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1.
Emerg Radiol ; 28(3): 601-611, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33452963

RESUMO

PURPOSE: The purpose of this study is to examine the incidence, location, and magnetic resonance imaging (MRI) features of spinal epidural hematoma (SEH) and spinal subdural hematoma (SSH) in post-traumatic ankylosing spondylitis (AS) patients. METHODS: A total of 2256 consecutive referrals for urgent and emergency MRI scans of the spine over a period of eight years and nine months were manually reviewed for any mentions indicating axial ankylosis and post-traumatic spinal hematoma. We found 164 patients with ankylosed spines complicated by spinal fracture, of whom 32 had AS. Of the 132 excluded patients, 80 had diffuse idiopathic skeletal hyperostosis (DISH). The primary outcome was the presence of spinal hematoma, and the secondary outcome was spinal canal narrowing and spinal cord impingement. Two musculoskeletal radiologists and one fellow in musculoskeletal radiology reviewed the images for the presence of spinal hematoma and related signal characteristics, blinded to one another and initial reports. RESULTS: Of 28 post-traumatic AS patients, 19 had SEHs and five had spinal SSHs. There was a statistically significant difference between Frankel grades before and after surgery in respect of neurological improvement (p = 0.008). Patients who had radiologically proven spinal cord impingement showed more severe neurological deficits (p = 0.012). Hematomas with T1 heterogeneity showed a significantly increased delay (p = 0.047) between injury and imaging, while other signal characteristics were only approximate. CONCLUSIONS: Both SEH and SSH are common complications in post-traumatic AS patients. Patients benefit from surgery, but the relevance of spinal hematoma as a separate factor causing neurological deficit remains unclear.

2.
Knee Surg Sports Traumatol Arthrosc ; 29(6): 1872-1879, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32862240

RESUMO

PURPOSE: In knee dislocation with bicruciate ligament and medial side injury (KDIIIM), treatment method of medial side injuries is controversial. The purpose of this study was to evaluate the outcomes of non-operative treatment of proximal and midsubstance and operative treatment of distal avulsion medial collateral ligament (MCL) ruptures in patients with early bicruciate reconstruction. METHODS: One-hundred and forty-seven patients with a knee dislocation and bicruciate ligament injury (KDII-KDV) were identified. Sixty-two patients had KDIIIM injury. Of these, 24 patients were excluded and 13 were lost to follow-up. With a minimum of 2 years of follow-up, IKDC2000 (subjective and objective), Lysholm and Tegner scores and stress radiographs were recorded. RESULTS: Twenty-five patients were available for follow-up: 18 had a proximal or midsubstance grade-III MCL rupture (proximal MCL group) and 7 had a distal MCL avulsion (distal MCL group). In the proximal MCL and distal MCL groups, respectively, median IKDC2000 subjective scores were 80 (range 57-99) and 62 (range 39-87), and median Lysholm scores were 88 (range 57-99) and 75 (range 40-100). The median medial opening (side-to-side difference) was 2.4 mm (range 0.1-9.2) in the proximal MCL group and 2.5 mm (range 0.2-4.8) in the distal MCL group. CONCLUSION: We found acceptable recorded outcomes in patients who underwent non-operative treatment of proximal and midsubstance grade-III MCL rupture and operative treatment of distal MCL avulsion with early bicruciate ligament reconstruction. LEVEL OF EVIDENCE: Level IV.


Assuntos
Artroscopia , Luxação do Joelho/cirurgia , Ligamento Colateral Médio do Joelho/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Luxação do Joelho/diagnóstico por imagem , Luxação do Joelho/terapia , Articulação do Joelho/cirurgia , Masculino , Ligamento Colateral Médio do Joelho/diagnóstico por imagem , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Ruptura/cirurgia , Resultado do Tratamento , Adulto Jovem
3.
J Oral Maxillofac Surg ; 76(7): 1509.e1-1509.e9, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29679584

