Stress Fracture of the Capitate

Most capitate fractures occur in association with additional carpal injuries, particularly scaphoid fractures. Isolated fractures of the capitate account for only 0.3% of carpal injuries, and stress fractures are one form of this fracture. We report the case of a 20-year-old male who had a stress fracture of the capitate after serving as an honor guard in the military. Conventional radiographs and computed tomography of the right wrist revealed a minimally displaced fracture line located at the midcarpal aspect of the right capitate. A magnetic resonance imaging scan demonstrates a subarticular capitate fracture with diffuse bone marrow edema, small osteophytes, and irregularity of the midcarpal articular cartilage. We also review the carpal kinematics which possibly caused the stress fracture. Although stress fractures of the capitate are rare, they should also be accounted for with patients who perform repetitive motions of the wrist to a considerable extent.

High-Resolution CT in Patients with Chronic Airflow Obstruction: Correlation with Clinical Diagnosis and Pulmonary Function Test

PURPOSE: To determine the utility of HRCT in the diagnosis of chronic airflow obstruction and to correlate the morphologic abnormalities revealed by this modality with functional impairment in patients with chronic air-flow obstruction. MATERIALS AND METHODS:This study involved 80 patients with chronic airflow obstruction who underwent HRCT and a pulmonary function test. Final clinical diagnosis in these patients was determined by a chest physician on the basis of clinical features, bronchoscopy, pulmonary function test, and HRCT. In order to diagnose and determine the extent of areas of decreased attenuation revealed by HRCT (the CT score), the find-ings of HRCT were retrospectively reviewed by two radiologists, who reached a consensus. Clinical and HRCT diagnoses were then compared, and the rate of agreement between them was calculated. The relation-ship between the extent of areas of decreased attenuation revealed by HRCT and by FEV1/FVC was evaluated using Correl 's account and Student 's unpaired t-test. RESULTS: The agreement rate between clinical and HRCT diagnoses was 77.5% (62/80). The rates for bronchiec-tasis (88.9%, 24/27), emphysema (93.9%, 31/33), and bronchiolitis obliterans (100%, 6/6) were considerably higher than those for chronic bronchitis and bronchial asthma. The correlation rate between CT score and FEV1/FVC was significant in bronchiectasis (p0.05). CONCLUSION: HRCT is valuable in the diagnosis and prediction of physiologic impairment in patients with bronchiectasis and bronchiolitis obliterans, but has limited value in those with emphysema, chronic bronchitis or asthma.

CT Square Index of Hepatic Segment: The Significance in Cirrhotic Patients

PURPOSE: To determine changes in the square index of the liver segments of liver cirrhosis(LC) patients, as seen on CT, and the value of this indicator during follow-up. MATERIALS AND METHODS: Twenty-three patients with LC were included in this study. Abdominal CT scans were performed twice in each patient and the mean follow-up period was 15 (6-36) months. We measured the square index of the right lobe, the caudate lobe, and the medial and lateral segment of the left lobe of the liver, as seen on initial and follow-up CT images, and compared the results. The square index was obtained by deter-mining the product of the transverse and longitudinal diameters. According to the Child-Pugh classification, the condition was classified as either progressive or non-progressive, and the square index was compared between the two groups. RESULTS: The square index of the left lobe medial segment showed a significant decrease in both the progression group(n=13) and non-progression group(n=10), while that of the right lobe was significantly lower only in the progression group. There was no significant change in the square index of the caudate lobe or the lateral segment of the left lobe. CONCLUSION: For predicting the progression of LC, the square index of the medial segment of the left lobe is a more sensitive index than the Child-Pugh classification. For ascertaining the progression of the condition, the square index of the right lobe is a valuable deferminant.

Radiologic and Histopathologic Evaluation of Various Contrast Media for Bronchography

PURPOSE: To determine which contrast media are both efficient and safe for the imaging of airways. MATERIALS AND METHODS: We evaluated five contrast media (barium, gastrografin, iotrolan, ioxaglate, iopentol) in terms of image quality and their effects on the lungs of 25 white rabbits. For bronchography 0.5ml of contrast media was used. In each contrast group, HRCT scans were obtained immediately (n=5), 12 hours (n=4), 1 day (n=3), 2 days (n=2), and 1 week (n=1) after bronchography. Histopathologic specimens were obtained immediately, 12 hours, 1 day, 2 days, and 1 week later. Bronchograms were evaluated for image quality by three radiologists working independently, and were scored as 1(poor), 2(moderate), or 3(good) in terms of contrast quality and bronchial coating. HRCT was evaluated by two radiologists who reached a concensus; they determined the presence of contrast media, and then the pattern and extent of pulmonary opacity, and any related changes. Histopatholgic specimens were evaluated by two pathologists who sought consensus as to the extent of inflammation, pulmonary edema, and hemorrhage, and any changes in these aspects. RESULTS: Bronchography indicated that the sum of scores for contrast quality was 45 for barium, 33 for gastrografin, 28 for iotrolan, 30 for ioxaglate, and 28 for iopentol, while for each of these media, the sum of scores for bronchial coating was 39, 19, 25, 23, and 21, respectively. Barium showed the best image quality. In all rabbits, HRCT demonstrated the variable extent of groundglass attenuation and/or consolidation. Lesions were most extensive at 1-2 days and then regressed at 1 week; these HRCT findings correlated well with histologic findings. In histologic studies of all five contrast media groups, variable severe inflammatory reactions were observed, with or without necrosis, congestion, edema, and hemorrhage. It was noted that ioxaglate appeared to cause least tissue reaction. CONCLUSIONS: The imaging results of this experimental study indicate that for bronchography, barium is the best available contrast media, On the basis of the histologic and HRCT results, however, ioxaglate is the best.