Evidence-based imaging. Optimizing imaging in patient care

Cover Page......Page 1
Title Page......Page 3
ISBN 0387259163......Page 4
Foreword......Page 6
Preface......Page 8
Contents......Page 10
Contributors......Page 13
I. What Is Evidence-Based Imaging?......Page 18
II. The Evidence-Based Imaging Process......Page 20
Take-Home Appendix 1: Equations......Page 33
References......Page 34
I. What Are Error and Bias?......Page 36
II. What Is Random Error?......Page 37
III. What Is Bias?......Page 39
IV. What Are the Inherent Biases in Screening?......Page 41
Conclusion......Page 43
References......Page 44
Key Points......Page 45
Pathophysiology and Epidemiology......Page 47
Methodology......Page 48
I. How Effective Is Mammographic Screening?......Page 49
II. Who Should Undergo Screening?......Page 52
III. How Frequently Should Women Be Screened?......Page 53
IV. How Cost-Effective Is Mammographic Screening?......Page 54
V. How Should Ultrasound Be Applied To Breast Cancer Screening?......Page 55
VI. How Accurate Is Ultrasound in Evaluating Palpable Breast Masses?......Page 57
VIII. How Accurate Is Ultrasound in Determining Local Extent of Disease?......Page 59
IX. Which Lesions (BIRADS 1-6) Should Undergo Biopsy?......Page 60
X. What Is the Performance of Percutaneous Image-Guided Breast Biopsy Compared with Standard Surgical Excisional Biopsy?......Page 62
XI. What Type of Imaging Guidance Is Best Suited for Breast Lesions Manifest as Masses or as Microcalcifications?......Page 67
XII. How Cost-Effective Is Image-Guided Biopsy?......Page 68
References......Page 69
Definition and Pathophysiology......Page 74
Methodology......Page 75
I. Is There a Role for Imaging in Lung Cancer Screening?......Page 76
II. How Should Lung Cancer Be Staged?......Page 83
Future Research......Page 89
References......Page 90
Definition and Pathophysiology......Page 96
Goals......Page 97
I. Who Should Undergo Colorectal Screening?......Page 98
II. What Imaging-Based Screening Methods Are Available, and How Do They Compare with FOBT, Sigmoidoscopy, and Colonoscopy?......Page 101
III. What Is the Role of Imaging in Staging Colorectal Carcinoma?......Page 107
V. Cost-Effectiveness......Page 108
VI. What Imaging-Based Screening Developments Are on the Horizon that May Improve Compliance with Colorectal Screening?......Page 109
Take-Home Tables......Page 110
Imaging Case Studies......Page 111
References......Page 115
Key Points......Page 119
Epidemiology......Page 120
Overall Cost to Society......Page 121
Methodology......Page 122
I. Who Should Undergo Imaging to Exclude Brain Cancer?......Page 123
II. What Is the Appropriate Imaging in Subjects at Risk for Brain Cancer?......Page 125
IV. What Is the Cost-Effectiveness of Imaging in Patients with Suspected Primary Brain Neoplasms or Brain Metastatic Disease?......Page 129
Take-Home Figure......Page 130
Imaging Case Studies......Page 131
Future Research......Page 133
References......Page 134
Issues and Key Points......Page 136
Methodology......Page 137
I. Is Transrectal Ultrasound Valuable as a Prostate Cancer Screening Tool?......Page 138
II. Is Transrectal Ultrasound Useful to Guide Prostate Biopsy?......Page 139
III. Is Imaging Accurate for Staging Prostate Cancer?......Page 141
IV. How Accurate Is Bone Scan for Detecting Metastatic Prostate Cancer?......Page 148
Imaging Case Studies......Page 150
Imaging Protocols Based on the Evidence......Page 151
Future Research......Page 153
References......Page 154
Key Points......Page 159
Goals......Page 160
I. How Accurate Are the Clinical Criteria for the Diagnosis of Alzheimer Disease?......Page 161
II. Does Neuroimaging Increase the Diagnostic Accuracy of Alzheimer Disease in the Clinical Setting?......Page 162
