Evidence-Based Imaging: Improving the Quality of Imaging in Patient Care

Description

Evidence-Based Imagingis a user-friendly guide to the evidence-based science and merit defining the appropriate use of medical imaging in both adult and pediatric patients.  Chapters are divided into major areas of medical imaging and cover the most prevalent diseases in developed countries, including the four major causes of mortality and morbidity: injury, coronary artery disease, cancer, and cerebrovascular disease. This book gives the reader a clinically-relevant overview of evidence-based imaging, with topics including epidemiology, patient selection, imaging strategies, test performance, cost-effectiveness, radiation safety and applicability. Each chapter is framed around important and provocative clinical questions relevant to the daily physician’s practice. Key points and summarized answers are highlighted so the busy clinician can quickly understand the most important evidence-based imaging data. A wealth of illustrations and summary tables reinforces the key evidence. This revised, softcover edition adds ten new chapters to the material from the original, hardcover edition, covering radiation risk in medical imaging, the economic and regulatory impact of evidence-based imaging in the new healthcare reform environment in the United States, and new topics on common disorders. By offering a clear understanding of the science behind the evidence, Evidence-Based Imaging fills a void for radiologists, family practitioners, pediatricians, surgeons, residents, and others with an interest in medical imaging and a desire to implement an evidence-based approach to optimize quality in patient care. Cover Evidence-Based Imaging Foreword Preface Contents Contributors Part I Principles, Methodology, Economics, and Radiation Risk 1: Principles of Evidence-Based Imaging I. What Is Evidence-Based Imaging? II. The Evidence-Based Imaging Process A. Formulating the Clinical Question B. Identifying the Medical Literature C. Assessing the Literature 1. What Are the Types of Clinical Studies? 2. What Is the Diagnostic Performance of a Test: Sensitivity, Specificity, and Receiver Operating Characteristic Curve? 3. What Are Cost-Effectiveness and Cost-Utility Studies? D. Types of Economic Analyses in Medicine E. Summarizing the Data F. Applying the Evidence III. How to Use This Book IV. Take Home Appendix 1: Equations V. Take Home Appendix 2: Summary of Bayes’ Theorem References 2: Critically Assessing the Literature: Understanding Error and Bias Issues I. What Are Error and Bias? II. What Is Random Error? A. Type I Error B. Confidence Intervals C. Type II Error D. Power Analysis III. What Is Bias? IV. What Are the Inherent Biases in Screening? V. Qualitative Literature Summary Conclusion Take Home Tables and Figures References 3: Radiation Risk from Medical Imaging: A Special Need to Focus on Children Key Points Definition and Pathophysiology Radiation Terminology Radiation Mechanisms of Effect Types of Biological Effects Radiation Doses in Medical Imaging Epidemiology and Medical Utilization of Ionizing Radiation Increased Dose from Medical Imaging Increased Use of CT Scans Assessing Risk Versus Benefit when Using Medical Imaging in Children Overall Cost to Society Goals Methodology I. Is There a Cancer Risk from Low-Level Radiation Used in Medical Imaging? What Are the Uncertainties in the Data? A. Cancer Risk and Radiation Following Diagnostic Medical Imaging B. CT Scan and Risk C. Assumptions in Estimating Radiation Risks D. Increased Radiosensitivity in Children E. Nonfatal Cancers F. Additional Confounders in Risk Estimation G. Radiation Doses from Medical Imaging and Uncertainty in Cancer Risks II. What Is the Estimated Risk from a Single Chest X-Ray in a Child? III. What Is the Estimated Risk from a Single Abdominal CT Scan in a Child? A. The Changing Landscaping of Radiation Dose for Medical Imaging B. Lowering CT Dose in Children IV. Understanding Benefit Versus Risk of Imaging Tests in Well-Indicated Studies Versus Those that Have Very Low Probability A. The Example of CT in Children with Headache V. How Should I Communicate Radiation Risk from Imaging to Parents and Patients? VI. Special Situation: Increased Cancer Risk Following Therapeutic Medical Radiation Take Home Tables and Figures Future Research References 4: The Economic and Regulatory Impact of Evidence-Based Medicine on Radiology Issues Key Points I. What Political and Economic Forces Influence the United States’ Healthcare System? II. What Is the Impetus Driving US Healthcare Reform Now? III. How Are Rising Costs of Healthcare Affecting Governments and Individuals? IV. Do Increased Health Expenditures Lead to Better Care? V. How Does Supplier-Driven Demand Influence Imaging Utilization? VI. What Can Be Learned from “High-Value” Systems? VII. Cost-Control Strategies: Rationing Versus Reducing Inappropriate Care A. Reimbursement Cuts B. Intermediaries (RBM Organizations) C. Accountable Care Organizations VIII. How Is the Recently Passed US Healthcare Reform Initiative Expected to Influence Cost and Quality? A. Learning What Works B. Coming Changes C. Political Outlook IX. What Are the Challenges and Opportunities for Evidence-Based Imaging? Take Home