Neuroimaging clinics of North America
-
Neuroimaging Clin. N. Am. · May 2003
ReviewImaging of adults with low back pain in the primary care setting.
The evidence for the diagnostic accuracy of the four main imaging modalities used in low back pain (plain radiographs, CT, MR imaging, radionuclide bone scans) is variable in quality and limits the ultimate conclusions regarding the effectiveness and cost-effectiveness of diagnostic strategies. In addition, the frequent finding of abnormalities in normal adults limits the specificity of all of these tests. Nevertheless, MR imaging is likely in most cases to offer the greatest sensitivity and specificity for systemic diseases, and its performance is superior to that of radiographs and comparable with CT and radionuclide bone scans for most conditions causing neurologic compromise.
-
This article summarizes the evidence behind the imaging evaluation of scoliosis, which is primarily performed with plain radiographs and MR imaging. Issues related to the radiographic evaluation of spinal curvature include interobserver variability of scoliosis measurements and the radiologist's detection of unexpected findings. The effects of radiation exposure during scoliosis evaluation and strategies to minimize radiation dose are summarized. The use of MR imaging in idiopathic scoliosis is discussed, with special attention to imaging groups at higher risk for underlying pathology of the neural axis.
-
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.
-
Evidence-based medicine is useful in epilepsy and neuroimaging (Figs. 1 and 2). An understanding of the pretest probability suggests that focal neurologic deficits are important in predicting the outcome of neuroimaging examinations. In cases of nonacute symptomatic seizures, confusion and postictal deficits should prompt MR evaluation. ⋯ Evidence-based medicine can only work if there is physician communication. The pretest probability is helpful only when an accurate history is provided to the consulting physician. This field will flourish if physicians can develop accurate methods of collating information and reporting it in a timely fashion in the literature.
-
Cavernous malformations are commonly being recognized on CT and MR imaging in both asymptomatic and symptomatic patients. The diagnosis of CMs can often be made on MR imaging based on the characteristic morphology of the subacute and chronic blood products. An atypical appearance of a CM in the setting of a recent hemorrhage requires follow-up imaging to confirm the diagnosis. Deep CMs have a significant clinical event rate that justifies close follow up or surgical treatment if possible.