European radiology
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Comparative Study
Traumatic injuries of the pelvis and thoracic and lumbar spine: does thin-slice multidetector-row CT increase diagnostic accuracy?
The objective is to evaluate different multidetector-row CT (MDCT) strategies for adequate classification of spinal and pelvic injuries. Seventy intubated patients after multiple trauma underwent conventional radiography (CR) and MDCT. Examinations included the pelvis (P), the lumbar spine (LS) and the thoracic spine (TS). ⋯ Fractures were identified by CT3R in 100% of cases, by CT5R in 95%, by CT3 in 90% [P]-100% [TS], by CT5 in 83.3% [LS]-90% [P] and by CR in 57.1% [TS]-87.2% [P]. Unstable fractures were identified in 100% by CT3R, CT5R and CT3, 85.7% [TS]-100% [P/LS] by CT5 and 57.1% [TS]-80% [P] by CR. Only overlapping thin-slice multiplanar reformation allows for an adequate classification of spinal and pelvic injuries and thus is highly emphasized in patients after severe blunt trauma.
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It has been reported that 3D-FLAIR can reduce the flow artifact resulting from cerebrospinal fluid (CSF) at 1.5 T compared to 2D-FLAIR. Flow-related artifacts tend to be worse at 3 T than at 1.5 T. The purpose of this study was to compare the CSF flow artifacts of 2D-FLAIR and 3D-FLAIR sequences at 3 T in eight healthy volunteers. ⋯ The CSF in-flow artifact scores were significantly higher on axial 2D-FLAIR than on axial 3D-FLAIR MPR images in all areas except the bilateral sylvian fissures, and higher on sagittal 2D-FLAIR than on sagittal 3D-FLAIR MPR images in perimedullary, bilateral CP angle and suprasellar cisterns. The CSF-related flow artifacts were significantly reduced by 3D-FLAIR, while structures in the cistern were depicted more clearly, even at 3 T. Further study is necessary to compare the clinical efficacy between 2D-FLAIR and 3D-FLAIR in depicting subtle abnormalities.
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The aim of this retrospective study was to emphasize the performances of spiral CT (HCT) and multidetector-row CT (MDCT) as very effective imaging modalities for the diagnosis of intestinal perforations caused by calcified alimentary foreign bodies. Eight sites of perforations of the ileum by ingested foreign bodies were found in seven patients--one patient presenting with two separate sites of perforation. The diagnosis was successfully made by HCT in four patients and MDCT in the remaining three. ⋯ In each patient, this identification was only possible thanks to the scrupulous analysis of very thin overlapping reconstructions obtained not only in the perforation sites (6/8 sites), but also through the entire abdomen (2/8 sites). Our report emphasizes the high performances of CTA and MDCT in identifying intestinal perforation caused by calcified alimentary foreign bodies. Moreover, the high specificity of the CT diagnosis made it possible to avoid surgerical exploration in three patients.
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When attempting a literature review on contrast-enhanced ultrasound (CEUS) in trauma, very few articles are found. There are a large number of papers dealing with FAST (focused assessment with sonography in trauma) which, in practice, is the definition for detection of free fluid in the abdomen, but there are papers covering assessment of parenchymal damage with non-enhanced ultrasound. This review focuses on direct assessment of parenchymal damage in blunt abdominal trauma, and includes papers on non-enhanced ultrasound to give a historical background to scientific approaches to ultrasound diagnosis of parenchymal injury. A report on our local experience of CEUS in trauma has also been included.
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An uncommon cause of cerebral ischemia in the territory of the posterior cerebral artery (PCA) is the combination of a fetal origin of the PCA and atherosclerotic disease in the internal carotid artery. This study compared the accuracy of CTA with DSA in the assessment of a fetal origin of the PCA. Patients in whom an intracranial DSA and CTA had been performed were reviewed. ⋯ Sensitivity and specificity of CTA in the assessment of a fetal origin could be estimated at 100 and 97%, respectively. Positive and negative predictive values were 77 and 100%, respectively. CTA can be considered a valid diagnostic tool for the assessment of a fetal origin of the PCA in patients with a cerebral ischemic event in the territory of the PCA.