Diagnosis of acute fractures of the extremities: comparison of low-field MRI and conventional radiography

The aim of this study was to compare low-field MRI (0.2 T) and conventional radiography for the detection of acute fractures of the distal part of the extremities. X-ray and MRI examinations of 78 (41 fractures, 37 without fracture) patients with the clinical suspicion of an acute fracture in the distal part of the extremities were compared. Four experienced radiologists, two for each of the two modalities, independently analyzed the images. Interobserver variability and receiver operating characteristic (ROC) analysis for both methods were established. The MRI and conventional radiography revealed an accuracy of 81.4 and of 79.5%, respectively, in the detection of acute fractures. The diagnostic accuracy of MRI to detect fractures in the hand and forefoot proved to be significantly inferior to conventional X-ray examinations. On the other hand, MRI achieved a better accuracy for the examination of bones near a large joint. The interobserver variability for both methods was rated as moderate. In ROC analysis both methods were rated as good. There was no statistical difference of the accuracy between low-field MRI and conventional radiography in the detection of acute fractures of the distal part of the extremities. Consequently, a routine use of low-field MRI as an alternative to conventional radiography to diagnose acute fractures of the extremities seems not to be justified.     

Panoramic versus conventional radiography of scaphoid fractures

OBJECTIVE: The objective of this study was to compare the diagnostic value of panoramic and conventional radiography in the detection of fractures of the carpal scaphoid bone. MATERIALS AND METHODS: Panoramic (orthopantomographic) and conventional radiographs of 90 patients with acute or chronic wrist trauma were reviewed retrospectively. Images were analyzed and reviewed independently by four observers: two radiologists and two traumatologists. The kappa statistic was used to calculate intraand interobserver agreement and the correlation between the two imaging techniques. RESULTS: Panoramic radiography of the wrist was superior to conventional radiography in ruling out scaphoid fractures (74%, 20/27) in patients with suspicious findings on conventional radiography; revealed more cases of scaphoid fractures (21.4%, 12/56); and revealed more cases of delayed union (n = 2), nonunion (n = 3), and union (n = 3). Agreement values were higher, with better inter- and intraobserver agreement, for the panoramic examinations than for the conventional radiographic examinations. CONCLUSION: The panoramic examination of the wrist is a useful technique for the diagnosis and follow-up of scaphoid fractures. Its use is recommended as a complement to conventional radiography in cases with inconclusive findings.     

Fracture healing: direct magnification versus conventional radiography

The aim of the study was to evaluate the potential of magnification radiography in diagnosing fracture healing and assessing its complications. Seventy-three patients with fractures or who had undergone osteotomy were radiographed with both conventional (non-magnified) and magnification (5-fold) techniques. Since 10 patients were radiographed twice and 1 three times, 83 radiographs using each technique were obtained. All radiographs were analysed and the findings correlated with the patients' follow-up studies. The microfocal X-ray unit used for magnification radiography had a focal spot size of 20–130 m. As an imaging system, digital luminescence radiography was employed with magnification, while normal film-screen systems were used with conventional radiography. Manification radiography proved superior to conventional radiography in 47% of cases: endosteal and periosteal callus formations were sen earlier and better in 26 cases, and osseous union could be evaluated with greater certainty in 33 cases. In 49% of cases magnification radiography was equal and in 4% inferior to conventional radiography. Additionally an inter-observer analysis was carried out. Anatomical and pathological structures were classified into one of four grades. Results were significantly (P < 0.01) better using magnification radiography. We conclude that the magnification technique is a good method for monitoring fracture healing in its early stages.     

