European radiology
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Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of intra-abdominal hemorrhage and blunt hepatic and splenic injuries. ⋯ The vast majority of hepatic injuries can be successfully managed conservatively, even when CT demonstrates parenchymal damage of more than three segments and major hemoperitoneum. Delayed complications, e. g., formation of biloma or a false aneurysm, can be readily detected on repeat CT studies, although they are quite uncommon. The outcome of conservative treatment of splenic injuries remains unpredictable because delayed splenic rupture may occur even when initial CT shows only minor parenchymal lesions and little or no intraperitoneal hemorrhage.
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The purpose of our study was to determine relative values of rapid acquisition relaxation enhancement (RARE) and half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences in breathhold magnetic resonance (MR) urography in healthy volunteers under nonobstructive conditions of the urinary tract. A total of 20 healthy volunteers underwent MR urography with breathhold RARE and HASTE sequences at 1.5 T. For evaluation, the urinary tract was divided into nine segments on each side. ⋯ RARE InRs were higher in the bladder (p = 0.0008-0.014). We concluded that neither the RARE nor the HASTE sequences allowed the evaluation of the entire urinary tract under nonobstructive conditions. Although it cannot entirely replace intravenous urography, MR urography seems to lend itself to combination with other MR techniques, particularly in the investigation of pelvic or retroperitoneal disease.
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Comparative Study
MR imaging of uterine cervical carcinoma: comparison between fast spin-echo MRI and GRASE.
The aim of our study was to compare the image quality of T2-weighted gradient-echo-and-spin-echo (GRASE) MRI and fast spin-echo (FSE) MRI for imaging of cervical carcinoma. In 40 patients FSE8 (TR/TE = 3400/90 ms) MRI with echo train length (ETL) of 8, GRASE (3400/90) MRI with ETL of 18, turbo factor of 6 and 3 gradient reversals, and FSE18 (2500/120) MRI with ETL of 18 were performed. Tissue contrast, subjectively rated image quality, and accuracy of tumor delineation were compared. ⋯ The accuracy of FSE and GRASE MRI for the delineation of cervical carcinoma is similar. Based on measurement of image quality and CNRs, however, high turbo factor FSE provides better image quality in MRI of cervical carcinoma. Whether the superior characteristics may result in better staging has to be explored in larger clinical trials.
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We report on two patients with biliary tract injury and associated biloma following blunt abdominal trauma. Both patients underwent emergency surgery because of hemodynamic instability and bloody peritoneal aspiration. ⋯ Bile duct injury was well demonstrated on endoscopic retrograde cholangiography (ERCP) and treated by endobiliary stent placement. This report advocates the use of ERCP and endobiliary stenting in the management of biliary injury resulting from liver trauma.
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Paget's disease is a common entity but osteosarcoma arising in Paget's disease is an infrequent complication. Primary osteosarcomas are typically long bone tumours and the skull is rarely affected. ⋯ Computed tomography scans of the tumour area show interesting results. Main features are: an intensive sclerotic reaction of the host bone, an inner and outer spiculation of the calvarium, radial ossifications in the soft extracranial mass, and spotty calcifications and ossifications of the osteosarcomatous portion infiltrating the brain.