Computed tomography and hangman's fractures.
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Axis, Cervical Vertebra↗
Biomedical subjects
M Mirfakhraee
Publications and source records attributed to M Mirfakhraee.
Computed tomography of traumatic atlantooccipital dislocation.
Although atlantooccipital dislocation is a well-recognized radiological entity, its computed tomographic (CT) recognition has not been previously described. It is the purpose of this report to show the complementary role of CT in precisely defining the abnormalities in both the coronal and the sagittal reconstruction planes. A case is presented and the literature is reviewed.
Atlanto-Occipital Joint↗
Superior sagittal sinus thrombosis diagnosed by computed tomography.
Superior sagittal sinus thrombosis is an often unrecognized clinical condition. This is due to its variable clinical presentation and its association with other serious disease states. The following cases demonstrate that, in the infant, thrombosis of the superior sagittal sinus can be diagnosed quickly and noninvasively by computed tomography (CT). In those clinical situations in which thrombosis of the superior sagittal sinus may occur and neurological changes exist, axial and coronal CT scans may be quite specific in detecting its occurrence.
Humans↗
Intraoperative ultrasound examination of the brain.
In a preliminary demonstration of cranial intraoperative real-time ultrasound, both supratentorial and posterior fossa scans displayed the pertinent anatomy. A grade III astrocytoma was visualized on the supratentorial scan as well. Ultrasound may be valuable for surgical planning and biopsy procedures because of its reliable depiction of intracranial anatomy and ease of use.
Brain Neoplasms↗
MR imaging of orbital blow-out fractures.
We report on a case of orbital blow-out fractures involving the medial and inferior walls. In this case conventional multiplanar 8 mm thick sections with magnetic resonance (MR) imaging proved to be more helpful than 1.5 mm axial thin sections with CT in demonstrating the extent of orbital floor herniation of fat. Entrapment of muscle was excluded. Oblique sagittal views were most helpful in evaluating the orbital floor, since the full course of the inferior rectus muscle is seen. Additionally, the optic nerve is seen along its entire length. Masking of intraorbital contents by isodense hemorrhage on CT studies apparently is not a problem with MR imaging if hemorrhage is small or nonacute.
Adult↗
MR imaging of transverse/sigmoid dural sinus and jugular vein thrombosis.
Magnetic resonance (MR) imaging was performed on six patients with thrombosis involving the transverse/sigmoid sinus and jugular bulb/vein. Venographic confirmation was obtained in five cases. Thrombi were characterized by increased intraluminal signal on all planes of section and pulse sequences. The change in signal intensity from first to second echo for thrombi was qualitatively less than that found with slow flow. Partial thrombosis in one case was seen as a ring pattern of central intermediate intensity corresponding to the thrombus, surrounded by a peripheral ring of signal void related to flowing blood. The MR findings closely correlated with venography in predicting thrombosis. Evidence of thrombi was not available from CT. Magnetic resonance is well suited for the diagnosis of occlusive disease of the dural venous sinus and jugular bulb.
Aged↗
Evaluation of CSF shunt function: value of functional examination with contrast material.
Functional positive-contrast shuntography includes a patency check of both limbs of the shunt and the shunt valve by fluoroscopy following the injection of an iodinated contrast agent (anatomic shuntogram) and an assessment of the adequacy of ventricular fluid drainage under physiologic conditions by using serial CT scans to assess the rate of iodine dissipation from the ventricular system (physiologic shuntogram). To demonstrate its efficacy and utility, 82 functional shuntograms were obtained in 55 patients. Fifty-one of the 82 studies were abnormal. Of these, 22 demonstrated patency of both the proximal and distal limbs with an accompanying slow dissipation of contrast material after injection (21 of 22 patients were adults). Eighteen of these 22 patients improved following the reduction of shunt drainage pressure. In the case of frank shunt obstruction, the site of obstruction was delineated clearly in all 29 cases. Correlation of clinical outcome with test results confirmed the utility of this technique, especially when applied to the shunted adult hydrocephalic patient whose response to the shunt had been inadequate. The technique described here allows the clinician to differentiate between physiologic and anatomic shunt failure and between shunt failure and normal shunt function. It also allows for precise localization of the shunt obstruction in anatomic shunt failure and for demonstration of physiologic shunt failure when shunt patency is demonstrated in the presence of the slow dissipation of intraventricular contrast medium.
Adult↗
Duplex sonography in embolotherapy of external carotid artery traumatic aneurysms.
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Adolescent↗
Surface coil MR of spinal trauma: preliminary experience.
Nineteen fractured vertebral bodies involving the spine from C1 to L2 in 14 patients were imaged with a 0.6-T magnet using prototypical surface coils. Ten of these patients were studied within the first week of trauma. CT and plain films are superior to MR in detecting fractures and identifying the origin of displaced fragments in cases of extensive comminution. However, all body fractures and most posterior element fractures in the thoracolumbar spine were visible on MR. Fractures involving the cervical neural arch were difficult to detect on transverse section without CT correlation. Our results indicate that MR can probably replace CT in the thoracolumbar region. MR is superior to CT in demonstrating ligamentous injury and trauma to the disk. Unlike CT, MR shows the relation of the thecal sac and spinal cord to retropulsed fragments and epidural hematoma. MR also visualizes cord parenchyma; two cases of cord hemorrhage were not seen on CT. Even at this early stage of development, surface coil MR promises to become important in the evaluation of spinal trauma, not only in assessing the integrity of the spinal canal and cord, but in separating stable from unstable fractures on the basis of disruption of the posterior ligaments and elements. Additionally, the demonstration of rupture of specific ligaments may have an impact on surgical management.
Adolescent↗
Metrizamide shuntography for evaluation of shunt malfunction in hydrocephalus.
Ventricular shunts were evaluated by a shuntographic technique using metrizamide for the contrast material and delayed spot films and computed tomography (CT) to evaluate shunt function. Thirty hydrocephalic patients were studied who had clinical presentations of shunt malfunction. Fifty-two shuntograms were obtained; most demonstrated the cause of shunt malfunction. No contrast-related complications resulted from the procedure. Diagnostic accuracy was greatly improved by this method, since both anatomic and functional evaluations could be performed. In patients with normal studies, unnecessary surgery was eliminated; in abnormal shuntograms, the duration of surgery and the likelihood of complications were reduced because the surgeons knew the exact anatomic derangements to be corrected.
Cerebrospinal Fluid Shunts↗