Compare Computed Tomography Scans Research Articles

Comparative Effect of Multi-Dose Contrast Median on Contrast-Enhanced Computed Tomography Workflow of Nurses and Hospital Efficiency: A Multi-CenterReal-World Prospective Observational Study in China.

This study aims to evaluate and compare computed tomography (CT)-contrast operational workflow and hospital imaging efficiency when using a multi-dose bulk IV contrast delivery system and when using a single-dose packaging contrast. A multi-center prospective observational study was conducted in six regions in China. The operating time and workflow of radiology nursing staff were evaluated and observed using an investigational tool and recorded by the investigators using a stopwatch. Nursing staff's knowledge and the imaging capabilities of hospitals were collected using a questionnaire. Rate, t-test, χ 2 test, and partial correlation analysis were used to describe the knowledge of nursing staff. The operation time and frequency of the two contrast agent packages were further compared using the Stata 15.0 software. A total of 42 radiology nurses and 1,167 CT contrast-operating procedures in six provinces in China were evaluated. The total operating times for the 100 ml contrast agent versus the 200 ml contrast agent were 80.67 s and 63.81 s, respectively (P < 0.01). According to the average annual hospital CT scans (49,807 scans) and the power injector (PI) market share, approximately 233 h yearly could be saved in a hospital. Regarding CT contrast knowledge, approximately 57.14% nurses expressed their willingness to use multi-dose packaging contrast agents. Through difference and correlation analysis on real-world data, this study suggests that, considering safety, the use of a multi-dose bulk IV contrast agent is more time-saving and efficient for Chinese nurses and medical institutions compared with that of a single-dose package.

Periosteal reaction of medication-related osteonecrosis of the jaw (MRONJ): clinical significance and changes during conservative therapy.

We previously reported that the periosteal reaction (PR) in medication-related osteonecrosis of the jaw (MRONJ) is a poor prognostic factor in surgical cases, but it is not clear how PR changes during conservative therapy. The purpose of this retrospective study was to compare computed tomography (CT) findings at the first visit and during follow-up visits in MRONJ patients subjected to conservative therapy and to investigate factors associated with the exacerbation of PR during conservative therapy. Sixteen patients with MRONJ of the lower jaw who underwent conservative therapy and experienced a PR on CT images at the first visit and underwent CT examination again after 6 months or more were enrolled in the study. Clinical features and CT findings (extent of osteolytic lesion, extent of PR, type of PR, and changes during conservative treatment) were investigated. On the second CT scan, the osteolytic lesion improved in 4 patients, had not changed in 5, and deteriorated in 7, whereas the PR improved in 5 patients, had not changed in 4, and deteriorated in 7 patients. PR was significantly deteriorated in patients who continued to receive antiresorptive agents during conservative treatment and in patients with deteriorated osteolytic lesions. PR in MRONJ often expands during conservative therapy and the PR type progresses from the attached type to the gap type, and the irregular type, but discontinuation of antiresorptive agent may improve PR as well as osteolytic lesions.

Short-Term Bone Fusion With Arthroscopic Double-Button Latarjet Versus Open-Screw Latarjet

