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

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.

Hypoattenuating periportal halo on CT in a patient population can occur in presence of a variety of diseases

Many pathologies can occur in the periportal space and manifest as fluid accumulation, visible in Computed tomography (CT) images as a circumferential region of low attenuation around the intrahepatic portal vessels, called periportal halo (PPH). This finding is associated with different types of hepatic and extra-hepatic disease in humans and remains a non-specific sign of unknown significance in veterinary literature. The aim of this study was to investigate the prevalence of PPH in a population of patients undergoing CT examination and to assess the presence of lesions related to hepatic and extra-hepatic disease in presence of PPH. CT studies including the cranial abdomen of dogs and cats performed over a 5-year period were retrospectively reviewed. The prevalence of PPH was 15% in dogs and 1% in cats. 143 animals were included and the halo was classified as mild, moderate and severe, respectively in 51%, 34% and 15% of animals. The halo distribution was generalized in 79 cases, localized along the second generation of portal branches in 63, and along the first generation only in one. Hepatic disease was present in 58/143 and extra-hepatic disease in 110/143 of the cases. Main cause of hepatic (36%) and extra-hepatic disease (68%) was neoplasia. Associations between halo grades and neoplasia revealed to be not statistically significant (p = 0.057). In 7% of animals the CT examination was otherwise unremarkable. PPH is a non-specific finding, occurring in presence of a variety of diseases in the examined patient population.

Establishing local diagnostic reference levels for adult computed tomography in Morocco

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.

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

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.

The CT assessment of uncovertebral joints degeneration in a healthy population

Background A retrospective study investigated the degeneration trend of uncovertebral joints in a healthy population based on CT assessment. Methods A total of 200 males and 160 females, aged 21–79 years old (50.82 ± 17.06), who underwent CT examination in our hospital from September 2020 to March 2021 were enrolled. Sixty patients were included in each age group. According to the Kellgren and Lawrence classification and CT was used to evaluate the uncovertebral joints degeneration in different groups. Results With the increase of age, the degeneration of each segment was gradually aggravated. The uncovertebral joints started degenerating in the 20 s, and the C5–6 is the most degenerative segment, followed by the C4–5 and C6–7. Significant degeneration occurred in each segment between the 40 s and 60 s and became more severe after the 70 s. Conclusions The modified Kellgren and Lawrence classification based on CT scan could provide a quantitative assessment of uncovertebral joints degeneration in a healthy population and could provide more details for artificial cervical arthroplasty.

Ultrasound at the patient’s bedside for the diagnosis and prognostication of a renal colic

Background Diagnosing a ureteral colic is sometimes difficult; however, clinicians should not fail to detect a surgical emergency. This is why diagnostic strategies depend on the imaging examinations, especially ultrasound. Prior studies have investigated the accuracy of Point of Care Ultrasound (PoCUS), but there are relatively few. This study aimed to evaluate the performance of the PoCUS in the diagnosis of renal colic. The secondary objective was to evaluate the relationship between the imaging results and the treatment performed. Methods After the clinical evaluation of patients aged > 18 years with suspected ureteral colic, the Emergency Physician (EP) trained in ultrasound performed PoCUS to conclude whether a diagnosis of “renal colic” should be made. A computed tomography (CT) examination was subsequently performed, to determine whether ureteral or bladder lithiasis was present to diagnose a ureteral colic. The patient’s management was decided according to the to degree of urinary tract dilatation, presence of perinephric fluid, size, and localization of stones. Results Of the 12 Eps in our units, seven met the training criteria for the inclusion of patients. A total of 103 patients were analyzed, and the renal colic diagnosis was retained in 85 cases after the CT examination. The accuracy of PoCUS was 91% (86; 95%) for detecting urinary tract dilatation, 83% (76; 90%) for detecting perinephric fluid, and 54% (44; 64%) for detecting lithiasis. Only high urinary tract stones with ≥ 6 mm diameter were surgically managed (p < 0.01). Conversely, distal ureteral stones with a diameter of < 6 mm were managed with medical ambulatory treatment (p < 0.05). Conclusion PoCUS is a good diagnostic tool, for renal colic, and could help reduce the requirement for the CT examinations and, hence, reduce induced radiation exposure.

Chest Computed Tomography Images in Neonatal Bronchial Pneumonia under the Adaptive Statistical Iterative Reconstruction Algorithm

This study was to explore the application value of chest computed tomography (CT) images processed by artificial intelligence (AI) algorithms in the diagnosis of neonatal bronchial pneumonia (NBP). The AI adaptive statistical iterative reconstruction (ASiR) algorithm was adopted to reconstruct the chest CT image to compare and analyze the effect of the reconstruction of CT image under the ASiR algorithm under different preweight and postweight values based on the objective measurement and subjective evaluation. 85 neonates with pneumonia treated in hospital from September 1, 2015, to July 1, 2020, were selected as the research objects to analyze their CT imaging characteristics. Subsequently, the peripheral blood of healthy neonates during the same period was collected, and the levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were detected. The efficiency of CT examination, CRP, ESR, and combined examination in the diagnosis of NBP was analyzed. The results showed that the subjective quality score, lung window subjective score, and mediastinal window subjective score were the highest after CT image reconstruction when the preweight value of the ASiR algorithm was 50%. After treatment, 79 NBP cases (92.9%) showed ground-glass features in CT images. Compared with the healthy neonates, the levels of CRP and ESR in the peripheral blood of neonates with bronchial pneumonia were much lower ( P < 0.05 ). The accuracy rates of CT examination, CRP examination, ESR examination, CRP + ESR examination, and CRP + ESR + CT examination for the diagnosis of NBP were 80.7%, 75.3%, 75.1%, 80.3%, and 98.6%, respectively. CT technology based on AI algorithm showed high clinical application value in the feature analysis of NBP.

