AJR. American journal of roentgenology
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AJR Am J Roentgenol · Jun 2012
Pulmonary embolism diagnosis and mortality with pulmonary CT angiography versus ventilation-perfusion scintigraphy: evidence of overdiagnosis with CT?
The purposes of this study were to determine whether pulmonary emboli diagnosed with pulmonary CT angiography (CTA) represent a milder disease spectrum than those diagnosed with ventilation-perfusion (V/Q) scintigraphy, to determine the trends in incidence and mortality among patients with the diagnosis of pulmonary embolism from 2000 to 2007, and to correlate incidence and mortality trends with imaging modality trends. ⋯ The results of this study are evidence that the shift in imaging from V/Q scintigraphy to pulmonary CTA resulted in increased diagnosis of a less fatal spectrum of pulmonary embolic disease, raising the possibility of overdiagnosis. Outcome-based clinical trials with long-term follow-up would be helpful to further guide management.
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AJR Am J Roentgenol · Jun 2012
Axial and reformatted four-chamber right ventricle-to-left ventricle diameter ratios on pulmonary CT angiography as predictors of death after acute pulmonary embolism.
The purpose of this article is to retrospectively compare right ventricular-to-left ventricular (RV/LV) diameter ratios measured on the standard axial view versus the reformatted four-chamber view as predictors of mortality after acute pulmonary embolism (PE). ⋯ The axial RV/LV diameter ratio is no less accurate than the reformatted four-chamber RV/LV diameter ratio for predicting 30-day mortality after PE.
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AJR Am J Roentgenol · Jun 2012
ReviewInferior vena cava filter-associated abnormalities: MDCT findings.
Deep venous thrombosis from the pelvis or lower extremities has significant morbidity, and subsequent pulmonary embolism has a high mortality rate. Immediate anticoagulation in patients with deep venous thrombosis is crucial in preventing this lethal complication. However, in patients with contraindications for or failure of anticoagulation, inferior vena cava filters reduce mortality by decreasing the incidence of pulmonary embolism. ⋯ In this review, we discuss the various pathologic abnormalities related to inferior vena cava filters, as seen on MDCT images.
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AJR Am J Roentgenol · Jun 2012
ReviewWhat the radiologist needs to know about urolithiasis: part 2--CT findings, reporting, and treatment.
This article reviews types of urinary calculi and their imaging appearances, presents direct and secondary imaging findings of urolithiasis, and provides an overview of treatment methods. Pertinent imaging findings that affect clinical management are highlighted. The implications of complex or variant genitourinary anatomy are reviewed. We outline a standard format for the reporting of urolithiasis to facilitate informed clinical management decisions. ⋯ Unenhanced CT is the preferred examination for evaluation of urolithiasis because of its availability, ease of performance, and high sensitivity. An awareness of the important imaging findings to report allows appropriate and efficient therapy.
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AJR Am J Roentgenol · Jun 2012
ReviewWhat a differential a virus makes: a practical approach to thoracic imaging findings in the context of HIV infection--part 2, extrapulmonary findings, chronic lung disease, and immune reconstitution syndrome.
The Centers for Disease Control and Prevention reported more than one million people with HIV infection in the United States in 2006, an increase of 11% over 3 years. Worldwide, nearly 34 million people are infected with HIV. Pulmonary disease accounts for 30-40% of acute hospitalizations of HIV-seropositive patients, underscoring the importance of understanding the range of cardiothoracic imaging findings associated with HIV infection. This article will cover extrapulmonary thoracic diseases, chronic lung diseases, and immune reconstitution inflammatory syndrome in HIV-infected patients. Our approach is focused on the radiologist's perspective by recognizing and categorizing key imaging findings to generate a differential diagnosis. The differential diagnosis can be further refined by incorporating clinical data, such as patient demographics, CD4 count, and presenting symptoms. In addition, with prolonged survival of HIV-infected patients in the era of highly active antiretroviral therapy, radiologists can also benefit from awareness of imaging features of a myriad of chronic cardiopulmonary diseases in this patient population. Finally, the change of imaging findings and clinical status in response to treatment provides important diagnostic information, such as in immune reconstitution syndrome. ⋯ Developing a practical approach to key cardiothoracic imaging findings in HIV-infected patients will aid the radiologist in generating a clinically relevant differential diagnosis and interpretation, thereby improving patient care.