Arthrography of the glenohumeral joint: experience with a non-ionic dimeric contrast agent and future perspectives

The role of conventional arthrography versus computed tomography (CT) arthrography of the glenohumeral joint using iotrolan was evaluated in patients with different shoulder problems. In addition, a diagnostic combination of conventional and CT arthrography was compared with magnetic resonance (MR) arthrography of the glenohumeral joint. Two diagnostic protocols were used. Protocol 1: conventional followed after 30 min by CT arthrography of 37 joints using a double contrast technique with iotrolan 300. Protocol 2: conventional followed after 90–180 min by MR arthrography in 20 patients using a single-contrast technique with 10 ml iotrolan 300 and 1 ml gedopentetate dimeglumine 500 mM. Ten patients also underwent CT arthrography. Neither patient group experienced contrast-related complications. Image quality was good for all conventional arthrograms, excellent in 45/47 CT arthrograms and good in 20 MR arthrograms. CT and MR arthrography were diagnostically valuable in many patients. We conclude that glenohumeral joint evaluation should be perfomed first using conventional or CT arthrography. Iotrolan has proven to be highly reliable and safe in these applications. Iotrolan in combination with gadopentetate dimeglumine, permits MR arthrography following completion of the standard examinations if necessary.     

Detection of dental root fractures by using cone-beam computed tomography

OBJECTIVES: The purpose of this study was to compare the diagnostic accuracy of cone beam CT (CBCT) with that of conventional dental radiography in the detection of root fractures and to evaluate the influence of root canal fillings on root fracture detection. METHODS: We investigated 128 patients with clinically suspected root fractures in 135 teeth. These patients underwent conventional dental radiography, CBCT and eventually surgical exploration. Among the 135 teeth, 86 were non-endodontically treated teeth and 49 were endodontically treated teeth. Two oral radiologists independently analysed the dental radiographs and CBCT images of each patient and reached a consensus. The CBCT findings of root fractures were set as the detection of a separation of the adjacent root segments on at least two contiguous sections and on at least two of the three-dimensional (3D) planes. Results: Root fracture was intraoperatively detected in 95 of the 135 teeth. The sensitivity and specificity of root fractures diagnosed on the basis of the consensus between the 2 evaluators were 26.3% and 100%, respectively, for dental radiography and 89.5% and 97.5%, respectively, for CBCT. CBCT was significantly more accurate than dental radiography in detecting root fractures (P < 0.001). The sensitivity of CBCT was reduced in the presence of root canal fillings but its specificity remained unaffected. Both the sensitivity and specificity of dental radiography were not influenced by the presence of root canal fillings. Conclusions: CBCT appears to be more accurate than conventional dental radiography in the detection of root fractures.     

Arthrography of the glenohumeral joint: experience with a non-ionic dimeric contrast agent and future perspectives

The role of conventional arthrography versus computed tomography (CT) arthrography of the glenohumeral joint using iotrolan was evaluated in patients with different shoulder problems. In addition, a diagnostic combination of conventional and CT arthrography was compared with magnetic resonance (MR) arthrography of the glenohumeral joint. Two diagnostic protocols were used. Protocol 1: conventional followed after 30 min by CT arthrography of 37 joints using a double contrast technique with iotrolan 300. Protocol 2: conventional followed after 90–180 min by MR arthrography in 20 patients using a single-contrast technique with 10 ml iotrolan 300 and 1 ml gedopentetate dimeglumine 500 mM. Ten patients also underwent CT arthrography. Neither patient group experienced contrast-related complications. Image quality was good for all conventional arthrograms, excellent in 45/47 CT arthrograms and good in 20 MR arthrograms. CT and MR arthrography were diagnostically valuable in many patients. We conclude that glenohumeral joint evaluation should be perfomed first using conventional or CT arthrography. Iotrolan has proven to be highly reliable and safe in these applications. Iotrolan in combination with gadopentetate dimeglumine, permits MR arthrography following completion of the standard examinations if necessary.     

