scholarly journals Clinical and Radiological Clues of Traumatic Craniocervical Junction Injuries Requiring Occipitocervical Fusion to Early Diagnosis

Neurospine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. 741-748
Author(s):  
Daimon Shiraishi ◽  
Yusuke Nishimura ◽  
Isaac Aguirre-Carreno ◽  
Masahito Hara ◽  
Satoshi Yoshikawa ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Ct Scan ◽  
Facet Joint ◽  
Early Stage ◽  
High Energy ◽  
Craniocervical Junction ◽  
Ct Scans ◽  
Atlantoaxial Instability ◽  
Occipitocervical Fusion ◽  
Imaging Characteristics

Objective: The purpose of this study is to find the clinical and radiographic characteristics of traumatic craniocervical junction (CCJ) injuries requiring occipitocervical fusion (OC fusion) for early diagnosis and surgical intervention.Methods: We retrospectively reviewed 12 patients with CCJ injuries presenting to St. Michaels Hospital in Toronto who underwent OC fusion and looked into the following variables; (1) initial trauma data on emergency room arrival, (2) associated injuries, (3) imaging characteristics of computed tomography (CT) scan and magnetic resonance imaging (MRI), (4) surgical procedures, surgical complications, and neurological outcome.Results: All patients were treated as acute spinal injuries and underwent OC fusion on an emergency basis. Patients consisted of 10 males and 2 females with an average age of 47 years (range, 18–82 years). All patients sustained high-energy injuries. Three patients out of 6 patients with normal BAI (basion-axial interval) and BDI (basion-dens interval) values showed visible CCJ injuries on CT scans. However, the remaining 3 patients had no clear evidence of occipitoatlantal instability on CT scans. MRI clearly described several findings indicating occipitoatlantal instability. The 8 patients with normal values of ADI (atlantodens interval interval) demonstrated atlantoaxial instability on CT scan, however, all MRI more clearly and reliably demonstrated C1/2 facet injury and/or cruciate ligament injury.Conclusion: We advocate measures to help recognize CCJ injury at an early stage in the present study. Occipitoatlantal instability needs to be carefully investigated on MRI in addition to CT scan with special attention to facet joint and ligament integrity.

scholarly journals Chest CT Imaging Characteristics of COVID-19 Pneumonia in Surviving and Non-Surviving Hospitalized Patients: A Retrospective Study in a Referral Center in Tehran, Iran

2021 ◽  
Vol 18 (2) ◽  
Author(s):  
Sara Besharat ◽  
Fatemehsadat Rahimi ◽  
Siamak Afaghi ◽  
Farzad Esmaeili Tarki ◽  
Fatemeh Pourmotahari ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Ct Scan ◽  
Chest Ct ◽  
Ct Scans ◽  
Early Management ◽  
Ct Findings ◽  
Imaging Characteristics ◽  
Significant Difference ◽  
Chest Ct Scan ◽  
Lung Lobes

Background: Coronavirus disease 2019 (COVID-19) has several chest computed tomography (CT) characteristics, which are important for the early management of this disease, because viral detection via RT-PCR can be time-consuming, resulting in a delayed pneumonia diagnosis. The Radiological Society of North America (RSNA) proposed a reporting language for CT findings related to COVID-19 and defined four CT categories: typical, indeterminate, atypical, and negative. Objectives: To retrospectively evaluate the chest CT characteristics of patients with COVID-19 pneumonia. Patients and Methods: A total of 115 hospitalized laboratory-verified COVID-19 cases, underdoing chest CT scan, were included in this study from April 30 to May 15, 2020. Of 115 cases, 53 were discharged from the hospital, and 62 expired. The initial clinical features and chest CT scans were assessed for the type, pattern, distribution, and frequency of lesions. Moreover, the findings were compared between ward-hospitalized, ICU-admitted, and non-surviving (expired) patients. Results: Of four CT categories, typical CT findings for COVID-19 were more frequent in the expired group (77.4%), compared to the ward-admitted (44.8%) and ICU-admitted (70.8%) groups (P = 0.017). However, no significant difference was observed in the prevalence of intermediate or atypical CT findings between the groups. Negative CT scans for the diagnosis of COVID-19 were significantly fewer in the expired group (0%) as compared to the ward-admitted (10.3%) and ICU-admitted (8.3%) groups (P = 0.0180). Also, the mean number of involved lung lobes and segments was significantly higher in the expired group compared to the other two groups (P = 0.032 and 0.010, respectively). The right upper lobe involvement, right middle lobe involvement, bilateral involvement, central lesion, air bronchogram, and pleural effusion were among CT scan findings with a significantly higher prevalence in non-surviving cases (P < 0.0001, 0.047, 0.01, 0.036, 0.038, and 0.047, respectively). Conclusion: The increased number of involved lung lobes and segments, bilateral and central distribution patterns, air bronchogram, and severe pleural effusion in the initial chest CT scan can be related to the increased severity and poor prognosis of COVID-19.

scholarly journals Imaging analysis of 13 rare cases of renal collecting (Bellini) duct carcinoma patients in northen China.

