MRI of the Ankle: Effect on Diagnostic Confidence and Patient Management

Bearcroft, P.W.P.; Guy, S.; Bradley, Michelle; Robinson, Fred Byron

doi:10.2214/ajr.05.1071

Cited by 20 publications

(12 citation statements)

References 13 publications

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“…31,33 Higher frequencies were shown for MRI in joint diseases but were still ,50%. 32,34 The major factor behind the high therapeutic decision efficacy outcome in our study was probably the strict selection criteria achieved by stringent adherence to the European Commission guidelines. 29 The 57 patients represent 4% of all examined patients during the study period.…”

Section: Consideration Of the Resultsmentioning

confidence: 92%

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The effect of cone beam CT (CBCT) on therapeutic decision-making in endodontics

Almeida¹,

Knutsson²,

Flygare³

2014

Dentomaxillofacial Radiology

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Objectives: The aim was to assess to what extent cone beam CT (CBCT) used in accordance with current European Commission guidelines in a normal clinical setting has an impact on therapeutic decisions in a population referred for endodontic problems. Methods: The study includes data of consecutively examined patients collected from October 2011 to December 2012. From 2 different endodontic specialist clinics, 57 patients were referred for a CBCT examination using criteria in accordance with current European guidelines. The CBCT examinations were performed using similar equipment and standardized among clinics. After a thorough clinical examination, but before CBCT, the examiner made a preliminary therapy plan which was recorded. After the CBCT examination, the same examiner made a new therapy plan. Therapy plans both before and after the CBCT examination were plotted for 53 patients and 81 teeth. As four patients had incomplete protocols, they were not included in the final analysis. Results: 4% of the patients referred to endodontic clinics during the study period were examined with CBCT. The most frequent reason for referral to CBCT examination was to differentiate pathology from normal anatomy, this was the case in 24 patients (45% of the cases). The primary outcome was therapy plan changes that could be attributed to CBCT examination. There were changes in 28 patients (53%). Conclusions: CBCT has a significant impact on therapeutic decision efficacy in endodontics when used in concordance with the current European Commission guidelines.

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Section: Consideration Of the Resultsmentioning

confidence: 92%

“…therapeutic decision efficacy, in Fryback and Thornbury's 30 hierarchical model. Other studies [31][32][33][34] have used quite similar designs to assess diagnostic thinking efficacy (Level 3) and therapeutic efficacy (Level 4) of other imaging methods in diverse fields. These kinds of studies have inherent limitations.…”

Section: Methodological Considerationsmentioning

confidence: 99%

The effect of cone beam CT (CBCT) on therapeutic decision-making in endodontics

Almeida¹,

Knutsson²,

Flygare³

2014

Dentomaxillofacial Radiology

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“…This study is considered a before-and-after study, which is a design that has been appraised and is used to study the impact of diagnostic tests on diagnostic and therapeutic choices at levels 3 and 4 (Fineberg et al 1977, Wittenberg et al 1978, Fryback & Thornbury 1991, Hobby et al 2001, Bearcroft et al 2006, Shelley et al 2014. The recommendations proposed by Guyatt et al (1986) were followed to optimise such study designs, which include a prospective study design with a well-defined consecutive population and (100) D1) CBCT examination confused the examiner's understanding of the patient's disease and led to investigations that the examiner would not otherwise have performed; D2) CBCT examination confused the examiner's understanding of the patient's disease but did not lead to any additional investigations; D3) CBCT examination had no effect or little effect on the examiner's understanding of the patient's problem; D4) CBCT examination provided information that significantly improved the examiner's understanding of the patient's problem; D5) CBCT examination provided the only information for the examiner's understanding of this patient's problem.…”

Section: Discussionmentioning

confidence: 99%

The impact of cone beam computed tomography on the choice of endodontic diagnosis

2014

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Aim To determine whether the outcome of cone beam computed tomography (CBCT) examinations performed in accordance with the European Commission guidelines in a clinical setting has an impact on choosing diagnoses in endodontics. Methodology A prospective observational study was conducted. Fifty-three consecutive patients (81 teeth) from two different endodontic specialist clinics in Sweden were followed. After performing a thorough clinical examination (based on the history, clinical findings, and diagnostic tests such as intra-oral radiography), the examiner wrote down a preliminary diagnosis before CBCT examination. After the CBCT examination, a new diagnosis was made by the same examiner. Both the pre-and the post-CBCT examination diagnoses were plotted according to patients and teeth. The CBCT examinations were performed using similar equipment and protocols that were standardized amongst the clinics. Results The diagnoses were changed for at least one tooth in 22 patients (41%); overall, the diagnoses were changed for 28 teeth (35%). Conclusion CBCT has a substantial impact on diagnostic thinking in endodontics when used in accordance with the European Commission guidelines.

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“…18,32,39 MRI findings can detect a great deal of abnormalities not seen on plain radiographs and can have a significant impact on clinical decision making. 2 As with the hip and the knee, there is a wide variety of ankle imaging techniques. A general rule of thumb is to image in the smallest possible field of view, while still covering the anatomy in question.…”

Section: Ankle Tmentioning

confidence: 99%