Sensitivity Of Radiography Research Articles

Візуалізація у діагностиці ушкоджень органів черевної порожнини при бойовій травмі

The article presents the results of radiographic and ultrasound examinations in the diagnosis of injuries to the abdominal organs in the case of gunshot wounds in 67 patients. In case of gunshot wounds to the abdomen, damage to hollow organs was recorded significantly (P<0.001) more often than to parenchymal organs. The sensitivity of radiography in the diagnosis of pneumoperitoneum was 90.3%, specificity — 75.0%, accuracy — 88.6%. The sensitivity of ultrasound was 89.3%, specificity — 66.7%, accuracy — 82.9%, respectively. In the diagnosis of hemoperitheneum, the sensitivity of ultrasound was 88.9%, the specificity was 80.0%, and the accuracy was 93.8%. The sensitivity of radiography was 89.3%, specificity — 66.7%, accuracy — 82.9%, respectively.

Radiologic diagnosis of pneumothorax in combat trauma

Background. Chest injuries during combat operations occupy a prominent place and often become the cause of mortality. Before the widespread introduction of imaging methods into clinical practice, the mortality rate for chest combat injuries exceeded 50 %. Objective: a comparative assessment of radiography and ultrasonography options in the diagnosis of pneumothorax that occurred as a result of combat trauma. Materials and methods. A comparative analysis of the radiography and ultrasonography results was carried out in 76 patients with pneumothorax due to chest combat trauma. Results. During X-ray in the supine position, the sensitivity of the method was 58.1 %, specificity — 72.7 %, accuracy — 64.5 %, positive predictive value — 73.5 %, negative predictive value — 57.1 %. The sensitivity of the method in the sitting position of patients was 71.9 %, specificity — 89.5 %, accuracy — 76.3 %, positive predictive value — 95.3 %, negative predictive value — 51.5 %. Ultrasound diagnosis of pneumothorax was based on identifying the “barcode” sign due to the lack of sliding of the visceral pleura during the patient’s inspiration. The sensitivity of ultrasonography in B-mode was 90.8 %, specificity — 81.8 %, accuracy — 89.5 %, positive predictive value — 96.7 %, negative predictive value — 60.0 %, and in combined B + M modes — 94.0, 88.9, 93.4, 98.4, 66.7 %, respectively. In the diagnosis of large pneumothorax, the sensitivity of radiography was 96.8 %, specificity — 100.0 %, accuracy — 96.9 %, positive predictive value — 100.0 %, negative predictive value — 50.0 %, respectively, and of ultrasonography — 96.7, 100.0, 96.9, 100.0, 66.7 %, respectively. Conclusions. Ultrasonography has greater sensitivity for diagnosing small pneumothorax than conventional radiography, especially in bedridden patients. Ultrasonography in combined B + M modes can be both a primary and a clarifying method for diagnosing pneumothorax in combat trauma.

Abdominal Trauma Imaging in a Nigerian Tertiary Hospital-Our Experience with 87 Adult Patients.

Abdominal trauma is a major cause of morbidity and mortality in low- and medium-income countries (LMICs). Abdominal trauma imaging is important in determining the location and severity of organ injury, the need for surgery, and the identification of complications. The choice of imaging in abdominal trauma in LMICs is influenced by peculiar problems, which include the availability of imaging modality, expertise, and cost. There are few reports on options of trauma imaging in LMICs, and this study aimed to identify and characterise the type of imaging done for patients presenting with abdominal trauma at the University of Ilorin Teaching Hospital. This was a retrospective observational study of patients with abdominal trauma who presented at the University of Ilorin Teaching Hospital from 2013 to 2019. Records were identified, and data were extracted and analysed. A total of 87 patients were included in the study. There were 73 males and 14 females. The abdominal ultrasound was the commonest modality done in 36 (41%) patients, whereas abdominal computed tomography was done in five (6%) patients. Eleven patients (13%) had no imaging done, and 10 of these patients proceeded to having surgery. In patients with intraoperative finding of perforated viscus, the sensitivity of radiography was 85% and specificity was 100%, whereas that of the ultrasound was 86.7% and 50% for sensitivity and specificity, respectively. The ultrasound scan was the commonest imaging done for patients who presented with features of haemorrhage (P = 0.04), odds ratio (OR) = 1.29 (95% confidence interval [CI] = 1.08-1.6), and patients with severe injury, P = 0.03, OR = 2.07 (95% CI = 1.06-4.06). Gender (P = 0.64), shock at presentation (P = 0.19), and mechanism of injury (P = 0.11) did not influence the choice of imaging. Abdominal trauma imaging in this setting was majorly via ultrasound and abdominal radiographs. Factors suggested to influence the pattern of abdominal trauma imaging in LMICs include the availability of specific imaging modality, cost, lack of standardisation and definite abdominal trauma protocols.