Background: Recently, arthroscopic double-button Latarjet (AL) has provided an alternative to conventional open Latarjet (OL) in the treatment of anterior shoulder instability with glenoid bone loss. Therefore, theoretically, the faster fusion is obtained, the sooner return to sports under safe conditions can occur. The emerging flexible fixation of the bone block has clearly offered a new approach to achieve bone fusion. However, the period required to achieve this goal remains controversial. Purpose/Hypothesis: The purpose was to compare computed tomography (CT) scan results of AL and OL in the early postoperative period. It was hypothesized that the bone block fusion with AL would require a longer time than that with OL. Study Design: Cohort study; Level of evidence, 3. Methods: In a retrospective 1-year study, the authors compared 17 primary double-button AL to 22 primary 2-screw OL procedures indicated for anterior shoulder instability in patients with an Index Severity Instability Score >3 points. These patients were reviewed with a CT scan at 1 day, 3 months, and 6 months postoperatively. The characteristics for the 2 groups were comparable. CT scans aimed to analyze graft position, bone contact area with the scapula, and fusion at 3 and 6 months. Clinical assessment was based on the Walch-Duplay and Rowe scores. Results: The mean preoperative Index Severity Instability Score was 5.3 ± 1.9 points, with a mean anterior glenoid bone loss of 9.1% ± 4.6%. At 3 months, the rates of fusion were 41% and 100% for the AL and OL groups, respectively (P < .001). This rate increased to 70% in the AL group at 6 months (P = .006). In the axial and sagittal planes, there was no difference in graft position between the AL group and the OL group. The bone block was longer and there was a more extensive bone contact area in the OL group (AL, 131 mm2 vs OL, 223 mm2; P < .001). At 6 months of follow-up, no significant difference in clinical scores was noted between the groups: Walch-Duplay score, 93.0 ± 10.9 points versus 91.8 ± 12.5 points (P = .867); and Rowe score, 99.0 ± 2.2 points versus 95.0 ± 8.4 points (P = .307) for the AL and OL groups, respectively. Conclusion: AL required more time to achieve bone block fusion than OL. This finding should be taken into account when considering this procedure for patients in a hurry to return to sports involving the shoulder.

Examining the Severity of Roof‐Hooking Injuries in Dolphinfish: a Comparison between Computed Tomography and Gross Necropsy

AbstractWe describe hook trauma to the roof of the mouth in Dolphinfish Coryphaena hippurus and compare computed tomography (CT) scanning to gross necropsy (GN) as a technique for diagnosing hooking injury in fish. Forty‐two Dolphinfish carcasses spanning a range of hook injuries were collected and CT scanned, and 33 of those carcasses were evaluated using GN. Specimens were hooked either in the roof of the mouth, the eye via the roof or upper jaw, or the jaw (control group). In 75% of roof‐hooked individuals, GN revealed nondisplaced to comminuted fractures of the bones of the suspensorium, hematomas in and laceration of the extraocular muscles, and/or damage to the optic nerve. These injuries have the potential to compromise vision and therefore decrease postrelease survival rates of obligate sight‐feeding species such as the Dolphinfish. We evaluated the effectiveness of CT scanning to diagnose injury and found that CT could efficiently and accurately identify fractures and some soft‐tissue damage, but some injuries found in GN (e.g., optic nerve damage) were not observed on CT scans. Based on our findings, it is likely that mortality is greater in Dolphinfish when hooked in the roof of the mouth than when hooked in the jaw. This study demonstrates a novel technique that was effective at diagnosing hooking injuries associated with the roof of the mouth.

Treatment Effect of Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension Quantified by Automatic Comparative Imaging in Computed Tomography Pulmonary Angiography.

Balloon pulmonary angioplasty (BPA) in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) can have variable outcomes. To gain more insight into this variation, we designed a method for visualizing and quantifying changes in pulmonary perfusion by automatically comparing computed tomography (CT) pulmonary angiography before and after BPA treatment. We validated these quantifications of perfusion changes against hemodynamic changes measured with right-sided heart catheterization. We studied 14 consecutive CTEPH patients (12 women; age, 70.5 ± 24), who underwent CT pulmonary angiography and right-sided heart catheterization, before and after BPA. Posttreatment images were registered to pretreatment CT scans (using the Elastix toolbox) to obtain corresponding locations. Pulmonary vascular trees and their centerlines were detected using a graph cuts method and a distance transform method, respectively. Areas distal from vessels were defined as pulmonary parenchyma. Subsequently, the density changes within the vascular centerlines and parenchymal areas were calculated and corrected for inspiration level differences. For visualization, the densitometric changes were displayed in color-coded overlays. For quantification, the median and interquartile range of the density changes in the vascular and parenchymal areas (ΔVD and ΔPD) were calculated. The recorded changes in hemodynamic parameters, including changes in systolic, diastolic, and mean pulmonary artery pressure (ΔsPAP, ΔdPAP, and ΔmPAP, respectively) and vascular resistance (ΔPVR), were used as reference assessments of the treatment effect. Spearman correlation coefficients were employed to investigate the correlations between changes in perfusion and hemodynamic changes. Comparative imaging maps showed distinct patterns in perfusion changes among patients. Within pulmonary vessels, the interquartile range of ΔVD correlated significantly with ΔsPAP (R = -0.58, P = 0.03), ΔdPAP (R = -0.71, P = 0.005), ΔmPAP (R = -0.71, P = 0.005), and ΔPVR (R = -0.77, P = 0.001). In the parenchyma, the median of ΔPD had significant correlations with ΔdPAP (R = -0.58, P = 0.030) and ΔmPAP (R = -0.59, P = 0.025). Comparative imaging analysis in CTEPH patients offers insight into differences in BPA treatment effect. Quantification of perfusion changes provides noninvasive measures that reflect hemodynamic changes.