RESUMO

PURPOSE: The risk factors for blunt cerebrovascular injuries (BCVIs) are currently under intensive research, yet it is still controversial who should be screened. This study aimed to determine whether craniofacial fractures are associated with BCVI. PATIENTS AND METHODS: This retrospective cohort study focused on patients with suspected polytrauma after whole-body computed tomographic angiography of the cervical arteries. Patients were reviewed for BCVI and craniofacial fractures. Exclusion criteria were hanging injury, gunshot injury or other penetrating injury to the neck, and a cervical fracture on any level. The outcome variable was BCVI, and the main predictor variable was a craniofacial fracture. A secondary predictor variable was a type of craniofacial fracture classified as a facial fracture, skull fracture, or a combination of facial and skull fracture. Other predictor variables were gender, age, and mechanism of injury. In addition, specific craniofacial fractures were analyzed in more detail. The relevance of associations between BCVI and the predictors underwent χ2 testing. Significance was set at .01. RESULTS: Four hundred twenty-eight patients 13 to 90 years old during a 12-month period were included in the analysis. Craniofacial fractures occurred in 75 (17.5%). BCVI occurred significantly more frequently in those with than in those without a craniofacial fracture (18.6 vs 7.4%; P = .002). Patients with craniofacial fracture had a 4-fold increased risk for BCVI, whereas those 31 to 50 years old had 3.4-fold increased risk. Type of craniofacial fracture, gender, and mechanism of injury were not associated with BCVI. CONCLUSION: Craniofacial fractures are a serious risk factor for BCVI. This research suggests that in patients with any craniofacial fracture and suspected polytrauma, rigorous imaging of cervical arteries in search of BCVI is essential.


Assuntos
Traumatismo Cerebrovascular/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Fraturas Cranianas/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo , Estudos Retrospectivos , Fatores de Risco , Imagem Corporal Total
4.
Dentomaxillofac Radiol ; 46(2): 20160261, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27786546

RESUMO

OBJECTIVES: This study aimed to determine the optimal post-operative CT imaging method that enables best visualization of facial bony structures in the vicinity of osteosynthesis material. METHODS: Conducted at Töölö Hospital (Helsinki, Finland), this study relied on scanning a phantom with CBCT, 64-slice CT and high-definition multislice CT with dual-energy scan (providing monochromatic images of 70-, 100-, 120- and 140-keV energy levels) and iterative reconstruction (IR) methods. Two radiologists assessed the image quality, and the assessments were analyzed. In addition, a physicist performed a semi-quantitative analysis of the metal-induced artefacts. RESULTS: The three subjects most easily assessed were the loose screw and both the bone structure and the fracture further away from the screw and the plate. Soft tissues adjacent to the screw and the plate remained more difficult for assessment. Both image interpreters agreed that the artefacts disturbed their assessments under dual energy. Metal artefacts disturbed the least under multislice CT with IR [adaptive statistical iterative reconstruction (ASiR) and VEO]. Neither interpreter found metal suppression helpful in CBCT. CONCLUSIONS: CBCT with or without a metal artefact reduction algorithm was not optimal for post-operative facial imaging compared with multislice CT with IR. Multislice CT with ASiR filtering offered good image quality performance with fast image volume reconstruction, representing the current sweet spot in post-operative maxillofacial imaging.


Assuntos
Fixação de Fratura , Fraturas Cranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Artefatos , Placas Ósseas , Parafusos Ósseos , Humanos , Fraturas Cranianas/cirurgia
5.
Emerg Radiol ; 21(2): 165-71, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24221020

