Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Aug 2003
ReviewInfection of the facial area, oral cavity, oropharynx, and retropharynx.
Radiologists play an important role in the evaluation of upper neck infections. Although most oral cavity infections arise from diseased teeth, several other sources of infection need to be considered. The distinction between abscess and phlegmon is of particular importance. Cross-sectional imaging is frequently used to identify complications of the initial infection.
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Before application of any cross-sectional imaging modality, the orthopanoramic view is indispensable in assessing the status of dentition, in recognizing direct radiographic signs of osteomyelitis, or in determining the presence of predisposing conditions such as a fracture or systemic bone disease. The orthopanoramic view is the procedure of choice in follow-up examinations in patients who have osteomyelitis. In acute osteomyelitis, the higher sensitivity of MR imaging for detection of intramedullary inflammation advocates this imaging modality for confirmation of the clinical diagnosis. ⋯ In chronic osteomyelitis, the higher sensitivity of MR imaging to detect periosteal inflammation and soft tissue involvement advocates this modality to reveal the presence, location, and extent of chronic inflammation. The assessment of persistence or recurrence of chronic inflammation after surgical treatment is by high-resolution CT for the first 6 months following surgery. Finally, scintigraphy is recommended when multi-focal systemic disease is suspected, such as in CRMO and SAPHO syndrome.
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Because the diagnosis of mandibular ORN can often essentially be based on clinical grounds, radiology is used for confirmation and evaluation of the extent of the bone involvement. The localization and extent of the bone destruction can be better evaluated with CT than with conventional occlusal or panoramic films. Nevertheless, plain films often provide sufficient information for patient management. Based on the clinical evaluation and plain imaging findings, a decision can be made to treat patients conservatively or surgically.
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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.