Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · May 2003
ReviewEvidence-based imaging evaluation of the cervical spine in trauma.
Despite the relatively low frequency of cervical spine fractures in trauma patients, tremendous resources are expended on the use of imaging to exclude fracture. Some level 2 evidence can direct the selection of subjects for imaging and optimization of the imaging strategy. A suggested algorithm for evidence-based cervical spine imaging is shown in Fig. 1. ⋯ For high-risk subjects, cost-effectiveness analysis suggests that CT is the preferred initial strategy. When compared with radiography, the higher short-term costs of CT are counter-balanced by the decreased need for further imaging in patients without injury and by the increased sensitivity for fracture. The high-risk cervical spine criteria used at the author's center seem to be valid for identifying appropriate patients for initial imaging with CT.
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Neuroimaging Clin. N. Am. · May 2003
ReviewImaging evaluation of sinusitis: diagnostic performance and impact on health outcome.
Sinusitis is a highly prevalent disease, with a significant impact on the health care economy. Sinus CT is the primary imaging modality for evaluation of acute and chronic sinusitis. ⋯ Although sinus CT has been criticized for lack of specificity and correlation with patients' clinical symptoms, sinus CT may provide pivotal objective information that affects treatment decisions for acute and chronic sinusitis. This article provides a clinical overview and reviews the role of imaging studies in diagnosis and treatment of sinusitis.
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Neuroimaging Clin. N. Am. · May 2003
ReviewPercutaneous vertebroplasty: rationale, clinical outcomes, and future directions.
Percutaneous transpediculate vertebroplasty is an innovative and successful treatment of painful osteoporotic and pathologic compression fractures that are refractory to medical therapy. Large-scale clinical series have shown that vertebroplasty can provide significant pain relief with very low complication rates. Expectations of positive results of the ongoing randomized trials are high. With the accumulation of scientific data, technological advancements, and acceptance by the general community, vertebroplasty may be become the standard of care for treatment of painful vertebral body compression fractures.
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Neuroimaging Clin. N. Am. · May 2003
ReviewImaging of adults with low back pain in the primary care setting.
The evidence for the diagnostic accuracy of the four main imaging modalities used in low back pain (plain radiographs, CT, MR imaging, radionuclide bone scans) is variable in quality and limits the ultimate conclusions regarding the effectiveness and cost-effectiveness of diagnostic strategies. In addition, the frequent finding of abnormalities in normal adults limits the specificity of all of these tests. Nevertheless, MR imaging is likely in most cases to offer the greatest sensitivity and specificity for systemic diseases, and its performance is superior to that of radiographs and comparable with CT and radionuclide bone scans for most conditions causing neurologic compromise.
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The imaging work-up of patients with acute neurologic deficits should begin with noncontrast CT to exclude intracerebral hemorrhage. Based on positive results from the NINDS t-PA trial, the overriding objectives of imaging in the selection of patients for t-PA treatment are the detection of hemorrhage and rapid evaluation (speed of imaging). ⋯ Clinical outcome data are lacking; therefore, the routine use of screening MR imaging before t-PA therapy is not supported. Rigorous validation and correlation to clinical outcomes will be required.