Asymmetric sensorineural hearing loss caused by vestibular schwannoma: Characteristic imaging features before and after treatment with stereotactic radiosurgery.

We report the case of a 71-year-old man who presented with a 2-year history of progressive left-sided hearing loss caused by a cerebellopontine angle mass lesion with classic imaging characteristics of a vestibular schwannoma. Vestibular schwannomas are typically diagnosed on dedicated MRI of the internal auditory canals obtained for asymmetric sensorineural hearing loss, as in this case. We review the characteristic imaging features of vestibular schwannomas that enable their differentiation from other mass lesions of the cerebellopontine angle cistern, allowing for treatment with stereotactic radiosurgery in this case.

Musculoskeletal biopsies using computed tomography fluoroscopy.

OBJECTIVE: To determine the diagnostic yield, accuracy, and safety of computed tomography (CT) fluoroscopy guidance for musculoskeletal biopsies. MATERIALS AND METHODS: A retrospective analysis of musculoskeletal biopsies performed with CT fluoroscopy guidance over a 2-year period was made. Data collected were biopsy sites, CT fluoroscopic times, and biopsy results. Results were categorized as the following: positive, negative (but diagnostic), or nondiagnostic. Reference standard consisted of 5 years of follow-up to verify results. RESULTS: Ninety-five CT fluoroscopy-guided musculoskeletal biopsies were performed. Bone biopsies comprised 83% (79/95), and soft tissue biopsies comprised 17% (16/95). The mean age was 54 years (range, 16-90 years); 40.0% (38/95) were male subjects, and 60.0% (57/95) were female subjects. For all subjects, CT fluoroscopic times ranged from 2 to 310 seconds, with a mean time of 63 seconds and a median time of 34 seconds. The diagnostic yield was 96% (91/95), with a nondiagnostic result in 4% (4/95) of subjects. Diagnostic biopsy specimens showed a positive result in 63% (60/95) of subjects and a negative but diagnostic result in 33% (31/95) of subjects. There were no major complications. CONCLUSIONS: Computed tomography fluoroscopic-guided musculoskeletal biopsies show a high diagnostic yield and are accurate and safe. The biopsy results are similar or superior to other published reports using conventional CT guidance with only a small overall fraction being nondiagnostic. The benefits of real-time imaging are at the cost of operator exposure to ionizing radiation and the risk of potentially high exposures to both patient and operator. The impact on indications for which lesions are most amenable to percutaneous biopsy using CT fluoroscopy and procedure time has yet to be determined.

Assessing medical informatics confidence among 1st and 2nd year medical students.

Currently no medical informatics curriculum is required at US medical schools. In 1998 the Association of American Medical Colleges (AAMC) Medical School Objectives Project (MSOP) identified topics for inclusion in medical school curriculum, categorized in five domains: Life-Long Learner, Clinician, Educator/Communicator, Researcher, and Manager. Here we present the results of a web-based survey of 1st and 2nd year medical students at Case Western Reserve University (Case). The survey determined the perceived skills of 1st and 2nd year students in the five domains of medical informatics as defined by the AAMC.