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OBJECTIVE Patient-reported outcomes (PROs) have become the standard means to measure surgical outcomes. Insurers and policy makers are also increasingly utilizing PROs to assess the value of care and measure different aspects of a patient’s condition. For cervical myelopathy, it is currently unclear which outcome measure best reflects patient satisfaction. In this investigation, the authors evaluated patients treated for cervical myelopathy to determine which outcome questionnaires best correlate with patient satisfaction. METHODS The Quality Outcomes Database (QOD), a prospectively collected multi-institutional database, was used to retrospectively analyze patients undergoing surgery for cervical myelopathy. The North American Spine Society (NASS) satisfaction index, Neck Disability Index (NDI), numeric rating scales for neck pain (NP-NRS) and arm pain (AP-NRS), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scale were evaluated. RESULTS The analysis included 1141 patients diagnosed with myelopathy, of whom 1099 had an NASS satisfaction index recorded at any of the follow-up time points. Concomitant radiculopathy was an indication for surgery in 368 (33.5%) patients, and severe neck pain (NP-NRS ≥ 7) was present in 471 (42.8%) patients. At the 3-month follow-up, NASS patient satisfaction index scores were positively correlated with scores for the NP-NRS (r = 0.30), AP-NRS (r = 0.32), and NDI (r = 0.36) and negatively correlated with EQ-5D (r = −0.38) and mJOA (r = −0.29) scores (all p < 0.001). At the 12-month follow-up, scores for the NASS index were positively correlated with scores for the NP-NRS (r = 0.44), AP-NRS (r = 0.38), and NDI (r = 0.46) and negatively correlated with scores for the EQ-5D (r = −0.40) and mJOA (r = −0.36) (all p < 0.001). At the 24-month follow-up, NASS index scores were positively correlated with NP-NRS (r = 0.49), AP-NRS (r = 0.36), and NDI (r = 0.49) scores and negatively correlated with EQ-5D (r = −0.44) and mJOA (r = −0.38) scores (all p < 0.001). CONCLUSIONS Neck pain was highly prevalent in patients with myelopathy. Notably, improvement in neck pain–associated disability rather than improvement in myelopathy was the most prominent PRO factor for patients. This finding may reflect greater patient concern for active pain symptoms than for neurological symptoms caused by myelopathy. As commercial payers begin to examine novel remuneration strategies for surgical interventions, thoughtful analysis of PRO measurements will have increasing relevance.

