Imaging Technology News - October 2008 - (Page 37)

> > special report Contrast Agents Compete continued from page 34 “The ENHANCE study looks at reader preferences, so it is not comparing diagnostic efficacy,” indicated Dr. Vitti. “In other words, it is not showing that patient outcomes are affected, that patient surgical approaches were affected or that patient outcomes were better by having a scan with one agent rather than another. He added, “It’s really a reader preference comparison and there are many things that can affect a reader's preference. For instance one neuroradiologist may prefer one agent over another because of training or experience.” Sensitivity a sticking point MultiHance also met the endpoint used in the study for quantitative parameters linked to the contrast enhancement obtained with the two agents (contrast-to-noise ratio, [CNR]). Dr. Vitti is quick to point out that the research acknowledges that all of the studies were diagnostically adequate for interpretation, adding, “An interesting point is that they were able to see the lesions with both tracers. So that is why they are able to put a cursor over both of them and make the measurements.” According to one of the study’s principal investigators, Howard Rowley, M.D., of the University of Wisconsin in Madison, the key differential between MultiHance and other gadolinium contrast agents may be that it demonstrates weak and transient interactions with serum proteins, which result in a proton magnetic relaxivity that is approximately twice that of other gadolinium contrast agents available for sale in the U.S. for CNS imaging. Researchers suggest that the higher relaxivity may result in greater signal intensity enhancement and better contrast enhancement at equivalent dose for CNS imaging. Dr. Rowley said the study produced “significant findings relative to the performance of one of the most widely used gadolinium agents administered in MRI procedures to improve the conspicuity and detectability of central nervous system (CNS) lesions.” He added, “These results are consistent in showing some clear advantages relative to performance associated with using the higher relaxivity agent versus another well-known widely used gadolinium agent in MR imaging of the brain.” However, greater lesion enhancement does not necessarily indicate diagnostic superiority. “When they make the measurements, the lesions do appear brighter by the measurements they make. But that doesn’t mean the study is more diagnostic because obviously they are seeing the lesions with both agents. They say in the discussion that all of the studies were diagnostically adequate for interpretation,” said Dr. Vitti. “I know they have published a great deal about this measurable difference and R1 relaxivity. But this has not been born out in clinical use of this product in the last couple of years as impacting patient care or diagnostic efficacy as far as anyone can tell.” The benefit of detecting just one more tumor, according to Dr. Rowley, is it can alter the entire direction of treatment. “The metrics we look at are the things we in clinical medicine look at everyday to help determine treatment programs, whether it’s surgical or radiation,” Dr. Rowley explained. “Finding one or more additional lesion could alter the decision to proceed with certain therapies or certainly in the case of radiation or surgery, it could help target additional lesions or could heed more complete detection of lesions.” Although better tumor detection could mean a significantly more effective treatment, the study does not set out to demonstrate improved diagnostic efficacy. He added, “There are recent studies that look at stroke triage, using a combination of diffusion-related images with ischemic injury and perfusion-weighted images that show areas at risk called ischemic penumbra. Having an agent that gives you excellent perfusion capabilities is also a benefit. By extension, we would expect to benefit from that as well.” And by extension, studies like ENHANCE may hold important clues that lead researchers to discover the right agent to detect stroke, Alzheimer’s or other neurological diseases. > special report DC-3 Color Ultrasound Gains FDA Clearance The FDA cleared Mindray’s DC-3 color ultrasound imaging system, equipped with extensive applications in abdominal, OB/GYN, endovaginal, cardiac, small parts and pediatric markets. This new system combines 2D imaging and color Doppler performance and is suited for hospitals and doctors’ offices in hopes of replacing black and white ultrasound imaging systems. Mindray Medical