Accuracy of adrenal imaging and adrenal venous sampling in diagnosing unilateral primary aldosteronism.

The correct differentiation between unilateral and bilateral adrenal involvement in patients with primary aldosteronism (PA) is of utmost importance to justify surgical treatment. The aim of this study was to determine the accuracy of adrenal imaging compared to adrenal venous sampling (AVS), histopathology and postoperative outcome. The data of all patients with unequivocal AVS who underwent unilateral laparoscopic adrenalectomy for primary aldosteronism between May 2004 and April 2015 were entered in this retrospective study. We compared computed tomography (CT) and magnetic resonance imaging (MRI) results with corresponding AVS data, histopathology findings and postoperative outcome. A total of 175 patients underwent unilateral laparoscopic adrenalectomy for primary aldosteronism. AVS was successful in 152 patients and postoperative outcome available in 148 patients. Despite unilateral disease according to AVS results, bilateral normal glands were seen in 15 MRI (17·2%) and 7 CT scans (8·5%), respectively. Unilateral enlargement of the nonhypersecreting adrenal gland was found in three MRI (3·5%) and 10 CT scans (12·2%) of patients who showed aldosterone hypersecretion deriving from the contralateral gland. Fifteen MRI (17·2%) and 18 CT scans (22·0%) revealed bilateral adrenal pathology despite unilateral aldosterone hypersecretion. The accuracy of CT and magnetic resonance imaging in predicting unilateral disease is poor. AVS appears to be an essential diagnostic step to identify those patients who may benefit from unilateral adrenalectomy.

Comparison of Computed Tomography– and Magnetic Resonance Imaging–based Clinical Target Volume Contours at Brachytherapy for Cervical Cancer

We prospectively compared computed tomography (CT)- and magnetic resonance imaging (MRI)-based high-risk clinical target volume (HR-CTV) contours at the time of brachytherapy for cervical cancer in an effort to identify patients who might benefit most from MRI-based planning. Thirty-seven patients who had undergone a pretreatment diagnostic MRI scan were included in the analysis. We delineated the HR-CTV on the brachytherapy CT and brachytherapy MRI scans independently for each patient. We then calculated the absolute volumes for each HR-CTV and the Dice coefficient of similarity (DC, a measure of spatial agreement) for the HR-CTV contours. We identified the clinical and tumor factors associated with (1) a discrepancy in volume between the CT HR-CTV and MRI HR-CTV contours; and (2) DC. The mean values were compared using 1-way analysis of variance or paired or unpaired t tests, as appropriate. Simple and multivariable linear regression analyses were used to model the effects of covariates on the outcomes. Patients with International Federation of Gynecology and Obstetrics stage IB to IVA cervical cancer were treated with intracavitary brachytherapy using tandem and ovoid (n=33) or tandem and cylinder (n=4) applicators. The mean CT HR-CTV volume (44.1cm3) was larger than the mean MRI HR-CTV volume (35.1cm3; P<.0001, paired t test). On multivariable analysis, a higher body mass index (BMI) and tumor size ≥5cm with parametrial invasion on the MRI scan at diagnosis were associated with an increased discrepancy in volume between the HR-CTV contours (P<.02 for both). In addition, the spatial agreement (as measured by DC) between the HR-CTV contours decreased with an increasing BMI (P=.013). We recommend MRI-based brachytherapy planning for patients with tumors >5cm and parametrial invasion on MRI at diagnosis and for those with a high BMI.

