Prescription practices of diagnostic imaging in dementia: a survey of 47 Alzheimer's Centres in Northern Italy.
BACKGROUND
To date, there are no data at the national or European level on the prescription practices of imaging (CT, MR, and SPET) in the diagnosis of cognitively impaired elderly patients.


METHODS
We addressed prescription practices of diagnostic imaging in 47 Alzheimer's Centres in Northern Italy, with an ad-hoc questionnaire.


RESULTS
The use of imaging in new cases was relatively intensive: 62% of the Alzheimer's Centres prescribed CT to more than 95% of cases, 24% prescribed MR to more than 33% of cases, and 33% prescribed SPET to more than 5% of cases. A minority of Alzheimer's Centres (n = 3, 6%) prescribed imaging to less than 100% of new cases. The association between onsite scanner availability and frequency of prescription increased from CT (Odds ratio (OR) = 1.8) through MR (OR = 2.4) to SPET (OR = 4.6), although only the latter was significant (95% confidence interval (CI) 1.2-17.7, p = 0.003). Patient-related factors (age, severity of cognitive impairment, and clinical suspicion of cerebrovascular disease) influenced prescription of structural imaging in 30-53% of Alzheimer's Centres and organizational factors (onsite scanner availability, and waiting list) in a similar proportion (32 and 43% respectively).


CONCLUSIONS
Organizational factors play a relevant role in the prescription of imaging exams in patients with cognitive impairment and, at least for CT, the perceived diagnostic added value is rather low, suggesting a high degree of uncertainty in the clinical use of imaging techniques.
Riello
R
R
Laboratory of Epidemiology and Neuroimaging, IRCCS San Giovanni di Dio-FBF, via Pilastroni 4, 25125 Brescia, Italy.
Albini
C
C
Galluzzi
S
S
Pasqualetti
P
P
Frisoni
G B
GB
D003704:Dementia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003952:Diagnostic Imaging / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008279:Magnetic Resonance Imaging / Q000191:economics / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data