MRI Pathology May Be Misleading

By Warren Hammer, MS, DC, DABCO

How often does a patient come in with an MRI showing a herniated or extruded disc who has been told they need surgery? Examination may show minimal weakness or even diminished reflexes.
The problem is that often, the patient did not receive a functional examination to determine other possible causations or treatments that might help repair the area without surgery.

Structural changes are immediately assumed to be causative from a torn meniscus to a disc herniation to facet degeneration, etc. A significant portion of the population have torn menisci, rotator-cuff and disc lesions, especially as they age. Frequently, rather than the spine being the causative factor, passive and resistive testing of the hip reduplicate the patient's pain.

There is no doubt that MRI is a wonderful diagnostic instrument, but doctors must make sure they provide a clinical examination that emphasizes soft-tissue examination and function before a final decision is made based on structure alone. Regrettably, the rush to surgery based on an MRI occurs too often.

complete article: Dynamic Chiropractic


Study Looks at CT Scans, Cancer Risk

Animal Model Suggests Increased Risk for People with Cancer Susceptibility Genes

Newswise — WINSTON-SALEM, N.C., -- Dec. 14, 2011 -- From the doctor’s office to the airport, Americans have more opportunity for radiation exposure than ever before.

While low levels of radiation are used in medical imaging and airport body scanners, there is much debate about exposure levels and potential cancer risks. New research from Wake Forest Baptist Medical Center has found that there could be an increased risk of cancer for certain individuals who are exposed to multiple CT scans.

The research, published in the December issue of the journal Radiation Research, was the first to look at how CT scans affected mice specially bred with a lung cancer-susceptibility gene known as Ki-ras. Mutations in this gene have been implicated in about 30 percent of a common form of human lung cancer. In this study, mice that expressed the mutant Ki-ras gene were exposed to low-dose helical computed tomography (CT) radiation. The mice exposed to CT radiation had 43 percent more tumors than unirradiated mice, and females were more susceptible than males.

We believe we are the first to use an animal model in an actual clinical CT scanner to directly look at the risk of producing tumors after a diagnostic procedure,” said lead researchers Michael T. Munley, Ph.D., associate professor of radiation oncology, and Mark S. Miller, Ph.D., professor of cancer biology, at Wake Forest Baptist. “What we found is that there may be an increased risk of tumor formation from CT scans in certain individuals with cancer susceptibility.”

source: Newswise


MRI Power to Track MS

Medical researchers at the University of Alberta have discovered a new way to track the progression of multiple sclerosis (MS) in those living with the disease, by using a powerful, triple strength MRI to track increasing levels of iron found in brain tissue.

The researchers discovered that iron levels in MS patients are increasing in grey matter areas of the brain that are responsible for relaying messages. High iron levels in a specific "relay area" were noted in patients who had physical disabilities associated with MS. Iron is very important for normal function of the brain and the amount of iron is a tightly controlled system by the brain tissue. The discovery suggests there is a problem with the control system. Too much iron can be toxic to brain cells and high levels of iron in the brain have been associated with various neurodegenerative diseases. But to date, no tests have been able to quantify or measure iron in living brain.

Alan Wilman and Gregg Blevins, co-principal investigators from the Faculty of Medicine & Dentistry, used a new MRI method to quantitatively measure iron in the brain to gain a better understanding of what the disease is doing in the brains of those who were recently diagnosed with MS. Twenty-two people with MS took part in the study, along with 22 people who did not have the condition.

"In MS, there is a real desire and need to get a good idea of the state and progression of the disease," says Blevins, who is both a practising neurologist and a researcher from the Division of Neurology.

"When patients with MS currently get an MRI, the typical measures we look at may not give us a good idea of the nature and state of MS. Using this new MRI method would give physicians a new way to measure the effectiveness of new treatments for patients with MS by watching the impact on iron levels. This opens up the idea of having a new biomarker, a new way of looking at the disease over time, watching the disease, seeing the progression or lack of progression of the disease, a new way to track it."

Wilman, a researcher and physicist in the Department of Biomedical Engineering, says the new MRI method may be a better gauge for disease progression than strictly looking at number and frequency of relapses.

source: Unioversity of Alberta


Costly Diagnostic MRI Tests Unnecessary for Many Back Pain Patients

Johns Hopkins-led study suggests imaging studies add no value for patients getting epidural steroid injections

Newswise — Johns Hopkins-led research suggests that routine MRI imaging does nothing to improve the treatment of patients who need injections of steroids into their spinal columns to relieve pain. Moreover, MRI plays only a small role in a doctor’s decision to give these epidural steroid injections (ESIs), the most common procedure performed at pain clinics in the United States.

With greater focus on runaway health care costs, the study’s findings, appearing online in the Archives of Internal Medicine, highlight one element of the problem: the indiscriminate use of an expensive imaging tool that shows little clinical benefit.

“Our results suggest that MRI is unlikely to avert a procedure, diminish complications or improve outcomes,” says study leader Steven P. Cohen, M.D., an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. “Considering how frequently these epidural injections are performed, not routinely ordering an MRI before giving one may save significant time and resources.”