Comparison of Intra- and Inter-Observer Consistency (Intra-Expert Reliability, Inter-Expert Reliability) in Assessing the Extent of COVID-19 Pneumonia Lesions on Chest Computed Tomography

Background. The SARS-CoV-2 pandemic has set new challenges for the radiological community: early diagnosis of interstitial pneumonia, estimation of its severity, and dynamics. Computed tomography has become the method of choice for assessing lung tissue in COVID-19 patients, which is due to the low sensitivity of radiography in detecting a decrease in airiness by the ground glass opacity type. The criteria for assessing visual signs of lung tissue damage often have a degree of subjectivity, and the conclusion based on them affects the patients management tactics. Aims to determine the inter- and intra-expert consistency in the assessment of the percentage of lesions and the CT stage of COVID-19 pneumonia among experts-radiologists with different experience, to analyze the level of precision depending on the prevalence of the lesion and other factors. Materials and methods. The research analyzed CT scans of 221 patients with confirmed SARS-CoV-2 by PCR. Patients with additional lung pathology and some patients with lesions up to 50% were excluded to create a uniform degree sample of 100 patients. Four expert radiologists determined the percentage of lung damage and the CT stages. The results of the expert assessment are analyzed using the methods of classical descriptive statistics and the analysis of intra-and inter-expert consistency. Results. The correlation of the level of lung damage, when evaluating intra-expert convergence (after 6 months), as a percentage between the first and second reading was R = 0.86 (p 0.05) for expert 1 (high level of training), R = 0.84 (p 0.05) for expert 2 (high level of training). Within the expert agreement, Kappa (for K-degree) was 0.54 for expert 1 and 0.46 for expert 2, which corresponds to a moderate level of consistency. When assessing inter-expert convergence, the connectivity between the level of lung damage as a percentage between experts 1 and 2 (high level of training) was R = 0.87 (p 0.05), between experts 3 and 4 (low level of training) R = 0.78 (p 0.05). The measure of inter-expert agreement Kappa was 0.51 for experts 1 and 2 and 0.56 for experts 3 and 4. The average assessment of experts in the sample varied up to 4.5%, and when analyzing the differences in expert opinions, the difference varied evenly, both in the degree of increase and decrease in the volume of the lesion. Conclusions. In spite of the high level of correlation in the assessment of the percentage of lesion, the convergence of the Cap on the CT degree was moderate, not significantly differing from the degree of expert training. More often, differences in the level of damage are observed in non-classical patterns: reverse halo, curvilinear lines, etc. The difference in opinions doesnt represent a systematic error. Hereby the expert assessment of the volume of lung damage empirically has a moderate, insufficient level of reliability.

Actual concepts of classification, diagnosis and treatment of atlanto-occipital dislocations in adults: non-systematic literature review

Objective. To review the literature on atlanto-occipital dislocation (AOD) in adults to determine the optimal classification, diagnostic method and treatment.Material and Methods. A search was conducted in the PubMed database for the period from 1966 to 2020. The initial search revealed 564 abstracts of articles. A total of 95 studies were selected for a detailed study of the full text, of which 47 studies describing data from 130 patients were included in this review.Results. The paper describes all the available AOD classifications, and discusses their advantages and disadvantages. The clinical picture, features of the diagnosis in published observations of AOD in adults, as well as the applied treatment methods and their results are presented.Conclusion. Atlanto-occipital dislocation is one of the most severe types of injuries of the cervical spine in adults, which is accompanied by damage to the medulla oblongata and gross neurological deficit in 70 % of cases. The sensitivity of radiography for the diagnosis of AOD was 56.3 %. In 18.5 % of patients, its use led to untimely diagnosis and could cause subsequent deterioration. The CT sensitivity was 96.8 %. The most accurate method of AOD verification was to determine the atlanto-occipital interval (100 % sensitivity and specificity). The optimal method of treating victims with AOD is surgical one.

