Post-traumatic spinal hematoma in diffuse idiopathic skeletal hyperostosis (DISH).

OBJECTIVES: To determine the incidence of spinal hematoma and its relation to neurological deficit after trauma in patients with spinal ankylosis from diffuse idiopathic skeletal hyperostosis (DISH). MATERIALS AND METHODS: A retrospective review of 2256 urgent or emergency MRI referrals over a period of 8 years and nine months revealed 70 DISH patients who underwent CT and MRI scans of the spine. Spinal hematoma was the primary outcome. Additional variables were spinal cord impingement, spinal cord injury (SCI), trauma mechanism, fracture type, spinal canal narrowing, treatment type, and Frankel grades during injury, before and after treatment. Two trauma radiologists reviewed MRI scans blinded to initial reports. RESULTS: Of 70 post-traumatic patients (54 men, median age 73, IQR 66-81) with ankylosis of the spine from DISH, 34 (49%) had spinal epidural hematoma (SEH) and 3 (4%) had spinal subdural hematoma, 47 (67%) had spinal cord impingement, and 43 (61%) had SCI. Ground-level fall (69%) was the most common trauma mechanism. A transverse, AO classification type B spine fracture (39%) through the vertebral body was the most common injury type. Spinal canal narrowing (p < .001) correlated and spinal cord impingement (p = .004) associated with Frankel grade before treatment. Of 34 patients with SEH, one, treated conservatively, developed SCI. CONCLUSIONS: SEH is a common complication after low-energy trauma in patients with spinal ankylosis from DISH. SEH causing spinal cord impingement may progress to SCI if not treated by decompression. CLINICAL RELEVANCE STATEMENT: Low-energy trauma may cause unstable spinal fractures in patients with spinal ankylosis caused by DISH. The diagnosis of spinal cord impingement or injury requires MRI, especially for the exclusion of spinal hematoma requiring surgical evacuation. KEY POINTS: • Spinal epidural hematoma is a common complication in post-traumatic patients with spinal ankylosis from DISH. • Most fractures and associated spinal hematomas in patients with spinal ankylosis from DISH result from low-energy trauma. • Spinal hematoma can cause spinal cord impingement, which may lead to SCI if not treated by decompression.

Ankylosis of the cervical spine increases the incidence of blunt cerebrovascular injury (BCVI) in CTA screening after blunt trauma.

PURPOSE: To examine the incidence, location, and grade of blunt cerebrovascular injury (BCVI), as well as associated strokes in patients with ankylosis of the cervical spine, imaged with CT angiography (CTA) after blunt trauma. The related etiologies of ankylosis had an additional focus. MATERIALS AND METHODS: Altogether of 5867 CTAs of the craniocervical arteries imaged after blunt trauma between October 2011 and March 2020 were manually reviewed for a threshold value of ankylosis of at least three consecutive cervical vertebrae. BCVI was the primary outcome and associated stroke as the secondary outcome. Variables were craniofacial and cervical spine fractures, etiology and levels of ankylosis, traumatic brain injury, spinal hematoma, spinal cord injury, and spinal cord impingement, for which correlations with BCVI were examined. RESULTS: Of the 153 patients with ankylosis and blunt trauma of the cervical spine, 29 had a total of 36 BCVIs, of whom two had anterior and 4 posterior circulation strokes. Most of the BCVIs (n = 32) were in the vertebral arteries. Injuries were graded according to the Biffl scale: 17 grade II, 4 grade III, 14 grade IV, and 1 grade V. A ground-level fall was the most common trauma mechanism. Cervical spine fracture was the only statistically significant predictor for BCVI (OR 7.44). Degenerative spondylosis was the most prevalent etiology for ankylosis. CONCLUSION: Ankylosis of the cervical spine increases the incidence of BCVI up to sevenfold compared to general blunt trauma populations, affecting especially the vertebral arteries.