2020 ◽  
Author(s):  
Zhehao Lyu ◽  
Lili Liu ◽  
Huimin Li ◽  
Haibo Wang ◽  
Qi Liu ◽  
...  
Keyword(s):  
Ct Scan ◽  
Early Stage ◽  
Clinical Manifestations ◽  
Renal Tumors ◽  
Duct Carcinoma ◽  
Unenhanced Ct ◽  
Imaging Characteristics ◽  
Pet Ct ◽  
Bellini Duct Carcinoma ◽  
Mass Type

Abstract Background: Collective duct carcinoma (CDC) is a highly malignant kidney tumor which is rare in clinical. We report our 12-year experience of Collecting (Bellini) duct carcinoma (CDC) and retrospectively analyzed patients and tumour characteristics, clinical manifestations, different imaging characteristics including CT, MRI and PET/CT. Methods: From January 2007 to December 2019, we retrospectively examined all renal tumors and identifed 13 cases of CDC from 3 medical centers in the northern China. All 13 patients underwent CT scan, 8 of whom underwent dynamic enhanced CT scan, 2 underwent PET/CT scan and 1 underwent MRCP examination. The lesions were divided into nephritis type and mass type according to the morphology of the tumors.Results: The study group included 10 men and 3 women, with an average age of 64.23±10.74 years old. Of these 13 patients, the main clinical manifestations include gross hematuria, flank pain or waist discomfort. The mean tumour size was 8.48 ± 2.48 cm. In this group of cases, 6 (46.2%) cases are cortical-medullary involved type, 7 (53.8%) cases are cortex-medullary-pelvis involved type. 11 (84.6%) cases were nephritis type and 2 (15.4%) cases were mass type. The lesions appeared solid or complex solid and cystic on CT and MRI. The parenchymal part of 13 CDC tumors showed isodensity or slightly higher density on unenhanced CT scan. the parenchymal part of 13 CDC tumors showed isodensity or slightly higher density on unenhanced CT scan. Two patients with PET/CT showed increased radioactivity intake. Evidence of intra-abdominal metastatic disease was present on CT in 9 ( 69.2% ) cases. The incidence of metastasis reached 69%.Conclusions: The Collecting (Bellini) duct carcinoma has its certain imaging characteristics which were different from the other renal cell carcinoma. A renal tumor should be considered as CDC when it locates in the junction zone of the renal cortex and medulla, with unclear border, slight enhancement and metastases in early stage. PET/CT can greatly enrich the key information of diagnosis, surgery and treatment options, which provide significant help to the clinic.

scholarly journals Detection of Lung Cancer Tumor in CT Scan Images Using Novel Combination of Super Pixel and Active Contour Algorithms

2020 ◽  
Vol 37 (6) ◽  
pp. 1029-1035
Author(s):  
Farzaneh Shafiei ◽  
Shervan Fekri-Ershad
Keyword(s):  
Lung Cancer ◽  
Ct Scan ◽  
Active Contour ◽  
Human Error ◽  
Early Stage ◽  
Poor Quality ◽  
Ct Scans ◽  
Step Method ◽  
Cancer Tumor ◽  
Random Location

Lung cancer is a problem that has become increasingly widespread in recent years due to smoking, poor nutrition and other factors. If lung cancer cells are identified at an early stage, they will be crucial in saving lives. Machine learning-based approaches to detecting lung cancer tumors have reduced the need for manpower, reduced human error and reduced medical costs. CT scan images are one of the efficient image types to identify these tumors in the lung. However, the random location and shape of the tumors and poor quality of CT scans are biggest challenges in lung cancer tumor detection. In this paper, a multi-step method for detecting cancer tumors in CT scans is proposed. In the proposed method, the images are first clustered using the super pixel algorithm. The morphological operators are then used to cut the unconnected parts. Finally, the cancerous nodules and tumors are identified using the active contour algorithm. The performance of the proposed approach is evaluated on benchmark LIDC database in terms of Dice similarity measure which is 84.88%. Results show the higher performance of the proposed approach in comparison with state-of-the-art methods in this area.

