JBR-BTR : organe de la Société royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR)
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Pelvic injuries are an important issue in trauma patients, largely as a result of the major disruptive forces required to fracture the pelvic ring. Despite the growing influence of more sophisticated techniques such as CT and MR in the evaluation of pelvic trauma, conventional imaging remains important, especially in the initial detection of fractures. Several plain film incidences can be used to detect and evaluate a fracture, so that the exact diagnosis can be made in the emergency room. ⋯ Cystography can be used to detect bladder ruptures. Angiography can detect the bleeding site, and therapeutic embolization can stop bleeding. MR imaging is becoming more important, as it can detect occult fractures, especially in the elderly patient.
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A direct frontal upper abdominal impact and a bicycle fall in a child are classical mechanisms of blunt pancreatic injury. Clinical symptoms are not characteristic. Serum amylase level is frequently normal at admission and peritoneal lavage fluid amylase is not diagnostic. ⋯ Both modalities are unable to detect pancreatic duct rupture. As ERP cannot be performed in all trauma patients, only patients with minor pancreatic injury can be enrolled in a conservative management without surgical revision. The role of multislice CT at admission and MRP has to be investigated to increase diagnostic efficiency in pancreatic duct injury.
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Benzodiazepines are given orally as a premedication before an interventional radiological procedure. Local analgesia is achieved by drugs such as lidocaine, bupivacaine or ropivacaine. General analgesia is obtained by non opioid analgesics and opioid narcotics. ⋯ Monitoring equipments, drugs and nursing staff assistance should be provided in the interventional suite. Vital signs should be monitored for several hours until patient's discharge. Close collaboration between anesthesiologists and interventional radiologists is a prerequisite for achieving high standard sedation and analgesia.
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A questionnaire was mailed to 217 interventional radiologists to evaluate current practice in analgesia and sedation in adults. Response rate was 15% (33/217). Diagnostic angiography was performed with local anesthesia in 94% to 99%; for PTA, local thrombolysis or stent placement, light sedation was added in 0.1%. ⋯ Intravenous sedation was applied given in 53% of percutaneous biliary drainage, in 42% of bile duct dilatation or stenting, in 40% of percutaneous nephrostomy and in 72% of ureteral balloon dilatation. Patient monitoring during an interventional procedure was always carried out by an anesthesiologist in 52% of cases. 21% of radiologists never visited the patient before a therapeutic procedure, and 36% never did so after completion of a procedure. This survey showed that high standard practice of sedation and analgesia, with the assistance of anesthesiologists, is underused by interventional radiologists in Belgium.
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Though CT and MRI are presently the most frequently required noninvasive methods for the diagnosis of lumbar spinal stenosis (LSS), imaging of a supine patient may not demonstrate the maximal spinal stenosis shown by upright flexion-extension myelography (FEM). Our prospective study tries to assess the averaging discrepancies between the supine CT-myelograms and the upright FEM in 50 patients. Considering all L2-L3 to L4-L5 vertebral levels, a mean underestimation of 16% of the diameter of the dural sac is found when and CT-myelograms are compared with extension myelography. ⋯ Measuring the mean cross-sectional surface occupied by the neural elements in the dural sac on CT-myelograms (189 evaluations), our study also empirically confirms a 60 to 80 mm2 are++ being the landmark of absolute stenosis. Finally, measurements of the cross-sectional area of the dural sac-109 L2-L5 levels inferior to 8.5 mm on CT myelograms or CT studies--show a large dispersion of areas for diameters superior to 6.5 mm and confirm cross-sectional area of the dural sac to be a much reliable parameter of LSS than diameter of the dural sac. We conclude that upright FEM--while not a first-line imaging modality for LSS--should be performed to exclude functional or dynamic position-dependent LSS in the patients whose symptoms are not explained by routine cross-sectional imaging, as long as no other upright technology is available.