Cost Analysis of Diffusion Tensor Imaging and MR Tractography of the Brain


Purpose: To determine the total direct costs (fixed and variable costs) of diffusion tensor imaging (DTI) and MR tractography reconstruction of the brain. Materials and Methods: The direct fixed and variable costs of DTI with MR tractography were determined prospectively with time and motion analysis in a 1.5-Tesla MR scanner using 15 encoding directions. Seventeen patients with seizure disorders, 9 males & 8 females, with mean age of 13 years (age range 2 - 33 years) were studied. Total direct costs were calculated from all direct fixed and variable costs. Sensitivity analyses between 1.5 versus a 3-Tesla MR system, and 15 versus 32 encoding directions were done. Results: The total direct costs of DTI and MR tractography for a 1.5-T system with 15 encoding directions were US $97. Variable cost was $76.80 and fixed cost was $20.20. Total direct costs for a 3-T system with 15 directions decreased to US $94.5 because of the shorter scan time despite the higher cost of the 3-T system. The most costly component of the direct cost was post-processing analysis at US $46.00. Conclusion: DTI with MR tractography has important total direct costs with variable costs higher than the fixed costs. The post processing variable cost is the most expensive component. Developing more accurate automated post-processing software for DTI and MR tractography is important to decrease this variable labor cost. Given the added value of DTI-MR tractography and the costs involved reimbursement codes should be considered.

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Hancock, C. , Bernal, B. , Medina, C. and Medina, S. (2014) Cost Analysis of Diffusion Tensor Imaging and MR Tractography of the Brain. Open Journal of Radiology, 4, 260-269. doi: 10.4236/ojrad.2014.43034.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Assaf, Y. and Pasternak, O. (2008) Diffusion Tensor Imaging (DTI)-Based White Matter Mapping in Brain Research: A Review. Journal of Molecular Neuroscience, 34, 51-61.
[2] Hagmann, P., et al. (2003) DTI Mapping of Human Brain Connectivity: Statistical Fibre Tracking and Virtual Dissection. Neuroimage, 19, 545-554.
[3] Mukherjee, P., et al. (2008) Diffusion Tensor MR Imaging and Fiber Tractography: Theoretic Underpinnings. American Journal of Neuroradiology, 29, 632-641.
[4] Klose, U., et al. (2005) Segmentation of the White Matter in the Brain Based on MR-DTI Fiber Directions. Zeitschrift für Medizinische Physik, 15, 247-255.
[5] Sanchez, D., et al. (2006) 3-D Brain Segmentation towards the Integration of DTI and MRI Modalities. Biomedical Sciences Instrumentation, 42, 326-331.
[6] Holdsworth, S.J., et al. (2012) Diffusion Tensor Imaging (DTI) with Retrospective Motion Correction for Large-Scale Pediatric Imaging. Journal of Magnetic Resonance Imaging, 36, 961-971.
[7] Qiu, T.M., et al. (2010) Virtual Reality Presurgical Planning for Cerebral Gliomas Adjacent to Motor Pathways in an Integrated 3-D Stereoscopic Visualization of Structural MRI and DTI Tractography. Acta Neurochirurgica (Wien), 152, 1847-1857.
[8] Radhakrishnan, A., et al. (2011) Utility of Diffusion Tensor Imaging Tractography in Decision Making for Extratemporal Resective Epilepsy Surgery. Epilepsy Research, 97, 52-63.
[9] van der Aa, N.E., et al. (2011) Does Diffusion Tensor Imaging-Based Tractography at 3 Months of Age Contribute to the Prediction of Motor Outcome after Perinatal Arterial Ischemic Stroke? Stroke, 42, 3410-3414.
[10] Jang, S.H., et al. (2008) Motor Outcome Prediction Using Diffusion Tensor Tractography in Pontine Infarct. Annals of Neurology, 64, 460-465.
[11] Newcombe, V., Chatfield, D., Outtrim, J., Manktelow, A., Coles, J., Menon, D., et al. (2011) Mapping Traumatic Axonal Injury Using Diffusion Tensor Imaging: Correlations with Functional Outcome. PLoS ONE, 6, e19214.
