The RSNA Cervical Spine Fracture CT Dataset.

This dataset is composed of cervical spine CT images with annotations related to fractures; it is available at https://www.kaggle.com/competitions/rsna-2022-cervical-spine-fracture-detection/.

Post-Traumatic Surgical Emphysema and Sialocele with Fistula Following Knife Wounds to the Head and Neck of a 30-Year-Old Woman.

BACKGROUND Trauma to the left submandibular gland is an infrequent entity, with only a few cases reported in the literature. Recommended management consists of excision of the gland if trauma is suspected; if trauma is not clearly identified during the surgical exploration and the gland is not removed, post-traumatic complications such as fistula or sialocele may occur. In such cases, conservative measures including aspiration, pressure bandages, and anti-sialogogues are the first step of treatment and surgical excision is reserved for unsuccessful cases. CASE REPORT This report describes a case of post-traumatic surgical emphysema and sialocele with fistula following knife wounds to the head and neck of a 30-year-old woman. The patient had an incised wound to the left submandibular gland. Subsequently, a painful slow-growing mass developed and the diagnosis of sialocele was considered. Confirmation of this diagnosis was achieved by performing a fine-needle aspiration, which revealed a high amylase level within the collection. Afterwards, pressure bandages were applied and no recurrence of the sialocele was observed in imaging follow-up. CONCLUSIONS This report shows that although submandibular gland trauma is rare, it can lead to salivary fistula or sialocele. The diagnosis of sialocele can be confirmed by imaging combined with fine-needle aspiration and measurement of amylase levels in the aspirate. Identification of traumatic sialocele and fistula at an early stage will lead to the most appropriate management.

Non-union and use of proton pump inhibitors in the treatment of femoral and tibial shaft fractures: a nested case-control study.

BACKGROUND: Proton pump inhibitors (PPIs) are one of the most frequently used drugs worldwide. Previous research has shown that they could increase the risk of fracture and interfere with the fracture healing process. In this study, we analyzed the effect of PPIs on the risk of fracture non-union in patients with femoral and tibial shaft fractures. METHODS: A case-control study was conducted at our institution, including a total of 254 patients who underwent fixation surgery for a femoral or tibial shaft fracture between January 2012 and December 2017. We defined cases as patients who experienced a delayed union (case group A; n = 44), or non-union (cases group B; n = 12). Cases were matched by age, sex, and fractured bone, to 144 controls who did not experience delayed fracture union and did not require further procedures. A conditional logistic regression analysis was performed adjusted to potential confounders, and to the proportion of days covered (PDC) with PPIs. RESULTS: Adjusted ORs (95% CI) for undergoing a nail dynamization following a tibial or femoral shaft fracture were 1.38 (0.70-2.65) for any use PPIs. Patients with a longer PPI treatment courses (PDC ≥ 0.5) had an adjusted OR of 1.86 (0.70-4.76) for undergoing nail dynamization when compared with controls. Contrastingly, patients with a PDC < 0.5 had an adjusted OR of 1.03 (0.43-2.48). The adjusted OR (95% CI) for undergoing additional surgical procedures due to non-union was 4.5 (0.62-32.8) for any use of PPIs, and 12.3 (1.9-81.0) in patients with a PDC ≥ 0.5. CONCLUSIONS: A prolonged use of PPIs use was associated with a higher risk of fracture non-union in tibial and femoral shaft fractures.

[Prognostic value of the Charlson index in mortality in patients with pulmonary embolism associated with cancer versus non-tumour pulmonary embolism]. / Valor pronóstico del índice de Charlson en la mortalidad en pacientes con embolia pulmonar asociada a cáncer frente a embolia pulmonar no tumoral.

