Congenital tufting enteropathy and chronic arthritis: a clinical and radiological perspective.

Congenital tufting enteropathy is a rare condition which presents in early infancy. It is a condition which should be suspected in infants who present with diarrhoea soon after birth. A rare association with arthritis has been observed with a handful of cases documented in the literature. Our case differs as the arthritis described is erosive in nature, a feature which is not present in other cases.

Reproducibility and Diagnostic Accuracy of Kellgren-Lawrence Grading for Osteoarthritis Using Radiographs and Dual-Energy X-ray Absorptiometry Images.

Advances in image quality from modern dual-energy X-ray absorptiometry (DXA) scanners now allow near radiograph-like quality images at a low radiation dose. This opens potential new applications for the use of DXA scanners to study other musculoskeletal conditions, such as osteoarthritis, which is often investigated by visual assessment of radiographs. Together, osteoporosis and osteoarthritis are the 2 most common musculoskeletal conditions, both of which primarily affect older people. The aim of this study was to determine whether Kellgren-Lawrence grading of DXA images can be used to grade hip osteoarthritis as effectively as radiographs. People who had attended for recent pelvic radiographs underwent DXA of hips (50 hips from 25 people) using a GE Healthcare iDXA scanner. Three observers assigned Kellgren-Lawrence grades to each image, and grading was repeated at least 1 week apart. Intraobserver and interobserver reliability for radiographs and DXA images were calculated using quadratic-weighted kappa (QWK). People were recalled 12 months later, and the tests were repeated with both the radiograph and DXA scans taken within 2 weeks of each other. Hip DXA intraobserver reproducibility achieved a QWK range of 0.88-0.95 and interobserver reproducibility of 0.85-0.88, similar to QWK from hip radiographs. Intraobserver reliability between subject-matched radiograph and iDXA images revealed QWK ranging between 0.80 and 0.88. Reproducibility of hip osteoarthritis grading using DXA was comparable with that of radiographs in this study and similar to repeatability scores previously published in literature. Given the lower radiation dose and the opportunity to simultaneously investigate osteoporosis, DXA presents an attractive imaging option for osteoarthritis.

Retrospective review of image quality of CT in polytrauma patients: comparison of patients scanned using a scoop stretcher and without a scoop stretcher.

Increasingly pre-hospital trauma management involves transfer of patients using a scoop stretcher; a number of computed tomography (CT) compatible scoops have recently appeared on the market. We sought to evaluate any differences in image quality in polytrauma patients scanned in a scoop stretcher. CT studies of 234 consecutive patients presenting between December 2011 and August 2012 at our regional level 1 tertiary trauma centre were retrospectively reviewed. Patients were allocated into two groups: those scanned with a scoop stretcher and without. CTs were reviewed by a consultant radiologist and two senior radiology trainees and graded separately for quality/artefact. A scale of 1-5 was employed: 1-uninterpretable, 2-borderline image quality, 3-acceptable, 4-good, 5-excellent. A total of 128 (54.7 %) patients were scanned in a scoop stretcher and 106 (45.3 %) were scanned without, 183 males and 51 females (average age, 46 (16-94) years; SD, 20). The average quality grading for the patients scanned in the scoop was 4.64 compared to 4.68 in those without the scoop. There was no significant grading difference between the groups, consultant (p = 0.096) and trainees (p = 0.782). No artefacts were attributable to the scoop stretcher 0/128 (0 %). Following our experience, the use of scoop stretchers is recommended for efficient, safe and practical management of trauma patients and in terms of imaging, with no detrimental effect on image quality.

Rapid imaging protocol in trauma: a whole-body dual-source CT scan.

The purpose of this study is to determine whether a single acquisition whole-body trauma multi-detector CT scan is able to reduce resuscitation time, scan time, and effective radiation dose without compromising diagnostic quality in the setting of polytrauma. Retrospective analysis of 33 trauma patients undergoing single acquisition whole-body CT with injury severity scores of ≥ 16 was compared to 34 patients imaged with a segmented whole-body CT protocol. Time spent in the emergency department, effective radiation dose, image quality, and mortality rates were compared. The single acquisition group spent 53.7 % less time in the emergency department prior to imaging (p=0.0044) and decreased scanning time by 25 %. The protocol yielded a 24.5 % reduction in mean effective radiation dose (24.66 mSv vs. 32.67 mSv, p<0.0001). The image noise was similar in both groups. Standardized mortality ratios were comparable. The single acquisition protocol significantly reduces time spent in the emergency department by allowing faster imaging at a lower radiation dose while maintaining image quality. Other contributors to reduction in radiation dose include use of dual-source CT technology, removal of delayed CT intravenous pyelogram, and arm positioning.

Role of imaging in penetrating and blunt traumatic injury to the heart.

Cardiac injury due to blunt or penetrating chest trauma is common and is associated with significant morbidity and mortality. Understanding the mechanisms, types, and complications of cardiac injuries and the roles of various imaging modalities in characterizing them is important for appropriate diagnosis and treatment. These injuries have not been well documented at imaging, but there are now fast and accurate methods for evaluating the heart and associated mediastinal structures. The authors review the broad spectrum of injuries that can result from blunt or penetrating trauma to the chest, as well as the imaging modalities commonly used in the acute trauma setting for evaluation of the heart and mediastinal structures. A pictorial review of both common and, to date, rarely documented cardiac injuries imaged with a variety of modalities is also presented. While many imaging modalities are available, the authors demonstrate the value of multidetector computed tomography (CT) for the initial evaluation of patients with blunt or penetrating chest trauma. With the advent of multidetector CT, imaging of cardiac injury has increased and accurate identification of these rare but potentially lethal injuries has become paramount for improving survival. Selection of the most appropriate modality for evaluation and recognition of the imaging findings in cardiac injuries in the acute trauma setting is important to expedite treatment and improve survival.

Low-dose MDCT findings of blunt hepatobiliary trauma.

This pictorial essay shows low-dose multi-detector computed tomography (MDCT) findings of blunt hepatobiliary trauma, and describes the indications and protocol for MDCT. Given the universal usage of MDCT in assessing the liver in blunt abdominal trauma, reduction of patient dose is essential. The new l0se MDCT protocol presented here can achieve up to 50% dose reduction while maintaining diagnostic image quality and thus facilitate dose sensitive patient management. Our institution's blunt hepatobiliary MDCT imaging algorithm can help determine which patients require operative therapy. Injury to the liver is graded on various schemes, one being the Organ Injury Scale devised by the American Association for the Surgery of Trauma classification based on the extension of the lesion and bleeding.

Dual-energy CT as a potential new diagnostic tool in the management of gout in the acute setting.

OBJECTIVE: Gout is the most common crystal deposition arthropathy currently diagnosed clinically and with arthrocentesis. Dual-energy CT is a promising new imaging technique offering potential new applications in a number of clinical areas. CONCLUSION: The ability of dual-energy CT to diagnose early gout and its use as a problem-solving tool is shown here. Diagnosis of subclinical gout could avert associated long-term complications, thereby reducing disease burden and improving overall quality of life.