Computed tomographic imaging in cervical vertebral fractures

Spinal computed tomography scanning was performed in five patients with different types of cervical fractures. Computed tomography scanning was superior to plain x-ray studies in determining the narrowing of the spinal canal by bone fragments or soft tissues and in determining the involvement of the intervertebral joints. The value of computed tomography was clearly demonstrated in scanning those regions that are difficult to be examined by conventional radiologic methods. A disadvantage of computed tomography scanning is the impossibility of functional diagnostic investigations and examinations after surgery of patients who underwent stabilization with plates and wires.     

Torsion of the greater omentum: preoperative computed tomographic diagnosis and therapeutic laparoscopy.

Primary or idiopathic segmental infarction of the greater omentum is a rare surgical condition. We describe a case of omental torsion in an adult patient who was diagnosed preoperatively by contrast-enhanced computed tomography and managed by laparoscopy.     

Unusual computed tomographic findings in a case of arachnoid cyst in the middle cranial fossa

A rare case is reported of arachnoid cyst in the middle cranial fossa associated with intracystic hemorrhage and subdural hematoma. The preoperative computed tomography scans showed no difference in density among the cyst, the hematoma, and the brain parenchyma. The serial computed tomography scans after the accident were the most helpful in making the correct diagnosis.     

Immediate postoperative seizures: Incidence and computed tomographic findings

Convulsive seizures within 48 hours after intracranial operations using a craniotomy were reviewed. Incidence was 8.9% (44 of 493 operations): 13.5% of brain tumor operations and 3.8% of aneurysmal operations. We demonstrated that preoperative seizures, sites of lesion, subtherapeutic anticonvulsant levels, and postoperative local organic lesions were important factors causing the immediate postoperative seizures. Among them, a survey of postoperative computed tomography scans disclosed nine intracerebral hemorrhages, eight cases of cerebral edema, and four cerebral infarctions in the 44 patients; such major complications had a significant correlation with postoperative seizures (p < 0.005).     

Computed tomographic findings in metastatic dural carcinomatosis

A case is presented of metastatic dural carcinomatosis associated with a thickened subdural membrane similar to those found in association with posttraumatic chronic subdural hematomas. In this case burr-hole drainage was attempted as a result of findings on computed tomography scanning that suggested a right frontal chronic subdural hematoma. However, no chronic subdural hematoma or effusion was found. The pathology, radiographic findings, and clinical features of this phenomenon are discussed.     

Computed tomographic demonstration of the effect of proximal parent artery ligation for giant intracranial aneurysms

Four patients with giant intracranial aneurysms, which measured over 2.5 cm in diameter, were treated by ligation of the proximal parent artery. The location of the aneurysms were intracavernous in two patients, paraophthalmic in one patient, and vertebral in the other patient. The effect of ligation was followed by repeated computed tomography scans with angiographic correlation. The aneurysms thrombosed soon after ligation, and with time, gradually organized with a reversal of the mass effect. Five years after the ligation, one aneurysm thrombosed completely and lost its mass effect upon the adjacent structures. For giant aneurysms treated with ligation of the proximal parent artery, computed tomography scans are a useful method for continuing review, producing precise information concerning actual size, thrombus formation, and various pathological changes.     

Computed tomographic diagnosis of midgut volvulus in a 5-year-old child

Malrotation with midgut volvulus requires prompt recognition and urgent treatment. We describe a 5-year-old boy who presented with malrotation and midgut volvulus in whom the diagnosis was made by computed tomography. We describe the diagnostic images and operative findings in the patient. This case highlights the importance of recognizing the inversion in orientation of the superior mesenteric vessels and “whirlpool” sign in making the diagnosis of midgut volvulus when few other clues may be present.     

Efficacy of 3-D computed tomographic reconstruction in evaluating anatomical relationships of colovesical fistula

A case of colovesical fistula is reported. The anatomy of the pelvis was determined preoperatively with 3-D computed tomography (CT), and the fistula, including adjacent structures, could clearly be seen. Compared with conventional axial CT imaging, 3-D CT provided better and more complete visualization of the anatomical relationships, which facilitated the surgical procedure and provided a good outcome.     

