Comparison of real-time ultrasonography and coronal computed tomography in the diagnosis of orbital fractures.

Real-time ultrasonography (US) was used to evaluate the bony orbit in 19 patients who had sustained orbital trauma. The ability of US to demonstrate clinically significant orbital fractures was compared with that of thin-section coronal computed tomography (CT); the latter method was treated as definitive. US had a sensitivity of 92%, a specificity of 100% and a positive predictive value of 100%. Quantification of the size of fragments by the two methods yielded similar results. Real-time US adequately displayed the anatomic features of the orbit and detected clinically significant fractures. This technique may have a role in post-traumatic imaging of the orbit when coronal CT is not possible.

The role of orbital ultrasound in the diagnosis of orbital fractures.

The role of CT scanning in the diagnosis and management of craniomaxillofacial injuries is well documented. However, coexistent injuries, limitations on patient positioning, CT availability, or financial constraints may prevent or delay the diagnosis of significant orbital wall defects. Real-time ultrasound represents a safe, inexpensive, noninvasive, portable, and readily available diagnostic modality which has had a limited application in the diagnosis of orbital pathology. The objectives of this study were to define the role of orbital ultrasound in the assessment of the traumatized orbit and to provide correlation of pathology with CT imaging. Eighteen patients (16 males, 2 females) having sustained trauma to the orbitozygomatic region were assessed at a regional trauma center over a 6-month period. Each patient underwent an ultrasound examination of both orbits. Confirmatory CT scans (5-mm axial and 1.5-mm coronal orbital cuts) were then obtained for comparative assessment. Patients with open globe injuries, alteration of visual acuity, or life-threatening conditions were excluded from the study. The results of the study revealed a positive correlation between the ultrasound and CT findings in 17 (94 percent) of the patients. Ultrasound demonstrated satisfactory sensitivity (92 percent) and specificity (100 percent) and positive predictive value (100 percent) when compared with CT scanning. Soft-tissue herniation, orbital emphysema, and muscle entrapment were well visualized by means of real-time ultrasound. It is concluded that orbital ultrasound is an accurate diagnostic modality in the investigation of orbital trauma and correlates well with CT findings. A cost analysis will be presented, and details of the limitations and efficacy of orbital ultrasound will be discussed.

Medical audit of mammography: a simplified alternative.

Assessing radiologists' mammographic interpretation and performing a complete audit of a mammographic practice are notoriously difficult and time consuming. The authors propose a simplified method for accomplishing a satisfactory medical audit. A search of the 1987 pathological reports of St. Michael's Hospital in Toronto yielded 153 patients who underwent excisional biopsy of the breast and for whom preoperatively obtained mammograms were available. The medical records of the patients were reviewed to obtain demographic data, as well as information as to whether the excised lesions had been palpable and the stage of the tumour. The mammograms of the patients were categorized retrospectively by four independent observers. The findings were correlated with the results of the pathological examinations and analysed with receiver-operating characteristic (ROC) curves. Forty-five nonpalpable and 121 palpable lesions were identified, of which 70 were malignant and 96 benign. The positive predictive value of mammography for the nonpalpable lesions was 20%. Three of the 9 nonpalpable cancers and 35 of the 56 palpable ones had metastasized to the axillary lymph nodes. The area under the ROC curves for the four radiologists ranged from 0.84 to 0.89. This audit method in inexpensive and easily applied.

Role of MRI bone marrow imaging in recurrent lymphoma.

Infiltration by Hodgkin disease of the bone marrow of a thoracic vertebral body in a symptomatic patient was identified by magnetic resonance imaging, but not by radiography, radionuclide bone scanning, or computed tomography. The discovery of disease at this site substantially altered subsequent therapy.