Clinical Utility of Computed Tomography and Magnetic Resonance Imaging for Diagnosis of Posterior Reversible Encephalopathy Syndrome after Stem Cell Transplantation in Children and Adolescents

Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome characterized by vision changes, altered mental status, and seizures, typically caused by an acute rise in blood pressure. PRES has been reported after hematopoietic stem cell transplantation (HSCT) in association with hypertension from calcineurin inhibitors and corticosteroids. The imaging evaluation of PRES after HSCT in children and young adults has not been well described. We performed a retrospective review of all HSCT recipients presenting to the intensive care unit with new neurologic symptoms. A neuroradiologist reviewed all radiologic images and compared computed tomography (CT) versus magnetic resonance imaging (MRI) findings indicative of diagnosis of PRES. Alternative imaging diagnoses explaining the patients' symptoms were also recorded. Fifty-four transplant recipients were admitted to the intensive care unit with new neurologic symptoms. Thirty-nine percent (21 of 54) of subjects had imaging findings consistent with PRES, 24% (13 of 54) had imaging findings consistent with an alternative diagnosis, 9% (5 of 54) had a nonspecific finding, and 28% (15 of 54) had no acute imaging findings. PRES was diagnosed at a median of 49 days (interquartile range, 29 to 94) after HSCT. The presenting symptom for the majority of patients with PRES was seizures (86%), whereas 14% presented with acute encephalopathy. Ninety-five percent of subjects diagnosed with PRES (20 of 21) underwent a head CT as their initial imaging evaluation. CT scan was diagnostic of PRES in 40% (8 of 20). Subsequently, 16 patients underwent brain MRI with 12 additional patients being diagnosed with PRES on MRI. The median time elapsed between negative CT and a positive MRI examination was 20 hours (range, 3.6 hours to 9 days). CT serves as an excellent screening test for acute pathology, such as intracranial hemorrhage; however, it lacks sensitivity for the diagnosis of PRES. Patients with clinical symptoms suggestive of PRES who have a negative CT should be treated appropriately for PRES and should undergo MRI of the brain as soon as clinically stable to confirm the diagnosis.

Detection of radiolucencies around endodontically treated teeth on routine CT scans.

This retrospective study compared computed tomography (CT) imaging to routine dental periapical radiographs in diagnosing radiolucencies around endodontically treated teeth. Of the 244 CT scans evaluated, 104 had no teeth on the scan. On the remaining 140 scans, 353 teeth fell into the following categories: 59 maxillary molars, 30 mandibular molars, 66 maxillary premolars, 56 mandibular premolars, and 141 anterior teeth. Positive and negative predictive values were calculated, as were sensitivity, specificity, and prevalence assuming the CT scan was the test standard. For the total tooth population periapical radiograph - CT slice sensitivity was 52, specificity was 90, the positive predictive value (PPV) was 97, the negative predictive value (NPV) was 25, and the prevalence 85. In the population studied, the CT scan had a greater ability to show radiolucencies that were not evident on periapical radiographs.

