Radiologic Assessment for Evaluating the Post-operative Reduction of Syndesmosis: A Retrospective Study

Background: Assessing the reduction of syndesmosis is highly recommended due to the complications occurring after the malreduction of the syndesmosis. This study evaluated the post-operative Computed Tomography (CT) scans and standard plain radiographs for assessing the reduction of syndesmosis post-operatively. Objectives: Evaluating the radiologic assessments of post-operative reduction of syndesmosis. Methods: In this retrospective cohort study, 45 patients presented with ankle fractures and syndesmosis failure to the emergency department of our hospital between 2015 and 2019 were evaluated by post-operative CT scans and plain radiographs. Results: Diastasis was demonstrated in 18 patients (40%) in plain radiographs, in 4 patients (8%) by tibial clear space, in 5 patients (11%) by medial clear space, in 10 patients (22%) by AP tibiofibular overlap, and in patients 8 (17%) by mortise tibiofibular overlap. Diastasis was demonstrated in 24 patients (53%) in CT scans, of whom 18 patients had abnormal radiographic parameters, while 6 patients had normal radiographic parameters. Conclusion: We found a post-operative CT scan more useful than standard plain radiographic measurement for assessing the reduction of the syndesmosis. We suggest the use of post-operative CT scan as a routine to evaluate the syndesmosis reduction.

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The Role of Imaging in the Preoperative Assessment of Patients with Nasal Obstruction and Septal Deviation—A Retrospective Cohort Study

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1712933 ◽

2020 ◽

Author(s):

Narin Nard Carmel-Neiderman ◽

Ahmad Safadi ◽

Anat Wengier ◽

Tomer Ziv-Baran ◽

Anton Warshavsky ◽

...

Keyword(s):

Computed Tomography ◽

Cohort Study ◽

Nasal Obstruction ◽

Retrospective Cohort Study ◽

Nasal Septum ◽

Retrospective Cohort ◽

Preoperative Planning ◽

Preoperative Assessment ◽

Ct Scans ◽

Radiological Findings

Abstract Introduction Isolated nasal obstruction (INO) is a common complaint of multiple etiology. The preoperative evaluation of patients presenting with nasal obstruction and deviated nasal septum (DNS) does not typically include imaging. The benefits of performing computed tomography (CT) in the preoperative setting are inconclusive. Objective Assessing the contribution of preoperative CT to the surgical treatment of non-sinusitis patients presenting with INO and DNS. Methods A retrospective cohort study on patients referred to surgery for nasal obstruction due to DNS or turbinate hypertrophy between 2006 and 2015. Data was retrieved from patients' medical charts. The CT scans and clinical data were reassessed by a second surgeon blinded to the patients' clinical course. Results Seventy of the 843 patients (8.06%) who underwent endoscopic sinonasal procedures during the study period had presented with INO and met the inclusion criteria. Thirty-eight (55.88%) of them underwent CT scans during their preoperative assessment. Modification of the initial preoperative planning based on the radiological findings was required in 32 cases (84.2%). When reassessed by a second blinded surgeon, 58% of cases required surgical modification rather than classical submucosal resection of nasal septum and turbinate reduction (P = 0.048). Conclusion Computed tomography was found beneficial in the preoperative planning for patients with INO. The original surgical plan based upon physical examination findings was modified based on radiological findings in 84.2% of the patients.

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Comparison of extra-articular radiographic parameters of distal radius fractures on plain radiographs and CT scans

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211021042 ◽

2021 ◽

pp. 175319342110210

Author(s):

Simon B. Kramer ◽

Caroline A. Selles ◽

Daniel Bakker ◽

Niels W. L. Schep

Keyword(s):