计算机辅助检测肺结节在数字化X线胸片肺癌筛查中的应用价值

目的 评价计算机辅助检测(CAD)肺结节系统在数字化X线胸片上肺癌筛查中的应用价值.方法 由1名放射科医师和CAD肺结节检测系统独立阅读100例连续的数字摄影(DR)X线胸片,CAD系统可以检出最长直径在5～15 mm的肺结节.由2名放射科专家(有15年胸部影像诊断经验)进行回顾性阅读,参照相应的CT图像,两人意见达成一致后标记真结节的个数和位置并保存标记结果,将标记结果作为金标准来比较放射科医师和CAD系统的肺结节检测敏感性和假阳性率.结果 放射科医师共检测到95个结节,CAD系统共检测到304个结节.在回顾性检查中2名放射科专家共标记134个真结节,其中放射科医师检测到82个(61.2%),CAD检测到105个(78.4%),CAD系统检测到而被放射科医师漏诊的结节35个,放射科医师检测到而CAD系统漏诊的结节10个.放射科医师应用CAD系统后检测到112个真结节,检测率提高到83.6%.放射科专家意见一致后认为CAD系统检出199个假阳性结节,平均每张胸片约2.0个.结论 在肺癌筛查中放射科医师和CAD系统必须联合应用才可以识别X线胸片中所有的结节.     

不同部位放大像与普通X线平片对照分析(附210例分析)

目的：探讨放大像与普通Ｘ线平片对同一部位骨质病变的诊断效果。材料与方法：对２１０例（男１２０例、女９０例）既有Ｘ线平片又有放大像的病例所摄照片进行分析、对比。结果：放大像发现病变的阳性率为７２％；Ｘ线平片发现病变的阳性率为５９％。结论：当临床高度怀疑有骨质病变，常规Ｘ线平片表现为正常或怀疑异常时，应摄放大像以减少漏诊。     

Positioning of the wrist for scaphoid radiography

PURPOSE: The purpose of this cadaver study was to determine the ideal position of the wrist for scaphoid radiography. MATERIALS AND METHODS: Four cadaver wrists were rotated around their longitudinal axis in 15 degrees increments and exposures were taken. Seven postero-anterior images were taken as well. Thus, 18 images of each wrist were available for assessment. Views were determined in which the main anatomic regions of the scaphoid were visualized undistorted. The size and localization of the overlap of other carpal bones were also evaluated. Finally, views with the best visualization of anatomic landmarks were selected. The results of these three investigations were compared to literature data. RESULTS: We consider the following four images the most valuable in the diagnostic imaging of scaphoid bone: (1) Postero-anterior view in ulnar deviation of wrist and fist position of the hand; (2) oblique view in 60 degrees of pronation; (3) oblique view in 60 degrees of supination; (4) lateral view. CONCLUSION: We concluded that our four views are sufficient for proper radiographic evaluation of the scaphoid.     

Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray

The aim was to compare X-ray and ultrasound (US) in diagnosing gout. In a prospective study, 105 consecutive patients with clinical suspicion of gout underwent conventional X-ray und high-resolution US in order to help in arriving at a definite diagnosis. X-ray findings suggestive of gout included soft-tissue opacifications with densities between soft tissue and bone, articular and periarticular bone erosions, and osteophytes at the margins of opacifications or erosions. US findings suggestive of gout included bright stippled foci and hyperechoic soft-tissue areas. Fifty-five patients had a definite diagnosis of gout (102 involved sites), 31 patients were diagnosed as having another disease (59 involved sites), and 19 patients were excluded from the study because a definite diagnosis could not be established. X-ray suggested gout with a sensitivity of 31% (32/102) and a specificity of 93% (55/59), whereas US suggested gout with a sensitivity of 96% (98/102) and a specificity of 73% (43/59). US was much more sensitive than conventional X-ray but less specific. Our data show that US often provided additional diagnostic information in patients with clinical suspicion of gout when laboratory findings and X-ray results were negative or inconclusive and should therefore be used in these cases.     

