scholarly journals Incidence and underreporting of osseous wrist and hand injuries on whole-body computed tomographies at a level 1 trauma center

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
L. Schmehl ◽  
A. Hönning ◽  
A. Asmus ◽  
S. Kim ◽  
S. Mutze ◽  
...  
Keyword(s):  
Trauma Center ◽  
Hand Injuries ◽  
Whole Body ◽  
Radiology Reports ◽  
Hand Fractures ◽  
Additional Imaging ◽  
Multiplanar Reformations ◽  
Primary Evaluation ◽  
Low Sensitivity ◽  
Motorcycle Accidents

Abstract Background To investigate the incidence of osseous wrist and hand injuries on whole-body computed tomographies (WBCT) at an urban maximum-care trauma center, to report the number of missed cases in primary radiology reports, and to develop an algorithm for improved detection of these injuries. Methods Retrospective analysis reviewing all WBCT for a period of 8 months for osseous wrist and hand injuries. (1) Reconstruction of hands/wrists in three planes (thickness 1–2 mm) and analysis by a blinded musculoskeletal radiologist. (2) Scanning of primary radiology reports and comparison to the re-evaluation. (3) Calculation of the diagnostic accuracy of WBCT during primary reporting. (4) Search for factors potentially influencing the incidence (trauma mechanism, associated injuries, Glasgow Coma Scale, artifacts). (5) Development of an algorithm to improve the detection rate. Results Five hundred six WBCT were included between 01/2020 and 08/2020. 59 (11.7%) WBCT showed 92 osseous wrist or hand injuries. Distal intra-articular radius fractures occurred most frequently (n = 24, 26.1%); 22 patients (37.3%) showed multiple injuries. The sensitivity of WBCT in the detection of wrist and hand fractures during primary evaluation was low with 4 positive cases identified correctly (6.8%; 95% CI 1.9 to 16.5), while the specificity was 100% (95% CI 99.2 to 100.0). Forty-three cases (72.9%) were detected on additional imaging after clinical reassessment. Twelve injuries remained undetected (20.3%). Motorcycle accidents were more common in positive cases (22.0% vs. 10.1%, p = 0.006). 98% of positive cases showed additional fractures of the upper and/or lower extremities, whereas 37% of the patients without osseous wrist and hand injuries suffered such fractures (p < 0.001). The remaining investigated factors did not seem to influence the occurrence. Conclusion Osseous wrist and hand injuries are present in 11.7% on WBCT after polytrauma. 93.2% of injuries were missed primarily, resulting in a very low sensitivity of WBCT during primary reporting. Motorcycle accidents might predispose for these injuries, and they often cause additional fractures of the extremities. Clinical re-evaluation of patients and secondary re-evaluation of WBCT with preparation of dedicated multiplanar reformations are essential in polytrauma cases to detect osseous injuries of wrist and hand reliably. Trial registration The study was registered prospectively on November 17th, 2020, at the German register for clinical trials (DRKS-ID: DRKS00023589).

scholarly journals Multi-task weak supervision enables anatomically-resolved abnormality detection in whole-body FDG-PET/CT

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Sabri Eyuboglu ◽  
Geoffrey Angus ◽  
Bhavik N. Patel ◽  
Anuj Pareek ◽  
Guido Davidzon ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Location Estimation ◽  
Supervised Machine Learning ◽  
Whole Body ◽  
Free Text ◽  
Abnormality Detection ◽  
Weak Supervision ◽  
Radiology Reports ◽  
Pet Ct ◽  
Fdg Pet Ct

AbstractComputational decision support systems could provide clinical value in whole-body FDG-PET/CT workflows. However, limited availability of labeled data combined with the large size of PET/CT imaging exams make it challenging to apply existing supervised machine learning systems. Leveraging recent advancements in natural language processing, we describe a weak supervision framework that extracts imperfect, yet highly granular, regional abnormality labels from free-text radiology reports. Our framework automatically labels each region in a custom ontology of anatomical regions, providing a structured profile of the pathologies in each imaging exam. Using these generated labels, we then train an attention-based, multi-task CNN architecture to detect and estimate the location of abnormalities in whole-body scans. We demonstrate empirically that our multi-task representation is critical for strong performance on rare abnormalities with limited training data. The representation also contributes to more accurate mortality prediction from imaging data, suggesting the potential utility of our framework beyond abnormality detection and location estimation.