Back to the basics: Study of portable chest radiographic findings in 116 COVID-19 positive patients in an Indian tertiary care hospital.

Context:Paucity of literature of portable CXR findings in COVID-19.Aims:Evaluate radiographic findings in COVID-19 patients and calculate sensitivity of radiographs with RT-PCR as gold standard.Subjects and Methods:Total 116 COVID-19 patients underwent portable CXR between April-June, 2020. Two radiologists reviewed radiographs with respect to laterality, craniocaudal, mediolateral distribution, shape, density, unifocality/multifocality and number of lung zones. Sensitivity of radiography was calculated with RT-PCR as gold standard.Statistical Analysis Used:IBM SPSS Statistics Subscription software (IBM, New York, USA).Results:Many patients 67.2% (78/116) were asymptomatic. Cough (21.5%, 25/116) and fever (17.6%, 20/116) were the most frequent symptoms. 36.2% (42/116) patients revealed COVID-19 pneumonia-like abnormalities on CXR. Sensitivity of CXR with RT-PCR as gold standard was 36.2% (CI: Confidence interval = 27.46% - 44.95%). More patients in symptomatic group (68.4%, 26/38) had abnormal CXR compared to asymptomatic group (20.5%, 16/78) [P < 0.0001]. Radiographs revealed both unilateral (57.1%, 24/42), bilateral (42.8%, 18/42), GGO (80.9%, 34/42), or consolidation (11/42, 26.1%) in a middle (57.1%, 24/42), lower zone (83.3%, 35/42) and peripheral distribution (78.5%, 33/42). Lesions were commonly patchy (88%, 37/42) and multifocal (59.5%, 25/42). Majority had single (40.4%, 17/42) or two zone (35.7%, 15/42) involvement.Conclusions:Significant number of COVID-19 patients were asymptomatic. Over 1/3rd of patients showed radiographic abnormalities. Symptomatic patients were more likely to show radiographic findings than asymptomatic patients. If radiographs identify pneumonia in appropriate clinical setting, CT can be avoided. Common radiographic abnormalities among COVID 19 patients were bilateral/unilateral, patchy, multifocal, ground glass opacity or consolidation in peripheral and middle/lower zone distribution.

Sensitivity of urolithiasis detection using urinary, radiography and ultrasound parameters

Although many information has been published regarding canine urolithiasis, sensitivity of radiography, ultrasound and urinary parameters have been poorly correlated with number, size, and composition of the stones. One hundred and thirteen clinical files of dogs with diagnosis of urolithiasis were retrospectively selected. Information regarding number, appearance, location, size, and composition of the stones were noted after surgical removed. Urolithiasis data was compared with radiographs and ultrasound images and urinalysis parameters. Pure struvite was found in 42.4% and calcium oxalate in 35.6%. Survey radiographs enabled the detection of radiopaque stones and when an ultrasound examination was also performed, the sensitivity was increased. Double contrast radiography enabled identification in 100% of radiolucent stones, and allowed for size measurement and number counts in 76.9% of radiolucent stones. Crystalluria had low sensitivity (31.5%) and specificity (58.8%). Hematuria (96.3%) and leukocyturia (61.1%) were the most common parameters found. We concluded that double contrast radiography can be considered the method of choice for detection of radiolucent stones. Crystalluria is not a good parameter to detect or predict type of stone. Hematuria and leukocyturia, although non-specific findings, can be used as triage for investigation of urolithiasis.

Radiography, abdominal CT and MRI compared with sacroiliac joint CT in diagnosis of structural sacroiliitis