III. Can Neuroimaging Identify Individuals at Elevated Risk for Alzheimer Disease and Predict Its Future Development?......Page 166
V. Can Neuroimaging Measure Disease Progression and Therapeutic Efficacy in Alzheimer Disease?......Page 170
Future Research Areas......Page 173
References......Page 174
Key Points......Page 177
Overall Cost to Society......Page 178
I. What Is the Imaging Modality of Choice for the Detection of Intracranial Hemorrhage?......Page 179
II. What Are the Imaging Modalities of Choice for the Identification of Brain Ischemia and the Exclusion of Stroke Mimics?......Page 182
III. What Imaging Modality Should Be Used for the Determination of Tissue Viability—the Ischemic Penumbra?......Page 186
IV. What Is the Role of Noninvasive Intracranial Vascular Imaging?......Page 190
V. What Is the Role of Acute Neuroimaging in Pediatric Stroke?......Page 192
Areas of Future Research......Page 193
References......Page 194
Key Points......Page 197
Definition and Pathophysiology......Page 198
Goals of Neuroimaging......Page 199
II. What Neuroimaging Approach Is Most Appropriate in Adults with New-Onset Headache?......Page 200
III. What Is the Role of Neuroimaging in Adults with Migraine or Chronic Headache?......Page 202
V. What Is the Recommended Neuroimaging Examination in Adults with Headache and Known Primary Neoplasm Suspected of Having Brain Metastases?......Page 203
VI. When Is Neuroimaging Appropriate in Children with Headache?......Page 204
VIII. What Is the Cost-Effectiveness of Neuroimaging in Patients with Headache?......Page 206
Imaging Case Studies......Page 207
References......Page 209
Key Points......Page 211
Definitions......Page 212
Overall Cost to Society......Page 213
I. Is Neuroimaging Appropriate in Patients with Febrile Seizures?......Page 214
II. What Neuroimaging Examinations Do Patients with Acute Nonfebrile Symptomatic Seizures Need?......Page 215
III. What Is the Role of Neuroimaging in Patients with First Unprovoked Seizures?......Page 216
IV. What Is the Most Appropriate Study in the Workup of Patients with Temporal Lobe Epilepsy of Remote Origin?......Page 218
V. When Should Functional Imaging Be Performed in Seizure Patients and What Is the Study of Choice?......Page 223
Take Home Figure......Page 226
References......Page 227
Key Points......Page 229
Epidemiology......Page 230
Overall Cost to Society......Page 231
I. Acute Sinusitis: How Can We Identify Patients with Acute Sinusitis Who Will Benefit from Antibiotic Treatment?......Page 232
II. Acute Sinusitis: How Accurate Are Imaging Studies for the Diagnosis of Acute Bacterial Sinusitis?......Page 233
III. Chronic Sinusitis: How Can We Diagnose Chronic Sinusitis?......Page 239
IV. Chronic Sinusitis: What Is the Role of Imaging in Chronic Sinusitis? Does Imaging Change Treatment Decision Making?......Page 243
Suggested Imaging Protocol......Page 246
Summary......Page 247
References......Page 248
Issues and Key Points......Page 250
Definition and Pathophysiology......Page 251
Epidemiology in the United States......Page 252
Methodology......Page 253
I. Which Patients with Head Injury Should Undergo Imaging in the Acute Setting?......Page 254
III. What Is the Sensitivity and Specificity of Imaging for All Brain Injuries?......Page 256
IV. Can Imaging Help Predict Outcome After Traumatic Brain Injury (TBI)?......Page 259
V. Is the Approach to Imaging Children with Traumatic Brain Injury Different from that for Adults?......Page 266
Imaging Case Studies......Page 269
References......Page 273
Key Points......Page 277
Epidemiology......Page 278
Methodology......Page 279
