Should Preoperative Computed Tomography Be Routine Examination For Cervicofacial Space Infections?

Abstract Background: Cervicofacial space infections are potentially life-threatening, which require accurate diagnosis, early incision, and adequate drainage. The utilization of computed tomography (CT) in cervicofacial space infections has significantly increased. However, the clinical value of preoperative CT imaging in cervicofacial space infections remains controversial. We, therefore, investigated whether CT examination should be used as a routine examination in the treatment of patients with cervicofacial space infections.Methods: A retrospective study of all patients affected by cervicofacial space infections that received incision and drainage surgery from Jan 2016 to Dec 2020 was performed. Patients were divided into 2 groups: the group with preoperative CT and the group without preoperative CT. Outcomes, including re-operation rate, missed diagnosis rate, days of symptom relief, length of stay, duration of surgery, and total cost of hospitalization, were analyzed.Results: Of 153 patients, 108 patients underwent surgery with preoperative CT and 45 patients without preoperative CT. The re-operation rate in the preoperative CT group (6/108, 5.6%) was significantly lower (P<0.05) than that in the group without preoperative CT (10/45, 22.2%). Significant reduction of missed diagnosis rate, days of symptom relief, length of stay, and duration of surgery (P<0.05) were detected in the preoperative CT group. Conclusions: Preoperative CT examination should be recommended as a routine examination in the treatment of cervicofacial space infections for its usefulness in reducing the missed diagnosis rate and repeated surgery complication.

Download Full-text

Analysis of Sports Knee Fractures Based on X-Ray and Computed Tomography Imaging

Computational and Mathematical Methods in Medicine ◽

10.1155/2021/9572363 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Bo Cui ◽

Yan Liu ◽

Shuxiang Chen

Keyword(s):

Computed Tomography ◽

Tibial Plateau ◽

Specific Situation ◽

X Ray ◽

Ct Examination ◽

Patella Fractures ◽

Diagnosis Rate ◽

Examination Methods ◽

The Difference ◽

Free Body

Objective. To analyse the X-ray and computed tomography (CT) findings of 128 patients with sports-related knee fractures and to improve the diagnosis rate based on the existing methods of diagnosis of sports knee fractures on X-ray and CT images. Method. In this study, we retrospectively analyse the medical records of 128 cases of sports-related fractures in the hospital, analyse the results of X-ray examination and CT imaging of patients with sports knee fractures, and compare the results obtained by the two examination methods, while referring to MRI images performed. Results. CT examination of knee fractures, tibial plateau fractures, and knee joint free body results were compared with X-ray results ( P < 0.05 ), while CT examination of patella fractures and X-ray results were compared. The difference was not statistically significant ( P > 0.05 ). Conclusion. For imaging examination of knee fractures, a single ordinary X-ray or CT scan should be selected according to the specific situation of the patient. For patients with suspected unstable fractures, when the patient’s informed consent and the condition are not allowed, ordinary X-ray film combined with CT examination is used to improve the accuracy of diagnosis and avoid the existence of hidden fractures, resulting in medical accidents.

Download Full-text

CT Diagnosis of the Fracture of Anterior Nasal Spine

Ear Nose & Throat Journal ◽

10.1177/0145561320942679 ◽

2020 ◽

pp. 014556132094267

Author(s):

Tingting You ◽

Yanjie Meng ◽

Yonghua Wang ◽

Haisong Chen

Keyword(s):

