| 1. |
- Collin, David, et al.
(author)
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Added value of interpreter experience in occult and suspect hip fractures: a retrospective analysis of 254 patients.
- 2016
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In: Emergency Radiology. - : Springer Science and Business Media LLC. - 1438-1435 .- 1070-3004. ; 23:3, s. 229-234
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Journal article (peer-reviewed)abstract
- The influence of experience in categorizing suspect and occult fractures on radiography compared to MRI and clinical outcome has not been studied. The aim of this study is to evaluate the importance of experience in diagnosing normal or suspect hip radiographs compared to MRI. Primarily reported normal or suspect radiography in 254 patients with low-energy hip trauma and subsequent MRI was re-evaluated by two experienced reviewers. Primary readings and review were compared. The prevalence of fractures among normal and suspect radiographic studies was assessed. Clinical outcome was used as reference. At review of radiography, 44 fractures (17 %) were found. Significantly more fractures were found among suspect cases than among normal cases. At MRI, all 44 fractures were confirmed, and further 64 fractures were detected (25 %). MRI detected all fractures with no missed fractures revealed at follow-up. There were a significantly higher proportion of fractures at MRI among the suspect radiographic diagnoses for both the primary report and at review than among occult cases. The more experienced reviewers classified radiography examinations with higher accuracy than primary reporting general radiologists. There was almost complete agreement on MRI diagnoses.
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| 3. |
- Collin, David, et al.
(author)
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Prevalence of exclusively and concomitant pelvic fractures at magnetic resonance imaging of suspect and occult hip fractures.
- 2015
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In: Emergency Radiology. - : Springer Science and Business Media LLC. - 1438-1435 .- 1070-3004.
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Journal article (peer-reviewed)abstract
- Pelvic fractures may occur together with hip fractures as a result of low energy trauma. It is unclear whether they do require special attention. There are conflicting results in the literature about the prevalence of both concomitant hip and pelvic fractures as well as exclusive pelvic fractures. It has been reported that hip fractures and obturator ring fractures are mutually exclusive. To retrospectively analyze the prevalence of exclusively pelvic as well as concomitant hip and pelvic fractures in patients examined with MRI after low-energy trauma in elderly. During 9 years, 316 elderly patients had been examined with MRI for suspected or occult hip fracture after a fall. A fracture was diagnosed when MRI showed focal signal abnormalities in the subcortical bone marrow, with or without disruption of adjacent cortices. One observer reviewed all studies. A second observer verified all studies with hip fractures. Follow-up was available for all but two patients that died prior to hip surgery. The prevalence of concomitant pelvic and femoral neck or trochanteric fractures was statistically compared using chi-squared test for categorical variables. Hip fractures were found in 161 (51 %) patients of which 29 (9 %) had concomitant pelvic fractures. There were exclusively pelvic fractures in 82 (26 %) patients of which 65 (79 %) were on the traumatized side only. In 73 patients, there were no fractures. Occult or suspected hip fractures are not infrequently associated with pelvic fractures. Exclusively pelvic fractures are not uncommon.
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| 4. |
- Deminger, Anna, 1973, et al.
