Purpose: To evaluate time efficiency, radiation dose, precision and complications of percutaneous iliosacral screw placement under CT-guidance in local anaesthesia. Material and Methods: Retrospective analysis of 143 interventions in 135 patients during a period of 42 months. Implant failures could be evaluated in 85/182 screws and bony healing or refracturing in 46/182 screws. Results: A total of 182 iliosacral screw placements in 179 vertical sacral fractures (105 unilateral, 37 bilateral) took place in 135 patients. 166/179 of the sacral fractures were detected in Denis zone 1,?10 in Denis zone 2 and 3 in Denis zone 3. No screw misplacements including the simultaneous bilateral procedures were noted. The average time for a unilateral screw placement was 23 minutes (range: 14???52 minutes) and 35 minutes (range: 21???60 minutes) for simultaneous bilateral screwing. The dose length product was 365 mGy???cm (range: 162???1014 mGy???cm) for the unilateral and 470mGy???cm (range: 270???1271 mGy???cm) for the bilateral procedure. 1 gluteal bleeding occurred as the only acute minor complication (0.7?%). Fracture healing was verified with follow-up CTs in 42/46 sacral fractures after screw placement. Backing out occurred in 12/85 screws between 6 and 69 days after intervention. In 8 patients contralateral stress fractures were detected after unilateral screw placement between day 10 and 127 (average: 48 days). Conclusion: CT-guided iliosacral screw placement in sacral fractures is a safe tool providing a very high precision. The radiation dose is in the order of a diagnostic CT of the pelvis for both unilateral and bilateral screws. Contralateral stress fractures in unilateral screw placements have to be considered during the first weeks after intervention. Key Points: ??Sacral fractures are frequent in the elderly and are often only detected in CT or MRI. ??CT-guided screw placement is a precise and time-efficient procedure in non-dislocated vertical fractures of the sacral wings. ??Contralateral stress fractures may occur after unilateral screw placements. Citation Format: ??Reuther G, R?hner U, Will T et?al. CT-Guided Screw Fixation of Vertical Sacral Fractures in Local Anaesthesia Using a Standard CT . Fortschr R?ntgenstr 2014; 186: 1???6
Single-shot MR cholangiography may replace intravenous cholangiography for visualization of the biliary tract. However, the delineation of tiny gallbladder calculi and shrunken gallbladders with thickened bile is limited.
The purpose of this study was to evaluate detection of urinary tract dilatation, depiction of obstruction level and determination of cause with single-shot MR imaging in an acquisition time of 2.8 s. Heavily T2-weighted single-shot MR images in 50 patients with ureterohydronephrosis as suspected by ultrasound were prospectively compared with IV urography and clinical outcome. Imaging techniques were obtained within a maximum time interval of 4 h and assessed independently on the same day. Single-shot MR urography was able to demonstrate dilatation and obstruction levels in 96 % of urinary tracts in accordance with X-ray urograms. In 4 patients with a unilaterally negative IV urogram, obstruction levels were demonstrated in single-shot MR urography. Single-shot MR urography did not depict 2 of 7 collecting systems with mild dilatation and contralateral undilated ureters were not adequately visible. Single-shot MR urography consistently visualizes dilated urinary tracts and obstruction levels in moderate and severe dilatation. Single-shot MR urography may be an alternative for IV urography in cases of renal impairment, when iodinated contrast or the application of X-rays is contraindicated, and may help in avoiding direct ureteropyelography. Single-shot MR urography rarely allows determination of the cause of urinary tract dilatation.
A 2 1/2-year prospective study of surgically treated malignant mesenchymal neoplasms showed magnetic resonance imaging (MRI) to be superior to computed tomography (CT) in sensitivity for local recurrent disease measuring less than 15 cm3. Larger masses were detected with similar sensitivity; specificity and predictive values did not differ. The presence of areas of high signal intensity on T2-weighted images proved to be a reliable criterion except in fibrous neoplasms. However, differentiation between non-hemorrhagic fluid collections, cross-sectioned veins or bowel contents and small tumor nodules cannot be made simply by signal intensity, but has to be based upon the evaluation of gross morphologic criteria.
Renal allograft recipients were routinely monitored by means of duplex Doppler ultrasound. In a 20-month survey period, four instances of acute renal vein thrombosis were detected among 75 patients. All episodes occurred within the first 3 postoperative days. The examinations disclosed peaked, abruptly dropping systolic frequency shifts and retrograde plateaulike frequency shifts during diastole at the level of the main renal artery and its proximal branches. A venous Doppler signal could not be recorded. The findings are interpreted as indicating renal impedance exceeding diastolic pressure with nonpropulsive blood flow within the arterial vasculature.
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