US versus conventional radiography in the diagnosis of sternal fractures

Purpose: To investigate the value of ultrasonography (US) in the diagnosis of sternal fractures.Material and Methods: Twenty-three patients (mean age 35.4 years) with a clinical suspicion of sternal fracture after blunt chest trauma were retrospectively reviewed. At admission, a.p. and lateral chest radiographies and sternal US were obtained. Sternal fractures were classified as nondisplaced or displaced. US and conventional radiographic findings were compared.Results: In 3/23 (13.0%) of the patients, no fracture was found by radiography or by US. Both radiography and US demonstrated sternal fractures in 16/23 (69.6%) of the patients. Sternal fractures were detected only by US while the conventional radiography was negative in 2/23 (8.7%) cases. Also in 2/23 (8.7%) of the patients with US positive for fracture, radiographies were suspicious. In 2 patients, the degree of fracture displacement on US was lesser than that found by radiography.Conclusion: US was better than lateral radiography to diagnose sternal fractures; however, conventional radiography remains the standard means of demonstrating grade of displacement.     

痛风影像学诊断方法分析及发展

痛风是由于尿酸盐沉积产生的异质代谢性疾病,严重者可导致关节残疾引起肾功能损伤,但若能早期诊断该病或可逆转.众所周知,痛风不同时期有不同的临床表现和影像学表现.一般而言,在痛风早期,其双轨征特征明显,特异性高,适合采用超声法进行检测;在痛风反复发作期及慢性期,适合采用X线平片、CT和MRI等影像技术进行检测,其中MRI能...     

Digital chest radiography with a large-area flat-panel silicon X-ray detector: clinical comparison with conventional radiography

This was a radiologists' preference study to compare a digital chest radiography system that utilizes a large-area silicon flat-panel detector with conventional radiography for visualizing anatomic regions of the chest. Conventional and digital posteroanterior (PA) and lateral chest radiographs were obtained in 115 patients. The PA and lateral image pairs were compared independently by three radiologists rating the overall appearance, 11 anatomic regions in the PA, and 9 in the lateral views. Statistical analysis was performed with the Wilcoxon signed-rank test with Bonferroni-Holm adjustment (p=0.05). For the PA view, the digital system performed significantly better for the overall appearance and for all anatomic regions except for the peripheral pulmonary vasculature and hilum, where no significant difference was found. For the lateral digital images, the regions trachea, costodiaphragmatic recess, and hilum were rated significantly worse. The regions retrosternal and retrocardiac lung were rated significantly better. The other regions and the overall appearance showed no significant differences. The described digital chest radiography system showed statistically superior visualization of anatomic regions for PA and an ambiguous performance for lateral images as compared with conventional radiography. After changing some image processing parameters for the lateral view, this system may be suitable for digitalization of chest radiography.     

X线数字化断层融合成像在冈上肌出口位的肩峰下撞击综合征中的诊断价值

目的 探讨X线数字化断层融合（DTS）成像在冈上肌出口位的肩峰下撞击综合征（SIS）中的诊断价值。 方法 回顾性分析2017年7月至2020年1月于巴彦淖尔市医院因肩关节不适就诊,且经临床查体、MRI检查确诊的93例SIS患者的临床资料和影像学资料,其中男性56例、女性37例,年龄30~77（55.4±8.2）岁。所有患者均在MRI检查后 7 d 内,为明确是否有行肩峰成形术或肩袖重建术的必要而行X线数字化摄影（DR）和DTS成像检查。3种影像学检查方法测量的肩峰形态差异的比较采用非参数秩和检验,肩-肱距离（AHI）的比较采用方差分析,进一步两两比较采用最小显著差异法（LSD）-t检验。采用受试者工作特征（ROC）曲线计算3种影像学检查方法测量的AHI的曲线下面积（AUC）、灵敏度和特异度,AUC的比较采用Z检验。 结果 MRI、DR、DTS 3 种影像学检查方法对 SIS患者肩峰形态检查结果的差异无统计学意义（χ2=2.84,P＞0.05）。MRI、DR、DTS 3种影像学检查方法测量SIS患者AHI的差异有统计学意义[（8.37±1.21） mm对（8.91±1.50） mm对（8.66±1.25） mm,F=3.84,P<0.05],两两比较结果显示,MRI与DR的差异有统计学意义（t=−2.69,P<0.05）,而MRI与DTS、DR与DTS的差异均无统计学意义（t=−1.60、1.24,均P>0.05）。MRI、DTS、DR诊断AHI的灵敏度分别为 96.35%、96.36%、86.79%,特异度分别为72.44%、58.28%、54.73%,AUC分别为0.906、0.808、0.677,95%CI分别为0.839~0.951、0.727~0.874、0.586~0.760,三者间的差异有统计学意义（Z=3.01,P<0.05）。 结论 冈上肌出口位DTS是确诊SIS相对经济、实用的影像学检查方法,可以作为肩部不适患者的一种普查方法。     