Stent Graft Placement for Postsurgical Hemorrhage from the Hepatic Artery: Clinical Outcome and CT Findings

PurposeTo evaluate the clinical results and imaging follow-up findings of stent grafts placed for hemorrhage from hepatic arteries following surgery. Materials and MethodsThe investigation included 17 patients (14 men and 3 women) who underwent endovascular stent graft placement for hepatic arterial hemorrhage following surgery. Bleeding occurred from the common hepatic artery (n = 1; 6%), right hepatic artery (n = 1; 6%), proper hepatic artery (n = 6; 35%), and gastroduodenal artery stump (n = 9; 53%). Stent graft patency, thrombus at the graft, target hepatic artery diameter, and liver perfusion status were analyzed by comparing computed tomography (CT) scans performed before the procedure with follow-up CT scans. Laboratory data were also analyzed before the procedure and at follow-up intervals. ResultsThere were 17 stent grafts placed in 17 patients. The mean follow-up period was 356 days (range, 1–2,119 d). The stent graft primary patency rate was 79.5% at 1 month, 69.6% at 6 months, and 69.6% at 1 year. The clinical success rate was 82% (14 of 17 patients), and the technical success rate was 94% (16 of 17 patients). Mortality related to the stent graft was 12% (2 of 17 patients). Occlusion occurred in 4 of 16 stent grafts (25%). There was one technical failure. The mean stent graft diameter was 6.2 mm (range, 3.5–8.0 mm), and the degree of stent graft oversizing was 38% of the hepatic artery diameter on CT scans and 58% on angiography. Hepatic parenchymal perfusion was preserved in 80% of patients (12 of 15). ConclusionsHepatic artery hemorrhage following surgery can be treated effectively with stent graft placement.

CT sensitivities for large (≥3cm) adrenal adenoma and cortical carcinoma.

To retrospectively compare computed tomography (CT) sensitivities of large (≥3cm) adenoma and cortical carcinoma. Between January 2004 and November 2012, 43 non-oncologic patients with 43 adrenal masses [31 large adenomas, and 12 carcinomas] underwent unenhanced CT, early contrast-enhanced CT, and delayed contrast-enhanced CT scans prior to adrenalectomy. Three types of region-of-interest (ROI) were used on early contrast-enhanced CT images:aROI (large ROI) covering more than half of a mass and two small ROIs fitted to the highest (high ROI) or lowest (low ROI) attenuation area. These ROIs were also placed in the same area on the other CT images. Adenoma was diagnosed if a mass measured≤10 HU on unenhanced CT image, or if it had≥60% absolute percentage washout (APW)or≥40% relative percentage washout (RPW).Carcinoma was diagnosed if a mass had<60% APW and<40% RPW. CT sensitivities for large adenoma and carcinoma were compared. CT sensitivities for large adenoma vs. carcinoma were 64.5% (20/31) vs. 100% (12/12) using a large ROI, 100% (31/31) vs. 50.0% (6/12) using a high ROI, and 51.6% (16/31) vs. 100% (12/12) using a low ROIs, respectively. CT sensitivities for large adenoma and cortical carcinoma are influenced by the size or location of an ROI.A large ROI helps to minimize loss of CT sensitivity for large adenoma and to detect carcinoma.

A Synthesis of Research Examining Timely Removal of Cervical Collars in the Obtunded Trauma Patient With Negative Computed Tomography

Currently, the standard to clear the cervical spine in obtunded blunt trauma patients is computed tomography in combination with plain films, dynamic fluoroscopy, or magnetic resonance imaging. The objective of this study was to answer the question "Can computed tomography alone provide adequate clinical information to clear the cervical spine in the obtunded patient?" The author performed a search of the literature for studies that compared computed tomography (CT) with other radiologic modalities utilized to clear the cervical spine in obtunded patients. PubMed, TRIPdatabase, SUMsearch, Cochrane library, and Google Scholar were the databases applied. Additional sources included bibliographies of selected articles. Studies that integrated CT scan with at least 1 other diagnostic examination were included. A review of 11 studies and 1 meta-analysis encompassing 2458 and 14327 patients, respectively, met inclusion criteria. The meta-analysis generated a negative predictor value for CT scan of 100% without evidence of acute injury with an overall sensitivity and specificity of 99.9% each. The results suggest that CT alone is a reliable clinical indicator to clear the cervical spine in obtunded patients.