scholarly journals In vitro maintaining of CD4+ central and effector memory cells in normal and inflammatory conditions

2020 ◽  
Vol 22 (5) ◽  
pp. 837-846
Author(s):  
E. A. Blinova ◽  
A. V. Kolerova ◽  
V. E. Balyasnikov ◽  
V. A. Kozlov
Keyword(s):  
T Cells ◽  
Memory T Cells ◽  
Cell Receptor ◽  
Whole Body ◽  
Effector Memory ◽  
Adherent Cell ◽  
Memory Cells ◽  
Inflammatory Conditions ◽  
Low Sensitivity

IL-7 is a key factor for the survival and maintenance of CD4+ central (Tcm) and effector (Tem) memory cells in the whole body. In many autoimmune diseases, an elevated level of IL-7 is detected in blood serum and at the site of inflammation, thus suggesting participation of this homeostatic factor in the survival of memory T cells, including auto-reactive clones, in inflammatory disorders. The aim of the study was to investigate the mechanisms of maintaining CD4+ memory T cells under normal and inflammatory conditions. We developed an in vitro model of inflammation, based on induction of pro-inflammatory cytokines, and then evaluated the effects of IL-7 upon purified sorted populations of CD4+Tcm and Tem under normal conditions and in vitro inflammatory model. IL-7 treatment promoted maintenance of CD4+Tcm phenotype in all variants of cultures. In the absence of contact with adherent cell fraction, the IL-7-induced proliferation of Tcm and Tem was slightly reduced, both under normal and inflammatory conditions, thus suggesting low sensitivity of memory T cells to contacts with MHC, and, probably, a requirement for additional signals to provide complete stimulation with IL-7. The last suggestion is also supported by data about CD127 and CD132 expression, i.e., in the absence of contact with MHC, the proportion of CD127+CD132+ cells was decreased in both subpopulations of CD4+ memory cells. Upon in vitro cultures, IL-7 contributed to decreased expression of CD127, and increased expression of CD132 on CD4+Tcm and Tem. We have evaluated the CD4+Tcm and Tem populations by affinity of T cell receptor (TCR), using the level of CD5 expression. Т cells with high TCR affinity for self-antigens are known to have higher expression of CD5. In comparison to Tem, the Tcm contained more CD5high cells. In cultures, IL-7 promoted a high level of CD5 expression on Tcm, which was comparable to levels observed in peripheral blood cells. High CD5 expression on Tem was observed after stimulation with IL-7 in the in vitro inflammatory model. In the absence of contact with MHC, the number of CD5high cells decreased among CD4+Tem and Tcm. Thus, CD4+Tcm cells with high affinity for autologous antigens are probably dependent on the presence of homeostatic factors, in particular, IL-7, and contacts with antigen-presenting cells (APCs). Under conditions of inflammation, no changes were revealed in the mechanism of maintaining CD4+Tcm, in contrast to CD4+Tem. Being less dependent on IL-7 under normal conditions, CD4+CD5highTem are accumulated in the presence of IL-7 under in vitro inflammatory conditions.

