min. CT was performed in 19/33 patients (57%) causing an additional day of hospitalization (costs 374 euro). The costs for equipment and material were higher for MRI compared to sequential algorithm (equipment 116 vs. 30 euro; material 159 vs. 60 euro per patient). The personnel costs were markedly lower for MRI (436 vs. 732 euro per patient). Altogether, the absolute cost advantage of MRI was 31.3% (711 vs. 1035 euro for sequential algorithm).. Substantial savings are achievable with the use of whole-body MRI for the preoperative TNM staging of patients with rectal cancer.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Contrast Media; Costs and Cost Analysis; Endosonography; Female; Gadolinium DTPA; Germany; Hospital Costs; Humans; Length of Stay; Liver; Liver Neoplasms; Lung; Lung Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; National Health Programs; Neoplasm Staging; Personnel, Hospital; Proctoscopy; Prospective Studies; Rectal Neoplasms; Tomography, Spiral Computed; Ultrasonography; Whole Body Imaging

In TNM staging of rectal cancer by MRI, unspecific extracellular contrast agent Gd-DTPA is established for extrahepatic and vascular enhancement whereas liver-specific gadoxetic acid has proven high accurate detection of liver metastasis.. To compare intraindividually the qualification and quantification of enhancement in liver parenchyma, abdominal, pulmonary, and pelvic vessels between gadoxetic acid and Gd-DTPA.. Sixteen patients with histologically proven rectal carcinoma (mean age 62.9 years) were imaged twice by MRI. For pretherapeutic staging 10 mL gadoxetic acid (mean dose 0.032 mmol Gd/kg body weight) and for restaging after neoadjuvant therapy Gd-DTPA (0.1 mmol Gd/kg body weight) were administered. The liver was acquired in arterial-dominant and portal venous phases, the thorax and pelvis were depicted in venous phases using three-dimensional T1-weighted sequences. Contrast enhancement was rated by two independent readers and compared by means of multinomial regression analysis using generalized estimating equations. Signal-to-noise ratios were compared by two-sided paired t-tests.. Overall contrast enhancement was rated sufficient for diagnosis in all examinations and both contrast agents. Vascular enhancement was rated comparable with exception of the aorta, the peripheral intrahepatic veins, and the central lung vessels (p = 0.0182, p = 0.0053, p = 0.0083, in favor of Gd-DTPA). Quantitative evaluation revealed no statistically significant differences in parenchymal and vascular signal-to-noise ratios with exception of the aorta, and the central pulmonary artery (67.4 vs. 89.3; p = 0.0421, 44.5 vs. 59.5; p = 0.0446 respectively, in favor of Gd-DTPA).. The contrast enhancement after gadoxetic acid is comparable to Gd-DTPA and appears suitable for comprehensive TNM-staging by combining high accurate liver-specific phases with efficacious vascular enhancement in the different anatomic regions.

Topics: Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Lung; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Pelvis; Prospective Studies; Rectal Neoplasms; Regression Analysis; Whole Body Imaging