Tables and Figures References Part II: Oncologic Imaging 5: Breast Imaging Issues Mammography Screening Breast Ultrasound Diagnosis of Nonpalpable Breast Cancer by Percutaneous Image-Guided Biopsy Mammography Ultrasound Biopsy Pathophysiology and Epidemiology Overall Cost to Society Goals Methodology I. How Effective Is Mammographic Screening? II. Who Should Undergo Screening? III. How Frequently Should Women Be Screened? IV. How Cost-Effective Is Mammographic Screening? V. How Should Ultrasound Be Applied to Breast Cancer Screening? VI. How Accurate Is Ultrasound in Evaluating Palpable Breast Masses? VII. How Accurate Is Ultrasound in Evaluating Nipple Discharge? VIII. How Accurate Is Ultrasound in Determining Local Extent of Disease? IX. Which Lesions (BIRADS 1–6) Should Undergo Biopsy? A. Special Case: Radial Sclerosing Lesions (Radial Scars) X. What Is the Performance of Percutaneous Image-Guided Breast Biopsy Compared with Standard Surgical Excisional Biopsy? XI. What Type of Imaging Guidance Is Best Suited for Breast Lesions that Manifest as Masses or as Microcalcifications? A. Special Case: Biopsy of Breast Lesions Detected on Breast MRI XII. How Cost-Effective Is Image-Guided Biopsy? Take Home Tables and Figures Future Research References 6: Imaging of Lung Cancer Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. Is There a Role for Imaging in Lung Cancer Screening? A. What Is the Role of Chest X-Ray? B. What Is the Role of Computed Tomography? Will Computed Tomography Screening Be Cost-Effective? II. How Should Lung Cancer Be Staged? A. How Is the Primary Tumor Evaluated? B. How Is the Mediastinum Evaluated? C. How Are Distant Metastases Evaluated? Pleural Effusion Liver Metastasis Adrenal Metastasis Bone Metastasis Cerebral Metastasis D. Special Case: How Is Small Cell Lung Cancer Evaluated? E. Special Case: What Is the Appropriate Radiologic Follow-Up? Suggested Imaging Protocols Low-Dose Screening Computed Tomography Chest Computed Tomography for Lung Cancer Staging Take Home Tables and Figures Future Research References 7: Imaging-Based Screening for Colorectal Cancer Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. Who Should Undergo Colorectal Screening? A. Fecal Occult Blood Testing B. Sigmoidoscopy C. Combined Sigmoidoscopy and FOBT D. Colonoscopy II. What Imaging-Based Screening Methods Are Available, and How Do They Compare with FOBT, Sigmoidoscopy, and Colonoscopy? A. Double Contrast Barium Enema B. Computed Tomographic Colonography C. Special Case: Patients with Increased Risk of CRC Family History of CRC or Adenomatous Polyps D. Special Case: Patients with High Risk of CRC Familial Adenomatous Polyposis III. What Is the Role of Imaging in Staging Colorectal Carcinoma? IV. Applicability to Children V. Cost-Effectiveness VI. What Imaging-Based Screening Developments Are on the Horizon that May Improve Compliance with Colorectal Screening? Take Home Tables and Figures (Tables 7.1–7.3) Imaging Case Studies Case 1: False-Negative CTC (Fig. 7.1) Case 2: False-Positive CTC (Fig. 7.2) Case 3: True-Positive CTC and Colonoscopy (Fig. 7.3) Case 4: True-Positive CTC and False-Negative Colonoscopy (Fig. 7.4) Suggested Imaging Protocol for Asymptomatic Screening Patients Future Areas of Research References 8: Imaging of Brain Cancer Issues Key Points Definition and Pathophysiology Unique Challenges of Brain Cancer Epidemiology Adult Brain Cancer Pediatric Brain Cancer Overall Cost to Society Goals Methodology I. Who Should Undergo Imaging to Exclude Brain Cancer in Adult Individual? IIA. Who Should Undergo Imaging to Exclude Brain Cancer in Pediatric Age Group? IIB. What Imaging Is Appropriate in High-Risk Pediatric Subjects? Nuclear Medicine Imaging Tests III. What Is the Appropriate Imaging in Subjects at Risk for Brain Cancer? Special Case: Neuroimaging Differentiation of Post-treatment Necrosis from Residual Tumor Special Case: Neuroimaging Modality in Patients with Suspected Brain Metastatic Disease Special Case: How Can Tumor Be Differentiated from Tumor-Mimicking Lesions? IV. What Is the Role of Proton Magnetic Resonance Spectroscopy in the Diagnosis and Follow-Up of Brain Neoplasms? V. Can Imaging Be Used to Differentiate Post-treatment Necrosis from Residual/Recurrent Tumor? VI. What Is the Added Value of Functional MRI in the Surgical Planning of Patients with Suspected Brain Neoplasm or Focal Brai VII. What Is the Cost-Effectiveness of Imaging in Patients with Suspected Primary Brain and Disease? Take Home Tables and Figures (Figs. 8.1–8.6; Tables 8.1–8.5) Future Research References 9: Imaging in the Evaluation of Patients with Prostate Cancer Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. Is Transrectal Ultrasound Valuable as a Prostate Cancer Screening Tool? II. Is Transrectal Ultrasound Useful to Guide Prostate Biopsy? III. Is Imaging Accurate for Staging Prostate Cancer? A. Ultrasound B. Computed Tomography Scan C. Magnetic Resonance Imaging D. Magnetic Resonance Spectroscopic Imaging E. Positron Emission Tomography IV. How Accurate Is Bone Scan for Detecting Metastatic Prostate Cancer? A. Special Case: Which Patients Should Undergo Imaging After Initial Treatment to Look for Metastatic Disease? Take Home Figures Imaging Case Studies Case 1 Case 2 Imaging Protocols Based on the Evidence Transrectal Ultrasound Computed Tomography Magnetic Resonance Imaging Radionuclide Bone Scan Positron Emission Tomography Scan Future Research References Part III:
