Cost effectiveness of MRA’s in Healthcare Reform.

MRI’s have been looked at as overused and overutilized in many circles recently. I firmly disagree, I feel there are a few people that have abused the system but most exams are needed. We need to consider what information we get from the MRI/MRA Scans that we do. This Information is essential in the treatment of patients.

These are just a few things …..

Age of strokes (MRI Brains)

Infection of soft tissue.(MRI’s)

Osteomyelitis, MRSA

Detail of vascular anatomy.(MRA’s)

When a patient has an MRA of the Chest, Carotid, Runoff, or Abdomen, we are able to see in detail the anatomy of their arteries. In some cases we can see veins using delayed scanning. This may be essential information before proceeding with a coronary arteriogram or peripheral arteriogram. It may save the interventional doctor time by already having a map of the blood vessels before starting the procedure. Placing Stents, Angioplasty, and using new technologies like the Silverhawk arthrectomy catheter can take time.http://www.ev3.net/assets/006/5645.mov

Having the MRA done first gives you a head start going into the case already knowing what the vessels look like and where the stenosis is. The Doctors can already have an Idea of what type of intervention will best suit the patient due to the site of the disease. Having the MRA first is an advantage I would not want to be without. In the cases of Emergency Cardiac Cath it may be best not to do the MRA’s, to expedite care. For all non emergent procedures MRA’s can be beneficial.

In this Image below It is helpful to know ahead of time there is stenosis in the left leg. This may or may not play a deciding factor on where the initial groin stick will be.

http://radiographics.rsna.org/content/21/2/357.full

Figure

Knowing there is an aneurysm may also be important to the Interventional Doctor.

There is a definite improvement in the MRI technology. “Three-dimensional (3D) gadolinium-enhanced magnetic resonance (MR) angiography has become very popular in the few years since its inception. A technique that combines speed, superb contrast, and relative simplicity, 3D gadolinium-enhanced MR angiography has been applied to virtually all regions of the body from the extremities to the brain.” (James F. Glockner, MD, PhD). We can now cost effectively diagnose most patients without needing to do a conventional angiogram. If a conventional angiogram is needed after the MRA, to place a stent or fix a stenotic lesion, then the Interventional Doctor has the original MRA to use as a guide.

Three-dimensional Gadolinium-enhanced MR Angiography: Applications for Abdominal Imaging

Resources

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