RESUMO

Road traffic accidents are a major health problem worldwide resulting frequently in maxillofacial injuries. The purpose of the study was to assess the incidence and spectrum of facial fractures in patients involved in a motor vehicle accident (MVA). Using picture archiving and communication system, all requests for suspected facial trauma were retrieved during a 62-month period; 374 met the inclusion criteria. Two researchers interpreted the multidetector computed tomography images by consensus. The motor vehicles involved were divided into two groups: those involving a passenger car or a larger vehicle and those involving a motorized two-wheeler. Furthermore, the motor vehicle accidents were divided into collisions and run-off-road accidents. Of the 374 patients (aged 15-80, mean 34), 271 (72 %) were male and 103 (28 %) female. Of all patients, 262 (70 %) had a facial or skull base fracture; of these, multiple separate fractures were present in 56 %. Nasal fractures were the most common fractures followed by orbital, skull base, and maxillary fractures. Frontal bone, LeFort, and zygomatic arch fractures were always accompanied by other fractures. Fractures were more frequent in the group of collisions compared with run-off-road accidents. In the two-wheeled group, only 15 % did not have facial or skull base fractures. Fractures often occur in multitudes as 39 % of all patients have multiple facial or skull bone fractures, and thus, emergency radiologists should be familiar with the complexity of the injuries. Negative clear sinus sign and low-energy sentinel injuries should be trusted as indications of undetected injuries in MVA victims.


Assuntos
Acidentes de Trânsito , Ossos Faciais/diagnóstico por imagem , Ossos Faciais/lesões , Tomografia Computadorizada Multidetectores , Fraturas Cranianas/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Fraturas Maxilares/diagnóstico por imagem , Fraturas Maxilares/epidemiologia , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/epidemiologia , Osso Nasal/diagnóstico por imagem , Osso Nasal/lesões , Fraturas Orbitárias/diagnóstico por imagem , Base do Crânio/lesões , Fraturas Cranianas/epidemiologia
6.
J Digit Imaging ; 26(6): 1020-4, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23779151

RESUMO

Speech recognition (SR) speeds patient care processes by reducing report turnaround times. However, concerns have emerged about prolonged training and an added secretarial burden for radiologists. We assessed how much proofing radiologists who have years of experience with SR and radiologists new to SR must perform, and estimated how quickly the new users become as skilled as the experienced users. We studied SR log entries for 0.25 million reports from 154 radiologists and after careful exclusions, defined a group of 11 experienced radiologists and 71 radiologists new to SR (24,833 and 122,093 reports, respectively). Data were analyzed for sound file and report lengths, character-based error rates, and words unknown to the SR's dictionary. Experienced radiologists corrected 6 characters for each report and for new users, 11. Some users presented a very unfavorable learning curve, with error rates not declining as expected. New users' reports were longer, and data for the experienced users indicates that their reports, initially equally lengthy, shortened over a period of several years. For most radiologists, only minor corrections of dictated reports were necessary. While new users adopted SR quickly, with a subset outperforming experienced users from the start, identification of users struggling with SR will help facilitate troubleshooting and support.


Assuntos
Competência Clínica , Documentação/métodos , Sistemas de Informação em Radiologia , Interface para o Reconhecimento da Fala/estatística & dados numéricos , Tecnologia Radiológica/métodos , Adulto , Intervalos de Confiança , Diagnóstico por Imagem/normas , Diagnóstico por Imagem/tendências , Finlândia , Pesquisas sobre Serviços de Saúde , Humanos , Curva de Aprendizado , Masculino , Registros Médicos , Pessoa de Meia-Idade , Serviço Hospitalar de Radiologia/organização & administração , Avaliação da Tecnologia Biomédica , Tecnologia Radiológica/educação , Fatores de Tempo , Gestão da Qualidade Total
7.
Int J Comput Assist Radiol Surg ; 8(5): 703-9, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23443983