INTRODUCTION: The aim of this study is to analyse comorbidity, survival, and mortality from pulmonary embolism (PE) in people with cancer and without cancer. And to determine whether the Charlson Comorbidity Index (CCI) predicts mortality in the short and long term in this population. METHODS: A retrospective observational study on survival in patients hospitalized in the Hospital Central de la Defensa from 1-01-2009 to 15-03-2018, stratifying into tumour PE group (EPT) and non-tumour PE group (EPnT), all of whom were classified according to age adjusted CCI. RESULTS: A total of 368 patients were diagnosed with PE, 108 with associated cancer. The mean CCI in the EPT group was 7.2 and 4.5 in the EPnT group. Patients with PE and CCI>5 were 10.7 times more likely to die (95%CI 1.5-77.6) compared to CCI 0 (P=.019). The CCI of patients with EPT was 2.6 points higher (95%CI 1.9-33) than EPnT patients (P<.001). Cancer patients were 1.9 times more likely to die (95%CI 1.23-2.8) and had higher mortality at 30 days and at one year after the event, with a median survival of 8.98 years and 3.4 years, respectively (P<.001). CONCLUSIONS: The CCI in EPT is an independent risk factor related to mortality. The CCI can predict higher mortality in the short and long term in patients with PE.

Evaluation of the Khorana Predictive Thrombotic Risk and Thromboprophylaxis Score in Cancer Patients in a Third Level Hospital.

Introduction: Current clinical guidelines do not recommend the routine use of thromboprophylaxis in cancer primary unselected patients. Identifying cancer patients who could be beneficiaries of thrombotic prophylaxis is a real challenge. We aimed to analyse the application of Khorana score in cancer patients. We also tried to evaluate the prescription of primary thromboprophylaxis in cancer patients at risk of venous thromboembolic disease (VTED). Methods: A retrospective observational study of survival of hospitalised patients diagnosed with pulmonary embolism (PE) at the Hospital Central de la Defensa from January 2009 to March 2018. They were stratified into tumour PE (TPE) and non-tumour PE (nTPE). A case-control study was also carried out by TPE patients and non PE cancer patients (nPEC). Results: 108 patients were diagnosed with TPE, 260 nTPE and 324 nPEC. Gynaecological tumours were the most frequent (23.1%), followed by lung, digestive and urological cancer (20.4% each) in the TPE group. Death risk was 1.9 times higher in cancer patients (95% CI: 1.23-2.8) (p < 0.001). Khorana score was ≥3 points in 9.7% of TPE and 3.1% of nPEC compared to 26.2% of TPE and 9.9% of nPEC with Khorana score ≥2 points (p < 0.001). 7.4% of TPE patients received thromboprophylaxis. Khorana score in TPE patients without thromboprophylaxis was ≥3 points in the 9% and ≥2 points in the 24%. Conclusions: There is an underutilisation of thromboprophylaxis in our cancer patients and mainly in those with high risk of VTED, as well as poor adherence to the Khorana score. More studies are needed to validate these findings and to optimise predictive strategies in the management of these patients.

Introducción: El objetivo del estudio es analizar la aplicación de la escala predictiva de Khorana en el paciente oncológico. Asimismo el estudio trata de evaluar la prescripción de tromboprofilaxis primaria en los pacientes con cáncer en riesgo de enfermedad tromboembólica venosa (ETV). Métodos: Estudio observacional retrospectivo de supervivencia en pacientes hospitalizados en el Hospital Central de la Defensa diagnosticados de embolia pulmonar (EP) desde el 01 de enero de 2009 al 15 de marzo de 2018, estratificándose en EP tumoral (EPT) y EP no tumoral (EPnT). Se ha realizado también un estudio de casos y controles, con pacientes con EPT y con cáncer sin EP (CsEP). Resultados: Se encontró que 108 pacientes presentaron EPT, 260 EPnT y 324 CsEP. En la EPT el tumor ginecológico fue el más frecuente (23,1%), seguido de pulmón, digestivo y urológico (20,4% cada uno). Los pacientes con cáncer presentaron 1,9 veces más riesgo de muerte (IC 95%: 1,23-2,8) (p < 0,001). Mediante la escala de Khorana el 9,7% de EPT y el 3,1% de CsEP presentaron ≥3 puntos, frente a 26,2% de EPT y 9,9% de CsEP con ≥2 puntos (p < 0,001). Un 7,4% de EPT recibió tromboprofilaxis. De los que no la recibieron el 9% tenía ≥3 puntos y el 24% ≥2 puntos. Conclusiones: Existe una infrautilización de la tromboprofilaxis en nuestros pacientes oncológicos y fundamentalmente en los de alto riesgo de ETV, así como una escasa adherencia a la escala de Khorana. Son necesarios más estudios para validar estos hallazgos y conseguir optimizar las estrategias predictivas en el manejo de estos pacientes.