Neuroimaging 10: Neuroimaging in Alzheimer Disease Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. How Accurate Are the Clinical Criteria for the Diagnosis of Alzheimer Disease? II. Does Neuroimaging Increase the Diagnostic Accuracy of Alzheimer Disease in the Clinical Setting? A. Structural Neuroimaging 1. Special Case: Volumetric Measurements B. Functional Neuroimaging C. Other Magnetic Resonance Techniques III. Can Neuroimaging Identify Individuals at Elevated Risk for Alzheimer Disease and Predict Its Future Development? A. Prodromal Alzheimer Disease, or Mild Cognitive Impairment B. Asymptomatic Apolipoprotein E e4 Carriers IV. Is Neuroimaging Cost-Effective for the Clinical Evaluation of Alzheimer Disease? V. Can Neuroimaging Measure Disease Progression and Therapeutic Efficacy in Alzheimer Disease? Take Home Tables (Tables 10.1 and 10.2) Suggested Protocols Computed Tomography Imaging Magnetic Resonance Imaging Fluorodeoxyglucose-PET and SPECT Imaging Future Research Areas References 11: Neuroimaging in Acute Ischemic Stroke Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. What Is the Imaging Modality of Choice for the Detection of Intracranial Hemorrhage? A. Computed Tomography B. Magnetic Resonance Imaging II. What Are the Imaging Modalities of Choice for the Identification of Brain Ischemia and the Exclusion of Stroke Mimics? A. Computed Tomography B. Magnetic Resonance Imaging III. What Imaging Modality Should Be Used for the Determination of Tissue Viability: The Ischemic Penumbra? A. Magnetic Resonance Imaging B. Computed Tomography C. Positron Emission Tomography D. Single Photon Emission Computed Tomography (SPECT) IV. What Is the Role of Noninvasive Intracranial Vascular Imaging? A. Computed Tomography Angiography B. Magnetic Resonance Angiography V. What Is the Role of Acute Neuroimaging in Pediatric Stroke? Take Home Table Acute Imaging Protocols Based on the Evidence Areas of Future Research References 12: Pediatric Sickle Cell Disease and Stroke Issues Key Points Definition, Pathophysiology, and Clinical Presentation Epidemiology of SCD Epidemiology of Stroke Risk of Stroke Epidemiology of Recurrent Stroke Epidemiology of Silent Infarcts Diagnosed by MRI Overall Cost to Society Cost of Screening Cost-Effectiveness Analysis Goals Methodology I. What Is the Role of Neuroimaging in Acute Stroke in Children with Sickle Cell Disease? CT MRI MRA Angiography Nuclear Medicine (PET, SPECT) II. What Is the Role of Neuroimaging in Children with Sickle Cell Disease at Risk of Their First Stroke? Risk of Symptomatic Stroke in Children with Silent Infarct on MRI III. What Is the Role of Neuroimaging in Prevention of Recurrent Ischemic Stroke in Children with Sickle Cell Disease? IV. Are There Neuroimaging Criteria That Indicate That Blood Transfusions Can Be Safely Halted? V. What Is the Role of Neuroimaging in Hemorrhagic Stroke in Children with SCD? Take Home Figures and Tables Imaging Case Studies Case 1 Suggested Imaging Protocol for Sickle Cell Disease and Stroke Future Research References 13: Neuroimaging for Traumatic Brain Injury Issues Key Points Definition and Pathophysiology Epidemiology in USA Overall Cost to Society Goals Methodology I. Which Patients with Head Injury Should Undergo Imaging in the Acute Setting? II. What Is the Sensitivity and Specificity of Imaging for Injury Requiring Immediate Treatment/Surgery? III. What Is the Overall Sensitivity and Specificity of Imaging in the Diagnosis and Prognosis of Patients with Head Trauma? Imaging Classification Schemes Normal Scans Brain Swelling Midline Shift Hemorrhage Number, Size, and Depth of Lesions Diffuse Axonal Injury Combinations of Imaging Abnormalities and Progressive Brain Injury Measures of Atrophy Combinations of Clinical and Imaging Findings IV. What Are Considerations for Imaging of Children with Head Trauma? V. What Is the Role of Advanced Imaging (Functional MRI, MR Spectroscopy, Diffusion Imaging, SPECT, and PET) in TBI? Take Home Data Imaging Case Studies Study 1: Example of MR Imaging for TBI Study 2: Example of MR Spectroscopy Suggested Protocols for Acute TBI Imaging Future Research References 14: Neuroimaging of Seizures Issues Key Points Definitions Epidemiology Specific Epidemiologic Data Overall Cost to Society Goals Methodology I. Is Neuroimaging Appropriate in Patients with Febrile Seizures? II. What Neuroimaging Examinations Do Patients with Acute Nonfebrile Symptomatic Seizures Need? III. What Is the Role of Neuroimaging in Patients with First Unprovoked Seizures? IV. What Is the Most Appropriate Study in the Workup of Patients with Temporal Lobe Epilepsy of Remote Origin? V. When Should Functional Imaging Be Performed in Seizure Patients and What Is the Study of Choice? Take Home Figure Future Research Imaging Case Studies References 15: Adults and Children with Headaches: Evidence-Based Role of Neuroimaging Issues Key Points Definition and Pathophysiology Epidemiology Adults Children Overall Cost to Society Goals Methodology I. Which Adults with New-Onset Headache Should Undergo