Positive predictive value of CT urography in the evaluation of upper tract urothelial cancer.

Objective: The purpose of this study was to determine the positive predictive value of CT urography in the diagnosis of upper tract urothelial malignancies.

Materials And Methods: Retrospective review of the records of patients who underwent 2,602 CT urographic examinations revealed that 81 (3%) examinations of 77 patients had findings suggesting upper tract urothelial cancer. Two radiologists in consensus categorized the findings as large masses (> 5 mm), small masses (≤ 5 mm), or urothelial thickening.

Bisphosphonate use in conditions other than osteoporosis.

Bisphosphonates are the gold standard of treatment of postmenopausal osteoporosis, male osteoporosis, and steroid-induced osteoporosis. They have potential use in multiple musculoskeletal conditions other than osteoporosis and have also been shown to treat Paget's disease of the bone and osteogenesis imperfecta. Bisphophonates may have potential use in periprosthetic bone loss, osteonecrosis of the hip, fibrous dysplasia, and calcinosis in juvenile dermatomyositis.

Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee.

As multidetector CT has come to play a more central role in medical care and as CT image quality has improved, there has been an increase in the frequency of detecting "incidental findings," defined as findings that are unrelated to the clinical indication for the imaging examination performed. These "incidentalomas," as they are also called, often confound physicians and patients with how to manage them. Although it is known that most incidental findings are likely benign and often have little or no clinical significance, the inclination to evaluate them is often driven by physician and patient unwillingness to accept uncertainty, even given the rare possibility of an important diagnosis.

Multimodality non-rigid image registration for planning, targeting and monitoring during CT-guided percutaneous liver tumor cryoablation.

Rationale And Objectives: The aim of this study was to develop non-rigid image registration between preprocedure contrast-enhanced magnetic resonance (MR) images and intraprocedure unenhanced computed tomographic (CT) images, to enhance tumor visualization and localization during CT imaging-guided liver tumor cryoablation procedures.

Materials And Methods: A non-rigid registration technique was evaluated with different preprocessing steps and algorithm parameters and compared to a standard rigid registration approach. The Dice similarity coefficient, target registration error, 95th-percentile Hausdorff distance, and total registration time (minutes) were compared using a two-sided Student's t test.

The utility and limitations of FRAX: A US perspective.

The FRAX calculator is a major achievement in terms of our understanding of measuring fracture risk. Along with being an easily accessible web-based tool, it is the only model based on extensive data on multiple cohorts. FRAX will help clinicians identify individuals who need osteoporosis treatments, while also screening out those who do not require osteoporosis treatments.

Osteoporosis therapies: evidence from health-care databases and observational population studies.

Osteoporosis is a well-recognized disease with severe consequences if left untreated. Randomized controlled trials are the most rigorous method for determining the efficacy and safety of therapies. Nevertheless, randomized controlled trials underrepresent the real-world patient population and are costly in both time and money.

Clinical risk factors for fracture among postmenopausal patients at risk for fracture: a historical cohort study using electronic medical record data.

Osteoporosis represents a growing health burden, but recognition and screening rates are low. Electronic reminders for osteoporosis have been beneficial but are not based on clinical risk factors. Available risk screening tools may contain useful constructs for creating risk-based electronic medical record (EMR) reminders.

Impact of prevalent fractures on quality of life: baseline results from the global longitudinal study of osteoporosis in women.

Objective: To examine several dimensions of health-related quality of life (HRQL) in postmenopausal women who report previous fractures, and to provide perspective by comparing these findings with those in other chronic conditions (diabetes, arthritis, lung disease).

Patients And Methods: Fractures are a major cause of morbidity among older women. Few studies have examined HRQL in women who have had prior fractures and the effect of prior fracture location on HRQL.

Pregabalin: an alpha2-delta (alpha2-delta) ligand for the management of fibromyalgia.

Objective: To review the efficacy and safety of pregabalin, an alpha(2)-delta (alpha(2)-delta) ligand, for the management of fibromyalgia (FM).

Methods: Review of 2 pivotal phase 3 trials that evaluated the efficacy and safety of pregabalin for the management of FM.

Results: FM is a chronic condition that is characterized by widespread musculoskeletal pain and has a greater prevalence in women than in men.

New selective estrogen receptor modulators (SERMs) in development.

Selective estrogen receptor modulators (SERMs) or estrogen agonists/antagonists have shown promise in osteoporosis in that they have the potential to reduce the risk of fracture, and also reduce the risk of breast cancer. SERMs maybe classified according to their core structure, which is typically a variation of the 17 beta-estradiol template and subclassified according to the side chain at the helix 12 affector region. The best known are the triphenylethylenes such as tamoxifen, used in the management of breast cancer.

Abdominal masses sampled at PET/CT-guided percutaneous biopsy: initial experience with registration of prior PET/CT images.

Purpose: To establish the feasibility of performing combined positron emission tomography (PET)/computed tomography (CT)-guided biopsy of abdominal masses by using previously acquired PET/CT images registered with intraprocedural CT images.

Materials And Methods: In this HIPAA-compliant institutional review board-approved study, 14 patients underwent clinically indicated percutaneous biopsy of abdominal masses (mean size, 3.3 cm; range, 1.

The application of cytogenetics and fluorescence in situ hybridization to fine-needle aspiration in the diagnosis and subclassification of renal neoplasms.

Background: Percutaneous fine-needle aspiration (FNA) cytology is an important diagnostic test for the evaluation and management of selected renal masses. Cytogenetic analysis of cytology specimens can serve as an adjunct for precise classification because certain tumors are associated with specific chromosomal aberrations. This study summarizes our experience with the application of conventional cytogenetics and fluorescence in situ hybridization (FISH) to renal FNA specimens.