Epiphyseal and physeal injury: comparison of conventional radiography and magnetic resonance imaging

PurposeTo compare conventional radiography and magnetic resonance imaging (MRI) in the assessment of epiphyseal and physeal injury.Materials and methodsSeventeen cases with epiphyseal and physeal injury were examined with conventional radiography and MRI. Two blinded experienced radiologists separately evaluated the results retrospectively.ResultsTwo Salter–Harris II fractures showed displacement of epiphysis and metaphyseal fragment, as well as T1 hypointensity and T2 hyperintensity in the physis on MRI. Three Salter–Harris IV fractures showed a fracture line in the epiphysis and metaphysis on two modalities, as well as linear T2 hyperintensity in the physis. All five slipped epiphysis showed signal intensity abnormality in the physis on MRI aside from the physeal widening and epiphyseal displacement seen on radiographs. Seven patients with bony bridge formation showed premature closure of the physis, shortening, and remodeling of the end of bones involved.ConclusionsConventional radiography and MRI are both useful in the diagnosis of epiphyseal and physeal injury. MRI can provide more detailed information, which could direct treatment planning and prognosis predicting.     

先天性肺结核：胸片在诊断中的价值

目的 探讨胸部X线片在先天性肺结核中的诊断价值。材料与方法 对1992年10月－1999年4月经细菌学检查或尸解证实的先天性肺结核5例进行了分析。结果 肺部X线表现虽复杂多变,但有两种形式的表现仍具有一定的特殊性;（1）弥漫性栗粒病变;（2）广泛分布的斑片－结节病变。结论 胸部X线片在先天性肺结核的诊断中具有十分重要的作用,它常能首先提出诊断,引导临床及时确诊和治疗,降低死亡率。     

Radiological evaluation of temporal bone disease: high-resolution computed tomography versus conventional X-ray diagnosis

Sixty-two patients with different temporal bone lesions were prospectively examined by high-resolution computed tomography (CT) and conventional plain radiography, including pluridirectional tomography. High-resolution CT enabled a clear diagnosis in 80% of cases, conventional radiology in 63%; 1.6-times more bone information was recorded by high-resolution CT which is clearly superior for imaging cholesteatomas, metastases and inflammatory processes and for evaluating osseous destruction. With regard to pathological soft tissue or effusions filling the tympanic cavities, conventional radiology shows poor sensitivity (0.61). High-resolution CT is the most sensitive method for the imaging and classification of temporal bone fractures, including labyrinthine damage and ossicular chain injuries. Only in cases of atypical fractures with an unfavourable relationship to the CT planes, can carefully directed tomography be more effective. In most cases high-resolution CT replaces conventional radiology and should be the method of choice for comprehensive radiological examination of the temporal bone.     