CT arthrography of the wrist using a novel, mobile, dedicated extremity cone-beam CT (CBCT).

PURPOSE: To evaluate the feasibility and intra- and interobserver agreement of CBCT arthrography of wrist ligaments, triangular fibrocartilaginous complex (TFCC), and to assess the sensitivity (SE), specificity (SP), accuracy (ACC), and positive and negative predictive value (PPV, NPV) of CBCT arthrography in the diagnosis of scapholunate (SLL) and lunotriquetral (LTL) ligament tears, TFCC, and cartilage abnormalities of the scaphoid and lunate with their corresponding radial surfaces (scaphoid and lunate fossa) using a novel, mobile, dedicated extremity CBCT scanner. MATERIALS AND METHODS: Fifty-two consecutively enrolled subjects (26 M, 26 F, mean age 38 years, range 18-66 years) with suspected wrist ligament tears underwent CBCT-arthrography before normally scheduled MR arthrography.An extremity CBCT was used for imaging with isotropic voxel size of 0.4 × 0.4 × 0.4 mm(3). Subsequent routine 1.5 T MRI was performed using a dedicated wrist coil.Two observers reviewed the anonymized CBCT images twice for contrast enhancement (CE) and technical details (TD), for tears of the SLL, LTL, and TFCC. Also, cartilage abnormalities of the scaphoid and lunate with their corresponding radial surfaces (scaphoid and lunate fossa) were evaluated. Inter- and intraobserver agreement was determined using weighted kappa statistics. Since no surgery was performed, MRI served as a reference standard, and SE and SP, ACC, PPV, and NPV were calculated. RESULTS: Intra- and interobserver kappa values for both readers (reader 1/reader 2; first reading/second reading) with 95 % confidence limits were: CE 0.54 (0.08-1.00)/ 0.75 (0.46-1.00); 0.73 (0.29-1.00)/ 0.45 (0.07-0.83), TD 0.53 (0.30-0.88)/ 0.86 (0.60-1.00); 0.56 (0.22-0.91)/ 0.67 (0.37-0.98), SLL 0.59 (0.25-0.93)/ 0.66 (0.42-0.91); 0.31 (0.06-0.56)/ 0.49 (0.26-0.73), LTL 0.83 (0.66-1.00)/ 0.68 (0.46-0.91); 0.90 (0.79-1.00)/ 0.48 (0.22-0.74); TFCC (0.72-1.00)/ (0.79-1.00); 0.65 (0.43-0.87)/ 0.59 (0.35-0.83), radius (scaphoid fossa) 0.45 (0.12-0.77)/ 0.64 (0.31-0.96); 0.58 (0.19-0.96)/ 0.38 (0.09-0.66), scaphoid 0.43 (0.12-0.74)/ 0.76 (0.55-0.96); 0.37 (0.00-0.75)/ 0.32 (0.04-0.59), radius (lunate fossa) 0.68 (0.36-1.00)/ 0.42 (0.00-0.86); 0.62 (0.29-0.96)/ 0.51 (0.12-0.91), and lunate 0.53 (0.16-0.90)/ 0.68 (0.44-0.91); 0.59 (0.29-0.88)/ 0.42 (0.00-0.84), respectively. The overall mean accuracy was 82-92 % and specificity was 81-94 %. Sensitivity for LTL and TFCC tears was 76-83, but for SLL tears it was 58 %. For cartilage abnormalities, the accuracy and negative predictive value were high, 90-98 %. CONCLUSIONS: A dedicated CBCT extremity scanner is a new method for evaluating the wrist ligaments and radiocarpal cartilage. The method has an overall accuracy of 82-86 % and specificity 81-91 %. For cartilage abnormalities, the accuracy and negative predictive value were high.

Multidetector CT in shoulder fractures.