RESUMO

PURPOSE: Craniosynostosis may lead to reduced intracranial volume (ICV) and disturb normal brain growth and development. Thus, ICV is an important parameter with respect to the surgical outcome. Current methods for ICV determination from computed tomography (CT) images have drawbacks. The aim of this study was to investigate the performance of the novel mesh-based method (MBM) for ICV determination with craniosynostosis patients. METHODS: Twenty-two patients operated on for scaphocephaly were included in this study. ICVs from preoperative, one-week postoperative, and one-year postoperative CT images were measured with MBM. The level of agreement with the manual segmentation method (MSM) was determined for the measurements of preoperative and one-year postoperative datasets. Repeatability was determined with re-measurements of six datasets. Measurement time was recorded for MBM. RESULTS: Mean [Formula: see text] preoperative ICV values were 895.0 [Formula: see text] 153.1 [Formula: see text] and 896.4 [Formula: see text] 147.2 [Formula: see text] as measured with MBM and MSM, respectively. Corresponding one-year postoperative values were 1,238.3 [Formula: see text] 118.7 [Formula: see text] and 1,250.1 [Formula: see text] 117.5 [Formula: see text]. The MBM allowed ICV determination from one-week postoperative datasets. Measurement time with MBM was 4 CONCLUSIONS: MBM is an efficient method for determining the ICV of craniosynostosis patients, allowing the measurement of skulls with bony defects. The repeatability and short measurement time of MBM are attributable to the user interference and assessment of the measurement process.


Assuntos
Craniossinostoses/diagnóstico , Imageamento Tridimensional , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada Multidetectores/métodos , Crânio/diagnóstico por imagem , Craniossinostoses/cirurgia , Progressão da Doença , Feminino , Seguimentos , Humanos , Lactente , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos
9.
Acta Radiol ; 52(10): 1107-12, 2011 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-22013010

RESUMO

BACKGROUND: Sports and recreational accidents involving critical areas of the body occur commonly in the general population. Reports on their demographics and recommendations for screening procedures are, however, few. PURPOSE: To assess injuries of the craniofacial area, spine, and torso resulting from sports and recreational accidents with multidetector computed tomography (MDCT) as primary imaging method in a Level I trauma center. MATERIAL AND METHODS: All emergency room CT requests over a time span of 105 months were reviewed retrospectively for trauma mechanism and injury. Patients were identified using an electronic picture archiving and communications system (PACS), and MDCT studies interpreted by two radiologists independently. RESULTS: Of a total of 5898 patients, 492 patients (301 boys/men, 191 girls/women, age range 2-76 years, mean 33.5 years, median 29.5 years) with sports or recreational accidents emerged. A total of 102 traumatic findings were diagnosed, thereof 72 (71%) serious. The three most commonly encountered serious injuries were intracranial injury, fractures of facial bones, and vertebral injuries. The three most common injury mechanisms were bicycling, horseback riding, and team ball sports. Patients from recreational activities were on average significantly younger (29.2 years) than those from sports accidents (36.9 years; P < 0.001). Only age groups <21 years and 41-50 years differed in injury severity from the other age groups (P = 0.004 and P = 0.063, respectively). Of all trauma mechanisms, only bicycling had a significantly increased risk of injury (P < 0.001). CONCLUSION: Injuries in sports and recreational accidents presented with an overall incidence of 21%, of which 71% are serious. The most common mechanisms of injury were bicycling, horseback riding, and team ball sports. The largest incidence of serious injury involved bicycling. Because of the high probability of a serious injury and the high energies that are often involved in these accidents, we recommend ruling out of internal injury by MDCT as the primary imaging modality.


Assuntos
Acidentes/estatística & dados numéricos , Traumatismos em Atletas/epidemiologia , Tomografia Computadorizada Multidetectores/métodos , Recreação , Adolescente , Adulto , Distribuição por Idade , Idoso , Análise de Variância , Criança , Pré-Escolar , Ossos Faciais/diagnóstico por imagem , Ossos Faciais/lesões , Feminino , Finlândia/epidemiologia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/epidemiologia , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Sistemas de Informação em Radiologia , Estudos Retrospectivos , Crânio/diagnóstico por imagem , Crânio/lesões , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/epidemiologia , Tronco/diagnóstico por imagem , Tronco/lesões , Centros de Traumatologia , Adulto Jovem
10.
World J Surg ; 35(12): 2643-9, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21989646

