Thema: Presse: MRI provides best diagnostic strategy for brain tumor
Presse: MRI provides best diagnostic strategy for brain tumor
Peter[a]
24.09.2002 20:26:21
Pediatrics 2001;108:255-263.
MRI provides best diagnostic strategy for brain tumor in high-risk children
Routine magnetic resonance imaging (MRI) is the most clinically effective and cost-effective approach to identifying brain tumors in high-risk children with headache, according to an analysis published in the August issue of Pediatrics.
Dr. L. Santiago Medina, of Miami Children´s Hospital in Florida, and colleagues compared the cost-effectiveness of three diagnostic approaches in 315 children who had headaches and were suspected of having a brain tumor. The researchers divided the children into low-, intermediate- and high-risk groups based on clinical characteristics and probability of a brain tumor.
The three diagnostic approaches were: MRI; CT followed by MRI for positive results (CT-MRI); and close clinical follow-up without neuroimaging.
In low-risk children with headaches of greater than 6 months´ duration but no other symptoms of brain tumor, close clinical follow-up alone was less costly and more effective in terms of quality-adjusted life years gained compared with the two other strategies.
For high-risk children with headaches of greater than 6 months´ duration and other clinical predictors of brain tumor, routine "MRI is the best test to perform because it maximizes quality-adjusted life year gain" at a reasonable cost, Dr. Medina told Reuters Health.
But in intermediate-risk children (migraine headache and normal neurologic examination), the choice of best diagnostic strategy is less clear. While CT-MRI appears to be the optimal clinical strategy, it costs more than $1 million per quality-adjusted life year gained. Despite its cost, Dr. Medina believes that this is the best diagnostic strategy for children at intermediate risk.
"What is very important in any of these categories is that [children] need to be followed closely by a physician," Dr. Medina added. Since children can change risk groups over time, he believes that close monitoring is necessary to ensure the early and appropriate implementation of diagnostic strategies when needed.
Overall, the team concludes, "appropriate selection of patients and diagnostic strategy may maximize quality-adjusted life expectancy and decrease costs of medical workup" in this population.
Reference
2001-08-21 (Reuters Health)
MRI provides best diagnostic strategy for brain tumor in high-risk children
Routine magnetic resonance imaging (MRI) is the most clinically effective and cost-effective approach to identifying brain tumors in high-risk children with headache, according to an analysis published in the August issue of Pediatrics.
Dr. L. Santiago Medina, of Miami Children´s Hospital in Florida, and colleagues compared the cost-effectiveness of three diagnostic approaches in 315 children who had headaches and were suspected of having a brain tumor. The researchers divided the children into low-, intermediate- and high-risk groups based on clinical characteristics and probability of a brain tumor.
The three diagnostic approaches were: MRI; CT followed by MRI for positive results (CT-MRI); and close clinical follow-up without neuroimaging.
In low-risk children with headaches of greater than 6 months´ duration but no other symptoms of brain tumor, close clinical follow-up alone was less costly and more effective in terms of quality-adjusted life years gained compared with the two other strategies.
For high-risk children with headaches of greater than 6 months´ duration and other clinical predictors of brain tumor, routine "MRI is the best test to perform because it maximizes quality-adjusted life year gain" at a reasonable cost, Dr. Medina told Reuters Health.
But in intermediate-risk children (migraine headache and normal neurologic examination), the choice of best diagnostic strategy is less clear. While CT-MRI appears to be the optimal clinical strategy, it costs more than $1 million per quality-adjusted life year gained. Despite its cost, Dr. Medina believes that this is the best diagnostic strategy for children at intermediate risk.
"What is very important in any of these categories is that [children] need to be followed closely by a physician," Dr. Medina added. Since children can change risk groups over time, he believes that close monitoring is necessary to ensure the early and appropriate implementation of diagnostic strategies when needed.
Overall, the team concludes, "appropriate selection of patients and diagnostic strategy may maximize quality-adjusted life expectancy and decrease costs of medical workup" in this population.
Reference
2001-08-21 (Reuters Health)
Peter[a]