A singular case of primary aorto-duodenal fistula without pre-existing abdominal aortic aneurism: why and when you should suspect it

Although gastrointestinal hemorrhage from aorto-enteric fistulae (AEF) secondary to previous aortic grafts are well known, a primary aorto-enteric fistula (PAEF) without aortic aneurysm is an extremely rare event resulting in poor prognosis and outcome. PAEF is a rare cause of gastro-intestinal (GI) bleeding that radiologists should consider because often its presence is not easily guessed by clinical features. It is difficult to detect at Computed Tomography (CT) examination therefore PAEF might be not diagnosed until a laparotomy. We report a case of a 74-year-old Italian male who presented to our Emergency Department (ED) with brightly red rectal bleeding that occurred from some hours and a pre-syncopal episode. There was no history of analgesic abuse, peptic ulceration, alcohol excess, weight loss. Standard resuscitation was commenced with the hope that common sources of bleeding such as peptic ulcers or varices would eventually be discovered by endoscopy and treated definitely. An upper GI endoscopy showed brightly red blood in the stomach and in the first portions of duodenum, but no source of active bleeding was found. Diagnosis of PAEF was made by Computed tomography (CT) and after confirmed during surgical intervention. Both the duodenum and the aorta were successfully repaired by direct suture and synthetic graft replacement respectively. Diagnosis of primary aortic duodenal fistula (ADF) has been very difficult in this case especially because our patient didn’t have abdominal aortic aneurism (AAA) history confirmed by CT examination. Radiologist should remember that upper GI bleeding could however be determined by primary ADF also if atherosclerotic damage is severe as in this case. A technically good and complete exam is mandatory to achieve this rare and complex diagnosis. Particularly, an ultra-tardive acquisition phase (5 min after contrast administration) could be helpful to suspect the presence of PADF: the appearance of contrast into the duodenal lumen is an evocative sign useful to increase clinical and radiological suspicious of ADF. Gl bleeding should be assumed to be caused from a PAEF unless another source can be identified without delay. A timely and accurate diagnosis of primary AEF may be challenging due to insidious episodes of GI bleeding, which are frequently under diagnosed until the occurrence of massive hemorrhage.

Improvement of methods of diagnosis the hypertrophy of the styloid process of the temporal bone and stylohyoid syndrome in an outpatient and polyclinic conditions using functional tests

The Eagle's syndrome is a disease is caused by irritation of the nervous, vascular and muscular structures the surround the subcutaneous process of the temporal bone. A syndrome manifested by chronic pain at the deep part of the lateral region of the face, which irradiates in to the root of the tongue, pharynx and ear, dysphagia, symptoms of disorders of the circulation of the brain. Symptoms of Eagle’s syndrome are founding various otolaryngological, dental, neurological diseases. Aim: due to the lack of information on the development and course of the stylohyoid syndrome, conservative treatment and the complexity of diagnosis, the anatomical features of the hypertrophied styloid process, their length and angles of deviation and the need for local impact on the process, the stylohyoid ligament and the neurovascular bundle, to varying degrees presenting to the styloid process, it becomes necessary to develop the most effective and simple method for diagnosis a hypertrophied styloid process and to optimize the need for CT examination with contrasting of the great vessels of the neck and performing functional tests. Materials and methods: Over the past 9 years, we examined and treated 184 patients. The appeals were random, with no specific focus. Of these, there were 133 women (72.3%), men – 51 (27.7%); age – from 25 to 70 years old: 25-30 years old – 15 people (8.1%), 30-45 years old – 116 (63%), 45-60 years old – 38 (20.6%), 60-70 years old – 15 (8.1%); the duration of the disease is from 1 to 10-15 years. Our work was aimed at improving and simplifying the diagnosis of the hypertrophied styloid process during the initial treatment of the patient in an outpatient and polyclinic conditions using functional tests, determining the need to refer patients to CT examination to visualize the relationship of the elongated styloid process with the main vessels of the neck, the possibility of pressure of the append age on the vessels and nerves of the neck, both at rest and in the movement of the head and neck, the development of impaired blood circulation in the brain due to impaired blood flow through the arteries and impaired out flow through the veins, and the development of corresponding symptoms in addition to those described in the literature. Due to the difficulty of diagnosing hypertrophy of the styloid process of the temporal bone in an outpatient and polyclinic conditions and the lack of awareness of practical otolaryngologists about this problem, we proposed a scheme for examining patients with suspicion of this problem.