Compliance to Diagnostic Reference Levels for radiation exposure in common radiological procedures in Dutch hospitals: A nation-wide survey carried out by medical imaging students

IntroductionIn the Netherlands, hospitals have difficulty in implementing the formal procedure of comparing radiation dose values to Diagnostic Reference Levels (DRLs).MethodsTo support the hospitals, train radiography students, and carry out a nationwide dose survey, diagnostic radiography students performed 125 DRL comparisons for nine different procedures in 29 radiology departments. Students were instructed at three Dutch Universities of Applied Sciences with a radiography programme and supervised by medical physicists from the participating hospitals.ResultsAfter a pilot study in the western part of the country in eight hospitals, this study was enlarged to involve 21 hospitals from all over the Netherlands. The 86 obtained dose comparisons fall below the DRLs in 97% of all cases. This very high compliance may have been enhanced by the voluntary participation of hospitals that are confident about their performance.ConclusionThe results indicate that the current DRLs that were not based on a national survey, may need to be updated, sometimes to half their current value. For chest and pelvis examinations the DRLs could be lowered from 12 and 300 μGy·m² to the 75-percentile values found in this study of 5,9 and 188 μGy·m², respectively.     

双源CT痛风识别技术在检测尿酸盐沉积中的应用

目的 评价双能量CT(DECT)痛风识别技术在检测痛风患者尿酸盐结晶沉积中的应用.方法 回顾性分析108例近2周发作过单关节肿和(或)痛患者的患肢关节双能量CT扫描资料,其中符合美国风湿病学会(ACR) 1977年分类标准的痛风患者95例,非痛风组13例.95例痛风患者双能量CT扫描后得到的双能0.3比例融合图像组作为常规组;所获得的80 kV及140 kV图像输入痛风识别软件,后处理获得的伪彩图像组作为后处理组.观察常规组与后处理组发现的尿酸盐结晶,并采用x2检验比较;比较两组发现尿酸盐结晶的敏感度和准确率,并采用x2检验进行比较.结果 常规组中有51例患者能显示软组织内尿酸盐结晶,显示病灶的部位共298处;13例非痛风患者中有2例显示高密度结晶;常规组发现尿酸盐结晶的敏感度为53.7％,特异度为84.6％,准确率为57.4％.后处理组中69例患者发现散在的绿色的尿酸盐结晶,显示病灶的部位共401处;13例非痛风患者均未显示绿色的尿酸盐结晶;后处理组发现尿酸盐结晶的敏感度为72.6％,特异性为100.0％,准确率为75.9％.两组发现尿酸盐结晶的病灶数差异有统计学意义(x2=5.193,P＜0.05),发现尿酸盐结晶的敏感度和准确率差异也有统计学意义(x2值分别为7.329和8.333,P值均＜0.05).结论 DECT痛风识别技术能发现更多部位、更小体积的尿酸盐结晶,在痛风早期诊断、监测治疗疗效中有潜能.     

抗精神病药物致麻痹性肠梗阻的X线与超声诊断价值探讨

目的：探讨抗精神病药物所致麻痹性肠梗阻的X线和超声表现及其诊断价值。方法：回顾性分析临床确诊的47例抗精神病药物所致麻痹性肠梗阻的X线和超声检查资料，对比其影像学表现和诊断符合率。47例均行立位X线腹部平片和透视检查，其中36例同时行B超检查。结果：依据其典型影像学表现判定，X线诊断符合率为87．2％（41／47），6例漏诊；超声诊断符合率为83．3％（30／36），6例漏诊；卡方检验两者无显著性差异（P〉0.05）。结论：X线检查是诊断抗精神病药物所致麻痹性肠梗阻的首选方法，超声对肠腔积液的发现具有优越性。两者结合能够提高诊断符合率。     

双角度和单角度体层摄影与全数字化乳腺摄影的比较:高分辨率X线成像的观察研究

目的对于二维全数字化乳腺摄影与双角度(侧位和头尾位)和单角度(侧斜位)体层摄影进行诊断精确性的比较,该观察研究涉及两个研究所。材料与方法本研究获得伦理委员会批准,所有受试的女性均签订知情同意书。2008年     

