CHICAGO—According to early experience at one imaging center in
Massachusetts, whole-body screening CT is attracting individuals who may
benefit from early detection of disease, such as current or former smokers and
persons with other risk factors for cancer and heart disease. These researchers
found that whole-body screening CT is not, as some have feared, leading to
additional unnecessary invasive and expensive testing. However, a California
study found that nearly half of persons with an abnormality found on screening
required follow-up testing.

Further, the California study suggests that the procedure may be costly to
patients who may not receive the reassurance they are looking for in return for
an $800 to $1,000 charge, as well as to insurers who pay for laboratory and
other follow-up imaging tests.

Speaking at the 88th Annual Meeting of the Radiological Society of North
America (RSNA), Giovanna Casola, MD, recommended that whole-body CT screening
should be confined to individuals who are at the highest risk for serious
disease, and it should be provided in a facility that also can perform any
indicated follow-up tests. Dr. Casola is professor of radiology and chief of
body imaging, University of California, San Diego (UCSD), and lead author of a
study on whole-body screening CT at a private outpatient imaging center in San
Diego.

She also suggested that the facilities that provide whole-body screening CT
should be sure to use contrast media for imaging the abdomen in patients with a
previous known malignancy. "If we are truly trying to find cancers, it is okay
to do a CT scan in the chest without intravenous contrast. But in the abdomen,
you will miss cancers if you don’t give intravenous contrast, and therefore a
negative examination would give patients a false sense of security," she said.

San Diego Center Study

Of 1,192 patients scanned in Dr. Casola’s study, 86.5% had at least one
abnormality, and 13.5% had a totally negative exam (RSNA abstracts 319 and
320). Of the patients with an abnormality, 54% had benign findings of only
minimal clinical significance that did not require further screening. Among the
46% who had more substantial abnormalities requiring follow-up, 15% had
significant benign disease such as emphysema and 25% had a possible malignancy.

Of the 25% of persons screened who were classified as high risk, 24% had a
suspicious lesion in the chest or abdomen that required additional testing, but
less than 1% had a potential malignancy or life-threatening condition such as
an aortic aneurysm, Dr. Casola said.