Frequency of acute longus colli tendinitis on CT examinations.

PURPOSE: We attempted to determine the frequency of acute longus colli tendinitis on diagnostic CT imaging performed at a large multicenter health care system. By correlating with the pre-imaging clinical information, we investigated which patient presentations should lead the radiologist to increased suspicion for this condition. METHODS: Images from a total of 8101 adult CT examinations of the neck and cervical spine performed over a 3-month period were evaluated by researchers independent of the original clinical report. Clinical information available at the time of imaging was reviewed and assigned to one of five categories. Frequency of the condition was calculated by sex and clinical presentation. This retrospective study with waiver of consent and waiver of HIPPA was approved by our IRB. RESULTS: Nine positive scans were found for an overall frequency of 1.1 per 1000 examinations. The frequency was significantly higher (11.4 per thousand) on scans performed of patients presenting without history of recent trauma, concern for tumor, suspected postoperative complication, or clinical signs of infection localized to the neck. Although frequency in males was higher than in females, this did not reach statistical significance. In no positive or negative case was longus colli tendinitis considered in the pre-imaging documentation. CONCLUSIONS: Findings of acute longus colli tendinitis on CT examination generally occur in the absence of prior mention of this condition in the medical record. The radiologist should be particularly alert for this diagnosis when a patient presents with rapid-onset neck pain without a clear history of recent trauma or other etiologies.

Lumbar Transforaminal Epidural Steroid Injections: Incidental Extraspinal Findings on Planning Imaging.

OBJECTIVE: Planning imaging performed during CT-guided procedures may occasionally contain important incidental findings. The purpose of this study was to identify and characterize by clinical relevance the extraspinal findings detected on planning imaging for CT-guided lumbar transforaminal epidural steroid injections (TFESIs). MATERIALS AND METHODS: Four radiologists retrospectively evaluated the planning scout views and CT studies for 488 consecutive CT-guided lumbar TFESIs performed in 400 patients over a 1-year period. Incidental extraspinal findings were identified and used to characterize patients by the need for follow-up using the CT Colonography Reporting and Data System (C-RADS), a classification scheme originally developed to characterize incidental findings on CT colonography. Patients with C-RADS E4 findings have potentially important findings that should be communicated to the referring physician; patients with C-RADS E3 findings have findings that are likely unimportant, but workup may be indicated. All previously unknown C-RADS E3 and E4 findings discovered in the course of this research were reported to referring physicians for appropriate patient follow-up. RESULTS: Ten of 400 (2.5%) patients were classified as C-RADS E4; the most common C-RADS E4 finding was vascular aneurysm or stenosis (4/400, 1.0%). Thirteen of 400 (3.3%) patients were classified as C-RADS E3; the most common C-RADS E3 finding was hepatomegaly (4/400, 1.0%). Of 22 patients with C-RADS E3 and E4 findings unknown to clinicians, the finding for only one (4.5%) was communicated to clinicians at the time of the procedure. CONCLUSION: Clinically important incidental extraspinal findings were identified in 5.8% of patients on the planning imaging performed for CT-guided lumbar TFESIs. Communication of clinically important findings was poor (4.5%).

Molecular imaging of inflammation in atherosclerosis with targeted ultrasound detection of vascular cell adhesion molecule-1.

BACKGROUND: The ability to image vascular inflammatory responses may allow early diagnosis and treatment of atherosclerosis. We hypothesized that molecular imaging of vascular cell adhesion molecule-1 (VCAM-1) expression with contrast-enhanced ultrasound (CEU) could be used for this purpose. METHODS AND RESULTS: Attachment of VCAM-1-targeted and control microbubbles to cultured endothelial cells was assessed in a flow chamber at variable shear stress (0.5 to 12.0 dynes/cm2). Microbubble attachment to aortic plaque was determined by en face microscopy of the thoracic aorta 10 minutes after intravenous injection in wild-type or apolipoprotein E-deficient mice on either chow or hypercholesterolemic diet. CEU molecular imaging of the thoracic aorta 10 minutes after intravenous microbubble injection was performed for the same animal groups. VCAM-1-targeted but not control microbubbles attached to cultured endothelial cells, although firm attachment at the highest shear rates (8 to 12 dynes/cm2) occurred only in pulsatile flow conditions. Aortic attachment of microbubbles and targeted CEU signal was very low in control wild-type mice on chow diet. Aortic attachment of microbubbles and CEU signal for VCAM-1-targeted microbubbles differed between treatment groups according to extent of VCAM-1-positive plaque formation (median CEU videointensity, 1.8 [95% CI, 1.2 to 1.7], 3.7 [95% CI, 2.9 to 7.3], 6.8 [95% CI, 3.9 to 7.6], and 11.2 [95% CI, 8.5 to 16.0] for wild-type mice on chow and hypercholesterolemic diet and for apolipoprotein E-deficient mice on chow and hypercholesterolemic diet, respectively; P<0.001). CONCLUSIONS: CEU molecular imaging of VCAM-1 is capable of rapidly quantifying vascular inflammatory changes that occur in different stages of atherosclerosis. This method may be potentially useful for early risk stratification according to inflammatory phenotype.