Efficacy of inhaled corticosteroids for patients with asthma: a descriptive review of randomized controlled trials

Objective: To evaluate the efficacy of inhaled corticosteroids (ICS) in patients with asthma based on changes in sputum eosinophil counts, through a review of relevant randomized controlled trials (RCTs). Methods: Studies were retrieved from MEDLINE, EMBASE, the SYSTEM FOR INFORMATION ON GREY LITERATURE, and the INSTITUTE FOR SCIENTIFIC INFORMATION from February 1, 2003 to February 1, 2013 based on a comprehensive search strategy. Articles were screened through two stages: title and abstract; and full-text screening. RCTs enrolling patients with asthma, testing an ICS intervention, and reporting outcomes on changes in sputum eosinophil counts pre- and post-intervention were included. Following screening, data extraction, and quality appraisal, a descriptive synthesis of trials was conducted. Results: The search strategy retrieved 447 articles, of which 66 articles underwent full-text screening, resulting in 37 RCTs that met the inclusion criteria for this review. The articles were stratified according to the type of ICS: budesonide, fluticasone propionate, ciclesonide, beclomethasone dipropionate, and mometasone.  Across trials, 9 of 16 budesonide, 5 of 14 fluticasone propionate, 4 of 9 of nine ciclesonide, 2 of 4 beclomethasone dipropionate, and 1 of 2 mometasone interventions demonstrated a statistically significant (p < 0.05) reduction in sputum eosinophil counts. Conclusion: This study detected differences between ICS treatments however the clinical relevance is uncertain. There is insufficient evidence to suggest the superiority of one ICS treatment over another. Further research needs to be conducted to evaluate the relative impact of ICS products upon eosinophil counts, as well as in clarifying what quantitative level of change in baseline eosinophil counts is required to observe a change in symptom improvement and disease control

Cross-Sectional Imaging of Nontraumatic Peritoneal and Mesenteric Emergencies

Multiple nontraumatic peritoneal and mesenteric emergencies are encountered at imaging of patients in the emergency department. Peritoneal and mesenteric emergencies are usually detected in patients in the emergency department during evaluation of nonspecific abdominal pain. A high index of suspicion is required for the establishment of early diagnosis and aversion of life-threatening complications in cases of peritoneal carcinomatosis, nontraumatic hemoperitoneum, and peritonitis. A correct diagnosis of omental infarction, mesenteric adenitis, and mesenteric panniculitis helps patients primarily by avoiding unnecessary surgery. In this review article, we illustrate the cross-sectional imaging appearance of various nontraumatic peritoneal and mesenteric emergencies by emphasizing the role of the emergency radiologist in detecting and managing these entities

Evaluation of adipose tissue volume quantification with IDEAL fat-water separation

Purpose: To validate iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) for adipose tissue volume quantification. IDEAL allows MRI images to be produced only from adipose-containing tissues; hence, quantifying adipose tissue should be simpler and more accurate than with current methods. Materials and Methods: Ten healthy controls were imaged with 1.5 Tesla (T) Spin Echo (SE), 3.0T T1-weighted spoiled gradient echo (SPGR), and 3.0T IDEAL-SPGR. Images were acquired from the abdomen, pelvis, mid-thigh, and mid-calf. Mean subcutaneous and visceral adipose tissue volumes were compared between the three acquisitions for each subject. Results: There were no significant differences (P \u3e 0.05) between the three acquisitions for subcutaneous adipose tissue volumes. However, there was a significant difference (P = 0.0002) for visceral adipose tissue volumes in the abdomen. Post hoc analysis showed significantly lower visceral adipose tissue volumes measured by IDEAL versus 1.5T (P \u3c 0.0001) and 3.0T SPGR (P \u3c 0.002). The lower volumes given by IDEAL are due to its ability to differentiate true visceral adipose tissue from other bright structures like blood vessels and bowel content that are mistaken for adipose tissue in non-fat suppressed images. Conclusion: IDEAL measurements of adipose tissue are equivalent to established 1.5T measurement techniques for subcutaneous depots and have improved accuracy for visceral depots, which are more metabolically relevant. © 2011 Wiley-Liss, Inc

Impact of pre-operative abdominal MRI on survival for patients with resected pancreatic carcinoma: a population-based studyResearch in context

Summary: Background: This study determined the impact of pre-operative abdominal MRI on all-cause mortality for patients with resected PDAC. Methods: All adult (≥18 years) PDAC patients who underwent pancreatectomy between January 2011 and December 2022 in Ontario, Canada, were identified for this population-based cohort study (ICD-O-3 codes: C250, C251, C252, C253, C257, C258). Patient demographics, comorbidities, PDAC stage, medical and surgical management, and survival data were sourced from multiple linked provincial administrative databases at ICES. All-cause mortality was compared between patients with and without a pre-operative abdominal MRI after controlling for multiple covariates. Findings: A cohort of 4579 patients consisted of 2432 men (53.1%) and 2147 women (46.9%) with a mean age of 65.2 years (standard deviation: 11.2 years); 2998 (65.5%) died while 1581 (34.5%) survived. Median follow-up duration post-resection was 22.4 months (interquartile range: 10.8–48.8 months), and median survival post-pancreatectomy was 25.9 months (95% confidence interval [95% CI]: 24.8, 27.5). Patients who underwent a pre-operative abdominal MRI had a median survival of 33.1 months (95% CI: 30.7, 37.2) compared to 21.1 months (95% CI: 19.8, 22.6) for all others. A total of 2354/4579 (51.4%) patients underwent a pre-operative abdominal MRI, which was associated with a 17.2% (95% CI: 11.0, 23.1) decrease in the rate of all-cause mortality, with an adjusted hazard ratio (aHR) of 0.828 (95% CI: 0.769, 0.890). Interpretation: Pre-operative abdominal MRI was associated with improved overall survival for PDAC patients who underwent pancreatectomy, possibly due to better detection of liver metastases than CT. Funding: Northern Ontario Academic Medicine Association (NOAMA) Clinical Innovation Fund

ACR Appropriateness Criteria \u3csup\u3e®\u3c/sup\u3e Clinically Suspected Adnexal Mass, No Acute Symptoms

© 2019 American College of Radiology There are approximately 9.1 pelvic surgeries performed for every histologically confirmed adnexal malignancy in the United States, compared to 2.3 surgeries per malignancy (in oncology centers) and 5.9 surgeries per malignancy (in other centers) in Europe. An important prognostic factor in the long-term survival in patients with ovarian malignancy is the initial management by a gynecological oncologist. With high accuracy of imaging for adnexal mass characterization and consequent appropriate triage to subspecialty referral, the better use of gynecologic oncology can improve treatment outcomes. Ultrasound, including transabdominal, transvaginal, and duplex ultrasound, combined with MRI with contrast can diagnose adnexal masses as benign with specific features (ie, functional masses, dermoid, endometrioma, fibroma, pedunculated fibroid, hydrosalpinx, peritoneal inclusion cyst, Tarlov cyst), malignant, or indeterminate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment