AJR. American journal of roentgenology
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CT plays a crucial role in the evaluation of stable patients with blunt and penetrating trauma in the emergency department. Among the more severe injuries that may occur in penetrating and blunt trauma are those to the inferior vena cava (IVC). The purpose of this study was to evaluate and differentiate the CT findings associated with penetrating versus blunt trauma to the IVC to aid the radiologist in diagnosing IVC injuries. ⋯ Injury to the IVC is frequently fatal in patients with penetrating or blunt trauma. The CT appearance of IVC injury is dichotomous between the two causes, with blunt IVC injury more likely to show extravasation, contour abnormality, and associated hepatic laceration. Injury of the retrohepatic IVC portends a poor outcome. With the continued use of CT for evaluation of trauma patients, the radiologist should be familiar with IVC injury and its different CT appearances.
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AJR Am J Roentgenol · Oct 2016
The Zombie Plot: A Simple Graphic Method for Visualizing the Efficacy of a Diagnostic Test.
One of the most important jobs of a radiologist is to pick the most appropriate imaging test for a particular clinical situation. Making a proper selection sometimes requires statistical analysis. The objective of this article is to introduce a simple graphic technique, an ROC plot that has been divided into zones of mostly bad imaging efficacy (ZOMBIE, hereafter referred to as the "zombie plot"), that transforms information about imaging efficacy from the numeric domain into the visual domain. ⋯ The numeric rationale for the use of zombie plots is given, as are several examples of the clinical use of these plots. Two online calculators are described that simplify the process of producing a zombie plot.
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Spinal injections are common pain management procedures using corticosteroids and local anesthetics. Most corticosteroid preparations are particulate suspensions, such as methylprednisolone acetate and triamcinolone acetonide. In the cervical spine, particulate corticosteroids have been linked to catastrophic complications, including blindness, paralysis, and death. Serious neurologic injuries have also been reported at the thoracic, lumbar, and sacral levels. ⋯ Nonparticulate preparations, such as dexamethasone, are safer but have shorter-lived antiinflammatory effects. Local anesthetics are often mixed with corticosteroids in pain management procedures. Although everyday risks are minimal, injection techniques should take into account neural and cardiac toxicities. In this article, we discuss the potential for serious adverse events associated with injected medications. We review the current literature to make conclusions on medication combinations that balance safety and efficacy.
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AJR Am J Roentgenol · Sep 2016
Technique for CT Fluoroscopy-Guided Lumbar Medial Branch Blocks and Radiofrequency Ablation.
The purpose of this study is to describe the procedure for CT fluoroscopy-guided lumbar medial branch blocks and facet radiofrequency ablation. ⋯ CT fluoroscopic guidance allows more-precise needle tip positioning and is an alternative method for performing medial branch blocks and facet radiofrequency ablation.
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Peripheral nerves are well seen using ultrasound (US) imaging, making US an ideal modality for image-guided nerve injections. This article provides a technical guide for common upper and lower extremity peripheral nerve injections, including the median, ulnar, and radial nerves in the upper extremity and the lateral femoral cutaneous, sciatic, common peroneal, tibial, and sural nerves in the lower extremity. ⋯ US is an effective modality for use in common upper and lower extremity peripheral nerve injections. With correct technique, peripheral nerve injections can be performed safely and are useful for both diagnostic evaluation of and therapy for peripheral neuropathy.