Subject(s)
Nuclear Warfare/history , Nuclear Warfare/prevention & control , Nuclear Weapons/history , Nuclear Weapons/statistics & numerical data , Decision Making , Global Health/history , History, 20th Century , History, 21st Century , Humans , International Cooperation/history , Public Opinion , SwitzerlandABSTRACT
PURPOSE: To compare the magnetic resonance (MR) imaging findings in patients with acute whiplash injury with those in matched control subjects. MATERIALS AND METHODS: In a prospective multicenter controlled study, from 2005 to 2008, 100 consecutive patients underwent 1.5-T MR imaging examinations of the cervical spine within 48 hours after a motor vehicle accident. Findings in these patients were compared in a blinded fashion with those in 100 age- and sex-matched healthy control subjects. Four blinded independent readers assessed the presence of occult vertebral body and facet fractures, vertebral body and facet contusions, intervertebral disk herniations, ligamentum nuchae strains, ligamentum nuchae tears, muscle strains or tears, and perimuscular fluid. Accuracy (as compared with clinical findings) and interobserver reliability were calculated. RESULTS: Accuracy of MR imaging and interreader reliability were generally poor (sensitivity, 0.328; specificity, 0.728; positive and negative likelihood ratios, 1.283 and 1.084, respectively). MR imaging findings significantly associated with whiplash injuries were occult fracture (P<.01), bone marrow contusion of the vertebral body (P=.01), muscle strain (P<.01) or tear (P<.01), and the presence of perimuscular fluid (P<.01). While 10 findings thought to be specific for whiplash trauma were significantly (P<.01) more frequent in patients (507 observations), they were also regularly found in healthy control subjects (237 observations). There were no serious occult injuries that required immediate therapy. CONCLUSION: MR imaging at 1.5 T reveals only limited evidence of specific changes to the cervical spine and the surrounding tissues in patients with acute symptomatic whiplash injury compared with healthy control subjects.
Subject(s)
Cervical Vertebrae/injuries , Cervical Vertebrae/pathology , Magnetic Resonance Imaging/methods , Whiplash Injuries/pathology , Accidents, Traffic , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Observer Variation , Reproducibility of Results , Sensitivity and Specificity , Single-Blind Method , Young AdultABSTRACT
PURPOSE: To prospectively assess and compare two formulations and methods of administration of low-dose nasal midazolam for the treatment of claustrophobic patients undergoing magnetic resonance imaging (MRI) as part of a multicenter Phase III trial. MATERIALS AND METHODS: In all, 108 consecutive adult claustrophobic patients were randomly assigned to one of two treatment groups (multidose group: MDG, unit-dose group: UDG). MDG encompassed 55 patients who received intranasally a 0.5% midazolam formulation into each nostril (total dose, 1.0 mg), whereas the 53 patients in UDG received a 1% midazolam formulation into only one nostril (total dose, 1.0 mg). This initial dose could be repeated once. Patient tolerance and anxiety were assessed using a questionnaire and a visual analog scale immediately before and after MRI. Image quality was evaluated using a five-point scale. RESULTS: In all, 53/55 MR examinations (96%) with MDG and 52/53 (98%) with UDG were completed successfully. The dose of 1 mg had to be repeated significantly less often in UDG compared to MDG (4/53, 8% vs. 13/55, 24%; P = 0.003). The image quality of all MR examinations was rated good to excellent, and slightly better in UDG (P = 0.045). CONCLUSION: Nasally applied low-dose midazolam is a patient-friendly solution to facilitate MRI of claustrophobic patients. The nasal spray of UDG is superior to that of MDG with a necessity of additional dosing.
Subject(s)
Hypnotics and Sedatives/administration & dosage , Magnetic Resonance Imaging/psychology , Midazolam/administration & dosage , Phobic Disorders/drug therapy , Administration, Intranasal , Chi-Square Distribution , Feasibility Studies , Female , Humans , Male , Middle Aged , Prospective Studies , Statistics, Nonparametric , Surveys and Questionnaires , Treatment OutcomeABSTRACT
This paper describes the personal experience of the author with Shoulder Arthro MR. This imaging method is put into perspective with other, more widely used diagnostic methods, which also have their advantages. Indications for Shoulder Arthro MR are discussed and details on the technique and interpretaton are given. Also major shoulder pathology as impingement, rotator cuff tears and instability is discussed. Furthermore a review of the spectrum of pathology in 100 consecutively examined patients is made and treatment and outcome are listed. Lastly a pictorial review of typical pathologies in MR pictures is supplemented. After x-ray, Shoulder MR is now considered the standard among the imaging methods to diagnose shoulder disorders, as it allows for optimal depiction of pathology and diagnosis in all major imaging planes. At the same time the method gives the arthroscopist an excellent roadmap for his intervention. All in all, the treatment outcome of shoulder trauma has been improved by shoulder MR in conjunction with modern surgical and arthroscopic therapies.
