- Number Needed to Treat with Vertebral Augmentation to Save a Life
The purpose of this study was to calculate the number needed to treat to save 1 life at 1 year and up to 5 years after vertebral augmentation. A 10-year sample of the 100% US Medicare data base was used to identify patients with vertebral compression fractures treated with nonsurgical management, balloon kyphoplasty, and vertebroplasty. The number needed to treat was calculated between augmentation and nonsurgical management groups from years 1–5 following a vertebral compression fracture diagnosis, using survival probabilities for each management approach. The adjusted number needed to treat to save 1 life for nonsurgical management versus kyphoplasty ranged from 14.8 at year 1 to 11.9 at year 5. The adjusted number needed to treat for nonsurgical management versus vertebroplasty ranged from 22.8 at year 1 to 23.8 at year 5. The authors conclude that the NNT analysis of more than 2 million patients with VCF reveals that only 15 patients need to be treated to save 1 life at 1 year. This has an obvious clinically significant impact and given that all augmentation clinical trials are underpowered to detect a mortality benefit, this large dataset analysis reveals that vertebral augmentation provides a significant mortality benefit over nonsurgical management with a low NNT.
- Identification of Vortex Cores in Cerebral Aneurysms on 4D Flow MRI
The authors subjected 40 aneurysms (37 unruptured, 3 ruptured) to 4D flow MR imaging. They visualized streamlines with velocities below the threshold—that is, a percentage value of the aneurysm maximum inflow velocity—and progressively decreased the threshold to identify vortex cores as thin, streamline bundles with minimum velocities. A simple flow pattern (single vortex core) was identified in 27 aneurysms; the other 13 exhibited a complex flow pattern. The cores were stable in 32 and unstable in 8 aneurysms. Significantly more aneurysms with-than-without blebs or daughter sacs had a complex flow pattern. The identification of vortex cores on 4D flow MR imaging may help to stratify the rupture risk of unruptured cerebral aneurysms.
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