MAGNETIC RESONANCE IMAGING IN POSTERIOR CIRCULATION INFARCTION: IMPACT ON DIAGNOSIS AND MANAGEMENT

To compare the diagnostic yield of magnetic resonance imaging (MRI) with computed tomography (CT) in posterior circulation infarction, we used proton MRI with a 0.3 Tesla magnet and a 3rd generation CT scanner in 25 patients. Age-matched controls were compared in a blinded fashion. Seventeen patients (68%) showed relevant pathology on MRI not seen on CT, 11 with normal CT and six with more extensive lesions, chiefly in the brain stem. Evidence of abnormal vertebrobasilar blood flow was seen in 8/25 (32%) of patients, suggested by vascular high intensity signals on MRI. Two tissue and one flow abnormality were seen in the control group. MRI provides additional information concerning infarct site, extent and pathogenesis in posterior circulation infarction.     

Early (Stage A) prostatic cancer

Summary This study was performed in order to elucidate some of the problems of incidence, morphology and natural history concerned with Stage A prostatic cancer or prostatic microcarcinoma (PMC).The prostates of 100 patients, treated by subtotal prostatectomy for benign prostatic hyperplasia (BPH), were studied by comparing both routine and step-section techniques. The incidence of PMC was 41% by the former and 86% by the latter technique. Assessment of the size of PMC, as measured by the sum of the two main diameters, resulted in three groups: A₁, A₂, A₃. The last of these may represent a frankly malignant condition, judged by size and the histological appearance. Radical prostatectomy is strongly suggested as appropriate therapy for this group.Supported in part by a Grant from the Ministry of Education (art. 286 T.U., 1977/78)     

Disclosing incidental findings in brain research: The rights of minors in decision‐making

MRI is used routinely in research with children to generate new knowledge about brain development. The detection of unexpected brain abnormalities (incidental findings; IFs) in these studies presents unique challenges. While key issues surrounding incidence and significance, duty of care, and burden of disclosure have been addressed substantially for adults, less empirical data and normative analyses exist for minors who participate in minimal risk research. To identify ethical concerns and fill existing gaps, we conducted a comprehensive review of papers that focused explicitly on the discovery of IFs in minors. The discourse in the 21 papers retrieved for this analysis amply covered practical issues such as informed consent and screening, difficulties in ascertaining clinical significance, the economic costs and burden of responsibility on researchers, and risks (physical or psychological). However, we found little discussion about the involvement of minors in decisions about disclosure of IFs in the brain, especially for IFs of low clinical significance. In response, we propose a framework for managing IFs that integrates practical considerations with explicit appreciation of rights along the continuum of maturity. This capacity‐adjusted framework emphasizes the importance of involving competent minors and respecting their right to make decisions about disclosure. J. Magn. Reson. Imaging 2013;38:1009–1013. © 2013 Wiley Periodicals, Inc.     

Long‐term effects of neonatal hippocampal lesions on novelty preference in monkeys

In a recent longitudinal study to assess the development of incidental recognition memory processes in monkeys, we showed that the effects of neonatal hippocampal lesions did alter incidental recognition memory only when the animals reached the juvenile period (Zeamer et al., 2010 ). The current follow‐up study tested whether this incidental memory loss was long‐lasting, i.e., present in adulthood, or only transitory, due to functional compensation with further brain maturation. The same animals with neonatal hippocampal lesions and their sham‐operated controls were re‐tested in the visual paired‐comparison task when they reached adulthood (48 months). The results demonstrated that, at least for easily discriminable color pictures of objects, the involvement of the hippocampus was only transitory, given that when re‐tested as adults, animals with neonatal hippocampal lesions performed as well as sham‐operated controls at all delays. Yet, significant recognition memory impairment was re‐instated when the discriminability of the stimuli was made more difficult (black/white pictures of similar objects). The data demonstrate profound functional remodeling within the hippocampus and its interactions with different medial temporal lobe structures from the juvenile period to adulthood, which is substantiated by a parallel morphological maturation of hippocampal intrinsic circuits (Lavenex et al., 2007a ; Jabès et al., 2011 ). © 2013 Wiley Periodicals, Inc.     