CT扫描薄层骨算法重建对颅底骨折的诊断价值

目的对比CT常规扫描与薄层骨算法重建扫描在颅底骨折诊断中的作用。方法对80例外伤性颅底骨折进行回顾性对比分析。所有检查均采用SOMATOMAR或GEHispeedNX/iProCT扫描机,均先行头颅CT常规扫描,层厚层距均为10mm,再行薄层颅底扫描骨算法重建,层厚层距均为1mm～3mm。结果80例颅脑外伤均有颅底骨折的临床体征,但头颅CT常规扫描仅有23例显示骨折线,而薄层骨算法重建扫描颅底80例均见明确骨折线,其中19例见多发骨折。并且对中颅窝、前颅窝极不容易直接显示骨折的部分区域也可清楚显示。同时可更清楚地显示出筛窦、蝶窦、及乳突气房内积液情况。结论薄层颅底扫描骨算法重建明显优于头颅CT常规扫描,它可以明确显示颅底骨质损伤情况,为临床诊断提供可靠而客观的影像学资料。     

Elbow arthrography: a reassessment of the technique

Twenty-six elbow arthrograms were retrospectively reviewed. Each arthrogram consisted of conventional radiography, conventional tomography, standard double-contrast arthrography, and arthrotomography. Each of these four components was independently interpreted in a blinded fashion by six radiologists, each working alone. The four components were evaluated for presence or absence of intraarticular bodies, cartilage loss, or fractures. The results showed that conventional tomography was the most accurate single study. Arthrotomography rarely improved the diagnostic accuracy of noncontrast methods. It was useful in those few patients where detection of purely cartilaginous bodies, precise position of mineralized densities, or status of articular cartilage was desired. It may be possible to reduce the number of elbow arthrograms, thereby reducing time, cost, and radiation dose factors.     

MR imaging of recent spinal trauma

Proper therapeutic management of acute spinal trauma depends considerably on the assessment of the condition of the underlying spinal cord and the relative stability of the surrounding bony architecture. A series of 14 patients who were examined by magnetic resonance (MR) imaging following spinal trauma is presented. Comparison of information gained by MR with that obtained by conventional CT indicates that MR is useful in assessing spinal cord compression, traumatic disk pathology, and post-traumatic intramedullary abnormalities. Computed tomography is more accurate in detecting posterior neural arch fractures and in assessing the number of displaced fragments.     

Computed tomography of osteosarcoma after intraarterial chemotherapy

The response to intraarterial cis-diamminedichloroplatinum II (CDP) chemotherapy was evaluated by computed tomography (CT) in 33 patients with pathologically proved osteosarcoma of the long or flat bones. Twenty-one of the 33 patients had a CT scan before chemotherapy was started. In the other 12 patients, a CT scan was obtained after at least two courses of treatment, and additional studies were performed during the course of therapy. In those patients responding to treatment, the posttherapy scan revealed a remarkable decrease or complete disappearance of the associated soft-tissue mass and clear reestablishment of the fat planes between the muscle bundles that had been obscured. There was sharp definition of the peripheral margins of the calcified healing neoplasm, and the calcification in the healing tumor could be differentiated easily from that of the original bone neoplasm. The findings of CT were compared with those of conventional studies and pathologic results. CT was more accurate than conventional studies in detecting healing process and diagnosis of remission.     

Conventional radiology and computed tomography in facial fractures

The possibilities and limitations of conventional radiography and CT in detecting maxillo-facial fractures are shown both experimentally and in a clinical setting. In 36 patients examined by both methods after maxillo-facial trauma, CT and conventional radiography (including pluridirectional tomography) proved to be equal in detecting fractures of the orbital roof, the anterior wall of the frontal sinus, the nasal bone and the pterygoid process. CT is inferior to conventional radiography in fracture of the orbital floor, the frontal base of the skull, the hard plate and the zygomatic arch. CT is superior to conventional radiography in fractures of the medial and lateral wall of the orbit, the posterior wall of the frontal sinus, the posterior, medial and anterior wall of the maxillary sinus as well as the zygomatic bone.     

