Mayo Clinic Proceedings 07/2011; 86(7):681-4. · 5.70 Impact Factor
Mayo Clinic Proceedings 10/2010; 85(10):e70-3. · 5.70 Impact Factor
ABSTRACT: Little information exists concerning the frequency and medical significance of incidental findings (IFs) in imaging research.
Medical records of research participants undergoing a research imaging examination interpreted by a radiologist during January through March 2004 were reviewed, with 3-year clinical follow-up. An expert panel reviewed all IFs generating clinical action to determine medical benefit/burden on the basis of predefined criteria. The frequency of IFs that generated further clinical action was estimated by modality, body part, age, and sex, along with net medical benefit or burden.
Of 1426 research imaging examinations, 567 (39.8%) had at least 1 IF (1055 total). Risk of an IF increased significantly by age (odds ratio [OR], 1.5; 95% confidence interval, 1.4-1.7 per decade increase). Abdominopelvic computed tomography generated more IFs than other examinations (OR, 18.9 vs ultrasonography; 9.2% with subsequent clinical action), with computed tomography of the thorax and magnetic resonance imaging of the head next (OR, 11.9 and 5.9; 2.8% and 2.2% with action, respectively). Of the 567 examinations with an IF, 35 (6.2%) generated clinical action, resulting in clear medical benefit in 1.1% (6 of 567) and clear medical burden in 0.5% (3 of 567). Medical benefit/burden was usually unclear (26 of 567 [4.6%]).
Frequency of IFs in imaging research examinations varies significantly by imaging modality, body region, and age. Research imaging studies at high risk for generating IFs can be identified. Routine evaluation of research images by radiologists may result in identification of IFs in a high number of cases and subsequent clinical action to address them in a small but significant minority. Such clinical action can result in medical benefit to a small number of patients.
Archives of internal medicine 09/2010; 170(17):1525-32. · 11.46 Impact Factor
ABSTRACT: Cardiac troponins are the markers of choice for the diagnosis of acute myocardial infarction. The objective of this study was to compare the frequency of "aborted myocardial infarction" (no detectable myocardial injury) determined by measurement of troponin versus that determined by creatine kinase (CK) and creatine kinase-muscle brain (CK-MB) measurement criteria among patients with ST-elevation myocardial infarction (STEMI) who received reperfusion therapy.
Since 2004, the Mayo Clinic (Rochester, MN) has had a standard reperfusion protocol for the treatment of patients with STEMI. During the study period, 767 patients presented with new or presumed new ST elevation or left bundle block.
The diagnosis of STEMI was confirmed in 765 (99.7%) patients. Using the 99th percentile cutoff value, troponin T elevations occurred in 765 (100%) of 765 patients when serial samples were available. Creatine kinase-MB levels of twice or more the upper limit of normal occurred in 681 (90.1%) of 749 patients with serial samples for CK-MB, and CK equal or greater than twice the gender-specific upper limits of normal occurred in 521 (78.8%) of 661 patients with serial samples for CK available.
The frequency of aborted myocardial infarction is 0% when using troponin at the 99th percentile cutoff as recommended by contemporary guidelines from the European Society of Cardiology (Nice, France) and American College of Cardiology (Washington, DC).
American heart journal 05/2009; 157(4):636-41. · 4.65 Impact Factor
ABSTRACT: Some patients with congenital heart disease and irreversible plexogenic pulmonary arteriopathy survive into adulthood. The purpose of this study was to compare histopathological and antigen expression patterns in adults and children with congenital heart disease and plexogenic pulmonary arteriopathy.
Autopsy/explant lung tissues from 25 patients with congenital heart disease and plexogenic pulmonary arteriopathy were reviewed for 24 histopathological parameters associated with plexogenic pulmonary arteriopathy, including the prevalence and character of plexiform lesions. Immunohistochemistry using antibodies against CD31, C-kit, smooth muscle actin, CD68, and Fli-1 was performed to evaluate plexiform lesions.
Group 1 consisted of 14 patients aged <20 years, and Group 2 included 11 patients aged >or=20 years (range, 20-69 years). Cellular plexiform lesions trended toward greater prevalence in Group 1 than in Group 2 (P=.081), whereas involuted plexiform lesions more frequently affected Group 2 than Group 1 (P=.0037). In addition, recent platelet-fibrin thrombi within plexiform lesions occurred more often in Group 1 than in Group 2 (P=.0419). Intimal proliferation/fibrosis of elastic arteries and pulmonary vein dilation were more common in Group 2 (P=.0172 and P=.0048, respectively). CD31 and C-kit staining in non-lumen-lining cells of plexiform lesions was more frequent in Group 2 than in Group 1 (P=.0858 and P=.0173, respectively). No statistically significant differences in expression patterns between cellular and involuted plexiform lesions existed.
Among patients with congenital heart disease and plexogenic pulmonary arteriopathy, histopathological differences were observed between those surviving into adulthood and those dying in childhood/adolescence. Plexiform lesions in adults undergo remodeling from a cellular morphology to an involuted morphology. It is unclear whether this simply represents the natural progression of plexiform lesions or also confers a survival advantage.
Cardiovascular pathology: the official journal of the Society for Cardiovascular Pathology 04/2008; 17(6):382-91. · 1.63 Impact Factor