[12] Levin, H.S., Wilde, E.A., Chu, Z.L., Yallampalli, R., Hanten, G.R., Li, X.Q., Chia, J., Vasquez, A.C. and Hunter, J.V. (2008) Diffusion Tensor Imaging in Relation to Cognitive and Functional Outcome of Traumatic Brain Injury in Children. Journal of Head Trauma Rehabilitation, 23, 197-208.
[13] Karmonik, C., Dulay, M., Verma, A. and Grossman, R.G. (2010) Cost Function Evaluation for the Registration of Clinical DTI Images onto the ICBM DTI81 White Matter Atlas. Technology and Health Care, 18, 145-156.
[14] Bertani, G., Carrabba, G., Raneri, F., Fava, E., Castellano, A., Falini, A., Casarotti, A., Gaini, S.M. and Bello, L. (2012) Predictive Value of Inferior Fronto-Occipital Fasciculus (IFO) DTI-Fiber Tracking for Determining the Extent of Resection for Surgery of Frontal and Temporal Gliomas Preoperatively. Journal of Neurosurgical Sciences, 56, 137-143.
[15] Lascola, C.D. (2005) Diffusion Tensor Tractography: Exploring the Cost-Benefit Ratio of Incorporating CSF Suppression into Fiber Tracing Algorithms. AJNR American Journal of Neuroradiology, 26, 693-694.
[16] Siegel, J.E., Weinstein, M.C., Russell, L.B. and Gold, M.R. (1996) Recommendations for Reporting Cost-Effectiveness Analyses. Panel on Cost-Effectiveness in Health and Medicine. JAMA, 276, 1339-1341.
[17] Kiguba, R., Kutyabami, P., Kiwuwa, S., Katabira, E. and Sewankambo, N.K. (2012) Assessing the Quality of Informed Consent in a Resource-Limited Setting: A Cross-Sectional Study. BMC Medical Ethics, 13, 21.
[18] Tsao, J., Kozerke, S., Boesiger, P. and Pruessmann, K.P. (2005) Optimizing Spatiotemporal Sampling for k-t BLAST and k-t SENSE: Application to High-Resolution Real-Time Cardiac Steady-State Free Precession. Magnetic Resonance in Medicine, 53, 1372-1382.
[19] Finsterbusch, J. (2009) Eddy-Current Compensated Diffusion Weighting with a Single Refocusing RF Pulse. Magnetic Resonance in Medicine, 61, 748-754.
[20] Klose, U., Mader, I., Unrath, A., Erb, M. and Grodd, W. (2004) Directional Correlation in White Matter Tracks of the Human Brain. Journal of Magnetic Resonance Imaging, 20, 25-30.
[21] Wang, K., Zhu, S., Mueller, B.A., Lim, K.O., Liu, Z.M. and He, B. (2008) A New Method to Derive White Matter Conductivity from Diffusion Tensor MRI. IEEE Transactions on Biomedical Engineering, 55, 2481-2486.
[22] Wassermann, D., Bloy, L., Kanterakis, E., Verma, R. and Deriche, R. (2010) Unsupervised White Matter Fiber Clustering and Tract Probability Map Generation: Applications of a Gaussian Process Framework for White Matter Fibers. NeuroImage, 51, 228-241.
[23] Wassermann, D., Rathi, Y., Bouix, S., Kubicki, M., Kikinis, R., Shenton, M. and Westin, C.F. (2011) White Matter Bundle Registration and Population Analysis Based on Gaussian Processes. Information Processing in Medical Imaging, 22, 320-332.
[24] Medina, L.S., Aguirre, E., Bernal, B. and Altman, N.R. (2004) Functional MR Imaging versus Wada Test for Evaluation of Language Lateralization: Cost Analysis. Radiology, 230, 49-54.
[25] James, P., Bebee, P., Beekman, L., Browning, D., Innes, M., Kain, J., Royce-Westcott, T. and Waldinger, M. (2011) Effort Tracking Metrics Provide Data for Optimal Budgeting and Workload Management in Therapeutic Cancer Clinical Trials. Journal of the National Comprehensive Cancer Network, 9, 1343-1352.
[26] Baltussen, R., Acharya, A., Antioch, K., Chisholm, D., Grieve, R., Kirigia, J., Torres-Edejer, T.T., Walker, D.G. and Evans, D. (2009) Cost-Effectiveness and Resource Allocation (CERA)-Directions for the Future. Cost Effectiveness and Resource Allocation, 7, 14.