Neuroimaging? II. What Neuroimaging Approach Is Most Appropriate in High Risk Adults with New-Onset of Headache? III. What Is the Role of Neuroimaging in Adults with Migraine or Chronic Headaches? IV. What Is the Recommended Neuroimaging Examination in Adults with Headache and Known Primary Neoplasm Suspected of Having Br V. When Is Neuroimaging Appropriate in Children with Headache? VI. What Is the Sensitivity and Specificity of CT and MR Imaging for Space Occupying Lesions? VII. What Is the Sensitivity and Specificity of CT and MRI of Imaging in Patients with Headache and Subarachnoid Hemorrhage S VIII. What Is the Role of Advance Imaging Techniques in Primary Headache Disorders? IX. What Is the Cost-Effectiveness of Neuroimaging in Patients with Headache? Take Home Data Imaging Case Studies Study 1: Colloid Cyst Study 2: Chiari I Study 3: Brain Stem Infiltrative Glial Neoplasm Suggested Protocols CT Imaging CT Without Contrast CT with Contrast MR Imaging Future Research References 16: Imaging Evaluation of Sinusitis: Impact on Health Outcome Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. Is There a Role for Imaging in the Initial Diagnosis of Acute Bacterial Sinusitis? II. What Is the Diagnostic Performance of Sinus Radiography and Sinus CT in Acute Bacterial Sinusitis? What Diagnostic Criteria III. When Are Imaging Studies Indicated for the Diagnosis and the Management of Patients with Sinusitis? IV. What Is the Most Cost Effective Strategy for the Diagnosis and the Management of Acute Sinusitis? V. What Is the Imaging Role for Patients with Chronic Sinusitis? VI. Special Situation: What Is the Role of Imaging in Immunocompromised Patients? Take Home Tables Imaging Case Studies Suggested Imaging Protocols for Children Clinically Suspected Acute Sinusitis Sinus Radiographs Low Dose Screening Sinus CT MRI Future Research References Part IV:
Musculoskeletal Imaging 17: Imaging of Acute Hematogenous Osteomyelitis and Septic Arthritis in Children and Adults Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. What Are the Clinical Findings that Raise the Suspicion for Acute Hematogenous Osteomyelitis and Septic Arthritis to Direct II. What Is the Diagnostic Performance of the Different Imaging Studies in Acute Hematogenous Osteomyelitis and Septic Arthrit III. What Is the Natural History of Osteomyelitis and Septic Arthritis, and What Are the Roles of Medical Therapy Versus Surgi IV. Is There a Role for Repeat Imaging in the Management? V. What Is the Diagnostic Performance of Imaging of Osteomyelitis and Septic Arthritis in the Adult? VI. What Are the Roles of the Difference Imaging Modalities in the Evaluation of Acute Osteomyelitis and Septic Arthritis? Imaging Case Studies Case 1 Case 2 Case 3 Suggested Imaging Protocols Take Home Tables and Figures Future Research References 18: Imaging for Knee and Shoulder Problems Issues Imaging of the Knee Imaging of the Shoulder Key Points Epidemiology Overall Cost to Society Goals Methodology I. What Is the Role of Radiography in Patients with an Acute Knee Injury and Possible Fracture? A. Cost-Effectiveness Analysis B. Applicability to Children II. When Should Magnetic Resonance Imaging Be Used for Patients with Suspected Meniscal or Ligamentous Knee Injuries? A. Cost-Effectiveness Analysis III. Is Radiography Useful in Evaluating the Osteoarthritic Knee? IV. Special Case: Imaging of the Painful Prosthesis V. When Is Radiography Indicated for Patients with Acute Shoulder Pain? VI. Which Imaging Modalities Should Be Used in the Diagnosis of Soft Tissue Disorders of the Shoulder? Take Home Tables and Figures Suggested Imaging Protocols Future Research References 19: Pediatric Fractures of the Ankle Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. What Are the Clinical Indications for Obtaining the Ankle X-ray Series Following Trauma in a Child? II. What Is the Diagnostic Performance of Computed Tomography in the Investigation of Ankle Fractures in Children? III. What Is the Diagnostic Performance of Magnetic Resonance Imaging in the Investigation of Ankle Injuries in Children? IV. What Is the Diagnostic Performance of Ultrasound in the Investigation of Ankle Injuries in Children? Take Home Tables Imaging Case Studies Case 1 Case 2 Suggested Imaging Protocol for Fractures of the Ankle Radiographs CT and MRI Future Research References 20: Imaging of Adults with Low Back Pain in the Primary Care Setting Issues Key Points Definition and Pathophysiology Epidemiology and Differential Diagnosis of LBP in Primary Care Overall Cost to Society Goals Methodology I. What Is the Role of Imaging in Patients Suspected of Having a Herniated Disk? A. Plain Radiography B. Computed Tomography C. Magnetic Resonance II. What Is the Role of Imaging in Patients with Low Back Pain Suspected of Having Metastatic Disease? A. Plain Radiographs B. Computed Tomography C. Magnetic Resonance D. Bone Scanning and Single Photon Emission Computed Tomography E. Cost-Effectiveness Analysis III. What Is the Role of Imaging in Patients with Back Pain Suspected of Having Infection? A. Plain Radiographs B. Computed Tomography C. Magnetic Resonance D. Bone Scanning and Single Photon Emission Computed Tomography IV. What Is the Role of Imaging in Patients with Low Back Pain Suspected