Morphometric comparison of foramen magnum in non-syndromic craniosynostosis patients with or without Chiari I malformation.

BACKGROUND: In order to compare the morphometry of foramen magnum (FM) in a matched-pair study, in children with non-syndromic craniosynostosis with and without Chiari I malformation (CMI), both brain magnetic resonance (MRI) and multidetector computed tomography (MDCT) images were utilized. METHODS: Brain MR images were retrieved from the Helsinki University Hospital Picture Archiving and Communications System to identify patients with CMI during 1.1.2004 to 31.3.2009. Age-, gender-, and craniosynostosis-matched controls were retrieved from the same cohort. Morphometric analysis of FM was carried out. RESULTS: Seven patients with non-syndromic craniosynostosis with CMI were recorded. In CMI patients, the absolute anteroposterior length was 33.4 mm as compared to 36.7 mm in controls (p = 0.023). The mean width was 28.1 and 29.9 mm (p = 0.29), and the cross-sectional area was 654.1 and 764.9 mm(2) (p = 0.11) in CMI and controls, respectively. In CMI patients, the relative anteroposterior length of the FM was, on average, 91 % of the control's measurements. On average, the width was 95 % and the cross-sectional area was 88 % of the control's results. CONCLUSIONS: In pediatric non-syndromic craniosynostosis patients, a statistically significant reduced anteroposterior diameter of the FM is found in patients with an adjacent CMI as compared to their age-, gender-, and type-matched controls of craniosynostosis.

Radiocarpal Injuries: Cone Beam Computed Tomography Arthrography, Magnetic Resonance Arthrography, and Arthroscopic Correlation among 21 Patients.

BACKGROUND AND AIMS: Patients with acute or chronic wrist pain often undergo wrist arthroscopy for evaluation of chondral and ligamentous abnormalities. The purpose of this study was to compare findings of wrist arthroscopy with cone beam computed tomography arthrography and magnetic resonance arthrography. MATERIALS AND METHODS: Altogether, 21 patients with wrist pain underwent cone beam computed tomography arthrography, magnetic resonance arthrography, and wrist arthroscopy. Chondral surfaces of the scaphoid, lunate, and radius facing the scaphoid and lunate were evaluated. The scapholunate ligament, the lunotriquetral ligament, and the triangular fibrocartilage complex were classified as either intact or torn. Sensitivity, specificity, positive and negative predictive values, and accuracy with 95% confidence intervals were assessed. RESULTS: For chondral lesions (n = 10), cone beam computed tomography arthrograms showed slightly higher specificity than magnetic resonance arthrography. The sensitivity of cone beam computed tomography arthrography was also better for these lesions, except for those on the chondral surface of the lunate. For triangular fibrocartilage complex injuries (n = 9), cone beam computed tomography arthrography showed a better specificity and sensitivity than magnetic resonance arthrography. For ligamentous injuries (n = 6), cone beam computed tomography arthrograms were more sensitive, but less specific than magnetic resonance arthrography images. However, the number of lesions was very small and the 95% confidence intervals are overlapping. CONCLUSION: Cone beam computed tomography is an emerging imaging modality that offers several advantages over computed tomography and magnetic resonance imaging. Its usefulness particularly in ligamentous injuries should be further explored in a larger study. Cone beam computed tomography arthrography seems to offer similar sensitivity, specificity, and accuracy compared to magnetic resonance arthrography and therefore serves as a valuable option in evaluating patients with wrist pain.

Multidetector computed tomography in acute knee injuries: assessment of cruciate ligaments with magnetic resonance imaging correlation.

PURPOSE: To evaluate whether non-contrast multidetector computed tomography (MDCT) for suspected acute knee fractures can also be used to evaluate cruciate ligament pathology. MATERIAL AND METHODS: A total of 42 patients (17-65 years) underwent four-section MDCT. The images were independently evaluated at clinical workstations by four radiologists. They assessed the integrity (normal or torn) and the best slice direction (axial, sagittal, or coronal) for visualization of the cruciate ligaments. Magnetic resonance imaging (MRI), performed within 4 weeks (mean 6 days) in relation to MDCT, was considered the gold standard. RESULTS: Ligament integrity at MDCT: the mean interobserver proportion of agreement for a normal anterior cruciate ligament (ACL) was 0.73, for a torn ACL 0.41, for a normal posterior cruciate ligament (PCL) 0.96, and for a torn PCL 0.54. Interobserver variation for ACL was significant (P = 0.0136-0.0260), but insignificant for PCL (P = 0.3389-0.7212). Intra-observer variation was insignificant. Visualization was best in the axial and sagittal direction for ACL and PCL, respectively. At MRI, 29 normal, one partially, and 12 completely torn ACLs, and 37 normal, four partially and one completely torn PCL were found. CONCLUSION: MDCT can detect an intact ACL and PCL with good specificity, accuracy, and negative predictive value. The assessment of torn ligaments is unreliable.

Multidetector computed tomography in acute joint fractures.

Conventional radiography plays an essential diagnostic role in the primary evaluation of acute joint trauma. In complex fractures, however, computed tomography (CT) is an imaging modality often used second to radiography. As a result of technical breakthroughs in the field, multidetector CT (MDCT) allows faster imaging and better temporal, spatial, and contrast resolution compared with conventional single-slice spiral CT. MDCT with multiplanar reformation is helpful in disclosing fracture patterns, particularly in complex joint fractures, where they reveal occult fractures and show the exact number of fracture components and their degree of displacement.

Multidetector computed tomography diagnosis of adult elbow fractures.

PURPOSE: To assess acute phase multidetector computed tomography (MDCT) findings in elbow traumas. MATERIAL AND METHODS: Fifty-six patients (32 M, 24 F, age 16 to 88 years, mean 44 years) underwent MDCT of the elbow due to an acute trauma during a time period of 34 months. RESULTS: A total of 65 fractures and 3 main fracture types were established: 16 (25%) ulnar coronoid process fractures, 13 (20%) radial head fractures, and 12 (18%) humeral supracondylar fractures. Three main injury mechanisms were falling (38 (68%) patients), falling from high places (6 (11%) patients), and traffic accidents (5 (9%) patients). In 6 (11%) patients, MDCT revealed 13 occult fractures in the elbow joint compared to primary radiography. In four (7%) patients a displaced fracture fragment was detected in primary radiography, but the origin of the fragment was unclear. In all four cases, MDCT revealed the origin of the fragment. CONCLUSION: Radiography remains the primary imaging modality in elbow trauma, but in complex fracture patterns, where the extent of the fractures and the position or origin of dislocated fragments is not clear by radiography, the MDCT is a recommended complementary examination.