International Ltd. www.mindray.com Women’s Health: Beating Breast Cancer with Better Treatments Women’s healthcare is a renaissance for tomosynthesis - which radiologists anticipate will be used to detect and treat breast cancer. Breast MRI plays an increasingly important role in pretreatment planning, and radiosurgery sharpens its edges for more precise breast biopsy procedures. Plus, learn which oncology information management systems (OIMS) best streamline RT workflow. FDA Clears Fuji’s CR GO Portable X-Ray The FDA cleared Fuji’s newest CR system, the FCR GO portable digital X-ray system, designed to provide remote users with all of the same functionality and image processing features available at the fixed technologist workstation and FCR digital X-ray cassette reader in the imaging department. All of the image optimization and advanced image processing features of Fuji’s Flash IIP are available at the portable console, allowing for comprehensive image adjustment to be completed remotely, and images can be sent directly to PACS without additional intervention at another workstation. Because the system accommodates wireless FCR GO continued on page 35 > > INSIDE Detecting Breast Disease: The Next Frontier for Tomosynthesis > p.25 BMRI Plots Out Treatments > p.26 RT PACS Streamlines Workflow > p.28 Look for us at the American Healthcare Radiology Administrators (AHRA) July 27-31, 2008 Denver, CO Now Available ITN Digital Edition Go to ITNonline.net for your FREE subscription to ITN Digital - a $120 value! Hurry, limited time offer. Alzheimer’s indication? Contrast has implications for a wide variety of situations beyond infection and tumors, such as multiple sclerosis, which also can show enhancement in the acute phase. One of the promises of agents like MultiHance is the potential to detect Alzheimer’s disease. “In the area of dementia, usually the contrast is given more to exclude another pathology. For example, a pyramidal lobe tumors exam might end up as dementia, but the MRI would be done in part to exclude structural causes of dementia,” noted Dr. Rowley. “With Alzheimer’s, right now contrast agents like PIB (Pittsburgh Compound-B) provide a more direct way to view that pathology. “We know that MultiHance not only has an R1 effect, which is the traditional relaxation behavior which translates through the contrast enhancement on T1 images. We know that it also has a greater affect on R2 used for looking at brain perfusion when we inject a bolus of contrast. And there are a lot of groups looking at the ability of MRI perfusion studies to start to sort out different types of dementia, whether vascularrelated dementia or more traditional degenerative conditions like Alzheimer’s or other subtypes,” said Dr. Rowley. “It is a little early to say this is ready for clinical work, but an added MultiHance and OMNISCAN are commonly used magnetic resonance advantage is that it gives you a greater R2 effect, and thereimaging (MRI) contrast agents. Photo fore it facilitates perfusion exams, which are finding wider courtesy of Bracco. application in stroke, dementia and other diseases.” Imaging Technology News magazine is now available in an easy-to-navigate digital version delivered directly to your eMail in-box. Filled with all the great content you find in the print edition, ITN Digital quickly downloads to your desktop in crisp, clear pages formatted for optimum viewing. So whether you’re viewing the digital version of ITN magazine on your laptop, reading ITN magazine in print, or surfing ITNonline.net, Imaging Technology News is available whenever, wherever and however you choose. Imaging Technology News — Delivering Formats to Fit Your Lifestyle. ITNonline.net October 2008 > special report > 37 CHANGE SERVICE REQUESTED Imaging Technology News 16 E. Schaumburg Rd. Schaumburg, IL 60194-3536 PRESORTED STANDARD U.S. POSTAGE PAID PONTIAC, IL PERMIT NO. 267 http://new.reillycomm.com/imaging/special-report-b.php http://new.reillycomm.com/imaging/subscribe.php http://www.ITNonline.net http://www.usa.siemens.com/medical http://www.mindray.com

Table of Contents Feed for the Digital Edition of Imaging Technology News - October 2008

Imaging Technology News - October 2008 Contents RSNA Low-Field MRI Systems Contrast Media Injectors AM-LCDs Special Report - Agents Target Neurological Diseases and Disorders IT Laser Imagers Monitors Meet Radiology Suite Needs MR Guides Ultrasound in Outpatient Treatments Replacing a Legacy PACS PACS SAs: Titles and Salaries

Imaging Technology News - October 2008

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