V. Metz

Open Meniscal Repair: Clinical and Magnetic Resonance Imaging Findings After Twelve Years

The purpose of this study was to document the long-term clinical, radiographic, and magnetic resonance imaging results after open meniscal repair. Twenty-two patients, with 23 open meniscal repairs, were evaluated after a mean follow-up of 12.9 years using patient history, physical examination, KT-1000 arthrometer testing, the “Orthopaedische Arbeitsgemeinschaft Knie” knee evaluation scheme, Tegner activity score, weightbearing radiographs, and magnetic resonance imaging. Two of the 22 patients had retears and both occurred in unstable knees. Radiographs revealed no degenerative changes in 17 of the 23 compartments. Grade III and IV signal alterations were present on magnetic resonance imaging scans in more than 50% of the repaired menisci. We concluded that the long-term survival rate of repaired menisci was 91%, and that magnetic resonance imaging is unsuitable for diagnosis of the healing process of a repaired meniscus.

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.

Ligamentous instabilities of the wrist

Carpal ligament instabilities are conditions in which the individual carpal bones have become unstable due to abnormal ligament support. Early diagnosis of ligamentous wrist instabilities is important because late diagnosis or failed diagnosis may lead to severe complications such as osteoarthritis. This article reviews the most common ligamentous instability patterns of the wrist and focuses on how to perform and obtain radiograms which will allow reliable diagnosis of wrist instabilities.

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.

Intraoperative and early postoperative colour Doppler sonography after carotid artery reconstruction: follow-up of technical defects

Abstract We studied 50 patients with intraoperative colour-coded Doppler sonography (CCDS) after carotid artery reconstruction. Technical defects could be detected in 19 cases (38 %): residual plaques in 9, flaps in 8 and strictures in 2. In 9 cases (18 %) the carotid endarterectomy was revised. One residual plaque and one residual stricture caused thrombosis at the operative site a few hours postoperatively. One of the patients with residual plaques developed a high-grade stenosis within the follow-up period. Of the patients with residual plaques two had a medium-grade stenosis at follow-up. Six flaps decreased in size or disappeared within 1 week after operation. No patient with a flap developed a stenosis within the follow-up period. Our findings seem to indicate that correction of intimal flaps less than 10 mm in size is not necessary.

Emergency radiology with particular emphasis of radiology in trauma

Trauma is a major cause of death and morbidity throughout the world. Radiology plays a key-role for both, the primary diagnostic work-up, and the secondary assessment of potential treatment. In addition, especially with respect to the increased availability of multidetector-row Computed Tomography, radiological management of severely injured patients is a matter of ongoing development. A close cooperation between the multiple involved medical disciplines is mandatory. The radiologist should be familiar with of what the trauma surgeon needs to know for optimal treatment. This implies that the radiologist plays a key-role in trauma management, not only responsible in establishing an accurate diagnosis, but moreover in guiding the clinician through the different imaging modalities to optimise patients management. Evidence-based approach in imaging trauma patients is a major job of the trauma radiologist in general and in different patient populations such as children, adults, and elderly. Finally, optimised imaging protocols and the refinement of different post processing algorithms, including multiplanar reformations and volume rendering techniques, not only creates new opportunities but also is a challenge for trauma imaging. This issue is designed to give an overview of radiological procedures and diagnostic approaches in several common injuries. We especially want to thank the authors and their coworkers for their valuable contribution for this special issue of European Journal of Radiology and for sharing their expertise with us.

Retrieval of Adherent, Centrally Embolized Foreign Bodies: Common and Advanced Methods

Percutaneous removal of centrally embolized foreign bodies left in situ is of utmost importance because of the high mortality. With the usual meth ods, however, removal is possible only if one end of the embolizate is freely accessible. In this report the authors present the common tech niques and a new method permitting the shifting of fixed foreign bodies into a position where they may be grasped and removed by snare or Dormia basket.

[The value of different clinical and imaging procedures for the postoperative follow-up of extra-anatomical bypasses].

In order to judge the patency of extra-anatomical by-passes in the lower extremities, 24 patients with 29 by-passes were examined clinically (palpation of the by-pass pulse, Fontaine staging, Doppler index) and by imaging methods (i-v DSA, Duplex sonography, colour-coded Doppler sonography). The value of these methods was compared. Sonography was found to be the ideal method for follow-up. Palpation was unreliable, particularly for femoro-femoral by-passes. The Doppler index and the Fontaine method provided no information about the actual state of the bypass. Angiography is indicated only if further vascular reconstruction is planned.

Chest Radiograph in the Acute Traumatic Rupture of the Aorta

The authors tried to determine the validity of sixteen well-known signs indicating an acute traumatic rup ture of the aorta on plain chest radio graphs of 22 patients. Angiograph ically 11 of the patients had a tear at the aortic isthmus. It turned out that seven of the sixteen signs (widened mediastinum, loss of the aortic knob contour, opacification of the aorto- pulmonary window, bulging of the vascular pedicle predominantly to the left, left apical cap, depression of the left main stem bronchus, and dis placement of the right paraspinous interspace) are of great diagnostic value.