Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · May 2003
ReviewSickle cell disease and stroke in a pediatric population. Evidence-based diagnostic evaluation.
Cerebrovascular complications are common in SCD and constitute a major source of concern to the pediatric hematologist. These complications can be either clinically overt or covert. ⋯ Imaging guidelines for children have emerged based on the available level 2 and 3 literature, however, CT and MR imaging remain the initial tests of choice for stroke assessment, and TCD is the imaging tool of choice for stroke prevention. Based on guidelines handed down from the NIH, TCD has become a part of routine continuing care of children with SCD.
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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.
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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
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.