Multimodal imaging features of intraocular foreign bodies.

Objective: To determine the imaging approach for evaluating intraocular foreign bodies (IOFBs) by comparing the ability of different modalities [plain film x-ray, computed tomography (CT), magnetic resonsance imaging (MRI), convetional ultrasound, and ultrasound biomicroscopy] to detect and characterize IOFBs.Methods & Design: Systematic review of the literature.Results: CT is the most practical first step for evaluating patients with suspected IOFBs because it can detect a wide range of IOFB types at small limitis of detection. MRI and ultrasound are best reserved as adjunctive tests in most cases although these tests may provide important insights especially with wood, plastic, and glass IOFBs. Imaging characteristics of metal, wood, glass, plastic, stone, concrete, and graphite IOFBs are reviewed.Conclusion: Understanding the limits of detection for each IOFB type and imaging modality as well as the characteristic features of different IOFBs is of paramount importance to optimizing the management of ocular trauma patients.

Radiographic Evaluation of Meniscal Extrusion.

Background Magnetic resonance imaging (MRI) is well established as the preferred noninvasive tool for meniscal evaluation. To our knowledge, there has been no study examining the utility of diagnosing meniscal extrusion from radiography alone. We hypothesize that with appropriate window settings, meniscal extrusion may be diagnosed on radiography with high sensitivity and specificity. Materials and methods We included 190 patients with MRI of the knee performed within three months of knee radiography. As defined within the literature, we utilized the MRI criteria of meniscal extrusion as meniscal tissue extending 3 mm or greater beyond the tibial plateau, excluding osteophytes. Two attending radiologists blindly and independently identified the absence or presence, in millimeters, of medial meniscal extrusion on plain film radiography. Kappa test and Pearson correlation coefficient were calculated to assess the extent of inter-reader agreement and correlation. Sensitivity and specificity were calculated for each reader, assuming the concurrent MRI served as the gold standard. Results Ninety-six patients had medial meniscal extrusion and 94 had no medial extrusion by MRI. Kappa test for inter-reader agreement = 0.61. Pearson coefficient for inter-reader measurement correlation = 0.69. Reader A had sensitivity of 0.59 (95% CI 0.49-0.69) and specificity of 0.88 (95% CI 0.79-0.94). Reader B had sensitivity of 0.61 (95% CI 0.51-0.71) and specificity of 0.85 (95% CI 0.76-0.91). Conclusion There is substantial inter-reader agreement and high correlation of meniscal extrusion measurement between readers. Our results suggest that while radiographs have low sensitivity for evaluation of meniscal extrusion, their high specificity may be of clinical utility.

Bladder debris on ultrasound in the emergency department: correlation with urinalysis.

PURPOSE: To evaluate the correlation between the presence of bladder debris on ultrasound and urinalysis results in the emergency department setting. METHODS: Adult patients presenting to the emergency department with an ultrasound of the bladder and a urinalysis performed within 24 h of the ultrasound were included in this retrospective study. Two radiologists in consensus evaluated for the presence or absence of debris within the bladder. Urinalysis results were recorded including continuous variables (specific gravity and pH) and categorical variables (presence of occult blood, bilirubin, ketones, glucose, protein, urobilinogen, nitrite, leukocyte esterase, white blood cells, and red blood cells). The presence and absence of white and red blood cells were defined as > 5 cells/high-powered field. To control the experimentwise type I error rate at 0.05, a Bonferroni-corrected significance level of 0.0042 was used to determine significant associations. RESULTS: The presence of bladder debris was associated with the presence of urobilinogen, nitrite, and white blood cells (p = < 0.0001, 0.0005, and 0.0004, respectively). CONCLUSIONS: Bladder debris in the emergency department setting correlates with urinalysis laboratory values suggesting a urinary tract infection. Therefore, the presence of bladder debris should elicit the recommendation of a urinalysis in such a setting.

Intraneural Hemangioma: Case Report of a Rare Tibial Nerve Lesion.

An intraneural hemangioma is a rare, benign mesodermal lesion. We present a case of a three-year-old female with the inability to straighten her right knee and fullness over the right popliteal fossa for one year. Magnetic resonance imaging (MRI) demonstrated a T2 hyperintense lesion of the popliteal fossa, within the tibial nerve. The patient underwent an uncomplicated right knee excisional biopsy, which confirmed the diagnosis of an intraneural hemangioma. Although rare, an intraneural hemangioma should be considered in the differential diagnosis of a soft tissue lesion located in the expected course of a peripheral nerve.

Traumatic Cardiac Injury: Ventricular Perforation Caught on CT.

Myocardial rupture is a rare imaging diagnosis given its clinical severity and high mortality. Early findings should be promptly communicated to the trauma service to ensure immediate intervention. We present a rare case of blowout perforation of the right ventricle which was prospectively diagnosed on computed tomography (CT) leading to emergent operative repair. The patient subsequently survived and was discharged after a lengthy hospital course.

Surveillance imaging after intracranial stent implantation: non-invasive imaging compared with digital subtraction angiography.

BACKGROUND: Digital subtraction angiography (DSA) is the gold standard imaging for detection of in-stent restenosis (ISR) but there is limited literature on optimal non-invasive surveillance imaging. In this study, the ability of CT angiography (CTA) and MR angiography (MRA) compared with DSA in recognizing ISR was assessed. METHODS: A single center database of patients treated with stent implantation for ICAD was accessed. All patients who underwent follow-up imaging with DSA paired with either MRA or CTA within 30 days were included. Two angiography readers and two non-invasive imaging readers measured restenosis with a submillimeter digital caliper. ISR was categorized as: none/minimal, mild (<50%), moderate (≥50-70%) or severe (≥70%). Analysis was performed with weighted κ statistics. RESULTS: 17 cases of individual stents that underwent surveillance imaging with paired DSA and CTA and five stents with paired DSA and MRA were identified. Of those undergoing DSA and CTA, inter-reader agreement produced κ=0.68 (95% CI 0.40 to 0.95) for DSA and κ=0.75 (95% CI 0.55 to 0.95) for CTA. Agreement across CTA and DSA was κ=0.36 (95% CI 0.26 to 0.52). Of those undergoing DSA and MRA, inter-reader agreement produced κ=0.71 (95% CI 0.27 to 1.00) for DSA and κ=1.00 (95% CI 1.00 to 1.00) for MRA. Agreement across MRA and DSA was κ=0.34 (95% CI 0.18 to 0.51). CONCLUSIONS: Good inter-reader agreement exists within DSA, CTA and MRA. However, when comparing non-invasive imaging (CTA and MRA) with DSA, only fair agreement exists. These data suggest that CTA and MRA are not comparable to DSA for evaluation of ISR.

Bilateral triceps tendon tear.

Triceps tendon tear is one of the least commonly recognized major tendon tears. Bilateral triceps tendon tears are especially rare. We present a case of simultaneous complete tears of bilateral triceps tendons secondary to a fall. The anatomy, etiology, image findings, and current literature are discussed.