scholarly journals Occipital Condyle Fracture: A Case Report of a Typically Stable Fracture That Required Surgical Treatment

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Takeshi Suzuki ◽  
Satoshi Maki ◽  
Masaaki Aramomi ◽  
Tomonori Yamauchi ◽  
Manato Horii ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surgical Treatment ◽  
Facet Joint ◽  
Atlantoaxial Instability ◽  
Occipital Condyle ◽  
Asian Woman ◽  
Atlantoaxial Joint ◽  
Occipitocervical Fusion ◽  
Occipital Condyle Fracture ◽  
Condyle Fracture

An occipital condyle fracture (OCF) is a relatively rare trauma that is now increasingly diagnosed because of the wide availability of computed tomography. For nondisplaced OCFs, conservative treatment is generally recommended, and there is no previous report of a nondisplaced OCF requiring surgery. We report a patient who had a nondisplaced OCF with craniocervical misalignment (a condyle-C1 interval > 2.0 mm) and C1-C2 translation treated with a halo vest and occipitocervical fusion surgery. An 87-year-old Asian woman fell from a 4-meter height and hit her head. She was transferred to our emergency room. Computed tomography revealed a nondisplaced impaction OCF with a 2.5 mm occipital condyle-C1 interval and a 5 mm C1-C2 translation. The fracture pattern was considered stable. However, since craniocervical misalignment and C1-C2 translation were present, the patient was placed in a halo device, and we reduced the occipitoatlantoaxial joint, adjusting the halo ring position preoperatively. Confirming reduction of the atlantooccipital facet joint and the atlantoaxial joint by computed tomography, we performed an occipitocervical fusion. This is the first report of a nondisplaced OCF with craniocervical misalignment and C1-C2 translation that required surgical treatment. Clinicians should be aware of craniocervical misalignment and atlantoaxial instability even in Tuli type 1 OCFs.

Occipitocervical fusion using a contoured rod and wire construct in children: a reappraisal of a vintage technique

2013 ◽  
Vol 11 (2) ◽  
pp. 160-169 ◽  
Author(s):  
Paul Klimo ◽  
Nelson Astur ◽  
Kyle Gabrick ◽  
William C. Warner ◽  
Michael S. Muhlbauer
Keyword(s):  
Epithelioid Sarcoma ◽  
Wound Dehiscence ◽  
Patient Characteristics ◽  
Craniocervical Junction ◽  
Atlantoaxial Instability ◽  
Trauma Patients ◽  
Occipitocervical Fusion ◽  
Csf Leakage ◽  
Fixation Techniques

Object Many methods to stabilize and fuse the craniocervical junction have been described. One of the early designs was a contoured (Luque) rod fixated with wires, the so-called Hartshill-Ransford loop. In this study, the authors report their 20-year experience with this surgical technique in children. Methods The authors reviewed the medical records of patients 18 years of age or younger who underwent dorsal occipitocervical fusion procedures between March 1992 and March 2012 at Le Bonheur Children's Hospital using a contoured rod and wire construct. Data on basic patient characteristics, causes of instability, neurological function at presentation and at last follow-up, details of surgery, complications, and radiographic outcome were collected. Results Twenty patients (11 male) were identified, with a mean age of 5.5 years (range 1–18 years) and a median follow-up of 43.5 months. Fourteen patients had atlantooccipital dislocation, 2 patients had atlantoaxial fracture–dissociations, 2 had Down syndrome with occipitocervical and atlantoaxial instability, 1 had an epithelioid sarcoma from the clivus to C-2, and 1 had an anomalous atlas with resultant occipitocervical instability. Surgical stabilization extended from the occiput to C-1 in 3 patients, C-2 in 6, C-3 in 8, and to C-4 in 3. Bone morphogenetic protein was used in 2 patients. Two patients were placed in a halo orthosis; the rest were kept in a hard collar for 6–8 weeks. All patients were neurologically stable after surgery. One patient with a dural tear experienced wound dehiscence with CSF leakage and required reoperation. Eighteen patients went on to achieve fusion within 6 months of surgery; 1 patient was initially lost to follow-up, but recent imaging demonstrated a solid fusion. There were no early hardware or bone failures requiring hardware removal, but radiographs obtained 8 years after surgery showed that 1 patient had an asymptomatic fractured rod. There were no instances of symptomatic junctional degeneration, and no patient was found to have increasing lordosis over the fused segments. Five (31%) of the 16 trauma patients required a shunt for hydrocephalus. Conclusions Despite the proliferation of screw-fixation techniques for craniocervical instability in children, the contoured rod–wire construct remains an effective, less expensive, and technically easier alternative that has been in use for almost 30 years. It confers immediate stability, and therefore most patients will not need to be placed in a halo device postoperatively. A secondary observation in our series was the high (30%) rate of hydrocephalus requiring a shunt in patients with traumatic instability.