ObjectiveTo assess the performance of pelvic plain radiograph (radiography), abdominal CT and sacroiliac joint MRI (MRI) compared with sacroiliac joints CT (SI joint CT) for the diagnosis of structural sacroiliitis in a population suffering from spondyloarthritis (SpA) meeting the New York or ASAS criteria. MethodsAll SpA patients eligible for biologic treatment who received a pre-therapeutic check-up including the four imaging techniques in the same year were selected from 2005 to 2012. An assessment of sacroiliitis was based independently by a rheumatologist and a radiologist on radiography according to the modified New York criteria and on abdominal CT, MRI and SI Joint CT depending on the presence of erosion on at least two consecutive slices. A final diagnosis was established for conflicting exams. ResultsOf the 58 selected patients, sacroiliitis was diagnosed on radiography, abdominal CT, MRI and SI Joint CT in 32, 26, 34 and 35 patients, respectively. Inter-reader agreements for the grade of sacroiliitis were substantial with a weighted Kappa that varied between 0.60 and 0.76 and they were moderate for the diagnosis of sacroiliitis with a Kappa that varied between 0.45 and 0.55 for the four imaging modalities. The sensitivities of radiography, abdominal CT and MRI were 82.8%, 71.4% and 85.7% respectively and the specificities were 86.9%, 100% and 82.6% respectively with excellent accuracy and positive predictive value and good negative predictive value. ConclusionThis study demonstrates the relevance of MRI and abdominal CT for the diagnosis of structural sacroiliitis with good sensitivities and excellent specificities. These imaging modalities may also contribute for the diagnosis of structural sacroiliitis.

Radiographic interpretation of carpometacarpal arthroplasty: correlation between radiographic loosening and clinical outcome.

To assess the radiographic appearance and interpretation of loosening in patients following first carpometacarpal joint pyrohemisphere arthroplasty. A retrospective review over a 6-year period was performed identifying patients with first carpometacarpal pyrohemisphere implants. All postoperative radiographs were reviewed and compared with clinical information. Loosening was defined as greater than 1mm of periprosthetic lucency or increasing lucency on serial studies. Adverse clinical outcome was defined as infection, complex regional pain syndrome, subluxation or an inability to return to activities of daily living. Statistical analysis included Cohen's Kappa coefficient to measure inter-reader agreement for radiographic interpretation and the agreement between radiographic loosening and an undesired or adverse clinical outcome. Thirty-one implants in 26 patients were reviewed. A total of 73 postoperative radiographs were reviewed. The mean age of the study subjects was 58years. The mean radiographic follow-up was 13months (range: 1-56). All arthroplasties were performed for osteoarthritis. Only one repeat surgery was performed. There was good agreement amongst readers with regard to radiographic interpretation, but the strength of agreement between radiographic loosening and adverse clinical outcome was poor. The sensitivity of radiography in predicting an adverse clinical outcome was 63%, specificity 65%, positive predictive value 39%, and negative predictive value 83%. Although radiography may be useful in the correct clinical context, it should not be utilized as the sole predictor of adverse clinical outcomes following carpometacarpal arthroplasty.

Cone-Beam CT in diagnosis of scaphoid fractures.

This prospective study investigated the sensitivity of cone beam computed tomography (CBCT), a low dose technique recently made available for extremity examinations, in detecting scaphoid fractures. Magnetic resonance imaging (MRI) was used as gold standard for scaphoid fractures. A total of 95 patients with a clinically suspected scaphoid fracture were examined with radiography and CBCT in the acute setting. A negative CBCT exam was followed by an MRI within 2weeks. When a scaphoid fracture was detected on MRI a new CBCT was performed. Radiography depicted seven scaphoid fractures, all of which were also seen with CBCT. CBCT detected another four scaphoid fractures. With MRI another five scaphoid fractures were identified that were not seen with radiography or with CBCT. These were also not visible on the reexamination CBCT. Sensitivity for radiography was 44, 95% confidence interval 21-69%, and for CBCT 69%, 95% confidence interval 41-88% (p = 0.12). Several non-scaphoid fractures in the carpal region were identified, radiography and CBCT depicted 7 and 34, respectively (p < 0.0001). CBCT is a superior alternative to radiography, entailing more accurate diagnoses of carpal region fractures, and thereby requiring fewer follow-up MRI examinations. However, CBCT cannot be used to exclude scaphoid fractures, since MRI identified additional occult scaphoid fractures.

