- Yield of CT Angiography and Contrast-Enhanced MR Imaging in Patients with Dizziness
Which is the preferred imaging modality in patients presenting with isolated dizziness? These authors retrospectively evaluated CTA, contrast-enhanced MRI of the brain, and contrast-enhanced MRI of the internal auditory canals and temporal bones in a large group of patients and showed that all 3 are unlikely to identify significant findings that will lead to a change in clinical management in this situation.
- Diagnostic Evaluation in Patients with Intractable Epilepsy and Normal Findings on MRI: A Decision Analysis and Cost-Effectiveness Study
Here is an investigation designed to determine cost-effectiveness of diagnostic tests on patients with focal epilepsy and normal MRI. Studies compared were PET, ictal SPECT, and MEG, individually and in various combinations. PET + MEG and SPECT were the preferred imaging modalities and PET + MEG was favored when the willingness to pay was less than US $10,000, while SPECT was favored when the willingness to pay was above $10,000.
- Angioarchitecture of Brain AVM Determines the Presentation with Seizures: Proposed Scoring System
This group of authors came up with a scoring system to predict seizures in patients with brain AVMs. They retrospectively reviewed imaging studies of 1299 patients and found 33 with unruptured AVMs and seizures and 45 with unruptured lesions without seizures. Features that predicted seizures included: arterial dilation, pial recruitment, fistula, intranidal aneurysm, pial long draining vein, pseudophlebitic pattern, venous outflow obstruction, and venous ectasia. Because seizures are associated with significant morbidity, AVMs with these features may be targeted for treatment with surgery and/or embolization.
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