by
Sean Ruck, Contributing Editor | March 06, 2015
From the March 2015 issue of HealthCare Business News magazine
“So the need for contrast enhancement may disappear if we combine either CT or MR with PET which is becoming the powerhouse in medical imaging. By adopting this approach, you are combining the benefits of structural imaging without contrast with those of imaging at molecular-cellular level. You’re using PET with FDG which is quite safe and the balance radiation-wise is not substantially different (but lower) from that delivered from CT with contrast enhancement.
However, the significant risks associated with iodinated contrasted agents are eliminated. There is really no single report that describes that FDG itself has caused any side effect in the millions of people who have received this diagnostic agent. The body doesn’t recognize this preparation as a true drug, it’s just a spy that goes inside our body and lets us to get to the information we need to properly manage our patients,” he says.
According to Alavi, it’s not just the risk of a relatively rare but serious problem, like an anaphylactic reaction, or significant renal damage. The real risk comes with not having the needed level of sensitivity and specificity with CT or MR alone to manage serious diseases like cancer and heart disease effectively. The latter according to Alavi stands as a counter to the cost-versus-benefit argument of the use of standalone contrast-enhanced CT rather than PET/CT or PET/MR in the near future. “It turns out CT costs maybe half to one-third the cost of PET, but in reality, the story changes,” he says, “When you look at the impact of standalone contrast-enhanced CT versus FDG-PET in disease outcome.” The low sensitivity and specificity of CT and or MR result in under-over treating of many serious diseases which results in enormous suffering of affected patients and significant costs to the health care system.
For an example, if the cancer has already spread to the lymph nodes or the other sites in the body, but based on CT findings that indicate the disease is confined to the primary site an operation is performed on that assumption, then six months and $100k later, the cancer appears at the spots that were missed by CT on the original scan. It is horrible for the patient to go through this surgery and then end up with a disaster that could have been avoided by performing PET imaging at the outset.
Furthermore, CT is non-specific and about 20 to 30 percent of the lesions visualized are false positive finding and as such should be left alone. The non-specificity of CT can lead to more tests and sometimes surgeries/treatments which increase the potential for needless suffering and even death.”
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