[27] Ziran, B.H., Barrette-Grischow, M.K. and Marucci, K. (2008) Economic Value of Orthopaedic Trauma: The (Second to) Bottom Line. Journal of Orthopaedic Trauma, 22, 227-233.
[28] Brauer, C.A., Rosen, A.B., Greenberg, D. and Neumann, P.J. (2006) Trends in the Measurement of Health Utilities in Published Cost-Utility Analyses. Value in Health, 9, 213-218.
[29] Mitsutake, N., Oku, S., Fujii, R., Furui, Y. and Yasunaga, H. (2008) Business Administration of PET Facilities: A Cost Analysis of Three Facilities Utilizing Delivery FDG. Kaku Igaku, 45, 119-123.
[30] Sistrom, C.L. and McKay, N.L. (2005) Costs, Charges, and Revenues for Hospital Diagnostic Imaging Procedures: Differences by Modality and Hospital Characteristics. Journal of the American College of Radiology, 2, 511-519.
[31] Glaser, J. and Sett, A. (2012) Using Technology to Reveal True Costs. Healthcare Financial Management, 66, 44-49.
[32] Sharara, N., Adam, V., Crott, R. and Barkun, A.N. (2008) The Costs of Colonoscopy in a Canadian Hospital Using a Microcosting Approach. Canadian Journal of Gastroenterology, 22, 565-570.
[33] Rego, G., Nunes, R. and Costa, J. (2010) The Challenge of Corporatisation: The Experience of Portuguese Public Hospitals. European Journal of Health Economics, 11, 367-381.
[34] Rinker, G. (1995) Cost Accounting Applied to the Clinical Laboratory. Clinical Laboratory Science, 8, 339-342.
[35] Weiss, M., Martin, J., Feser, U., Schafmayer, C. and Bauer, M. (2005) Necessity and Problems with Case-Related Costing for Intensive Care Patients. Der Anaesthesist, 54, 254-262.
[36] Bell, R.A. (1996) Economics of MRI Technology. Journal of Magnetic Resonance Imaging, 6, 10-25.
[37] Hennekens, C.B. and Buring, J.E. (1987) Epidemiology in Medicine. Little, Brown, Boston, 252-258.
[38] Rosner, B. (1995) Fundamentals of Biostatistics. 4th Edition, Duxbury, Belmont, 141-190.
[39] Glantz, S. (1987) Primer of Biostatistics. 2nd Edition, McGraw-Hill, New York.
[40] Rasmussen Jr., I.A., Lindseth, F., Rygh, O.M., Berntsen, E.M., Selbekk, T., Xu, J., et al. (2007) Functional Neuronavigation Combined with Intra-Operative 3D Ultrasound: Initial Experiences during Surgical Resections Close to Eloquent Brain Areas and Future Directions in Automatic Brain Shift Compensation of Preoperative Data. Acta Neurochirurgica, 149, 365-378.
[41] Sherman, J.H., Hoes, K., Marcus, J., Komotar, R.J., Brennan, C.W. and Gutin, P.H. (2011) Neurosurgery for Brain Tumors: Update on Recent Technical Advances. Current Neurology and Neuroscience Reports, 11, 313-319.
[42] Gonzalez-Darder, J.M., González-López, P., Talamantes-Escribá, F., García-March, G., Roldán-Badía, P., Quilis-Quesada, V., et al. (2011) Treatment of Intrinsic Brain Tumors Located in Motor Eloquent Areas. Results of a Protocol Based in Navigation, Tractography and Neurophysiological Monitoring of Cortical and Subcortical Structures. Neurocirugía, 22, 23-35.
[43] Li, Z.X., Dai, J.P., Jiang, T., Li, S.W., Sun, Y.L., Liang, X.L. and Gao, P.Y. (2006) Function Magnetic Resonance Imaging and Diffusion Tensor Tractography in Patients with Brain Gliomas Involving Motor Areas: Clinical Application and Outcome. Chinese Journal of Surgery, 44, 1275-1279.
[44] Caeyenberghs, K., Leemans, A., Geurts, M., Taymans, T., Linden, C.V., Smits-Engelsman, B.C.M., Sunaert, S. and Swinnen, S.P. (2010) Brain-Behavior Relationships in Young Traumatic Brain Injury Patients: DTI Metrics Are Highly Correlated with Postural Control. Human Brain Mapping, 31, 992-1002.
