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Early MRI may lower costs for prostate cancer treatment

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Study finds MRI and MRI-guided biopsy cheaper long-term than standard ultrasound.

A diagnostic MRI followed by one of three MRI-guided biopsy strategies is a cost-effective method to detect prostate cancer, according to a new study out of Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center. Researchers compared MR-guided approaches to the current standard of transrectal ultrasound guided biopsies and found that these approaches yielded net health benefits that were well within commonly accepted threshold for costs-benefit ratios and thus are cost-effective strategies for detecting prostate cancer. The paradigm-shifting research was published in the preeminent journal Radiology.

“Many consider MRIs to be cost-prohibitive, especially when evaluating for a common entity such as prostate cancer. This was our expectation as well, prior to doing this work, but our study found the opposite. We found that performing MRI before biopsy and using that information to alter biopsy pathways would be a strategy that would add health benefits to the patient population in a cost effective manner,” said Vikas Gulani, MD, PhD, study advisor and associate professor of radiology, urology, and biomedical engineering at Case Western Reserve University School of Medicine, and member of both the Case Comprehensive Cancer Center and Case Center for Imaging Research.

The study was jointly first-authored by Shivani Pahwa, MD, department of radiology, and Nicholas Schiltz, PhD, department of biostatistics; and was developed in close collaboration with Lee Ponsky, MD, department of urology, and Mark Griswold, PhD, department of radiology.

The researchers found using MRI to help detect lesions and guide biopsies increased standardized quality-adjusted life years for patients and was cost-effective in 94.05% of simulations. The benefits were consistent across age groups, and could change how doctors identify and sample cancer lesions.

The current standard of care for detecting prostate cancer involves 12 biopsy samples collected during an invasive transrectal ultrasound. Since most tumors are not visible on ultrasound, up to 40% of clinically significant tumors are missed via this method, and many found are clinically insignificant. The approach regularly results in patients entering treatment pathways with potential negative side effects, to treat low-risk tumors. Biopsies may also cause bleeding and complications, increasing health care costs.

MRI offers a non-invasive alternative to transrectal ultrasound which can help better steer biopsy pathways. Doctors could use MRI to evaluate patients for potentially harmful lesions, and then use that information in one of three MRI guided strategies for biopsying potential foci of cancer, and bypass biopsy if a scan is completely negative. Although scans are expensive, they can add health benefits by triaging patients into proper treatment pathways. MR tends to miss low risk cancer, the overtreatment of which is a major contributor to high health and financial costs in prostate cancer. Similarly, a negative MRI is a very good predictor of exclusion of aggressive disease. A combination of such factors is likely the reason for the cost effectiveness of the MRI guided strategies. Current estimates place prostate cancer care costs in the United States at over $10 billion annually, and the price tag is rising.

The findings may help streamline prostate cancer treatment protocols to better serve patients. Said Gulani, “Costs are escalating in part due to expensive and inefficient diagnostic pathways, and placement of patients in incorrect treatment groups. If we can maximize efficiency in how we identify clinically significant lesions and diagnose patients, we can reduce unnecessary treatments for our patients, and reduce costs to our hospitals.”

Source: Case Western Reserve University

URL: https://www.sciencedaily.com/releases/2017/05/170517154720.htm

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Researchers discover MRI can measure kidney scarring and predict future kidney function

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Researchers from St. Michael’s Hospital have made what are believed to be two world first discoveries: an MRI can measure kidney damage and can predict future kidney function within one year while avoiding needle biopsies.

The researchers used a specific magnetic resonance imaging test called an elastogram to measure kidney scarring in 17 people who had kidney transplants, according to the study published online in the Clinical Journal of the American Society of Nephrology.

An elastogram maps the stiffness of tissue using MRI to determine the presence of scarring, according to Dr. Anish Kirpalani, the study’s lead author, a radiologist and a scientist in the Li Ka Shing Knowledge Institute of St. Michael’s.

Scarring is a major cause of kidney transplant failure.

“Healthy kidney is soft, whereas scar tissue is stiffer,” said Dr. Darren Yuen, a transplant nephrologist and scientist in the Keenan Research Centre for Biomedical Science of St. Michael’s.

“We needed a way to measure how soft or stiff your kidney is without actually going inside the body. Using the MRI elastogram, we were able to measure kidney stiffness, which gave us an indication of how much scarring there was.”

Scarring is irreversible and can cause progressive kidney injury that can eventually lead to kidney failure. Diabetes, high blood pressure and kidney transplant rejection all cause scarring.

Needle biopsy is the current “gold standard” way to assess kidney scarring. A long needle is inserted into the kidney and a sample about the size of a mechanical pencil tip is removed. The procedure requires pain medications, can be associated with bleeding and requires a day off of work, according to the authors.

The study found that the MRI results were not only comparable to the results of a kidney biopsy, but the test was able to detect a high variability in the amount and location of scarring throughout the entire organ.

“The MRI allowed us to get a full picture of the kidney, whereas with a biopsy we would only see a tiny piece,” said Dr. Kirpalani.

“We were able to tell that in some parts of the kidney it’s very stiff, and in others, it’s not stiff at all, which is information we couldn’t get from a biopsy.”

The researchers also found that kidney stiffness predicted how well the kidney would be working one year after the MRI. They found that those with higher levels of stiffness in their kidneys had a greater loss of kidney function, while those with softer kidneys did not.

This shows that MRI can accurately predict future kidney function, according to the authors, which may be particularly helpful for kidney transplant patients.

“When we’re looking at a transplanted kidney, we’re dealing with a precious resource–these patients have waited a long time for a transplant, and have been on dialysis, which is a difficult and painful process,” said Dr. Kirpalani.

“Scarring is a big problem for transplant patients, and with MRI we may be able to better guide how kidney transplant patients are treated early on to improve their long-term outcomes.”

MRIs would not replace biopsies, said Dr. Yuen, but rather act as an additional test to give a more comprehensive understanding of kidney health.

“Clinicians are hesitant to send patients for a test that has risks such as internal bleeding unless a diagnosis can’t be made without it,” he said. “With this new MRI test, doctors can gather valuable information in the many patients for whom the risks of a biopsy are too high.”

He also emphasized that this new MRI test may help facilitate the testing of new anti-scarring treatments.

“There are currently no anti-scarring drugs on the market, in part because it is hard to rationalize doing multiple kidney biopsies as part of a pharmaceutical trial,” said Dr. Yuen.

“By providing a needle-free way to measure kidney scarring, we may create more opportunities for this crucial research into finding an effective anti-scarring treatment.”

The study was conducted in the hospital’s MRI research centre, which houses MRI equipment dedicated specifically to clinical research.

“The unique MRI research centre that we have created, including elastography equipment, is focused on research that will directly impact patient care, allowing us to do this important study in people with transplant kidneys,” said Dr. Kirpalani.

Source: http://www.medicalnewstoday.com/releases/319278.php

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