Accuracy of ultrasonography for the diagnosis of pneumoperitoneum

Patients and methods Study patients: 11 consecutive adults with a diagnosis of pneumoperitoneum by CT. Control patients: 11 consecutive adults with severe acute abdominal pain with a diagnosis other than pneumoperitoneum by CT. US examination has been performed with a convex and a linear probe using the following scans: epigastrium, right and left hypocondrium, umbelical area and right hypocondrium. All exams were recorded in a video of 5 seconds and each videos reviewed by 2 radiologists and 2 senior physicians blinded to other imaging studies. The reviewers fulfilled a standardized form signing for each scan either presence or absence of pneumoperitonem signs (enhancement of the peritoneum stripe with ring-down artifacts or “comet tails” starting from peritoneum). If one of the signs of pneumopeitoneum was present in at least one scan, the patient was considered to have a US diagnosis of pneumoperitoneum. The reviewers also evaluated abdomen radiography for the presence/absence of pneumoperitoneum. CT was considered the gold standard. Results 1) Accuracy of abdomen US was 88.6%. Sensitivities of convex and linear probes were similar (88.6% vs 84.1%), while specificity of convex was lower than linear probe (81.8% vs 95.5%). 2) Accuracy of a “2 scan-fast exam” was similar to global exam (87.5%). 3) Abdominal radiography sensitivity (72.2%) was lower than US while specificity (92.5%) was higher.

Visual Diagnosis: An 11-Month-Old With Nausea, Vomiting, and an Abdominal Mass

Children with intussusception can present with a wide variety of symptoms, including vomiting, fever,lethargy, and abdominal pain. The classic triad of abdominal pain, hematochezia, and palpable abdominal mass is seen in a few patients.• Early diagnosis of intussusception depends on a high level of clinical suspicion in any child with non specific abdominal findings followed by appropriate radiographic or ultrasonographic evaluation and confirmation with a contrast enema.• Abdominal radiography, although an appropriate component of the initial workup for gastrointestinal symptoms, lacks the sensitivity to reliably exclude the presence of intussusception.• Because ultrasonography is a safe, sensitive, and specific test for the diagnosis of intussusceptions, it should be performed early whenever there is clinical suspicion of intussusception.• Contrast enema is the gold standard for diagnosis and first-line treatment of intussusception. There is an increasing trend for pneumatic reduction of intussusception compared with hydrostatic reduction.Intravenous placement, fluid resuscitation, and notification of the pediatric surgeon should be completed before contrast enema.

Especificidade e sensibilidade da radiografia digital da coluna lombar como ferramenta de auxílio ao diagnóstico da osteoporose

INTRODUÇÃO: A osteoporose é considerada um distúrbio osteometabólico que tem como característica a diminuição da densidade mineral óssea e a deterioração da microarquitetura do tecido ósseo, o que ocasiona aumento da fragilidade esquelética e do risco de fraturas. A técnica adotada como padrão-ouro para quantificar massa óssea é a densitometria óssea (DXA). Porém, o alto custo e o consequente baixo acesso da população ao exame dificultam o diagnóstico, o que leva a maior número de pacientes com fraturas e suas consequências. OBJETIVO: O objetivo desse trabalho é estudar a sensibilidade e a especificidade da radiografia digital da coluna lombar como ferramenta de auxílio ao diagnóstico da osteoporose. METODOLOGIA: O estudo foi realizado com 64 pacientes, sendo 4 do gênero masculino e 60 do feminino, avaliados por radiografia digital e por densitometria quanto à presença ou não de osteopenia ou osteoporose. As radiografias foram analisadas independentemente por três radiologistas experientes e no caso de divergência no laudo, foi considerada a classificação modal. RESULTADOS: Conforme o coeficiente Kappa, o grau de concordância entre as técnicas foi baixo, sendo a sensibilidade e a especificidade da radiografia para o diagnóstico de osteopenia/osteoporose estimadas em 85% e 16,7%, respectivamente. CONCLUSÃO: A radiografia digital mostrou ser uma técnica sensível para verificar se a condição da vértebra no exame apresenta-se normal ou alterada, porém se mostrou pouco específica para distinguir entre osteopenia e osteoporose. Apesar da especificidade da densitometria, a radiografia mostrou ser o melhor método quando há fraturas vertebrais.

