Carpal tunnel syndrome assessment with diffusion tensor imaging: Value of fractional anisotropy and apparent diffusion coefficient.

OBJECTIVES: To quantitatively assess carpal tunnel syndrome (CTS) with DTI by evaluating two approaches to determine cut-off values. METHODS: In forty patients with CTS diagnosis confirmed by nerve conduction studies (NCs) and 14 healthy subjects (mean age 58.54 and 57.8 years), cross-sectional area (CSA), apparent diffusion coefficient (ADC) and fractional anisotropy (FA) at single and multiple levels with intraobserver agreement were evaluated. RESULTS: Maximum and mean CSA and FA showed significant differences between healthy subjects and patients (12.85 mm2 vs. 28.18 mm2, p < 0.001, and 0.613 vs. 0.524, p=0.007, respectively) (10.12 mm2 vs. 19.9 mm2, p<0.001 and 0.617 vs. 0.54, p=0.003, respectively), but not maximum and mean ADC (p > 0.05). For cut-off values, mean and maximum CSA showed the same sensitivity and specificity (93.3 %). However, mean FA showed better sensitivity than maximum FA (82.6 % vs. 73.9 %), but lower specificity (66.7 % vs. 80 %), and significant correlation for maximum CSA, 97 % (p < 0.01), with good correlation for maximum ADC and FA, 84.5 % (p < 0.01) and 62 % (p=0.056), respectively. CONCLUSIONS: CSA and FA showed significant differences between healthy subjects and patients. Single measurement at maximum CSA is suitable for FA determination. Key Points • DTI showed that FA is stronger than ADC for CTS diagnosis. • Single- and multiple-level approaches were compared to determine FA and ADC. • Single-level evaluation at the thickest MN cross-sectional area is sufficient.

Operative management of ectopic pregnancy: a cost analysis.

OBJECTIVES: The purpose of this study was to analyze the cost for hospital-based services related to the operative management of ectopic pregnancies and determine the most cost-conscious approach by distinguishing the constituent components. STUDY DESIGN: This is a retrospective comparative review of every ectopic pregnancy that was surgically managed at the Memorial Medical Center of Long Beach. Unit cost estimates that are based on a cost accounting system were derived and compared between different procedures according to resources used among separate services. RESULTS: Hemodynamic instability significantly increases the cost of management by increasing the length of stay and laboratory costs. Among stable patients laparoscopic excision of ectopic pregnancies saves nearly 25% per case (p < 0.001) compared with laparotomy. However, when we compared all intended laparoscopic excisions (i.e., including the 21% of cases in which laparotomy was eventually done), the savings were markedly reduced. In addition, the cost savings was lost if patients undergoing laparotomy were discharged on or before postoperative day 2. Discharging patients after laparotomy on postoperative day 1 is the least costly management for operative treatment of ectopic pregnancy. CONCLUSIONS: Whereas laparoscopy may decrease recuperation time and incisional scarring, operative cost is not a significant reason to choose laparoscopy over laparotomy in a hemodynamically stable patient, especially as postoperative stays decrease.