A Radiologist’s Primer on Bundles and Care Episodes

Bundled or episode payments are among the most heavily emphasized approaches to aligning incentives and promoting care coordination, efficiency, and accountability in health care redesign. Bundled or episode payments price a market basket of services for an entire episode of care with both a clearly defined trigger and termination. Because the radiologist is “ancillary” in many bundles, the specialty is often unaware of the phenomenon. This is likely to change rapidly. Radiology is pivotal in high-prevalence, high-impact care areas such as low back pain and stroke that are focuses of widely used system performance metrics. More important, radiology is central to the diagnosis and management of a wide range of important diagnostic issues in areas such as breast cancer, pulmonary nodules, and incidental findings. Three models of bundled care will probably involve radiology intimately in the near future. Pure radiology bundles might be constructed for breast cancer screening and diagnosis, and these could be priced on the basis of guideline-based best-practice frequencies of care events such as recall and biopsy. Clinical bundles, for example low back pain, could be priced on the basis of optimal imaging frequencies. Finally, pricing of imaging studies might include evidence-based frequencies of follow-up imaging for incidental findings.     

Introduction of Stent Grafts in the Management of Patients with a Abdominal or Thoracic Aortic Aneurysm: Why,Perspectives, Results

In May 2001 we worked out a system in order to reimburse stentgrafts through the compulsory insurance. An agreement was signed between the different bodies of the NISDI (INAMI/RIZIV) and the association of radiologists and vascular surgeons, specifying the conditions of reimbursement.

In this article, I will explain the medical indications as well as the conditions that have to be met by the implanting surgeons.

After two years, a first evaluation was made. The figures show some remarkable evolutions. The author therefore has some considerations concerning the procedure.     

Diagnostic accuracy,yield, and comparative effectiveness of whole-body computed tomography in blunt trauma: A protocol for systematic review and meta-analysis

Objectives:Controversies emerge over routine performances of whole-body computed tomography (WBCT) in patients with blunt polytrauma. The existing randomized and non-randomized evidence is inconclusive, and during observations of non-trauma, incidental findings, detected by WBCT, have left uncertainty regarding their consequences and optimal management. Additionally, previous meta-analyses have failed to address the limitations of primary studies and issues associated with incidental findings. Therefore, we planned a new systematic review to address these points.Methods:We will search the PubMed, EMBASE, and Cochrane Central databases from inception to December 31, 2020, with no language restriction and perform full-text evaluation of potentially relevant articles. We will include prospective and retrospective studies with a single-gate design that assessed diagnostic accuracy and/or yield of WBCT to detect traumatic injuries, and studies that assessed incidental findings detected by WBCT. Additionally, we will include randomized controlled trials and non-randomized comparative studies that assessed the effectiveness of WBCT against conventional care, including selective computed tomography (CT). Studies of patients of all ages with blunt traumatic injuries, assessed at an emergency department, will be included. Two reviewers will extract data and rate the study validity via standard quality assessment tools. The primary outcome of interest will be reduction in mortality. Our secondary outcomes will include diagnostic accuracy and yield, detection of incidental findings and clinical outcomes associated with these detections, and improvement in other non-mortality clinical outcomes. We will qualitatively assess study, patient, and intervention characteristics and clinical outcomes. If appropriate, we will perform random-effects model meta-analyses to obtain summary estimates. Finally, we will assess the certainty of evidence by the grading the quality of evidence and strength of recommendations.Ethics and dissemination:Ethics approval is not applicable, as this is a secondary analysis of publicly available data. The review results will be submitted for publication in peer-reviewed journals.Prospero registration:CRD42020187852.     

Latent learning of spatial information is impaired in middle‐aged rats

The present study determined if the middle age related impairment that occurs with nonspatial latent learning also occurs in spatial latent learning. Thirty young (3‐months‐old) and 30 middle‐aged (12‐months‐old) male Sprague–Dawley rats were given either pre‐exposure to spatial cues surrounding a Barnes maze (SpatialPX), or pre‐exposure to just the maze (MazePX). They were then given 10 training trials in which they had to find a hidden escape box while experiencing an aversive environment produced by bright lights and wind. Results showed that young rats given the SpatialPX condition demonstrated faster escape latencies and fewer errors than young rats given the MazePX condition. However, middle‐aged rats given the SpatialPX condition did not show this improved performance. These findings indicate that the middle age learning deficit is not task specific, but rather is a general impairment in latent learning, possibly due to the early degeneration of the entorhinal cortex. © 2012 Wiley Periodicals, Inc. Dev Psychobiol 55: 309–315, 2013