Computed tomography for the detection of thumb base osteoarthritis: comparison with digital radiography

To compare computed tomography (CT) with digital radiography for the detection of osteoarthritis (OA) of the first carpometacarpal (CMC1) and scaphotrapeziotrapezoid (STT) joint. We retrospectively identified patients who were assessed for CMC1 OA or STT OA at our hand surgery outpatient clinic between January 2008 and March 2011, and who had both a digital radiograph and a CT scan of the hand within a 3-month period. CT and radiographic images were scored independently by two musculoskeletal radiologists for joint space narrowing (JSN), osteophytes, subchondral sclerosis, bone cysts, and erosions in the CMC1 and STT joints. Thirty patients were identified. The inter-reader reliability of CT for the detection of CMC1 OA (ICC 1.00) and STT OA (ICC 0.80) was higher than radiography (ICC's 0.15 and 0.45). In comparison with their own radiographical scoring, both readers detected with CT 3 more patients with CMC1 OA, and 13 and 5 more patients with STT OA. Computed tomography had a higher inter-reader reliability and detection rate for both CMC1 and STT OA, compared with radiography. As surgical treatment selection of thumb base OA depends on the presence of pathology in the CMC1 and STT joints, CT may improve treatment selection and surgical planning.

Volumetric changes of the anterolateral thigh free flap following adjuvant radiotherapy in total parotidectomy reconstruction

The aim of this study was to prospectively evaluate volume change in anterolateral thigh free flaps pre- and postradiotherapy and to compare computed tomography (CT) volumetric analysis with intraoperative water displacement calculation. Matched pair cohort study. Thirteen patients with advanced carcinoma of the parotid gland underwent anterolateral thigh free flap reconstruction following total parotidectomy resections and neck dissection. Before the initiation of external beam radiation, routine CT planning scans were done on all patients. A minimum of 6 months after surgery, a CT scan of the head and neck was carried out, and a detailed volumetric assessment was performed. The mean preradiotherapy flap volume was 94.3 mL, and the postradiotherapy volume was 84.8 mL. The mean volume reduction in all 13 patients was 8.12%. In this prospective study we observed an 8% volume loss in anterolateral thigh free flaps 6 months postradiotherapy. This loss of volume should be taken into account when reconstructing large defects of the face and lateral skull base. Intraoperative water displacement measurement is a useful adjunctive tool for shaping free tissue transfers that are to be used for volume replacement and soft-tissue fill-in.

A dose comparison survey in CT departments of dedicated paediatric hospitals in Australia and Saudi Arabia

To measure and compare computed tomography (CT) radiation doses delivered to patients in public paediatric hospitals in Australia and Saudi Arabia. Doses were measured for routine CT scans of the head, chest and abdomen/pelvis for children aged 3-6 years in all dedicated public paediatric hospitals in Australia and Saudi Arabia using a CT phantom measurement cylinder. CT doses, using the departments' protocols for 3-6 year old, varied considerably between hospitals. Measured head doses varied from 137.6 to 528.0 mGy(·)cm, chest doses from 21.9 to 92.5 mGy(·)cm, and abdomen/pelvis doses from 24.9 to 118.0 mGy(·)cm. Mean head and abdomen/pelvis doses delivered in Saudi Arabian paediatric CT departments were significantly higher than those in their Australian equivalents. CT dose varies substantially across Australian and Saudi Arabian paediatric hospitals. Therefore, diagnostic reference levels should be established for major anatomical regions to standardise dose.

Computed tomography findings after endoscopic sinus surgery with preserving or enlarging maxillary sinus ostium surgery

Endoscopic sinus surgery (ESS) is the main surgical approach in the treatment of chronic rhinosinusitis (CRS) after failure of medical treatment. ESS is based on the theory that obstruction of the maxillary sinus ostium is mainly behind the pathogenesis of CRS. Controversy remains concerning the enlargement of the natural maxillary sinus ostium. The aim of this study was to compare computed tomography (CT) findings after preservation or enlargement of the maxillary sinus ostium. Thirty patients with non-polypous CRS underwent randomized endoscopic sinus surgery with uncinectomy on one side and additional middle meatal antrostomy on the other side. Lund-Mackay (LM) scores and the ostium diameters were analysed from CT scans taken preoperatively and nine months postoperatively, and were used for comparison of the two operative techniques. In addition, the correlation between CT findings and subjective outcomes was studied. Comparison of the preoperative and postoperative CT scans revealed that significant reduction of LM score was achieved on both sides, regardless of the type of procedure performed. The postoperative area of the ostium remained significantly larger on the antrostomy side compared to the uncinectomy side. A large maxillary sinus ostium size seems to associate with lower postoperative LM score, but does not seem to provide superior symptom relief.

