The ability of plain radiography to predict intracranial aneurysm occlusion instability during follow-up of endosaccular treatment with Gugliemi detachable coils

Incomplete occlusion of an intracranial aneurysm at follow-up after treatment with Gugliemi detachable coils (GDC) increases the risk of rebleeding and serial angiographic monitoring is therefore currently indicated. We aimed to determine if a change in the plain radiographic appearances of the GDC ball could accurately predict the presence of unstable angiographic occlusion. Paired GDC radiographs (in two planes) and cerebral angiograms, performed immediately after treatment and at follow-up or at two consecutive follow-up examinations, were retrospectively compared. Radiographs were assessed for the radiographic change (loosening, compaction or reorientation) in the coil-ball and angiograms for unstable aneurysm occlusion (neck recurrence or deteriorating occlusion). We compared 49 paired films from 38 patients. Radiographic change in the coil ball had a negative predictive value of 96 %, positive predictive value of 57 % and accuracy of 76 % for the presence of angiographic aneurysm instability. It may be possible to increase the interval between follow-up angiographic examinations after GDC treatment safely if there is no change in the radiographic appearances in two planes. Received: 24 February 2000 Accepted: 16 October 2000     

儿童头位正常与颅面结构的相关性研究

 目的研究正常ND03F儿童头位与颅面结构的相关性。方法选取33例正常ND03F儿童拍摄自然头位时的头颅侧位片,对其颅面结构、颈椎姿势及头位进行分析。结果正常ND03F儿童的SN-VEL、SN-OPT、SN-CVT与SNA、SNB、SND、SNPo存在显著负相关,与SN-GoGn、SN-PP、SN-OP、NSGn等变量存在显著正相关。结论正常ND03F儿童头位变量与一些颅面结构变量间存在显著的相关关系,尤其是与代表面部生长趋势和下颌骨生长方向的若干变量显著相关。     

骨原发性恶性淋巴瘤影像学诊断与组织病理对照研究

目的 探讨骨原发恶性淋巴瘤(PLB)的影像学表现特点.方法 回顾性分析经手术或穿刺活检病理学证实的PLB 9例,其中男6例,女3例,年龄9～60岁,中位年龄26.5岁.9例中X线平片检查8例、CT检查5例、MRI检查7例.其中2例行X线平片和MR检查,2例CT和MR检查,4例具有X线、CT和MR资料.2例为穿刺活检证实;7例行手术切除和病理学检查证实,全部病例均做了常规的组织切片HE染色和免疫组化检查.结果 病灶位于骨盆4例、额骨1例、枕骨斜坡1例、脊柱1例、股骨上端2例.影像学表现:X线表现,病变骨组织外形基本正常4例,内部可见斑点状、大小不等的虫蚀状骨质破坏;4例表现为病变骨质轻度～中度膨胀性改变,局部骨质呈明显溶骨性破坏:CT表现骨髓腔内和骨皮质上可见大小不等的溶骨性破坏,病变骨质周围围绕明显的软组织肿块;MR表现病变区骨髓腔内及周围软组织肿块在T2WI上呈不均匀中度～明显高信号,T1WI上呈均匀等信号.增强扫描后骨髓腔内病灶和周围软组织肿块在CT和MRI上均呈中度～明显强化.病理结果B细胞型5例、T细胞型4例.结论 影像学上PLB以斑点状或渗透性溶骨性破坏为主,病变骨质外形可正常或呈膨胀性改变,伴有明显的周围软组织肿块,中块以病骨为中心生长并有明显强化为其特征.     

锥形束CT与根尖X线片对牙根纵裂诊断价值的对比研究

目的:对比研究牙科锥形束CT(CBCT)与普通根尖X线片在牙根纵裂诊断中的价值。方法:对2009-11—2010-10在我科经临床检查疑似牙根纵裂的69例病人(84个患牙)的根尖X线片及CBCT图像资料进行回顾性分析。由2位有经验的牙体牙髓科主治医生独立阅片,商讨达成一致后,与根尖切除、牙周翻瓣、拔除术等外科手术所见结果进行比较。并将CBCT与根尖X线片对牙根纵裂的诊断结果进行统计学分析。结果:CBCT诊断根裂的阳性检出率、灵敏度、准确度分别为82.1%、87.3%、88.1%,而根尖X线则为39.3%、41.8%、45.2%,差异有统计学意义(P<0.05)结论:CBCT与根尖X线片相比可更准确的诊断牙根纵裂,具有重要的临床应用价值。     

Efficient radiological assessment of the internal snapping hip syndrome

The aim of this study was to evaluate the diagnostic value/significance of various imaging techniques for demonstrating the underlying causative pathology of clinically suspected internal snapping hip syndrome. We intended to define the most efficient diagnostic imaging algorithm that leads to a specific definite therapy for this rare hip disorder. The imaging studies of 54 patients (43 women, 11 men, average age 58 years) with the clinical suspicion of internal snapping hip syndrome were compared for their diagnostic value/significance for finding the underlying pathology. Radiological workup included plain radiographs of the pelvis and hip joints (n=54), ultrasound (US) of the hip joints (n=29), computed tomography (CT) of the pelvis and proximal femur (n=17), and magnetic resonance imaging (MRI) of the pelvis/hip joint (n=21). In order to establish an efficient diagnostic algorithm we compared the diagnostic value of each imaging technique alone and in combination with the other methods. The underlying causative pathology could be established in 37% of patients (n=20) by the use of conventional radiographs alone and in 46% of the patients (n=25) by US alone, and in combination in 83% of the patients (n=45). By adding CT to the radiological workup, we established final diagnosis in 88% (in combination with X-ray; n=15/17) and 94% (together with X-ray and US; n=16/17) of the patients. Whenever MR imaging was used a causative pathology was found in all patients (100%; n=21). The most efficient radiological algorithm in the assessment of patients with internal snapping hip syndrome is the combination of plain radiography and US. MR imaging can be retained for unresolved and difficult cases.     