RESUMO

BACKGROUND: Management of severe liver injuries has evolved to include the options for nonoperative management and damage control surgery. The present study analyzes the criteria for choosing between nonoperative management and early surgery, and definitive repair versus damage control strategy during early surgery. METHODS: In a retrospective analysis of 144 patients with severe (AAST grade III-V) liver injuries (94% blunt trauma), early laparotomy was performed in 50 patients. Initial management was nonoperative in 94 blunt trauma patients with 8 failures. Uni- and multivariate analyses were used to calculate predictor odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Factors associated with early laparotomy in blunt trauma included shock on admission, associated grade IV-V splenic injury, grade IV-V head injury, and grade V liver injury. Only shock was an independent predictor (OR, 26.1; 95% CI, 8.9-77.1; P < 0.001). The presence of a grade IV-V splenic injury predicted damage control strategy (OR infinite; P = 0.021). Failed nonoperative management was associated with grade IV-V splenic injury (OR, 14.00; 95% CI, 1.67-117.55), and shock (OR, 6.82; 95% CI, 1.49-31.29). The hospital mortality rate was 15%; 8 of 21 deaths were liver-related. Shock (OR, 9.3; 95% CI, 2.4-35.8; P = 0.001) and severe head injury (OR, 9.25; 95% CI, 3.0-28.9; P = 0.000) were independent predictors for mortality. CONCLUSIONS: In patients with severe liver injury, associated severe splenic injury favors early laparotomy and damage control strategy. Patients who arrive in shock or have an associated severe splenic injury should not be managed nonoperatively. In addition to severe head injury, uncontrollable bleeding from the liver injury is still a major cause of early death.


Assuntos
Fígado/lesões , Fígado/cirurgia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ferimentos e Lesões/terapia , Adulto Jovem
11.
AJR Am J Roentgenol ; 193(5): 1354-60, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19843753

RESUMO

OBJECTIVE: The purposes of this retrospective study were to elaborate our experience in postoperative MDCT of tibial plateau fractures, to establish the frequency of these fractures and the indications for MDCT, and to assess the common findings and their clinical importance. MATERIALS AND METHODS: A total of 782 knee injuries were imaged with MDCT at a level 1 trauma center over 86 months. A total of 592 knees had a tibial plateau fracture; 381 of these fractures were managed surgically, and postoperative MDCT was performed on 36 of these knees (9%). At postoperative image analysis, an orthopedic surgeon evaluated reduction as good or suboptimal using the first postoperative radiographs. Fracture healing was determined as complete ossification, partial ossification, or nonunion on MDCT images acquired later in follow-up. The MDCT findings were compared with the radiographic findings to assess the usefulness and clinical importance of MDCT. RESULTS: The main indications for MDCT were assessment and follow-up of the joint articular surface and evaluation of fracture healing. Orthopedic hardware caused no diagnostic problems at MDCT. Postoperative MDCT revealed additional clinically important information on 29 patients (81%), and 14 patients (39%) underwent reoperation. CONCLUSION: Postoperative MDCT of tibial plateau fractures is performed infrequently, even in a large trauma center. When it is performed, however, because of suspicion of increasing articular step-off or fracture nonunion, postoperative MDCT reveals clinically significant information in most cases.


Assuntos
Fraturas da Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Feminino , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador , Reoperação , Estudos Retrospectivos , Fraturas da Tíbia/cirurgia , Centros de Traumatologia
12.
Skeletal Radiol ; 38(9): 887-93, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19430781

RESUMO

OBJECTIVE: To assess the reliability of measurements of spinal canal narrowing, vertebral body compression, and interpedicular widening in burst fractures in radiography compared with multidetector computed tomography (MDCT). MATERIALS AND METHODS: Patients who had confirmed acute vertebral burst fractures over an interval of 34 months underwent both MDCT and radiography. Measurements of spinal canal narrowing, vertebral body compression, and interpedicular widening from MDCT and radiography were compared. RESULTS: The 108 patients (30 female, 78 male, aged 16-79 years, mean 39 years) had 121 burst fractures. Eleven patients had multiple fractures, of which seven were not contiguous. Measurements showed a strong positive correlation between radiography and MDCT (Spearman's rank sum test: spinal canal narrowing k = 0.50-0.82, vertebral compression k = 0.55-0.72, and interpedicular widening k = 0.81-0.91, all P < 0.05), except for the cervical spine (k = -0.50 to 0.61, with all P > 0.25) and for interpedicular widening in the thoracic spine (k = 0.35, P = 0.115). The average difference in measurements between the modalities was 3 mm or fewer. CONCLUSION: Radiography demonstrates interpedicular widening, spinal canal narrowing and vertebral compression with acceptable precision, with the exception of those of the cervical spine.