不稳定型骨盆骨折三维空间移位的X线诊断方法及其在闭合复位术中的初步应用

目的 研究不稳定型骨盆骨折在三维空间上各种移位的X线诊断及其对术中进行闭合复位的指导意义. 方法 选取正常成人骨盆标本1具,剔除软组织,保留骨盆周围的韧带,使用木框固定骨盆于仰卧位姿势,然后锯断单侧骨盆前后环,分别制作半骨盆在水平面上的旋转、矢状面上的旋转及垂直上移模型.拍摄骨盆模型前后位X线片,利用影像归档和通信系统(picture archiving and communication system,PACS)测量髂骨翼宽度、半骨盆上下径、髂嵴、髋臼顶、耻骨结节及坐骨结节的垂直移位幅度及闭孔面积.总结半骨盆各种移位的X线片诊断方法并应用于治疗43例不稳定型骨盆骨折,统计手术时间、术中出血量,采用Matta标准进行术后影像学评价.结果 水平面旋转分为外翻与内翻,半骨盆外翻时髂骨翼的宽度增大,闭孔的面积变小;内翻时髂骨翼的宽度变小,闭孔面积变大.矢状面旋转分为前旋与后旋,前旋时耻骨结节下移明显,髂嵴不变或轻度上移,上下径变长,髋臼顶及坐骨结节位置保持不变,闭孔面积变小;后旋时耻骨结节上移明显,髂嵴不变或轻度下移,上下径变短,髋臼顶及坐骨结节位置保持不变,闭孔面积变大;垂直上移时髂嵴、髋臼顶、耻骨结节及坐骨结节均等距离上移.本组手术时间15～85 min,平均55 min.出血量10 ～50ml,平均26 ml.术后3d内复查骨盆X线片,按Matta标准,本组优31例,良12例,优良率100％. 结论 骨盆X线片能诊断不稳定型骨盆骨折在三维空间的各种移位,并能实时、快速指导术中闭合复位,取得满意的复位效果.     

直接数字X线摄影与传统高千伏胸部摄影对比分析

目的　评价直接数字X线摄影术 (DR)在胸部的应用。方法　抽取我院DR胸部影像和传统高kV胸片各 10 0 0例 ,由 3位放射学医师对影像进行分析 ,分别统计甲、乙、丙及废片率 ,同时对胸部的细微结构显示率进行评价。结果　 (1)DR影像 :甲片率 5 0 6% ,乙片率 3 8 5 % ,丙片率 10 9% ,废片率 0 %。 (2 )传统高kV胸片 :甲片率 41 1% ,乙片率 44 1% ,丙片率 13 3 % ,废片率 1 5 %。 (3 )肺内的细微结构显示率 :DR影像为 10 0 0 % ,传统高kV胸片为 78 6%。经统计学处理 ,差异有非常显著性意义 (χ2 =968 6,P <0 0 0 1)。结论　DR胸部影像的诊断图像质量好于传统高kV胸片。DR系统操作简单 ,成像快捷 ,有利于放射诊断     

儿童髌骨套状骨折的X线特点

目的 探讨儿童髌骨套状骨折的X线表现特点.方法 对11例儿童髌骨套状骨折的X线表现和临床资料进行回顾性分析,评价髌骨套状骨折的X线特征.结果 11例儿童髌骨套状骨折中,X线平片表现为关节肿胀11例、髌骨移位9例、髌股关节间隙增宽5例、髌骨上下极边缘毛糙或游离小斑状、蛋壳状骨片11例.1例儿童髌骨下极套状骨折初诊X线平片未显示骨折片,15 d后复诊时蛋壳样的撕脱骨折片可清晰显示.结论 儿童髌骨套状骨折X线表现具有特征性.     

肌间隙入路与传统入路椎弓根螺钉内固定治疗胸腰椎骨折

目的 评价肌间隙入路椎弓根螺钉内固定治疗胸腰椎骨折的临床疗效,并与传统后正中入路手术进行比较. 方法 选择2008年12月-2010年5月收治的42例胸腰椎单椎体骨折患者,行单纯后路椎弓根螺钉内固定复位治疗,其中椎旁肌间隙入路19例(肌间隙入路组),传统后正中入路23例(传统入路组).比较两组切口长度、手术时间、术中出血量、术后引流量、术后住院时间、术前与术后视觉模拟评分(visual analogue scale,VAS)围术期指标及伤椎骨折复位情况,并行术后Oswestry功能障碍指数(Oswestry disability index,ODI)功能评估. 结果 两组切口长度、手术时间、术后住院时间、伤椎高度恢复差异无统计学意义(P＞0.05).肌间隙入路组术中出血量为(148.5±26.5) ml,术后引流量为(72.9±17.3) ml,术后VAS评分为(1.1±0.3)分,ODI功能评分为(13.4±2.7)分,与传统入路组比较,差异有统计学意义(P＜0.05). 结论 与传统后正中入路相比,采用椎旁肌间隙入路具有创伤小、出血少、疼痛轻、恢复快等优点,可作为无需椎管内减压的椎体骨折的首选手术入路.     