SUVmax of FDG PET-CT Can Be Used As An Identifier of Lesion for AI To Interpret Radiology Reports

2020 ◽  
Author(s):  
Kenji Hirata ◽  
Osamu Manabe ◽  
Keiichi Magota ◽  
Sho Furuya ◽  
Tohru Shiga ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Standardized Uptake Value ◽  
Local Maximum ◽  
Ct Images ◽  
Whole Body ◽  
Training Dataset ◽  
Imaging Biomarkers ◽  
Radiology Reports ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Background Radiology reports contribute not only to the particular patient, but also to constructing massive training dataset in the era of artificial intelligence (AI). The maximum standardized uptake value (SUVmax) is often described in daily radiology reports of FDG PET-CT. If SUVmax can be used as an identifier of lesion, that would greatly help AI interpret radiology reports. We aimed to clarify whether the lesion can be localized using SUVmax written in radiology reports.Methods The institutional review board approved this retrospective study. We investigated a total of 112 lesions from 30 FDG PET-CT images acquired with 3 different scanners. SUVmax was calculated from DICOM files based on the latest Quantitative Imaging Biomarkers Alliance (QIBA) publication. The voxels showing the given SUVmax were exhaustively searched in the whole-body images and counted. SUVmax was provided with 5 different degrees of precision: integer (e.g., 3), 1st decimal places (DP) (3.1), 2nd DP (3.14), 3rd DP (3.142), and 4th DP (3.1416). For instance, when SUVmax=3.14 was given, the voxels with 3.135≤SUVmax<3.145 were extracted. We also evaluated whether local maximum restriction could improve the identifying performance, where only the voxels showing the highest intensity within some neighborhood were considered. We defined that “identical detection” was achieved when only single voxel satisfied the criterion.Results A total of 112 lesions from 30 FDG PET-CT images were investigated. SUVmax ranged from 1.3 to 49.1 (median = 5.6, IQR = 5.2). Generally, when larger and more precise SUVmax values were given, fewer voxels satisfied the criterion. The local maximum restriction was very effective. When SUVmax was determined to 4 decimal places (e.g., 3.1416) and the local maximum restriction was applied, identical detection was achieved in 33.3% (lesions with SUVmax<2), 79.5% (2≤SUVmax<5), and 97.8% (5≤SUVmax) of lesions.Conclusions SUVmax of FDG PET-CT can be used as an identifier to localize the lesion if precise SUVmax is provided and local maximum restriction was applied, although the lesions showing SUVmax<2 were difficult to identify. The proposed method may have potential to make use of radiology reports retrospectively for constructing training datasets for AI.

scholarly journals Missed orthopaedic injuries in adult trauma patients at a major trauma centre

2020 ◽  
Author(s):  
Christopher David Roche
Keyword(s):  
Major Trauma ◽  
Whole Body ◽  
Trauma Patients ◽  
Injury Incidence ◽  
Injury Rates ◽  
Missed Injuries ◽  
Missed Injury ◽  
Radiology Reports ◽  
Trauma Networks ◽  
The Impact

IntroductionDespite advances in trauma care, missed injury remains a significant cause of morbidity and mortality in trauma worldwide. In England, few have published their missed injury rates and there are no recent data for London. In 2010 London trauma networks were restructured and the impact on missed injury rates is not known. This study aimed to determine the incidence of missed orthopaedic injury for adult trauma patients at St George’s Hospital, London, and to analyse missed injuries and comment on risk factors.MethodTrauma patients were recorded prospectively at the daily trauma meeting from July to September 2012. The researcher attended clinical activities and reviewed the patient notes and radiology reports daily whilst each patient was an inpatient until discharge. Missed injuries were defined as fractures or dislocations discovered more than 12 h after arrival in the emergency department. The notes for missed injury patients were reviewed again at six months. Missed injury details were recorded/analysed.ResultsThree hundred and forty three adult trauma patients were referred to trauma and orthopaedics in the three-month study period; 5 (1.5%) had a missed injury and 148 (43.1%) had an ISS&gt;15. All missed injuries occurred in these major trauma patients, giving an incidence of 5/148 (3.4%). Four were extremity injuries and one was cervical. All missed injury patients had a GCS of 15/15, were admitted outside normal working hours, were direct admissions and had whole-body CT.ConclusionsAt 3.4% our missed injury incidence is comparable to those published from similar major trauma centres. This provides recent London data following the restructuring of trauma networks.

