Journal of the Canadian Association of Radiologists最新文献

Two patients with acute bacterial arthritis of the hip joint were suspected clinically to have a psoas abscess. For this reason a computed tomographic scan of the abdomen and pelvis (two patients) and ultrasonography (one patient) were requested. These scans showed no evidence of an abscess in the abdominal cavity nor retroperitoneum but did demonstrate a hip joint effusion which was compatible with septic arthritis.

We present a patient with syringomyelia and neuropathic osteoarthropathy involving the elbow, wrist, and hand unilaterally and discuss the differential diagnosis of the radiographic features. The unique pattern of joint involvement in this patient may be explained by selective involvement of specific anatomic sites within the spinal cord.

The normal gross and computed tomographic anatomy of the bony pelvis is briefly reviewed, with special reference to the bony masses of greatest concern to a surgeon. Normal transverse computed tomography (CT) images are shown. I describe a unique, comprehensive protocol for multiplanar CT reformation of the osseous pelvis. This algorithm provides "direct-view" images that are considerably more reliable than "mental reformatting" from transverse images alone. The procedure is of particular value in assessing fractures and dislocations occurring separately or together.

We draw attention to the value of selective digital subtraction angiography (DSA) and ioxaglate meglumine (Hexabrix) in demonstrating extensive cerebral collateral circulation (moyamoya) in a patient with homozygous sickle cell disease.

I report the computed tomographic and angiographic findings in a patient with an intracavernous intrapetrous fusiform aneurysm of the internal carotid artery. The patient presented with a third nerve palsy and was treated successfully by surgical "trapping" of the aneurysm. A review of the literature reveals one report of a similar case.

We reviewed the investigation of liver masses in 45 children. Plain films of the abdomen (in 42) and radionuclide liver and spleen scans (in 38) were nonspecific, although the latter had a sensitivity of 100%. Sonography detected lesions in 39 of the 40 patients in whom it was performed (sensitivity 97.5%), and suggested a specific diagnosis in 16 (41%). Computerized tomography (CT) detected all lesions (sensitivity 100%) and gave more information than the other modalities in 17 of the 38 cases (44.7%), as well as the best definition of the extent of liver lesions. Sonography should be the initial modality of choice in children with suspected liver masses but, in most patients, CT is the single most helpful method for defining the extent of such masses. In addition, CT may also show extrahepatic disease. In a particular clinical context, the characteristic CT pattern of contrast enhancement is diagnostic of hemangioma. Angiography provides a preoperative map of abdominal vasculature in patients with malignant disease or vascular aneurysm, and is indicated for this purpose.

Fractures of the pelvis are frequently complex, and conventional radiography, including special views, may be inadequate for accurate diagnosis. One must ascertain the integrity of the anterior and posterior columns, hip joint spaces for debris, and the medial walls of the acetabula. Computed tomography (CT) is indicated early in management, whenever initial plain radiographs reveal complex or questionable fractures of any of these structures. I have developed a unique, multiplanar reformatting protocol using oblique reformations of transverse CT images. This allows clear spatial perception of the nature and extent of pelvic fractures. Twelve selected patients with complex pelvic fractures, as determined by conventional and special radiographs, underwent transaxial and multiplanar CT scanning according to the devised protocol, using transverse CT and multiplanar reformation of the pelvis. The planes of reformation are illustrated by drawings, and multiplanar radiographs demonstrate the injuries. Nine of the 12 patients had additional injuries revealed, over and above the abnormalities shown by CT, by the use of the reformatting technique I describe. Also fractures or fracture dislocations of the sacroiliac joints were diagnosed in four of the 12 patients using CT but in six patients when reformatted images were examined.

We report three patients with myeloma involving the skull base. A large extracranial soft-tissue mass, intracranial extension, homogeneous enhancement, smooth margins, and bone remodelling were features common to the three lesions. In two patients the lesions extended into the orbit with one patient presenting with proptosis.