Marcel O. Philipp

Radiological emergency room management with emphasis on multidetector-row CT

Trauma is the fifth leading cause of death after disease of the cardiovascular system, malignomas and disease of the respiratory and digestive system. The management of severely injured patients, including radiological imaging, is a matter of ongoing development. In particular, as for the imaging modalities, multidetector-row CT represents a substantial refinement in the diagnostic work-up of multitrauma patients. Sufficient therapy within the first hour after trauma increases the patients chances for survival significantly. Thus, therapeutic procedures and diagnostic evaluation have to be concomitant events, performed by a multidisciplinary team, namely trauma surgeon, anesthesiologist and, last but not least, radiologist. The increased performance of multidetector-row CT leads to increased spatial resolution, which is a prerequisite for sophisticated two- and three-dimensional postprocessing. The increased volume coverage speed allows for comprehensive whole-body CT at still high levels of spatial resolution, resulting in significant spare of time which influences patients survival. Using this technique conventional imaging such as plane film or angiography may be omitted.

Three-dimensional volume rendering of multidetector-row CT data: applicable for emergency radiology.

Multidetector-row computed tomography (MD-CT) not only creates new opportunities but also challenges for medical imaging. Isotropic imaging allows in-depth views into anatomy and disease but the concomitant dramatic increase of image data requires new approaches to visualize, analyze and store CT data. The common diagnostic reviewing process slice by slice becomes more and more time consuming as the number of slice increases, while on the other hand CT volume data sets could be used for three-dimensional visualization. These techniques allow for comprehensive interpretation of extent of fracture, amount of dislocation and fragmentation in a three-dimensional highly detailed setting. Further more, using minimal invasive techniques like CT angiography, new opportunities for fast emergency room patients work up arise. But the most common application is still trauma of the musculoskeletal system as well as face and head. The following is a brief review of recent literature on volume rendering technique and some exemplary applications for the emergency room.

Imaging of the scrotum in children.

Clinical examination of the scrotum is difficult due to the small size of the testes and the epididymis in infants and young children, and eliciting patients’ history is challenging. Therefore imaging of the scrotum in childhood bears great importance. Ultrasound is the standard imaging technique of choice providing the clinicians with a definitive diagnosis in most cases. However, in conditions of testicular torsion and epididymo-orchitis—the most common differential diagnosis of scrotal pain—ultrasound findings can be inconclusive and further evaluation is required. Since there is a large overlap between paediatric and adult pathology, differences from adults in anatomy and pathology must be considered when evaluating the paediatric scrotum.

First experiences with multidetector CT in traumatized children

INTRODUCTION The aim of this study was to describe and discuss first experiences with multidetector CT (MDCT) in the assessment of traumatized children. MATERIAL AND METHODS Since the implementation of a MDCT scanner in April 2002, 85 children (31 girls, 54 boys with a mean age of 9.2 years) consecutively underwent MDCT (Siemens, Erlangen, Germany) with different protocols depending on age, weight, trauma mechanism and clinical presentation. In all patients in whom pathology was suspected, multiplanar reformations (MPR) in coronal and or sagittal orientation was performed. Examinations were evaluated by two radiologists retrospectively and in consensus. RESULTS In 55 (65%) children, a MDCT solely of the head was performed, in 46 there was no pathology found. In six (7%), head and facial bones were scanned. Head and abdomen was examined in two (2%), in two (2%) the abdomen only and in one (1%) the pelvis solely. Scans of the spine were obtained in seven (8%) children. A thorax and abdomen examination only was obtained in one (1%) child each. In 11 (13%) children, a polytrauma protocol was performed. In all patients, the time of examination did not exceed 17 min, including setup time. All children survived at the writing of this report. CONCLUSION MDCT was promising in the management of traumatized children and seems to shorten the necessary time to reach diagnosis and to initiate life-saving treatment.

Role of Doppler Sonography in the Evaluation of Accessory Spleens After Splenectomy

Splenectomy influences the Doppler blood flow pattern in the splenic artery. Blood flow in this vessel might return to normal if an accessory spleen increases in size after splenectomy. Our objective was to evaluate the resistive index of the splenic artery depending on the presence or absence of a hypertrophic accessory spleen in splenectomized patients.