Assuntos
Fraturas por Compressão/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Filme para Raios X , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
13.
AJR Am J Roentgenol ; 191(4): 1002-9, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18806134

RESUMO

OBJECTIVE: The purpose of this study was to evaluate the prevalence, type, and location of meniscal injuries, particularly to assess the prevalence of unstable meniscal tears in acute knee trauma with tibial plateau fractures. MATERIALS AND METHODS: A total of 78 menisci were evaluated in 39 patients who had undergone knee MDCT and MRI. Meniscal tears were classified as horizontal, vertical (subdivided into longitudinal and radial), flap, bucket-handle, or complex. The presence of meniscal contusion was documented. The anterior horn, body, and posterior horn were assessed separately for both menisci. Knee arthroscopy was performed on 28 patients. RESULTS: Of the 39 patients in the study, 24 had detectable abnormal menisci, for a total of 33 abnormal menisci (42%). Among the 33 meniscal abnormalities were 11 longitudinal tears (33%), 17 contusions (52%), four flap tears (12%), six horizontal tears (18%), and six radial tears (18%). Among the 16 patients with meniscal tears (41% of the 39), 14 patients had an unstable tear. No significant correlation was found between degree of articular depression and site or morphologic features of the meniscal injury. Correspondingly, no statistical correlation was evident between normal menisci and degree of articular depression, nor was a significant correlation found between differing fracture groups and meniscal findings. CONCLUSION: A high percentage of patients (36%) with a tibial plateau fracture had an unstable meniscal tear. If a meniscal tear is detected preoperatively, meniscal surgery can be combined with fracture fixation, and reoperation can be avoided. A large number of meniscal contusions were found. Awareness of this abnormality can help radiologists increase specificity by avoiding false-positive findings of meniscal tear.


Assuntos
Traumatismos do Joelho/diagnóstico , Imageamento por Ressonância Magnética/métodos , Fraturas da Tíbia/diagnóstico , Lesões do Menisco Tibial , Adolescente , Adulto , Idoso , Artroscopia , Feminino , Finlândia/epidemiologia , Humanos , Traumatismos do Joelho/classificação , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/cirurgia , Masculino , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fraturas da Tíbia/classificação , Fraturas da Tíbia/epidemiologia , Fraturas da Tíbia/cirurgia
14.
Emerg Radiol ; 15(4): 241-7, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18481126

RESUMO

The aim of this study is to assess multidetector computed tomography (MDCT) findings of facial trauma due to a falling accident. Using picture-archiving and communications system, we retrieved all MDCT requests for suspected facial injury during a 62-month period. Images were interpreted by two researchers. Five hundred patients met the inclusion criteria and 329 (66%) had a total of 515 fractures. Falls on stairs were seen in 109 (22%) patients and slips or trips in 391 (78%). The corresponding number of fractures was 169 (33%) and 346 (67%). Males (N = 241) had more fractures than females (N = 259), 327 vs. 188, respectively. The zygomatic complex was the most common fracture, seen in 40% of patients suffering a fracture. Twenty patients (4%) had fractures involving the sinus walls without paranasal sinus effusions. Facial fractures due to falls are common. The zygomatic complex is the most common fracture. A clear sinus sign may be less reliable than previously thought.


