MR imaging detection of cerebral microbleeds: effect of susceptibility-weighted imaging, section thickness, and field strength.

BACKGROUND AND PURPOSE: The emergence of cerebral microbleeds (CMB) as common MR imaging findings raises the question of how MR imaging parameters influence CMB detection. To evaluate the effects of modified gradient recalled-echo (GRE) MR imaging methods, we performed an analysis of sequence, section thickness, and field strength on CMB imaging properties and detection in subjects with cerebral amyloid angiopathy (CAA), a condition associated with microhemorrhage. MATERIALS AND METHODS: Multiple MR images were obtained from subjects with probable CAA, with varying sequences (GRE versus susceptibility-weighted imaging [SWI]), section thicknesses (1.2-1.5 versus 5 mm), and magnetic field strengths (1.5T versus 3T). Individual CMB were manually identified and analyzed for contrast index (lesion intensity normalized to normal-appearing white matter signal intensity) and diameter. CMB counts were compared between 1.5T thick-section GRE and thin-section SWI for 3 subjects who underwent both protocols in the same scanning session. RESULTS: With other parameters constant, use of SWI, thinner sections, and a higher field strength yielded medium-to-large gains in CMB contrast index (CI; Cohen d 0.71-1.87). SWI was also associated with small increases in CMB diameter (Cohen d <0.3). Conventional thick-section GRE identified only 33% of CMB (103 of 310) seen on thin-section SWI. Lesions prospectively identified on GRE had significantly greater CI and diameter measured on the GRE image than those not prospectively identified. CONCLUSIONS: The examined alternatives to conventional GRE MR imaging yield substantially improved CMB contrast and sensitivity for detection. Future studies based on these techniques will most likely yield even higher prevalence estimates for CMB.

Health-related quality of life and healthcare resource utilization by COPD patients: a comparison of three instruments.

The aim of this study was to compare the SF-36 and two disease-specific instruments--St. George's Respiratory Questionnaire (SGRQ) and Chronic Respiratory Disease Questionnaire (CRDQ) among chronic obstructive pulmonary disease (COPD) patients using healthcare utilization data. The three instruments were administered twice by telephone interview to 40 COPD patients separated by a 3-month interval. Healthcare utilization data were obtained for the 3 months immediately prior to each administration. Reliabilities for sub-scales on the three instruments ranged from 0.70 to 0.90 for the SF-36, from 0.78 to 0.85 for the SGRQ, and from 0.64 to 0.91 for the CRDQ. In general, the study sample had poor physical health, and somewhat better mental health. None of the demographic variables were significantly associated with either health status or utilization. Among the three instruments, the SF-36 explained the most variance in healthcare utilization. The aggregate scores such as the summary scores of the SF-36 and the total score of the SGRQ did not perform as well as the individual sub-scales of the respective instruments in explaining the variation in utilization. The conclusion that the SF-36 provides the best association to healthcare utilization data from among the three instruments studied should be interpreted with caution given the small sample size and relatively brief duration of the study.

Effects of copper supplementation on ceruloplasmin and copper-zinc superoxide dismutase in free-living rheumatoid arthritis patients.

Inflammation, an acute phase stress, alters copper (Cu) metabolism, but effects on human Cu requirements are unknown. Cu supplementation (2 mg/day, 4 weeks) increased erythrocyte Cu-zinc (Zn) superoxide dismutase (SOD) activity levels in 18 of 23 rheumatoid arthritis (RA) patients receiving gold or methotrexate (mean increase 21%). SOD values were significantly lower in RA patients than in 47 age- and sex-matched controls before, but not after supplementation. Supplementation did not significantly affect ceruloplasmin (Cp) activity or protein concentrations in either group. However, RA subjects showed significantly lower Cp activity to protein ratios compared to controls, before and after supplementation. Cu supplementation did not affect acute phase status of RA patients as evidenced by unchanged serum alpha-1-acid glycoprotein levels. In conclusion, the effects of Cu supplementation on erythrocyte SOD activities suggested a trend toward marginal Cu status in RA patients.

Reliability of colposcopy and directed punch biopsy.

A group of 118 women underwent laser cone biopsy. Data were collected routinely on proforma case notes and entered into a computerized database. The histology of the cone biopsies was compared with that of previous, colposcopically directed punch biopsies, with the cytology of smears taken in the clinic and with the colposcopic diagnosis. The punch biopsy had a 54% false negative rate and neither of the two microinvasive carcinomas biopsied in this way were detected by the biopsy. Ten of 24 women with negative punch biopsies had CIN III in the cone. When the punch biopsy showed CIN II or worse, the cone biopsy confirmed the presence of CIN in 86%. There was some evidence of false negative cone biopsies. The data suggest that management should not be based solely upon the punch biopsy result but should include consideration of the cytology and colposcopy findings. Excisional methods of treatment are more likely to reveal early invasion and adenocarcinoma-in-situ.

Further investigation of the role of personality, lifestyle and arthritic severity in predicting pain.

Lichtenberg et al. (1984) presented empirical research on elderly osteoarthritics that indicated that personality, specifically hypochondriasis, was the most powerful predictor of pain as compared with arthritic severity and recent life stress. This study investigated further the role of psychological predictors and arthritic severity ratings in accounting for perceived pain. The study included 70 subjects with an average age of 68 years. The results indicated that hypochondriasis was the predictor most highly related to pain. Arthritic severity ratings and other psychological predictors were also significantly related to pain. In a multiple regression analysis arthritic severity predicted 13 percent of pain variance whereas the psychological predictors accounted for an additional 41 percent of the variance. Age of the individual was related to several psychological variables. New possibilities for therapeutic intervention are discussed.

The role of personality, recent life stress and arthritic severity in predicting pain.

This study investigated the role of personality, life stress and osteoarthritic severity in accounting for pain in aged individuals. Previous empirical research on older adults with chronic pain is nonexistent. The study included 40 subjects with an average age of 70 yr. Results indicated that personality, specifically hypochrondriasis of the individual, was the most powerful predictor of pain as compared with arthritic severity and life stress. Subjective pain was lower among older patients than among younger patients despite greater arthritic severity. The amount of hypochondriasis and life stress was also less for older patients. Implications for interventions in terms of modifying perception of pain in older adults is discussed.