Does lumbar spinal degeneration begin with the anterior structures? A study of the observed epidemiology in a community-based population.

BACKGROUND: Prior studies that have concluded that disk degeneration uniformly precedes facet degeneration have been based on convenience samples of individuals with low back pain. We conducted a study to examine whether the view that spinal degeneration begins with the anterior spinal structures is supported by epidemiologic observations of degeneration in a community-based population. METHODS: 361 participants from the Framingham Heart Study were included in this study. The prevalences of anterior vertebral structure degeneration (disk height loss) and posterior vertebral structure degeneration (facet joint osteoarthritis) were characterized by CT imaging. The cohort was divided into the structural subgroups of participants with 1) no degeneration, 2) isolated anterior degeneration (without posterior degeneration), 3) combined anterior and posterior degeneration, and 4) isolated posterior degeneration (without anterior structure degeneration). We determined the prevalence of each degeneration pattern by age group < 45, 45-54, 55-64, ≥65. In multivariate analyses we examined the association between disk height loss and the response variable of facet joint osteoarthritis, while adjusting for age, sex, BMI, and smoking. RESULTS: As the prevalence of the no degeneration and isolated anterior degeneration patterns decreased with increasing age group, the prevalence of the combined anterior/posterior degeneration pattern increased. 22% of individuals demonstrated isolated posterior degeneration, without an increase in prevalence by age group. Isolated posterior degeneration was most common at the L5-S1 and L4-L5 spinal levels. In multivariate analyses, disk height loss was independently associated with facet joint osteoarthritis, as were increased age (years), female sex, and increased BMI (kg/m(2)), but not smoking. CONCLUSIONS: The observed epidemiology of lumbar spinal degeneration in the community-based population is consistent with an ordered progression beginning in the anterior structures, for the majority of individuals. However, some individuals demonstrate atypical patterns of degeneration, beginning in the posterior joints. Increased age and BMI, and female sex may be related to the occurrence of isolated posterior degeneration in these individuals.

Efficacy and toxicity of concurrent chemoradiotherapy in patients with advanced oropharyngeal squamous cell carcinoma.

PURPOSE: The aim of this study was to evaluate the feasibility and toxicity of concurrent chemoradiotherapy (CCRT) with docetaxel, cisplatin (CDDP) and 5-fluorouracil (5-FU) (TPF regimen) or with CDDP, 5-FU, methotrexate and leucovorin (PFML regimen) in previously untreated patients with advanced oropharyngeal squamous cell carcinoma (SCC). METHODS: Fifty-six eligible patients with stage III or IV oropharyngeal SCC were treated with CCRT. Forty-four patients were men and 12 were women, and the average age of the patients was 58.8 years (range, 37-72 years). In the TPF group, patients received CCRT with the TPF regimen [docetaxel (50 mg/m(2), day 1), CDDP (60 mg/m(2), day 4) and a continuous 5-FU infusion (600 mg/m(2)/day, days 1-5)]. In the PFML group, patients received CCRT with the PFML regimen [CDDP (60 mg/m(2), day 4), a continuous 5-FU infusion (600 mg/m(2)/day, days 1-5), methotrexate (30 mg/m(2), day 1) and leucovorin (10 mg/m(2)/day, days 1-5)]. The total radiation dose was between 66.6 and 70.2 Gy. RESULTS: The overall 5-year survival rate was 64.6% in all patients, 68.6% in the resectable group and 47.4% in the unresectable group. The 5-year disease-specific survival rate was 72.2% in all patients, 78.1% in the resectable group and 47.7% in the unresectable group. Regarding clinical stage, the 5-year disease-specific survival rates were 91% in stage III, 72% in stage IVa and 44% in stage IVb. CONCLUSION: CCRT with TPF or PFML regimen for advanced oropharyngeal SCC is tolerable and effective, especially in patients with resectable disease.

Accuracy of preliminary interpretation of neurologic CT examinations by on-call radiology residents and assessment of patient outcomes at a level I trauma center.

PURPOSE: The aims of this study were to evaluate the accuracy of preliminary interpretations of emergency neurologic CT scans after hours by on-call radiology residents and to assess the clinical impact of residents' errors at a level I trauma center. METHODS: A quality assurance database of neurologic CT examinations was reviewed to compare preliminary interpretations by on-call residents with final analyses by attending neuroradiologists during a 12-month period. All disagreements were reviewed for confirmation of the findings and categorized as significant or nonsignificant. Significant errors were further classified as acute intracranial, acute extracranial, and nonacute. Medical records for scans with significant errors were reviewed to evaluate any negative impact on the patient for each significant case. Residents' postgraduate years were also recorded. RESULTS: There were 252 cases (3.7%) with disagreements among 6,852 total cases. Of those, 226 (3.3%) were confirmed as resident errors, which included 171 (2.5%) that were significant. There were 73 (1.1%) acute intracranial, 77 (1.1%) acute extracranial, and 21 (0.3%) nonacute misinterpretations. Among the 171 significant cases, 105 (1.5%) had no changes in clinical management, and 55 (0.8%) required some changes. CONCLUSION: The rate of significant errors by on-call radiology residents was low. These errors had a minimal impact on clinical outcomes. Continued monitoring of residents' performance is important to maintain or improve patient safety.

Magnetic resonance imaging of thyroid cancer.

Thyroid cancer is a unique malignancy arising from the endocrine system, and its nature is different from more common squamous cell carcinoma in the head and neck region. Multiple imaging modalities are used for imaging work up for thyroid cancer, including nuclear medicine imaging, ultrasound, computed tomography, and magnetic resonance imaging (MRI). Imaging findings of benign and malignant thyroid lesions overlap substantially, and differentiation may be difficult. The role of MRI is to evaluate the extent of disease and to assess the spread of nodal disease. In this chapter, we will discuss the role of MRI in thyroid cancer staging and key imaging appearance that affect staging of thyroid cancer.