Dislocation of the temporomandibular joint meniscus: contrast arthrography vs. computed tomography

A prospective study to determine the accuracy of computed tomography (CT) for the diagnosis of dislocation of the temporomandibular joint (TMJ) meniscus was made by performing both CT and contrast arthrography on 18 joints suspected of meniscus dislocation. Arthrography rather than surgery was chosen as the quality standard for comparing CT findings, as not all patients undergoing the studies underwent surgery. The CT protocol included scanning with both closed- and open-mouth series, 1.5-mm-thick slices, soft-tissue and bone-detail settings, and coronal and sagittal reformations. Arthrography was done with linear tomography, after both lower and upper compartmental injections under fluoroscopic control. The results of each test were reported independently by the radiologist who obtained either all of the arthrograms or all of the CT scans. For dislocation of the meniscus, there was excellent agreement between the two methods. Nine menisci were dislocated according to both arthrography and CT. One meniscus was thought to be dislocated by CT, but this was not confirmed with arthrography. CT seems to be nearly as accurate as arthrography for showing meniscus dislocation, is performed with lower x-ray exposure, and is noninvasive. Arthrography discloses more detailed information about the joint meniscus, such as perforation and maceration, and should continue to be used when this kind of information is clinically important.     

Occult scaphoid fractures: comparison of multidetector CT and MR imaging--initial experience

PURPOSE: To compare the diagnostic performance of multidetector computed tomography (CT) and magnetic resonance (MR) imaging in patients clinically suspected of having a scaphoid fracture and who had normal initial radiographs, with radiographs obtained 6 weeks after trauma as the reference standard. MATERIALS AND METHODS: The ethics committee approved the study, and all patients gave written informed consent. Twenty-nine patients (17 male, 12 female; age range, 17-62 years; mean age, 34 years +/- 13) underwent multidetector CT and MR imaging within 6 days after trauma. CT data were obtained with 0.5-mm collimation. For image review, 0.7-mm-thick multiplanar reformations were performed in transverse, coronal, and sagittal planes relative to the wrist. The 1.0-T MR examination consisted of coronal and transverse short inversion time inversion-recovery, coronal and transverse T1-weighted spin-echo, and coronal volume-rendered T2-weighted gradient-echo sequences. Two radiologists analyzed the CT and MR images. A binomial test was used to evaluate the significance of the differences between MR imaging and CT in detection of scaphoid fractures and cortical involvement (P < .05). RESULTS: The 6-week follow-up radiographs depicted a scaphoid fracture in 11 (38%) patients. Eight patients had a cortical fracture, while three patients had only a bandlike lucency within the trabecular portion of the scaphoid. MR imaging depicted all 11 fractures but only three [corrected] cortical fractures. Multidetector CT depicted all eight cortical fractures but failed to depict trabecular fractures. No false-positive fractures were seen on MR or CT images. Differences between MR imaging and CT were not significant for the detection of scaphoid fractures (P = .25) but were significant for cortical involvement (P = .03). CONCLUSION: Multidetector CT is highly accurate in depicting occult cortical scaphoid fractures but appears inferior to MR imaging in depicting solely trabecular injury. MR imaging is inferior to multidetector CT in depicting cortical involvement.     

CT in carcinoma of the larynx and pyriform sinus: value of phonation scans

The structural and functional information obtained from CT performed during quiet breathing and phonation of the letter E was investigated in 25 patients with carcinoma of the larynx or pyriform sinus. Significant additional information was obtained from the phonation scans in all patients. In 16 patients, vocal cord dysfunction was found on the phonation scans. In 14 patients, phonation CT demonstrated an abnormal aryepiglottic fold better than CT during quiet breathing. A pyriform sinus was distorted or displaced in 11 patients and CT during phonation was more accurate than laryngoscopy or CT during quiet breathing in detecting abnormalities deep to this region. CT scans were the most accurate method of detecting tumor extension into the subglottic space, and into the preepiglottic space; each extension was seen in seven patients. Thyroid cartilage destruction was detected only by CT in six patients. CT scans during phonation should be an integral part of laryngeal CT and in conjunction with laryngoscopy could possibly replace laryngography for the evaluation of patients with laryngeal carcinoma.     

The role of spiral CT vs plain films in acute cervical spine trauma: a comparative study

Purpose: To compare the diagnostic yield of conventional radiographs versus helical computed tomography (CT) in screening acute trauma patients. Methods: We reviewed 604 trauma patients who presented to our level I trauma emergency room and underwent both conventional radiography and spiral CT of the cervical spine of. Results: Of the 604 patients, 30 (5.13 %) had fractures seen on helical CT, only 10 of which were diagnosed on conventional radiography. Conclusion: In the screening of acute trauma patients, conventional radiography is less sensitive in detecting fractures than helical CT. CT should therefore be considered as a standard modality choice in such cases.     