Computed Tomography ◽

Diagnostic Accuracy ◽

Ct Images ◽

Spine Fractures ◽

Ct Diagnosis ◽

Anterior Nasal Spine ◽

Diagnosis Rate ◽

Axial Ct ◽

Missed Diagnosis ◽

The Relationship

Objective: To study anterior nasal spine fractures, including the incidence, missed diagnosis rates, and relationship with shapes using computed tomography (CT). Methods: Two hundred cases of axial CT images performed for maxillofacial trauma were reviewed. The incidence, correct, and missed diagnosis rates of anterior nasal spine fractures were studied. The relationship between the fracture and the shape of the anterior nasal spine was also analyzed. Results: The rate of anterior nasal spine fractures was 22.00% (44 of 200). The diagnostic accuracy was 4.55% (2 of 44) and the missed diagnosis rate was 95.45% (42 of 44). The fracture rates of the double rod, single rod, triangle, and irregular anterior nasal spine were 33.85% (22 of 65), 32.26% (10 of 31), 12.24% (12 of 98), and 0.00% (0 of 6), respectively. The double and single rod types of anterior nasal spine were most likely to be fractured than the type of triangle (χ2 = 11.05, 6.67, P < .0167). No fracture was found in the irregular type of anterior nasal spine. Conclusion: Anterior nasal spine fractures are not rare and the high missed diagnostic rate results from unfamiliarity with the structure. Double and single rod types of anterior nasal spines are easy to fracture. Bony reconstruction and thin thickness of CT images are necessary for diagnosis.

Download Full-text

Medical Image Diagnostic Value of Computed Tomography for Bladder Tumors

Computational and Mathematical Methods in Medicine ◽

10.1155/2021/3781028 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Lin Li ◽

Risu Na ◽

Tao Mi ◽

Hao Cheng ◽

Lili Ma ◽

...

Keyword(s):

Computed Tomography ◽

Urothelial Carcinoma ◽

Bladder Wall ◽

Ct Imaging ◽

Imaging Features ◽

Bladder Tumors ◽

Ct Value ◽

Imaging Characteristics ◽

Diagnosis Rate ◽

Missed Diagnosis

Objective. To study computed tomography (CT) imaging characteristics of bladder tumors, to explore the value of CT in tumor diagnosis, and to identify the relevant factors of CT missed diagnosis so that medical staff can be more accurate in the diagnosis of bladder tumors. Methods. To retrospectively analyze the CT manifestations of 153 bladder tumor cases confirmed by paraffin pathology in our hospital and to study the difference between the benign and CT imaging features. CT indicators mainly include the number, location, morphology, calcification, bladder wall smoothness, CT value, degree of enhancement, and invasion of surrounding tissues and organs. Then, we retrospectively analyze 17 cases of CT missed diagnosis of bladder tumors, analyze related factors, and discuss the role of CT in the diagnosis of bladder tumors. Results. This study has shown that with the help of CT images, the diagnosis rate of bladder tumors has been greatly improved. Of the 153 patients studied, noninvasive urothelial carcinoma accounted for 18.95% of all benign and malignant bladder tumors, invasive urothelial carcinoma accounted for 67.93%, prostatic metastatic carcinoma and inflammatory myofibroblastoma accounted for 8.47%, pheochromocytoma accounted for 1.31%, inverted papilloma accounted for 1.31%, tubular choriocarcinoma accounted for 0.63%, and endocystitis accounted for 1.31%. In addition, the blood supply level, CT index bladder wall smoothness, and CT value are also statistically significant ( P < 0.05 ). Conclusions. CT is of high value in the diagnosis of bladder tumors, and benign and malignant bladder tumors have CT and CT imaging features. The size of bladder tumors is related to the missed diagnosis rate of CT. The application of CT examination technology can improve the accuracy of diagnosis of bladder tumors.

Download Full-text

Reduced Computed Tomography Use in the Emergency Department Evaluation of Headache Was Not Followed by Increased Death or Missed Diagnosis

Western Journal of Emergency Medicine ◽

10.5811/westjem.2017.12.34886 ◽

2018 ◽

Vol 19 (2) ◽

pp. 319-326 ◽

Cited By ~ 3

Author(s):

Daniel Miller ◽

Priyanka Vakkalanka ◽

Mark Moubarek ◽

Sangil Lee ◽

Nicholas Mohr

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Missed Diagnosis ◽

Department Evaluation

Download Full-text

Safety and feasibility of a nurse-led ambulatory abdominal paracentesis service.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.63 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 63-63

Author(s):

Kim Hua Lee

Keyword(s):