[45] Braus, D.F., Tost, H., Hirsch, J.G. and Gass, A. (2001) Diffusion Tensor Imaging (DTI) and Functional Magnetic Resonance Tomography (fMRI) Expand Methodological Spectrum in Psychiatric Research. Der Nervenarzt, 72, 384-390.
[46] Chahboune, H., Ment, L.R., Stewart, W.B., Rothman, D.L., Vaccarino, F.M., Hyder, F. and Schwartz, M.L. (2009) Hypoxic Injury during Neonatal Development in Murine Brain: Correlation between in Vivo DTI Findings and Behavioral Assessment. Cerebral Cortex, 19, 2891-2901.
[47] Cirillo, M., Esposito, F., Tedeschi, G., Caiazzo, G., Sagnelli, A., Piccirillo, G., Conforti, R., et al. (2012) Widespread Microstructural White Matter Involvement in Amyotrophic Lateral Sclerosis: A Whole-Brain DTI Study. AJNR American Journal of Neuroradiology, 33, 1102-1108.
[48] Ding, A.Y., Chan, K.C. and Wu, E.X. (2012) Effect of Cerebrovascular Changes on Brain DTI Quantitation: A Hypercapnia Study. Magnetic Resonance Imaging, 30, 993-1001.
[49] Bobholz, J.A., Rao, S.M., Saykin, A.J. and Pliskin, N. (2007) Clinical Use of Functional Magnetic Resonance Imaging: Reflections on the New CPT Codes. Neuropsychology Review, 17, 189-191.
[50] Prost, R.W., Mark, L.P., Rand, S.D., Kim, T.A. and Haughton, V.M. (1997) Recent Advances in MR Spectroscopy Expand Its Applications in Neurologic Disease. WMJ: Official Publication of the State Medical Society of Wisconsin, 96, 41-45.
[51] Levin, D.C., Spettell, C.M., Rao, V.M., Sunshine, J., Bansal, S. and Busheé, G.R. (1998) Impact of MR Imaging on Nationwide Health Care Costs and Comparison with Other Imaging Procedures. AJR American Journal of Roentgenology, 170, 557-560.
[52] Arenson, R.L., Lu, Y., Elliott, S.C., Jovais, C. and Avrin, D.E. (2001) Measuring the Academic Radiologist’s Clinical Productivity: Applying RVU Adjustment Factors. Academic Radiology, 8, 533-540.
[53] Eisenberg, J.M. (1989) Clinical Economics. A Guide to the Economic Analysis of Clinical Practices. JAMA, 262, 2879-2886.
[54] Weinstein, M.C. and Stason, W.B. (1977) Foundations of Cost-Effectiveness Analysis for Health and Medical Practices. New England Journal of Medicine, 296, 716-721.
[55] Garrison Jr., L.P., Bresnahan, B.W., Higashi, M.K., Hollingworth, W. and Jarvik, J.G. (2011) Innovation in Diagnostic Imaging Services: Assessing the Potential for Value-Based Reimbursement. Academic Radiology, 18, 1109-1114.
[56] Forman, H.P. (2006) MRI and CT Imaging: How Fast Can Reimbursement Be Cut? AJR American Journal of Roentgenology, 187, 601-602.
[57] Blankart, R., Schreyogg, J. and Busse, R. (2008) Performance of Reimbursement Schemes in Valuation of Technologies: The Example of Magnetic Resonance Imaging. Technology and Health Care, 16, 171-182.
[58] Pearce, J.W. (2012) The Return of Capitation Preparing for Population-Based Health Care. Healthcare Financial Management, 66, 50-57.
[59] Silverman, S.G., Deuson, T.E., Kane, N., Adams, D.F., Seltzer, S.E., Phillips, M.D., Khorasani, R., Zinner, M.J. and Holman, B.L. (1998) Percutaneous Abdominal Biopsy: Cost-Identification Analysis. Radiology, 206, 429-435.
[60] van Erkel, A.R., van Rossum, A.B., Bloem, J.L., Kievit, J. and Pattynama, P.M. (1996) Spiral CT Angiography for Suspected Pulmonary Embolism: A Cost-Effectiveness Analysis. Radiology, 201, 29-36.
