Pain, weakness, and sensory loss occur frequently in the hypothenar eminence. However, clinical examination is difficult and nonspecific, and the prescribed imaging technique may be inadequate, or images may be misinterpreted. Different imaging modalities have various degrees of usefulness for the diagnosis of painful pathologic conditions of the hypothenar eminence. Radiography, multidetector computed tomography (CT), multidetector CT arthrography, and magnetic resonance (MR) imaging of the wrist are useful for surveying the anatomy of the hypothenar eminence, the Guyon canal, and the ulnar nerve and artery and for determining the cause of pain or other symptoms. A fracture of the pisiform bone or the hook of the hamate bone, osteoarthritis or osteochondromatosis of the pisotriquetral joint, Guyon canal syndrome, hypothenar hammer syndrome, tendinopathy of the flexor carpi ulnaris, an anomalous muscle, a ganglion cyst, or a tumor may be responsible for ulnar neuropathy. Specific radiographic views, such as the semisupinated oblique view and the lateral view with the hand radially deviated and the thumb abducted, often provide a sufficient basis for the diagnosis of acute fracture of the hook of the hamate or the pisiform bone. Multidetector CT angiography is an efficient method for diagnosing hypothenar hammer syndrome, and multidetector CT arthrography is well suited for evaluation of the pisotriquetral joint. MR imaging is the modality of choice for depiction of the ulnar nerve.
In MDCT, reducing the amount of contrast medium does not affect aortic enhancement in the early arterial phase but decreases hepatic enhancement at the portal phase. The saline chaser technique had no influence on the phases studied. Greater than 1.5 mL/kg reduction in the dose of contrast medium followed by saline flushing may not be advisable for liver CT in low- and medium-weight patients.
• Motion artefacts can hamper the quality and interpretation of dynamic joint studies • The recommendations presented here help increase image quality • Patient training and preparation can be improved • The artefact-free distance concept helps protocol adaptation and comparison.
Purpose:To compare multidetector CT scan (MDCT) results with intraoperative findings in the detection of an inferior-pole pedicle crossing the ureteropelvic junction.Patients and Methods: Over the 2-year study period, 35 patients receiving laparoscopic pyeloplasty underwent preoperative investigation with a novel MDCT protocol in order to detect crossing vessels. Postprocessing, including maximum intensity projection, volume-rendering technique, and multiplanar reconstruction, was used in addition to standard axial views.Results: All the arteries found during laparoscopic surgery were detected by MDCT, but one radiologic false-positive was noted at the beginning of the series. Seven veins were not detected with MDCT. In the only case featuring an isolated inferior-pole vein, the aberrant vessel was identified by MDCT.Conclusion: Multidetector CT scanning is a highly accurate way of providing all the information necessary preoperatively concerning renal parenchymal anomalies, urinary stones, and collecting system and vessel anatomy. It helps physicians make appropriate therapeutic decisions and gives surgeons information about what they can expect during laparoscopic procedures.
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