Lateral Meniscus Height and ACL Reconstruction Failure: A Nested Case-Control Study.

Previous work has shown that the morphology of the knee joint is associated with the risk of primary anterior cruciate ligament (ACL) injury. The objective of this study is to analyze the effect of the meniscal height, anteroposterior distance of the lateral tibial plateau, and other morphological features of the knee joint on risk of ACL reconstruction failure. A nested case-control study was conducted on patients who underwent an ACL reconstruction surgery during the period between 2008 and 2015. Cases were individuals who failed surgery during the study period. Controls were patients who underwent primary ACL reconstruction surgery successfully during the study period. They were matched by age (±2 years), gender, surgeon, and follow-up time (±1 year). A morphological analysis of the knees was then performed using the preoperative magnetic resonance imaging scans. The anteroposterior distance of the medial and lateral tibial plateaus was measured on the T2 axial cuts. The nonweightbearing maximum height of the posterior horn of both menisci was measured on the T1 sagittal scans. Measurements of the medial and lateral tibial slope and meniscal slope were then taken from the sagittal T1 scans passing through the center of the medial and lateral tibial plateau. A binary logistic regression analysis was done to calculate crude and adjusted odds ratios (ORs) estimates. Thirty-four cases who underwent ACL revision surgery were selected and were matched with 68 controls. Cases had a lower lateral meniscal height (6.39 ± 1.2 vs. 7.02 ± 0.9, p = 0.008, power = 84.4%). No differences were found between the two groups regarding the bone slope of the lateral compartment (6.19 ± 4.8 vs. 6.92 ± 5.8, p = 0.552), the lateral meniscal slope (-0.28 ± 5.8 vs. -1.03 ± 4.7, p = 0.509), and the anteroposterior distance of the lateral tibial plateau (37.1 ± 5.4 vs. 35.6 ± 4, p = 0.165). In addition, no differences were found in the medial meniscus height between cases and controls (5.58 ± 1.2 vs. 5.81 ± 1.2, respectively, p = 0.394). There were also no differences between cases and controls involving the medial bone slope, medial meniscal slope, or anterior posterior distance of the medial tibial plateau. Female patients had a higher medial (4.8 degrees ± 3.2 vs. 3.3 ± 4.1, p = 0.047) and lateral (8.1 degrees ± 5.1 vs. 5.6 degrees ± 5.6, p = 0.031) tibial bone slope, and a lower medial (5.3 mm ± 1.0 vs. 6.1 mm ± 1.2, p = 0.001) and lateral (6.6 ± 1.0 vs. 7.0 ± 1.2, p = 0.035) meniscus height, and medial (4.3 ± 0.4 vs. 4.8 ± 0.4, p =0.000) and lateral (3.3 ± 0.3 vs. 3.9 ± 0.4, p = 0.000) anteroposterior distance than males, respectively.The adjusted OR of suffering an ACL reconstruction failure compared to controls was 5.1 (95% confidence interval [CI]: 1.7-14.9, p = 0.003) for patients who had a lateral meniscus height under 6.0 mm. The adjusted OR of suffering an ACL reconstruction failure was 2.4 (95% CI: 1.0-7.7, p = 0.01) for patients who had an anteroposterior distance above 35.0 mm. Patients with a lateral meniscal height under 6.0 mm have a 5.1-fold risk of suffering an ACL reconstruction failure compared to individuals who have a lateral meniscal height above 6.0 mm. Patients with a higher anteroposterior distance of the lateral tibial plateau also have a higher risk of ACL reconstruction failure.

A Prediction Model for Primary Anterior Cruciate Ligament Injury Using Artificial Intelligence.

