Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · May 2003
ReviewExamining the role of cranial CT in the evaluation of patients with minor head injury: a systematic review.
This systematic review demonstrates that, in patients sustaining minor head injury with a history of loss of consciousness or amnesia, the proportion who subsequently have positive CT scans is not negligible. Published clinical prediction rules for selecting patients for subsequent CT examination are associated with a trade-off between sensitivity and specificity; therefore, a prediction rule with high sensitivity is expected to have relatively low specificity. Separate evaluation of the literature is required to determine the significance of positive and negative CT scans with respect to patient outcome.
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Society is increasingly demanding proof that imaging has an impact on patient outcome and questioning its cost on the health care delivery system. Radiologists should provide the following three key components in their research publications: (1) the statistical power and confidence intervals of the results obtained; (2) the diagnostic performance of the tests, including sensitivity, specificity, and ROC curves; and (3) comprehensive decision analysis and cost-effectiveness analysis to determine the impact that imaging has on health outcome, cost, and quality of life. Strict adherence to these evidence-based medicine principles would help advance the field and provide the best health care for patients.
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Neuroimaging Clin. N. Am. · May 2003
ReviewAmyotrophic lateral sclerosis and primary lateral sclerosis: evidence-based diagnostic evaluation of the upper motor neuron.
Magnetic resonance imaging and MR spectroscopy are important tools in the diagnostic evaluation of patients with suspected motor neuron disease. Further investigation is needed to determine and to compare the utility of various neuroimaging markers for diagnosis and disease progression [112]. Newer MR tools, such as diffusion tensor imaging, magnetization transfer imaging, and functional MR imaging, have substantial promise as scientific and clinical tools in this ongoing endeavor.
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Neuroimaging Clin. N. Am. · May 2003
ReviewNeuroimaging in Alzheimer disease: an evidence-based review.
Current clinical criteria (DSM-IIIR and NINCDS-ADRDA) for the diagnosis of dementia and AD are reliable; however, these criteria remain to be validated by clinicians of different levels of expertise at different clinical settings. Structural neuroimaging has an important role in initial evaluation of dementia for ruling out potentially treatable causes. Although CT is the appropriate choice when brain tumors, subdural hematoma, or normal pressure hydrocephalus is suspected, MR imaging is more sensitive to the white-matter changes in vascular dementia. ⋯ These neuroimaging markers may be useful for monitoring symptomatic progression in groups of patients with AD for drug trials. Furthermore, antemortem MR-based hippocampal volumes correlate with the pathologic stage of AD, and the rate of hippocampal volume loss on MR imaging correlates with clinical disease progression in the cognitive continuum from normal aging to MCI and to AD. Hence, as an in vivo correlate of pathologic involvement, structural imaging measures are potential surrogate markers for disease progression in patients with established AD and in patients with prodromal AD, who will benefit most from disease-modifying therapies underway.
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Neuroimaging Clin. N. Am. · May 2003
ReviewHow different MR imaging criteria relate to the diagnosis of multiple sclerosis and its outcome.
This article reviews the evolution of MR imaging criteria used to diagnose multiple sclerosis (MS) over the past decade and a half to help demonstrate how these changes have influenced the sensitivity and specificity of diagnosing and treating patients with MS. The article discusses the benefits and drawbacks of making very specific diagnoses versus sensitive but less specific diagnoses. In addition, the application of these various diagnostic criteria to patient outcomes and clinical trials is reviewed.