髋臼骨折CT诊断的临床价值

目的：探讨髋臼骨折的ＣＴ表现及其临床价值。方法：分析２１例髋臼骨折的ＣＴ表现，并与平片对照。其中８例采用保守疗法，１３例行手术治疗。结果：ＣＴ检查能清楚显示各型髋臼骨折，发现平片不能看到的关节腔内骨折碎片和股骨头皮质凹陷性骨折，同时还可显示软组织的损伤。结论：髋臼骨折的ＣＴ检查能准确地对骨折分型，治疗方案的选择和预后的估计提供帮助。     

Diagnostic value of pelvic radiography in the initial trauma series in blunt trauma

The purpose of the study was to evaluate the diagnostic value of pelvic radiography in the initial trauma series when compared to multidetector CT (MDCT) findings in serious blunt trauma. Inclusion criteria were blunt trauma and pelvic radiography in the initial trauma series, followed by a whole-body MDCT. A total of 1386 patients (874 male, 512 female, age 16–91 years, mean 41 years) met the inclusion criteria. Imaging studies were evaluated retrospectively by anatomical region and classified, when possible, using the Tile classification. Based on MDCT, a total of 629 injuries occurred in 226 (16%) of these 1386 patients. Radiography depicted 405 fractures in these 226 patients, giving an overall sensitivity of 55%. In 24 patients (11%) radiography was false-negatively normal. The sensitivity of radiography was mainly good in the anteroinferior parts of the pelvis, fair in the acetabulum and ileum, and poor in the posterior ring. By MDCT 141 (62%) patients were classified using the Tile classification and by radiography 133 patients (59%) were classified. MDCT and radiography showed the same type of pelvic injury in 72 patients (59%) and the subtype in 17 patients (14%). In 48 patients (40%) the pelvis was shown to be stable by radiography but unstable by MDCT. In conclusion, the sensitivity of pelvic radiography is low, and it is not reliable for determining if the pelvic injury is stable or not.     

蜡泪样骨病的影像诊断

目的：探讨蜡泪样骨病(Melorheostosis)的X线表现特点。方法：结合临床病例和献资料分析本病的X线表现征象。结果：病变常选择性分布于肢体的同一侧。本病可单发或多发,多侵犯一侧肢体的数个骨结构,其典型影像特征为受累的肢骨皮质呈不规则的波浪状骨质增生硬化,增生的骨质形似蜡烛表面向下流淌的溶蜡柱,多跨越关节,个别病例关节周围软组织中可以见到骨化或钙化。结论：本病多具有典型的影像表现,常规X线检查可以提供满意的诊断信息。     

X线摄片诊断儿童支原体肺炎的价值分析

目的：总结儿童支原体肺炎的临床表现特点,分析X线摄片诊断儿童支原体肺炎的临床价值。方法回顾性分析2013年1月至2014年1月63例儿童支原体肺炎的临床资料,其中男性36例,女性27例,年龄2个月至1岁5例（8％）,～3岁11例（17％）,3～6岁32例（51％）,7～12岁15例（24％）,平均年龄（5±3）岁。采用美国GE公司计算机X线摄影（CR）行胸部正侧位片,曝光条件根据患儿体厚设定,靶片距100～160 cm,患儿安静时曝光拍摄,尽可能避免再次拍摄和降低射线剂量。总结X线图片质量、临床表现,分析X线摄片的影像学特点。结果126张胸片图像中,一级片120张（95．2％）,二级片5张（4．0％）,三级片1张（0．8％）,废片0张。临床症状主要是咳嗽、发热、咽部发红、喘息、呼吸音粗糙等。63例患儿肺部均存在影像学改变,双侧肺病变23例（37％）,单侧肺40例（63％）,其中右侧肺27例（68％）,左侧肺13例（32％）。 X线表现为间质浸润型阴影35例（56％）、肺泡浸润型阴影19例（30％）、肺门增浓型阴影8例（13％）和混合型阴影2例（3％）。结论儿童支原体肺炎临床表现主要是咳嗽、发热等,X线表现主要是间质浸润型阴影、肺泡浸润型阴影等,确诊应结合临床表现和实验室检查。     