Bones in Multiple Myeloma: Imaging and Therapy

2018 ◽  
pp. 638-646 ◽  
Author(s):  
Elena Zamagni ◽  
Michele Cavo ◽  
Bita Fakhri ◽  
Ravi Vij ◽  
David Roodman
Keyword(s):  
Multiple Myeloma ◽  
Bone Disease ◽  
Standard Of Care ◽  
Conventional Radiography ◽  
Imaging Modalities ◽  
Whole Body ◽  
Clinical Feature ◽  
Bone Lesions ◽  
Low Sensitivity ◽  
Fdg Pet Ct

Bone disease is the most frequent disease-defining clinical feature of multiple myeloma (MM), with 90% of patients developing bone lesions over the course of their disease. For this reason, imaging plays a major role in the management of disease in patients with MM. Although conventional radiography has traditionally been the standard of care, its low sensitivity in detecting osteolytic lesions has called for more advanced imaging modalities. In this review, we discuss the advantages, indications, and applications of whole-body low-dose CT (WBLDCT), 18F-fluorodeoxyglucose (FDG)-PET/CT, MRI, and other novel imaging modalities in the management of disease in patients with plasma cell dyscrasias. We also review the state of the art in treatment of MM bone disease (MMBD) and the role of bisphosphonates and denosumab, a monoclonal antibody that binds and blocks the activity of receptor activator of nuclear factor-kappa B ligand (RANKL), which was recently approved by the U.S. Food and Drug Administration for MMBD.

New Functional Classification of Severe Hand Injuries (FU-classification)

2013 ◽  
Vol 20 (1) ◽  
pp. 3-9
Author(s):  
E. A Afonina ◽  
I. O Golubev ◽  
K. P Pshenisnov
Keyword(s):  
Surgical Treatment ◽  
Blood Vessels ◽  
Soft Tissues ◽  
Functional Unit ◽  
Hand Injuries ◽  
Functional Classification ◽  
Functional Units ◽  
Primary Evaluation

New functional classification of severe hand injuries is suggested. Concept of hand functional unit of the hand, i.e. finger segment containing joint, blood vessels and all surrounding soft tissues, is introduced. New functional classification of severe hand injuries is related to the algorithm of patient’s treatment depending on the level ofpreserved functional units. Division of the hand into functional units and primary evaluation of every unit condition enables to choose surgical treatment tactics directly after injury as well as to prognosticate the outcome.

Patterns of Hand Fractures and Dislocations in A District General Hospital

1993 ◽  
Vol 18 (4) ◽  
pp. 511-514 ◽  
Author(s):  
G. J. PACKER ◽  
M. A. SHAHEEN
Keyword(s):  
Risk Factors ◽  
General Hospital ◽  
Leisure Activities ◽  
District General Hospital ◽  
Hand Injuries ◽  
Aetiological Factor ◽  
Retrospective Survey ◽  
Hand Fractures ◽  
Hospital Comparison ◽  
Little Finger

In a retrospective survey of patients with fractures and dislocations attending the Accident department of a District General hospital, comparison was made between patients with fractures and dislocations in the hand and fractures and dislocations of other sites. Patients with hand injuries accounted for 28% of the total patients seen. They were more likely than other fracture patients to be male and between the ages of 10 and 40 years. Almost a quarter of hand injuries attended on Monday. Leisure activities outside the home formed the commonest aetiological factor. Only 66% of patients with hand injuries attended the Accident department within 24 hours of injury. The little finger was the commonest site of injury. This survey emphasizes the differences between hand injuries and injuries of other sites, identifies the risk factors for hand injuries and has implications for the management of hand injuries in a District General Hospital.

scholarly journals Comparing magnetic resonance angiography (MRA) and computed tomography angiography (CTA) with conventional angiography in the detection of distal territory cerebral mycotic and oncotic aneurysms

