Features of cranio-maxillofacial trauma in the massive Sichuan earthquake: analysis of 221 cases with multi-detector row CT.

OBJECTIVE: In a massive earthquake, cranio-maxillofacial trauma was common. The present study was to determine the features of cranio-maxillofacial trauma sustained in the massive Sichuan earthquake by multi-detector row computed tomography (MDCT). METHODS: The study included 221 consecutive patients (123 males and 98 females; age range, 1-83 years; median age, 35 years) with cranio-maxillofacial trauma in the Sichuan earthquake, who underwent cranio-maxillofacial MDCT scans. The image data were retrospectively reviewed focusing on the injuries of the cranio-maxillofacial soft tissue, facial bones and cranium. RESULTS: All patients had soft tissue injuries frequently with foreign bodies. Ninety-seven (43.9%) patients had fractures (1.5 involved sites per patient, range from 1 to 8) including single cranial fractures in 36 (37.1%) cases, single maxillofacial fractures were seen in 48 (49.5%) and cranio-maxillofacial fractures in 13 (13.4%). Single bone fracture was more common than multiple bone fractures (p<0.05). Nasal, ethmoid bones and the orbits were the most commonly involved sites of the craniofacial region. Thirty-eight (17.2%) patients had intracranial injuries, the commonest being subarachnoid haemorrhage and the commonest sites were the temporal and frontal regions. Coexisting intracranial injuries were more common in patients with cranial fractures than in patients with maxillofacial fractures (p<0.05). CONCLUSION: Our results indicate that the cranio-maxillofacial trauma arising from the massive Sichuan earthquake had some characteristic features, and a significant number of individuals had the potential for combined cranial and maxillofacial injuries, successful management of which required a multidisciplinary approach.

Carotid and cerebrovascular disease in symptomatic patients with type 2 diabetes: assessment of prevalence and plaque morphology by dual-source computed tomography angiography.

BACKGROUND: Plaque morphology directly correlates with risk of embolism and the recently developed dual-source computed tomography angiography (DSCTA) may help to detect plaques more precisely. The aim of our study was to evaluate the prevalence and morphology of carotid and cerebrovascular atherosclerotic plaques in patients with symptomatic type 2 diabetes mellitus (DM) by DSCTA. METHODS: From July 2009 to August 2010, DSCTA was prospectively performed in 125 consecutive patients with symptomatic type 2 DM. We retrospectively analyzed plaque type, distribution, and extensive and obstructive natures were determined for each segment for all patients. RESULTS: Atherosclerotic plaques were detected in 114 (91.2%) patients. Relatively more noncalcified (45%) and calcified (39%) plaques and less mixed (16%) plaques were observed (p < 0.001). Noncalcified plaques were found mainly in the intracranial arteries (81.8%), mixed plaques in the intracranial arteries (25.2%) and intracranial internal carotid artery (ICA) (56.1%). Calcified plaques were found mainly in the intracranial ICA (65.9%) and extracranial arteries (28.2%) (for all, p < 0.001). Extension of plaques from the 1(st) to 5(th) segments was observed in 67 (58.8%) patients and from the 6(th) to 10(th) segments in 35 (30.7%) patients. The most common site of all detected plaques was the cavernous segment. Regarding stenosis, there were significantly more nonobstructive than obstructive stenosis (91% vs. 9%, p < 0.001). CONCLUSION: DSCTA detected a high prevalence of plaques in patients with symptomatic type 2 DM. A relatively high proportion of plaques were noncalcified, as well as with nonobstructive stenosis. The distribution of plaques was extensive, with the cavernous portion of ICA being the most common site.

A new method to classify pathologic grades of astrocytomas based on magnetic resonance imaging appearances.

BACKGROUND: Astrocytoma is the most common neuroepithelial neoplasm, and its grading greatly affects treatment and prognosis. OBJECTIVE: According to relevant factors of astrocytoma, this study developed a support vector machine (SVM) model to predict the astrocytoma grades and compared the SVM prediction with the clinician's diagnostic performance. PATIENTS AND METHODS: Patients were recruited from a cohort of astrocytoma patients in our hospital between January 2008 and April 2009. Among all astrocytoma patients, nine had grade I, 25 had grade II, 12 had grade III, and 60 had grade IV astrocytoma. An SVM model was constructed using radial basis kernel. The SVM model was trained with nine magnetic resonance (MR) features and one clinical parameter by fivefold cross-validation and differentiated astrocytomas of grades I-IV at two levels, respectively. The clinician also predicted the grade of astrocytoma. According to the two prediction methods above, the areas under receiving operating characteristics (ROC) curves to discriminate low- and high-grade groups, accuracies of high-grade grouping, overall accuracy, and overall kappa values were compared. RESULTS: For SVM, the overall accuracy was 0.821 and the overall kappa value was 0.679; for clinicians, the overall accuracy was 0.651 and the overall kappa value was 0.466. The diagnostic performance of SVM is significantly better than clinician performance, with the exception of the low-grade group. CONCLUSIONS: The SVM model can provide useful information to help clinicians improve diagnostic performance when predicting astrocytoma grade based on MR images.

[CT and MRI features of diseases involving masticator spaces].

OBJECTIVE: This is a study on the CT and MRI features of diseases involving the masticator spaces; the purpose is to improve the diagnostic accuracy. METHODS: Fifty-seven cases involving the masticator spaces were collected, among which, 11 cases were originated from the masticator space, another 46 cases were secondary invasion from the adjacent structures, including 18 cases from the buccal mucosa, 10 from the nasopharynx, 5 from the gingiva, 3 from the parotid gland, 6 from the maxillary sinus, 1 from the intracranial location, 2 from the palate and 1 from the orbit. The CT and MRI features of the masticator space involvement were analysed. RESULTS: Masticator space involvement is visualized on CT and MRI as effacement of the fat plane, swelling of the masticatory muscles, and erosion of the mandibular ramus. Disease from surrounding structures can invade the masticator space via the pterygopalatine fossa, the buccal space immediately anterior to the ramus, the foramen ovale, or by way of direct invasion. CONCLUSION: Masticator space involvement is not uncommon in the maxillofacial diseases, which must be noticed in the imaging diagnosis.