Suspected rotator cuff lesions: tissue harmonic imaging versus conventional US of the shoulder

PURPOSE: To compare tissue harmonic imaging (THI) of the shoulder with conventional ultrasonography (US) in patients suspected of having rotator cuff lesions. MATERIALS AND METHODS: THI and conventional US images were obtained in 50 patients suspected of having rotator cuff lesions. Images were graded for visibility of acromioclavicular (AC) joint surfaces and rotator cuff tendon contours and substances: Grade 1 meant poor; grade 2, moderate; and grade 3, good visibility. Accuracy, sensitivity, and specificity of the diagnosis of AC joint osteoarthritis and accuracy of the diagnosis and rates of underestimation and overestimation of the extent of rotator cuff tears were evaluated. Visibility grade differences were evaluated with the Wilcoxon signed rank test. The McNemar test was used to assess differences in diagnoses. Magnetic resonance (MR) arthrography was the reference standard. RESULTS: Mean visibility grades for readers 1 and 2, respectively, were as follows: for AC joint bone surfaces, 2.1 and 2.0 with THI and 1.7 (P =.010) and 1.7 (P =.16) with conventional US; for AC joint capsule surfaces, 2.2 and 1.9 with THI and 1.8 (P =.005) and 1.8 (P =.34) with US; for supraspinatus tendon contour, 2.6 and 2.2 with THI and 2.1 (P =.001) and 1.9 (P =.055) with US; for supraspinatus tendon substance, 2.2 and 1.9 with THI and 2.0 (P =.036) and 1.7 (P =.070) with US; for subscapularis tendon contour, 2.4 and 2.1 with THI and 2.2 (P =.07) and 2.0 (P =.25) with US; and for subscapularis tendon substance, 1.8 and 1.7 with THI and 2.0 (P =.86) and 1.7 (P =.91) with US. Diagnostic accuracies for the supraspinatus tendon for readers 1 and 2, respectively, were 84% and 74% with THI and 86% and 70% with US (P >.99 for both readers). Corresponding values for the subscapularis tendon were 78% and 72% with THI and 64% (P =.27) and 52% (P =.006) with US. CONCLUSION: Joint and tendon surface visibility improves with THI, as compared with the visibility achieved with conventional US. THI is superior to conventional US for diagnosis of subscapularis tendon abnormalities.     

肺泡癌的X线表现及误诊分析

目的：肺泡癌的Ｘ线表现多种多样，易误诊，为提高认识，探讨其Ｘ线特点。方法：收集两家医院１９７３－１０～１９９６－０２经病理证实的肺泡癌７４例，均有两次以上胸片，此外，ＣＴ４１例，分层２７例。结果：首次胸片误诊３８例（５１．４％），四周内复查或作ＣＴ后纠正诊断９例（１２％），根据影像表现分为五型：１．粟粒型；２．多发结节型；３．≤３ｃｍ单发结节型，４．３～５．７ｃｍ块状型；５．肺炎型。上述各型误诊由高到低依次为肺炎型、单发结节型、粟粒型、多发结节型。结论：各型Ｘ线表现有其特点，全面分析，及时复查，可望提高诊断正确率。     

肺炎性假瘤41例X线和CT影像

目的探讨肺炎性假瘤的放射学及临床表现。方法对41例患者进行X线胸片及肺尖至肺底的螺旋CT容积扫描,并进行结果分析。结果肺炎性假瘤多位于肺的外围,按CT形态可分为结节或肿块型、浸润型。其特征性表现：桃尖征、平直征、灶周网点征和晕征及均匀强化等征象,注意分析肺部阴影前的病史及症状对诊断本病有帮助。结论CT影象对炎性假瘤的诊断具有重要价值。     

Ultrasound detection of bone erosions in rheumatoid arthritis: a comparison to routine radiographs of the hands and feet

