Various imaging techniques may be employed in the investigation of suspected bone and joint infections. These include ultrasound, radiography, functional imaging such as positron emission tomography (PET) and nuclear scintigraphy, and cross-sectional imaging, including computed tomography (CT) and magnetic resonance imaging (MRI). The cross-sectional modalities represent the imaging workhorse in routine practice. The role of imaging also extends to include assessment of the anatomical extent of infection, potentially associated complications, and treatment response. The imaging appearances of bone and joint infections are heterogeneous and depend on the duration of infection, an individual patient’s immune status, and virulence of culprit organisms. To add to the complexity of radiodiagnosis, one of the pitfalls of imaging musculoskeletal infection is the presence of other conditions that can share overlapping imaging features. This includes osteoarthritis, vasculopathy, inflammatory, and even neoplastic processes. Different pathologies may also coexist, for example, diabetic neuropathy and osteomyelitis. This pictorial review aims to highlight potential mimics of osteomyelitis and septic arthritis that are regularly encountered, with emphasis on specific imaging features that may aid the radiologist and clinician in distinguishing an infective from a noninfective aetiology.
Introduction
To optimize CT chest protocol by comparing venous contrast timing with arterial timing for contrast opacification in vessels, qualitative image quality and radiologists’ satisfaction and diagnostic confidence in assessing for potential nodal, pleural and pulmonary disease in general oncology outpatients.
Method
Matched case−control study performed following CT protocol update. 92 patients with a range of primary malignancies with 2 CT chests in a 2‐year period, one with an arterial phase protocol and the second in the 60 second venous phase, were included. Contrast attenuation in aorta, pulmonary artery and liver were measured. Subjective measurements assessed perivenous artefact, confidence in nodal pleural and pulmonary assessment and presence of pulmonary emboli. Statistical analysis was performed using paired and unpaired t‐tests.
Results
Venous‐phase CT demonstrated more consistent enhancement of the vessels, with higher attenuation of the nodes, pulmonary and pleural lesions. There was a significant reduction in perivenous beam hardening artefact on venous‐phase CT (P < 0.001). Diagnostic confidence was significantly higher for nodal assessment and pleural abnormality visibility (P < 0.001) and pleural assessment (P < 0.05). There was no significant difference in pulmonary mass visibility. There was adequate enhancement to diagnose significant pulmonary emboli (PE) with 4 incidental PEs detected on the venous phase, extending to segmental vessels.
Conclusion
Venous‐phase CT chest performs better than arterial‐phase on all fronts, without compromising assessment of incidental pulmonary emboli. When intravenous contrast is indicated in a routine chest CT (excluding a CT‐angiogram), the default timing should be a venous or 60s phase.
Abusive head trauma (AHT) is a significant cause of morbidity and mortality in the paediatric population, typically in children under the age of two years. Neuroimaging plays a key role in the diagnostic work up of these patients as information regarding the mechanism of injury is often lacking and the findings on examination can be nonspecific. A number of conditions, both traumatic and atraumatic can mimic AHT based on neuroimaging features alone. The repercussions associated with a diagnosis or misdiagnosis of AHT can be severe and radiologists therefore need to be aware of and familiar with the imaging differentials of AHT. In this paper we review the imaging findings of the radiological mimics of AHT and focus on features that can help differentiate these entities from AHT.
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