[Improved image quality of the cervical spine neck CT using an arm traction device]

BACKGROUND

The assessment of the cervico-thoracic junction in the neck CT is frequently hampered by streak artifacts from the shoulder girdles.

PURPOSE

To evaluate the effects of an optimized patient positioning through the use of an arm traction device.

MATERIALS AND METHODS

25 patients (age [mean ± standard deviation]: 58.9 ± 11.6 years; sex [m:f]: 15:10) underwent a neck CT using an arm traction device together. Further 25 patients underwent this in standard positioning (59.8 ± 15.2 years; 16:9). An experienced neuroradiologist determined the last free accessible vertebra on the CT scout view and assessed the image quality of the intervertebral disc space of the lower neck on a three-point grading scale. The procedure was evaluated by the medical-technical radiology assistants performing it.

RESULTS

The last free accessible vertebra on CT scout was statistically significant one vertebra lower using an arm traction device, yielding on average the sixth cervical vertebra (p = 0.010). Subjective image quality increased in all evaluated intervertebral disc spaces (median and absolute frequencies [good/middle/bad]: 1.0 [53/21/8] vs. 2.0 [41/30/24]), resulting in a statistically significant effect between the cervical vertebra 6/7 (p = 0.0041). The traction device approach was rated to be suitable for daily routine in the categories of patient's cooperation (good), comprehensibility for the patient (84%) and management for the assistants (good).

CONCLUSION

Using an arm traction device on neck CT both the accessibility of vertebra on CT scout increased and image quality of the cervico-thoracic junction improved. The simply applicable device could be favourable for cooperative patients with lower neck pathology.

Shape Modification is Common in Woven EndoBridge-Treated Intracranial Aneurysms: A Longitudinal Quantitative Analysis Study

BACKGROUND AND PURPOSE

After endovascular treatment of intracranial aneurysms with the Woven EndoBridge (WEB) device, worsening of aneurysm occlusion or re-opening was reported to be possibly associated with WEB shape modification. This study analyzed quantitatively the WEB shape modification with time in association with anatomic results.

MATERIALS AND METHODS

Thirty patients with 32 WEB-treated intracranial aneurysms fulfilled the inclusion criteria of cranial CT at baseline (day of intervention) and a follow-up CT at least >1 months' later (median follow-up time, 11.4 months; interquartile range, 6.5-21.5 months). Adequate occlusion was observed in 84.4%, and aneurysm remnant, in 15.6%. WEB shape modification was quantified by a semiautomated approach on CT scans. Time courses were evaluated graphically and analytically; association analyses were performed by linear mixed-effects regression models.

RESULTS

In 29/32 WEB devices (90.6%), the reduction in height was found to be at least 5%. The decrease in height with time was significantly associated with the time interval in days since the intervention (P < .0001): A stronger decrease in WEB height was associated with a longer time since the intervention (median reduction in 1 year, 19.2%; range, 8.6%-52.3%). No significant association was found with the quality of aneurysm occlusion, device size, rupture status of the aneurysm, aneurysm location, and reintervention rate.

CONCLUSIONS

Shape modification was common in WEB-treated intracranial aneurysms with a median height reduction of 19.2% in 1 year. The quality of aneurysm occlusion was not associated with WEB modification.

MR imaging and quantification of the movement of the lamina terminalis depending on the CSF dynamics

BACKGROUND AND PURPOSE

Brain pulsation is a well-known observation in neurosurgery, but methods for its visualization on MR imaging, like phase imaging, do not provide a detailed structural view. We prospectively investigated electrocardiographic (ECG)-gated cine true fast imaging with steady-state precession (FISP) sequence on volunteers to test a sequence for demonstrating brain pulsation and movements of intracranial structures related to CSF dynamics.

MATERIALS AND METHODS

Eleven healthy volunteers were investigated with prospectively ECG-gated cine true-FISP in the midsagittal plane. A total of 50 phases were recorded per cardiac cycle and per volunteer. The lamina terminalis was chosen to study the pulsatility of the brain, and the optic recess diameter was chosen for means of objective quantification of the degree of pulsatility.

RESULTS

Pulsatile motion of the lamina terminalis was apparent in all volunteers on the cine mode. The mean diameter of the optic recess was 2.5 mm. The greatest change in diameter in 1 volunteer was 1.5 mm. The mean change in diameter was 40% during 1 cardiac cycle.

CONCLUSIONS

Cine true-FISP sequence is a well-suited method for investigations of passive movements of the ventricular system. It shows pulsations of the brain as well as passive changes caused by CSF dynamics with high temporal and spatial resolution.

Acute gastrointestinal bleeding: value of MDCT

Contrast-enhanced multidetector row helical computed tomography (MDCT) scanning is establishing itself as a rapid, noninvasive, and accurate diagnostic method in suspected acute gastrointestinal bleeding. Active bleeding can be depicted as an area of focal high attenuation within the bowel lumen on arterial phase MDCT images. New MDCT technologies facilitate three-dimensional image reconstruction, and higher temporal resolution is available with new MDCT scanner generations. This allows for the acquisition of arterial- and portal-venous phase images of the whole abdomen, revealing potential bleeding sources and simultaneously depict morphological changes in the abdomen, such as intestinal tumors. This article gives an overview of available diagnostic modalities in assessing gastrointestinal (GI) tract hemorrhage, with a special emphasis on new MDCT technology.

Detection and localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi-detector row helical CT

The purpose of this study was to evaluate the accuracy of multi-detector row helical CT (MDCT) for detection and localization of acute upper and lower gastrointestinal (GI) hemorrhage or intraperitoneal bleeding. Thirty-six consecutive patients with clinical signs of acute bleeding underwent biphasic (16- or 40-channel) MDCT. MDCT findings were correlated with endoscopy, angiography or surgery. Among the 36 patients evaluated, 26 were examined for GI bleeding and 10 for intraperitoneal hemorrhage. Confirmed sites of GI bleeding were the stomach (n = 5), duodenum (n = 5), small bowel (n = 6), large bowel (n = 8) and rectum (n = 2). The correct site of bleeding was identifiable on MDCT in 24/26 patients with GI bleeding. In 20 of these 24 patients, active CM extravasation was apparent during the exam. Among the ten patients with intraperitoneal hemorrhage, MDCT correctly identified the bleeding source in nine patients. Our findings suggest that fast and accurate localization of acute gastrointestinal and intraperitoneal bleeding is achievable on MDCT.