76例颞下颌关节紊乱病患者许氏位片中髁突位置的分析

目的通过颞下颌关节紊乱病(TMD)患者的许氏位片来分析患者的髁突位置变化。方法选取76例TMD患者为研究对象,男性30例,女性46例,年龄为17～53岁。采用Cohlmia法对76例患者的双侧颞下颌关节(TMJ)的牙尖交错位标准许氏位片进行测量分析。结果76例TMD患者左侧颞下颌关节的PO1(反映髁突矢状向位置)平均值为1.220±0.422,PO2(反映髁突垂直向位置)平均值为0.386±0.085,右侧颞下颌关节的PO1平均值为1.119±0.386,PO2平均值为0.397±0.098,左、右侧髁突位置及关节窝形态的差异均无统计学意义(P>0.05)。结论在颞下颌关节紊乱病患者的许氏位片中,髁突位置变化不明显,诊断意义不大。     

Comparison of plain radiographs with CT scan to evaluate interbody fusion following the use of titanium interbody cages and transpedicular instrumentation

The availability of lumbar interbody cages has fuelled renewed interest in interbody fusion. Despite this, there is no consensus regarding the best non-invasive method for evaluation of interbody fusion, especially where cages have been used. The purpose of this study was to determine whether high-quality thin-slice (1- to 3-mm) computed tomography (CT) scans allow proper evaluation of interbody fusion through titanium cages. Patients undergoing lumbar interbody fusion were prospectively evaluated with CT scan and plain radiographs 6 months following surgery. These images were blindly and independently evaluated by a consultant radiologist and a spine research fellow, for bridging bony trabeculation both through and surrounding the cages as well as for changes at the cage endplate interface. Fifty-three patients (156 cages) undergoing posterior lumbar interbody fusion using titanium interbody cages were evaluated. Posterior elements were used to pack the cages and no graft was packed outside the cages. The outcome data were analysed using the Kappa co-efficient and chi-squared analysis. On CT scan, both observers noted bridging trabeculation in 95% of the cages (Kappa 0.85), while on radiographs this was present in only 4% (Kappa 0.74). Both observers also identified bridging trabeculation surrounding the cages on CT scan in 90% of cages (Kappa 0.82), while on the radiographs this was 8% (Kappa 0.86). Radiographs also failed to demonstrate all the loose cages. The results of the study show that high-quality CT scans show images suggesting bridging bony trabeculae following the use of titanium interbody cages. They also appear to show consistent bone outside the cages in spite of no bone graft having been used, and they appear to be better than plain radiographs in the early detection of cage loosening.     

Pneumatosis cystoides intestinalis and intramural intestinal gas

Gas in the bowel wall is an unusual but important finding on an abdominal radiograph. The so-called “benign form,” pneumatosis cystoides intestinalis, may be asymptomatic or may cause a variety of symptoms and can result in a bowel obstruction or a sterile pneumoperitoneum. On the other hand, intramural intestinal gas may represent severe underlying disease such as necrotizing enterocolitis or mesenteric vascular occlusion. This finding should be sought when examining abdominal radiographs. A thorough appreciation of the clinical significance of this unusual entity is necessary to make timely therapeutic decisions.     

Preoperative imaging of cervical pedicles: comparison of accuracy of oblique radiographs versus axial CT scans

In spite of concerns about safety during their insertion, cervical spine pedicle screws have demonstrated biomechanical superiority over lateral mass screws in several biomechanical studies. One of the concerns for placement of cervical pedicle screws is their small size. Preoperative planning with computed tomography to assess pedicle width has been shown to be extremely accurate and is recommended by several authors. To date there has been no study assessing the accuracy of oblique radiographs for pedicle measurement. We sought to compare accuracy of the oblique radiographic measurements of cervical pedicle width with axial CT scan measurements. Five fresh-frozen human cadaveric cervical spines C3–C7 were studied. Thin cut 1.25 mm computed tomography axial cuts were made through the pedicle isthmus. Oblique radiographs at 35°, 45°, and 55° angles were taken of the right and left pedicles of each specimen using a standardized technique. Each radiograph contained a pin of known length to correct for magnification. All pedicles were again measured and corrected for magnification using the standard pin. Corrected oblique radiograph measurements were compared to CT for each specimen. The outer pedicle width was measured and agreed upon by consensus. The radiograph measurements were on average significantly larger than CT measurements for the pedicles indicating that the pin standard did not completely correct magnification. Plain radiographic data failed to reveal that one oblique angle was favorable to another in terms of magnification or precision. Plain radiographs at oblique angles do not provide accurate measurements of subaxial cervical pedicles at 35°, 45°, or 55° angles. We recommend that thin cut axial CT scans be obtained on all patients prior to transpedicular fixation in the cervical spine. This research was supported by Evanston Northwestern Healthcare Medical Group Orthopaedic Faculty Practice Institutional funds.