Diagnosis of deep-vein thrombosis and pulmonary embolism:The new guideline of the Dutch institute for health care improvement

Reliable diagnosis of venous thrombosis or pulmonary embolism is crucial, as especially pulmonary embolism is a potentially fatal disorder. Recently the guideline of the Dutch institute for health care improvement (CBO), 'diagnosis, prevention and treatment of venous thromboembolism (VTE) and secondary prevention of arterial thrombosis' was published. The diagnostic algorithm in case of suspected VTE starts with a clinical decision rule according to Wells followed by a d-dimer test. These simple, non-invasive and cheap tests, exclude VTE in 25-30% of the patients with a suspected episode of VTE. With a dichotomized clinical decision rule, a 'likely' Wells score or an abnormal d-dimer concentration necessitates additional testing, like ultrasonography of the leg veins when deep-vein thrombosis is suspected, or multidetector computerized tomographic scanning in the case of suspected pulmonary embolism. These diagnostic algorithms considerably simplify the diagnosis of VTE.</p

Diagnosis of deep-vein thrombosis and pulmonary embolism:The new guideline of the Dutch institute for health care improvement

Reliable diagnosis of venous thrombosis or pulmonary embolism is crucial, as especially pulmonary embolism is a potentially fatal disorder. Recently the guideline of the Dutch institute for health care improvement (CBO), 'diagnosis, prevention and treatment of venous thromboembolism (VTE) and secondary prevention of arterial thrombosis' was published. The diagnostic algorithm in case of suspected VTE starts with a clinical decision rule according to Wells followed by a d-dimer test. These simple, non-invasive and cheap tests, exclude VTE in 25-30% of the patients with a suspected episode of VTE. With a dichotomized clinical decision rule, a 'likely' Wells score or an abnormal d-dimer concentration necessitates additional testing, like ultrasonography of the leg veins when deep-vein thrombosis is suspected, or multidetector computerized tomographic scanning in the case of suspected pulmonary embolism. These diagnostic algorithms considerably simplify the diagnosis of VTE.</p

Brain metastases from different primary carcinomas:An evaluation of DSC MRI measurements

This study evaluated the roles of different dynamic susceptibility contrast magnetic imaging (DSC MRI) measurements in discriminating between brain metastases derived from four common primary carcinomas. Thirty-seven patients with brain metastases were enrolled. Relative cerebral blood volume (rCBV), cerebral blood flow (rCBF) and relative mean transit time (rMTT) in both tumor and peritumoral edema were measured. Metastases were grouped by their primary tumor (lung, gastrointestinal, breast and renal cell carcinoma). DSC MRI measurements were compared between groups. Mean rCBV, rCBF, rMTT in tumor and peritumoral edema of all brain metastases (n=37) were 2.79 ± 1.73, 2.56 ± 2.11, 1.21 ± 0.48 and 1.05 ± 0.53, 0.86 ± 0.40, 1.99 ± 0.41, respectively. The tumoral rCBV (5.26 ± 1.89) and rCBF (5.32 ± 3.28) of renal metastases were greater than those of the other three metastases (P&lt;0.05). The tumoral rMTT (1.58 ± 0.77) of breast metastases was statistically greater than that (0.96 ± 0.31) of gastrointestinal metastases (P=0.013). No statistical difference was found between peritumoral rCBV, rCBF and rMTT (P&gt;0.05). Evaluating various DSC MRI measurements can provide complementary hemodynamic information on brain metastases. The tumoral rCBV, rCBF and likely rMTT can help discriminate between brain metastases originating from different primary carcinomas. The peritumoral DSC MRI measurements had limited value in discriminating between brain metastases.</p

Breast magnetic resonance imaging as a problem-solving modality?

Mammography is the primary imaging modality for the early detection of breast cancer. Because of the low predictive value of mammography, a large majority of patient referred for biopsy have benign disease. The question is whether magnetic resonance imaging (MRI) is a diagnostic alternative to biopsy for women with inconclusive findings at mammography or mammographic (Breast Imaging Reporting And Data System (BIRADS) 3 lesions. In this article the breast MRI and indications will be described. An overview will be given of MRI as a problem-solving modality in mammographic BIRADS 3 lesions and inconclusive mammographic findings with and without microcalcifications. The negative predictive value of breast MRI must be sufficiently high to definitively indicate a lack of need for biopsy and thus to be an effective addition to the work-up of mammographic BIRADS 3 lesions or inconclusive findings on mammography. Therefore, breast MRI should only be used for cases with proven diagnostic value.</p

Brain metastases from different primary carcinomas:An evaluation of DSC MRI measurements

This study evaluated the roles of different dynamic susceptibility contrast magnetic imaging (DSC MRI) measurements in discriminating between brain metastases derived from four common primary carcinomas. Thirty-seven patients with brain metastases were enrolled. Relative cerebral blood volume (rCBV), cerebral blood flow (rCBF) and relative mean transit time (rMTT) in both tumor and peritumoral edema were measured. Metastases were grouped by their primary tumor (lung, gastrointestinal, breast and renal cell carcinoma). DSC MRI measurements were compared between groups. Mean rCBV, rCBF, rMTT in tumor and peritumoral edema of all brain metastases (n=37) were 2.79 ± 1.73, 2.56 ± 2.11, 1.21 ± 0.48 and 1.05 ± 0.53, 0.86 ± 0.40, 1.99 ± 0.41, respectively. The tumoral rCBV (5.26 ± 1.89) and rCBF (5.32 ± 3.28) of renal metastases were greater than those of the other three metastases (P&lt;0.05). The tumoral rMTT (1.58 ± 0.77) of breast metastases was statistically greater than that (0.96 ± 0.31) of gastrointestinal metastases (P=0.013). No statistical difference was found between peritumoral rCBV, rCBF and rMTT (P&gt;0.05). Evaluating various DSC MRI measurements can provide complementary hemodynamic information on brain metastases. The tumoral rCBV, rCBF and likely rMTT can help discriminate between brain metastases originating from different primary carcinomas. The peritumoral DSC MRI measurements had limited value in discriminating between brain metastases.</p