Length Of Stay ◽

Adverse Events ◽

Average Length ◽

Symptom Relief ◽

Bleeding Complications ◽

Inpatient Setting ◽

Bed Occupancy ◽

Abdominal Drain ◽

Hospital Bed ◽

Abdominal Paracentesis

63 Background: Ascites is a common complication of cancer. Symptomatic ascites contributes to cancer-related morbidity and is distressing for patients (pts). Therapeutic abdominal paracentesis (TAP) provides symptom relief but requires specialized procedural knowledge and is usually performed in the inpatient setting with several days of hospitalization. Additionally, high hospital bed occupancy during the COVID-19 pandemic prevented timely admission for TAP. An Advanced Practice Nurse (APN)-led ambulatory TAP service was introduced at our center, with the aim of improving access to TAP and reducing hospital bed occupancy. Methods: A multidisciplinary team developed workflows and safety guidelines for TAP to enable right-siting of pts in a cancer day care unit. Pts were scheduled for radiologically guided insertion of abdominal drains in the morning before 10am to allow adequate time for drainage. Pre-procedure clinical examination and safety checks were performed by APNs in the day unit. Following the procedure, abdominal fluid was drained with concurrent administration of 20% IV albumin. Drains were removed by the APN and pts were examined before discharge on the same day. Data for all cancer pts requiring TAP in the day unit and hospital from 1 Jan to 30 Nov 2020 were extracted from the electronic medical record system. The primary outcome was length-of-stay (LOS). The primary safety outcome was adverse events in the day unit. Continuous data were compared using the t-test. Data analysis was done in SPSS version 22. Results: The number of TAPs performed in the day unit and general ward requiring hospitalization were 102 and 133, respectively. There was a significant reduction in average LOS with TAPs performed in the day unit vs. hospitalization (1.48 vs. 5.82 days, p<0.001) (Table). The mean difference was 4.34 (95% confidence interval 3.33 - 5.34) days saved per pt, or a saving of 443 inpatient bed days. The TAP day unit service encountered 10 adverse events (AEs) requiring admission to the ward for continued drainage. AEs were borderline baseline blood pressure, pt frailty and inability to care for an indwelling catheter. There were no infective or bleeding complications. The majority of TAPs (86.8%) were performed in one day, with the remainder over 2-days with the abdominal drain left in-situ and reattendance at the day unit the next day for further drainage. Differences in average length-of-stay with TAP in the hospital vs. day unit. Conclusions: An APN-led ambulatory abdominal paracentesis service is a safe alternative to inpatient paracentesis. Optimal utilization of a day unit enabled reduced LOS for pts with advanced cancer. This reduction in LOS was critical during a pandemic where bed demand was high. This was possible from advanced scheduling and control over the day unit capacity.[Table: see text]

Download Full-text

Establishing local diagnostic reference levels for adult computed tomography in Morocco

Radioprotection ◽

10.1051/radiopro/2021035 ◽

2022 ◽

Author(s):

M. El Mansouri ◽

M. Talbi ◽

A. Choukri ◽

O. Nhila ◽

M. Aabid

Keyword(s):

Computed Tomography ◽

Adult Patients ◽

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Dose Length Product ◽

Head Ct ◽

Ct Examination ◽

Japanese Studies ◽

The Uk

In Morocco, the radiation doses received by adult patients are increasing due to the number of CT examinations performed and the larger number of computed tomography (CT) scanners installed. The aim of this study was to evaluate the radiation doses received by patients for the most common adult CT examinations in order to establish local diagnostic reference levels (DRLs). Data from 1016 adult patients were collected during 3 months from four Moroccan hospitals. Dose length product (DLP) and volumetric computed tomography dose index (CTDIvol) were evaluated by determining the 75th percentile as diagnostic reference levels for the most common examinations including head, chest and abdomen. The DRL for each examination was compared with other studies. The established DRLs in Morocco in terms of CTDIvol were 57.4, 12.3 and 10.9 for CT examinations of the head, chest, abdomen, respectively. For DLP, they were 1020, 632 and 714, respectively. These established DRLs for CTDIvol were almost similar to the UK DRLs at all examinations, higher than the Egyptian DRLs and lower than the Japanese DRLs at the head CT examination, lower than the DRLs from Egypt and Japan at the CT abdomen examination. In terms of DLP, the DRLs were higher than those of the British studies, lower than those of the Egyptian and Japanese studies at the head CT examination were higher at chest CT and lower at abdominal CT than those of all selected studies. The higher level of established DRLs in our study demonstrates the requirement of an optimization process while keeping a good image quality for a reliable diagnosis.

Download Full-text

Safety and reliability of computed tomography-guided lipiodol marking for undetectable pulmonary lesions

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz304 ◽

2020 ◽

Vol 30 (4) ◽

pp. 546-551

Author(s):

Kazuhiro Ito ◽

Junichi Shimada ◽

Masanori Shimomura ◽

Kunihiko Terauchi ◽

Motohiro Nishimura ◽

...

Keyword(s):

Computed Tomography ◽

Lesion Size ◽

Ct Guided ◽

Pulmonary Lesions ◽

Pleural Surface ◽

Intraoperative Fluoroscopy ◽

Safety And Reliability ◽

Preoperative Ct ◽

The Mean ◽

Lipiodol Marking

Abstract OBJECTIVES This study aimed to evaluate the safety and reliability of percutaneous computed tomography (CT)-guided lipiodol marking for undetectable pulmonary lesions before video-assisted thoracic surgery (VATS). METHODS We retrospectively analysed the cases of CT-guided lipiodol marking followed by VATS in 9 institutes from May 2006 to March 2018. Lipiodol (0.2–0.5 ml) was percutaneously injected closely adjacent to undetectable pulmonary lesions with computed-tomography guidance. Lipiodol spots were identified using C-arm-shaped fluoroscopy during VATS. We grasped the lipiodol spots, including the target lesions, with ring-shaped forceps and resected them. RESULTS Of 1182 lesions, 1181 (99.9%) were successfully marked. In 1 case, the injected lipiodol diffused, and no spot was created. Of the 1181 lesions, 1179 (99.8%) were successfully resected with intraoperative fluoroscopy. Two lipiodol spots were not detected because of the lipiodol distribution during the division of pleural adhesions. The mean lesion size was 9.1 mm (range 1–48 mm). The mean distance from the pleural surface was 10.2 mm (range 0–43 mm). Lipiodol marking-induced pneumothorax occurred in 495 (57.1%) of 867 cases. Of these, chest drainage was required in 59 patients (6.8%). The other complications were 19 (2.2%) cases of bloody sputum, 3 (0.35%) cases of intravascular air, 1 (0.12%) case of pneumonia and 1 (0.12%) case of cerebral infarction. There were no lipiodol marking-induced deaths or sequelae. CONCLUSIONS Preoperative CT-guided lipiodol marking followed by VATS resection was shown to be a safe and reliable procedure with a high success rate and acceptably low severe complication rate.

Download Full-text

Endoscopic Visualization of the True Maxillary Ostium Following Uncinectomy

Ear Nose & Throat Journal ◽

10.1177/0145561319853260 ◽

2019 ◽

Vol 99 (6) ◽

pp. 384-387 ◽

Cited By ~ 1

Author(s):

Omar H. Ahmed ◽

Marissa P. Lafer ◽

Ilana Bandler ◽

Elcin Zan ◽

Binhuan Wang ◽

...

Keyword(s):

Computed Tomography ◽

Retrospective Study ◽

Chronic Rhinosinusitis ◽

Study Design ◽

Endoscopic Sinus Surgery ◽

Nasolacrimal Duct ◽

Sinus Surgery ◽

Academic Hospital ◽

Preoperative Ct

Objectives: To examine the frequency in which angled endoscopes are necessary to visualize the true maxillary ostium (TMO) following uncinectomy and prior to maxillary antrostomy. Additionally, to identify preoperative computed tomography (CT) measures that predict need for an angled endoscope to visualize the TMO. Study Design: Retrospective study. Setting: Tertiary academic hospital. Patients and Methods: Patients who underwent endoscopic sinus surgery (ESS) between December of 2017 and August of 2018 were retrospectively identified. Cases were reviewed if they were primary ESS cases for chronic rhinosinusitis without polyposis and if they were at least 18 years of age. Results: Sixty-three maxillary antrostomies were reviewed (82.5% were from bilateral cases). Thirty-five cases (55.6%) required an angled endoscope in order to visualize the TMO. Of the preoperative CT measures examined, a smaller sphenoid keel-caudal septum-nasolacrimal duct (SK-CS-NL) angle was significantly associated with need for an angled endoscope intraoperatively to visualize the TMO (17.1° SD ± 3.2 vs 15.0° SD ± 2.9; P = .010). Conclusion: Angled endoscopes are likely required in the majority of maxillary antrostomies to visualize the TMO. This is important to recognize in order to prevent iatrogenic recirculation. The SK-CS-NL angle may help to identify cases preoperatively which require an angled endoscope to identify the TMO during surgery.