Ct Scan ◽

Intraclass Correlation ◽

Plain Radiograph ◽

Ulnar Variance ◽

Ct Scans ◽

Distal Radial Fractures ◽

Plain Radiographs ◽

Radial Inclination ◽

Radiographic Parameters ◽

Radiograph Measurements

The aim of this study was to compare extra-articular radiographic parameters of distal radial fractures measured on plain radiographs and CT scans. Two researchers independently measured four extra-articular radiographic parameters (dorsal tilt, carpal alignment, radial inclination and ulnar variance) on both radiographs and CT scans in 85 patients. Inter-observer reliability for both techniques was assessed, along with the agreement between CT scans and radiographs using the intraclass correlation coefficient and Bland–Altman plots. The results showed that dorsal tilt, carpal alignment, radial inclination and ulnar variance can be measured reliably on both radiographs and CT scans. At a patient level, carpal alignment, radial inclination and ulnar variance CT scan measurements are an acceptable alternative to plain radiograph measurements in the vast majority of patients. In contrast, dorsal tilt CT scan measurements are not comparable with radiographs in 40% of the cases. Therefore, caution should be taken in measuring dorsal tilt on CT scans.

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LO69: A retrospective cohort study on the impact of point-of-care ultrasound on radiologic imaging in patients presenting to the emergency department with suspected uncomplicated renal colic

CJEM ◽

10.1017/cem.2019.112 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S32-S33

Author(s):

J. Alain ◽

R. Huard ◽

A. Mokhtari ◽

M. Parent ◽

D. Simonyan ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Renal Colic ◽

Point Of Care ◽

Ct Scans ◽

Point Of Care Ultrasound ◽

Kappa Score ◽

Radiologic Imaging

Introduction: The number of CT scans prescribed in the Emergency department (ED) for suspected renal colic has increased over recent years without an associated improvement in patient-centred outcomes. We assessed whether Point-of-Care Ultrasound (PoCUS) decreases the use of formal radiologic imaging. Methods: We completed a retrospective cohort study on consecutive patients 18 years of age and older presenting to the ED with suspected uncomplicated renal colic in a tertiary care centre in Québec in 2016. Exclusion criteria included: previous urologic intervention, solitary kidney, dialysis, fever, pyuria, acute kidney injury, pregnancy, suspicion of a serious alternative diagnosis or persistent symptoms despite analgesia. We compared the proportion (95%CI) of formal radiologic imaging performed (Ultrasound or CT) in patients who had PoCUS in the ED vs. those who did not. Two-tailed Fisher exact test (α = 0.05) and odds ratios (95%CI) calculated from multivariate logistic regression models adjusted for age, gender, Charlson Index and previous renal colic were used to compare the two groups. The reliability of data collection was evaluated with a kappa score (95%CI). Results: 169 patients with uncomplicated renal colic were included. There was no difference between the groups in terms of age, gender, Charlson Index, or previous renal colic. The PoCUS level of training and the doctor's education level was significantly higher in the PoCUS group. There was a non-significant trend towards less formal imaging in patients of the PoCUS group 65/88 (73.9% [63.4-82.7%]) vs. the non-PoCUS group 69/81 (85.2% [75.6-92.1%]), p = 0.087. After adjustment for confounders, the patients not evaluated with PoCUS were more likely to have formal imaging with a significant odds ratio of 2.41 [1.05-5.56]). Among patients who underwent a CT, incidentalomas were found in 16.5% and only 2.0% demonstrated significant findings leading to changes in ED management, such as an alternative diagnosis, need for admission, or an urgent urological intervention. Inter-observer agreement was excellent between assessers with a kappa score of 0.88 [0.66-1.00]. Conclusion: ED patients with uncomplicated renal colic who are investigated with PoCUS tend to have fewer formal imaging test. When CT scans were performed, incidentalomas were found in 16.5% and ED management changed only 2.0% of the time. PoCUS appears to be a useful tool for decreasing CT utilisation in this low-risk ED population.

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Impact of Computed Tomography Scans on the Risk of Thyroid Disease in Minor Head Injury Patients: A Population-Based Retrospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17113873 ◽

2020 ◽

Vol 17 (11) ◽

pp. 3873

Author(s):

Shao-Lun Tsao ◽

Yin-Yang Chen ◽

Liang-Tsai Yeh ◽

Jing-Yang Huang ◽

Wen-Tyng Li ◽

...