Assuntos
Acidentes por Quedas , Traumatismos Faciais/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ossos Faciais/diagnóstico por imagem , Ossos Faciais/lesões , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Skeletal Radiol ; 37(9): 813-9, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18421455

RESUMO

OBJECTIVE: The objective was to study characteristic MRI findings in cervical spine fractures complicating ankylosing spondylitis (AS). Technical issues related to MRI are also addressed. MATERIALS AND METHODS: A review of 6,774 consecutive cervical spine multidetector CT (MDCT) scans obtained during 6.2 years revealed 33 ankylosed spines studied for suspected acute cervical spine injury complicating AS. Of these, 20 patients also underwent MRI. RESULTS: On MRI, of these 20 patients, 19 had a total of 29 cervical and upper thoracic spine fractures. Of 20 transverse fractures traversing both anterior and posterior columns, 7 were transdiskal and exhibited less bone marrow edema than did those traversing vertebral bodies. One Jefferson's, 1 atlas posterior arch (Jefferson's on MDCT), 2 odontoid process, and 5 non-contiguous spinous process fractures were detectable. MRI showed 2 fractures that were undetected by MDCT, and conversely, MDCT detected 6 fractures not seen on MRI; 16 patients had spinal cord findings ranging from impingement and contusion to complete transection. CONCLUSION: Magnetic resonance imaging can visualize unstable fractures of the cervical and upper thoracic spine. Paravertebral hemorrhages and any ligamentous injuries should alert radiologists to seek transverse fractures. Multiple fractures are common and often complicated by spinal cord injuries. Diagnostic images can be obtained with a flexible multipurpose coil if the use of standard spine array coil is impossible due to a rigid collar or excessive kyphosis.


Assuntos
Vértebras Cervicais/lesões , Imageamento por Ressonância Magnética/métodos , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/etiologia , Espondilite Anquilosante/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Tomografia Computadorizada por Raios X
16.
J Digit Imaging ; 21(4): 378-82, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18437491

RESUMO

Speech recognition (SR), available since the 1980s, has only recently become sufficiently reliable to allow utilization in medical environment. This study measured the effect of SR for the radiological dictation process and estimated differences in report turnaround times (RTTs). During the transition from cassette-based reporting to SR, the workflow of 14 radiologists was periodically followed up for 2 years in a university hospital. The sample size was more than 20,000 examinations, and the radiologists were the same throughout the study. A RTT was defined as the time from imaging at the modality to the time when the report was available for the clinician. SR cut down RTTs by 81% and the standard deviation by 83%. The proportion of reports available within 1 h escalated from 26% to 58%. The proportion of reports created by SR increased during a follow-up time of this study from 0% up to 88%. SR decreases turnaround times and may thus speed up the whole patient care process by facilitating online reporting. SR was easily adopted and well accepted by radiologists. Our findings encourage the utilization of SR, which improves the productivity and accelerates the workflow with excellent end-user satisfaction.


Assuntos
Eficiência Organizacional/estatística & dados numéricos , Registros Médicos , Serviço Hospitalar de Radiologia/organização & administração , Sistemas de Informação em Radiologia/estatística & dados numéricos , Interface para o Reconhecimento da Fala/estatística & dados numéricos , Seguimentos , Hospitais Universitários/estatística & dados numéricos , Avaliação da Tecnologia Biomédica/estatística & dados numéricos , Estudos de Tempo e Movimento , Gestão da Qualidade Total/métodos , Gestão da Qualidade Total/estatística & dados numéricos
17.
Pediatr Radiol ; 37(2): 173-9, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17180365

RESUMO

BACKGROUND: Muscle pathology of the arm and forearm in brachial plexus birth injury (BPBI) with elbow flexion contracture has not been evaluated with MRI. OBJECTIVE: To determine whether limited range of motion of the elbow in BPBI is correlated with specific patterns of muscular pathology. MATERIALS AND METHODS: For 15 BPBI patients, total active motion (TAM) of the elbow (extension-flexion) and the forearm (pronation-supination) were measured. MRI of the elbow joints and musculature allowed assessment of elbow congruency. Fatty infiltration and size reduction of the muscles were graded semiquantitatively. RESULTS: Mean TAM of the elbow was 113 degrees (50 degrees-140 degrees) and that of the forearm 91 degrees (10 degrees-165 degrees). The greater the size reduction of the brachioradialis muscle, the more diminished was elbow TAM. The more extensive the BPBI and muscle pathology of the pronator teres muscle, the more limited was the TAM of the forearm. Pathology of the supinator and brachialis muscles was evident in every patient. CONCLUSION: Extensive BPBI may result in marked limitation of TAM. Elbow flexion contracture seems to be caused mainly by brachialis muscle pathology. Prosupination of the forearm is better preserved when the pronator teres is not severely affected. MRI can reliably show the extent of muscle pathology in BPBI.


