Spontaneous ankylosis of the sacroiliac joint: prevalence and risk factors.

PURPOSE: Evidence on spontaneous sacroiliac joint (SIJ) ankylosis is lacking. The aim of this analysis was to assess the prevalence of spontaneous SIJ ankylosis and examined different ankylosis patterns and risk factors for spontaneous SIJ ankylosis. METHODS: Pelvic computed tomography (CT) data of 102 consecutive patients with spinal pathologies were compared to CT of a control group consisting of 102 consecutive patients without spinal pathologies. SIJ ankylosis patterns and risk factors for SIJ ankylosis, such as age, sex, and previous spinal fusion surgery were examined. RESULTS: Overall, 117 men and 86 women were examined between 2019 and 2020. Non-spinal patients were significantly older (mean age 70.5 years, standard deviation [SD] 11.4) than those in the spinal group (mean age 65.3 years, SD 14.3; p = 0.005). The prevalence of SIJ ankylosis was 24.5% in the non-spinal group and 23.5% in the spinal group. The anterior ankylosis type prevalence was 91.7% in the spinal group, compared to 48.0% in the non-spinal group. Factors associated with SIJ ankylosis were older age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.01-1.07, p = 0.004) and male sex (OR 5.14, 95% CI 2.29-11.55, p < 0.001). CONCLUSION: Spontaneous ankylosis of the SIJ was a frequent phenomenon in patients with and without spinal pathologies and more likely with older age and male sex. Anterior type SIJ ankylosis was substantially more frequent in patients with spinal pathologies. This may be due to strain exerted on the anterior SIJ aspects in patients with compromised posture due to spine degeneration.

Successful evacuation of large perirenal hematoma after extracorporeal shock wave lithotripsy (ESWL) - step 1 of the IDEAL recommendations of surgical innovation.

Larger perirenal hematomas after extracorporeal shock wave lithotripsy (ESWL) are sometimes related to the loss of renal function due to compression of the normal renal tissue. After computed tomography-guided drainage and locally applied urokinase, the hematoma was fractionally evacuated. This procedure is a save and fast way to recover normal renal function.

Diameter changes of occluded venous coronary artery bypass grafts in electron beam tomography: preliminary findings.

OBJECTIVE: To differentiate acute from chronic graft occlusions through diameter measurements by means of electron beam tomography (EBT). METHODS: Contrast enhanced EBT volume studies were carried out in 37 patients with one or more occluded venous coronary bypass grafts. Seventeen of 37 patients did not meet the inclusion criteria and were excluded from the assessment. The remaining 20 patients had a total of 39 bypasses (16 patent, 23 occluded) and were assigned to one of three groups: group A consisted of patent grafts only (patent grafts, 13 patients). Group B comprised 11 of 23 occluded grafts diagnosed within 10 days after bypass surgery (acutely occluded grafts, ten patients). Group C contained 12 of 23 bypass occlusions that were at least 6 months old as documented by coronary angiography (chronically occluded grafts, ten patients). The mean graft diameter was determined by repetitive measurements on a workstation through blinded readers. The Mann-Whitney-U-test for unpaired samples was used for statistical evaluation. RESULTS: Mean graft diameter for groups A-C (patent, acutely, and chronically occluded bypasses, respectively) was 3.9 mm (+/-0.6; n=16), 5.4 mm (+/-1.9; n=11), and 0.3 mm (+/-.9; n=12), respectively (P<0.01 each). Sensitivity and specificity for the detection of acute and chronic occlusions were 87 and 92% (cut-off 4.5 mm), respectively, and 92 and 96% (cut-off 1 mm), respectively. CONCLUSIONS: EBT may allow for non-invasive differentiation between acute and chronic venous coronary bypass occlusions. This could help prevent unnecessary invasive recanalization procedures. Body veins may conserve their ability to increase in diameter in acute thrombosis when transplanted as coronary bypasses.

Optimization of contrast agent volume for helical CT in the diagnostic assessment of patients with severe and multiple injuries.

PURPOSE: The aim of this study was to determine the optimal amount of contrast agent for helical CT of the trunk during primary radiologic evaluation of polytraumatized patients. METHOD: Eighty-three patients with severe and multiple injuries (mean age 36.2 years) underwent standardized helical CT examination with administration of a single contrast agent bolus of iohexol (Accupaque 300) at volumes of 120, 150, and 180 ml. Image quality was estimated by two blinded radiologists using a visual analogue scale. Analysis further included density measurements in regions of interest (ROIs) placed in the ascending, descending, and abdominal aorta as well as in the liver and spleen. RESULTS: The qualitative rating of the contrast agent effect after administration of 150 and 180 ml was significantly better compared with 120 ml [odds ratio (OR) 12.05, 95% confidence interval (CI) 3.50-41.52 and OR 12.14, 95% CI 3.36-43.85, respectively]. A dose increase from 120 to 150 ml resulted in a significantly better enhancement of the abdominal aorta (p = 0.006). The highest dose of 180 ml was not associated with a diagnostic gain in the other ROIs. CONCLUSION: We recommend administration of 150 ml of iohexol as the optimal amount of contrast material for single phase bolus administration in emergency helical CT examination of the chest and abdomen.