Keyword(s):

Computed Tomography ◽

Cohort Study ◽

Head Injury ◽

Confidence Interval ◽

Ct Scan ◽

Thyroid Disease ◽

Population Based ◽

Thyroid Diseases ◽

Minor Head Injury ◽

Ct Scans

We investigated the association between head computed tomography (CT) scans and the risk of noncancer thyroid diseases in patients with minor head injury in a Taiwanese healthcare setting. For this retrospective population-based cohort study, the 2009–2013 Longitudinal Health Insurance Database was used to include patients with a minor head injury at admission or emergency visit between 2009 and 2013. Multivariate analysis with a multiple Cox regression model was applied to analyze the data. According to whether a CT scan was conducted within 14 days of admission, patients were divided into a CT scan group (n = 14,041) or a non-CT scan group (n = 34,684). No increased incidence of thyroid diseases was observed in the CT scan group regardless of the number of CT scans performed. The incidence rate ratio for one scan was 1.10 (95% confidence interval: 0.94–1.29) and for two or more scans was 1.09 (95% confidence interval: 0.93–1.28). In conclusion, this population-based cohort study showed that a head CT scan is not associated with increased risk of thyroid disease in patients with minor head injury. The short-term adverse effects on the thyroid could be mild when a regular CT scan is appropriately performed.

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External validation of computed tomography decision rules for minor head injury: prospective, multicentre cohort study in the Netherlands

BMJ ◽

10.1136/bmj.k3527 ◽

2018 ◽

pp. k3527 ◽

Cited By ~ 13

Author(s):

Kelly A Foks ◽

Crispijn L van den Brand ◽

Hester F Lingsma ◽

Joukje van der Naalt ◽

Bram Jacobs ◽

...

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Cohort Study ◽

Head Injury ◽

Decision Rules ◽

Ct Scanning ◽

Minor Head Injury ◽

Ct Scans ◽

Multicentre Cohort Study ◽

Multicentre Cohort

Abstract Objective To externally validate four commonly used rules in computed tomography (CT) for minor head injury. Design Prospective, multicentre cohort study. Setting Three university and six non-university hospitals in the Netherlands. Participants Consecutive adult patients aged 16 years and over who presented with minor head injury at the emergency department with a Glasgow coma scale score of 13-15 between March 2015 and December 2016. Main outcome measures The primary outcome was any intracranial traumatic finding on CT; the secondary outcome was a potential neurosurgical lesion on CT, which was defined as an intracranial traumatic finding on CT that could lead to a neurosurgical intervention or death. The sensitivity, specificity, and clinical usefulness (defined as net proportional benefit, a weighted sum of true positive classifications) of the four CT decision rules. The rules included the CT in head injury patients (CHIP) rule, New Orleans criteria (NOC), Canadian CT head rule (CCHR), and National Institute for Health and Care Excellence (NICE) guideline for head injury. Results For the primary analysis, only six centres that included patients with and without CT were selected. Of 4557 eligible patients who presented with minor head injury, 3742 (82%) received a CT scan; 384 (8%) had a intracranial traumatic finding on CT, and 74 (2%) had a potential neurosurgical lesion. The sensitivity for any intracranial traumatic finding on CT ranged from 73% (NICE) to 99% (NOC); specificity ranged from 4% (NOC) to 61% (NICE). Sensitivity for a potential neurosurgical lesion ranged between 85% (NICE) and 100% (NOC); specificity from 4% (NOC) to 59% (NICE). Clinical usefulness depended on thresholds for performing CT scanning: the NOC rule was preferable at a low threshold, the NICE rule was preferable at a higher threshold, whereas the CHIP rule was preferable for an intermediate threshold. Conclusions Application of the CHIP, NOC, CCHR, or NICE decision rules can lead to a wide variation in CT scanning among patients with minor head injury, resulting in many unnecessary CT scans and some missed intracranial traumatic findings. Until an existing decision rule has been updated, any of the four rules can be used for patients presenting minor head injuries at the emergency department. Use of the CHIP rule is recommended because it leads to a substantial reduction in CT scans while missing few potential neurosurgical lesions.

