Multidetector CT of blunt traumatic venous injuries in the chest, abdomen, and pelvis

Venous injuries as a result of blunt trauma are rare. Even though current protocols for multidetector computed tomography (CT) of patients with trauma are designed to evaluate primarily the solid organs and arteries, blunt venous injuries may nevertheless be identified, or at least suspected, on the basis of the multidetector CT findings. Venous injuries are associated with high morbidity and mortality rates. Diagnosis of a possible venous injury is crucial because the physical findings of a venous injury are nonspecific and may be absent. This article aims to make the radiologist aware of various venous injuries caused by blunt trauma and to provide helpful hints to aid in the identification of venous injuries. Multidetector CT technology, in combination with interactive manipulation of the raw dataset, can be useful in the creation of multiplanar reconstructed images and in the identification of a venous injury caused by blunt trauma. Familiarity with direct and indirect signs of venous injuries, as well as with examples of blunt traumatic venous injuries in the chest, abdomen, and pelvis, will help in the diagnosis of these injuries.     

胸部、腹部或盆腔螺旋CT容积灌注扫描的放射剂量

目的评估进行胸部、腹部或盆腔螺旋CT容积灌注扫描的放射剂量。方法记录因评估肿瘤而行CT(4Dadaptivespiral,适应性全器官四维螺旋技术)检查的病人的剂量-长度乘积(dose-length product,DLP)、CT剂量指数(CTDIvol)和有效剂量(E)的计算结果。同时评估有关质量的强化峰值     

Opportunistic CT screening of osteoporosis on thoracic and lumbar spine: a meta-analysis

BackgroundOsteoporotic fractures are a major contributor to late life morbidity and mortality, and impose a substantial societal cost, yet osteoporosis remains substantially underdiagnosed and undertreated. The purpose of this meta-analysis was to assess the pooled diagnostic sensitivity and specificity of computed tomography (CT) images for diagnosing osteoporosis in patients who meet WHO dual X-ray absorptiometry (DXA) osteoporosis criteria using specific Hounsfield unit (HU) values as a threshold.MethodsSystematic literature searches in PubMed, Embase, Web of Science and Google Scholar were performed from the earliest available date through 1 July 2018, restricted to publications in English. Participants in all studies underwent CT scans that included the lumbar and/or thoracic spine for different indications and HU measurements were used to identify osteoporosis. DXA scans served as the reference standard.ResultsTen eligible studies were identified. The mean area under the hierarchical summary receiver operating characteristic (ROC) curve for diagnosis osteoporosis was 0.84 (95% CI: 0.81, 0.87). The pooled diagnostic sensitivity and specificity of CT images to identify osteoporosis were 0.83 (95% CI: 0.73, 0.90) and 0.74 (95% CI: 0.69, 0.79). The positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio were 3.4 (95% CI: 2.7, 4.5), 0.21 (95% CI: 0.12, 0.36), and 16.4 (95% CI: 7.8, 34.3), respectively. The bias-adjusted sensitivity and specificity of CT were 0.73 and 0.71. Meta-regression demonstrated that country of study, DXA criteria and scanner manufacturer were significant factors associated with the sensitivity of CT in detecting osteoporosis while scanner manufacturer was the only factor associated with specificity of CT.ConclusionsThis meta-analysis showed reasonable pooled sensitivity and specificity for using threshold values measured on CT scans to identify osteoporosis opportunistically.     

Chordomas: their CT appearance in the cervical, thoracic and lumbar spine

We reviewed 25 CT scans of 21 patients who had chordomas in the cervical, thoracic, or lumbar spine. Nine patients were studied at the time of initial presentation and 12 after tumor recurrence. All scans showed vertebral body destruction coupled with an associated soft tissue mass located anteriorly or laterally. Additional CT findings included septated areas of low attenuation within the tumor, amorphous soft tissue calcification, tumor extension into the spinal canal, disk space involvement, and contrast enhancement.     

Radiation dose from volumetric helical perfusion CT of the thorax, abdomen or pelvis

Purpose

To evaluate the radiation doses delivered during volumetric helical perfusion CT of the thorax, abdomen or pelvis.

Materials and methods

The dose-length product (DLP) and CT dose index (CTDIvol) were recorded and effective dose (E) determined for patients undergoing CT (4D adaptive spiral) for tumour evaluation. Image noise and contrast to noise (CNR) at peak enhancement were also assessed for quality.

Results

Forty two consecutive examinations were included: thorax (16), abdomen (10), pelvis (16). Z-axis coverage ranged from 11.4 to 15.7?cm. Mean DLP was 1288.8?mGy.cm (range: 648 to 2456?mGy.cm). Mean CTDIvol was 96.2?mGy (range: 32.3 to 169.4?mGy). Mean effective dose was 19.6?mSv (range: 12.3?mSv to 36.7?mSv). In comparison mean DLP and effective dose was 885.2?mGy.cm (range: 504 to 1633?mGy.cm) and 13.3 mSV (range: 7.8 to 24.5?mSv) respectively for the standard staging CT thorax, abdomen and pelvis. Mean tumour CNR at peak enhancement was 1.87.