I. What are the Clinical Findings that Raise the Suspicion for Acute Hematogenous Osteomyelitis and Septic Arthritis to Direct Further Imaging?......Page 280
II. What Is the Diagnostic Performance of the Different Imaging Studies in Acute Hematogenous Osteomyelitis and Septic Arthritis?......Page 281
III. What Is the Natural History of Osteomyelitis and Septic Arthritis, and What Are the Roles of Medical Therapy Versus Surgical Treatment?......Page 282
V. What Is the Diagnostic Performance of Imaging of Osteomyelitis and Septic Arthritis in the Adult?......Page 283
VI. What Are the Roles of the Difference Imaging Modalities in the Evaluation of Acute Osteomyelitis and Septic Arthritis?......Page 284
Imaging Case Studies......Page 285
Suggested Imaging Protocols......Page 286
Future Research......Page 287
References......Page 288
Issues and Key Points......Page 290
Overall Cost to Society......Page 291
I. What Is the Role of Radiography in Patients with an Acute Knee Injury and Possible Fracture?......Page 292
II. When Should Magnetic Resonance Imaging Be Used for Patients with Suspected Meniscal or Ligamentous Knee Injuries?......Page 295
III. Is Radiography Useful in Evaluating the Osteoarthritic Knee?......Page 299
IV. Special Case: Imaging of the Painful Prosthesis......Page 300
V. When Is Radiography Indicated for Patients with Acute Shoulder Pain?......Page 301
VI. Which Imaging Modalities Should Be Used in the Diagnosis of Soft Tissue Disorders of the Shoulder?......Page 302
Suggested Imaging Protocols......Page 306
References......Page 307
Issues......Page 311
Key Points......Page 312
Epidemiology and Differential Diagnosis of LBP in Primary Care......Page 313
Methodology......Page 315
I. What Is the Role of Imaging in Patients Suspected of Having a Herniated Disk?......Page 316
II. What Is the Role of Imaging in Patients with Low Back Pain Suspected of Having Metastatic Disease?......Page 322
III. What Is the Role of Imaging in Patients with Back Pain Suspected of Having Infection?......Page 324
IV. What Is the Role of Imaging in Patients with Low Back Pain Suspected of Having Compression Fractures?......Page 325
V. What Is the Role of Imaging in Patients with Back Pain Suspected of Having Ankylosing Spondylitis?......Page 326
VI. What Is the Role of Imaging in Patients with Back Pain Suspected of Having Spinal Stenosis?......Page 327
VII. What Are Patients’ Perceptions of the Role of Imaging in Low Back Pain?......Page 328
VIII. What Is the Role of Vertebroplasty for Patients with Painful Osteoporotic Compression Fractures?......Page 330
Suggested Imaging Protocols......Page 331
Future Research......Page 332
References......Page 333
Issues and Key Points......Page 336
Overall Cost to Society......Page 337
I. Who Should Undergo Cervical Spine Imaging?......Page 338
II. What Cervical Spine Imaging Is Appropriate in High-Risk Patients?......Page 341
III. Special Case: Defining Patients at High Fracture Risk......Page 343
V. Who Should Undergo Thoracolumbar Spine Imaging?......Page 345
VI. Which Thoracolumbar Imaging Is Appropriate in Blunt Trauma Patients?......Page 346
Take-Home Table and Figure Suggested Imaging Protocols......Page 347
References......Page 348
Key Points......Page 351
Definition and Pathophysiology......Page 354
Epidemiology......Page 355
I. How Accurate Is Imaging in Occult Spinal Dysraphism?......Page 356
II. Defining Risk of Occult Spinal Dysraphism......Page 357
III. What Is the Natural History and Role of Surgical Intervention in Occult Spinal Dysraphism?......Page 358
IV. What Is the Cost-Effectiveness of Imaging in Children with Occult Spinal Dysraphism?......Page 359