Factors affecting the rectus femoris-patellar tendon Q-angle, measured using a computed tomographic scan

We devised a method to measure the Q-angle (the angle between the rectus femoris and the patellar ligament), using computed tomography (CT), in 1993. In this study, I investigated the lateral shift at each point forming the angle as factors affecting the Q-angle. The study group consisted of 83 patients with recurrent patellar dislocation (83 lower limbs) and a control group of 55 healthy people (55 lower limbs). A lateral shift was found in the anterosuperior iliac spine (ASIS) in the dislocation group compared with the control group (P < 0.01). A lateral shift was also found in the anteroinferior iliac spine (AIIS) in the dislocation group compared with the control group (P < 0.05). A medial shift was found in the bottom of the groove of the femoral condyle in the dislocation group compared with the control group (P < 0.001). A lateral shift was also seen in the tibial tubercle of the dislocation group in comparison with the control group (P < 0.0001). Lateral shift of the tibial tubercle may be the main factor influencing the Q-angle, as measured by CT. Received for publication on April 7, 1998; accepted on Sept. 20, 1998     

Cerebrospinal fluid abdominal cyst. Computed tomographic resolution of a sonographic dilemma

A case of subhepatic cerebrospinal fluid cyst, an uncommon complication of ventriculoperitoneal shunting, is presented. Sonography could not reliably prove shunt tubing to be entering the cystic spaces. Results of computed tomography scanning were definitive.     

青少年特发性脊柱侧凸患者脊椎中央软骨发育相关的CT研究

目的通过影像学测量结果分析脊椎中央软骨（NCC）在青少年特发性脊柱侧凸（AIS）发病中的可能作用。方法AIS患者组（A组）和相应年龄正常对照组（B组）的胸椎CT片各30例,每组均包括青春期前15例和发育成熟者15例。分别测量两组T7-T10椎体CT横断面上的椎弓根长度、椎弓根与脊椎中线的夹角以及NCC与脊椎中线的夹角。对各个相应参数进行比较分析。结果同一组内青春期前和发育成熟的患者的椎弓根长度无明显差异。同年龄层两亚组的椎弓根的长度亦无明显差异。四个亚组组内左、右侧（凹、凸侧）椎弓根与脊椎中线夹角以及NCC与脊椎中线的夹角无明显差异。结论在青春期NCC对椎弓根的生长无明显影响,对AIS的发生发展没有明显的作用,可能与NCC在此期生长活性较低有关。     

Computed tomographic appearance of laryngoceles

The diagnosis of laryngoceles is usually not difficult and can be made clinically and by conventional radiological methods. Computed tomography is a useful, non-invasive, complementary method for confirming the diagnosis especially in complicated cases.     

Computerized tomographic evaluation of acute distal radial fractures.

To learn whether computerized tomography offered additional useful information over conventional radiographic evaluation of acute distal radial fractures in the younger adult, we scanned 22 consecutive injured wrists. Of the distal radial fractures in 19 wrists, sixteen were defined on plain films as intra-articular. In contrast, computerized tomography demonstrated that all fractures of the distal radius had intra-articular extension. In 3 wrists interpreted as being normal on plain films, despite clinical suspicion of a fracture, fractures were confirmed by computerized tomography. As a result of computerized tomography, injuries were assigned a higher Frykman value in 5 cases, and consideration of alternative patient management became necessary in 5 of the 22 patients.     

Computer tomographic assessment of the pre- and postoperative ventricle width in patients with traumatic intracranial haematomas

Summary The cellular integrity of the brain tissue is not only disturbed by space occupying traumatic intracranial haematomas but also by traumatic brain tissue damage and the accompanying oedema. Due to the insufficiency of visual inspection, methods for an objective quantification of the ventride width are required. A number of techniques have been used for evaluation of the CSF-space after cerebral trauma.In the present study changes of the ventricle size have been evaluated by using planimetric measurements of CT scans. In 222 patients with traumatic intracranial haematomas significant changes in the ventricle width could be demonstrated when the data were analysed by Wilcoxon signed rank test for pair differences. Comparison of the initial cranial computed tomography (CT) with a CT 14 days later revealed a significant dilatation of the ventricle width in all age groups in the second measurement. When patients were divided into groups with or without signs and symptoms of brainstem alteration after trauma, patients with symptoms of brainstem alteration exhibited a significantly greater ventricle width as compared to patients without such symptoms and signs.     

Computed tomographic staging of anterior mediastinal neoplasms.

