Leading the News
Leading the News
Combination of Imaging Exams Improves AD Diagnosis
Researchers say using a combination of imaging and biomarker tests improves doctors' ability to predict Alzheimer disease (AD) in patients with mild cognitive impairment. The findings, published in the journal Radiology, offer new insight into how to detect AD before the full onset of the disease. Researchers studied three tests, magnetic resonance imaging (MRI), fluorine 18 fluorodeoxyglucose positron emission tomography (FDG-PET), and cerebrospinal fluid analysis to see if the combination provides greater accuracy than each test individually. They analyzed data from 97 older adults with mild cognitive impairment from the Alzheimer's Disease Neuroimaging Initiative, a national study that collects data in hundreds of elderly patients with varying levels of cognitive impairment. Participants took part in clinical cognitive testing, as well as the three diagnostic exams: MRI, FDG-PET, and cerebrospinal fluid analysis. They then checked in with doctors for up to four years. The misclassification rate based solely on neuropsychological testing and other clinical data was relatively high at 41.3 percent. Adding each of the diagnostic tests reduced the number of misdiagnoses so that, with all three tests combined, researchers achieved the lowest misclassification rate of 28.4 percent. Of the three individual diagnostic tests, FDG-PET added the most information to clinical testing to detect early AD in patients with mild cognitive impairment.
From "Combination of Imaging Exams Improves Alzheimer's Diagnosis"
Medical Xpress (12/11/12)
Brain Scans Could Help Scientists Uncover Mechanisms Underlying Mental Fatigue
In a study published in the International Journal of Computer Applications in Technology, researchers used functional magnetic resonance imaging (fMRI) to monitor the brain activity of subjects experiencing mental fatigue. The study's subjects were 10 students aged 19 to 25 years who were physically and mentally fit and demonstrated no sleep problems. Researchers deprived the subjects of sleep for 25 hours and had them perform a simple task repeatedly during that period, and carried out fMRI scans of the subjects at intervals of nine, six, and 12 hours the next day. The researchers observed correlated increases in the activation of the left thalamus and decreases in activation of the inferior parietal cortex as the students became more sleep deprived. Increased sleep deprivation also led to decreased activity in the anterior cingulate gyrus, as well as the right inferior frontal, left middle frontal, and right superior temporal cortices.
From "Brain Scans Could Help Scientists Uncover Mechanisms Underlying Mental Fatigue"
Costly Cancer Therapy Dinged
A new study comparing the use of proton-beam radiotherapy and intensity-modulated radiotherapy (IMRT) to treat prostate cancer has failed to find a significant difference in outcome between the two treatments. Researchers at Yale School of Medicine compared the medical records of 30,000 male Medicare beneficiaries with prostate cancer who had been treated with either proton therapy or IMRT between 2008 and 2009. The researchers found the only area in which proton therapy outcomes differed from IMRT was a slightly lowered rate of impaired urinary function at six months, a difference that disappeared at 12 months. Both groups of men experienced virtually identical rates of other side effects, including erectile dysfunction, hip fracture, gastrointestinal issues, and musculoskeletal problems. The Yale study was published Dec. 12 in the Journal of the National Cancer Institute.
From "Costly Cancer Therapy Dinged"
Wall Street Journal (12/13/12) Beck, Melinda
DTI-MRI Shows Concussions' Long-Term Effects in Kids
Diffusion-tensor MRI (DTI-MRI) has shown that brain changes in children who have sustained mild traumatic brain injury can last for months, even after symptoms of the injury are gone, according to a study published in the December 12 issue of the Journal of Neuroscience. Using DTI, researchers from the Mind Research Network and the University of New Mexico examined children ages 10 to 17 years old who had mild traumatic brain injury. They found structural changes in white matter approximately two weeks after the injury, and the changes were still evident more than three months later, despite the disappearance of symptoms related to the injury. The researchers conducted cognitive testing and DTI to examine the brains of 15 children within 21 days of experiencing a concussion, in addition to examining 15 healthy children for comparison. The cognitive testing and imaging were repeated at a follow-up of approximately four months. Initial testing showed that the children with mild brain injury had subtle cognitive deficits and changes in white matter compared to the healthy counterparts. While the children did not report symptoms of the injury during the follow-up visit, DTI revealed that the structural changes to the brain were still present.
From "DTI-MRI Shows Concussions' Long-Term Effects in Kids"
Gentler Radiation Safe for Early Breast Cancer
A lower dose and shorter course of adjuvant radiation for nonmetastatic breast cancer cuts down on toxicity without raising recurrence risk, according to research presented at the San Antonio Breast Cancer Symposium. Local or regional tumor recurrence was no different over 10 years with 40 Gy administered in 15 fractions compared with the standard 50 Gy in 25 fractions, the researchers found in the START trial. The B portion of the trial showed an 8.1 percentage point reduction in moderate or marked effects on normal breast tissue at 10 years with that hypofractionation, compared with the standard regimen.
