Items in AFP with MESH term: Magnetic Resonance Imaging
ABSTRACT: Frontotemporal dementia (FTD) is one of the most common forms of dementia in persons younger than 65 years. Variants include behavioral variant FTD, semantic dementia, and progressive nonfluent aphasia. Behavioral and language manifestations are core features of FTD, and patients have relatively preserved memory, which differs from Alzheimer disease. Common behavioral features include loss of insight, social inappropriateness, and emotional blunting. Common language features are loss of comprehension and object knowledge (semantic dementia), and nonfluent and hesitant speech (progressive nonfluent aphasia). Neuroimaging (magnetic resonance imaging) usually demonstrates focal atrophy in addition to excluding other etiologies. A careful history and physical examination, and judicious use of magnetic resonance imaging, can help distinguish FTD from other common forms of dementia, including Alzheimer disease, dementia with Lewy bodies, and vascular dementia. Although no cure for FTD exists, symptom manage- ment with selective serotonin reuptake inhibitors, antipsychotics, and galantamine has been shown to be beneficial. Primary care physicians have a critical role in identifying patients with FTD and assembling an interdisciplinary team to care for patients with FTD, their families, and caregivers.
American Heart Association Issues Guidelines on Imaging in Transient Ischemic Attacks and Stroke - Special Medical Reports
Headache Consortium Releases Guidelines for Use of CT or MRI in Migraine Work-Up - Practice Guidelines
Acute Venous Thromboembolism: Diagnostic Guidelines - Editorials
ABSTRACT: Crohn’s disease is a chronic inflammatory condition affecting the gastrointestinal tract at any point from the mouth to the rectum. Patients may experience diarrhea, abdominal pain, fever, weight loss, abdominal masses, and anemia. Extraintestinal manifestations of Crohn’s disease include osteoporosis, inflammatory arthropathies, scleritis, nephrolithiasis, cholelithiasis, and erythema nodosum. Acute phase reactants, such as C-reactive protein level and erythrocyte sedimentation rate, are often increased with inflammation and may correlate with disease activity. Levels of vitamin B12, folate, albumin, prealbumin, and vitamin D can help assess nutritional status. Colonoscopy with ileoscopy, capsule endoscopy, computed tomography enterography, and small bowel follow-through are often used to diagnose Crohn’s disease. Ultrasonography, computed axial tomography, scintigraphy, and magnetic resonance imaging can assess for extraintestinal manifestations or complications (e.g., abscess, perforation). Mesalamine products are often used for the medical management of mild to moderate colonic Crohn’s disease. Antibiotics (e.g., metronidazole, fluoroquinolones) are often used for treatment. Patients with moderate to severe Crohn’s disease are treated with corticosteroids, azathioprine, 6-mercaptopurine, or anti–tumor necrosis factor agents (e.g., infliximab, adalimumab). Severe disease may require emergent hospitalization and a multidisciplinary approach with a family physician, gastroenterologist, and surgeon.
ABSTRACT: Although historical findings have some value in diagnosing internal derangement of the knee, a thorough physical examination can often rule out fracture and ligamentous and meniscal injuries. The Ottawa Knee Rule can help physicians determine which patients require radiography. Positive physical examination tests and findings of acute effusion suggest internal derangement. An abnormal McMurray or Thessaly test strongly suggests meniscal injury, whereas a normal Thessaly test may rule out meniscal injury. Absence of evidence of joint effusion significantly decreases the probability of internal derangement. Magnetic resonance imaging should be reserved for ruling out internal derangement in patients with suggestive historical and physical examination findings.
ABSTRACT: Risks of diagnostic imaging include cancer from radiation exposure and nephrogenic systemic fibrosis. The increase in volume of imaging between 1980 and 2006 has led to a sixfold increase in annual per capita radiation exposure. It is predicted that 2 percent of future cancers will be caused by radiation from computed tomography (CT) exposure. Gadolinium contrast media should be avoided in patients with stage 4 or 5 chronic kidney disease because of the risk of nephrogenic systemic fibrosis. Appropriate use of imaging based on guidelines for specific clinical conditions can reduce these risks. Although noncontrast CT of the head is needed to rule out bleeding in patients with suspected stroke within the first three hours of symptom onset, diffusion-weighted imaging with magnetic resonance of the head and neck is superior to CT within three to 24 hours of symptom onset. Headache merits neuroimaging in special circumstances only. Sestamibi radioisotope has less radiation than thallium for myocardial perfusion imaging. Use of intravenous contrast media with abdominopelvic CT significantly increases the diagnostic accuracy for appendicitis. Cholescintigraphy has better discrimination to diagnose acute cholecystitis than CT in patients with equivocal ultrasonography results. Limited three-view intravenous urography is recommended in pregnancy to evaluate urolithiasis if initial ultrasonography findings are negative or equivocal. Given that many asymptomatic adults have abnormal findings on lumbar spine magnetic resonance imaging, this modality generally should not be performed for nonspecific chronic low back pain in the absence of red flags. Whole body scanning is not supported by current evidence.
Breast Cancer Screening Update - Article
ABSTRACT: Breast cancer is the most common non–skin cancer and the second leading cause of cancer death in North American women. Mammography is the only screening test shown to reduce breast cancer–related mortality. There is general agreement that screening should be offered at least biennially to women 50 to 74 years of age. For women 40 to 49 years of age, the risks and benefits of screening should be discussed, and the decision to perform screening should take into consideration the individual patient risk, values, and comfort level of the patient and physician. Information is lacking about the effectiveness of screening in women 75 years and older. The decision to screen women in this age group should be individualized, keeping the patient’s life expectancy, functional status, and goals of care in mind. For women with an estimated lifetime breast cancer risk of more than 20 percent or who have a BRCA mutation, screening should begin at 25 years of age or at the age that is five to 10 years younger than the earliest age that breast cancer was diagnosed in the family. Screening with magnetic resonance imaging may be considered in high-risk women, but its impact on breast cancer mortality is uncertain. Clinical breast examination plus mammography seems to be no more effective than mammography alone at reducing breast cancer mortality. Teaching breast self-examination does not improve mortality and is not recommended; however, women should be aware of any changes in their breasts and report them promptly.