Assuntos
Traumatismos do Nascimento/diagnóstico , Neuropatias do Plexo Braquial/diagnóstico , Contratura/diagnóstico , Articulação do Cotovelo/patologia , Imageamento por Ressonância Magnética/métodos , Músculo Esquelético/patologia , Doenças Musculares/diagnóstico , Adolescente , Traumatismos do Nascimento/complicações , Neuropatias do Plexo Braquial/complicações , Criança , Pré-Escolar , Articulação do Cotovelo/inervação , Feminino , Humanos , Masculino , Músculo Esquelético/inervação , Doenças Musculares/etiologia
18.
Emerg Radiol ; 12(3): 124-9, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16374646

RESUMO

This study was conducted to assess occurrence and distribution of burst fractures as well as common accident mechanisms and the associated neurologic deficit. Using picture archiving and communications system, all emergency multidetector computed tomography studies over 34 months were retrieved and evaluated for burst fractures by two radiologists by consensus. Initial neurological findings were retrieved from patients' medical records. One hundred fifty-two patients (112 male) with a total of 169 burst fractures were found. In both genders, the incidence of burst fractures peaked at the thoracolumbar junction and between levels T5 and T8. In 10% of cases, more than one burst fracture was seen, thereof 53% on noncontiguous levels. Main accident mechanisms were falls, traffic, and sports. Neurological deficit was highest in patients with burst fractures of the cervical spine, independent of accident mechanism, and lowest in thoracolumbar junction fractures. Burst fractures occur frequently in high energy traumas and are most commonly associated with falling and traffic accidents. Multiple burst fractures occur in 10% of cases, half thereof on noncontiguous levels.


Assuntos
Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Tomografia Computadorizada por Raios X , Adulto , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia , Estatísticas não Paramétricas
19.
Emerg Radiol ; 10(4): 182-5, 2004 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15290486

RESUMO

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.


Assuntos
Tomografia Computadorizada por Raios X , Traumatismos do Punho/diagnóstico por imagem , Adulto , Idoso , Ossos do Carpo/diagnóstico por imagem , Ossos do Carpo/lesões , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Articulação do Punho/diagnóstico por imagem
20.
Eur Spine J ; 13(7): 610-6, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15300472

RESUMO

We compared clinical outcomes following conservative treatment of subaxial fracture dislocations of the cervical spine and posterior fusion using bone grafts and interspinous Roger's wiring (Bohlman modification). We reviewed 106 patients: 51 were treated primarily surgically, and 55 treated conservatively served as historical controls. Those patients who neurologically recovered at least one Frankel grade had on average less displacement on discharge (1.3 mm vs 3.1 mm, p=0.04). Although anatomical outcomes were better in the operatively treated group (1.6 mm vs 2.9 mm displacement at end of follow-up, p=0.001), there was no difference in neurological recovery. Late neck pain correlated with residual displacement ( p=0.04) and was more common in the conservatively treated patients ( p=0.01). Time in hospital was shorter in the group with posterior fusions, and complication rates were similar to those found after conservative treatment. A significant number of the conservatively treated patients developed kyphotic deformity, and 29% needed later surgery because of chronic instability or unacceptable anatomical results.


Assuntos
Fios Ortopédicos , Braquetes , Vértebras Cervicais , Luxações Articulares/terapia , Fraturas da Coluna Vertebral/terapia , Fusão Vertebral , Tração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/fisiopatologia , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Sistema Nervoso/fisiopatologia , Radiografia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/fisiopatologia , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
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