Diagnostic significance of the CT rim sign in cases of gangrenous cholecystitis

PURPOSE

To evaluate the association between the CT rim sign and gangrenous cholecystitis (GC) and increased surgical difficulty.

METHOD

Patients who had a contrast enhanced CT of the abdomen and pelvis, followed by non-elective cholecystectomy were analyzed. The scans were reviewed for the CT rim sign by radiologists blinded to the pathologic and clinical outcomes. Demographic and clinical characteristics were compared between patients with and without GC using t-tests or Wilcoxon ranked sum test for continuous variables, and Fishers' exact test for categorical variables, when appropriate. A logistic regression model was fitted with multiple risk factors. Odds ratios as well as 95% confidence intervals were then calculated for the risk factors. A secondary analysis predicting increased surgical difficulty, defined as an operative time of greater than 2 h or increased conversion rate to open surgery, was also examined.

RESULTS

A total of 100 patients were included; 20 of which had GC. On imaging, patients with GC were more likely to have a CT rim sign (65% vs 32.5%, OR = 3.80, 95% CI: 1.24-12.7, p = 0.011). The presence of the CT rim sign did not reach a statistically significant association with an operative time >2 h or conversion to open case (56.52% vs 33.77%, OR = 2.55, p = 0.056).

CONCLUSION

The CT rim sign can be utilized to raise the possibility of GC, however the presence of the CT rim sign does not demonstrate an association with increased surgical difficulty.

Contrast enhanced ultrasound: A review of radiology applications

Ultrasound contrast agents have been used for decades in Europe and Asia for cardiac and abdominal imaging and are now being more commonly utilized in the United States for radiology applications. Our article reviews the basics of contrast-enhanced ultrasound including how the contrast agent works, advantages and disadvantages, as well as pearls and pitfalls to help the radiologist efficiently integrate this technology into day-to-day clinical practice. We also discuss the diagnosis of focal hepatic lesions as well as off-label applications such as evaluation of renal masses.

MRI anatomy and pathology of the anal canal

The normal function of the anal sphincter complex is crucial for quality of life, as it is the mechanism by which fecal continence is maintained. Additionally, the anal sphincter complex is an integral part of the coordinated effort of defecation. As imaging plays an important role in assessment of pathologic conditions involving the anal region, understanding the normal anatomy of the anal sphincter complex is important for correct image interpretation and accurate diagnosis. This review discusses the anatomy and function of the anal sphincter complex, important technical considerations for MRI, and various inflammatory, infectious, and neoplastic processes, as well as pathologic structural conditions that affect the anal region. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:1018-1032.

Association between linear skull fractures and intracranial hemorrhage in children with minor head trauma

BACKGROUND

To determine whether skull fractures can be used to associate intracranial hemorrhage with minor head trauma (MHT).

OBJECTIVE

We conducted a retrospective study evaluating the association between linear skull fractures and intracranial hemorrhage among children with MHT. Furthermore, we evaluated the significance of small intracranial hemorrhages by assessing the need for neurosurgical interventions.

MATERIALS AND METHODS

The case group included 114 children with a diagnosis of a linear skull fracture and the control group included 125 children without the diagnosis. We conducted multivariable logistic regression analyses to estimate the odds ratio (OR) between linear skull fractures and intracranial bleeding.

RESULTS

Among the cases, 29 of 114 (25%) children were diagnosed with an intracranial hemorrhage on CT, compared to only 14 of 125 (11%) among the controls. The multivariable OR for intracranial hemorrhages comparing cases and controls adjusted for age and gender was 2.17 (95% confidence interval [CI]: 1.01, 4.68). All the intracranial hemorrhages were small (3.8 +/- 2.3 mm) and none of them required any neurosurgical intervention.

CONCLUSION

The presence of a linear skull fracture is an independent risk factor for intracranial hemorrhage. However, all the intracranial hemorrhages associated with the skull fractures were small and did not require any neurosurgical interventions.

Evaluation of suture abrasion against rotator cuff tendon and proximal humerus bone

PURPOSE

This study evaluates the abrasion properties of different suture materials through the rotator cuff tendon and proximal humerus tuberosity bone.

METHODS

Three types of sutures were compared: monofilament polypropylene, braided polyester, and braided polyblend polyester with a polyethylene core. For soft-tissue testing, the suture was passed through the infraspinatus tendons of 11 cadaveric shoulders. The suture was cycled with a fixed load, and the migration of the suture as it cut through the tissue was measured at intervals of 5 cycles, for a total of 50 cycles. For tuberosity testing, the sutures were passed through a transosseous tunnel created in the lesser tuberosity, and the suture was cycled with a fixed load until suture failure occurred.

RESULTS

On soft-tissue testing, the monofilament suture showed the least amount of abrasion, followed by the braided polyblend and then the braided polyester suture (cutting rate of 0.06 +/- 0.11 mm/cycle, 0.99 +/- 0.44 mm/cycle, and 1.75 +/- 0.91 mm/cycle, respectively; P < .0001). On tuberosity testing, suture breakage for the braided polyblend suture occurred at 501.3 +/- 220.4 cycles. The braided polyester and monofilament sutures broke after 256.6 +/- 120.9 and 193.5 +/- 144.8 cycles, respectively. The difference between cycles to failure of the polyblend and latter 2 sutures was statistically significant (P < .0001).

CONCLUSIONS

This study shows increased abrasion properties for braided sutures compared with monofilament sutures, as well as different abrasion properties among different types of braided sutures. Furthermore, the braided polyblend suture showed significantly increased cycles before suture failure through a transosseous tunnel.

CLINICAL RELEVANCE

Although development of new suture materials has increased their failure strength, further advancements in suture material design should focus on decreasing soft-tissue abrasion properties and increasing strength to suture failure when cycled through bone.