of Having Compression Fractures? A. Plain Radiographs B. Computed Tomography C. Magnetic Resonance D. Bone Scanning and Single Photon Emission Computed Tomography V. What Is the Role of Imaging in Patients with Back Pain Suspected of Having Ankylosing Spondylitis? A. Plain Radiographs B. Computed Tomography C. Magnetic Resonance D. Bone Scanning and Single Photon Emission Computed Tomography VI. What Is the Role of Imaging in Patients with Back Pain Suspected of Having Spinal Stenosis? A. Plain Radiographs B. Computed Tomography C. Magnetic Resonance D. Bone Scanning and Single Photon Emission Computed Tomography VII. What Are Patients’ Perceptions of the Role of Imaging in Low Back Pain? VIII. What Is the Role of Vertebroplasty for Patients with Painful Osteoporotic Compression Fractures? Overall Modality Accuracy Summary Suggested Imaging Protocols Plain Radiographs Computed Tomography Magnetic Resonance Take Home Tables and Figures Future Research References 21: Imaging of the Spine in Victims of Trauma Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. Who Should Undergo Cervical Spine Imaging? A. NEXUS Prediction Rule B. Canadian Cervical Spine Prediction Rule C. Applicability to Children II. What Cervical Spine Imaging Is Appropriate in High-Risk Patients? A. Cost-Effectiveness Analysis III. Special Case: Defining Patients at High Fracture Risk A. Applicability to Children IV. Special Case: The Unconscious Patient V. Who Should Undergo Thoracolumbar Spine Imaging? A. Applicability to Children VI. Which Thoracolumbar Imaging Is Appropriate in Blunt Trauma Patients? Take Home Tables and Figures Future Research Suggested Imaging Protocols References 22: Imaging of Spine Disorders in Children: Dysraphism and Scoliosis Issues Spinal Dysraphism Scoliosis Key Points Spinal Dysraphism Scoliosis Definition and Pathophysiology Spinal Dysraphism Scoliosis Conus Medullaris Position Epidemiology Spinal Dysraphism Scoliosis Goals Spinal Dysraphism Scoliosis Methodology I. How Accurate Is Imaging in Occult Spinal Dysraphism? II. What Are the Clinical Predictors of OSD? III. What Are the Natural History and Role of Surgical Intervention in Occult Spinal Dysraphism? IV. What Is the Cost-Effectiveness of Imaging in Children with Occult Spinal Dysraphism? V. How Should the Radiographic Evaluation of Scoliosis Be Performed? VI. What Radiation-Induced Complications Result from Radiographic Monitoring of Scoliosis? VII. What Is the Role of Magnetic Resonance Imaging in Idiopathic Scoliosis? Take Home Figures and Tables How Should Physicians Evaluate Newborns with Suspected Occult Spinal Dysraphism? How Should Scoliosis Be Evaluated? Imaging Case Studies Case 1: Spinal Dysraphism Case 2: Scoliosis Suggested Imaging Protocols Spinal Dysraphism Spinal Ultrasound Entire Spine MRI Scoliosis Scoliosis Radiographs Entire Spine MRI Future Research References Part V:
Cardiovascular and Chest Imaging 23: Imaging of the Solitary Pulmonary Nodule Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. Who Should Undergo Imaging? A. Nodule Stability in Size B. Nodule Morphology: Calcification C. Nodule Morphology: Fat D. Nodule Morphology: Feeding Artery and Draining Vein E. Nodule Morphology: Rounded Atelectasis F. Applicability to Children II. Which Imaging Is Appropriate? A. Computed Tomography Densitometry B. Thin-Section Computed Tomography C. Computed Tomography Contrast Enhancement D. Dual-Energy Computed Tomography E. Positron Emission Tomography F. Single Photon Emission Computed Tomography G. Percutaneous Needle Biopsy H. Cost-Effectiveness III. Special Case: Estimating the Probability of Malignancy in Solitary Pulmonary Nodules IV. Special Case: Solitary Pulmonary Nodule in a Patient with a Known Extrapulmonary Malignancy Take Home Tables and Figures Future Research References 24: Cardiac Evaluation: The Current Status of Outcomes-Based Imaging Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. Does Coronary Artery Calcification Scoring Predict Outcome? II. Special Case: High-Risk Patients III. Which Patients Should Undergo Coronary Angiography? IV. Which Patients Should Undergo Noninvasive Imaging of the Heart? V. What Is the Appropriate Use of Coronary Artery Computed Tomography and Magnetic Resonance? Recommended Imaging Protocols Based on the Evidence Cardiac Catheterization Stress Echo Cardiac SPECT Take Home Figures Future Research References 25: Imaging in the Evaluation of Pulmonary Embolism Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology Comment I. What Is the Performance of Various Imaging Modalities in the Evaluation of Pulmonary Embolism? A. Modality 1: Angiography B. Modality 2: Nuclear Ventilation-Perfusion Imaging C. Modality 3: Computed Tomography Pulmonary Angiography (Scanners with Fewer than Four Detectors) D. Modality 4: Multidetector Computed Tomography E. Modality 5: Electron Beam Computed Tomography F. Modality 6: Magnetic Resonance Angiography G. Modality 7: Ultrasound of Lung and Pleura H. Method 8: Echocardiography I. Modality 9: Chest Radiography II. How Can Imaging Modalities Be Combined in the Diagnosis of Pulmonary Embolism? Take Home Tables and Figures Imaging Case Studies Case 1 History Imaging Discussion Case 2 History Imaging Discussion Protocols Based on the