BACKGROUND: Supervised machine learning models in artificial intelligence (AI) have been increasingly used to predict different types of events. However, their use in orthopaedic surgery has been limited. HYPOTHESIS: It was hypothesized that supervised learning techniques could be used to build a mathematical model to predict primary anterior cruciate ligament (ACL) injuries using a set of morphological features of the knee. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Included were 50 adults who had undergone primary ACL reconstruction between 2008 and 2015. All patients were between 18 and 40 years of age at the time of surgery. Patients with a previous ACL injury, multiligament knee injury, previous ACL reconstruction, history of ACL revision surgery, complete meniscectomy, infection, missing data, and associated fracture were excluded. We also identified 50 sex-matched controls who had not sustained an ACL injury. For all participants, we used the preoperative magnetic resonance images to measure the anteroposterior lengths of the medial and lateral tibial plateaus as well as the lateral and medial bone slope (LBS and MBS), lateral and medial meniscal height (LMH and MMH), and lateral and medial meniscal slope (LMS and MMS). The AI predictor was created using Matlab R2019b. A Gaussian naïve Bayes model was selected to create the predictor. RESULTS: Patients in the ACL injury group had a significantly increased posterior LBS (7.0° ± 4.7° vs 3.9° ± 5.4°; P = .008) and LMS (-1.7° ± 4.8° vs -4.0° ± 4.2°; P = .002) and a lower MMH (5.5 ± 0.1 vs 6.1 ± 0.1 mm; P = .006) and LMH (6.9 ± 0.1 vs 7.6 ± 0.1 mm; P = .001). The AI model selected LBS and MBS as the best possible predictive combination, achieving 70% validation accuracy and 92% testing accuracy. CONCLUSION: A prediction model for primary ACL injury, created using machine learning techniques, achieved a >90% testing accuracy. Compared with patients who did not sustain an ACL injury, patients with torn ACLs had an increased posterior LBS and LMS and a lower MMH and LMH.

Site-Specific Variation in Radiomic Features of Head and Neck Squamous Cell Carcinoma and Its Impact on Machine Learning Models.

Current radiomic studies of head and neck squamous cell carcinomas (HNSCC) are typically based on datasets combining tumors from different locations, assuming that the radiomic features are similar based on histopathologic characteristics. However, molecular pathogenesis and treatment in HNSCC substantially vary across different tumor sites. It is not known if a statistical difference exists between radiomic features from different tumor sites and how they affect machine learning model performance in endpoint prediction. To answer these questions, we extracted radiomic features from contrast-enhanced neck computed tomography scans (CTs) of 605 patients with HNSCC originating from the oral cavity, oropharynx, and hypopharynx/larynx. The difference in radiomic features of tumors from these sites was assessed using statistical analyses and Random Forest classifiers on the radiomic features with 10-fold cross-validation to predict tumor sites, nodal metastasis, and HPV status. We found statistically significant differences (p-value ≤ 0.05) between the radiomic features of HNSCC depending on tumor location. We also observed that differences in quantitative features among HNSCC from different locations impact the performance of machine learning models. This suggests that radiomic features may reveal biologic heterogeneity complementary to current gold standard histopathologic evaluation. We recommend considering tumor site in radiomic studies of HNSCC.

Dual-Energy CT Texture Analysis With Machine Learning for the Evaluation and Characterization of Cervical Lymphadenopathy.

PURPOSE: To determine whether machine learning assisted-texture analysis of multi-energy virtual monochromatic image (VMI) datasets from dual-energy CT (DECT) can be used to differentiate metastatic head and neck squamous cell carcinoma (HNSCC) lymph nodes from lymphoma, inflammatory, or normal lymph nodes. MATERIALS AND METHODS: A retrospective evaluation of 412 cervical nodes from 5 different patient groups (50 patients in total) having undergone DECT of the neck between 2013 and 2015 was performed: (1) HNSCC with pathology proven metastatic adenopathy, (2) HNSCC with pathology proven benign nodes (controls for (1)), (3) lymphoma, (4) inflammatory, and (5) normal nodes (controls for (3) and (4)). Texture analysis was performed with TexRAD® software using two independent sets of contours to assess the impact of inter-rater variation. Two machine learning algorithms (Random Forests (RF) and Gradient Boosting Machine (GBM)) were used with independent training and testing sets and determination of accuracy, sensitivity, specificity, PPV, NPV, and AUC. RESULTS: In the independent testing (prediction) sets, the accuracy for distinguishing different groups of pathologic nodes or normal nodes ranged between 80 and 95%. The models generated using texture data extracted from the independent contour sets had substantial to almost perfect agreement. The accuracy, sensitivity, specificity, PPV, and NPV for correctly classifying a lymph node as malignant (i.e. metastatic HNSCC or lymphoma) versus benign were 92%, 91%, 93%, 95%, 87%, respectively. CONCLUSION: Machine learning assisted-DECT texture analysis can help distinguish different nodal pathology and normal nodes with a high accuracy.

