The importance of fluoroscopy as an imaging modality has been minimized relative to other cross-sectional modalities,including high-resolution computed tomography(CT),magnetic resonance imaging(MRI)and ultrasound.Fluo...The importance of fluoroscopy as an imaging modality has been minimized relative to other cross-sectional modalities,including high-resolution computed tomography(CT),magnetic resonance imaging(MRI)and ultrasound.Fluoroscopy examinations have decreased in clinical practice due to reduced appreciation of its usefulness,insufficient training of residents,fewer staff with adequate expertise,and poor reimbursements relative to other modalities.We revisit and build upon the prior literature and history of this decreased utilization.We then seek to prove continued value,through categorized examples and within multiple subspecialties,wherein fluoroscopy plays an integral part toward clinical diagnoses as well as optimizing patient outcomes.This is particularly true for motility and esophageal disorders,where structure and function with real-time evaluation is essential.We additionally show several post-operative cases where the synergy of fluoroscopy with CT and endoscopy is apparent.The fluoroscopic radiologist also has the unique ability to vary patient positioning,as opposed to traditional CT or MRI,where orthogonal views are employed without positional or temporal changes.We turn attention to the modern era,with synergistic and novel cases demonstrating that fluoroscopy remains instrumental toward achieving a diagnosis alongside other modalities.Our cases stress the need to maintain expertise in fluoroscopy skill,and underline its continued importance in residency training programs.We conclude that fluoroscopy is a relatively inexpensive modality that is often under-appreciated in diagnostic radiology.We suggest that competency in fluoroscopy is crucial for future generations of radiologists to both work with their peers,as well as to aid clinicians in the optimal treatment of patients.展开更多
Objective:To examine the relationship between changes in lumbar spine facet joint(FJ)orientation and chronic low back pain(CLBP).Methods:We retrospectively analyzed lumbar spine CT and MRI images of 98 patients referr...Objective:To examine the relationship between changes in lumbar spine facet joint(FJ)orientation and chronic low back pain(CLBP).Methods:We retrospectively analyzed lumbar spine CT and MRI images of 98 patients referred for localized paraspinal CLBP and 98 age-and sex-matched asymptomatic individuals as controls.They were divided into four age groups(A,<40;B,41-50;C,51-60;D,61-70;and E,71-80 years old,respectively).FJ orientations were evaluated at the L3-4,L4-5,and L5-S1 lumbar levels.Results:FJ angle showed a statistically significant more sagittal orientation in CLBP patients than in control groups in lower lumbar spine segments.The overall mean FJ angles in CLBP groups including all age groups combined at L3-4,L4-5,and L5-S1 levels were 32.33±4.5,36.11±2.9,and 37.4±6.1,degrees,respectively.The FJ angles in control group for all ages were 32.21±3.7,38.01±4.6,and 40.18±6.8°,respectively.The differences in FJ angle were statistically significant at both L4-5 and L5-S1 levels between the control and the CLBP groups(p<0.01).The FJ orientation from upper lumbar spine to lumbar sacral junction demonstrated a gradual more coronal orientation transition in all subjects but this trend was significantly less in CLBP patients.The mean FJ angles for the control group at age groups A,B,C,D,and E were 33.52±3.8,35.7±4.5,38.25±2.4,35.49±4.1,and 38.13±5.8,respectively,while those in the CLBP groups were 35.63±2.4,35.26±3.6,35.99±5.1,35.3±4.3,and 35.17±6.7,respectively.Conclusion:There is a significant association between a more sagittal FJ orientation and facetogenic CLBP in lower lumbar vertebral levels.There is also age-dependent decrease in FJ orientation in sagittal plane at lower lumbar spinal levels in control as well as CLBP groups,however,this decrease in the CLBP groups was significantly more pronounced.Whether this change was an adaptive remodeling or alterations associated with chronic FJ osteoarthropathy should warrant further longitudinal studies.展开更多
