Comparison of whole-body DW-MRI with 2-[18F]FDG PET for staging and treatment monitoring of children with Langerhans cell histiocytosis.

PURPOSE: To assess and compare the diagnostic accuracy of whole-body (WB) DW-MRI with 2-[18F]FDG PET for staging and treatment monitoring of children with Langerhans cell histiocytosis (LCH). METHODS: Twenty-three children with LCH underwent 2-[18F]FDG PET and WB DW-MRI at baseline. Two nuclear medicine physicians and two radiologists independently assessed presence/absence of tumors in 8 anatomical areas. Sixteen children also performed 2-[18F]FDG PET and WB DW-MRI at follow-up. One radiologist and one nuclear medicine physician revised follow-up scans and collected changes in tumor apparent diffusion (ADC) and standardized uptake values (SUV) before and after therapy in all detectable lesions. 2-[18F]FDG PET results were considered the standard of reference for tumor detection and evaluation of treatment response according to Lugano criteria. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of WB DW-MRI at baseline were calculated, and the 95% confidence intervals were estimated by using the Clopper-Pearson (exact) method; changes in tumor SUVs and ADC were compared using a Mann-Whitney U test. Agreement between reviewers was assessed with a Cohen's weighted kappa coefficient. Analyses were conducted using SAS software version 9.4. RESULTS: Agreement between reviewers was perfect (kappa coefficient = 1) for all analyzed regions but spine and neck (kappa coefficient = 0.89 and 0.83, respectively) for 2-[18F]FDG PET images, and abdomen and pelvis (kappa coefficient = 0.65 and 0.88, respectively) for WB DW-MRI. Sensitivity and specificity were 95.5% and 100% for WB DW-MRI compared to 2-[18F]FDG PET. Pre to post-treatment changes in SUVratio and ADCmean were inversely correlated for all lesions (r: -0.27, p = 0·06) and significantly different between responders and non-responders to chemotherapy (p = 0.0006 and p = 0·003 for SUVratio and ADCmean, respectively). CONCLUSION: Our study showed that WB DW-MRI has similar accuracy to 2-[18F]FDG PET for staging and treatment monitoring of LCH in children. While 2-[18F]FDG PET remains an approved radiological examination for assessing metabolically active disease, WB DW-MRI could be considered as an alternative approach without radiation exposure. The combination of both modalities might have advantages over either approach alone.

Patient Satisfaction With Medical Care for Chronic Low Back Pain: A Pain Research Registry Study.

PURPOSE: The process and outcomes of delivering medical care for chronic low back pain might affect patient satisfaction. We aimed to determine the associations of process and outcomes with patient satisfaction. METHODS: We conducted a cross-sectional study of patient satisfaction among adult participants with chronic low back pain in a national pain research registry using self-reported measures of physician communication, physician empathy, current physician opioid prescribing for low back pain, and outcomes pertaining to pain intensity, physical function, and health-related quality of life. We used simple and multiple linear regression models to measure factors associated with patient satisfaction, including a subgroup of participants having both chronic low back pain and the same treating physician for >5 years. RESULTS: Among 1,352 participants, only physician empathy (standardized ß, 0.638; 95% CI, 0.588-0.688; t = 25.14; P < .001) and physician communication (standardized ß, 0.182; 95% CI, 0.133-0.232; t = 7.22; P < .001) were associated with patient satisfaction in the multivariable analysis that controlled for potential confounders. Similarly, in the subgroup of 355 participants, physician empathy (standardized ß, 0.633; 95% CI, 0.529-0.737; t = 11.95; P < .001) and physician communication (standardized ß, 0.208; 95% CI, 0.105-0.311; t = 3.96; P < .001) remained associated with patient satisfaction in the multivariable analysis. CONCLUSIONS: Process measures, notably physician empathy and physician communication, were strongly associated with patient satisfaction with medical care for chronic low back pain. Our findings support the view that patients with chronic pain highly value physicians who are empathic and who make efforts to more clearly communicate treatment plans and expectations.

Application of Structural Retinal Biomarkers to Detect Cognitive Impairment in a Primary Care Setting.

Background: Despite the diagnostic accuracy of advanced neurodiagnostic procedures, the detection of Alzheimer's disease (AD) remains poor in primary care. There is an urgent need for screening tools to aid in the detection of early AD. Objective: This study examines the predictive ability of structural retinal biomarkers in detecting cognitive impairment in a primary care setting. Methods: Participants were recruited from Alzheimer's Disease in Primary Care (ADPC) study. As part of the ADPC Retinal Biomarker Study (ADPC RBS), visual acuity, an ocular history questionnaire, eye pressure, optical coherence tomography (OCT) imaging, and fundus imaging was performed. Results: Data were examined on n = 91 participants. The top biomarkers for predicting cognitive impairment included the inferior quadrant of the outer retinal layers, all four quadrants of the peripapillary retinal nerve fiber layer, and the inferior quadrant of the macular retinal nerve fiber layer. Conclusion: The current data provides strong support for continued investigation into structural retinal biomarkers, particularly the retinal nerve fiber layer, as screening tools for AD.