螺旋CT三维重建在颌面部外伤中的临床应用价值

目的探讨螺旋CT三维重建对颌面部外伤的诊断准确性。方法50例颌面部外伤患者均经螺旋CT扫描及三维重建。结果螺旋CT三维重建在显示颌面部骨折的类型、位置、范围、骨折的移位、塌陷深度等方面明显优于常规CT,特别是对一些复合的粉碎性骨折,SSD可以显示出畸形的立体形态。结论螺旋CT三维重建能立体、直观地显示颌面部的解剖及病理解剖关系,增加了影像的信息量,为制定临床治疗方案提供大量依据。     

胫骨下端爆裂性关节内骨折的CT三维影像重建

目的探讨三维ＣＴ影像重建在评估胫骨下端爆裂性关节内（Ｐｉｌｏｎ）骨折中的临床意义。方法收集自１９９４年１０月～１９９６年１０月间的Ｐｉｌｏｎ骨折患者１０例。所有患者均接受Ｘ线摄片、ＣＴ扫描和ＣＴ三维影像重建检查。根据以上３种影像学检查的显示，评估骨折的形态、骨折的碎裂程度及移位情况，对Ｐｉｌｏｎ骨折进行分类并选择合适的治疗方法。结果采用ＡＯ系统对骨折分类：Ｃ１型２例，Ｃ２型３例，Ｃ３型５例。４例在Ｘ线平片上显示关节面较完整，仅有轻度移位，但在三维ＣＴ影像和ＣＴ平扫中可见骨关节面不平整，有明显移位。６例患者在ＣＴ影像上可见骨折碎片数目多于平片，并有碎骨块的嵌插。根据三维ＣＴ重建对Ｐｉｌｏｎ骨折不同方位的立体显示，结合Ｘ线征和ＣＴ扫描对１０例患者均采用切开复位内固定，取得良好疗效。结论三维ＣＴ重建能多角度立体显示复杂的涉及关节面的Ｐｉ－ｌｏｎ骨折，弥补了Ｘ线平片和ＣＴ扫描等二维影像在这方面的不足，尤其是在显示关节面碎裂和移位的程度、碎骨块的嵌插及主要骨折线形态上，更是体现了三维影像和ＣＴ扫描的优点，是提高复杂关节内骨折诊断和治疗水平的有效手段之一。     

Diagnosis of pelvic fractures in patients with acute pelvic trauma: efficacy of plain radiographs.

Although CT is widely recognized as an important adjunct to plain films in the evaluation of patients with acute pelvic trauma, accurate diagnosis of orthopedic injuries with plain films alone is often important to determine if immediate external fixation is necessary. The purpose of this study was to determine the efficacy of plain radiographs in the detection of pelvic fractures and dislocations in patients with acute pelvic trauma by using CT as the gold standard. CT scans and plain films collected prospectively in 50 patients with acute pelvic injuries were evaluated independently, and fractures and dislocations were identified and tabulated. Of a total of 162 fractures and dislocations seen on CT, only 14 (9%) were misdiagnosed on plain films. None of these misdiagnoses altered patients' management. Sixteen (80%) of 20 cases of intraarticular fragments in the hip joint associated with acetabular fractures were not identified on plain films. We conclude that plain film examination of the patient with pelvic trauma is sufficient to identify virtually all clinically important fractures and dislocations. Plain radiographs alone are not accurate in detecting fracture fragments within the hip joint.     

Computed tomography of the bony pelvis: a protocol for multiplanar imaging. Part II: Trauma

Fractures of the pelvis are frequently complex, and conventional radiography, including special views, may be inadequate for accurate diagnosis. One must ascertain the integrity of the anterior and posterior columns, hip joint spaces for debris, and the medial walls of the acetabula. Computed tomography (CT) is indicated early in management, whenever initial plain radiographs reveal complex or questionable fractures of any of these structures. I have developed a unique, multiplanar reformatting protocol using oblique reformations of transverse CT images. This allows clear spatial perception of the nature and extent of pelvic fractures. Twelve selected patients with complex pelvic fractures, as determined by conventional and special radiographs, underwent transaxial and multiplanar CT scanning according to the devised protocol, using transverse CT and multiplanar reformation of the pelvis. The planes of reformation are illustrated by drawings, and multiplanar radiographs demonstrate the injuries. Nine of the 12 patients had additional injuries revealed, over and above the abnormalities shown by CT, by the use of the reformatting technique I describe. Also fractures or fracture dislocations of the sacroiliac joints were diagnosed in four of the 12 patients using CT but in six patients when reformatted images were examined.     

