Adams Scott J, Rakheja Rajan, Bryce Rhonda, Babyn Paul S
Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Can Assoc Radiol J. 2018 Feb;69(1):63-70. doi: 10.1016/j.carj.2017.08.001.
The study sought to determine the incidence of incidental findings on whole-body positron emission tomography with computed tomography (PET/CT) imaging and the average costs of investigations to follow-up or further characterize incidental findings.
Imaging reports of 215 patients who underwent whole-body PET/CT imaging were retrospectively reviewed. Our provincial picture archiving and communication system was queried and patient charts were reviewed to identify all investigations performed to follow-up incidental findings within 1 year of the initial PET/CT study. Costs of follow-up imaging studies (professional and technical components) and other diagnostic tests and procedures were determined in Canadian dollars (CAD) and U.S. dollars (USD) using the 2015 Ontario Health Insurance Plan Schedule of Benefits and Fees and 2016 U.S. Medicare Physician Fee Schedule, respectively.
At least 1 incidental finding was reported in 161 reports (74.9%). The mean number of incidental findings ranged from 0.64 in patients <45 years of age to 2.2 in patients 75 years of age and older. Seventy-five recommendations for additional investigations were made for 64 (30%) patients undergoing PET/CT imaging, and 14 of those were carried out specifically to follow-up incidental findings. Averaged across all 215 patients, the total cost of investigations recommended to follow-up incidental findings was CAD$105.51 (USD$127.56) per PET/CT study if all recommendations were acted on, and CAD$22.77 (USD$29.14) based on investigations actually performed.
As the incidence of incidental findings increases with age and a larger proportion of elderly patients is expected as population demographics change, it will be increasingly important to consider incidental findings on PET/CT imaging with standardized approaches to follow-up.
本研究旨在确定全身正电子发射断层扫描与计算机断层扫描（PET/CT）成像中偶然发现的发生率，以及对偶然发现进行随访或进一步特征化检查的平均费用。
对215例行全身PET/CT成像患者的影像报告进行回顾性分析。查询我省的图像存档与通信系统，并查阅患者病历，以确定在首次PET/CT检查后1年内为随访偶然发现而进行的所有检查。分别使用2015年安大略省健康保险计划福利和费用明细表以及2016年美国医疗保险医师费用明细表，以加元（CAD）和美元（USD）确定随访成像研究（专业和技术部分）以及其他诊断测试和程序的费用。
161份报告（74.9%）中至少报告了1项偶然发现。偶然发现的平均数量在45岁以下患者中为0.64项，在75岁及以上患者中为2.2项。对64例（30%）行PET/CT成像的患者提出了75项进一步检查的建议，其中14项是专门为随访偶然发现而进行的。在所有215例患者中平均计算，如果所有建议都得到执行，随访偶然发现所建议的检查总费用为每次PET/CT检查105.51加元（127.56美元），基于实际进行的检查则为22.77加元（29.14美元）。
随着偶然发现的发生率随年龄增加而上升，并且随着人口结构变化预计老年患者比例会更大，采用标准化的随访方法来考虑PET/CT成像中的偶然发现将变得越来越重要。