Head and neck squamous cell carcinoma: prediction of cervical lymph node metastasis by dual-energy CT texture analysis with machine learning.

OBJECTIVES: This study was conducted in order to evaluate a novel risk stratification model using dual-energy CT (DECT) texture analysis of head and neck squamous cell carcinoma (HNSCC) with machine learning to (1) predict associated cervical lymphadenopathy and (2) compare the accuracy of spectral versus single-energy (65 keV) texture evaluation for endpoint prediction. METHODS: Eighty-seven patients with HNSCC were evaluated. Texture feature extraction was performed on virtual monochromatic images (VMIs) at 65 keV alone or different sets of multi-energy VMIs ranging from 40 to 140 keV, in addition to iodine material decomposition maps and other clinical information. Random forests (RF) models were constructed for outcome prediction with internal cross-validation in addition to the use of separate randomly selected training (70%) and testing (30%) sets. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for predicting positive versus negative nodal status in the neck. RESULTS: Depending on the model used and subset of patients evaluated, an accuracy, sensitivity, specificity, PPV, and NPV of up to 88, 100, 67, 83, and 100%, respectively, could be achieved using multi-energy texture analysis. Texture evaluation of VMIs at 65 keV alone or in combination with only iodine maps had a much lower accuracy. CONCLUSIONS: Multi-energy DECT texture analysis of HNSCC is superior to texture analysis of 65 keV VMIs and iodine maps alone and can be used to predict cervical nodal metastases with relatively high accuracy, providing information not currently available by expert evaluation of the primary tumor alone. KEY POINTS: • Texture features of HNSCC tumor are predictive of nodal status. • Multi-energy texture analysis is superior to analysis of datasets at a single energy. • Dual-energy CT texture analysis with machine learning can enhance noninvasive diagnostic tumor evaluation.

Anatomical Variations of the Vertebral Artery in the Upper Cervical Spine: Clinical Relevance for Procedures Targeting the C1/C2 and C2/C3 Joints.

BACKGROUND AND OBJECTIVES: Accidental breach of the vertebral artery (VA) during the performance of cervical pain blocks can result in significant morbidity. Whereas anatomical variations have been described for the foraminal (V2) segment of the VA, those involving its V3 portion (between the C2 transverse process and dura) have not been investigated and may be of importance for procedures targeting the third occipital nerve or the lateral atlantoaxial joint. METHODS: Five hundred computed tomography angiograms of the neck performed in patients older than 50 years for the management of cerebrovascular accident or cervical trauma (between January 2010 and May 2016) were retrospectively and independently reviewed by 2 neuroradiologists. Courses of the VA in relation to the lateral aspect of the C2/C3 joint and the posterior surface of the C1/C2 joint were examined. For the latter, any medial encroachment of the VA (or one of its branches) was noted. The presence of a VA loop between C1 and C2 and its distance from the upper border of the superior articular process (SAP) of C3 were also recorded. If the VA loop coursed posteriorly, its position in relation to 6 fields found on the lateral aspects of the articular pillars of C2 and C3 was tabulated. RESULTS: At the C1/C2 level, the VA coursed medially over the lateral quarter of the dorsal joint surface in 1% of subjects (0.6% and 0.4% on the left and right sides, respectively; P = 0.998). A VA loop originating between C1 and C2 was found to travel posteroinferiorly over the anterolateral aspect of the inferior articular pillar of C2 in 55.5% of patients on the left and 41.9% on the right side (P < 0.001), as well as over the SAP of C3 in 0.4% of subjects. When present in the quadrant immediately cephalad to the C3 SAP, VA loops coursed within 2.0 ± 1.5 and 3.3 ± 2.5 mm on the left and right sides, respectively, of its superior aspect (P < 0.001). CONCLUSIONS: The VA commonly travels adjacent to areas targeted by third occipital nerve procedures and more rarely over the access point for lateral atlantoaxial joint injections. Modifications to existing techniques may reduce the risk of accidental VA breach.

Spectral Computed Tomography: Technique and Applications for Head and Neck Cancer.