Objectives The aim of this study was to evaluate the high-helical pitch, multienergy (ME) scanning mode of a clinical dual-source photon-counting detector (PCD) computed tomography (CT) and the benefit of virtual monoenergetic images (VMIs) for low-contrast-dose coronary CT angiography (CTA). Materials and Methods High-pitch (3.2) ME coronary CTA was performed in PCD-CT in 27 patients using low contrast dose (30 mL of iohexol 350 mg/mL) and in 26 patients at routine contrast dose (60 mL). Low-energy-threshold 120 kV images (also known as T3D images) and 50 kiloelectron volts (50 keV) and 100 kiloelectron volts (100 keV) VMIs were reconstructed using a 1024 × 1024 matrix and 0.6-mm slices. The CT numbers, noise, and contrast-to-noise ratio (CNR) were measured in the ascending aorta (AA), left main coronary artery (LMCA), and distal left anterior descending (LAD) artery. Confidence in grading luminal stenosis with calcific plaque, noncalcific plaque, and stent was evaluated by 2 independent readers on a 0–100 scale (0 the lowest), and a CAD-RADS score was assigned. Image contrast enhancement, sharpness, noise, artifacts, and overall image quality were rated using a 5-point ordinal scale (1 the lowest). Results The radiation doses (CTDI) in low- and routine-contrast cohorts were 2.5 ± 0.6 mGy and 3.1 ± 1.7 mGy, respectively ( P = 0.12). At all measured locations, the mean CT number was >300 HU in 120 kV (LMCA 382.9 ± 76.2, distal LAD 341.0 ± 53.9, AA 399.5 ± 76.1) and 50 keV images (LMCA 667.5 ± 139.9, distal LAD 578.1 ± 121.5, AA 700.8 ± 142.5) in the low-contrast cohort, with a 96% increase in CT numbers for 50 keV over 120 kV. The CT numbers were significantly higher ( P < 0.0001) in 50 keV than 120 kV and 100 keV VMI. The CNR was also significantly ( P < 0.0001) higher in 50 keV than 120 kV and 100 keV images in all vessels. Confidence in the assessment of luminal stenosis in the presence of calcific plaque was significantly higher ( P = 0.001) with the addition of 100 keV VMI (median score, 100) than using 50 keV alone (median score, 70) and 120 kV (median score, 70) for reader 1, but no significant differences were seen for reader 2 who had same median scores of 100 for all image types. The confidence in the assessment of luminal stenosis within a stent improved with the use of 100 keV images for both readers (reader 1: median scores for 50 + 100 keV = 100, 50 keV = 82.5, 120 kV = 82.5; reader 2: 50 + 100 keV = 100, 50 keV = 90, 120 kV = 90). There were no significant differences in confidence scores for assessment of luminal stenosis from noncalcific plaques for both readers. The reader-averaged qualitative scores for vascular enhancement and overall image quality were significantly higher for 50 keV VMI than for 120 kV images in both low- and routine-contrast dose cohorts. The image sharpness was nonsignificantly higher at 50 keV VMI than 120 kV images, and the artifact score was comparable for 50 keV VMI and 120 kV images. The noise was higher in 50 keV VMI than in 120 kV images. Conclusions High-pitch ME PCD-CT mode produced diagnostic quality coronary CTA images at low radiation and iodinated contrast doses. The availability of ME VMIs significantly improved the CNR, overall image quality, and confidence in assessment of luminal stenosis in the presence of calcific plaques and stents, and resulted in change of CAD-RADS categories in 9 patients.

AbstractObjectiveTo measure the accuracy of material decomposition using a dual‐source photon‐counting‐detector (DS‐PCD) CT operated in the high‐pitch helical scanning mode and compare the results against dual‐source energy‐integrating‐detector (DS‐EID) CT, which requires use of a low‐pitch value in dual‐energy mode.MethodsA DS‐PCD CT and a DS‐EID CT were used to scan a cardiac motion phantom consisting of a 3‐mm diameter iodine cylinder. Iodine maps were reconstructed using DS‐PCD in high‐pitch mode and DS‐EID in low‐pitch mode. Image‐based circularity, diameter, and iodine concentration of the iodine cylinder were calculated and compared between the two scanners. With institutional review board approval, in vivo exams were performed with the DS‐PCD CT in high‐pitch mode. Images were qualitatively compared against patients with similar heart rates that were scanned with DS‐EID CT in low‐pitch dual‐energy mode.ResultsOn iodine maps, the mean circularity was 0.97 ± 0.02 with DS‐PCD in high‐pitch mode and 0.95 ± 0.06 with DS‐EID in low‐pitch mode. The mean diameter was 2.9 ± 0.2 mm with DS‐PCD and 3.1 ± 0.2 mm with DS‐EID, both of which are close to the 3 mm ground truth. For DS‐PCD, the mean iodine concentration was 9.6 ± 0.8 mg/ml and this was consistent with the 9.4 ± 0.6 mg/ml value obtained with the cardiac motion disabled. For DS‐EID, the concentration was 12.7 ± 1.2 mg/ml with motion enabled and 11.7 ± 0.5 mg/ml disabled. The background noise in the iodine maps was 15.1 HU with DS‐PCD and 14.4 HU with DS‐EID, whereas the volume CT dose index (CTDIvol) was 3 mGy with DS‐PCD and 11 mGy with DS‐EID. On comparison of six patients (three on PCD, three on EID) with similar heart rates, DS‐PCD provided iodine maps with well‐defined coronaries even at a high heart rate of 86 beats per minute. Meanwhile, there were substantial motion artifacts in iodine maps obtained with DS‐EID for patients with similar heart rates.ConclusionIn a cardiac motion phantom, DS‐PCD CT can perform accurate material decomposition in high‐pitch mode, providing iodine maps with excellent geometric accuracy and robustness to motion at approximately 38% of the dose for similar noise as DS‐EID CT.

