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D'Angelo T, Albrecht MH, Caudo D, Mazziotti S, Vogl TJ, Wichmann JL, Martin S, Yel I, Ascenti G, Koch V, Cicero G, Blandino A, Booz C. Virtual non-calcium dual-energy CT: clinical applications. Eur Radiol Exp 2021; 5:38. [PMID: 34476640 PMCID: PMC8413416 DOI: 10.1186/s41747-021-00228-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/11/2021] [Indexed: 12/15/2022] Open
Abstract
Dual-energy CT (DECT) has emerged into clinical routine as an imaging technique with unique postprocessing utilities that improve the evaluation of different body areas. The virtual non-calcium (VNCa) reconstruction algorithm has shown beneficial effects on the depiction of bone marrow pathologies such as bone marrow edema. Its main advantage is the ability to substantially increase the image contrast of structures that are usually covered with calcium mineral, such as calcified vessels or bone marrow, and to depict a large number of traumatic, inflammatory, infiltrative, and degenerative disorders affecting either the spine or the appendicular skeleton. Therefore, VNCa imaging represents another step forward for DECT to image conditions and disorders that usually require the use of more expensive and time-consuming techniques such as magnetic resonance imaging, positron emission tomography/CT, or bone scintigraphy. The aim of this review article is to explain the technical background of VNCa imaging, showcase its applicability in the different body regions, and provide an updated outlook on the clinical impact of this technique, which goes beyond the sole improvement in image quality.
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Affiliation(s)
- Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Moritz H Albrecht
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Danilo Caudo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Julian L Wichmann
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Simon Martin
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Yang SJ, Jeon JY, Lee SW, Jeong YM. Added value of color-coded virtual non-calcium dual-energy CT in the detection of acute knee fractures in non-radiology inexpert readers. Eur J Radiol 2020; 129:109112. [PMID: 32526668 DOI: 10.1016/j.ejrad.2020.109112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/12/2020] [Accepted: 05/31/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluated the added value of dual-energy CT (DECT) virtual non-calcium (VNCa) protocol on conventional CT in the detection of acute knee fractures in non-radiology inexpert readers. METHOD One hundred fifty-six patients (mean age, 51.97 years; age range, 17-86 years) with knee trauma, who underwent DECT and MRI within 3 days between April 2017 and October 2018, were retrospectively analyzed. Three readers (intern, 1st-year general surgery resident, 1st-year emergency medicine resident) independently analyzed CT alone and then with the additional color-coded DECT VNCa for fractures. A board-certified radiologist, analyzed CT and MRI series to define the reference standard. Sensitivity, specificity, and AUC were compared between the two reading sessions. RESULTS Fifty-seven patients had acute fractures and 99 had no fractures. Thirteen of 57 fractures were nondisplaced. The additional use of VNCa images significantly increased the mean AUC (reader 1: 0.813 vs. 0.919; reader 2: 0.842 vs. 0.930; reader 3: 0.837 vs. 0.921; P < 0.05). When only nondisplaced fractures included, the mean AUC was more increased in the combined analysis of CT and DECT VNCa (reader 1: 0.521 vs. 0.916; reader 2: 0.542 vs. 0.926; reader 3: 0.575 vs. 0.926; P < .01). Sensitivity increased by 15 %-20 % in total fracture group and by 69 %-77 % in nondisplaced fracture group over that with CT alone when both CT and DECT VNCa were used. Specificity did not differ significantly. CONCLUSIONS The additional use of color-coded DECT VNCa protocol to conventional CT improved diagnostic performance in detecting acute knee fractures for inexperienced non-radiology readers.
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Affiliation(s)
- Su Jeong Yang
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine From the Department of Radiology, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon 21565, Republic of Korea
| | - Ji Young Jeon
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine From the Department of Radiology, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon 21565, Republic of Korea.
| | - Sheen-Woo Lee
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine From the Department of Radiology, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon 21565, Republic of Korea
| | - Yu Mi Jeong
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine From the Department of Radiology, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon 21565, Republic of Korea
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Abstract
Sports-related injuries to the shoulder are common causes of disability. Injuries to the sternoclavicular joint (SCJ) in sports are more rare, though have been reported in a small number of cases. SCJ injury classification is determined by the degree of joint displacement and direction of clavicular displacement. Direction of displacement is particularly important due to risk of injury to intrathoracic structures, which has the potential to result in fatal outcomes. These injuries are important to identify in athletes and can be difficult to assess on the field. Specific radiographic views and use of ultrasound can improve accuracy of diagnosis. Reduction of acute traumatic SCJ dislocations is recommended and may require open reduction in the case of posteriorly displaced dislocations. Surgical treatment is indicated in cases of persistent pain or significant compression to intrathoracic soft tissue structures. Long-term outcomes are generally favorable, and athletes are able to return to sport without functional limitations.
