Screening for Dementia Caused by Modifiable Lifestyle Choices Using Hybrid PET/MRI

Abstract

Significant advances in positron emission tomography (PET) and magnetic resonance imaging (MRI) brain imaging in the early detection of dementia indicate that hybrid PET/MRI would be an effective tool to screen for dementia in the population living with lifestyle risk factors. Here we investigate the associated costs and benefits along with the needed imaging infrastructure. A demographic analysis determined the prevalence of dementia and its incidence. The expected value of the screening program was calculated assuming a sensitivity and specificity of 0.9, a prevalence of 0.1, a QALY factor of 0.348, a willingness to pay $114,000 CAD and the cost per PET/MRI scan of $2,000 CAD. It was assumed that each head PET/MRI could screen 3,000 individuals per year. The prevalence of dementia is increasing by almost two-fold every 20 years due to the increased population at ages where dementia is more prevalent. It has been shown that a five-year delay in the incidence of dementia would decrease the prevalence by some 45%. In Canada, a five-year delay corresponds to a health care savings of $27,000 CAD per subject per year. The expected value for screening was estimated at $23,745 CAD. The number of subjects to be screened per year in Canada, USA, and China between 60 and 79 was 11,405,000. The corresponding number of head-only hybrid PET/MRI systems needed is 3,800. A brain PET/MRI screening program is financially justifiable with respect to health care costs and justifies the continuing development of MRI compatible brain PET technology.

Current Trends and Applications of PET/MRI Hybrid Imaging in Neurodegenerative Diseases and Normal Aging

“…Overall, the number of reviews after filtering was 19.4% (18/93) of the eligible articles. Common themes across these review articles included the rise of artificial intelligence, technical improvements to PET/MRI imaging, and new and previous regions of interest for evaluating dementia [ 8 , 10 , 72 , 73 , 74 , 75 , 76 , 77 ]. The distribution of these article types remains consistent with this current review and is discussed further in the sections below along with additional insights from the clinical articles sourced in the past five years.…”

“…PET/MRI has become more financially reasonable for the evaluation of cognitive impairment due to its increased efficacy [ 72 , 111 ]. Manuel et al estimate that for every five-year delay in dementia onset, there are direct savings of approximately USD 8 billion per year or approximately USD 135,000 per person [ 112 ].…”

“…Manuel et al estimate that for every five-year delay in dementia onset, there are direct savings of approximately USD 8 billion per year or approximately USD 135,000 per person [ 112 ]. Prato et al estimate savings of USD 115,000 per person assuming that PET/MRI costs approximately USD 2000 per study and approximately one in ten patients have evidence of cognitive impairment on hybrid imaging [ 72 ]. Currently, due to the slower-than-anticipated incorporation of hybrid systems, cycle times for newer generation of models may be greater than ten years.…”

“…Due to this trend, more companies are aiming to build dedicated brain PET inserts that can augment stand-alone MRI systems, which is cheaper than a full hybrid system. Specifically, it costs approximately USD 6 million for a packaged hybrid system versus USD 1.3 million for a PET insert that can be added to a USD 3 million 3 T MRI system, making PET/MRI more attractive as a modality [ 72 ]. Increasing adoption of the technology will continue to motivate clinical studies and reviews to more strongly inform the direction of multimodal imaging.…”

Zero Echo Time MRAC on FDG-PET/MR Maintains Diagnostic Accuracy for Alzheimer’s Disease; A Simulation Study Combining ADNI-Data

“…Positron emission tomography (PET)/magnetic resonance (MR) has been distributed worldwide and started to be used for the evaluation of dementia both in the clinical and research setting (Drzezga et al, 2014;Barthel et al, 2015;Fendler et al, 2016;Henriksen et al, 2016;Mainta et al, 2017;Zhang et al, 2017;Hope et al, 2019;Prato et al, 2019;Yan et al, 2020). The multimodal evaluation combining functional images such as PET and morphological images such as MR imaging (MRI) is optimal because each of them provides complementary information (Teipel et al, 2015;Kaltoft et al, 2019).…”