VI. What Radiation-Induced Complications Result from Radiographic Monitoring of Scoliosis?......Page 360
VII. What Is the Use of Magnetic Resonance Imaging (MRI) for Severe Idiopathic Scoliosis?......Page 361
VIII. What Is the Use of MRI for High-Risk Subgroups of Scoliosis?......Page 362
Take-Home Data......Page 363
Imaging Case Study of Scoliosis......Page 364
References......Page 365
Definition and Pathophysiology......Page 369
Overall Cost to Society......Page 370
I. Does Coronary Artery Calcification Scoring Predict Outcome?......Page 371
II. Special Case: High-Risk Patients......Page 373
III. Which Patients Should Undergo Coronary Angiography?......Page 374
IV. Which Patients Should Undergo Noninvasive Imaging of the Heart?......Page 380
V. What Is the Appropriate Use of Coronary Artery Computed Tomography and Magnetic Resonance?......Page 381
Future Research......Page 383
References......Page 384
Issues and Key Points......Page 386
Overall Cost to Society......Page 387
I. Aorta: What Are the Appropriate Imaging Studies for Suspected Acute Aortic Dissection or Traumatic Rupture?......Page 388
III. Aorta: Endovascular vs. Surgical Treatment of Abdominal Aortic Aneurysms: Which Is the Best Choice?......Page 390
IV. Peripheral Vascular Disease: What Are the Appropriate Noninvasive Imaging Studies for Patients with Suspected Peripheral Vascular Disease?......Page 392
V. Special Case: Evaluation of Abdominal Aortic Aneurysms Graft Endoleak......Page 394
VI. Special Case: Evaluation of the Renal Donor......Page 395
VII. Special Case: Evaluation of Renal Artery Stenosis......Page 396
Future Research......Page 397
References......Page 398
Key Points......Page 399
Definition and Pathophysiology......Page 400
Methodology......Page 401
I. What Is the Imaging Modality of Choice in Symptomatic Carotid Stenosis?......Page 402
II. What Is the Imaging Modality of Choice in Asymptomatic Carotid Stenosis?......Page 408
III. What Is the Role of Carotid Angioplasty and Stenting?......Page 409
IV. What Is the Role of Physiologic Imaging in Carotid Stenosis and Occlusion?......Page 410
Protocols Based on the Evidence......Page 414
References......Page 415
Key Points......Page 417
Methodology......Page 418
I. What Is the Performance of Various Imaging Modalities in the Evaluation of Pulmonary Embolism?......Page 419
II. How Can Imaging Modalities Be Combined in the Diagnosis of Pulmonary Embolism?......Page 424
Take-Home Points......Page 427
Imaging Case Studies......Page 429
References......Page 432
Issues and Key Points......Page 434
Epidemiology......Page 435
Overall Cost to Society......Page 436
I. Who Should Undergo Imaging?......Page 437
II. Which Imaging Is Appropriate?......Page 442
III. Special Case: Estimating the Probability of Malignancy in Solitary Pulmonary Nodules......Page 453
References......Page 455
Issues and Key Points......Page 458
Epidemiology......Page 459
I. What Imaging Is Appropriate for Patients with Blunt Trauma to the Chest?......Page 460
II. What Imaging Is Appropriate for Patients with Blunt Trauma to the Abdomen?......Page 462
III. What Is the Optimal Imaging Approach in Patients Suspected of Having Retroperitoneal Injury?......Page 465
Future Research......Page 467
References......Page 469
Issues and Key Points......Page 474
Definition and Pathophysiology......Page 475
Epidemiology......Page 476
Goals......Page 477
Methodology......Page 478
I. What Is the Accuracy of Imaging for Diagnosing Acute Appendicitis in Adults?......Page 479
II. What Is the Accuracy of Imaging for Diagnosing Acute Appendicitis in Children?......Page 480
III. What Is the Accuracy of Imaging for Diagnosing Small Bowel Obstruction?......Page 482
