No abstract

The radiologic appearances of 70 lunotriquetral coalitions in 52 patients were evaluated to determine whether a wide scapholunate joint space in subjects with this congenital abnormality reflects a scapholunate ligament disruption or is a normal variant. When the middle of the scapholunate joint space was larger than the capitolunate or third carpometacarpal joint space widths, it was considered to be abnormally wide. In 32 of 70 wrists (46%), a wide scapholunate joint space was detected. Results of instability radiographic series (n = 28) and arthrography (n = 11) were normal with respect to the scapholunate ligament in all cases, but the scapholunate joint space was markedly widened in six cases (55%) in which arthrography was performed. Arthroscopy, performed in one case, showed an intact scapholunate ligament. Because of the high prevalence of a wide scapholunate joint space and because of negative arthrographic and arthroscopic examinations, the authors conclude that widening of the scapholunate joint space is a normal variant that is common in patients with lunotriquetral coalition.

We evaluated in a retrospective study the therapeutic relevance of thoracic and abdominal CT examinations on 157 intensive-care patients with previously inconclusive radiological examinations. Indications for CT were sepsis (n = 105), rarely a decrease in haematocrit (n = 30), multiorgan failure (n = 16) or suspected aortic aneurysm (n = 6). In 83.4% of examinations CT detected clinically relevant features, in 44.3% positive CT studies resulted in invasive therapy within 72 hours and therefore changed patient management decisively. Our results justify the use of CT, enabling if necessary an on-target intervention, the advantages outweighing the inherent risks if the patient is exposed to the relatively small risk of being temporarily removed from the intensive-care unit for immediate invasive treatment.

Fifty-two intensive care unit (ICU) patients with clinical signs of sepsis who were considered to be at extremely high risk for operation were subjected to CT-guided interventions. Bedside ultrasound (US) had been performed prior to CT in all patients but diagnoses were equivocal or US-guided interventions had failed. Nineteen patients solely underwent CT-guided diagnostic aspiration of fluid collec tions to rule out infection. Eighteen patients (72%) with abscess formations after surgery or trauma were cured by catheter drainage alone; 4 patients required additional surgery. Out of 8 patients suffering from acute pancreatitis (after several necrosectomies), abs cesses could be cured in 5 (62.5%). Three patients with acute necrotizing pancreatitis (no surgery) were not cured by the interventional procedure and all required surgical debridement. Even patients who required additional surgery after drainage improved clinically after the interventional radiologie procedure. Our overall success rate was 64%, emphasizing the need for CT in the case of equivocal US results or if US-guided procedures have failed in ICU patients with signs of sepsis.

In this prospective study, we determined the value of MR as an imaging technique in diagnosis and therapy with the option of simultaneous assessment of bone and soft tissue. 20 patients with clinical diagnosis of reflex sympathetic dystrophy syndrome (RSDS) and positive results in radiogram and three-phase radionuclide bone scanning were examined by MR, using T1- and T2-weighted images before and after Gadolinium-DTPA i.v. Soft tissue and bone signal intensity changes can be classified in our diagnostic-therapeutic scheme and proven by histopathological changes. The differentiation between clinical stages is possible and allows an evaluation of course and therapy. The higher costs are justified by shorter examination time without using radiation.