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Risk Factors for and Frequency of CT Scans, Steroid Use, and Repeat Visits in Inflammatory Bowel Disease Patients Seen at a Single-Center Emergency Department: A Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10122679 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2679

Author(s):

Lindsay Euers ◽

Shaadi Abughazaleh ◽

Kerri Glassner ◽

Prianka Gajula ◽

Michelle Jones-Pauley ◽

...

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Emergency Department ◽

Ct Scan ◽

Bowel Disease ◽

Retrospective Cohort ◽

Ct Scans ◽

Steroid Use ◽

Increased Risk ◽

Inflammatory Bowel

Patients with inflammatory bowel disease often present to the emergency department due to the chronic relapsing nature of the disease. Previous studies have shown younger patients to have an increased frequency of emergency department visits, resulting in repeated exposure to imaging studies and steroids, both of which are associated with risks. We performed a retrospective cohort analysis of inflammatory bowel disease patients seen at Houston Methodist Hospital’s emergency department from January 2014 to December 2017 using ICD codes to identify patients with Crohn’s disease, ulcerative colitis, or indeterminate colitis from the electronic medical record. Data were collected on demographics, medications, and imaging. Five hundred and fifty-nine patients were randomly selected for inclusion. Older age was associated with decreased risk of CT scan or steroid use. Patients with ulcerative colitis compared to Crohn’s had decreased risk of CT scan, while there was an increased risk of CT in patients on a biologic, immunomodulator, or when steroids were given. Steroid use was also more common in those with inflammatory bowel disease as the primary reason for the visit. Patients in our study frequently received steroids and had CT scans performed. The increased risk of CT in those on a biologic, immunomodulator, or steroids suggests more severe disease may contribute. Guidelines are needed to reduce any unnecessary corticosteroid use and limit repeat CT scans in young inflammatory bowel disease patients to decrease the risk of radiation-associated malignancy over their lifetime.

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Faculty Opinions recommendation of Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717297801.792652801 ◽

2012 ◽

Author(s):

Christian Kratz

Keyword(s):

Cohort Study ◽

Radiation Exposure ◽

Retrospective Cohort Study ◽

Brain Tumours ◽

Retrospective Cohort ◽

Ct Scans ◽

Subsequent Risk

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Diagnostic Accuracy of Magnetic Resonance Imaging and Computed Tomography Scan in Young Athletes With Spondylolysis

Clinical Pediatrics ◽

10.1177/0009922819832643 ◽

2019 ◽

Vol 58 (6) ◽

pp. 671-676

Author(s):

Amy M. West ◽

Pierre A. d’Hemecourt ◽

Olivia J. Bono ◽

Lyle J. Micheli ◽

Dai Sugimoto

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Ct Scan ◽

False Negative ◽

False Negative Rate ◽

Ct Scans ◽

Resonance Imaging ◽

Young Athletes ◽

Negative Rate

The objective of this study was to determine diagnostic accuracy of magnetic resonance imaging (MRI) and computed tomography (CT) scans in young athletes diagnosed with spondylolysis. A cross-sectional study was used. Twenty-two young athletes (14.7 ± 1.5 years) were diagnosed as spondylolysis based on a single-photon emission CT. Following the diagnosis, participants underwent MRI and CT scan imaging tests on the same day. The sensitivity and false-negative rate of the MRI and CT scans were analyzed. MRI test confirmed 13 (+) and 9 (−) results while CT test showed 17 (+) and 5 (−) results. The sensitivity and false-negative rate of MRI were, respectively, 59.1% (95% confidence interval [CI] = 36.7% to 78.5%) and 40.9% (95% CI = 21.5% to 63.3%). Furthermore, the sensitivity and false-negative rate of CT scan were 77.3% (95% CI = 54.2% to 91.3%) and 22.7% (95% CI = 0.09% to 45.8%). Our results indicated that CT scan is a more accurate imaging modality to diagnose spondylolysis compared with MRI in young athletes.

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