Cohen adds that, “if we’re trying to cut back on unnecessary medical costs, we should stop routinely doing MRIs on almost everyone who comes to us needing ESIs.” A single MRI costs roughly $1,500.

source: Newswise


CT Scans Shown to Help in the Detection of Gout

CHIGAGO – According to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Chicago, a type of computed tomography scanning (commonly called CT scans) appears to help in the diagnosis of gout by detecting the urate crystals that are often a symptom of the disease.

Gout is a painful and potentially disabling form of arthritis that has been recognized since ancient times. Initial symptoms of gout usually consist of intense episodes of painful swelling in single joints, most often in the feet (especially the big toe). Gout occurs when excess uric acid (a normal waste product) accumulates in the body, and needle‐like uric acid crystals deposit in the joints. Large deposits of uric acid crystals, called tophi, may also deposit both in joints and in the tissues around joints. This may happen because either uric acid production increases or because the kidneys are unable to remove uric acid from the body adequately.

A type of CT scan called dual energy CT scan (commonly called DECT) is highly accurate in spotting kidney stones, and this technology has recently been modified to detect monosodium urate crystals. Researchers from the Mayo Clinic in Rochester, Minn. recently assessed the accuracy of using DECT scanning to diagnose gout as a complementary or alternative way for physicians to make a diagnosis of the disease (in addition to or instead of withdrawing and examining synovial fluid from a person’s joint).

source: American College of Rheumatology


MRI may be noninvasive method to measure breast cancer prognosis

Quantitative magnetic resonance imaging measures were associated with prognostic tumor markers, demonstrating the potential of magnetic resonance imaging for prediction of disease prognosis and stratification of patients to appropriate therapies, according to preliminary data presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium, held Dec. 6-10, 2011.

"Breast cancers are heterogeneous, and different subtypes of breast cancer will respond differently to therapy," said Sana Parsian, M.D., a research assistant in the department of radiology at the University of Washington in Seattle. "Every patient with breast cancer must undergo biopsy to be evaluated for the type of breast cancer they have. Based on that, adjuvant medical therapies are prescribed for them."

Parsian and her colleagues hypothesized that some quantitative magnetic resonance imaging (MRI) measures, such as diffusion-weighted MRI (DWI) and dynamic contrast-enhanced MRI (DCE), would correlate with histopathological markers by enabling the researchers to measure the tumor's cellularity and vascularity.

source: MedXpress


New Siemens SOMATOM Perspective CT Scanner Focuses on Cost-effectiveness

CHICAGO, Nov. 28, 2011 /PRNewswire/ -- At the 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA), Siemens Healthcare (NYSE: SI) (Booth #822, East Building/Lakeside Center, Hall D) is unveiling the SOMATOM® Perspective(1) – the first computed tomography (CT) scanner to offer the eMode software solution, which may potentially determine the best correlation between dose, efficiency and image quality, and may adjust the required scan parameters automatically. Potentially suited to cover a variety of clinical fields, the SOMATOM Perspective may potentially allow clinics and practices to extend their range of available examinations. The system's operation can potentially be optimized for the individual scan – for example, in terms of tube current or scan velocity – relieving wear and tear on the CT. The system is an example of Siemens approach to delivering innovative solutions that provide maximum value to customers – primary goals of the Healthcare Sector's recently announced Agenda 2013.

The SOMATOM Perspective's eMode software (the "e" represents efficiency) can be selected from the user interface control panel. eMode may potentially determine and automatically select the scan parameters so that the CT operates with as low a load as possible, potentially minimizing wear and increasing the scanner's life cycle.

With its slim gantry and footprint of 18 square meters, the SOMATOM Perspective has the potential to be placed even in smaller rooms. On average, it may use just 71 kVA of electricity and may emit approximately 7 kW of heat. To help facilitate its use in daily routines and possibly minimize exam times, the SOMATOM Perspective is equipped with new available Fully Assisting Scanner Technologies (FAST) features that may potentially simplify and automate time-consuming, complex procedures, thus potentially supporting clinical personnel at every stage of the CT examination.

source: Virtual Press Office


Self-Referral Leads to More Negative Exams for Patients

CHICAGO, Nov. 30, 2011 /PRNewswire-USNewswire/ -- Physicians who have a financial interest in imaging equipment are more likely to refer their patients for potentially unnecessary imaging exams, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

"Self-referral," whereby a non-radiologist physician orders imaging exams and directs patients to imaging services in which that physician has a financial interest, is a concerning trend in medicine and a significant driver of healthcare costs.

"Self-referred medical imaging has been shown to be an important contributor to escalating medical costs," said Ben E. Paxton, M.D., radiology resident at Duke University Medical Center in Durham, N.C.

"Attempts to date at reducing healthcare spending on medical imaging have come in the form of across-the-board cuts that threaten to reduce access to vital imaging services," said the paper's senior author, Ramsey Kilani, M.D., associate faculty member at Duke. "We believe patients would be better served if we instead eliminated underlying drivers of unnecessary imaging spending."

Between 2000 and 2005, ownership or leasing of MRI equipment by non-radiologists grew by 254 percent, compared to 83 percent among radiologists. The U.S. Government Accountability Office (GAO) reported that the proportion of non-radiologists billing for in-office imaging more than doubled from 2000 to 2006. During that same time period, private office imaging utilization rates by non-radiologists who control patient referral grew by 71 percent.

source: PR Newswire