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
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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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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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.