Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Feb 2004
ReviewDiagnosis of carpal tunnel syndrome: electrodiagnostic and MR imaging evaluation.
In clinically classic carpal tunnel syndrome (CTS) without symptoms or signs to suggest other disorders that can mimic CTS, it remains somewhat controversial as to whether performing nerve conduction studies is necessary or cost-effective. MR imaging reliably depicts normal carpal tunnel anatomy. It can also identify pathologic nerve compression and mass lesions, such as ganglion cysts, that compress nerves. ⋯ MR diffusion-weighted imaging of peripheral nerves might prove to be the most sensitive imaging sequence for the detection of early nerve dysfunction. Electrodiagnostic studies are likely to remain the pivotal diagnostic examination in patients with suspected CTS for the foreseeable future. With advances in both software and hardware, however, high-resolution MR imaging of peripheral nerves will become faster, cheaper, and likely more accurate, possibly paving the way for an expanded role in the diagnosis of this common syndrome.
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Neuroimaging Clin. N. Am. · Feb 2004
ReviewMR neurography: diagnostic utility in the surgical treatment of peripheral nerve disorders.
Advances in MR imaging have improved the visualization of normal and pathologic peripheral nerve structures in various clinical settings. Peripheral nerve imaging has the potential to dramatically change the diagnosis and treatment of peripheral nerve pathology and lead to an improved understanding of peripheral nerve pathophysiology. ⋯ The next major advance in MR imaging of peripheral nerves will likely be the transition from anatomic to physiologic imaging with higher resolution as better phased-array surface coils and higher-field-strength magnets become available. Finally, MR neurography should remain complementary to the clinical examination and electrodiagnostic studies in the evaluation of peripheral nerve disorders.
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Neuroimaging Clin. N. Am. · Nov 2003
ReviewImaging the pathology of Alzheimer's disease: amyloid-imaging with positron emission tomography.
The steep rise in the incidence of Alzheimer's disease (AD) has further added to the considerable public health burden caused by aging of the United States population. Among the most characteristic pathologic hallmarks of AD are neuritic plaques and neurofibrillary tangles. The capability to use positron emission tomography and selective markers for amyloid protein deposition promises to substantially alter the way we diagnosis and manage patients who have AD.
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Neuroimaging Clin. N. Am. · Nov 2003
ReviewThe use of positron emission tomography in cerebrovascular disease.
Even with rapid development of other neuroimaging modalities such as MR imaging and CT, PET is the only technique that provides accurate, quantitative measurements of regional hemodynamics and metabolism in human subjects. Through the use of these combined measurements, we have greatly expanded our knowledge of the pathophysiology of cerebrovascular disease of different types. It has been possible to document the compensatory responses of the brain to reductions in perfusion pressure and to directly relate these responses to prognosis. ⋯ In the field of cerebrovascular disease, PET has served as a specialized research tool at a few centers to help elucidate the pathophysiology of stroke. Up until now, however, PET scans in individual patients have not been demonstrated to be necessary for making patient care decisions. Whether the role of PET expands to impact the management of individual patients will depend on the results of investigations like the Carotid Occlusion Surgery Study that directly assess the ability of PET to influence patient outcome.
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Energy metabolism and amino acid transport and incorporation are important components of the pathophysiology of gliomas, about which molecular imaging is providing regional biologic information that is useful to clinical practice. Imaging hypoxia is straightforward and proliferation imaging with FLT shows significant promise. Neither has been exploited thoroughly enough to allow judgement of their potential benefit to the practice of neuro-oncology. ⋯ Annexin V binds to surface membranes that have exposed phosphatidyl serine residues resulting from programmed cell destruction. Recently, a Tc-99m-labeled derivative has been shown to accumulate in late stage lung cancer and lymphoma in response to chemotherapy [137]. As molecular pathways leading to and sustaining neoplasia become better understood, so will our capacity improve to measure them in vivo and intervene to the patient's advantage.