Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · May 2003
ReviewOccult spinal dysraphism: evidence-based diagnosis and treatment.
This article reviews the scientific evidence behind the diagnostic tools available for the appropriate workup and management of patients with occult spinal dysraphism (OSD). The diagnostic tools include the use of detailed history and physical examination, plain films, ultrasound, MR imaging, and neurophysiologic tests. In addition, the article discusses the epidemiology of the most common causes of OSD in children, which will allow physicians caring for children to develop a pretest probability of disease and make a more educated decision as to when additional diagnostic testing is required.
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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.
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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.
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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.
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Neuroimaging Clin. N. Am. · Feb 2003
ReviewImaging and anatomy of the normal intracranial venous system.
The intracranial venous system is a complex three-dimensional structure that is often asymmetric and considerably more variable than the arterial anatomy. The traditional approach has been to evaluate venous phase of catheter angiography. ⋯ MR angiography, and especially Gd-enhanced 3D MRA, has recently emerged and offers excellent visualization of venous morphology from multiple orientations. An overview of the current non-invasive MRA methods and their applications has been provided during depiction of normal venous anatomy.