Dynamic Imaging Changes of COVID-19 Pneumonia at Different Stages

2021 ◽  
Vol 17 ◽  
Author(s):  
Xiao-Yan Lv ◽  
Wei-Hong Xing ◽  
Xi Ma ◽  
Li-Hong Xing ◽  
Yu Zhang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Early Stage ◽  
Disease Onset ◽  
Ground Glass Opacity ◽  
Dynamic Imaging ◽  
Ct Scans ◽  
Ground Glass ◽  
Early Improvement ◽  
Imaging Characteristics ◽  
Progressive Stage

Purpose: To investigate the Computed Tomography (CT) imaging characteristics and dynamic changes of COVID-19 pneumonia at different stages. Methods: Forty-six patients infected with COVID-19 who had chest CT scans were enrolled, and CT scans were performed 4-6 times with an interval of 2-5 days. Results: At the early stage (n=25), ground glass opacity was presented in 11 patients (11/25 or 44.0%) and ground glass opacity mixed with consolidation in 13 (13/25 or 52.0%) in the lung CT images. At the progressive stage (n=38), ground glass opacity was presented in only one patient (1/38 or 2.6%) and ground glass opacity mixed with consolidation in 33 (33/38 or 86.8%). In the early improvement stage (n=38), the imaging presentation was ground glass opacity alone in three patients (3/38 or 7.9%) and ground glass opacity mixed with consolidation in 34 (34/38 or 89.5%). In the late improvement (absorption) stage (n=33), the primary imaging presentation was ground glass presentation in eight patients (8/33 or 24.2%) and ground glass opacity mixed with consolidation in 23 (23/33 or 69.7%). The lesion reached the peak at 4-16 days after disease onset, and 26 (26/38 or 68.4%) patients reached the disease peak within ten days. Starting from 6 to 20 days after onset, the disease began to be improved, with 30 (30/38 or 78.9%) patients being improved within 15 days. Conclusion: COVID-19 pneumonia will progress to the peak stage at a mediate time of seven days and enter the improvement stage at twelve days. Computed tomography imaging of the pulmonary lesion has a common pattern from disease onset to improvement and recovery and provides important information for evaluation of the disease course and treatment effect.

scholarly journals Scapholunate Diastasis in Distal Radius Fractures: Fracture Pattern Analysis on CT Scans

2020 ◽  
Vol 09 (04) ◽  
pp. 338-344
Author(s):  
Sezai Özkan ◽  
Chaitanya S. Mudgal ◽  
Jesse B. Jupiter ◽  
Frank W. Bloemers ◽  
Neal C. Chen
Keyword(s):  
Ct Scan ◽  
Distal Radius Fracture ◽  
Operative Treatment ◽  
Distal Radius ◽  
High Energy ◽  
Distal Radius Fractures ◽  
Ct Scans ◽  
Radius Fracture ◽  
Study Cohort ◽  
Radius Fractures

Abstract Objectives Our understanding of distal radius fractures with concomitant scapholunate (SL) diastasis primarily comes from plain radiographs and arthroscopy. The clinical implications of SL diastasis are not clear. The aim of this study is to describe fracture characteristics of distal radius fractures on computed tomography (CT) scans in patients with distal radius fractures and static SL diastasis. Methods We queried our institutional databases to identify patients who were treated for a distal radius fracture, had a CT scan with a wrist-protocol, and static SL diastasis on their CT scan. Our final cohort consisted of 26 patients. We then collected data on their demographics, injury, treatment, evaluated injury patterns, and measured radiographic SL characteristics. Our study cohort consisted of 11 men (42%) and almost half of our cohort (n = 12; 46%) had a high-energy mechanism of injury. The majority of the patients (n = 20; 77%) had operative treatment for their distal radius fracture and two patients (7.7%) had operative treatment of their SL injury. Results The mean SL distance was 3.5 ± 1.1 mm. Twenty patients (77%) had an intra-articular fracture. In these patients, we observed three patterns: (1) scaphoid facet impaction; (2) lunate facet impaction; and (3) no relative impaction. We observed other injury elements including rotation of the radial styloid relative to the lunate facet and partial carpal subluxations. Conclusion Static SL dissociation in the setting of distal radius fractures may be an indication of a complex injury of the distal radius, which may not be directly apparent on plain radiography. If these radiographs do not demonstrate impaction of the lunate or scaphoid facet, a CT scan may be warranted to have a more detailed view of the articular surface. Level of Evidence This is a Level III, diagnostic study.