Conclusion

The radiation dose imposed by perfusion CT was on average 1.5 times that of a CT thorax, abdomen and pelvis. The dose is not insubstantial, and must be balanced by the potential clinical utility of additional physiologic data. Further efforts towards dose reduction should be encouraged.     

Helical CT protocols for the abdomen and pelvis: a survey

OBJECTIVE: We surveyed members of the Society of Computed Body Tomography/Magnetic Resonance to evaluate current techniques used for helical CT in the abdomen and pelvis. MATERIALS AND METHODS: The survey was distributed to 70 members (36 institutions) of the Society of Computed Body Tomography/Magnetic Resonance. The survey included general questions related to abdominal and pelvic helical CT and also asked the members to write a protocol for 12 hypothetical requisitions. RESULTS: Thirty-two members (46%) responded, representing 28 institutions (78%). The number of protocols for helical CT of the abdomen and pelvis at each institution ranges from 2 to 35 (median, 11). IV contrast material is administered for 90% (median) of abdominal and pelvic CT examinations. Nonionic contrast material is used for 68% (median) of these examinations. IV contrast material is used by 100% of institutions for tumor staging protocols except for one institution that does not use IV contrast material for lymphoma staging. Fifty percent of the institutions obtain two- or three-phases of liver images for breast cancer staging. For all protocols, the average collimation and reconstruction interval is 7 mm except for renal (5 mm) and adrenal (4 mm) protocols. Rectal contrast material is administered most commonly for colon cancer staging (39% of institutions). CONCLUSION: There is a wide range in the number of protocols used for helical CT in the abdomen and pelvis among the responding institutions. Most protocols include use of nonionic IV contrast material injected at a rate of 3 ml/sec and a collimation of 7 mm.     

侧前路钛板内固定在胸腰椎陈旧性骨折中的应用体会

探讨Z-plate^TM前路钢板内固定系统在胸腰椎陈旧性骨折内固定术中的作用及价值,其具有操作简单、并发症少、生物相容性好、复位固定满意、植骨融合率高等特点。     

Radiological parameters and radiation doses of patients undergoing abdomen, pelvis and lumbar spine X-ray examinations in three Nigerian hospitals

Thermoluminescent dosemeters (TLDs) have been used to measure the entrance surface doses (ESDs) of patients undergoing pelvis, abdomen and lumbar spine diagnostic X-ray examinations in Nigeria. A total of three public hospitals and 171 patients were included in this investigation. The ages of the patients involved were from 40 years to 85 years, while their weights ranged from 64 kg to 73 kg. Mean, median, first and third quartiles of ESDs are reported. The results showed that in most cases, for each of the examinations, the individual ESD values are found to be comparable with, and higher than, those from Ghana and Tanzania, respectively. The mean ESD values are also found to be within the range of mean ESD values that have been previously been reported from countries outside Africa. When compared with the European Community (EC) reference values, the mean ESDs were found to be below the reference values in only two of the hospitals. The ranges found in this work are high and this indicates more attention needs to be given to X-ray facilities in the country. This also suggests that radiographic departments need to review their radiographic practices in order to bring their doses to optimum levels. Effective doses were also calculated from the ESD values. The mean effective doses were found to be generally low when compared with those found in the literature from other countries including two African countries. The radiographic parameters used for all the patients were also compared with the European criteria. It is recommended that the tube filtration at one hospital be increased. The importance of good regulatory activities and trained personnel is stressed in this work. Apart from the fact that the data provided in this work will be useful for the formulation of national guidance levels, they also provide patient dosimetry information on healthcare level IV countries.     

The prone position for CT of the lumbar spine

In scanning the L5-S1 disk space, the known technical difficulty is limitation of the gantry angle. A prone scanning technique used to examine the lumbar spine may help to overcome or lessen this problem. A prospective CT scanning of the L5-S1 level was performed in both the prone and supine positions on 25 patients who had low back pain and who had not undergone previous laminectomy or fusion. The angle between the S1 vertebral end plate and maximum tilted gantry line (15 degrees on the G.E. 8800) was measured in the supine position and compared with the same angle in the prone position. In 20 of 25 cases (80%), significant improvement in alignment was noted in the prone position. The prone scanning technique is also more desirable if CT is performed with metrizamide. Finally, printed images from the prone technique allow easier image-patient orientation for viewing in the operating room.     