Purpose To determine if ultrasound (US) of selected joints in the hands and feet can detect more erosions than radiography and establish the presence of erosive disease in patients with rheumatoid arthritis (RA).Methods Eighty joints in ten patients with RA and 40 joints in five healthy control subjects, who were age, gender and ethnicity-matched to the patients with arthritis, were prospectively studied with radiographs and sonography. Conventional radiographs of the hands and feet were obtained. US examinations of the 2nd and 5th metacarpal-phalangeal (MCP) joints of the hands, and the 1st and 5th metatarsal-phalangeal (MTP) joints of the feet were performed. Radiographs and US exams were independently graded for the presence of erosions.Results None of the control subjects had erosions. US detected erosions in 17/80, and radiographs detected erosions in 6/80 joints assessed with both modalities. US detected all erosions seen by radiographs in these selected joints. Erosive disease was present in the radiographs of seven of ten RA patients. US established erosive disease in eight of ten RA patients. US determined erosive disease in two of the three patients without radiographic erosions.Conclusions US of the MTP and MCP joints in RA can detect erosions not seen with radiography and may be complementary to radiography in establishing the presence of erosive disease in early RA.     

MR imaging- versus conventional X-ray fluoroscopy-guided renal angioplasty in swine: prospective randomized comparison

PURPOSE: To test the hypothesis that the technical success rates, complication rates, and procedural times for magnetic resonance (MR) imaging-guided percutaneous transluminal angioplasty (PTA) and conventional (x-ray) fluoroscopy-guided PTA for treatment of renal artery stenosis are similar. MATERIALS AND METHODS: The study was animal care and use committee approved. After surgically inducing bilateral renal artery stenosis in 11 swine, the authors performed baseline digital subtraction angiography. They transferred each animal to a 1.5-T MR imaging unit and randomly decided which artery would be treated with MR-guided PTA. With MR imaging guidance, angioplastic devices were tracked by using active and passive techniques. Vascular depiction was achieved by using catheter-directed MR angiography. Stenotic vessels were dilated by using 5-6-mm-diameter balloon catheters. PTA was then performed in the contralateral artery by using conventional fluoroscopy-guided techniques. With the intention to treat, the authors compared the technical success (residual stenosis < 50%) rates, complication rates, and procedural times for each guidance method. They compared technical successes and complications by using the McNemar test and procedural times by using a paired t test, with P < .05 indicating a significant difference. RESULTS: The authors successfully dilated nine (82%) of 11 renal arteries with MR guidance and all 11 arteries (100%) with conventional fluoroscopic guidance. The difference was not significant (P = .5). Complications occurred in three (27%) arteries with MR guidance and in one (9%) artery with fluoroscopic guidance, with no significant differences (P = .5). The mean MR-guided PTA procedural time was 46 minutes longer than the fluoroscopy-guided PTA procedural time; this difference was significant (P = .01). CONCLUSION: In a small cohort of swine, the authors did not observe a significant difference between MR imaging- and conventional fluoroscopy-guided renal artery PTA in terms of success and complication rates. However, no evidence of similarity between the techniques should be assumed. Procedural times differed significantly.     

Differentiation of benign from malignant solid breast masses: conventional US versus spatial compound imaging

