Comparison of Hospitalization Costs and Medicare Payments for Carotid Endarterectomy and Carotid Stenting in Asymptomatic Patients • R.J. McDonald, D.F. Kallmes, and H.J. Cloft
What is more expensive, carotid endarterectomy or stenting? The authors used Medicare data from elderly patients to explore this issue and identify variables that increased costs. Data were obtained from government sources for 2001-2008 and a total of 12,485 stentings and 181,200 endarterectomies were studied. Not surprisingly, the payments for stenting were $3241 less than costs and those for endarterectomy were $1318 less than costs. Greater disparities between payment and costs were found for patients with unfavorable outcomes. Draw your own conclusions.
Requirements for Emergent Neurosurgical Procedures among Patients Undergoing Neuroendovascular Procedures in Contemporary Practice • R. Khatri, M. Ansar, F. Sultan, S.A. Chaudhry, A.A. Khan, G.J. Rodriguez, R.P. Tummala, and A.I. Qureshi
Adjunctive emergent neurosurgery is always a consideration for patients undergoing neuroendovascular procedures. These authors reviewed 933 procedures done at 2 stroke centers during a 5-year period. Only 8 patients required surgery and just 3 were done immediately. Within this group, 5 deaths occurred. The most common surgeries were ventriculostomies and decompressive craniotomies. The conclusion was that the need for emergent surgery in patients undergoing neurovascular procedures is very low.
Natural History of Pain in Patients with Conservatively Treated Osteoporotic Vertebral Compression Fractures: Results from VERTOS II • A. Venmans, C.A. Klazen, P.N.M. Lohle, W.P. Mali, and W.J. van Rooij
What is the natural history of pain in patients treated with vertebroplasty vs those treated conservatively? In this article, the authors analyzed data from patients enrolled in the VERTOS II trial. The end point was 1 year from treatment in 95 conservatively managed patients. Most had sufficient pain relief during the initial 3 months, but at 1 year a substantial portion had disabling pain despite stronger medication. No predicting factors were found. Patients with pain after 3 months may be candidates for vertebroplasty.
Fellows’ Journal Club
Distinguishing between Germinomas and Pineal Cell Tumors on MR Imaging • N. Dumrongpisutikul, J. Intrapiromkul, and D.M. Yousem
Can one distinguish germinomas from pineal cell tumors or do they look the same on MRI? ADC values, T1-, and T2-weighted images from 20 patients with preoperative pineal tumors were assessed in an attempt to differentiate between these 2 tumors. The only significant difference was higher ADC values for germinomas. T1 and T2 images were not capable of differentiating between these tumors. Patients with germinomas were younger than those with pineal cell tumors (pineoblastomas, papillary tumor, and intermediate tumor).
Does MR Perfusion Imaging Impact Management Decisions for Patients with Brain Tumors? A Prospective Study • C.P. Geer, J. Simonds, A. Anvery, M.Y. Chen, J.H. Burdette, M.E. Zapadka, T.L. Ellis, S.B. Tatter, G.J. Lesser, M.D. Chan, K.P. McMullen, and A.J. Johnson
We spend a lot of time using and analyzing perfusion studies in patients with brain tumors, but do these help? After neuroradiologists evaluated conventional and perfusion imaging, a multidisciplinary team of treating physicians created hypothetic treatment plans based on clinical presentation, routine MRI, and perfusion studies. The addition of perfusion increased confidence in status assessment by 40% for neuroradiologists and 56% for the treatment team. Neuroradiologists and the management team found perfusion helpful and wanted it included in future MRI studies in over 80% of these patients. Thus, perfusion has a significant impact in the management of brain tumors.
The Effect of Age and Cerebral Ischemia on Diffusion-Weighted Proton MR Spectroscopy of the Human Brain • D.D. Zheng, Z.H. Liu, J. Fang, X.Y. Wang, and J. Zhang
Are MRS findings different for older and younger stroke patients? The ADC values of 3 MRS metabolites were studied in healthy younger and older patients as well as patients with acute and subacute cerebral ischemia. This new technique obtains diffusion information of Cho, Cr, and NAA. Older healthy adults showed lower ADC values for all 3 metabolites. In infarctions, these metabolites decreased during the acute period and increased during the subacute stage. When analyzing DWI-MRS, age differences must be considered and this new technique may offer data that can reveal the pathologic status of ischemia (also see the accompanying commentary by Mullins).