2016 ◽  
Vol 22 (5) ◽  
pp. 524-528 ◽  
Author(s):  
Lara Walkoff ◽  
Waleed Brinjikji ◽  
Aymeric Rouchaud ◽  
Jildaz Caroff ◽  
David F Kallmes
Keyword(s):  
Predictive Value ◽  
Interobserver Variability ◽  
Conventional Angiography ◽  
Cross Sectional ◽  
Radiology Reports ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Low Sensitivity ◽  
Sensitivity Specificity ◽  
Oncotic Aneurysm

Background Mycotic and oncotic aneurysms may result in devastating neurologic sequelae if undetected. The objectives of this study were to examine interobserver variability and accuracy of cross-sectional imaging for the detection of distal territory mycotic and oncotic aneurysms. Methods We searched our institutional database for all radiology reports from 2005 to 2015 with an indication or diagnosis of mycotic or oncotic aneurysm. Patients who underwent DSA and either CTA or MRA within 12 weeks of each other were identified. The cross-sectional images from each study were blinded and reviewed by two radiologists. If positive for aneurysm, location and number of aneurysms were reported. Sensitivity, specificity, positive predictive value, negative predictive value, and interobserver variability were determined for MRA and MRA/CTA. Results Twenty-five patients were included in this study. Ten (40%) harbored distal aneurysms. Cross-sectional imaging had a sensitivity of 45.5%, specificity of 90.0%, and kappa value of 0.29 (0.00–0.69) for the detection of cerebral mycotic and oncotic aneurysms. Conclusions Because of the low sensitivity and high interobserver variability of cross-sectional imaging, DSA should remain the gold standard for evaluation of suspected oncotic and mycotic aneurysms. In cases in which cross sectional imaging is negative and there is a high clinical suspicion for mycotic aneurysm, DSA should be strongly considered.

scholarly journals Comparison of two whole-body computer tomography protocols for polytrauma patients

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
N van Veelen ◽  
S Studer ◽  
B van de Wall ◽  
R Babst ◽  
B -C Link ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Upper Extremities ◽  
Whole Body ◽  
Trauma Patients ◽  
Two Phase ◽  
Whole Body Ct ◽  
Additional Imaging ◽  
Group A ◽  
Group B ◽  
Extremity Injuries

Abstract Objective The use of whole-body computed tomography (CT) is an established standard primary diagnostic method in the work up of polytrauma patients. The protocols used for such CTs however vary between trauma centers. In our Level 1 trauma Centre the protocol was changed from a three phase to a two phase protocol with different positioning of the patient. The primary aim of this study was to compare the estimated radiation dose and scan duration of the two protocols. The secondary aim was to evaluate whether the revision of the CT protocol led to a reduction of required additional imaging of the upper extremities. Methods For this retrospective, cross-sectional study two groups of consecutive trauma patients, which were treated in a level 1 trauma center in Switzerland and received a whole-body CT were analyzed. Group A consisted of patients, who presented between January and August 2016. These patients received a three-phased CT in which a repositioning of the arms from the side of the torso to above the head between phases two and three was needed. Group B consisted of those, who presented between January and July 2017. These patients received a CT according to a revised protocol, which was performed in two phases with the arms positioned ventral on a pillow to the torso throughout the entire CT. Scan duration, estimated radiation dose, number of upper extremity injuries, number of addition imaging (xray and CT) of the upper extremities within 24 hours of initial CT. Results A total of 182 patients were included in group A and 218 in group B. Baseline characteristics didn't differ, except for there being more males in group B (p 0.006). The estimated radiation dose was lower (15.0 mSv vs 22.9 mSv, p &lt; 0.001) and the scan duration shorter (4 vs 7 minutes, p &lt; 0.001) in group B. No difference could be shown in the number of upper extremity injuries detected. Further, the number of additional images of the upper extremities needed within 24 hours of the initial CT did not differ between the groups. Conclusion Both the estimated radiation dose and the scan duration of a whole-body CT scan in trauma patients can be reduced when a two phase protocol in which the arms are positioned on a pillow ventral to the torso is used instead of a three phase protocol with repositioning of the arms. The amount of additional imaging of the upper limb could not be reduced by having the arms visible on the scan.

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