Sinus CT Scan Findings in 'Sinus Headache' Migraineurs.
Prospective Studies; Tomography; Human; Evaluation Research; Severity of Illness Indices; X-Ray Computed – Methods; Migraine – Complications; Migraine – Radiotherapy; Paranasal Sinus Diseases – Complications; Paranasal Sinus Diseases – Radiography; Paranasal Sinuses – Abnormalities; Paranasal Sinuses – Radiography
Objective.- To evaluate the sinus CT scan findings in 'sinus headache' migraineurs, and to compare the findings to nonmigraine 'sinus headache' patients. Background.- The majority of patients presenting with 'sinus headache' satisfy the International Headache Society (IHS) criteria for migraine headache. Few studies have correlated the rhinologic complaints and computed tomography (CT) findings in these patients. Methods.- Thirty-five patients with 'sinus headache' were evaluated prospectively and referred for CT of the paranasal sinuses. The CT scans were assessed for sinus abnormality (recorded as a Lund-Mackay [L-M] score) and were analyzed for concha bullosa and septal deviation. The findings in the migraine cohort were compared with the nonmigraine 'sinus headache' patients. Findings.- Twenty-six patients (74.3%) satisfied the IHS criteria for migraine. The mean CT scan L-M score did not differ significantly between the migraine (2.07) and nonmigraine cohort (2.66). Five of the migraine group had substantial sinus disease radiographically (with L-M scores of 5 or above). Concha bullosa of at least 1 middle turbinate was more common in the nonmigraine cohort. An analysis of the sidedness of the headaches, sinus disease, concha bullosa, and/or septal deviation is presented. Conclusions.- The majority of 'sinus headache' patients satisfy the IHS criteria for migraine. Surprisingly, these patients often have radiographic sinus disease. This raises the possibility of selection bias in otolaryngology patients, inaccurate diagnosis, or radiographic sinus disease and migraine as comorbid conditions. Positive migraine histories apparently do not obviate the need for a thorough ENT workup, possibly including CT scanning.
Mehle ME; Kremer PS
Headache: The Journal of Head & Face Pain
2008
2008-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1526-4610.2007.00811.x" target="_blank" rel="noreferrer noopener">10.1111/j.1526-4610.2007.00811.x</a>
Ten-year outcomes: the clinical utility of single photon emission computed tomography/computed tomography capromab pendetide (Prostascint) in a cohort diagnosed with localized prostate cancer.
Male; Aged; Multivariate Analysis; Prognosis; Tomography; Antibodies; Human; Regression; Emission-Computed; Kaplan-Meier Estimator; X-Ray Computed – Methods; Prostate-Specific Antigen – Blood; Prostatic Neoplasms – Pathology; Brachytherapy – Methods; Monoclonal – Diagnostic Use; Prostate – Radiography; Prostatic Neoplasms – Blood; Prostatic Neoplasms – Radiography; Radioisotopes – Diagnostic Use; Single-Photon – Methods
Purpose: To evaluate the clinical utility of capromab pendetide imaging with single photon emission computed tomography coregistration with computed tomography (SPECT/CT) in primary prostate cancer (CaP) for pretreatment prognostic staging and localization of biologic target volumes (BTV) for individualized image-guided radiotherapy dose escalation (IGRT-DE). Methods and Materials: Patients consecutively presenting for primary radiotherapy (February 1997 to December 2002), having a clinical diagnosis of localized CaP, were evaluated for tumor stage using conventional staging and SPECT/CT (N=239). Distant metastatic uptake (mets) were identified by SPECT/CT in 22 (9.2%). None of the suspected mets could be clinically confirmed. Thus, all subjects were followed without alteration in disease management. The SPECT/CT pelvic images defined BTV for IGRT-DE (+150% brachytherapy dose) without (n=150) or with (n=89) external radiation of 45 Gy. The National Comprehensive Cancer Network criteria defined risk groups (RG). The median survivor follow-up was 7 years. Biochemical disease-free survival (bDFS) was reported by clinical nadir +2 ng/mL (CN+2) criteria. Statistical analyses included Kaplan-Meier, multivariate analysis, and Concordance-index models. Results: At 10-year analyses, overall survival was 84.8% and bDFS was 84.6%. With stratification by RG, CN+2 bDFS was 93.5% for the low-RG (n=116), 78.7% for the intermediate-RG (n=94), and 68.8% for the high-RG (n=29), p=0.0002. With stratification by pretreatment SPECT/CT findings, bDFS was 65.5% in patients with suspected mets (n=22) vs. 86.6% in patients with only localized uptake (n=217), p=0.0014. CaP disease-specific survival (DSS) was 97.7% for the cohort. With stratification by SPECT/CT findings, DSS was 86.4% (with suspected mets) vs. 99.0% (localized only), p=0.0001. Using multivariate analysis, the DSS hazard ratio for SPECT/CT findings (mets vs. localized) was 3.58 (p=0.0026). Concordance-index tests, based on all data, by CN+2 bDFS criteria were 0.710 for RG alone and 0.773 for SPECT/CT + RG. Conclusions: Through long-term outcomes we demonstrate statistically significant bDFS and DSS predictive value for pretreatment capromab pendetide SPECT/CT imaging in primary CaP. Dual clinical utility is demonstrated, using SPECT/CT to define BTV for individualized IGRT-DE.
Ellis RJ; Kaminsky DA; Zhou EH; Fu P; Chen WD; Brelin A; Faulhaber PF; Bodner D; Ellis Rodney J; Kaminsky Deborah A; Zhou Esther H; Fu Pingfu; Chen Wei-Dong; Brelin Alaina; Faulhaber Peter F; Bodner Donald
International Journal of Radiation Oncology, Biology, Physics
2011
2011-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ijrobp.2010.05.053" target="_blank" rel="noreferrer noopener">10.1016/j.ijrobp.2010.05.053</a>
Incidental findings in the cervical spine at CT for trauma evaluation.
Adult; Female; Humans; Male; Middle Aged; Adolescent; Aged; Retrospective Studies; Registries; Incidental Findings; Injury Severity Score; Length of Stay/statistics & numerical data; Data Collection; Tomography; Human; Middle Age; Adolescence; Retrospective Design; Diagnosis; Cervical Vertebrae/*diagnostic imaging/*injuries; Spinal Injuries/*diagnostic imaging; 80 and over; X-Ray Computed/*methods; Nonparametric; Statistics; Nonparametric Statistics; Trauma Severity Indices; 80 and Over; Length of Stay – Statistics and Numerical Data; X-Ray Computed – Methods; Cervical Vertebrae – Injuries; Cervical Vertebrae – Radiography; Spinal Injuries – Radiography
OBJECTIVE: CT is the standard of care for assessment of traumatic injuries. Because of the detail depicted with this technique, findings incidental to the injury are easily detected. We sought to determine the frequency and types of incidental findings in the cervical spines of trauma patients undergoing CT. MATERIALS AND METHODS: The trauma registry was accessed to identify the cases of patients evaluated with cervical spine CT at a level 1 trauma center from January to July 2007. Trauma registry data, including age, sex, injury severity score, mechanism of injury, length of stay, and diagnosis were recorded, and all CT scans of the cervical spine were reviewed for incidental findings. Clinically significant incidental findings were classified according to bodily location, and the association between various patient characteristics and the likelihood of an incidental finding was assessed. RESULTS: We identified incidental CT findings in 230 of 1,256 patients (18.3%) who underwent CT of the cervical spine during an initial trauma evaluation. We stratified the incidental findings as trauma-related and not trauma-related. The likelihood of non-trauma-related incidental findings was associated with age (p \textless 0.0001). The likelihood of trauma-related incidental findings was associated with injury severity score (p \textless 0.0001). CONCLUSION: Incidental findings in the cervical spine were associated with age, injury severity score, and mechanism of injury. Awareness of the prevalence of incidental findings is important to assuring that both traumatic and nontraumatic pathologic findings are detected and appropriately managed.