Sixty patients with anterior mediastinal neoplasms undergoing computed tomography before surgical exploration were entered in a prospective study to assess the value of computed tomography in the preoperative staging of anterior mediastinal tumours. Correct prediction of location, size, and tissue density was obtained in all 60 cases. Correct identification of the nature of the tumours was achieved by computed tomography in 37 of the 54 previously undiagnosed cases. Particular attention was given to the evaluation of the relation of the tumour to adjacent mediastinal structures, to predict the feasibility of radical surgical procedures. Overall sensitivity, specificity, and accuracy in identifying resectability were 46%, 85%, and 64%, with positive and negative predictive indices of 78% and 58%. Capsulated or highly invasive lesions were clearly distinguished, and the presence or absence of infiltration of mediastinal vessels, pericardium, and chest wall was correctly recognised in most cases. It is suggested that the evaluation of anterior mediastinal neoplasms should include computed tomography because of its accuracy in predicting size, location, and tissue density of the neoplasm. Computed tomography may suggest, often with good reliability, the histological type of the tumour and its relation to contiguous mediastinal structures, thus contributing to the choice of the appropriate surgical approach or route for biopsy.     

Computed tomographic scanning in children.

Computed tomographic scanning (CT) has been effectively utilized in evaluating the pediatric patient. Our experience with CT of the chest and abdomen in 19 patients has been described. The advantages offered by CT include: a unique anatomic display, the lack of morbidity, and an acceptable radiation dosage. Few technical disadvantages exist. Further application of this unique technique can be predicted.     

Meta-analysis of positron emission tomographic and computed tomographic imaging in detecting mediastinal lymph node metastases in nonsmall cell lung cancer

A systematic review was undertaken to select studies that compared the accuracy of 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography with computed tomographic imaging in detecting mediastinal lymph node metastases in patients with nonsmall cell lung cancer. Two authors selected relevant articles according to predefined criteria. With a meta-analytic method, summary receiver operating characteristic curves were constructed. The point on the receiver operating characteristic curve with equal sensitivity and specificity for 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography was Q* = 0.90 (95% confidence interval [CI], 0.86 to 0.95). For computed tomography it was 0.70 (95% CI, 0.65 to 0.75). The difference was highly significant (p < 0.0001). We conclude that 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography is more accurate than computed tomography in detecting mediastinal lymph node metastases.     

Thoracic disc herniation. Improved diagnosis with computed tomographic scanning and a review of the literature

Thoracic disc herniation is uncommon. One of the main problems in the treatment of thoracic disc herniation has been the lack of accuracy of diagnostic tests. Now, with the use of computed tomographic scanning with and without metrizamide in the subarachnoid space, this accuracy has greatly improved. Computed tomography scanning can demonstrate the type and level of the lesion even when the myelographic study is negative. We have reviewed 280 cases; a peak incidence was noted in the fourth decade with 75% of the protruded discs occurring below T-8. Back pain was the most common presenting symptom followed by sensory disturbances. By the time of diagnosis, 70% of the patients had signs of spinal cord compression. A small group of patients could be identified that invariably had a good prognosis. They had a history of trauma, symptoms lasting less than a month, and soft disc herniation. Regarding the results of surgical treatment, there was a success rate ranging from 57% for decompressive laminectomy to over 80% for the posterolateral, lateral, and transthoracic approaches.     

Computed tomographic measurement of gender differences in bowing of the sagittal femoral shaft in persons older than 50 years

Surgeons do not give enough weight to the effects of bowing of the sagittal femoral shaft in total knee arthroplasty (TKA), which can result in damage to the cortex, fractures, or malalignment of the femoral component. To determine gender differences in bowing, we used spiral computed tomography to scan the femurs of 26 men and 47 women older than 50 years who required TKA. Skeletal extraction of the total sagittal femoral shaft from computed tomographic images was done by a matrix laboratory. The extracted curves were evenly divided into 3 sections. Comparison of the curvature on different sections of the same side of the femur showed that the distal third was significantly bowed. In addition, the curvature of the distal third was significantly larger in women than in men. Such morphological characteristics put forward new requirements in how intramedullary guide rods are used in TKA.     

Computed tomographic appearance of an oleothorax.

Sequelae of oleothorax, formerly used in the treatment of tuberculosis, may still be encountered. A patient is reported whose oleothorax, created 44 years previously, was demonstrated by computed tomography.