[61] Vanninen, R., Manninen, H. and Soimakallio, S. (1995) Imaging of Carotid Artery Stenosis: Clinical Efficacy and Cost-Effectiveness. AJNR American Journal of Neuroradiology, 16, 1875-1883.
[62] Baldini, C.G. and Culley, E.J. (2011) Estimated Cost Savings Associated with the Transfer of Office-Administered Specialty Pharmaceuticals to a Specialty Pharmacy Provider in a Medical Injectable Drug Program. Journal of Managed Care Pharmacy, 17, 51-59.
[63] Chesson, H.W., Blandford, J.M., Gift, T.L., Tao, G.Y. and Irwin, K.L. (2004) The Estimated Direct Medical Cost of Sexually Transmitted Diseases among American Youth, 2000. Perspectives on Sexual and Reproductive Health, 36, 11-19.
[64] Russi, T.J., Libby, D.M. and Henschke, C.I. (1997) Clinical Utility of Computed Tomography in the Diagnosis of Pulmonary Embolism. Clinical Imaging, 21, 175-182.
[65] Rubens, D.J., Strang, J.G., Fultz, P.J. and Gottlieb, R.H. (1997) Sonographic Guidance of Mediastinal Biopsy: An Effective Alternative to CT Guidance. AJR American Journal of Roentgenology, 169, 1605-1610.
[66] Dwamena, B.A., Kloos, R.T., Fendrick, A.M., Gross, M.D., Francis, I.R., Korobkin, M.T. and Shapiro, B. (1998) Diagnostic Evaluation of the Adrenal Incidentaloma: Decision and Cost-Effectiveness Analyses. Journal of Nuclear Medicine, 39, 707-712.
[67] Litwin, M.S., Kahn, K.L. and Reccius, N. (1993) Why Do Sicker Patients Cost More? A Charge-Based Analysis of Patients Undergoing Prostatectomy. Journal of Urology, 149, 84-88.
[68] Yin, D. and Forman, H.P. (1995) Health Care Cost-Benefit and Cost-Effectiveness Analysis: An Overview. Journal of Vascular and Interventional Radiology, 6, 311-320.
[69] Topol, E.J., Leya, F., Pinkerton, C.A., Whitlow, P.L., Hofling, B., Simonton, C.A., et al. (The CAVEAT Study Group) (1993) A Comparison of Directional Atherectomy with Coronary Angioplasty in Patients with Coronary Artery Disease. New England Journal of Medicine, 329, 221-227.
[70] Guzman, L.A., Simpfendorfer, C., Fix, J., Franco, I. and Whitlow, P.L. (1994) Comparison of Costs of New Atherectomy Devices and Balloon Angioplasty for Coronary Artery Disease. American Journal of Cardiology, 74, 22-25.
[71] Hunink, M.G., Cullen, K.A. and Donaldson, M.C. (1994) Hospital Costs of Revascularization Procedures for Femoropopliteal Arterial Disease. Journal of Vascular Surgery, 19, 632-641.
[72] Brasel, K.J. and Weigelt, J.A. (1996) Blunt Thoracic Aortic Trauma. A Cost-Utility Approach for Injury Detection. JAMA Surgery, 131, 619-625.
[73] Shwartz, M., Young, D.W. and Siegrist, R. (1995) The Ratio of Costs to Charges: How Good a Basis for Estimating Costs? Inquiry, 32, 476-481.
[74] Schimmel, V.E., Alley, C. and Heath, A.M. (1987) Measuring Costs: Product Line Accounting versus Ratio of Cost to Charges. Topics in Health Care Financing, 13, 76-86.
[75] Yin, D., Baum, R.A., Carpenter, J.P., Langlotz, C.P. and Pentecost, M.J. (1995) Cost-Effectiveness of MR Angiography in Cases of Limb-Threatening Peripheral Vascular Disease. Radiology, 194, 757-764.
[76] Rogers, H.W. and Coldiron, B.M. (2009) A Relative Value Unit-Based Cost Comparison of Treatment Modalities for Nonmelanoma Skin Cancer: Effect of the Loss of the Mohs Multiple Surgery Reduction Exemption. Journal of the American Academy of Dermatology, 61, 96-103.
[77] Rubin, G.D., Armerding, M.D., Dake, M.D. and Napel, S. (2000) Cost Identification of Abdominal Aortic Aneurysm Imaging by Using Time and Motion Analyses. Radiology, 215, 63-70.

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