The use of CT angiography has surged in recent years, coupled with a corresponding drop in MRI exams, according to new research published Jan. 20 in Clinical Imaging [1].
From 2013 to 2019, the annual number of such CTA exams leapt by more than 90% among the Medicare population. At the same time, magnetic resonance angiography dropped by nearly 18%, James Goldfarb, PhD, and co-authors reported. During that same time, the number of physicians interpreting MRAs fell at both hospitals (–17%) and outpatient centers (–8%) with marked increases on the CT angiography side (up 29% and 54%, respectively).
“Although the decline in the use of MRA and the increase in use of CTA had statistically significant temporal relationships, the reasons for these changes cannot be ascertained from the available data,” Goldfarb, with the Division of Cardiovascular Imaging at St. Francis Hospital and Heart Center in Roslyn, New York, and colleagues advised. “Possibly, the main reason that CTA use has accelerated is the ease of access, lower cost, and short scan time, especially in the setting of emergent clinical indications such as acute stroke, trauma, pulmonary embolism, cerebral aneurysm, and suspected aortic dissection or rupture.”
For the study, researchers analyzed information from Medicare Part B physician payment databases through 2020. During the first year of the COVID-19 pandemic, MRA utilization decreased across all imaging environments by about 25% while CTA only dropped by about 6%. Intracranial MRA studies were most soften performed without imaging contrast, and contrast use for neck MRA was performed at similar rates as noncontrast exams. Radiology remained the “dominant” specialty offering both modalities, with neurology retaining a small share, the authors noted.
Head and neck was “by far” the most common use of MRA, versus other body regions that only demanded a small portion of the totals. The chest, meanwhile, was the most imaged area for CTA, which also had higher levels of neurological and body use compared to MRA.
The study did not delve into reasons why magnetic resonance angiography delivery declined. But Goldfarb and co-authors highlighted “outdated safety concerns” related to gadolinium-based contrast agents. In years past, patients with pacemakers or defibrillators were often not considered for MRI, they added.
“The cost (both purchase price and service as well as cost per exam) of an MR scanner compared to CT scanner may be a factor in many instances,” the authors advised. “Lastly, CTA may be simpler to order or implement in a typical clinical practice due to availability, access and workflow.”
Read much more in Clinical Imaging at the link below.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.