Metastatic lobular carcinoma of the breast: patterns of spread in the chest, abdomen, and pelvis on CT

OBJECTIVE: We determined the pattern of spread of metastatic lobular carcinoma in the chest, abdomen, and pelvis on CT. MATERIALS AND METHODS: We identified 57 women (age range, 30-79 years; mean age, 57 years) with metastatic lobular carcinoma of the breast who underwent CT of the chest, abdomen, or pelvis between 1995 and 1998. Then two experienced oncology radiologists retrospectively reviewed 78 CT examinations of those patients to identify sites of metastatic disease and to identify complications caused by metastases. RESULTS: Metastases were identified in bone in 46 patients (81%), lymph nodes in 27 patients (47%), lung in 19 patients (33%), liver in 18 patients (32%), peritoneum in 17 patients (30%), colon in 15 patients (26%), pleura in 13 patients (23%), adnexa in 12 patients (21%), stomach in nine patients (16%), retroperitoneum in nine patients (16%), and small bowel in six patients (11%). Eighteen patients (32%) had gastrointestinal tract involvement that manifested as bowel wall thickening. Hydronephrosis was present in six patients (11%). CONCLUSION: Although lobular carcinoma metastasized to common metastatic sites of infiltrating ductal carcinoma, lobular carcinoma frequently metastasized to unusual sites, including the gastrointestinal tract, peritoneum, and adnexa. Gastrointestinal tract involvement was as frequent as liver involvement, appearing as bowel wall thickening on CT. Hydronephrosis was a complication of metastatic lobular carcinoma.     

胸腰椎爆裂骨折105例CT诊断及临床意义

探讨CT对胸椎和腰椎爆裂骨折的诊断及临床意义。CT在显示脊柱三柱结构、附件骨折、椎管狭窄及脊髓受压损伤等方面优于X线平片,有利于指导临床治疗。     

3-D MRI/CT fusion imaging of the lumbar spine

Objective  

The objective was to demonstrate the feasibility of MRI/CT fusion in demonstrating lumbar nerve root compromise.     

"漏斗技术"在胸腰椎椎弓根钉内固定中的应用

目的探讨"漏斗技术"置入胸腰椎椎弓根螺钉的准确性并探讨其置钉方法。方法 69例胸椎或腰椎骨折、15例腰椎滑脱患者采用漏斗技术置入胸腰椎椎弓根螺钉,术中根据第12肋骨、骶骨或骨折的横突等标志确定椎体次序,记录置入操作中和术后并发症,其中34例术后行CT断层扫描检查判断螺钉的位置,记录穿透骨皮质螺钉的数目和距离。结果采用"漏斗技术"置入胸椎及腰椎椎弓螺钉338枚,1例术中即发现椎体次序定位错误。所有病例术后X线片观察椎弓根螺钉位置良好,CT观察136枚螺钉有5枚穿透椎体前骨皮质,无一枚穿透椎弓根内侧壁;术中和术后未出现神经、血管和脑脊液漏等并发症。结论椎弓根漏斗技术植入螺钉的方法是可靠、可行的。     

新型脊柱固定器械治疗胸腰椎爆裂性骨折

目的：观察新型脊柱固定器械治疗胸腰椎爆裂性骨折的临床结果。方法：用本法治疗１０例胸椎和２２例腰椎的爆裂性骨折。结果：经临床观察和随访,疗效满意,伴有神经症状的２８例中２４例中获得改善。１６例完全恢复,结论：根据临床需要,该器械可行压缩、撑开、成角和中立位固定。作者强调脊柱损伤只要有手术指征,手术时机甚为重要,早期或立即手术有利于脊柱骨折和椎管前方骨块的复位,早期复位也有利于神经功能的恢复。     

Quality criteria implementation for brain and lumbar spine CT examinations

A study was undertaken to implement the quality criteria proposed by the European Commission for brain general and lumbar spine (disc herniation) CT examinations. The proposed criteria were evaluated for samples including 93 brain and 86 lumbar spine CT examinations, with special emphasis on the diagnostic and radiation dose requirements. The extent to which the image criteria had been achieved was evaluated after two independent observers had each read the images twice. Dose measurements were conducted in parallel to estimate the proposed dose quantities needed to obtain the images. For brain examinations, we found that a group of image criteria were largely met, and met uniformly in all sites. One criterion (1.2.5) was frequently fulfilled but had intermediate values for two sites; the remaining criteria were fulfilled to different extents, although for criteria 1.2.1 and 1.2.2, scores were lower than 50% and 70%, respectively. The mean percentage image quality score had values between 57% and 78%, with variation coefficients in the range 30-68%. Mean values of the dose quantities were in the ranges 44-74 mGy for weighted CT dose index (CTDIw), 497-1018 mGy cm for dose-length product (DLP) and 1.1-2.2 mSv for effective dose (E). CTDIw and DLP were not correlated because of significant variations in the scanned length, whereas DLP and E were strongly correlated. A weak relationship between image quality score and DLP was found for the sample as a whole. For lumbar spine examinations, none of the critical reproduction image criteria was systematically achieved. One group of criteria (1.2.7, 1.2.8 and 1.2.9) was fulfilled to a large extent in many departments, but fulfilment of the remainder varied widely. The mean score fluctuated in the range 39-88%, with three groups of differences: low (39-51%), intermediate (67-71%) and high (85-88%). Mean values of the CTDIw varied between sites in the range 27-48 mGy. Mean DLP values varied between 188 mGy cm and 333 mGy cm, and the mean effective dose ranged between 3 mSv and 5 mSv. There were significant differences in effective dose between men and women. By sites, there was no relationship between DLP and mean score, with the highest image score associated with intermediate dose values. The percentage disagreement among the observers about a given criterion ranged between 2% and 22% for brain, and between 3% and 46% for lumbar spine.