(author)
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Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline : results from a 5-year prospective study
- 2017
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In: Arthritis Research & Therapy. - London, United,Kingdom : BioMed Central. - 1478-6362. ; 19
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Journal article (peer-reviewed)abstract
- BACKGROUND: Studies have shown increased prevalence of osteoporosis and increased risk for vertebral fractures in patients with ankylosing spondylitis (AS). Measurements of bone mineral density (BMD) in the lumbar spine anterior-posterior (AP) projection may be difficult to interpret due to the ligamentous calcifications, and the lateral projection might be a better measuring site. Our objectives were to investigate BMD changes after 5 years at different measuring sites in patients with AS and to evaluate disease-related variables and medications as predictors for BMD changes.METHODS: In a longitudinal study, BMD in Swedish AS patients, 50 ± 13 years old, was measured with dual-energy x-ray absorptiometry (DXA) at the hip, the lumbar spine AP and lateral projections, and the total radius at baseline and after 5 years. Patients were assessed with questionnaires, blood samples, and spinal radiographs for grading of AS-related alterations in the spine with the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and assessment of vertebral fractures by the Genant score. Multiple linear regression analyses were used to investigate predictors for BMD changes.RESULTS: Of 204 patients included at baseline, 168 (82%) were re-examined after 5 years (92 men and 76 women). BMD decreased significantly at the femoral neck and radius and increased significantly at the lumbar spine, both for AP and lateral projections. Mean C-reactive protein during follow-up predicted a decrease in the femoral neck BMD (change in %, β = -0.15, p = 0.046). Use of bisphosphonates predicted an increase in BMD at all measuring sites (p < 0.001 to 0.013), except for the total radius. Use of tumor necrosis factor inhibitors (TNFi) predicted an increase in AP spinal BMD (β = 3.15, p = 0.012).CONCLUSION: The current study (which has a long follow-up, many measuring sites, and is the first to longitudinally assess the lateral projection of the spine in AS patients) surprisingly showed that lateral projection spinal BMD increased. This study suggests that the best site to assess bone loss in AS patients is the femoral neck and that inflammation has an adverse effect, and the use of bisphosphonates and TNFi has a positive effect, on BMD in AS patients.
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| 5. |
- Geijer, Mats, et al.
(author)
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A retrospective analysis of the clinical impact of 939 chest radiographs using the medical records.
- 2012
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In: Radiology research and practice. - : Hindawi Limited. - 2090-195X .- 2090-1941. ; 2012
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Journal article (peer-reviewed)abstract
- Objective. Between one-third and half of all radiology examinations worldwide are probably chest studies. The aim of the current study was to retrospectively evaluate the clinical influence of chest radiography. Methods. In a tertiary referral hospital, 939 consecutive daytime chest radiography examinations were evaluated. The outcome was classified as normal, incidental, or pathologic. The referring physician's reaction to radiologic outcome was classified as highly expected, moderately expected, or unexpected. The influence on the patients' treatment was divided into four groups from major to no influence. Results. In all, 71.6% of the studies had a highly expected outcome. Moderately expected or unexpected outcomes were noted in 36.6% of 500 pathologic examinations. Unexpected outcome was noted in 11.6% of all studies. The radiologic outcome influenced treatment in 65.4% of patients where pathology was demonstrated. Patients with normal or incidental findings had treatment influenced in 1/3 of the cases. Unexpected findings influenced treatment more than moderately expected findings. When radiological findings were highly expected, treatment was influenced in less than half of the cases. Surprisingly few chest radiology examinations were commented upon in the medical records.
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| 6. |
- Geijer, Mats, et al.
(author)
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Bone bruise, lipohemarthrosis, and joint effusion in CT of non-displaced hip fracture.
- 2012
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In: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 53:2, s. 197-202
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Journal article (peer-reviewed)abstract
- BackgroundA suspected occult hip fracture after normal radiography is not uncommon in an elderly person after a fall. Despite a lack of robust validation in the literature, computed tomography (CT) is often used as secondary imaging.PurposeTo assess the frequency and clinical utility of non-cortical skeletal and soft tissue lesions as ancillary fracture signs in CT diagnosis of occult hip fractures.Material and MethodsAll fracture signs (cortical and trabecular fractures, bone bruise, joint effusion, and lipohemarthrosis) were recorded in 231 hip low-energy trauma cases with CT performed after normal or equivocal radiography in two trauma centers.ResultsThere were no fracture signs in 110 patients. Twelve of these had a joint effusion. In 121 patients with 46 cervical hip fractures and 75 trochanteric fractures one or more fracture signs were present. Cortical fractures were found in 115 patients. Bone bruise was found in 119 patients, joint effusion in 35, and lipohemarthrosis in 20 patients.ConclusionAncillary signs such as bone bruise and lipohemarthrosis can strengthen and sometimes indicate the diagnosis in CT of occult hip fractures. Joint effusion is a non-specific sign.
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