Role of radiologic imaging in management planning of giant cell tumor of bone

The radiologic studies of 24 patients with giant cell tumors were evaluated with respect to their ability to determine tumor extent and to influence management. Computed tomography (CT) was the most accurate method for detecting soft tissue tumor extension, and conventional tomography was the best technique for evaluating penetration of subarticular cortical bone. Detection of these findings led to performance of en bloc tumor resection rather than curettage and grafting in patients with lower extremity tumors. Arthrotomography was helpful in some instances in detecting cartilage and joint invasion by tumor, joint invasion being an indication for extra-articular rather than transarticular tumor resection. Scintigraphy was not as accurate as conventional tomography or CT in determining intraosseous tumor extent because of increased tracer, uptake beyond the true tumor limits in several cases. Angiography has been largely replaced by CT in evaluating giant cell tumors.     

CT arthrographic patterns in recurrent glenohumeral instability

CT double-contrast arthrograms were performed on 54 shoulders in 53 patients with recurrent dislocation or subluxation to detect responsible underlying bony or soft-tissue abnormalities. Lesions of the anterior labrum in 52 (96%) of 54 cases and of the capsuloligamentous complex in 42 (78%) of 54 cases were the two most common abnormalities. There was no difference in the degree or number of labral lesions between subluxations and dislocations. However, more severe capsular lesions, subscapularis tendon tears, and widened subscapularis bursae were consistently found among patients with dislocations. Subsequent clinical, arthroscopic, and surgical findings showed that the use of CT double-contrast arthrograms resulted in improved definition of the multiple lesions associated with glenohumeral dysfunction.     

64层螺旋CT在周围型肺小腺癌诊断中的初步应用

目的 探讨64层螺旋CT对周围型肺小腺癌基本征象的显示及其诊断价值.资料与方法 64层CT扫描并经病理证实的周围型肺小腺癌26例,分析薄层重组、多平面重组(MPR)及容积再现(VR)技术对周围型肺小腺癌的基本征象的显示率及价值,并与常规横断面对比分析.结果 (1)54层CT薄层重组、MPR及VR在显示肺小腺癌的分叶征、毛刺征、胸膜凹陷征及支气管血管集束征方面优于常规横断面.(2)MPR及VR对于空泡征、支气管气相和支气管血管集束征的判别有优势.结论 64层CT通过薄层重组配合MPR、VR能够无服横断扫描限制,在不增加患者辐射剂量的情况下,能够更加细微、准确、立体、完整地显示肺小腺癌的基本征象,为周围型肺小腺癌的诊断提供更多信息.     

Clearing the cervical spine in multiple trauma victims: A time-effective protocol using helical computed tomography

This study was performed to evaluate helical computed tomography (HCT) as the primary method of initial cervical spine assessment in multiple trauma victims. Prospective evaluation of the cervical spine using HCT and plain film radiography (PFR) was performed in 800 patients with suspected multisystem injuries. With HCT, an average of 32 slices were obtained at 5-mm intervals from the base of the skull to T1 using helical acquisition and a bone algorithm. HCT was performed following cross-table lateral radiographs of the cervical spine in all patients. We compared HCT and PFR for detection of abnormalities and duration of examination and also compared HCT with conventional CT in a subset of patients (N=20) for image quality/lesion detectability. Sixty-eight fractures were identified in 46 patients. HCT prospectively identified 67 fractures (98.5%), and plain films demonstrated 29 fractures (43%). No difference in image quality/lesion detectability was encountered when comparing HCT to conventional CT. HCT of the cervical spine could be completed in 4.5 minutes and added an average of only 8 minutes to the stay of the patient in the CT room. During the time of the study, the overall patient disposition time from the trauma resuscitation area was reduced from 6.5 to 4.5 hours. Rapid and accurate evaluation of the cervical spine is possible with HCT and is recommended as part of the initial imaging protocol in multiple trauma patients.