Purpose:To explore the advantages of differentiating inflammatory from malignant thoracic lymph nodes by integrating their features onpositron emission tomography(PET)and computed tomography(CT).Material and method:Fo...Purpose:To explore the advantages of differentiating inflammatory from malignant thoracic lymph nodes by integrating their features onpositron emission tomography(PET)and computed tomography(CT).Material and method:Following institutional review board approval,PET and CT parameters of thoracic lymph nodes were examined based ontheir pathologic diagnosis via endobronchial ultrasound-guided transbronchial needle aspiration.The standardized uptake value(SUV)of PETand CT findings of the long-and short-axis diameters,axial short to long diameter ratios(S/L),and measured nodal CT values of the lymphnodes were compared and analyzed statistically.Results:A total of 124 lymph nodes from 70 patients were studied.The inflammatory and malignant lymph nodes differed significantly in theirSUV(P=0.008),short-axis diameters(SAD,p<0.001),long-axis diameters(LAD,p=0.002)and S/L ratios(p<0.001).They did not differsignificantly in non-contrast enhanced CT values(p=0.304).The sensitivities,specificities,positive predictive values,negative predictivevalues,diagnostic accuracies and diagnostic odds ratios(DOR)were:1)elevated SUV alone-95.31%(61/64),20%(12/60),55.96%(61/109),80%(12/15),58.87%(73/124),and 5;2)combined SUV+SAD-89.06%,53.33%,67.06%,82.05%,71.77%,and 9.31;3)combined SUV+S/L ratio-87.5%,93.33%,93.33%,87.5%,90.32%,and 98,respectively.Conclusion:Increased SUV,SAD,LAD,and S/L ratio are accurate PET/CT parameters to characterize inflammatory or malignant lymph nodes.SUV has high sensitivity but low specificity,low positive and negative predictive values,and low DOR.The SUV+SAD and SUV+S/L ratioshave higher specificity,positive and negative predictive values,diagnostic accuracy and DOR.展开更多
Background:The clinical outcome of spinal epidural abscess(SEA)can deteriorate rapidly especially in immune-compromised patient.Awareness of all possible causes is key to expeditious diagnosis and treatment of SEA.Pur...Background:The clinical outcome of spinal epidural abscess(SEA)can deteriorate rapidly especially in immune-compromised patient.Awareness of all possible causes is key to expeditious diagnosis and treatment of SEA.Purpose:To report and analyze the imaging and clinical presentations characterizing an uncommon cause of SEA due to direct extension of intra-thoracic infections in immune compromised patients.Methods:Medical histories and CT/MRI findings of 2 cases presented with intrathoracic infections with subsequent development of SEA and 1 case with pneumorrhachis were retrospectively analyzed.Further investigation into the anatomic pathways from intrathoracic cavities to epidural space was also carried out on a cadaver.Results:One case with advanced esophageal adenocarcinoma on systemic chemotherapy complicated with esophageal obstruction and perforation requiring stomach pull-through surgery.MRI showed direct connection of thoracic infection to cervical and thoracic SEA which was caused by GI tract Candida Albicans.One case with systemic lupus erythematosus(SLE)on immune suppression therapy developed thoracic empyema,which directly extended into thoracic epidural space.The third case of pneumorrhachis and cadaveric study demonstrated the pathway from paraspinal tissue to the spinal epidural space.Conclusions:Our data confirmed that the direct connections between thoracic and paraspinal compartments to spinal epidural space which could serve as a potential conduit to spread infections.It is likely more commonly occur in immune compromised patient.Its awareness should be raised to justify early spinal imaging in such patient groups even with only mild neurological symptoms.展开更多
文摘The importance of fluoroscopy as an imaging modality has been minimized relative to other cross-sectional modalities,including high-resolution computed tomography(CT),magnetic resonance imaging(MRI)and ultrasound.Fluoroscopy examinations have decreased in clinical practice due to reduced appreciation of its usefulness,insufficient training of residents,fewer staff with adequate expertise,and poor reimbursements relative to other modalities.We revisit and build upon the prior literature and history of this decreased utilization.We then seek to prove continued value,through categorized examples and within multiple subspecialties,wherein fluoroscopy plays an integral part toward clinical diagnoses as well as optimizing patient outcomes.This is particularly true for motility and esophageal disorders,where structure and function with real-time evaluation is essential.We additionally show several post-operative cases where the synergy of fluoroscopy with CT and endoscopy is apparent.The fluoroscopic radiologist also has the unique ability to vary patient positioning,as opposed to traditional CT or MRI,where orthogonal views are employed without positional or temporal changes.We turn attention to the modern era,with synergistic and novel cases demonstrating that fluoroscopy remains instrumental toward achieving a diagnosis alongside other modalities.Our cases stress the need to maintain expertise in fluoroscopy skill,and underline its continued importance in residency training programs.We conclude that fluoroscopy is a relatively inexpensive modality that is often under-appreciated in diagnostic radiology.We suggest that competency in fluoroscopy is crucial for future generations of radiologists to both work with their peers,as well as to aid clinicians in the optimal treatment of patients.
