Faculty Bibliography

OBJECTIVE: Implantation of a spinal cord stimulator (SCS) is one option for pain control in individuals with chronic lumbosacral radicular or axial lumbar pain. The expected positioning of SCSs based on the location of pain, the types of electrodes (percutaneous vs surgical paddle), and the types of electrode arrays and the potential complications have not been described to date in the radiology literature. MATERIALS AND METHODS: A 5-year retrospective review of the radiology information system at our institution revealed 24 patients with images of 36 SCSs. Those images were reviewed to identify the location and type of electrodes as well as the location of the lead within the spinal canal. Not all implantable pulse generators were within the radiologic field of view. Complications identified by reviewing medical records were correlated with imaging findings. RESULTS: Fourteen different types of electrodes were identified. Most were placed in the thoracic spine only, but six thoracolumbar and two cervical spine electrodes were also present. We measured the position of the electrodes within the spinal canal on 26 CT studies of the 24 patients. On 22 of 26 CT studies, the electrodes were placed in the epidural space in the posterior one third of the spinal canal. Complications included misplaced, retained, and broken leads; puncture of the thecal sac; infection; and hematoma. CONCLUSION: Radiologists should be familiar with the different types of electrodes and typical spinal locations of electrodes, leads, and implantable pulse generators. Improper placement of electrodes may lead to ineffective pain relief or to other complications.

PURPOSE: To assess the patient care benefit of a recently implemented institutional policy requiring official second-opinion consultation for all studies performed outside the institution. MATERIALS AND METHODS: The institutional review board approved the retrospective review of patient data for this HIPAA-compliant study and waived the need for individual informed consent. The second-opinion consultation reports for outside neuroradiology studies finalized by subspecialty-trained neuroradiologists within calendar year 2008 were compared with the outside reports provided with the images. The reports were categorized by using a five-point scale: 1 indicated no difference in interpretation; 2, clinically unimportant difference in detection; 3, clinically unimportant difference in interpretation; 4, clinically important difference in detection; and 5, clinically important difference in interpretation. Clinically important differences were defined as those likely to change patient care or diagnoses. Statistical comparisons were performed by using two-sample continuity-corrected Z tests with two-sided alternatives. Bonferroni corrections were performed when more than two rates were compared. Confidence intervals for all rates were constructed by using the score interval along with the Yates continuity correction. RESULTS: Of 7465 studies, 4534 (60.7%) had an outside report for comparison. There were 347 (7.7%) instances with clinically important differences. Of these 347 discrepancies, 233 (67.1%) were category 4 and 114 (32.9%) were category 5. When the final diagnosis was determined from pathology reports, clinical assessments, and/or imaging follow-up, the second-opinion consultation was noted to be correct in 163 (84.0%) of 194 studies with category 4 or 5 discrepancies. CONCLUSION: A 7.7% rate of discrepant interpretations (347 of 4534 studies) was noted for a service offering second-opinion consultations for outside examinations. Most were discrepancies in detecting abnormalities rather than in interpreting identified findings. When a definitive diagnosis was obtainable, the second-opinion consultation was more accurate in 84% of studies. Review of outside studies benefits patient care.

OBJECTIVE: We performed this prospective study on patients with signs and symptoms of chronic venous disease to emphasize short saphenous vein (SSV) insufficiency, which is not routinely evaluated with Doppler ultrasonography in every center. METHODS: One hundred seventy-eight patients with signs and symptoms of chronic venous disease were included in the study. We used the CEAP (clinical, etiologic, anatomic, and pathophysiologic data) classification in evaluation of the limbs with isolated and nonisolated SSV incompetence. Patients were classified according to age, occupation, body mass index, and associated chronic illness. A chi(2) test and a t test were used in the statistical analysis. RESULTS: Reflux was observed in 190 (53%) of 356 limbs. In 11 limbs, isolated SSV reflux was observed. These 11 limbs were classified as CEAP grade 2 (3 limbs), CEAP grade 3 (3 limbs), and CEAP grade 4 (5 limbs). Short saphenous vein reflux was observed in 21 (5.9%) of 356 limbs. Mean SSV diameters were 3.89 mm (range, 1-11 mm) on the right and 4.03 mm (1.3-10 mm) on the left. CONCLUSIONS: No statistical significance was found between age, sex, body mass index, occupation, and associated chronic disease and deep or superficial venous system incompetence. A statistically significant difference was found between the SSV diameter of the limbs and associated venous incompetence.