Publications by authors named "Vivek B Kalra"
Purpose: An extensive literature has postulated multiple etiologies for aqueductal stenosis. No publications were found, discussing that evolutionary modifications might explain aqueductal anomalies. This study's objectives were to review the evolutionary modifications of vertebrates' tectum structures that might explain human aqueduct anomalies.
View Article and Find Full Text PDFUnlabelled: Meckel's cave is a dural recess in the posteromedial portion of the middle cranial fossa that acts as a conduit for the trigeminal nerve between the prepontine cistern and the cavernous sinus, and houses the Gasserian ganglion and proximal rootlets of the trigeminal nerve. It serves as a major pathway in perineural spread of pathologies such as head and neck neoplasms, automatically upstaging tumours, and is a key structure to assess in cases of trigeminal neuralgia. The purpose of this pictorial review is threefold: (1) to review the normal anatomy of Meckel's cave; (2) to describe imaging findings that identify disease involving Meckel's cave; (3) to present case examples of trigeminal and non-trigeminal processes affecting Meckel's cave.
View Article and Find Full Text PDFImportance: Magnetic resonance imaging (MRI) continues to be performed for cervical clearance of obtunded blunt trauma, despite poor evidence regarding its utility after a normal computed tomographic (CT) finding.
Objective: To evaluate the utility and cost-effectiveness of MRI vs no follow-up after a normal cervical CT finding in patients with obtunded blunt trauma.
Design, Setting And Participants: This cost-effectiveness analysis evaluated an average patient aged 40 years with blunt trauma from an institutional practice.
Cost-Effectiveness of Tomosynthesis in Annual Screening Mammography.
AJR Am J Roentgenol
November 2016
Objective: The purpose of this study was to evaluate the cost-effectiveness of the addition of annual screening tomosynthesis to 2D digital mammography alone for women beginning at 40 years old and to determine differences for age decade subgroups.
Materials And Methods: Decision-tree analysis comparing annual tomosynthesis versus 2D mammography alone from a federal payer perspective and lifetime horizon was created from published multiinstitutional data, published institutional data, literature values, and Medicare reimbursement rates. Cost-effectiveness was calculated through incremental cost-effectiveness ratios and net monetary benefit calculations.
Objectives: To quantify the rate of unstable injuries detected by MRI missed on CT in blunt cervical spine (CS) trauma patients and assess the utility of MRI in CS clearance.
Methods: We undertook a systematic review of worldwide evidence across five major medical databases and performed a meta-analysis. Studies were included if they reported the number of unstable injuries or gave enough details for inference.
Intracranial ectopic germinomas are often associated with synchronous midline disease. Germinomas involving the corpus callosum are exceedingly rare. The reported imaging appearance is not as varied as one might expect and a review of the literature reveals a few common imaging features amongst most ectopic lesions, including cyst formation.
View Article and Find Full Text PDFObjectives: Diagnostic workup of patients presenting with thunderclap headache and negative initial head CT remains a challenge, with most commonly employed strategies being lumbar puncture (LP) and CT angiography (CTA). The objective of this study was to determine the cost-effectiveness of these options.
Patients And Methods: A decision model was designed using clinical probabilities, costs, and utilities from published values in the literature.
Objectives: Accurate diagnosis of acute subarachnoid hemorrhage (SAH) is critical in thunderclap headache patients due to high morbidity and mortality associated with missed aneurysmal bleeds. The objective of this study was to determine the utility of computed tomography angiography (CTA) in managing patients with acute, severe headaches and negative noncontrast CT and assess the cost-effectiveness of three different screening strategies-no follow up, CTA, and lumbar puncture (LP).
Methods: A modeling-based economic evaluation was performed with a time horizon of 1 year for thunderclap headache patients in the emergency department with negative noncontrast CT for SAH.
Background: Timely and accurate screening for pediatric blunt cerebrovascular injury (BCVI) is important in order to administer appropriate anticoagulation therapy thus preventing stroke. The recommended criteria for screening in children are not clear. We performed a systematic review of the literature for screening and management of BCVI in children and designed a cost-effectiveness analysis in order to determine the optimal strategy for managing pediatric BCVI from a societal perspective.
View Article and Find Full Text PDFUnlabelled: Lumbar spine surgery for spinal stenosis is a frequently performed procedure and was the fastest growing type of surgery in the US from 1980 to 2000. With increasing surgical invasiveness, postoperative complications also tend to be higher. Cross-sectional imaging techniques (CT and MRI) are more sensitive than radiographs and play an increasingly important role in evaluation of patients with lumbar spine surgery.
View Article and Find Full Text PDFPurpose: To determine the most effective follow-up strategy for evaluation of patients with thunderclap headache and negative initial non-contrast CT for acute subarachnoid haemorrhage (SAH).
Materials And Methods: Institutional review was performed to assess the frequency of CT angiography (CTA) in screening patients with negative non-contrast CT. A comparative effectiveness analysis based on decision tree modelling was subsequently performed to assess three different strategies--no follow-up, lumbar puncture (LP) and CTA.
Study Design: Retrospective database analysis.
Objective: To determine C2 fracture patterns associated with vertebral artery injury (VAI) as assessed by computed tomography angiography.
Summary Of Background Data: The incidence of C2 fracture hospitalizations has increased significantly in the last decade.
Purpose: The objective of this study was to conduct a value analysis of digital breast tomosynthesis (DBT) for breast cancer screening among women enrolled in US commercial health insurance plans to assess the potential budget impact associated with the clinical benefits of DBT.
Methods: An economic model was developed to estimate the system-wide financial impact of DBT as a breast cancer screening modality within a hypothetical US managed care plan with one million members. Two scenarios were considered for women in the health plan who undergo annual screening mammography, ie, full field digital mammography (FFDM) and combined FFDM + DBT.
Background And Purpose: Multiple studies have shown that negative computed tomographic angiograms (CTAs) are reliable in excluding aneurysms in patients with isolated perimesencephalic subarachnoid hemorrhage (pSAH). We evaluate the use of digital subtraction angiography versus CTA for initial diagnosis and of angiographic follow-ups in patients with pSAH by performing an institutional analysis and a meta-analysis of literature.
Methods: Retrospective institutional analysis of patients with pSAH was performed from 2008 to 2014.
Background And Purpose: The purpose of this study is to perform a comprehensive cost-effectiveness analysis of all possible permutations of computed tomographic angiography (CTA) and digital subtraction angiography imaging strategies for both initial diagnosis and follow-up imaging in patients with perimesencephalic subarachnoid hemorrhage on noncontrast CT.
Methods: Each possible imaging strategy was evaluated in a decision tree created with TreeAge Pro Suite 2014, with parameters derived from a meta-analysis of 40 studies and literature values. Base case and sensitivity analyses were performed to assess the cost-effectiveness of each strategy.