Spectral computed tomography (CT) or dual-energy CT (DECT) is an advanced form of CT with increasing applications in head and neck radiology. This article provides an overview of the DECT technique and reviews current applications for the evaluation of neck pathology, focusing on oncologic applications. Included are an overview of the basic underlying principles and approaches for DECT scan acquisition and material characterization; a discussion of various DECT reconstructions and a brief overview of practical issues pertaining to DECT implementation, including those related to workflow impact of DECT; and a discussion of various applications of DECT for the evaluation of the neck, especially in oncology.

Dual-Energy Computed Tomography of the Neck: A Pictorial Review of Normal Anatomy, Variants, and Pathologic Entities Using Different Energy Reconstructions and Material Decomposition Maps.

There is increasing use of dual-energy computed tomography (DECT) for the evaluation of head and neck pathologic entities. Optimal DECT utilization requires familiarity with the appearance of normal tissues variants, and pathologic entities on different DECT reconstructions that may be used in clinical practice. The purpose of this article is to provide a practical, pictorial review of the appearance of normal anatomic structures and different neoplastic and nonneoplastic head and neck pathologic entities on commonly used DECT reconstructions.

Routine Dual-Energy Computed Tomography Scanning of the Neck in Clinical Practice: A Single-Institution Experience.

There is increasing use and popularity of dual-energy computed tomography (DECT) in many subspecialties in radiology. This article reviews the practical workflow implications of routine DECT scanning based on the experience at a single institution where a large percentage of elective neck CTs are acquired in DECT mode. The article reviews factors both on the production (technologist) and on the interpretation (radiologist) side, focusing on challenges posed and potential solutions for seamless workflow implementation.

Neuropsychiatric Symptoms in Patients With Alzheimer's Disease: The Role of Caregiver Burden and Coping Strategies.

This study was conducted to obtain data regarding the association of caregiver burden (CB) and neuropsychiatric symptoms (NPSs) in patients with Alzheimer's disease. We conducted a series of multiple linear regressions to determine the relationship between CB and NPSs and whether the caregiver coping strategies mediated this relationship. The NPSs were assessed using the Neuropsychiatric Inventory, and caregivers were evaluated with the Caregiver Burden Interview and the Inventory and the Coping Strategies Inventory. Results show that patients with more frequent and severe NPS were more likely to be cared for by more burdened caregivers, and this was partially mediated by caregiver coping strategies. More disengagement (ß = .330,P< .001) and less engagement coping (ß = -.347,P< .001) were predictors for NPS after adjusting for patient and caregiver characteristics. These results may be useful with a view to designing treatment interventions that aim to modify the use of caregiver coping strategies and to reduce NPSs.

The experience of caregiving: the influence of coping strategies on behavioral and psychological symptoms in patients with Alzheimer's disease.

OBJECTIVES: To determine whether caregiver coping strategies are independently associated with behavioral and psychological symptoms (BPS) in Alzheimer's disease (AD) after accounting for patient characteristics. METHODS: Cross-sectional data analysis of 80 patients with AD and their primary caregivers. The presence of BPS was recorded using the Neuropsychiatric Inventory (NPI). The relationship between caregiver characteristics and BPS was assessed through one-way analysis of variance, two-tailed student t-tests or correlation coefficients. Multivariate linear regression was used to determine the combined effect of all caregiver factors that were significant on bivariate analysis regarding coping and BPS controlling for patient characteristics. RESULTS: Caregivers were on average 62 years old, 77% female, and most were the children or the spouse of the patient. Over 50% had significant depression or anxiety. Patients were on average 77 years old and 62% were female, and most had moderate to severe dementia. After adjusting for patient characteristics, patients cared for by more depressed, more burdened, or those using more disengagement coping strategies showed higher NPI mean composite scores. CONCLUSION: Coping strategies are associated with BPS regardeless of patient characteristics. Interventions to reduce BPS should focus on which psychological coping strategies caregivers use. Understanding how coping strategies influence BPS may help tailor specific interventions for caregivers.

Sensitivity and positive predictive value of magnetic resonance imaging in the diagnosis of elastofibroma dorsi: review of fourteen cases.

