Strangulating Closed-Loop Obstruction: Sonographic Signs

PURPOSE

To evaluate different sonographic signs of strangulating closed-loop obstruction retrospectively.

MATERIALS AND METHODS

Over a period of approximately 10 years all documents, US scans and video clips of patients with strangulating intestinal obstruction were reviewed. The following sonographic signs were evaluated: akinetic bowel loops; echo-free luminal content; hyperechoic congestion of the mesentery; free peritoneal fluid; bowel wall thickening; signs of ischemia on color Doppler or contrast-enhanced US. Moreover, we looked for signs of bowel obstruction proximal to the closed loop and for the width of the strangulated segment.

RESULTS

The most often documented features of strangulating closed-loop obstruction were an akinetic bowel loop (94 %), a hyperechoic and thickened mesentery (82 %) and free peritoneal fluid (100 %). In 54 % of cases the luminal content was almost anechoic. In 76 % of patients bowel wall thickening and in 50 % signs of ischemia on color Doppler or contrast-enhanced US were documented. In 67 % small bowel dilatation proximal to the strangulated bowel segment was present. The width of the strangulated bowel loops was 2.86 cm on average.

CONCLUSION

The akinetic bowel loops, hyperechoic thickening of the attached mesentery and free peritoneal fluid are typical for strangulating closed-loop obstruction. An anechoic luminal content is only visible in about half of the patients, but this eye-catcher can lead the investigator to the correct diagnosis. In about one third of patients no signs of bowel obstruction proximal to the strangulated loops are present. Dilatation of the strangulated loop may be absent or mild.

Accuracy of MSCT Coronary Angiography with 64 Row CT Scanner-Facing the Facts

Improvements in multislice computed tomography (MSCT) angiography of the coronary vessels have enabled the minimally invasive detection of coronary artery stenoses, while quantitative coronary angiography (QCA) is the accepted reference standard for evaluation thereof. Sixteen-slice MSCT showed promising diagnostic accuracy in detecting coronary artery stenoses haemodynamically and the subsequent introduction of 64-slice scanners promised excellent and fast results for coronary artery studies. This prompted us to evaluate the diagnostic accuracy, sensitivity, specificity, and the negative und positive predictive value of 64-slice MSCT in the detection of haemodynamically significant coronary artery stenoses.Thirty-seven consecutive subjects with suspected coronary artery disease were evaluated with MSCT angiography and the results compared with QCA. All vessels were considered for the assessment of significant coronary artery stenosis (diameter reduction >/= 50%). Thirteen patients (35%) were identified as having significant coronary artery stenoses on QCA with 6.3% (35/555) affected segments. None of the coronary segments were excluded from analysis. Overall sensitivity for classifying stenoses of 64-slice MSCT was 69%, specificity was 92%, positive predictive value was 38% and negative predictive value was 98%. The interobserver variability for detection of significant lesions had a k-value of 0.43.Sixty-four-slice MSCT offers the diagnostic potential to detect coronary artery disease, to quantify haemodynamically significant coronary artery stenoses and to avoid unnecessary invasive coronary artery examinations.

Computer tomography aided 3D analysis of the distal dorsal radius surface and the effects on volar plate osteosynthesis

The aims of this study were to measure the size of Lister's Tubercle, the extent of the extensor pollicis longus (EPL) groove and the dihedral angle of the distal dorsal radius. Computer tomography scans of 30 forearms were performed by using a 64-slice Siemens SOMATOM Sensation CT system (Resolution 0.6 mm). DICOM raw data were calculated to 3D by MIMICS software (Materialise, Leuven, Belgium). The size of Lister's Tubercle varied from 1.4 to 6.6 mm (average 3.3 mm) in height radial to the tubercle, and from 5.6 to 18.6 mm (average 13.2 mm) in length. The depth of the EPL groove varied from 0.6 to 3.2 mm (average 1.6 mm). The height on the ulnar side, between the depth of the groove and the tip of the tubercle, varied from 2.2 to 5.8 mm (average 3.4 mm). The dihedral angle of the distal dorsal radius varied from 110 degrees to 135 degrees (average 123 degrees). The variations in height of Lister's Tubercle and in depth of the EPL groove are considerable. This needs to be taken into account when performing volar plating of distal radius fractures otherwise screws may inadvertently penetrate the dorsal cortex of the radius potentially leading to EPL rupture.

Thick curved planar reformation of unenhanced multislice computed tomography demonstrating urolithiasis

OBJECTIVES

To determine what slice thickness provides optimal curved planar reformation (CPR) images of the urinary tract.

METHODS

A total of 75 consecutive patients with acute flank pain were included in a retrospective pilot study and underwent unenhanced multislice computed tomography (MSCT) (collimation 3.75 mm, pitch 6, reconstruction increment 3 mm, working voltage 120 kV, and tube current 100 mA) with CPR reconstruction of the urinary tract. CPRs with differing slice thicknesses of 3-20 mm at 1-mm increments to reformat each ureter were assessed in each patient separately. Two radiologists and a urologist evaluated the quality of the reformatted images by judging each ureter in terms of the delineation of all its parts using a 5-point scale (insufficient, poor, moderate, good, and excellent).

RESULTS

Of the 75 patients in our cohort, 52 (69%) had urolithiasis. CPR images could be made of all ureters in all patients. Good to excellent image quality was found in the CPRs performed with a slice thickness of 8-12 mm: 27.7% at 8 mm, 14.3% at 9 mm, 26.9% at 10 mm, 12.6% at 11 mm, and 18.5% at 12 mm. Thus, a slice thickness of 8-12 mm determined a cumulative likelihood of 96.7% to demonstrate the ureter totally.

