Radiographics : a review publication of the Radiological Society of North America, Inc
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Clinical assessment of women with urethral symptoms is difficult, necessitating further evaluation with imaging. Urethrography provides limited information on luminal abnormalities of the urethra. Recent advances in ultrasound (US) and magnetic resonance (MR) imaging have dramatically improved evaluation of the female urethra, clarifying findings at physical examination and providing accurate road maps for surgeons. ⋯ Imaging features do not allow differentiation between histologic subtypes of urethral carcinoma; the diagnosis is established with histopathologic examination. Periurethral cysts do not communicate with the urethra and therefore can often be differentiated from urethral diverticula at endocavitary MR imaging. High-resolution multiplanar US and MR imaging allow comprehensive evaluation of abnormalities of the female urethra.
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Increasing activity in the general population and the high demands placed on athletes have resulted in injuries to the hamstring muscle complex (HMC) being commonplace in sports. Imaging of HMC injuries can form a considerable part of a sports medicine practice, with a wide spectrum of such injuries being reflected in their varied imaging appearances. Magnetic resonance (MR) imaging and ultrasonography (US) are the imaging modalities of choice in this setting. ⋯ Optimization of MR imaging involves the use of a surface coil and high-resolution techniques, allowing the musculoskeletal radiologist not only to diagnose injury and assess severity but also to provide the clinician with useful clues with respect to prognosis. The portability and availability of US make it an attractive modality for the diagnosis of acute hamstring injuries, although its effectiveness is dependent on operator experience. A thorough knowledge of the HMC anatomy and of the spectrum of imaging findings in HMC injury is crucial for providing optimal patient care and will enable the musculoskeletal radiologist to make an accurate and useful contribution to the treatment of athletes at all levels of participation.
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Review
Pelvic arterial hemorrhage in patients with pelvic fractures: detection with contrast-enhanced CT.
Arterial hemorrhage is one of the most serious problems associated with pelvic fractures, and it remains the leading cause of death attributable to pelvic fracture. At many trauma centers, contrast material-enhanced computed tomography (CT) is increasingly used for initial diagnosis in the evaluation of patients with pelvic fractures. Extravasation of contrast material in the pelvis at contrast-enhanced CT is an accurate indicator of ongoing arterial hemorrhage in patients with pelvic fractures. ⋯ Furthermore, the site of contrast material extravasation seen at CT corresponds well to the site of bleeding seen at angiography. This correspondence enables the interventional radiologist to selectively study the arteries most likely to be injured and therefore potentially reduce the patient's morbidity and mortality. Knowledge of the relevant pelvic anatomy, including the osseous, ligamentous, and especially axial vascular anatomy, is essential for understanding the relationship between a site of contrast material extravasation at CT and the specific injured artery visualized at angiography.
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Review
Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis.
Injuries of the pancreas, gallbladder, and bile ducts due to blunt trauma are relatively uncommon and difficult to detect but are associated with high morbidity and mortality, especially if diagnosis is delayed. Accurate and early diagnosis is imperative, and imaging plays a key role in detection. Knowledge of the mechanisms of injury, the types of injuries, and the roles of various imaging modalities is essential for prompt and accurate diagnosis. ⋯ Gallbladder injuries can be detected with CT, ultrasonography, hepatobiliary scintigraphy, or MR cholangiopancreatography. CT findings include a collapsed gallbladder, wall thickening, inhomogeneous mural enhancement, and pericholecystic fluid. Bile duct injuries can be suggested with CT, which may show ascites and associated liver injuries, and can be confirmed with hepatobiliary scintigraphy.
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Keyboard entry or correction of radiology reports by radiologists and transcriptionists remains necessary in many settings despite advances in computerized speech recognition. A report entry system that implements an automated phrase completion feature based on language modeling was developed and tested. The special text editor uses context to predict the full word or phrase being typed, updating the displayed prediction after each keystroke. ⋯ Performance was tested on 200 randomly selected reports outside of the training set. The phrase completion technique reduced the average number of keystrokes per report from 194 to 58; the average reduction factor was 3.3 (geometric mean) (95% confidence interval, 3.2-3.5). The algorithm significantly reduced the number of keystrokes required to generate a radiography report (P <.00005).