Lumbar MR imaging and reporting epidemiology: do epidemiologic data in reports affect clinical management?

PURPOSE: To retrospectively examine the association between the inclusion of epidemiologic information in lumbar spine magnetic resonance (MR) imaging reports regarding findings in asymptomatic individuals and the rates of subsequent cross-sectional imaging and treatments in patients with low back pain or radiculopathy referred for imaging by primary care providers. MATERIALS AND METHODS: Institutional review board approval was received for a retrospective chart review, with waiver of informed consent and HIPAA authorization. During 3 years, an epidemiologic statement was routinely but arbitrarily included in lumbar spine MR imaging reports. Two hundred thirty-seven reports documenting uncomplicated degenerative changes on initial lumbar spine MR images were identified, 71 (30%) of which included the statement (statement group) and 166 (70%) did not (nonstatement group). The rates of repeat cross-sectional imaging and treatments within 1 year were compared between groups by using logistic regression controlling for severity of MR imaging findings. RESULTS: Patients in the statement group were significantly less likely to receive a prescription for narcotics for their symptoms than patients in the nonstatement group (odds ratio = 0.29, P = .01). Repeat cross-sectional imaging and physical therapy referrals were also less common in the statement group than in the nonstatement group (odds ratio = 0.22 and 0.55, respectively), but these differences were not statistically significant (P = .14 and .06, respectively). Rates of steroid injections, surgical consultations, and surgeries were similar between groups. CONCLUSION: Patients were less likely to receive narcotics prescriptions from primary care providers when epidemiologic information was included in their lumbar spine MR imaging reports.

Is 18F-FDG PET more accurate than standard diagnostic procedures in the detection of suspected recurrent melanoma?

UNLABELLED: The aim of this study was to determine the accuracy of (18)F-FDG PET in detecting recurrent melanoma. METHODS: PET findings were compared with those obtained by standard diagnostic clinical procedures (CP) to establish the role of PET in the management of patients with melanoma. From 156 patients with confirmed melanoma and recurrence suspected by clinical examination, 184 PET scans were retrospectively reviewed. Histology or clinical follow-up was used for final diagnosis. RESULTS: The sensitivity and specificity of PET for detecting lesions on an individual-patient basis were 74% and 86%, respectively, compared with respective values of 58% and 45% for CP alone. The overall accuracy for PET was 81%, compared with 52% for other methods. PET was more accurate (91% vs. 67%) than CP in detecting locoregional disease and distant metastases (85% vs. 55%), and PET results led to a change in the planned clinical management of 36% of patients included in this study. PET was more accurate than CT in detecting skin lesions, malignant lymph nodes, and metastases to the abdomen, liver, and bone. In the assessment of pulmonary disease, PET showed higher specificity (92% vs. 70%) than CT for the detection of lung parenchyma lesions; however, the sensitivity was better for CT (93%) than for PET (57%). CONCLUSION: PET is better than CP in detecting locoregional disease and distant metastases in all sites except the lung, where it appears to be a useful adjunct to CT. The use of PET as a routine clinical tool can lead to a substantial change in the clinical management of suspected recurrent melanoma.

Roles of positron emission tomography with fluorine-18-deoxyglucose in the detection of local recurrent and distant metastatic sarcoma.

Sarcomas are a heterogeneous group of tumors comprising approximately 1% of all malignancies. Definitive treatment of sarcoma is surgical resection. However, after surgical removal, 40% to 60% of the patients will develop local or distant recurrence. Therefore, the early detection and treatment of recurrence is an important part of modern sarcoma therapy. Positron emission tomography with fluorine-18-deoxyglucose (FDG-PET) has been highly successful in detecting and staging a variety of malignancies. However, its use in the management of patients with sarcoma is less defined. The purpose of our study was to assess the potential roles of FDG-PET in the detection of local recurrence and distant metastases. In this retrospective study, the images of 33 FDG-PET scans, reports of 29 computed tomography (CT) scans, and 8 magnetic resonance imaging (MRI) scans from 28 patients were compared with surgical pathology or clinical follow up for at least 6 months. FDG-PET detected all 25 cases of local and distant recurrences with 100% sensitivity. CT was able to detect 18 of the 22 possible cases of recurrent disease, whereas MRI was able to detect 5 of 7 cases of recurrent disease. PET was particularly useful in patients with extensive histories of surgery and radiation therapy, precisely the setting in which CT and MRI have the lowest specificity and sensitivity. In conclusion, FDG-PET was a sensitive test to detect local and distant recurrences of sarcoma and this warrants further investigation.