Multidetector CT in shoulder fractures

The aim of this study was to assess the multidetector computed tomography (MDCT) findings in acute shoulder traumas compared to radiographic findings in patients referred to a level one trauma center. Two hundred and ten patients (128 male, 82 female, age 16–95 years, mean age 51.7 years) underwent shoulder MDCT due to acute trauma. Three main mechanisms of injury were established: falling (113 patients, 54%), traffic accidents (36 patients, 17%) and falling from a height (12 patients, 6%). Based on MDCT, a total of 311 fractures—152 in the scapula and 159 in the proximal humerus—occurred in 191 (91%) of the 210 patients. The two most common occult fractures were lesser tubercle and coracoid process fractures. In 20 (63%) of the patients with a comminuted fracture of proximal humerus the exact number of fracture fragments was underestimated in radiographs. MDCT with multiplanar reconstructions (MPR) is a recommended complementary examination in patients with complex proximal humerus fractures where the extent of the fractures and the position or origin of dislocated fragments is not clear on radiography. This may increase the accuracy of the fracture classification and reveal occult fractures in other parts of the shoulder.     

胸腰椎爆裂型骨折的CT诊断及其与X线平片对比分析

目的 比较CT扫描与X线平片对胸腰椎爆裂型骨折的诊断价值。方法 回顾性对照分析78例胸腰椎骨折的X线平片与CT表现。结果 78例96节胸腰椎爆裂型骨折中,单椎体骨折者64例,多椎体骨折者14例。以CT扫描为诊断标准,近30％X线平片将爆裂型骨折误诊为单纯压缩型骨折。结论 X线平片虽是脊柱损伤的基本检查手段,但部分病例X线平片较难区分单纯压缩型骨折和爆裂型骨折。CT检查能明确爆裂型骨折类型、判断脊柱失稳及椎管受累程度,对X线平片观察发现有压缩型骨折者应作常规CT扫描。     

A method of stereotaxic localization adopted for conventional and digital radiography

Summary A method for the determination of stereotaxic coordinates in radiography, e.g. angiography, pneumoencephalography or digital vascular radiography, is described. A special localization frame containing radiopaque structures and scales defines a diagnostic coordinate system. This frame is fixed to the X-ray-table prior to the radiographic procedure and two projections are obtained at arbitrary angles to each other. The focus-film distances do not how to be fixed. The target coordinates are then determined either by a simple graphical procedure or with the use of a digitizing x-y-table, by a computer. With the computer method the films are placed on the digitizing table and the target and a few reference points are marked using a cursor. From the relative positions the computer calculates the coordinates. With the special head fixation system, coordinates of structures visualized in radiographic examinations can be transferred to various therapeutic or diagnostic stereotaxic devices.     

X射线摄影所致受检者器官剂量-入射体表剂量转换系数的研究

目的 比较简单程式化数学模型(MIRD)与体素模型在常见X射线摄影下得到的器官剂量-入射体表剂量的转换系数差异。方法 利用蒙特卡罗模拟技术,分别模拟计算体素模型的5种常见摄影下受检者的器官剂量与入射体表剂量,并计算两者的转换系数,与MIRD模型所得结果进行比较。结果 体素模型得到射野内器官的转换系数分别是,胸部后前位0.149~0.650,胸部左侧位0.067~0.382,胸部右侧位0.023~0.374,腹部前后位0.035~0.431,腰椎前后位0.083~0.432。在胸部后前位下,两种模型模拟肺的剂量转换系数结果相差最大约54.3%;胸部左侧位照射的肝脏剂量转换系数差异最大为54.5%;胸部右侧位照射胃剂量转换系数差异最大为63.8%;而腹部前后位,两种模型模拟脾脏的剂量转换系数差异最大为65.0%;腰椎前后位发现胃的剂量转换系数相差最大约43.7%。结论 利用两种模型模拟得到的器官剂量转换系数偏差可达50%以上,由于MIRD模型的解剖结构过于简化,计算误差较大。利用体素模型得到的转换系数数据更加科学合理。