Download Full-text

Suitability of Deep Weakly Supervised Learning to detect Acute Ischemic Stroke and Hemorrhagic Infarction Lesions Using Diffusion-weighted Imaging

10.1101/2020.03.05.20031484 ◽

2020 ◽

Author(s):

Chen Cao ◽

Zhiyang Liu ◽

Guohua Liu ◽

Song Jin ◽

Shuang Xia

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Supervised Learning ◽

Superior Performance ◽

Weakly Supervised Learning ◽

Hemorrhagic Infarction ◽

Key Points ◽

Diagnosis Rate ◽

Missed Diagnosis ◽

Weakly Supervised

AbstractObjectivesThe automatic detection of acute ischemic stroke (AIS) and hemorrhagic infarction (HI) based on deep learning could avoid missed diagnosis. The fully supervised learning requires the amount of time and the expertise to manually outline lesions, which limits its applicability. The weakly supervised learning has the potential to reduce the labeling workload. The purpose of this study was to evaluate a weakly supervised method in detection of AIS and HI location using DWI.MethodsWe proposed to adopt weakly supervised learning to spatially-locate AIS lesions by residual neural network (ResNet) and visual geometry group (VGG) network. On an AIS dataset, the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity and precision were calculated. Next, ResNet, which presented superior performance on the AIS dataset, was further applied to an HI dataset.ResultsIn the AIS dataset, the AUCs of ResNet and VGG on identifying image slices with AIS were 0.97 and 0.94, respectively. On spatially-locating the AIS lesions, ResNet provided higher sensitivity and a lower missed diagnosis rate than VGG, especially for pontine AIS lesions. In the HI dataset, the sensitivity of ResNet was 87.73% for AIS detection, and 86.20% for HI detection, respectively.ConclusionsWeakly supervised learning can effectively detect the location of AIS and HI lesions in DWI, which is of paramount importance in avoiding misdiagnosis in clinical scenario.Key pointsThe deep weakly supervised learning can reduce the labeling workload; ResNet can obtain more exact results, especially for pontine AIS lesions; Weakly supervised learning can effectively detect AIS and HI lesions in DWI

Download Full-text

The impact of pre-operative computed tomography scan in patients underwent septoplasty on the postoperative complications

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20211001 ◽

2021 ◽

Author(s):

Abdulwahid S. AlQahtani ◽

Ramzi M. Dagriri ◽

Radeif E. Shamakhi ◽

Ahmad M. Alrasheed ◽

Ahmed A. Etwadi ◽

...

Keyword(s):

Computed Tomography ◽

Postoperative Complications ◽

Paranasal Sinus ◽

Nasal Obstruction ◽

Computed Tomography Scan ◽

Gold Standard Method ◽

External Nose ◽

Preoperative Ct ◽

The Impact ◽

Tomography Scan

Background: Deviated nasal septum (DNS) is one of the most frequent causes of nasal obstruction in adults. An anterior rhinoscopy (AR), which is usually the first diagnostic procedure in the evaluation of obstructive nasal pathologies, is often inadequate in the assessment of the posterior nasal cavity and the gold standard method for the evaluation of paranasal anatomy and inflammatory paranasal sinus pathologies is paranasal sinus computed tomography (PNS CT). Aim was to validate the recommendation of pre-operative computed tomography scan in minimizing post-septoplasty complications.Methods: A retrospective record based study was conducted including all patients with clinically diagnosed DNS and undergone surgical intervention at Khamis Mushayet General Hospital. Data extracted included patients demographic data, and post-operative recorded complications and history of preoperative CT scan for evaluating and grading DNS. Results: A total sample of 60 patients’ undergone septoplasty for DNS. Patients who undergone preoperative CT were 30. The remaining 30 patients didn’t undergone pre-operative CT for evaluation of DNS. The most diagnosed complication was nasal obstruction (28.3%) followed by external nose deformity (20%). Exact of 47% of patients had postoperative nasal obstruction didn’t undergone pre-operative CT. About 42% of those who had postoperative nasal deformity didn’t undergone CT while 33% of patient who had post-operative bleeding and septal perforation didn’t undergone CT.Conclusions: In conclusion, the study revealed that preoperative CT showed insignificant efficacy in relieving nasal obstruction or minimizing postoperative complications.

Download Full-text