Evidence A. Ventilation/Perfusion Imaging B. Computed Tomography Pulmonary Angiography Future Research References 26: Aorta and Peripheral Vascular Disease Issues Key Points Definition, Pathophysiology, and Epidemiology Overall Cost to Society Goals Methodology I. Aorta: What Are the Appropriate Imaging Studies for Suspected Acute Aortic Dissection or Traumatic Rupture? II. Aorta: What Is the Impact and Cost-Effectiveness of Screening for Abdominal Aortic Aneurysms on Mortality from Abdominal III. Aorta: Endovascular Versus Surgical Treatment of Abdominal Aortic Aneurysms: Which Is the Best Choice? IV. Peripheral Vascular Disease: What Are the Appropriate Noninvasive Imaging Studies for Patients with Suspected Peripheral V A. Magnetic Resonance Angiography B. Computed Tomography Angiography V. Special Case: Evaluation of Abdominal Aortic Aneurysms Graft Endoleak VI. Special Case: Evaluation of the Renal Donor VII. Special Case: Evaluation of Renal Artery Stenosis Take Home Tables and Figures Future Research References 27: Imaging of the Cervical Carotid Artery for Atherosclerotic Stenosis Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. What Is the Imaging Modality of Choice in Symptomatic Carotid Stenosis? A. Catheter Angiography B. Magnetic Resonance Angiography C. Computer Tomography Angiography D. Doppler Ultrasound II. What Is the Imaging Modality of Choice in Asymptomatic Carotid Stenosis? A. Cost-Effectiveness Analysis III. What Is the Role of Carotid Angioplasty and Stenting? IV. What Is the Role of Physiologic Imaging in Carotid Stenosis and Occlusion? A. Methods of Hemodynamic Assessment B. Association with Stroke Risk C. Cost-Effectiveness Analysis Take Home Tables (Tables 27.1–27.3) Protocols Based on the Evidence Carotid Angiography Doppler Ultrasound Contrast-Enhanced Magnetic Resonance Angiography Computed Tomographic Angiography References 28: Blunt Injuries to the Thorax and Abdomen Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. What Imaging Is Appropriate for Patients with Blunt Trauma to the Chest? A. Chest Wall B. Pleura and Lung C. Diaphragm II. What Imaging Is Appropriate for Patients with Blunt Trauma to the Abdomen? A. Spleen and Liver Injuries B. Bowel and Mesentery Injuries III. What Is the Optimal Imaging Approach in Patients Suspected of Having Retroperitoneal Injury? Take Home Figures Imaging Case Studies Case 1 Case 2 Future Research Suggested Imaging Protocols Trauma Computed Tomography of the Abdomen and Pelvis Trauma Ultrasound References Part VI:
Abdominal and Pelvic Imaging 29: Imaging of Appendicitis in Adult and Pediatric Patients Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. What Is the Accuracy of Imaging for Diagnosing Acute Appendicitis in Adults? II. What Is the Accuracy of Diagnostic Imaging in Pediatric Patients? III. Which Subjects Suspected of Having Appendicitis Should Undergo Imaging? IV. What Is the Effect of Imaging on Negative Appendectomy Rate? Take Home Tables and Figures Imaging Case Studies Case 1 Case 2 CT Protocols for Suspected Appendicitis Future Research References 30: Imaging in Non-appendiceal Acute Abdominal Pain Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology Methodology A: Imaging in Small Bowel Obstruction Methodology B: Imaging in Acute Diverticular Disease I. What Is the Accuracy of Imaging for Diagnosing Small Bowel Obstruction? IIA. What Is the Accuracy of Imaging for Acute Colonic Diverticulitis? IIB. What Is the Accuracy of CT in Predicting the Success of Conservative Management in Patients with Suspected Acute Colonic Take Home Tables (Tables 30.1–30.3) Imaging Case Studies Case 1 Case 2 Suggested Protocols Future Inquiry References 31: Intussusception in Children: Diagnostic Imaging and Treatment Issues Key Points Definition and Pathophysiology Epidemiology Rotavirus Vaccine Overall Cost to Society Goals Methodology I. What Are the Clinical Predictors of Intussusception? What Are the Clinical Predictors of Reducibility and Bowel Necrosis? Wh What Are the Clinical Predictors of Intussusception? What Are the Clinical Predictors of Reducibility and Bowel Necrosis? II. Which Imaging Studies Should Be Performed? What Is the Diagnostic Performance of Abdominal Radiographs? What Is the Diagnostic Performance of Sonography? What Are the Sonographic Predictors of Reducibility and Bowel Necrosis? What Are the Pathologic Lead Points? III. How Should Therapeutic Enema Be Performed? Air Versus Liquid Enema The Rule of Threes Radiation Dose Alternative Enema Approaches Fluoroscopy Versus Sonography Delayed Repeat Enema Where Should Patients Be Treated? What Are the Complications of Enema Therapy? What Are the Surgical Management and Complications? Cost-Effectiveness Analysis IV. What Is Appropriate Management in Recurrent Cases? V. Special Case: Intussusception Limited to the Small Bowel VI. Special Case: Intussusception with a Known Lead Point Mass Take Home Tables Imaging Case Study Case 1 Suggested Imaging Protocol for Intussusception in Children Ultrasound for Clinically Suspected Intussusception Air Enema for Reduction Future Research Studies References 32: Imaging of Infantile Hypertrophic Pyloric Stenosis Definition, Clinical Presentation, and Pathophysiology Issues Key Points Epidemiology Overall