AJR. American journal of roentgenology
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AJR Am J Roentgenol · Jul 2005
Informed decision making: age of 50 is arbitrary and has no demonstrated influence on breast cancer screening in women.
OBJECTIVE. The article discusses the fact that for more than 20 years, there has been controversy concerning whether there is a benefit from mammographic screening for women ages 40-49. Based on a decision made many years ago to try to determine how menopause might influence the value of screening, the age of 50 was chosen as a surrogate for menopause. ⋯ The data clearly show that the age of 50 is nothing more than an arbitrary age, and it is far from clear whether menopause has any important effect on screening. The "harms" of screening have been cited as reasons for not recommending screening before the age of 50, but since the ratio of harm to benefit changes steadily with increasing age, there is no legitimate rationale for this determination. Women and their physicians should be informed that the age of 50 is an arbitrary threshold in terms of mammography screening so that they can make informed decisions about their own health care.
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AJR Am J Roentgenol · Jun 2005
The status of appendiceal CT in an urban medical center 5 years after its introduction: experience with 753 patients.
Appendiceal CT was introduced at our hospital in 1996 and now is used in most patients. The use of appendiceal CT has generated controversy and mixed results in various investigations. Our purpose was to determine the percentage of patients for whom CT was performed, incidence of appendicitis, accuracy of CT, percentage of equivocal interpretations, and negative appendectomy rates for those patients who did and did not undergo CT. ⋯ Five years ago, the negative appendectomy rate dropped from 20% to 7%, and it is now 3.0%. The incidence of appendicitis in patients who are examined on CT is stable compared with similar cohorts from prior investigations. Patients who do not undergo CT also have a low negative appendectomy rate, but this relatively small group is selected on the basis of a convincing clinical presentation. Female pediatric patients likely would have a lower negative appendectomy rate with greater use of CT.
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Oligoarthritis is the most common manifestation of late Lyme disease in children. Considerable overlap can occur in the clinical presentation of Lyme arthritis and acute septic arthritis. Early differentiation is critical, given the disparate therapeutic implications; Lyme arthritis is treated with outpatient oral antibiotics, while septic arthritis requires hospitalization, IV antibiotics, and, often, surgical drainage. We wanted to identify MRI features that may distinguish Lyme arthritis from septic arthritis in children. ⋯ Our results identified three MRI features, specifically, myositis, adenopathy, and lack of subcutaneous edema, that strongly suggest the diagnosis of Lyme arthritis rather than septic arthritis in children with acute inflammation of the knee. Awareness of these characteristic MRI features may avoid unnecessary invasive procedures and cost.
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AJR Am J Roentgenol · May 2005
ReviewImaging of transposed ovaries in patients with cervical carcinoma.
Lateral ovarian transposition is a surgical procedure performed in premenopausal women with pelvic malignancies in which the ovaries are surgically displaced from the pelvis, before radiation therapy. In this article, we present the imaging features of normal transposed ovaries as well as the spectrum of abnormalities associated with lateral ovarian transposition. ⋯ After lateral ovarian transposition, it is important to recognize the ovaries to avoid confusing them with peritoneal implants. In addition, benign ovarian lesions must be distinguished from primary and secondary malignancies.
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AJR Am J Roentgenol · May 2005
16-MDCT in the detection of occult wrist fractures: a comparison with skeletal scintigraphy.
Our objective was to assess the potential use of MDCT in the detection of occult scaphoid fractures. Fifty-one patients with suspected radiographically occult scaphoid fractures at 10-14 days after trauma were investigated prospectively with skeletal scintigraphy and CT on the same day. Planar images of the wrist were taken 3 hr after IV injection of 400 MBq of (99m)Tc-methylene diphosphonate using a single-head gamma camera. CT was performed on a 16-MDCT machine using 0.75-mm detectors and reconstruction in 0.5-mm slices. Multiplanar reformatted images were then viewed in interactive cine mode. The examinations were reported independently, and discordant results were compared at follow-up. CT was positive for wrist fracture in 14 (27.4%) of 51 patients and skeletal scintigraphy in 23 (45.1%) of 51 patients. Even after retrospective review, there were seven discrepant cases (13.7%), all of which were positive for wrist fracture on scintigraphy but negative on CT. Four of these seven patients with discordant findings underwent further radiography at 6 weeks, which did not show fracture. ⋯ Although CT was preferred by most patients and was quicker, scintigraphy appears to detect bony abnormality more frequently. However, there appears to be an interesting group of patients (7/51) with normal initial radiography findings but positive scintigraphy findings who would normally be considered to have a fracture but for whom CT results were negative. In some of these patients, the results of follow-up radiography at 6 weeks were also negative, suggesting that this group of patients warrants further study.