Accuracy of radiography, computed tomography and magnetic resonance imaging in diagnosing foreign bodies in the foot

The purpose of this study was to determine the accuracy of conventional radiography, computed tomography (CT) and magnetic resonance imaging (MRI) in detecting foreign bodies by using cadaver feet. One hundred and sixty foreign bodies consisting of 5 × 2-mm fresh wood, dry wood, glass, porcelain and plastic fragments were randomly placed in the plantar soft tissue of the forefoot and sole. An additional 160 incisions were made without the insertion of foreign bodies. Radiographs, CT and MRI scans were assessed in a blinded fashion for the presence of a foreign body. Overall sensitivity and specificity for foreign body detection was 29% and 100% for radiographs, 63% and 98% for CT and 58% and 100% for MRI. The sensitivity of radiography was lower in the forefoot. CT and MRI detection rates depended on the attenuation values of the foreign bodies and on the susceptibility artefact, respectively. CT was superior to MRI in identifying water-rich fresh wood. Radiography, CT and MRI are highly specific in detecting foreign bodies but sensitivity is poor. The detection rate depends on the type of foreign body for all techniques and on location for radiography. To identify foreign bodies with MRI, pulse sequences should be used to enhance the susceptibility artefact. In water-rich wood, as in chronically retained wood, CT is more accurate than MRI.

Comparative study of radiography, CT and MRI in the identification of hip involvement in patients with ankylosing spondylitis

Objective To study the imaging findings of hip involvement and to compare the sensitivity of radiography,CT,and MRI in the identification of hip involvement in patients with ankylosing spondylitis(AS).Methods Anteroposterior radiography of the pelvis and MRI of hip were performed in 55 patients with AS.CT scan of hip was performed in 29 of 55 patients.T1-weighted,T2-weighted,short tau inversion recovery (STIR) and three dimensional balanced turbo field echo with water selective excitation (3D-BTFE-WATS) coronal sequences of hips were obtained in all patients,of which fat-saturated contrastenhanced T1-weighted sequence was performed in 24 patients.The imaging data of 55 patients were analyzed.The chi-square test was used to analyze the sensitivity in the identification of hip involvement among radiography,CT,and MRI.Results Among 110 hips in all 55 patients,abnormal changes were detected in 13 hips by radiography,85 hips by MRI.The findings of radiography included bone erosions in 13 hips,joint space narrowing in 4 hips,syndesmophytes in 5 hips.MRI revealed bone erosive destruction in 31 hips,joint space narrowing in 4 hips,joint effusion in 80 hips,subchondral bone marrow edema in 32 hips,fat accumulation of bone marrow in 28 hips,enthesitis in 21 hips.Bilateral synovial enhancement was showed in 19 of 24 patients who underwent fat-saturated contrast-enhanced T1-weighted sequence.Of the 58 hip joints in 29 patients who underwent CT examination,not only did CT show all bone erosions detected by radiography and MRI,but CT revealed bone erosive destruction that were not identified by radiography in 10 hips and by MRI in 1 hip as well.Abnormal changes were detected in 10.3％ (6/58)by radiography,27.6％ (16/58) by CT,and 77.6％ (45/58) by MRI.The sensitivity of MRI in the identification of hip involvement is higher than that of radiography and CT ( x2 =53.22 and 29.08,P ＜ 0.05 ).In addition to chronic bone structural changes,MRI depicted acute inflammatory changes which could not be detected by radiography and CT.Conclusions MRI can detect early acute inflammatory changes of hip joint that can not be showed by radiography and CT.Effusion of joint and synovial enhancement caused by synovitis are the most common MRI findings of the hip in patients with AS. Key words: Spondylitis, ankylosing; Hip joint; Magnetic resonance imaging; Tomography,X-ray computed; Radiography

Comparison of Computed Tomography and Routine Radiography of the Tympanic Bullae in the Diagnosis of Otitis Media in the Calf

Otitis media is difficult to diagnose antemortem. Case reports have described computed tomography (CT) in the diagnosis, but not all cases were confirmed. CT is a sensitive and specific imaging modality of the tympanic bullae and can be used as the gold standard for the diagnosis of otitis media. Sixteen Holstein calves 5-7 weeks of age were included. Prospective study. All calves were sedated with i.v. xylazine (0.05-0.15 mg/kg) for routine radiography (3 views) and CT of the tympanic bullae followed by necropsy. Based upon necropsy findings, 10 of 16 calves were affected with otitis media, 4 unilaterally and 6 bilaterally. Imaging changes associated with otitis media included increased soft tissue opacity within the bulla, thickening of the bulla wall, enlarged bulla, and osteolysis of the bulla wall and trabeculations. The most frequent radiographic changes were lysis of trabeculations and increased soft tissue opacity, which were present in 56.3% of affected bullae. On CT, increased soft tissue opacity within the bulla was present in 93.8% of affected bullae. Sensitivity of radiography and CT was 68.8 and 93.8% and specificity was 50 and 100%, respectively. The κ value between radiography and CT with necropsy diagnosis was 0.19 for radiography, indicating poor agreement, and 0.94 for CT, indicating excellent agreement. CT is more specific, more sensitive, and easier to interpret than radiography and can be used as the gold standard in the diagnosis of otitis media in the calf.