From "Gentler Radiation Safe for Early Breast Cancer"
MedPage Today (12/07/12) Phend, Crystal
MRI-Guided Biopsy Boosts Prostate Cancer Detection
Targeted prostate biopsy with magnetic resonance imaging (MRI) tripled the cancer yield compared with conventional systematic biopsies. In a study published online in the Journal of Urology, researchers report that MRI-targeted lesions contained biopsy-proven prostate cancer 21 percent of the time, compared to only 7 percent with systematic biopsy. The researchers reported findings from a follow-up investigation involving 171 consecutive patients who underwent outpatient MR-ultrasound fusion biopsy. All of the men had multiparametric MRI of the prostate, and each region of interest (lesion or target) was assigned a risk grade of 1 (normal) to 5 (highest risk) on the basis of MRI findings. Ultrasound was used to create a 3D prostate model, and the stored MRI data was aligned and fused with real-time ultrasound. A systematic array of 12 biopsy sites selected by the prostate biopsy system was paired with the regions of interest identified by MRI. Using guidance from the 3D model, the researchers biopsied target lesions and performed the systematic sampling generated by the prostate biopsy system.
From "MRI-Guided Biopsy Boosts Prostate Cancer Detection"
MedPage Today (12/11/12) Bankhead, Charles
PET Or PET/CT in Recurrent Bowel Cancer Benefit Unproven
For patients with a suspected recurrence of bowel cancer, study data available allow no robust conclusions as to the advantages and disadvantages of using positron emission tomography (PET), alone or in combination with computer tomography (CT). This is because no studies have directly compared the benefits of these imaging techniques in recurrent colorectal carcinoma (bowel cancer) with conventional diagnostic techniques. While PET or PET/CT shows a higher diagnostic accuracy, in certain cases recurrences can be detected more reliably; but it is still unclear how this actually affects patient-relevant outcomes like quality of life, according to the final report of the German Institute for Quality and Efficiency in Health Care. Bowel cancer is the second most common malignant tumor in both men and women; more than 65,000 people are diagnosed with the disease in Germany, and more than 25,000 die from the disease each year. Many experts hope that when a recurrence is suspected, an examination by PET or PET/CT either alone or in combination with other methods is better able to distinguish between benign and malignant tumors, and, if applicable, classify the stage correctly. Such information should allow patients to be given better treatment recommendations.
From "PET Or PET/CT in Recurrent Bowel Cancer Benefit Unproven"
Medical News Today (12/13/12)
GAO: Standardizing Prepayment Audits Could Save Millions
The U.S. Government Accountability Office (GAO) reports that the U.S. Centers for Medicare and Medicaid Services (CMS) could save tens of millions of dollars by standardizing the methods used to determine which Medicare claims get denied for payment. A recent GAO study found that in 2010, CMS contractors saved some $114.7 million by using standardized audit methods, of which $14.7 million in payments were withheld because they were in violation of CMS national coverage rules and $100 million in payments were withheld because they were in violation of local contractor rules.
From "GAO: Standardizing Prepayment Audits Could Save Millions"
Modern Healthcare (12/10/12) Carlson, Joe
CMS Proposal Could Ease Payment Path for Oncology PET Tracers
The U.S. Centers for Medicare & Medicaid Services (CMS) has proposed a new policy that could make it easier for new oncology PET tracers to win reimbursement. In a Dec. 13 memo, CMS proposed that local Medicare administrative contractors (MACs) determine coverage within their respective jurisdictions for oncologic PET imaging using radiopharmaceuticals for indications that are approved by the U.S. Food and Drug Administration (FDA). If the proposal is approved, the change would remove national noncoverage for any uses of the FDA-cleared PET radiopharmaceuticals that have not been determined nationally. The proposal would also cover hybrid modalities, such as PET/CT and PET/MRI.
From "Proposed Decision Memo for Positron Emission Tomography"
Centers for Medicare & Medicaid Services (12/13/12)
Shift Seen Toward Less Costly CT Scanners
The latest monthly edition of the Modern Healthcare/ECRI Institute Technology Price Index shows that average prices for CT scanners fell by 20 percent in October compared to the same time last year. In the October index, the average price paid for a CT scanner was $918,485, showing a decline for the fourth consecutive month. The ECRI Institute says this is likely due to recent market interest in standard 64-slice systems, which are the product of market pressure for more reasonably priced alternatives to full-featured scanners that can cost upwards of $2 million. At the same time, average prices have risen for MRI systems compared to the same time last year. The average cost of an MRI system in October was $1.93 million, 56 percent more than what was paid on average in October 2011. ECRI says this is likely due to growing interest in more expensive 3T MRI systems.
From "Shift Seen Toward Less Costly CT Scanners"
Modern Healthcare (12/13/12) Blesch, Gregg
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