PURPOSE: To compare prospectively the diagnostic performance of radiologists who used conventional ultrasonography (US) with that of radiologists who used spatial compound imaging for the differentiation of benign from malignant solid breast masses. MATERIALS AND METHODS: The study was approved by the institutional review board, and informed consent was obtained. Before excisional or needle biopsy was performed, conventional US and spatial compound images were obtained in 67 patients (age range, 25-67 years; mean age, 45 years) with 75 solid breast masses (21 cancers and 54 benign lesions). Three experienced radiologists who did not perform the examinations independently analyzed US findings and indicated the probability of malignancy. Results were evaluated with kappa statistics and receiver operating characteristic (ROC) analysis. RESULTS: For US findings, the presence of calcifications was the most discordant feature (kappa = 0.372) between conventional US and spatial compound imaging, followed by echotexture (kappa = 0.439), boundary echo (kappa = 0.496), orientation (kappa = 0.518), echogenicity (kappa = 0.523), shape (kappa = 0.526), margin (kappa = 0.569), and posterior acoustic transmission (kappa = 0.669). The area under the ROC curve for conventional US was 0.79 for reader 1, 0.88 for reader 2, and 0.82 for reader 3, and the area under the ROC curve for spatial compound imaging was 0.85 for reader 1, 0.88 for reader 2, and 0.89 for reader 3. The partial area index for conventional US was 0.29 for reader 1, 0.69 for reader 2, and 0.39 for reader 3, and the partial area index for spatial compound imaging was 0.29 for reader 1, 0.65 for reader 2, and 0.39 for reader 3. The difference between the diagnostic performances of the two techniques was not significant (P > .05). CONCLUSION: The performance of the radiologists with respect to the characterization of solid breast masses was not significantly improved with spatial compound imaging.     

早期先天性骨梅毒的X线诊断价值

目的:探讨先天性梅毒早期骨骼改变的X线表现,提高对早发型先天性骨梅毒的认识。方法:搜集我院42例先天性梅毒患儿的骨骼X线片和临床资料,分析其X线表现。结果:42例早期先天性梅毒患儿中34例有骨异常改变,表现为:(1)长管状骨:①骨膜炎7例;②干骺端改变:先期钙化带异常8例,干骺端透亮线形成19例,干骺端密度增高18例,干骺端呈尖角样改变15例;③骨质破坏5例;(2)不规则骨:髂骨缘透亮线形成9例,跟距骨尖角样改变5例,透亮线形成1例,骨质破坏1例,坐骨透亮线1例;(3)其他:软组织内多发钙化灶1例。结论:早期先天性梅毒的骨改变有一定的特征性,X线摄影可以辅助临床诊断早发型先天性骨梅毒,评估骨损害的程度。     

The impact of technical conditions of X-ray imaging on reproducibility and precision of digital computer-assisted X-ray radiogrammetry (DXR)

Objective To evaluate the reproducibility of imaging and analysis for bone mineral density (BMD) determination using digital computer-assisted X-ray radiogrammetry (DXR; Pronosco X-posure, version V.2, Sectra Pronosco, Denmark); to verify potential factors that influence BMD extrapolation such as tube voltage, film-focus distance (FFD), film quality and brand (Kodak T-MAT-Plus, Konika SRH, Agfa Scopix), imaging technology (conventional, digital), imaging system (Kodak, Agfa) and exposure level (mAs); and to clarify whether DXR analysis based on printouts of digital images is comparable to analysis of conventional images.Design and patients The hand of a cadaver was X-rayed using varied parameters: 4–8 mAs, 40–52 kV, 90–130 cm FFD. Radiographs under standardised conditions were performed 10 times using a conventional machine (Philips Super 80 CP) and the printouts of a digital system (Digital Diagnost Philips Optimus) for the analysis of reproducibility. One image was scanned and analysed 10 times additionally for imaging reproducibility.Results Reliability error of the system for the imaging process using conventional radiographs-rays was 0.49% (standard conditions: 6 mAs, 40 kV, 1 m FFD), using printouts of digital images was 2.89% (4 mAs, 42 kV, 1 m FFD) and regarding the analysis process was 0.22%. BMD calculation is not affected by alterations in FFD (precision error 1.21%), mAs (0.83%) or film quality/brand (0.38%), but differs significantly depending on tube voltage (2.70%). The system was not able to analyse conventional images with tube voltages of 49/52 kV.Conclusion DXR technology is stable with most of the tested parameters. Normative data should exclusively be used for calculations using similar tube voltage or correction factors. All other parameters had no significant influence on the BMD calculation. Reproducibility is high. For technical reasons it is not recommended to use the printouts of digital images for BMD determination.