Chronic Recurrent Multifocal Osteomyelitis: Comparison of Whole-Body MR Imaging with Radiography and Correlation with Clinical and Laboratory Data

To describe whole-body magnetic resonance (MR) imaging appearance of chronic recurrent multifocal osteomyelitis (CRMO) and assess the role of MR imaging versus radiography in diagnosis of disease and correlation with clinical findings and laboratory data. Institutional review board approved this retrospective HIPAA-compliant study; informed consent was waived. T1-weighted, short inversion time inversion-recovery, and contrast material-enhanced T1-weighted whole-body MR imaging was performed and two-plane radiographs, clinical findings, and laboratory data were reviewed in 13 children (median age, 13 years) with CRMO. Lesion depiction, location, and characterization and extraskeletal abnormalities were evaluated. MR imaging findings were compared with clinical and laboratory data and radiographic results. Data analysis was performed, and diagnostic performance statistics of radiography, physical examination results, and serum inflammatory markers were calculated. General multilevel linear modeling framework was used. Odds ratios were calculated to estimate effect of age, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level on reliabilities. Associations of ESR and CRP level with total number of lesions were assessed (chi(2) test). MR imaging depicted 101 ill-defined edemalike osseous lesions. Most frequent anatomic sites were distal femur (21%, 21 of 101), proximal tibia (17%, 17 of 101), and distal tibia and fibula (14% each, 14 of 101). In tubular bones (70 anatomic sites), metaphysis (86%, 60 of 70) and epiphysis (67%, 47 of 70) were involved. Contiguous physeal relationship (89%, 66 of 74), periosteal reaction (48%, 48 of 101), and symmetric involvement (85%, 11 of 13) were present. MR imaging demonstrated multifocality in all patients. There were no extraskeletal abnormalities and no relationship between serum inflammatory markers and number of symptomatic anatomic sites (P = .472). Sensitivity for radiography was 0.13 (70 of 119); physical examination, 0.31 (52 of 299); and serum inflammatory markers, 0.15 (two of 13). Whole-body MR imaging is useful for detection of CRMO, particularly in indeterminate cases, because it is more likely to show abnormalities.

Inner Table Sequestrum

Inner Table Sequestrum

Acute knee trauma: analysis of multidetector computed tomography findings and comparison with conventional radiography

To evaluate the multidetector computed tomography (MDCT) findings of acute knee trauma and to compare radiography with MDCT in patients referred to a level 1 trauma center. During a 5-year period, a total of 415 MDCT examinations were performed on 409 patients with acute knee trauma to reveal complex fracture anatomy or rule out a fracture. MDCT and primary radiographs were re-evaluated with respect to fracture location and trauma mechanism. Tibial plateau fractures were further analyzed depending on anatomical location: anterior-medial, anterior-lateral, posterior-lateral, and posterior-medial regions. Maximal depression of the tibial articular surface was measured. Findings on the primary knee radiographs were compared with MDCT findings. Of the 409 patients, 356 (87%) had a knee fracture. A total of 451 fractures were found in all anatomic regions: distal femur (n=49), proximal tibia (n=307), patella (n=23), and proximal fibula (n=72). Primary radiographs were available in 316 (76%) cases. Of these, 225 (71%) had MDCT in order to reveal the fracture anatomy better, and 91 (29%) had a subsequent MDCT after negative plain radiographs. Overall sensitivity of radiography was 83%, while negative predictive value was 49%. On radiography, tibial plateau articular depression was underestimated in all regions except when the fracture consisted of the whole half of the anterior or posterior plateau. The three main injury mechanisms were traffic accident, a simple fall, and sport. In 49 cases (15%), primary radiographs were suboptimal due to positioning. In severely injured patients, diagnostically sufficient radiographs are difficult to obtain, and therefore a negative radiograph is not reliable in ruling out a fracture. In these patients, MDCT is a fast and accurate examination and is also recommended in patients with tibial plateau fractures or complex knee injuries in order to evaluate the fracture adequately.

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.