Inflammatory bowel disease and the craniocervical junction

1999 ◽  
Vol 6 (6) ◽  
pp. E12 ◽  
Author(s):  
Timothy Ryken ◽  
Arnold Menezes
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Craniocervical Junction ◽  
Atlantoaxial Instability ◽  
Occipitocervical Fusion ◽  
Long Term Follow Up ◽  
History Of ◽  
Inflammatory Bowel

Rheumatological complications have been described in up to 30% of patients being followed for inflammatory bowel disease. The majority of these complications occur as spondylitic changes in the lumbar spine. Erosive arthritic disease associated with inflammatory bowel disease occurs less frequently, but it can result in ligamentous laxity and joint instability. To highlight the potential significance of the process at the craniocervical junction, the authors describe the long-term follow-up care of a complicated case. A 56-year-old woman, with a long history of ulcerative colitis, presented with atlantoaxial instability and underwent a C1-3 fusion; however, the presence of significant occipitoatlantal instability was not recognized. This resulted in high cervicomedullary quadriplegia, requiring traction reduction and a combined anterior transoral decompressive-posterior occipitocervical fusion. The patient's neurological deficit completely resolved postoperatively.

scholarly journals Contagion Management at the Méditerranée Infection University Hospital Institute

2021 ◽  
Vol 10 (12) ◽  
pp. 2627
Author(s):  
Pierre-Edouard Fournier ◽  
Sophie Edouard ◽  
Nathalie Wurtz ◽  
Justine Raclot ◽  
Marion Bechet ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Early Diagnosis ◽  
Personal Protective Equipment ◽  
Early Stage ◽  
Point Of Care ◽  
University Hospital ◽  
Protective Equipment ◽  
Monitoring Point ◽  
Epidemiological Monitoring ◽  
Wide Range

The Méditerranée Infection University Hospital Institute (IHU) is located in a recent building, which includes experts on a wide range of infectious disease. The IHU strategy is to develop innovative tools, including epidemiological monitoring, point-of-care laboratories, and the ability to mass screen the population. In this study, we review the strategy and guidelines proposed by the IHU and its application to the COVID-19 pandemic and summarise the various challenges it raises. Early diagnosis enables contagious patients to be isolated and treatment to be initiated at an early stage to reduce the microbial load and contagiousness. In the context of the COVID-19 pandemic, we had to deal with a shortage of personal protective equipment and reagents and a massive influx of patients. Between 27 January 2020 and 5 January 2021, 434,925 nasopharyngeal samples were tested for the presence of SARS-CoV-2. Of them, 12,055 patients with COVID-19 were followed up in our out-patient clinic, and 1888 patients were hospitalised in the Institute. By constantly adapting our strategy to the ongoing situation, the IHU has succeeded in expanding and upgrading its equipment and improving circuits and flows to better manage infected patients.

scholarly journals Evaluation of Energy Absorption Capabilities of Polyethylene Foam under Impact Deformation

Materials ◽  
2021 ◽  
Vol 14 (13) ◽  
pp. 3613
Author(s):  
Baohui Yang ◽  
Yangjie Zuo ◽  
Zhengping Chang
Keyword(s):  
Energy Absorption ◽  
Failure Modes ◽  
High Strain ◽  
Early Stage ◽  
High Energy ◽  
Test Method ◽  
Test Theory ◽  
Strain Rates ◽  
Impact Properties ◽  
The Impact

Foams are widely used in protective applications requiring high energy absorption under impact, and evaluating impact properties of foams is vital. Therefore, a novel test method based on a shock tube was developed to investigate the impact properties of closed-cell polyethylene (PE) foams at strain rates over 6000 s−1, and the test theory is presented. Based on the test method, the failure progress and final failure modes of PE foams are discussed. Moreover, energy absorption capabilities of PE foams were assessed under both quasi-static and high strain rate loading conditions. The results showed that the foam exhibited a nonuniform deformation along the specimen length under high strain rates. The energy absorption rate of PE foam increased with the increasing of strain rates. The specimen energy absorption varied linearly in the early stage and then increased rapidly, corresponding to a uniform compression process. However, in the shock wave deformation process, the energy absorption capacity of the foam maintained a good stability and exhibited the best energy absorption state when the speed was higher than 26 m/s. This stable energy absorption state disappeared until the speed was lower than 1.3 m/s. The loading speed exhibited an obvious influence on energy density.

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