Correlations between computed tomography findings and clinical manifestations of Streptococcus pneumoniae pneumonia

The aim of this study was to characterize the imaging features and compare computed tomography (CT) findings with clinical features of patients with Streptococcus pneumoniae pneumonia. We retrospectively reviewed 75 patients (44 men, 31 women; mean age 67 years) diagnosed with S. pneumoniae pneumonia who underwent chest CT scanning at our institution between January 2007 and August 2008. Diagnoses were based on detection of the S. pneumoniae antigen in urine. Chest CT scans revealed abnormalities in all patients. The predominant opacity patterns were an airspace pneumonia pattern (48%) and a bronchopneumonia pattern (48%), followed by an interstitial pneumonia pattern (4%). Consolidation was observed most frequently (84%) followed by ground glass opacity (82.7%), bronchial wall thickening (61.3%), and centrilobular nodules (49.3%). Airway dilatation (21.6%), pleural effusion (33.3%), lymphadenopathy (34.8%), and pulmonary emphysema (21.3%) were also observed. Pulmonary emphysema was significantly less frequent in patients with the bronchopneumonia pattern than in those without (p = 0.007). The clinical features and CT findings did not differ significantly. CT image analysis showed that patients with S. pneumoniae pneumonia exhibited the bronchopneumonia and airspace pneumonia patterns with equal frequency. Bronchopneumonia pattern was less common in patients with preexisting emphysema.

1454 VISCERAL ORGAN-TO-PERCUTANEOUS TRACT DISTANCE IS SHORTER WHEN PATIENTS ARE PLACED IN PRONE POSITION ON BOLSTERS COMPARED TO SUPINE POSITION

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal I1 Apr 20101454 VISCERAL ORGAN-TO-PERCUTANEOUS TRACT DISTANCE IS SHORTER WHEN PATIENTS ARE PLACED IN PRONE POSITION ON BOLSTERS COMPARED TO SUPINE POSITION Raed A. Azhar, Konrad M. Szymanski, Emmanuelle Lemercier, David Valenti, Sero Andonian, and Maurice Anidjar Raed A. AzharRaed A. Azhar More articles by this author , Konrad M. SzymanskiKonrad M. Szymanski More articles by this author , Emmanuelle LemercierEmmanuelle Lemercier More articles by this author , David ValentiDavid Valenti More articles by this author , Sero AndonianSero Andonian More articles by this author , and Maurice AnidjarMaurice Anidjar More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1168AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolithomy (PCNL) in the prone position is associated with a 0.1% risk of colon injury, yet there have not been any reported cases of colon injury with supine PCNL. Therefore, the aim of the present study was to prospectively compare computed tomography (CT) scans of patients performed in both supine and prone positions using bolsters. METHODS Sixteen consecutive patients (mean age 55, 12 males) with renal calculi (3 bilateral) in 19 renal units presenting for PCNL underwent preoperative supine (without bolsters) and prone (with bolsters) non-infused CT scans. Axial images through lower pole calyces containing stones requiring percutaneous access were then analyzed. Percutaneous access was planned based on both supine and prone CT scans. Skin-to-stone distance (cm), angle of the percutaneous tract to the perpendicular (degrees) and visceral organ-to-tract distance (cm) were measured. Wilcoxon signed rank test were used to compare the two groups. The Kruskal-Wallis test was used to assess if the distance of visceral organ-to-percutaneous access tract differed when corrected by skin-to-stone distance. RESULTS Visceral organ-to-tract distance decreased from 3.5cm in the supine position to 2.8cm (p=0.045) in the prone position. In 3 renal units, visceral organ-to-tract distance in the prone position was less than 0.4cm. On prone positioning, skin-to-stone distance decreased from 9.0 to 7.6cm (p=0.0001) and the tract angle increased from 35 to 40 degrees (p=0.02). Nineteen renal units were then divided into two groups according to the median skin-to-stone distance. There was a greater difference in visceral organ-to-tract distance between the two groups when patients were in the prone position (1.7cm vs. 2.7cm, although this was not statistically significant p=0.36). CONCLUSIONS Pre-operative planning CT scans should be performed in the prone position with bolsters to better assessment of organ-to-tract distance when prone PCNL is contemplated. Montreal, Canada© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e560 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raed A. Azhar More articles by this author Konrad M. Szymanski More articles by this author Emmanuelle Lemercier More articles by this author David Valenti More articles by this author Sero Andonian More articles by this author Maurice Anidjar More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