Image registration of pre-procedural MRI and intra-procedural CT images to aid CT-guided percutaneous cryoablation of renal tumors.

Purpose: To determine whether a non-rigid registration (NRR) technique was more accurate than a rigid registration (RR) technique when fusing pre-procedural contrast-enhanced MR images to unenhanced CT images during CT-guided percutaneous cryoablation of renal tumors.

Methods: Both RR and NRR were applied retrospectively to 11 CT-guided percutaneous cryoablation procedures performed to treat renal tumors (mean diameter; 23 mm). Pre-procedural contrast-enhanced MR images of the upper abdomen were registered to unenhanced intra-procedural CT images obtained just prior to the ablation.

Identifying fibromyalgia-associated symptoms and conditions from a clinical perspective: a step toward evaluating healthcare resource utilization in fibromyalgia.

Objective: The study aims to determine from the physician's perspective, the conditions and symptoms most relevant to the diagnosis of fibromyalgia (FM) for identifying International Classification of Diseases-diagnosis codes and prescription medications to evaluate FM-related healthcare resource utilization.

Methods: A questionnaire was administered using an online physician network (SERMO™) from which responses of 102 physicians were evaluated: anesthesiologists (n = 6), neurologists (n = 18), primary care physicians (n = 16), pain specialists (n = 16), psychiatrists (n = 15), and rheumatologists (n = 31). Physicians scored the relative importance to a diagnosis of FM (0 = least relevant/important, 10 = most relevant/important) of 24 conditions and symptoms derived from a list provided by the National Data Bank for Rheumatic Diseases.

Compliance and persistence with osteoporosis medications: a critical review of the literature.

It is widely acknowledged that compliance and persistence with oral osteoporosis medications, particularly with bisphosphonates, is poor. Several excellent reviews have been written on compliance and persistence with osteoporosis medications and have discussed improvements seen with extended dosing intervals. This review begins with studies on extended dosing intervals to examine the limitations of administrative claims data.

Anabolic therapies.

The striking clinical benefits of intermittent parathyroid hormone in osteoporosis have begun a new era of skeletal anabolic agents. Recombinant human parathyroid hormone (rhPTH) (1-34) is the first US Food and Drug Administration-approved anabolic therapy. Its use has been limited by the need for subcutaneous injection.

Toward characterization and definition of fibromyalgia severity.

Background: There are no standard criteria for defining or assessing severity of fibromyalgia (FM) as a condition as fibromyalgia is associated with multiple symptom domains. The objective of this study was to evaluate whether patient self-reported severity of FM is associated with severity of pain and sleep interference and the presence of core co-morbidities.

Methods: We recruited individuals >or= 18 years of age with a clinician-confirmed diagnosis of FM >or= 3 months and a current pain rating >2 on a 0-10 numeric rating scale (NRS).

The utility of changes in serum levels of C-terminal telopeptide of type I collagen in predicting patient response to oral monthly ibandronate therapy.

Bone turnover markers may provide a more rapid indication of patient response to osteoporosis treatment than bone mineral density (BMD) measurements. This post hoc analysis of data from the MOBILE (Monthly Oral iBandronate In LadiEs) study assessed the relationship between increases in BMD at 12 mo from baseline after starting ibandronate treatment and changes in bone resorption marker serum C-terminal telopeptide of type I collagen (sCTX) from baseline at 3 and 6 mo. MOBILE enrolled postmenopausal women aged 55-80 yr with mean lumbar spine (LS) BMD T-score of -2.

PET/CT pattern analysis for surgical staple line recurrence in patients with colorectal cancer.

Objective: The purpose of our study was to determine whether (18)F-FDG PET/CT interpretation with metabolic-anatomic pattern analysis can be used to accurately assess for surgical staple line recurrence after colorectal cancer resection.

Materials And Methods: Seventy-nine consecutive patients with previous surgical resection of colorectal cancer were studied retrospectively. The surgical anastomotic or Hartmann's pouch staple lines were evaluated for presence or absence of tumor recurrence with FDG PET/CT metabolic-anatomic pattern analysis.

Usefulness of percutaneous biopsy in diagnosing benign renal masses that mimic malignancy.

Percutaneous biopsy has long been used to diagnose malignancies of the kidney. It is an established technique with multiple indications. Percutaneous biopsy now can be used to diagnose benign conditions that may mimic a malignancy and lead to unnecessary treatments.

Percutaneous cryoablation techniques and clinical applications.

Once requiring surgery, cryoablation now can be performed percutaneously under image guidance, thanks to the development of small probes. Sonography was used to guide cryoablation performed surgically; now, computed tomography and magnetic resonance images are typically used to guide percutaneous cryoablation. Intraprocedural monitoring helps those performing the procedure to treat the tumor completely, while avoiding complications.

Bone loss or lost bone: rationale and recommendations for the diagnosis and treatment of early postmenopausal bone loss.

Recent reports suggest that bone loss begins during late perimenopause at a dramatic rate, even before estrogen levels plummet. During the ensuing 5 years, there is evidence of the beginnings of microarchitectural deterioration, which impacts bone strength and ultimately enhances its propensity to fracture. The diagnosis of osteoporosis based on T-scores alone, or through stratification for a high fracture risk by FRAX, excludes these women who are rapidly losing bone.

Burden of fibromyalgia and comparisons with osteoarthritis in the workforce.

Objectives: To calculate the fibromyalgia (FM) burden of illness (BOI) from the employer perspective and to compare annual prevalence, work output, absence, and health benefit costs of employees with FM versus osteoarthritis (OA).

Methods: Retrospective regression model analysis comparing objective work output, total health benefit (health care, prescription drug, sick leave, disability, workers' compensation) costs, and absence days for FM, versus OA and NoFM cohorts, while controlling for differences in patient characteristics.

Results: FM prevalence was 0.