Staging muskuloskeletaler Tumoren in der Bildgebung

ZusammenfassungDas Staging primärer maligner Knochen- und Weichteiltumoren erfordert zur optimalen Therapieplanung die Anwendung vereinheitlichter Stagingsysteme. Die gebräuchlichen Stagingsysteme der American Joint Commission for Cancer, das System nach Enneking und das Hajdu-System werden im Hinblick auf die radiologischen Unterscheidungskriterien beschrieben. Das Nativröntgen kann bei Knochentumoren die biologische Aggressivität einer Läsion einschätzen und oft die Differentialdiagnose einengen. Die Computertomographie hat die größte Sensitivität in der Darstellung der Kompaktadestruktion und von verkalkten Periostreaktionen sowie in der Detektion von Fernmetastasen. Die Angiographie wird heute primär bei vaskulären Tumoren zur Planung und Durchführung interventioneller Eingriffe eingesetzt. Bei Knochen- und Weichteiltumoren ist die Magnetresonanztomographie die Methode der Wahl zum Staging des intra- und extramedullären Tumoranteils, in der Abgrenzung der befallenen Kompartments, Darstellung eines Gelenksbefalles und in der Tumorbeziehung zum Gefäß/Nervenbündel. Nach Kontrastmittelapplikation kann die Art des Enhancements weitere Informationen für das Staging liefern. Die konsequente Anwendung eines Stagingsystems auch von Seiten der Bildgebung kann eine extremitätenerhaltende Therapie öfter ermöglichen und die Prognose der Erkrankung verbessern.SummaryThe staging of primary malignant bone and soft tissue tumors requires adherence to a unified staging system. The staging system of the American Joint Commission for Cancer, the Enneking system, and the Hajdu system are described in respect of the radiologic staging criteria. Plain film radiography can estimate the biological aggressiveness of a bone tumor and in many cases narrow the differential diagnosis. Computed tomography is most sensitive in depicting cortical erosions and calcified periosteal reactions as well as in screening for distant metastasis. Angiography is mainly employed for vascular tumors and for the monitoring of interventional procedures such as tumor embolization. For both bone and soft tissue tumors, magnetic resonance tomography is the method of choice for the staging of intra- and extramedullary tumor extension, for the differentiation of neighboring compartments, and in the detection of invasion of the regional neurovascular bundle. After administration of contrast agents, the mode of enhancement gives further information on the nature of the tumor. With consistent application of the staging criteria in preoperative imaging, limb-saving therapy can be employed more often and the prognosis of the disease can be improved.

Acute osseous traumatic lesions of the shoulder girdle

ZusammenfassungVerletzungen des Schultergürtels sind häufig und ereignen sich von der Geburt bis in das hohe Alter. Dabei ändern sich in Abhängigkeit zum Alter des Patienten Lokalisation und Art der Verletzung. Die Diagnose einer akuten traumatischen ossären Schulterläsion kann zumeist auf Basis der Anamnese und einer exakten klinischen Untersuchung sowie mit Hilfe konventioneller Röntgenbilder gestellt werden und erfordert nur in bestimmten Fällen weiterführende bildgebende Methoden. Basis jeder bildgebenden Abklärung traumatischer Schulterläsionen ist die so genannte Traumaserie, die aus zumindest 2–3 Aufnahmen in unterschiedlichen Ebenen, anteriorposterior (Grashey-Aufnahme), lateral (Y-Aufnahme) sowie axillär, besteht. Wesentlich ist die weitgehend überlagerungsfreie Darstellung aller Komponenten des Schultergelenks. Die Kenntnis der gängigen klinischen Klassifikationssysteme ist unerlässlich für eine adäquate Befunderstellung, auf deren Basis die Entscheidung bzgl. eines konservativen oder operativen Vorgehens getroffen wird.AbstractTraumatic injuries to the shoulder girdle are common lesions and occur from birth on through the whole life. Depending on the patient’s age, localization and type of injury change. Diagnosis of acute osseous traumatic lesions to the shoulder is based on evaluation of trauma mechanism, patient’s examination and, as for the most cases, conventional radiographs. Only in certain cases additional radiological examinations are necessary. As a minimum, two to three images in different planes, anteriorposterior, lateral and axillary, are recommended in order to display all components of the shoulder girdle without superposition. Knowledge of common clinical classifications systems is necessary for exact diagnosis in order to permit decision on conservative or operative treatment of injury.

