常规MRI与磁共振弥散加权成像定量化评估急性脑梗死发病:与CT及常规MRI的成本效果比

Routine MRI and diffusion-weighted imaging for quantitative evaluation of episode of acute cerebral infarction:Comparison of cost-effectiveness with CT or routine MRI

目的:应用CT与常规MRI和常规MRI+磁共振弥散加权成像3种方法评估急性脑梗死的发病,并进行成本效果的比较分析。方法:选择2003-01/2004-11在大庆油田总医院就诊、临床高度怀疑脑梗死患者180例。①对180例病例均行CT、MRI及常规MRI+磁共振弥散加权成像检查,三者检查时间间隔<1h。②根据临床随访和随访CT或常规MRI诊断结果进行评估;脑梗死的诊断标准:出现相应神经症状,持续24h以上,排除其他疾病,经CT和(或)常规MRI随访证实。③应用成本-效果分析进行经济学评价。根据成本核算结果及文献报道推算3种方法对脑梗死患者治疗效果及直接医疗成本的影响。结果:180例患者全部进入结果分析。①180例中有142例为脑梗死,CT,常规MRI,常规MRI+磁共振弥散加权成像诊断正确的例数分别为18,73,142例。②CT,常规MRI、常规MRI+磁共振弥散加权成像查出1例真阳性的费用为1200,1800元及976元,增量分析中,常规MRI+弥散加权成像与CT的增量比为943。③根据推算,常规MRI+磁共振弥散加权成像诊断脑梗死所产生的效益高于CT及常规MRI,与CT相比,可节约23.78%的医疗费用,与常规MRI相比,可节约14.64%的医疗费用。结论:常规MRI+磁共振弥散加权成像诊断急性脑梗死具有准确、非侵袭定量化的特征,从成本效果比的角度可以节约医疗费用,提高治疗后效果。

AIM： To evaluate the episode of acute cerebral infarction （ACI） respectively with CT, routine MRI and routine MRI plus magnetic resonance diffusion-weighted imaging （MR DWI）, and compare the costeffectiveness of three methods. METHODS： From January 2003 to November 2004, 180 highly suspected ACI patients were selected from Daqing Oilfield General Hospital. ①All the patients were subjected to CT, routine MRI and MRI plus DWI, with interval of no more than 1 hour. ②To evaluate based on the follow-ups of clinic and CT or routine MRI examination; The diagnosis standard of cerebral infarction： The corresponding sign of nerves appeared continuously for over 24 hours, and was verified by follow-up CT and/or routine MRI examination after excluding other diseases. ③The cost-effectiveness analysis was applied to perform economic evaluation. According to cost accounting results and literature reports, the therapeutic efficacy of ACI patients treated with three methods and the impact of direct medical costs were calculated. RESULTS： Totally 180 Patients entered the results of analysis. ①There were 142 ACI cases among 180 cases. There were 18, 73 and 142 cases precisely diagnosed by CT, routine MRI and routine MRI plus DWI respectively. ②The costs of diagnosing true positive case were 1 200 yuan, 1 800 yuan, and 976 yuan respectively with CT, routine MRI and routine MRI plus DWI examination. In incremental analysis, the ratio of increased cost and effect between MRI plus DWI and CT was 943. ③According to the calculation, the benefits of routine MRI plus DWI in diagnosing ACI was higher than that of CT or routine MRI, and the medical costs could save 23.78% and 14.64% respectively, compared with CT and routine MRI. CONCLUSION： The routine MRI plus DWI has an accurate and noninvasive quantification in diagnosing ACI, and in view of cost- effectiveness ratio, it can economize the medical costs as well as enhancing the post-treatment effects.