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Affiliation(s)
- Justin E Hellwinkel
- Department of Orthopedics, School of Medicine, University of Colorado , Aurora , CO , USA
| | - Eric C McCarty
- Department of Orthopedics, School of Medicine, University of Colorado , Aurora , CO , USA
| | - Morteza Khodaee
- Department of Family Medicine and Orthopedics, School of Medicine, University of Colorado , Aurora , CO , USA
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Schupp CM, Rand SE, Hanson TW, Lee BM, Jafarnia K, Jia Y, Moseley JB, Seaberg JP, Seelhoefer GM. Sideline Management of Joint Dislocations. Curr Sports Med Rep 2016; 15:140-53. [DOI: 10.1249/jsr.0000000000000266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kaldirim U, Dural F, Tuncer SK, Arziman I, Eyi YE. Fascia iliaca compartment block in dislocated hip reduction. Afr J Emerg Med 2015. [DOI: 10.1016/j.afjem.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Matuszak SA, Baker EA, Stewart CM, Fortin PT. Missed peritalar injuries: an analysis of factors in cases of known delayed diagnosis and methods for improving identification. Foot Ankle Spec 2014; 7:363-71. [PMID: 25037956 DOI: 10.1177/1938640014537302] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Because of the complex anatomy of the foot, rarity of fractures of the foot, and subtle radiographic cues, foot injuries are commonly overlooked and mis/undiagnosed. This study seeks to investigate a patient population whose peritalar injuries, including fractures and dislocations, were missed on initial examination, in order to analyze factors of known, missed injuries and provide insight into methods for reducing the incidence of missed diagnoses. Surgical cases between January 1999 and May 2011 were queried and retrospectively reviewed to identify missed peritalar injuries. Of 1682 surgical cases reviewed, 27 patients with missed peritalar injury(ies), which were subsequently confirmed by imaging studies, were identified. Using the Orthopaedic Trauma Association classification, fracture and dislocation subtypes were classified. A medical record review was performed to assess demographic and surgical data elements. In this study population, 7 types of peritalar injuries (talus, calcaneal, navicular, and cuboid fractures as well as subtalar, calcaneocuboid, and talonavicular joint dislocations) were diagnosed in 27 patients. All patients required surgical intervention. Talus fractures were the most commonly missed injury. In patients with multiple peritalar injuries, there was a strong correlation between talus and navicular fractures (r = -0.60; P < .01) as well as a moderate correlation between talus fractures and calcaneocuboid dislocations (r = -0.46; P = .02). The presence of a calcaneal fracture significantly decreased the time to definitive diagnosis (P = .01). Male patients' diagnoses were delayed an average of 324 days and females 105 days (P = .04). A moderate correlation was found between patient age at injury and time to diagnosis (r = -0.47; P = .04), with a decreased time to diagnosis as patient age increased. Significant factors were identified in this patient population, including patient sex and age, which may contribute to missed or delayed diagnosis in the clinical setting. Prompt and accurate diagnosis of peritalar injuries may improve long-term outcomes. LEVELS OF EVIDENCE Care Management, Level V.
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Affiliation(s)
- Sean A Matuszak
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI (SAM, PTF)Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI (EAB, CMS)
| | - Erin A Baker
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI (SAM, PTF)Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI (EAB, CMS)
| | - Cory M Stewart
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI (SAM, PTF)Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI (EAB, CMS)
| | - Paul T Fortin
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI (SAM, PTF)Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI (EAB, CMS)
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Swelling and right knee pain following a fall from a ladder. JAAPA 2013; 26:57-8. [DOI: 10.1097/01720610-201304000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Frakturen der unteren Extremität in der Notaufnahme. Med Klin Intensivmed Notfmed 2013; 108:139-43. [DOI: 10.1007/s00063-013-0225-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 01/09/2013] [Accepted: 01/26/2013] [Indexed: 10/27/2022]
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Tsai CL, Sullivan AF, Gordon JA, Kaushal R, Magid DJ, Blumenthal D, Camargo CA. Quality of care for joint dislocation in 47 US EDs. Am J Emerg Med 2012; 30:1105-13. [DOI: 10.1016/j.ajem.2011.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 07/20/2011] [Accepted: 07/21/2011] [Indexed: 01/21/2023] Open
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Falcon-Chevere JL, Mathew D, Cabanas JG, Labat E. Management and treatment of elbow and forearm injuries. Emerg Med Clin North Am 2010; 28:765-87. [PMID: 20971391 DOI: 10.1016/j.emc.2010.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Orthopedic injuries to the upper extremity are frequently seen in the emergency department (ED). The emergency medicine practitioner must be proficient in recognizing these injuries and their associated complications, and be able to provide appropriate orthopedic management. This article highlights the most frequent forearm and elbow injuries seen in the ED.
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Affiliation(s)
- Jorge L Falcon-Chevere
- Department of Emergency Medicine, University of Puerto Rico School of Medicine, Hospital UPR Dr Federico Trilla, 65th Infantry Avenue Km 3.8, Carolina, PR 00985, USA.
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Abstract
A 62-year-old woman with severe seizure disorder presented with right ankle and foot pain after being found down, presumably following a seizure recurrence. Imaging showed an acute comminuted fracture of the anterolateral aspect of the right calcaneus, as well as an acute avulsion fracture of the right navicular tuberosity at the site of insertion of the tibialis posterior tendon. This fracture pattern suggests forced abduction of the midfoot or forefoot with severe compression of the lateral column and failure of the medial column under tension, an entity that has previously been described as the nutcracker fracture. This mechanism of injury should prompt particularly careful evaluation of the navicular, cuboid, and calcaneus for any signs of injury. Subtle fractures of the navicular and calcaneus may be overlooked in the emergency setting, leading to a delay in surgical treatment and ultimately chronic foot deformities that can result in significant functional disability.
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