Das akute ossre Trauma des Schultergrtels@@@Acute osseous traumatic lesions of the shoulder girdle

ZusammenfassungVerletzungen des Schultergürtels sind häufig und ereignen sich von der Geburt bis in das hohe Alter. Dabei ändern sich in Abhängigkeit zum Alter des Patienten Lokalisation und Art der Verletzung. Die Diagnose einer akuten traumatischen ossären Schulterläsion kann zumeist auf Basis der Anamnese und einer exakten klinischen Untersuchung sowie mit Hilfe konventioneller Röntgenbilder gestellt werden und erfordert nur in bestimmten Fällen weiterführende bildgebende Methoden. Basis jeder bildgebenden Abklärung traumatischer Schulterläsionen ist die so genannte Traumaserie, die aus zumindest 2–3 Aufnahmen in unterschiedlichen Ebenen, anteriorposterior (Grashey-Aufnahme), lateral (Y-Aufnahme) sowie axillär, besteht. Wesentlich ist die weitgehend überlagerungsfreie Darstellung aller Komponenten des Schultergelenks. Die Kenntnis der gängigen klinischen Klassifikationssysteme ist unerlässlich für eine adäquate Befunderstellung, auf deren Basis die Entscheidung bzgl. eines konservativen oder operativen Vorgehens getroffen wird.AbstractTraumatic injuries to the shoulder girdle are common lesions and occur from birth on through the whole life. Depending on the patient’s age, localization and type of injury change. Diagnosis of acute osseous traumatic lesions to the shoulder is based on evaluation of trauma mechanism, patient’s examination and, as for the most cases, conventional radiographs. Only in certain cases additional radiological examinations are necessary. As a minimum, two to three images in different planes, anteriorposterior, lateral and axillary, are recommended in order to display all components of the shoulder girdle without superposition. Knowledge of common clinical classifications systems is necessary for exact diagnosis in order to permit decision on conservative or operative treatment of injury.

Das akute ossäre Trauma des Schultergürtels

ZusammenfassungVerletzungen des Schultergürtels sind häufig und ereignen sich von der Geburt bis in das hohe Alter. Dabei ändern sich in Abhängigkeit zum Alter des Patienten Lokalisation und Art der Verletzung. Die Diagnose einer akuten traumatischen ossären Schulterläsion kann zumeist auf Basis der Anamnese und einer exakten klinischen Untersuchung sowie mit Hilfe konventioneller Röntgenbilder gestellt werden und erfordert nur in bestimmten Fällen weiterführende bildgebende Methoden. Basis jeder bildgebenden Abklärung traumatischer Schulterläsionen ist die so genannte Traumaserie, die aus zumindest 2–3 Aufnahmen in unterschiedlichen Ebenen, anteriorposterior (Grashey-Aufnahme), lateral (Y-Aufnahme) sowie axillär, besteht. Wesentlich ist die weitgehend überlagerungsfreie Darstellung aller Komponenten des Schultergelenks. Die Kenntnis der gängigen klinischen Klassifikationssysteme ist unerlässlich für eine adäquate Befunderstellung, auf deren Basis die Entscheidung bzgl. eines konservativen oder operativen Vorgehens getroffen wird.AbstractTraumatic injuries to the shoulder girdle are common lesions and occur from birth on through the whole life. Depending on the patient’s age, localization and type of injury change. Diagnosis of acute osseous traumatic lesions to the shoulder is based on evaluation of trauma mechanism, patient’s examination and, as for the most cases, conventional radiographs. Only in certain cases additional radiological examinations are necessary. As a minimum, two to three images in different planes, anteriorposterior, lateral and axillary, are recommended in order to display all components of the shoulder girdle without superposition. Knowledge of common clinical classifications systems is necessary for exact diagnosis in order to permit decision on conservative or operative treatment of injury.