Radiologic clinics of North America
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Radiol. Clin. North Am. · Jan 2011
ReviewPosterior reversible encephalopathy syndrome and venous thrombosis.
Posterior reversible encephalopathy syndrome (PRES) and venous thrombosis are frequently encountered first in the emergency setting and share some common characteristics. The clinical presentation in both entities is vague, and the brain parenchymal findings of PRES syndrome may resemble those of venous thrombosis in some ways. Both entities often occur in a bilateral posterior distribution and may be associated with reversible parenchymal findings if the inciting factor is treated. These diagnoses should be at the forefront of the differential diagnosis when confronted with otherwise unexplained brain edema, among other findings described in this article.
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This article discusses the imaging of infectious and other inflammatory conditions that affect the spinal cord, spinal column, intradural spinal nerve roots, and spinal meninges with emphasis on magnetic resonance (MR) imaging. Inflammatory lesions of the spine are often indistinguishable on imaging and even on pathologic examination. ⋯ The most common inflammatory and infectious conditions affecting the anatomic compartments of the spine are described, following an external to internal anatomic approach. Subsequently, several infectious pathogenic agents are discussed individually as they affect the spinal column and its contents.
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When patients present to the emergency room with sudden onset of focal neurologic symptoms or altered consciousness, hemorrhagic stroke is a major focus of emergency diagnostic evaluation. The entities that compose hemorrhagic stroke, intracerebral and subarachnoid hemorrhage, are readily diagnosed with advanced imaging. ⋯ Common and unusual causes and their distinguishing imaging features are discussed. Imaging strategies and recent work in specific imaging findings that may guide patient management in the future are also addressed.
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Radiol. Clin. North Am. · Sep 2010
ReviewThe use of breast imaging to screen women at high risk for cancer.
Although there currently is no evidence of reduced breast cancer mortality for screening women at high risk with mammography, magnetic resonance (MR) imaging, or ultrasonography (US), the presumptive evidence of early cancer detection provided by numerous observational studies has led to the publication of guidelines and recommendations for the selective use of these imaging modalities. In general, annual screening mammography is recommended for women of appropriately high risk beginning at age 30 years, supplemental screening with MR imaging is recommended for a subset of women at very high risk, and screening US is suggested for women for whom MR imaging is appropriate but unavailable, impractical, or poorly tolerated. The use of screening US remains controversial among women who have no substantial risk factors other than dense breasts.
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Radiol. Clin. North Am. · Sep 2010
ReviewCost-effectiveness of mammography, MRI, and ultrasonography for breast cancer screening.
Screening mammography performed annually on all women beginning at age 40 years has reduced breast cancer deaths by 30% to 50%. The cost per year of life saved is well within the range for other commonly accepted medical interventions. Various studies have estimated that reduction in treatment costs through early screening detection may be 30% to 100% or more of the cost of screening. ⋯ Further studies are needed to determine whether MRI is cost-effective for those at moderately high (15%-20%) lifetime risk. Future technical advances could make MRI more cost-effective than it is today. Automated whole-breast ultrasonography will probably prove cost-effective as a supplement to mammography for women with dense breasts.