Dual-energy CT-generated bone marrow oedema maps improve timely visualisation and recognition of acute lower extremity fractures.

AIM: To assesses whether utilising bone marrow oedema (BMO) maps improved fracture read times and reader confidence in a large series of acute lower extremity trauma dual-energy computed tomography (DECT) studies. MATERIALS AND METHODS: One hundred and six DECT studies, including 60 fracture cases and 46 non-fracture cases, were evaluated retrospectively in this cross-sectional study. Three-dimensional (3D) BMO maps were generated for each study and coded to display skeletal anatomy in blue and marrow oedema in green. Studies were interpreted by two readers in two timed stages (without and with BMO maps). Readers identified the number, anatomical location, and comminution of fractures. Reader confidence (five-point Likert scale) for fracture identification and anatomical regions where oedema was present was also recorded. RESULTS: Decreased read times (p<0.01) were observed when readers utilised BMO maps for their fracture search. The presence of oedema on BMO maps corresponded with associated fracture in 75.7% reads. No differences in reader confidence were observed as a result of using this BMO-guided technique (>95%, 5/5 for both readers with and without the aid of BMO maps). CONCLUSIONS: DECT BMO maps improve the speed of radiological identification of suspected acute lower extremity fractures with preserved reader confidence. It may help emergent detection of fractures, important for patient management and outcomes.

Molecular weight of hydroxyethyl starch: is there an effect on blood coagulation and pharmacokinetics?

BACKGROUND: The development of hydroxyethyl starches (HES) with low impact on blood coagulation but higher volume effect compared with the currently used HES solutions is of clinical interest. We hypothesized that high molecular weight, low-substituted HES might possess these properties. METHODS: Thirty pigs were infused with three different HES solutions (20 ml kg(-1)) with the same degree of molar substitution (0.42) but different molecular weights (130, 500 and 900 kDa). Serial blood samples were taken over 24 h and blood coagulation was assessed by Thromboelastograph analysis and analysis of plasma coagulation. In addition, plasma concentration and in vivo molecular weight were determined and pharmacokinetic data were computed based on a two-compartment model. RESULTS: Thromboelastograph analysis and plasma coagulation tests did not reveal a more pronounced alteration of blood coagulation with HES 500 and HES 900 compared with HES 130. In contrast, HES 500 and HES 900 had a greater area under the plasma concentration-time curve [1542 (142) g min litre(-1), P<0.001, 1701 (321) g min litre(-1), P<0.001] than HES 130 [1156 (223) g min litre(-1)] and alpha half life (t(alpha)(1/2)) was longer for HES 500 [53.8 (8.6) min, P<0.01] and HES 900 [57.1 (12.3) min, P<0.01] than for HES 130 [39.9 (10.7) min]. Beta half life (t(beta)(1/2)), however, was similar for all three types of HES [from 332 (100) to 381 (63) min]. CONCLUSIONS: In low-substituted HES, molecular weight is not a key factor in compromising blood coagulation. The longer initial intravascular persistence of high molecular weight low-substituted HES might result in a longer lasting volume effect.