Barboza Richard; Fox Jason H; Shaffer Lynn E T; Opalek Judy M; Farooki Shella
AJR. American journal of roentgenology
2009
2009-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2214/AJR.08.1420" target="_blank" rel="noreferrer noopener">10.2214/AJR.08.1420</a>
Anatomical Look Into OnabotulinumtoxinA Injection for Chronic Migraine Headache.
80 and over; 80 and Over; Adolescence; Adolescent; Adult; Aged; Anatomic Landmarks/anatomy & histology/*diagnostic imaging; Body Regions; Body Regions – Anatomy and Histology; Botulinum Toxins; Botulinum Toxins – Administration and Dosage; Chronic Disease; Female; Human; Humans; Male; Middle Age; Middle Aged; Migraine; Migraine – Drug Therapy; Migraine Disorders/*diagnostic imaging/*drug therapy; Neck Muscles; Neck Muscles – Anatomy and Histology; Neck Muscles – Drug Effects; Neck Muscles/anatomy & histology/*diagnostic imaging/drug effects; Pilot Projects; Pilot Studies; Random Allocation; Random Assignment; Tomography; Type A/*administration & dosage; X-Ray Computed – Methods; X-Ray Computed/methods; Young Adult
BACKGROUND AND OBJECTIVES: While existing studies about onabotulinumtoxinA for chronic migraines have focused on injection location and appropriate dosing, little consideration has been given to patient body habitus and its potential impact on efficacy. We hypothesized that with increasing patient body mass index (BMI) there would be more subcutaneous fat separating targeted muscle groups from the skin surface, such that standard 0.5-inch needles used in existing protocols may not allow intramuscular injection. This may have implications for treatment planning. METHODS: Anatomically normal computed tomography scans of the head, neck, and face were randomly selected. Subjects were stratified into 4 groups based on BMI, with 30 patients in each group. Four standardized locations were chosen to obtain measurements from the skin surface to the underlying muscle fascia, including (1) frontalis, (2) temporalis, (3) semispinalis capitis, and (4) trapezius. RESULTS: Median depth for the temporalis was 12.65 mm (Q1 = 9.32 mm, Q3 = 15.08 mm) for the BMI greater than 35 kg/m group. Median depth for the semispinalis capitis was 13.77 mm (Q1 = 10.3 mm, Q3 = 15.7 mm) for the BMI 30 to 35 kg/m group, and 14.75 mm (Q1 = 11.00, Q3 = 17.00 mm) for the BMI greater than 35 kg/m group. Median depth for the trapezius was 13.95 mm (Q1 = 10.18 mm, Q3 = 19.00 mm) for the BMI greater than 35 kg/m group. These medians exceeded the length of the standard 0.5-inch (12.-mm) needle used in existing protocols. CONCLUSIONS: Our study demonstrates that with increasing BMI there is a greater distance between the skin surface and the muscle fascia of muscles that are targeted for injection in standard chronic migraine botulinum toxin injection protocols. Because of this, patient body habitus may be an important factor in injection technique.
Wu-Fienberg Yuewei; Ansari Hossein; Zardouz Shawn; Narouze Samer; Blaha Taryn; Swanson Marco; Totonchi Ali
Regional anesthesia and pain medicine
2018
2018-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/AAP.0000000000000818" target="_blank" rel="noreferrer noopener">10.1097/AAP.0000000000000818</a>
Noncontrast abdomen/pelvis computed tomographic scan in the evaluation of older adults.
*Contrast Media; *Tomography; Abdomen; Abdomen/*diagnostic imaging; Abdominal Pain – Etiology; Abdominal Pain/*etiology; Aged; Contrast Media; Humans; Pelvis; Pelvis/*diagnostic imaging; Retrospective Design; Retrospective Studies; Tomography; X-Ray Computed – Methods; X-Ray Computed/methods
McQuown Colleen M; Frey Jennifer A; Wilber Scott T
The American journal of emergency medicine
2016
2016-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajem.2016.08.011" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2016.08.011</a>