Cost-effectiveness analysis of MRI, CE-CT and 18F-FDG PET/CT for detecting colorectal liver metastases eligible for hepatic resection.

Objectives: Colorectal cancer (CRC) is a serious challenge for the health system. In 2022 CRC represented 8% of cancer diagnoses in the United States. 30% of patients already show metastases at the initial tumor staging. The majority of these metastases are sited in the liver. According to their extension and the status of the tumor colorectal liver metastases can be treated in several ways, with hepatic resection being the gold-standard. Contrast-enhanced computed tomography (CE-CT), positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) can be used for evaluation of resectability of these liver metastases. The aim of this study is to assess the most economic imaging modality for detecting liver metastases eligible for hepatic resection by analyzing their cost-effectiveness. Materials and methods: In our study, a Markov state transition model was built to calculate the quality-adjusted life years (QALYs) and overall costs for each diagnostic strategy in accord with the stated input values obtained from scientific research. Further, probabilistic sensitivity analyses by means of Monte Carlo simulations were performed to consider possible model uncertainties. For evaluation of the cost-effectiveness on an economic threshold, the Willingness-to-pay (WTP) was set at $ 100,000. The applied values and the calculated results are based on the U.S. healthcare system. Results: CE-CT led to overall costs of $ 42,874.02 and 8.47 QALYs, whereas MRI led to $ 40,863.65 and 8.50 QALYs. PET/CT resulted in overall costs of $ 43,216.74 and 8.48 QALYs. Therefore, MRI was determined to be the dominant strategy in the model. According to the performed sensitivity analyses, MRI remained cost-effective over a wide range of WTPs. Conclusion: In conclusion, according to our analysis, MRI is the dominant strategy for detecting hepatic metastases eligible for hepatic resection in colorectal cancer.

Safety assessment and diagnostic evaluation of patients undergoing contrast-enhanced urosonography in the setting of vesicoureteral reflux confirmation.

BACKGROUND: Vesicoureteral reflux (VUR) represents a common pediatric anomaly in children with an upper urinary tract infection (UTI) and is defined as a retrograde flow of urine from the bladder into the upper urinary tract. There are many diagnostic options available, including voiding cystourethrography (VCUG) and contrasted-enhanced urosonography (ceVUS). ceVUS combines a diagnostic tool with a high sensitivity and specificity which, according to previous study results, was even shown to be superior to VCUG. Nevertheless, despite the recommendation of the EFSUMB, the ceVUS has not found a widespread use in clinical diagnostics in Europe yet. MATERIALS AND METHODS: Between 2016 and 2020, 49 patients with a marked female dominance (n = 37) were included. The youngest patient had an age of 5 months, the oldest patient 60 years. The contrast agent used in ceVUS was SonoVue®, a second-generation blood-pool agent. All examinations were performed and interpreted by a single experienced radiologist (EFSUMB Level 3). RESULTS: The 49 patients included in the study showed no adverse effects. 51% of patients (n = 26) were referred with the initial diagnosis of suspected VUR, while 49% of patients (n = 23) came for follow-up examination or to rule out recurrence of VUR. The vast majority had at least one febrile urinary tract infection in their recent medical history (n = 45; 91,8%). CONCLUSION: ceVUS is an examination method with a low risk profile which represents with its high sensitivity and specificity an excellent diagnostic tool in the evaluation of vesicoureteral reflux, especially in consideration of a generally very young patient cohort.

A secondary task is not always costly: Context-based guidance of visual search survives interference from a demanding working memory task.

Repeatedly encountering a visual search display with the target located at a fixed position relative to the distractors facilitates target detection, relative to novel displays - which is attributed to search guidance by (acquired) long-term memory (LTM) of the distractor 'context' of the target. Previous research has shown that this 'contextual cueing' effect is severely impeded during learning when participants have to perform a demanding spatial working memory (WM) task concurrently with the search task, though it does become manifest when the WM task is removed. This has led to the proposal that search guidance by LT context memories critically depends on spatial WM to become 'expressed' in behaviour. On this background, this study, of two experiments, asked: (1) Would contextual cueing eventually emerge under dual-task learning conditions if the practice on the task(s) is extended beyond the short training implemented in previous studies? and given sufficient practice, (2) Would performing the search under dual-task conditions actually lead to an increased cueing effect compared to performing the visual search task alone? The answer is affirmative to both questions. In particular, Experiment 1 showed that a robust contextual cueing effect emerges within 360-720 dual-task trials as compared to some 240 single-task trials. Further, Experiment 2 showed that when dual- and single-task conditions are performed in alternating trials blocks, the cueing effect for the very same set of repeated displays is significantly larger in dual-task blocks than in single-task blocks. This pattern of effects suggests that dual-task practice eventually leads to direct, or 'automatic', guidance of visual search by learnt spatial LTM representations, bypassing WM processes. These processes are normally engaged in single-task performance might actually interfere with direct LTM-based search guidance.