The aim of this study was to assess the multi-detector computed tomography (MDCT) findings in acute shoulder traumas compared to radiographic findings in patients referred to a level one trauma center. Two hundred and ten patients (128 male, 82 female, age 16-95 years, mean age 51.7 years) underwent shoulder MDCT due to acute trauma. Three main mechanisms of injury were established: falling (113 patients, 54%), traffic accidents (36 patients, 17%) and falling from a height (12 patients, 6%). Based on MDCT, a total of 311 fractures--152 in the scapula and 159 in the proximal humerus--occurred in 191 (91%) of the 210 patients. The two most common occult fractures were lesser tubercle and coracoid process fractures. In 20 (63%) of the patients with a comminuted fracture of proximal humerus the exact number of fracture fragments was underestimated in radiographs. MDCT with multiplanar reconstructions (MPR) is a recommended complementary examination in patients with complex proximal humerus fractures where the extent of the fractures and the position or origin of dislocated fragments is not clear on radiography. This may increase the accuracy of the fracture classification and reveal occult fractures in other parts of the shoulder.

Ankle and foot injuries: analysis of MDCT findings.

OBJECTIVE: The purpose of our study was to assess MDCT findings and the advantages of MDCT compared with radiography in patients referred to a level 1 trauma center for diagnostic evaluation of acute ankle and foot trauma. MATERIALS AND METHODS: During a period of 37 months, 388 patients underwent MDCT of the ankle and foot due to an acute trauma. Imaging studies (MDCT and radiography) were retrospectively reevaluated with respect to fracture location, fracture type, and mechanism of injury, and findings from the primary radiographs of the ankle and foot were compared with MDCT findings. RESULTS: Of the 388 patients, 344 (89%) had one or more fractures in the ankle or foot. A total of 517 fractures were found in all anatomic regions: ankle, calcaneus, talus, midfoot, and forefoot. The three most common occult fractures in the ankle not detected on primary radiography were isolated fractures of the posterior and medial malleolus and Tillaux fractures. The calcaneus was the most commonly fractured bone, and the sensitivity of radiography in the detection of calcaneal fractures was 87%. The sensitivity of radiography in the detection of talar fractures was 78%, whereas it was only 25-33% in the detection of midfoot fractures. A Lisfranc fracture-dislocation was not detected on primary radiography in five (24%) of 21 cases. The three main injury mechanisms were falling from a height (164 patients [48%]), a simple fall (68 patients [20%]), and a traffic accident (47 patients [14%]). CONCLUSION: In patients with injuries from high-energy polytrauma and in those with complex ankle and foot fractures, the sensitivity of radiography is only moderate to poor; in these cases, MDCT is recommended as the primary imaging technique.

Wrist injuries; diagnosis with multidetector CT.

The aim of the study was to assess acute-phase multidetector CT (MDCT) findings in wrist injuries. We retrieved all emergency room MDCT requests processed in the period from August 2000 to May 2003. All patients with a wrist injury who underwent MDCT initially were included. Imaging studies were evaluated in relation to injury mechanism, fracture location, and fracture type. A total of 6422 MDCT examinations were performed during this 34-month period, and 38 patients (24 male, 14 female, age range 21-73 years, mean age 40 years) met the inclusion criteria. MDCT revealed 56 fractures and 7 dislocations in 29 patients. In 9 patients (24%) MDCT findings were normal. Eleven patients (29%) underwent surgical procedures. The main injury mechanism was a fall (58%). In 33 cases the primary radiograph was available. Compared to primary radiographs, MDCT revealed 9 occult fractures, mainly in small carpal bones. In 14 cases a suspected fracture (of the scaphoid in 7 cases) was ruled out by MDCT. Due to high-quality two-dimensional reformatting, MDCT examinations were not dependent on the wrist's position in the CT gantry. In the comparison with radiography, MDCT detected occult fractures and ruled out suspected fractures, both mainly in the small carpal bones. High-quality two-dimensional reformats gave significant information about the fracture anatomy. MDCT provides fast and valuable information in assessing complex wrist fractures or when the primary radiograph is equivocal.