Emergency radiology
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Emergency radiology · Aug 2011
Whole-body CT in polytrauma patients: effect of arm positioning on thoracic and abdominal image quality.
The purpose of this study is to assess the influence of different arm positioning techniques on thoracic and abdominal image quality and radiation dose of whole-body trauma CT (wbCT). One hundred and fifty polytrauma patients (104 male, mean age 47 ± 19) underwent wbCT with arms elevated above the head (group A, n=50), alongside the abdomen (group B, n=50), and on a pillow ventrally to the chest with both arms flexed (group C, n=50). Two blinded, independent observers measured image noise and rated image quality (scores 1-3) of the liver, aorta, spleen, spine, and lower lungs. ⋯ Estimated effective radiation doses were significantly (p<0.001) higher in groups B (21.2 mSv) and C (21.9 mSv) as compared to A (16.1 mSv). In wbCT for polytrauma patients, positioning of the arms above the head results in better image quality and lower radiation dose. Placing the flexed arms on a large pillow ventrally to the chest significantly improves image quality as compared to positioning alongside the abdomen.
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Emergency radiology · Aug 2011
Radiological prognostic factors in patients with pandemic H1N1 (pH1N1) infection requiring hospital admission.
The aim of this study was to determine the radiologic findings associated with admission to the intensive care unit (ICU) and the development of acute respiratory distress syndrome (ARDS) in patients with pH1N1 infection. One hundred and four patients (15-96 years) with laboratory-confirmed pH1N1 infection seen at the Emergency Department from July to December 2009 who underwent chest radiographs were studied. Radiographs were evaluated for consolidation, ground-glass opacities, interstitial patterns, distribution, and extent of findings. ⋯ A higher number of lung zones involved and consolidation on the initial chest radiograph as well as a rapid progression of the radiological abnormalities were identified in patients requiring ICU admission and development of ARDS. Initial chest radiographs show acute abnormalities in all patients with severe disease. The findings of a multifocal patchy consolidation pattern with bilateral or diffuse lung involvement on admission should alert of the impending severity of disease and the risk of necessitating ICU admission.
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Emergency radiology · Aug 2011
Comparative StudyThe value of a CT scan compared to plain radiographs for the classification and treatment plan in tibial plateau fractures.
This study aimed to evaluate the intra- and interobserver agreement for both fracture classification according to Schatzker and treatment plan of tibial plateau fractures using plain radiographs alone and with computed tomography (CT) scans. The study was carried out prospectively to assess the impact of an advanced radiographic study on the agreement of treatment plan and fracture classification of tibial plateau fractures. Eight experienced observers (six surgeons and two radiologists) classified 15 tibial plateau fractures with plain radiographs and CT scans and set up a treatment plan. ⋯ The mean intraobserver kappa coefficient for treatment plan based on plain radiographs alone was 0.53, which decreased to 0.45 after addition of CT scans. In contrast with other recent publications, there is no increase in inter- and intra-agreement of a CT scan compared to plain radiographs for the classification and treatment plan in tibial plateau fractures. Routine CT scanning of the knee for tibial plateau fractures is not supported by this study.
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Emergency radiology · Aug 2011
Optimizing multidetector CT for visualization of splenic vascular injury. Validation by splenic arteriography in blunt abdominal trauma patients.
Nonoperative management of blunt splenic injury is the treatment of choice in hemodynamically stable patients. Detection of vascular injury by multidetector CT (MDCT) is the most significant factor predicting the need for endovascular treatment. This study evaluated the timing of the appearance of vascular lesions during angiography. ⋯ PSAs are more frequently seen in postcapillary vascular injuries than arterial phase lesions with the current timing of MDCT. In a subset of patients in whom splenic injury grades III and IV warrant angiography, PSAs are not initially demonstrated on MDCT. Therefore, alteration of MDCT timing parameters to better correlate with arterial phase angiography may improve initial diagnosis of vascular injury.
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Emergency radiology · Aug 2011
Loss of gray-white matter discrimination as an early CT sign of brain ischemia/hypoxia in victims of asphyxial cardiac arrest.
Brain CT obtained from cardiac arrest (CA) victims immediately after resuscitation may be useful in predicting their outcomes. Most data have been derived from CA victims of cardiac etiology, however, CT signs of brain ischemia/hypoxia have rarely been studied in victims of asphyxial CA. Loss of gray-white matter discrimination (GWMD) at the basal ganglia seems to be the most reliable early CT sign of brain ischemia/hypoxia; a retrospective study was conducted to clarify its incidence, prognostic significance, and temporal profile in resuscitated victims of CA by food asphyxiation. ⋯ There were five victims with asphyxiation-ROSC interval ≤ 10 min, all of whom survived to discharge. In contrast, none of the 34 victims with the interval >10 min survived to discharge. Loss of GWMD may develop in a relatively time-dependent manner and may be a reliable radiographic indicator of poor outcome in resuscitated victims of asphyxial CA.