Cost to Society Goals Methodology I. What Are the Clinical Findings that Raise the Suspicion for IHPS and Direct Further Investigation? II. What Is the Diagnostic Performance of the Clinical and Imaging Examinations in IHPS? Clinical Palpation Abdominal Radiographs UGI Examination Ultrasound Examination III. Is There a Role for Follow-up Imaging in IHPS? IV. What Is the Natural History of IHPS and Patient Outcome with Medical Therapy Versus Surgical Therapy? Take Home Figures and Tables Imaging Case Studies Case 1 Case 2 Future Research References 33: Imaging of Biliary Disorders: Cholecystitis, Bile Duct Obstruction, Stones, and Stricture Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. What Is the Best Imaging Strategy for the Diagnosis of Acute Calculous Cholecystitis? A. Ultrasonography B. Cholescintigraphy C. Computed Tomography D. Magnetic Resonance Imaging E. Imaging Strategy II. What Is the Best Imaging Strategy for the Diagnosis of Acute Acalculous Cholecystitis? A. Ultrasonography B. Cholescintigraphy C. Computed Tomography D. Imaging Strategy III. What Is the Best Imaging Strategy for the Diagnosis of Chronic Calculous Cholecystitis? A. Ultrasonography B. Cholescintigraphy C. Imaging Strategy IV. What Is the Best Imaging Strategy for the Diagnosis of Chronic Acalculous Cholecystitis? A. Ultrasonography B. Cholescintigraphy C. Endoscopic Retrograde Cholangiopancreatography D. Imaging Strategy V. What Is the Best Imaging Strategy for the Evaluation of Bile Duct Obstruction? A. Ultrasonography B. Computed Tomography C. Magnetic Resonance Cholangiopancreatography D. Endoscopic Ultrasonography VI. What Is the Best Imaging Strategy for the Diagnosis of Choledocholithiasis? A. Ultrasonography B. Computed Tomography C. Endoscopic Retrograde Cholangiopancreatography D. Magnetic Resonance Cholangiopancreatography E. Endoscopic Ultrasonography F. Imaging Strategy VII. What Is the Best Imaging Strategy for the Evaluation of Bile Duct Stricture? A. Ultrasonography B. Computed Tomography C. Endoscopic Retrograde Cholangiopancreatography D. Magnetic Resonance Cholangiopancreatography E. Endoscopic Ultrasonography F. Special Case: Klatskin Tumor G. Imaging Strategy Take Home Tables (Tables 33.4 and 33.5) Future Research References 34: Hepatic Disorders: Colorectal Cancer Metastases, Cirrhosis, and Hepatocellular Carcinoma Issues Key Points Definition and Pathophysiology Liver Metastases Cirrhosis and Hepatocellular Carcinoma Epidemiology Liver Metastases Cirrhosis Goals Overall Cost to Society Methodology I. How Accurate Is Imaging in Patients with Suspected Hepatic Metastatic Disease? A. Ultrasonography B. Computed Tomography C. Magnetic Resonance Imaging D. Whole-Body Positron Emission Tomography II. What Is the Accuracy of Imaging in Patients with Cirrhosis for the Detection of Hepatocellular Carcinoma? A. Ultrasonography B. Computed Tomography C. Magnetic Resonance Imaging D. Whole-Body Positron Emission Tomography III. What Is the Cost-Effectiveness of Imaging in Patients with Suspected Hepatocellular Carcinoma? Take Home Tables and Figure (Tables 34.1 and 34.2; Fig. 34.4) Imaging Technique Protocols Abdominal Computed Tomography for Detection of Hepatocellular Carcinoma Using Multirow Detector Computed Tomography Liver MRI for Detection of Metastases or Hepatocellular Carcinoma (Minimum Sequences) Future Research References 35: Imaging of Inflammatory Bowel Disease in Children Issues Key Points Definition and Pathophysiology Epidemiology and Diagnosis Overall Cost to Society Goals Methodology I. What Are the Important Clinical Predictors of IBD? Laboratory Markers Children Under Age 5 Years II. What Is the Diagnostic Performance of Current Endoscopic Techniques in the Evaluation of Patients with IBD: Lower, Upper En Lower Endoscopy Upper Endoscopy Wireless Capsule Endoscopy III. What Is the Diagnostic Performance of Current Imaging Modalities in Evaluating IBD of the Small Bowel (Small Bowel Follow- Abdominal Radiographs Small Bowel Follow-Through Multidetector CT Enterography Enteroclysis (MR or CT) Ultrasound IV. Complications of IBD (Intra-abdominal Abscess, Intestinal Fistulae, Strictures and Small Bowel Obstruction, Primary Sclero Intra-abdominal Abscess Intestinal Fistulae Strictures and Small Bowel Obstruction Primary Sclerosing Cholangitis V. What Are the Most Important Imaging Features that Lead to Surgery in a Child with Crohn’s Disease and Ulcerative Colitis? Role of Conventional Barium Fluoroscopy and Multidetector CT Role of Enteroclysis (CT/MR) and Enterography (CT/MR) VI. What Are the Role and Risk of Repeat Imaging in Monitoring IBD Response to Treatment? VII. Special Situation: Which Imaging Modality Provides the Best Performance for the Evaluation of Perianal/Perirectal Diseas Take Home Tables and Figures Imaging Case Studies Case 1 Case 2 Case 3 Suggested Imaging Protocols for Inflammatory Bowel Disease in Children Definition of Imaging Techniques Upper Gastrointestinal Study with SBFT UGI/SBFT Enterography (MDCT, MR) Enteroclysis (CT, MR) Wireless Capsule Endoscopy General IBD Algorithm Clinical and Imaging Pathways for CD and UC Future Research References 36: Imaging of Nephrolithiasis and Its Complications in Adults and Children Issues Imaging of Nephrolithiasis