CT and MR findings in synovial chondromatosis of the temporo-mandibular joint: Our experience and review of literature

Objective To compare Computed Tomography (CT) and Magnetic Resonance (MR) features and their diagnostic potential in the assessment of Synovial Chondromatosis (SC) of the Temporo-Mandibular Joint (TMJ). Materials and methods Eight patients with symptoms and signs compatible with dysfunctional disorders of the TMJ underwent CT and MR scan. We considered the following parameters: soft tissue involvement (disk included), osteostructural alterations of the joints, loose bodies and intra-articular fluid. These parameters were evaluated separately by two radiologists with a “double blinded method” and then, after agreement, definitive assessment of the parameters was given. CT and MR findings were compared. Results Histopathological results showed metaplastic synovia in all patients and therefore confirmed diagnosis of SC. MR resulted better than CT in the evaluation of all parameters except the osteostructural alterations of the joints, estimated with more accuracy by CT scan. Conclusions CT scan is excellent to define bony surfaces of the articular joints and flogistic tissue but it fails in the detection of loose bodies when these are not yet calcified. MR scan therefore is the gold standard when SC is suspected since it can visualize loose bodies at early stage and also evaluate disk condition and eventual extra-articular tissues involvement. The use of T2-weighted images and contrast medium allows identifying intra-articular fluid, estimating its entity and discriminating from sinovial tissue.

Assessment of Distal Radioulnar Joint Instability After Distal Radius Fracture: Comparison of Computed Tomography and Clinical Examination Results

To compare computed tomography (CT) and clinical stress test findings in terms of the assessment of distal radioulnar joint (DRUJ) instability after distal radius fracture. Thirty-four patients with a healed unilateral distal radius fracture were evaluated after a mean follow-up period of 18 months. Stress test and CT were performed to detect DRUJ instability. Three CT methods were used: the modified radioulnar line, the epicenter, and the radioulnar ratio methods. The results of CT assessments were compared with stress test findings using kappa statistics. Relationships between DRUJ instability and the radiographic parameters of volar tilt, radial inclination, and radial shortening were analyzed. Twelve patients were considered to have DRUJ instability based on the stress test. DRUJ instability was diagnosed in 15, 8, and 11 patients by the modified radioulnar line, the epicenter, and the radioulnar ratio methods, respectively. Reliability analysis of stress test and CT results showed moderate or fair agreement (kappa value: .33 for the modified radioulnar line, .56 for the epicenter, .41 for the radioulnar ratio). DRUJ instability diagnosed by the stress test and by CT showed no statistical correlation with radiographic parameters, but instability determined by CT appeared to be related to dorsal tilt deformity. After distal radius fracture, CT assessments of DRUJ instability were found to be influenced by residual deformities, such as dorsal tilt, but not well correlated with stress test findings. Although CT assessments are objective, CT scans primarily show alterations of DRUJ alignment and have several risks of bias in patients with a prior distal radius fracture.