文摘Objective:To examine the relationship between changes in lumbar spine facet joint(FJ)orientation and chronic low back pain(CLBP).Methods:We retrospectively analyzed lumbar spine CT and MRI images of 98 patients referred for localized paraspinal CLBP and 98 age-and sex-matched asymptomatic individuals as controls.They were divided into four age groups(A,<40;B,41-50;C,51-60;D,61-70;and E,71-80 years old,respectively).FJ orientations were evaluated at the L3-4,L4-5,and L5-S1 lumbar levels.Results:FJ angle showed a statistically significant more sagittal orientation in CLBP patients than in control groups in lower lumbar spine segments.The overall mean FJ angles in CLBP groups including all age groups combined at L3-4,L4-5,and L5-S1 levels were 32.33±4.5,36.11±2.9,and 37.4±6.1,degrees,respectively.The FJ angles in control group for all ages were 32.21±3.7,38.01±4.6,and 40.18±6.8°,respectively.The differences in FJ angle were statistically significant at both L4-5 and L5-S1 levels between the control and the CLBP groups(p<0.01).The FJ orientation from upper lumbar spine to lumbar sacral junction demonstrated a gradual more coronal orientation transition in all subjects but this trend was significantly less in CLBP patients.The mean FJ angles for the control group at age groups A,B,C,D,and E were 33.52±3.8,35.7±4.5,38.25±2.4,35.49±4.1,and 38.13±5.8,respectively,while those in the CLBP groups were 35.63±2.4,35.26±3.6,35.99±5.1,35.3±4.3,and 35.17±6.7,respectively.Conclusion:There is a significant association between a more sagittal FJ orientation and facetogenic CLBP in lower lumbar vertebral levels.There is also age-dependent decrease in FJ orientation in sagittal plane at lower lumbar spinal levels in control as well as CLBP groups,however,this decrease in the CLBP groups was significantly more pronounced.Whether this change was an adaptive remodeling or alterations associated with chronic FJ osteoarthropathy should warrant further longitudinal studies.
文摘Purpose:To explore the advantages of differentiating inflammatory from malignant thoracic lymph nodes by integrating their features onpositron emission tomography(PET)and computed tomography(CT).Material and method:Following institutional review board approval,PET and CT parameters of thoracic lymph nodes were examined based ontheir pathologic diagnosis via endobronchial ultrasound-guided transbronchial needle aspiration.The standardized uptake value(SUV)of PETand CT findings of the long-and short-axis diameters,axial short to long diameter ratios(S/L),and measured nodal CT values of the lymphnodes were compared and analyzed statistically.Results:A total of 124 lymph nodes from 70 patients were studied.The inflammatory and malignant lymph nodes differed significantly in theirSUV(P=0.008),short-axis diameters(SAD,p<0.001),long-axis diameters(LAD,p=0.002)and S/L ratios(p<0.001).They did not differsignificantly in non-contrast enhanced CT values(p=0.304).The sensitivities,specificities,positive predictive values,negative predictivevalues,diagnostic accuracies and diagnostic odds ratios(DOR)were:1)elevated SUV alone-95.31%(61/64),20%(12/60),55.96%(61/109),80%(12/15),58.87%(73/124),and 5;2)combined SUV+SAD-89.06%,53.33%,67.06%,82.05%,71.77%,and 9.31;3)combined SUV+S/L ratio-87.5%,93.33%,93.33%,87.5%,90.32%,and 98,respectively.Conclusion:Increased SUV,SAD,LAD,and S/L ratio are accurate PET/CT parameters to characterize inflammatory or malignant lymph nodes.SUV has high sensitivity but low specificity,low positive and negative predictive values,and low DOR.The SUV+SAD and SUV+S/L ratioshave higher specificity,positive and negative predictive values,diagnostic accuracy and DOR.
文摘Background:The clinical outcome of spinal epidural abscess(SEA)can deteriorate rapidly especially in immune-compromised patient.Awareness of all possible causes is key to expeditious diagnosis and treatment of SEA.Purpose:To report and analyze the imaging and clinical presentations characterizing an uncommon cause of SEA due to direct extension of intra-thoracic infections in immune compromised patients.Methods:Medical histories and CT/MRI findings of 2 cases presented with intrathoracic infections with subsequent development of SEA and 1 case with pneumorrhachis were retrospectively analyzed.Further investigation into the anatomic pathways from intrathoracic cavities to epidural space was also carried out on a cadaver.Results:One case with advanced esophageal adenocarcinoma on systemic chemotherapy complicated with esophageal obstruction and perforation requiring stomach pull-through surgery.MRI showed direct connection of thoracic infection to cervical and thoracic SEA which was caused by GI tract Candida Albicans.One case with systemic lupus erythematosus(SLE)on immune suppression therapy developed thoracic empyema,which directly extended into thoracic epidural space.The third case of pneumorrhachis and cadaveric study demonstrated the pathway from paraspinal tissue to the spinal epidural space.Conclusions:Our data confirmed that the direct connections between thoracic and paraspinal compartments to spinal epidural space which could serve as a potential conduit to spread infections.It is likely more commonly occur in immune compromised patient.Its awareness should be raised to justify early spinal imaging in such patient groups even with only mild neurological symptoms.