CONCLUSIONS

The results of our study have shown that CPR is a feasible and quick useful tool. CPRs of the urinary tract with a slice thickness of 8-12 mm are best for good delineation of the whole ureter.

Pathology results in [18F]fluorodeoxyglucose positron emission tomography of the thyroid gland

The aim of this retrospective study was to evaluate pathologically increased uptake of [18F]fluorodeoxyglucose (18F-FDG) in positron emission tomography (PET) results of the thyroid gland. Results of 18F-FDG PET and [99mTc]pertechnetate scintigraphy of the thyroid gland are shown, compared to each other and discussed. In a retrospective study 16 patients underwent whole-body 18F-FDG PET and [99mTc]pertechnetate scintigraphy of the thyroid gland within 3 weeks. In addition, an examination of the thyroid gland by using ultrasound and laboratory tests was carried out. The 18F-FDG PET studies were carried out on a dedicated whole-ring PET scanner. Eight patients had a pathological FDG uptake in the thyroid and a cold nodule in [99mTc]pertechnetate scintigraphy of the thyroid gland (in 7/8 cases histology showed malignancy). Five patients had an inhomogeneous FDG uptake in the thyroid gland and were suspected of thyroiditis in 18F-FDG PET (in 3/5 cases thyroiditis was confirmed). Three patients had an especially low FDG uptake compared to normal physiological FDG uptake (no malignancy). Results from studies using 18F-FDG represent a growing body of evidence showing the differentiation between malignant and benign disease: we saw many pathological results in the thyroid gland. High uptake of 18F-FDG in the thyroid gland suggests possible malignancy. Thyroiditis can only be suspected based upon the results of 18F-FDG PET. We conclude that 18F-FDG PET has a potential clinical impact for detecting possible malignant lesions of the thyroid gland, but further studies, in which a higher number of patients are evaluated, are necessary.

[Therapy of neurotrophic keratopathy in trigeminal schwannoma with radiosurgery]

BACKGROUND

We present a patient with neurotrophic keratopathy due to a trigeminal nerve neurinoma, who was successfully treated by radiosurgery.

PATIENT

A patient was referred to us with recurrent corneal erosions of unknown origin in his left eye. In addition, he suffered from mild hypoesthesia in the distribution of the first branch of the trigeminal nerve. He was started on topical lubricants (hyaluronic acid 0.5%) and antibiotic ointments (gentamycin), but since no corneal healing occurred, a soft contact lens was applied. The patient developed severe corneal neovascularization within four weeks and the contact lens had to be removed. Three months later an MRI scan was performed, which showed an intracranial tumor originating from the first branch of the trigeminal nerve. Neurinoma of the trigeminal nerve was suspected, and this presumed diagnosis was confirmed by fine needle biopsy. The patient underwent radiosurgery seven weeks later. The epithelium closed, the cornea recovered and stayed stable until the last examination 18 months after radiosurgery.

CONCLUSION

Radiosurgery is a promising alternative to conventional microsurgery in cases of neurinomas of the trigeminal nerve including neurotrophic keratopathy, to keep or restore vision.

Focal nodular hyperplasia and hepatocellular adenoma of the liver: differentiation with multiphasic helical CT

OBJECTIVE

Differences of attenuation and enhancement patterns in focal nodular hyperplasia and hepatocellular adenoma were evaluated and quantified using triphasic single-slice helical CT.

MATERIALS AND METHODS

Forty-five histologically proven focal nodular hyperplasias in 27 patients and 18 hepatocellular adenomas in six patients were examined with helical CT. Quantitative evaluation included the following: attenuation of lesions, scar, and liver parenchyma during unenhanced, arterial (20 sec after injection), and portal venous phases (70 sec after injection); relative enhancement of lesions and liver (the ratio between attenuation in arterial phase and portal venous phase, respectively, and attenuation in unenhanced phase); and the prevalence of scar and its central vessel in focal nodular hyperplasia.

RESULTS

The study showed no significant difference between mean attenuation values of focal nodular hyperplasia (mean +/- SD, 51.2 +/- 5.9 H) and hepatocellular adenoma (mean +/- SD, 56.3 +/- 7.8 H) in the unenhanced phase. In the arterial phase attenuation values were significantly higher in focal nodular hyperplasia (mean +/- SD, 117.9 +/- 15.1 H) than in hepatocellular adenoma (mean +/- SD, 80.1 +/- 10.5 H). In the portal venous phase no significant differences in attenuation values were detected between focal nodular hyperplasia (mean +/- SD, 112.1 +/- 20.4 H) and hepatocellular adenoma (mean +/- SD, 110.2 +/- 12.9 H). For enhancement parameter thresholds separating focal nodular hyperplasia from hepatocellular adenoma, the following were found: the relative enhancement was higher in 100% of the focal nodular hyperplasias and lower than or equal to 1.6 (accuracy, 96%) in 87% of the hepatocellular adenomas.

CONCLUSION

Triphasic helical CT combined with quantitative evaluation of liver lesions offers the possibility of detecting differences in liver lesions that are visually similar on CT. The attenuation and relative enhancement in the arterial phase show significant differences that make accurate differentiation between focal nodular hyperplasia and hepatocellular adenoma possible.

Radiographic appearance of an ossifying fibromyxoid tumor of soft parts

This case report describes an ossifying tumor in the left musculus erector spinae in a 32-year-old man. Radiologically it showed irregular lamellar bone formation in the periphery, demonstrating as juxtacortical and macroscopically sarcoma-like features. Histologic it was diagnosed as an ossifying fibromyxoid tumor of soft parts (OFTSP). The CT features of this tumor have never previously been reported. This is the first time pulmonary metastases, malignant pleural effusion, and death of the patient directly related with an OFTSP have been described.