IV. What Is the Accuracy of Computed Tomography for Detecting Small Bowel Ischemia?......Page 483
V. What Is the Accuracy of Imaging for Acute Colonic Diverticulitis?......Page 484
Future Research......Page 485
Take-Home Tables......Page 486
Imaging Case Studies......Page 487
References......Page 489
Issues and Key Points......Page 492
Definition and Pathophysiology......Page 493
Overall Cost to Society......Page 494
I. Diagnosis of Intussusception: What Are the Clinical Predictors? Who Should Undergo Imaging?......Page 495
II. Which Imaging Should Be Performed?......Page 496
III. Treatment of Intussusception: How Should the Enema Be Performed?......Page 498
IV. What Is Appropriate Management in Recurrent Cases?......Page 504
Future Research......Page 505
References......Page 507
Issues......Page 510
Definition and Pathophysiology......Page 511
Epidemiology......Page 512
I. What Is the Best Imaging Strategy for the Diagnosis of Acute Calculous Cholecystitis?......Page 513
II. What Is the Best Imaging Strategy for the Diagnosis of Acute Acalculous Cholecystitis?......Page 516
III. What Is the Best Imaging Strategy for the Diagnosis of Chronic Calculous Cholecystitis?......Page 518
IV. What Is the Best Imaging Strategy for the Diagnosis of Chronic Acalculous Cholecystitis?......Page 520
V. What Is the Best Imaging Strategy for the Evaluation of Bile Duct Obstruction?......Page 521
VI. What Is the Best Imaging Strategy for the Diagnosis of Choledocholithiasis?......Page 523
VII. What Is the Best Imaging Strategy for the Evaluation of Bile Duct Stricture?......Page 526
References......Page 532
Issues and Key Points......Page 537
Definition and Pathophysiology......Page 538
Epidemiology......Page 540
I. How Accurate Is Imaging in Patients with Suspected Hepatic Metastatic Disease?......Page 541
II. What Is the Accuracy of Imaging in Patients with Cirrhosis for the Detection of Hepatocellular Carcinoma?......Page 548
III. What is the Cost-Effectiveness of Imaging in Patients with Suspected Hepatocellular Carcinoma?......Page 552
Take-Home Tables and Figure......Page 553
Imaging Technique Protocols......Page 554
References......Page 555
Issues and Key Points......Page 559
Definition and Pathophysiology......Page 560
Goals......Page 561
I. What Is the Appropriate Test for Suspicion of Obstructing Ureteral Stone?......Page 562
III. Special Case: The Pregnant Patient......Page 563
V. When Is Imaging Required in the Adult Male with a Urinary Tract Infection?......Page 564
VI. When is Imaging Required in the Child with a Urinary Tract Infection?......Page 565
Take-Home Table......Page 566
Imaging Case Studies......Page 567
Suggested Computed Tomography Imaging Protocols......Page 568
References......Page 569
Issues and Key Points......Page 570
Epidemiology......Page 571
Methodology......Page 573
II. Ovarian Cancer Screening: What Is the Diagnostic Performance (Accuracy) of Imaging?......Page 574
III. Ovarian Cancer Screening: What Is the Role of Imaging?......Page 576
V. Postmenopausal Bleeding Evaluation: What Is the Accuracy of Imaging Tests?......Page 578
VII. How Should Women on Tamoxifen Therapy Be Evaluated?......Page 580
Take-Home Tables and Figure......Page 581
Imaging Case Studies......Page 582
References......Page 584
A......Page 587
B......Page 588
C......Page 589
D......Page 590
E,F,G,H......Page 591
L......Page 592
M......Page 593
N,O,P......Page 594
Q,R,S......Page 595
T......Page 596
X......Page 597
Figure 5.1. False negative CTC. B and C......Page 598
Figure 5.3. True-positive CTC......Page 599
Figure 18.1. Photograph of the lower back reveals skin discoloration, hairy patch, and dorsal lipoma......Page 600
Figure 30.3. Benign ovarian mass......Page 601