• Raghav R Mattay, Karapet Davtyan, Jeffrey D Rudie, Govind S Mattay, Dina A Jacobs, Matthew Schindler, Laurie A Loevner, Mitchell D Schnall, Michel Bilello, Alexander C Mamourian, and Tessa S Cook.
• Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
• J Neuroimaging. 2022 Jul 1; 32 (4): 656-666.

Background And PurposeImaging and autopsy studies show intracranial gadolinium deposition in patients who have undergone serial contrast-enhanced MRIs. This observation has raised concerns when using contrast administration in patients who receive frequent MRIs. To address this, we implemented a contrast-conditional protocol wherein gadolinium is administered only for multiple sclerosis (MS) patients with imaging evidence of new disease activity on precontrast imaging. In this study, we explore the economic impact of our new MRI protocol.MethodsWe compared scanner time and Medicare reimbursement using our contrast-conditional methodology versus that of prior protocols where all patients received gadolinium.ResultsFor 422 patients over 4 months, the contrast-conditional protocol amounted to 60% decrease in contrast injection and savings of approximately 20% of MRI scanner time. If the extra scanner time was used for performing MS follow-up MRIs in additional patients, the contrast-conditional protocol would amount to net revenue loss of $21,707 (∼3.7%).ConclusionsImplementation of a new protocol to limit contrast in MS follow-up MRIs led to a minimal decrease in revenue when controlled for scanner time utilized and is outweighed by other benefits, including substantial decreased gadolinium administration, increased patient comfort, and increased availability of scanner time, which depending on type of studies performed could result in additional financial benefit.© 2022 American Society of Neuroimaging.

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