Mandrekar, Jay

Object Little information is available on follow-up MR imaging after treatment of spinal dural arteriovenous fistulas (DAVFs). The authors studied MR imaging findings in treated spinal DAVFs in relation to clinical outcomes. Methods A retrospective review of patients with spinal DAVFs who had undergone both pre- and postoperative spinal MR imaging was conducted. Postoperative MR images were obtained as routine follow-up studies or because of subjective or objective clinical deterioration. Several pre- and posttreatment MR imaging characteristics were evaluated by 2 neuroradiologists blinded to the clinical outcome. Clinical outcomes of motor, sensory, and urinary function (in relation to the patient's preoperative status) at the time of the postoperative MR imaging were obtained from the clinical record. The chi-square, Fisher exact, and rank-sum tests were performed to correlate imaging findings and changes with clinical outcomes. Results Thirty-four patients met inclusion criteria. Treatment was surgical in 33 patients and endovascular in 1 patient. Follow-up MR imaging was performed at a mean 168 ± 107 days after treatment. Twenty-seven patients (79.4%) were either clinically stable or improved, and 7 (20.6%) experienced worsening in one or more clinical outcomes. Most patients were found to have improvement of MR imaging changes. However, some degree of persistent spinal cord signal abnormality, enhancement, and swelling was observed in 31 (91.2%), 29 (85.3%), and 18 (52.3%) patients, respectively. Changes in these MR imaging characteristics compared with preoperative MR imaging did not correlate with clinical outcomes (p > 0.05), with the one exception of a significant correlation between change in urinary function and extent of spinal cord contrast enhancement (p = 0.026), a correlation of uncertain importance. Ten of the 34 patients underwent posttreatment digital subtraction angiography, and 3 of these patients had recurrent/residual DAVFs. Worsening of motor function significantly correlated with recurrent/residual DAVF (p = 0.053). Conclusions Spinal cord abnormalities persist on postoperative MR imaging studies in patients with treated spinal DAVFs, and although they tend to mildly improve with time, these changes may not correlate with clinical outcomes. However, regardless of imaging findings, worsening motor function may correlate with a recurrent or residual DAVF.

Abstract Experiences at time of breast cancer (BC) diagnosis are associated with patient psychological health several months to years later; however, little investigation of this relationship during initial period following diagnosis has been undertaken.METHODS:This prospective study was designed to characterize the experience of receiving cancer diagnosis in women initiating treatment for BC (Stage 0 to III) and to identify associations between this experience and early psychological adjustment, hopefulness, and satisfaction with medical care. 121 women who recently received BC diagnosis prompting referral to specialty center responded to questionnaires assessing their experiences and coping styles:1. Experience Receiving Breast Cancer Diagnosis (ERBCD), categorizing patient demographic, medical, and psychosocial factors; context factors (location, privacy); clinician factors and behaviors.2. Cancer Diagnostic Interview Scale (CDIS) for perceived psychotherapeutic techniques used by clinican conveying cancer diagnosis.3. Mental Adjustment to Cancer Scale (MAC) for coping styles of fighting spirit, hopelessness/helplessness, anxious preoccupation, fatalism, and avoidance.Subjects completed the Profile of Mood States (POMS), Spielberger State-Trait Anxiety Inventory (STAI) and ratings of hopefulness and satisfaction. Multivariate regression analysis was employed with scores from POMS, STAI, hopefulness and satisfaction as dependent variables and values from ERBCD, CDIS and MAC as independent variables.RESULTS:Patients received diagnosis from general physicians, surgeons, radiologists, nurses, NP/PAs, gynecologists, breast specialists, family members, and secretaries. BC diagnosis was disclosed by telephone (59%), face-to-face (40%), letter (1%) and spouse (1%). Mean CDIS-Caring score was 3.4 ± 1.1 and CDIS-Competence was 4.0 ± 0.9 of 5.0. Results of multivariate regression analysis are shown:POMS-Total Mood DisturbanceIndependent VariableParameterSEP ValueAge-0.6600.2760.0183MAC-Fighting Spirit-1.1550.4360.0093MAC-Anxious Preoccupation5.2720.780< 0.001 STAI-State AnxietyIndependent VariableParameterSEP ValueRecent Stress Level0.9420.3710.0127MAC-Fighting Spirit-0.3670.1480.0147MAC-Anxious Preoccupation1.9740.271<0.0001MAC-Avoidant4.4671.4950.0036 Satisfaction was predicted by CDIS-Caring, individual conveying diagnosis, type of information helpful, feeling concerns were understood.CONCLUSIONS:Experiences receiving BC diagnosis are variable and associated with hopefulness and satisfaction. Age, recent stress level and predominant coping style appear more predictive of psychological adjustment (POMS, STAI) than experience receiving BC diagnosis. Understanding these relationships provides direction for future research and clinical interventions to identify patients at risk for early mood disturbance and anxiety following BC diagnosis and to modify aspects of conveying BC diagnosis that influence hopefulness and satisfaction with medical care.HopefulnessIndependent VariableParameterSEP ValueCDIS-Caring0.4270.088<0.0001Diagnosis by Telephone0.3810.1770.0338Opportunity to Ask Questions0.4440.2270.0535Recent Stress Level-0.0820.0290.0057MAC-Fighting Spirit0.0430.0120.0005MAC-Anxious Preoccupation-0.0610.0230.0098 Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1069.