in Adults Imaging of Nephrolithiasis in Children Imaging of Nephrolithiasis in Adults and Children Key Points Nephrolithiasis in Adults Nephrolithiasis in Children Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. What Is the Appropriate Test When There Is Clinical Suspicion of Obstructing Ureteral Stone in Adults? II. How Should Stones Be Followed After Treatment in Adults? III. Special Case: The Pregnant Patient IV. What Are the Clinical Findings that Raise the Suspicion for Stones in Children? V. What Is the Diagnostic Performance of the Different Imaging Studies in Nephrolithiasis and Urinary Tract Calculi in the Pedi Abdominal Radiographs Multidetector Computed Tomography Intravenous Urogram Ultrasound KUB Plus US Ultrasound Followed by MDCT for Equivocal Cases Magnetic Resonance Imaging Special Case: Bladder Calculi VI. What Is the Role of Repeat Imaging in Children with Known Stone? In Children with Recurrent Symptoms (Suggesting Obstructin VII. What Is the Natural History of Nephrolithiasis and Urinary Tract Calculi and What Are the Roles of Medical Therapy Versu VIII. Special Case: Will the Stone Pass on Its Own (Adults and Children)? Take Home Tables (Tables 36.1 and 36.2) Imaging Case Studies Case 1: Pediatric Case 2: Pediatric Case 3: Adult Suggested Adult Computed Tomography Imaging Protocols Suggested Pediatric Imaging Protocols Plain Radiograph Ultrasound MDCT MRI Future Research References 37: Urinary Tract Infection in Infants and Children Issues Key Points Definitions and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. What Is Known About the Natural History of Urinary Tract Infections in Infants and Children? II. What Can Imaging Reveal in the Setting of UTI? Abdominal Radiographs Sonography Intravenous Pyelogram CT and MRI/MR Urography Nuclear Medicine Evaluation for Vesicoureteric Reflux III. What Are Reasonable Imaging Strategies When Caring for a Male Infant or Child with a History of a Febrile Urinary Tract In IV. What Are Reasonable Imaging Strategies When Caring for a Female Infant or Child with a History of a Febrile Urinary Tract I V. Special Case: Postnatal Management of Fetal Hydronephrosis Take Home Tables and Figures Imaging Case Studies Case 1 Case 2 Case 3 Case 4 Case 5 Suggested Imaging Protocols for Urinary Tract Infections in Infants and Children Future Research References 38: Current Issues in Gynecology: Screening for Ovarian Cancer in the Average Risk Population and Diagnostic Evaluation of Postmenopausal Bleeding Issues Key Points Definition and Pathophysiology Epidemiology Ovarian Cancer Endometrial Cancer Overall Cost to Society Ovarian Cancer Endometrial Cancer Goals Screening in Ovarian Cancer Evaluation in Postmenopausal Bleeding Methodology I. Ovarian Cancer Screening: What Is the Role of Biochemical Markers Such as CA 125? II. Ovarian Cancer Screening: What Is the Diagnostic Performance (Accuracy) of Imaging? III. Ovarian Cancer Screening: What Is the Role of Imaging? A. Screening with Gray-Scale Ultrasound Only B. Screening with Ultrasound and Color Doppler Imaging C. Multimodality Approach Using CA 125 and Ultrasound IV. Postmenopausal Bleeding Evaluation: When Should a Woman with PMB Be Referred for Additional Evaluation? V. Postmenopausal Bleeding Evaluation: What Is the Accuracy of Imaging Tests? A. Transvaginal Ultrasonography B. Saline-Infused Hysterosonography C. Hysteroscopy VI. Postmenopausal Bleeding Evaluation: What Is the Role of Imaging? VII. How Should Women on Tamoxifen Therapy Be Evaluated? Take Home Tables and Figures (Tables 38.1 and 38.2; Figs. 38.1–38.4) Protocol: Transvaginal Ultrasound Future Research References 39: Imaging of Female Children and Adolescents with Abdominopelvic Pain Caused by Gynecological Pathologies Issues Key Points Definition Pathology and Epidemiology Congenital Anomalies Endometriosis Pelvic Inflammatory Disease Adnexal Torsion Abdominopelvic Mass Pregnancy Overall Cost to Society Pelvic Inflammatory Disease Endometriosis Goals Methodology I. What Is the Diagnostic Performance of the Different Imaging Studies for the Diagnosis or Exclusion of Ovarian Torsion? II. What Is the Best Imaging Technique for the Diagnosis of PID? III. What Is the Best Imaging Technique for the Diagnosis of Endometriosis? IV. What Is the Best Technique for the Diagnosis of an Ectopic Pregnancy? Take-Home Tables Imaging Case Studies Case 1 Case 2 Suggested Imaging Protocols Plain Radiographs Ultrasound Multi-Detector Computed Tomography Magnetic Resonance Imaging Future Research References 40: Imaging of Boys with an Acute Scrotum: Differentiation of Testicular Torsion from Other Causes Issues Key Points Definition and Pathophysiology Epidemiology Overall Cost to Society Goals Methodology I. What Are the Clinical Findings that Raise the Suspicion of Testicular Torsion in Children with Acute Scrotal Pain? II. What Is the Diagnostic Performance of the Different Imaging Studies in Children with Acute Scrotal Pain? Doppler Ultrasound Magnetic Resonance Imaging Radionuclide Imaging III. In Cases of Testicular Torsion, Is Manual Reduction Required? Detorsion Take Home Figures and Tables Imaging Case Studies Case 1 Suggested Imaging Protocols for Acute Scrotum Ultrasound Manual Detorsion Future Research References Index