ABSTRACT Chronic hypoparathyroidism is characterized by low serum calcium, increased serum phosphorus, and inappropriately low or decreased serum parathyroid hormone. This rare disorder is associated with a variety of complications. The prevalence, incidence, mortality, financial burden, and epidemiology of complications of this disorder are not well understood. This narrative review summarizes current information on the epidemiology and complications of chronic hypoparathyroidism. The reported prevalence of chronic hypoparathyroidism ranges from 6.4–37/100,000, and the incidence is reported to be 0.8–2.3/100,000/year. Mortality is not increased in studies from Denmark or South Korea but was increased in studies from Scotland and Sweden. The financial burden of this disorder is substantial because of increased health care resource utilization in two studies but not well quantitated. Recognized complications include hypercalciuria, nephrocalcinosis, kidney stones, and chronic kidney disease; low bone turnover and possibly upper extremity fractures; cardiac and vascular calcifications; basal ganglia calcifications, cataracts, infections, neuropsychiatric complications, and difficulties with pregnancy. This review concludes that chronic hypoparathyroidism is a rare disorder associated with significant morbidity that may not increase overall mortality but is associated with a substantial financial burden. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Lymphoproliferative disorders (LPD) are conditions characterized by the uncontrolled proliferation of B or T-cell lines. They encompass a wide spectrum of abnormalities, which may be broadly classified as reactive processes or malignant diseases, such as lymphoma, based on their cellular clonality and clinical behavior. While some of these disorders are rare, they may be encountered sporadically in clinical practice, causing diagnostic dilemmas owing to overlap in their clinical and imaging features with more common disorders. The updated 4th edition WHO classification of lymphoid neoplasms was released in 2016 to incorporate the rapid clinical, pathological, molecular biology and cytogenetic advances of some of these disorders. Despite these updates, very little information is presented in the literature from the radiology perspective. The aim of this article is to familiarize radiologists and other physicians with certain rare variants of B-cell lymphoproliferative disorders with a focus on imaging features of these disorders, as well as to provide an overview of some important updates contained within the new WHO classification of lymphoid neoplasms.

Understanding the pathogenesis and molecular biology of malignant lymphomas is challenging, given the complex nature and incongruity of these disorders. The classification of lymphoma is continually evolving to account for advances in clinical, pathological, molecular biology and cytogenetic aspects, which impact our understanding of these disorders. The latest fourth edition of the WHO classification of lymphoid malignancies was released in 2016 to account for these changes. Additionally, unlike B-cell lymphomas (BCL), T-cell lymphomas (TCL) are uncommon, and may be sporadically experienced in clinical practice. These disorders are rare, thus early diagnosis is challenging for both physicians and radiologists, owing to the overlap in clinical and imaging features with other, more common disorders. We aim to discuss some rare variants of T-cell lymphomas, including clinicopathologic and imaging features, as well as to give a glimpse of the updates contained within the new 2016 WHO classification.

Abstract Context. —Hantavirus pulmonary syndrome (HPS) and acute interstitial pneumonia (AIP) can share similar clinical presentations. AIP is an acute, diffuse lung disease that has some clinical features suggesting a viral infection, although causative agent(s) have not been identified. Objective. —To clinically, histologically, and immunohistochemically compare cases of HPS to cases of AIP and to determine if any cases of AIP were actually examples of HPS. Design. —Seven cases of HPS and 9 cases of AIP were compared clinically and histologically by semiquantitative grading of features in lung tissue. The cases were also evaluated immunohistochemically for the presence of hantaviral antigens. Results. —Hantavirus pulmonary syndrome had a shorter clinical duration and more acute changes histopathologically; AIP was of longer clinical duration and was usually accompanied by histologic evidence of organization. Hantavirus pulmonary syndrome was distinguished by the presence of immature leukocytes in the pulmonary vasculature. No hantaviral antigens were identified immunohistochemically in the 9 case of AIP. Hantaviral antigens were identified in all 7 cases of HPS. Conclusion. —Cases of AIP and fatal cases of HPS can generally be distinguished on clinical and histologic grounds, and this distinction can be further confirmed immunohistochemically.

Background While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.

Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.