BACKGROUND: Elastofibroma dorsi (ED) is a benign soft tissue tumor that classically presents as an ill-defined mass at the inferior pole of the scapula. Several studies have indicated the benefits of using magnetic resonance imaging (MRI) to identify ED. In this study, we calculate the sensitivity and positive predictive value (PPV) of MRI in the diagnosis of ED using histopathology as the gold standard diagnostic method. Clinical characteristics of ED and radiologic features of MRI as well as treatment options are discussed. MATERIALS AND METHODS: A systematic retrospective review was performed of all ED patients treated in our center between 1999 and 2009. MRI and histopathology samples were performed in all cases. The MRI sensitivity and PPV in the diagnosis of ED were calculated. RESULTS: A total of 15 patients who were treated within the study period were reviewed; of these, were 14 (3 men, 11 women) true ED cases. MRI scan results matched the histopathology in 14 of 15 patients; 1 false-positive patient was observed, and no false-negative patients (negative MRI and positive histopathology) were noted. The PPV and sensitivity of MRI scan in the diagnosis of ED were 93.3% (95% confidence interval, 68.0%-100.0%) and 100% (95% confidence interval, 75.2%-100.0%) respectively. CONCLUSIONS: MRI is a useful tool for assessment of ED and can potentially help avoid the need for unnecessary biopsy and surgery, especially in the asymptomatic patient.

Anxiety and depression are associated with coping strategies in caregivers of Alzheimer's disease patients: results from the MÁLAGA-AD study.

BACKGROUND: Caregiving for people with Alzheimer's disease (AD) is highly stressful and has significant negative consequences, such as anxiety and depression. Previous research offers conflicting findings as to whether coping strategies are associated with greater psychological distress or not. We conducted this study with a view to obtaining new data regarding the association of coping strategies and psychological distress in AD caregivers. METHODS: Eighty people with AD and their primary caregivers living in the community were recruited from local health services. Purposive recruitment was carried out to ensure that the sample was representative of people living with dementia in terms of dementia severity, gender, and care setting. We used the State-Trait Anxiety Inventory to measure anxiety, the Beck Depression Inventory to measure depression, and the Coping Strategies Inventory to measure coping strategies. RESULTS: Most caregivers reported higher anxiety and depression levels. Use of disengagement coping strategies (Wald = 3.35, p = 0.01) and higher caregiver burden (Wald = 4.83, p = 0.02) predicted anxiety on logistic regression. In turn, use of disengagement coping strategies (Wald = 12.48, p = 0.001) and higher caregiver burden (Wald = 6.91, p = 0.009) predicted depression on logistic regression. CONCLUSION: These results may be useful for designing treatment interventions that aim to modify the use of coping strategies and thus reduces caregiver anxiety and depression.

Disengagement coping partially mediates the relationship between caregiver burden and anxiety and depression in caregivers of people with Alzheimer's disease. Results from the MÁLAGA-AD study.

BACKGROUND: Caring for people with Alzheimer's disease can be considered stressful and demand adjustment strategies. While various variables have been associated with caregiver anxiety and depression, a possible mediator role of coping strategies adopted by caregivers between caregiver burden and anxiety and depression is still unclear. We hypothesized that caregivers with clinically significant anxiety and depression were more likely to use disengagement coping strategies that non-anxious and non-depressed caregivers. METHODS: This study involved 80 Alzheimer disease patients and their primary caregivers. Patients were evaluated using the Mini Mental State Examination, the Bayer Activities of Daily Living Scale, the Global Deterioration Scale and the Neuropsychiatric Inventory. Caregivers were evaluated with the Caregiver Burden Interview, the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Coping Strategies Inventory. We conducted a series of multiple linear regressions to determine the relationship between caregiver burden and caregiver anxiety and depression, and if the coping strategies mediated this relationship. RESULTS: Using more disengagement (ß=0.270, p<0.001) and less engagement coping (ß=-0.310, p<0.001) were predictors for anxiety scores. Using more disengagement (ß=0.250, p<0.001) and less engagement coping (ß=-0.261, p<0.001) were predictors for depression scores. LIMITATIONS: This study was a cross-sectional design, so the direction of causality should be strengthened by a longitudinal study. CONCLUSIONS: Most caregivers reported higher anxiety and depression levels and this was partially mediated by their dysfunctional coping strategies.