CT scans as a tool for planning difficult airway intubation

Autor: David R. Grimes, Mary O’Connor, Timothy Taylor, Andrew J. Sidebottom, Iain Macleod
Rok vydání: 2014
Předmět:
Zdroj: Clinical Radiology. 69:S4
ISSN: 0009-9260
Popis: Clinical Radiology 69 (2014) S1eS9 S4 Getting to the bottom of MRI defeacating proctograms Authors: R Charis Brook*, Eirini Vrentzou, Sonya Snape Purpose: More than 15% of multiparous women have a symptomatic pelvic floordisorder that significantlyaffects their qualityof life. It iswell recognised that clinical examination underestimates pathology and thus imaging plays an important role. MRI proctograms are increasingly being used in the diagnosis of pelvic floor dysfunction. The lack of radiation, multiplanar imaging ability and better patient experience offer an advantage over conventional fluoroscopic proctography, and direct visualisation of pelvic organs allows amore comprehensive assessment of pelvic floor and rectal anatomy. Methods andmaterials: Through images acquired at our centre, our aim is to introduce the cross-sectional Radiologist to the basics of MRI proctograms e from clinical indications, pros and cons, to image acquisition and examples of pathology. Results: We present an educational pictorial review of: Patient preparation and technique involved The protocol and sequences acquired; Normal anatomy of pelvic compartments as seen on an MRI proctogram; Frequently diagnosed pathology. Conclusion: MRI proctograms are a validated and powerful tool that allows radiologists to comprehensively evaluate multicompartmental pelvic anatomical and functional abnormalities. Radiologists should be aware of the appearance of normal anatomy and common pathology on the MRI sequences acquired. Interobserver agreement of small bowel Crohn’s disease features in MR enterography: derivation of a MR severity score Authors: Zoe A. Davis*, Federica Fasci-Spurio, Nick A. Kennedy, Li Wong, Peter MacLean, Stephen Glancy, Jack Satsangi, Charlie W. Lees Purpose: To investigate inter-observer variability in reporting of MR enterography (MRE) and create a MRI score with high agreeability. Methods and materials: 150 MRE studies were identified from the Edinburgh faecal calprotectin register (2008-2012) with ileal Crohn’s disease. 56 scans were excluded due to poor technical quality and colonic abnormalities. Positive MREs were identified, retrospectively reported and scored independently by2of3 consultantgastrointestinal radiologists blind to eachother andtheclinicaldata. Themostaffecteddiseasesegmentwasassessedusing13 pre-determined radiological parameters, yielding a total of 56 abnormal segments. Inter-observer agreement was categorized by kappa statistics. Results: The 6 features with the best inter-observer variability were disease extent, bowel wall thickness, relative enhancement, bowel wall oedema, mesenteric oedema and pre-stenotic dilatation (k 1⁄4 0.801, k 1⁄4 0.780, k1⁄4 0.768, k1⁄4 0.642, k1⁄4 0.592, k1⁄4 0.566 respectively). A MRE score derived using these 6 parameters (score 0-10) was found to demonstrate excellent overall agreement (k1⁄4 0.85) and correlated to faecal calprotectin (Spearman’s rho 1⁄4 0.575) and CRP (rho 1⁄4 0.366) (both p < 0.0001). Conclusion: The 6 of the parameters with the best inter-observer variability could be used to form a simple MR scoring systemwith excellent agreement. CT scans as a tool for planning difficult airway intubation Authors: David R. Grimes, Iain Macleod*, Timothy Taylor, Mary O’Connor, Andrew J. Sidebottom Purpose: Oral and Maxillofacial Surgery procedures often require nasal intubation. Many patients have limited mouth opening making intubation more hazardous. Unfavourable nasal anatomy can make intubation more * Guarantor and correspondent: R Charis Brook * Guarantor and correspondent: Zoe A Davis * Guarantor and correspondent: David R. Grimes * Guarantor and correspondent: Charles J. Miranda * Guarantor and correspondent: Chuku-Dima Spencer challenging. If available this may be predicted using CT scans or 3D CT models, as previously described1. Our purpose was to establish if CT scans can aid prediction of intubation difficulties.Reference: Is the 3-D CT model useful to our anaesthetists? O’Connor M, Sidebottom AJ. British Journal of Oral and Maxillofacial Surgery April 2013, 51(3), 262-263. Methodsandmaterials: TMJreplacementpatientshaveCTscans to assess the joints that include the nasal cavities. 100 patients undergoing TMJ replacement surgery since 2008 had CT scans and anaesthetic records reviewed. Nostril intubatedanddifficulties in intubationwere recorded. Tworadiologists reviewed the CT scans independently to identify anatomy that might impede nasal intubation. Data were compared to establish if a correlation existed. Results: Preliminary results suggest abnormal nasal cavity anatomy on CT correlates with intubation findings. Conclusion: CT review for planning of nasal intubation is a useful adjunct to the anaesthetist. This may reduce failed attempts and time required to intubate this group of patients. Review of the nasal cavity for intubation is now part of the standard reporting in our unit. Use of a patient protocol to standardise the selection of patients treated for idiopathic intracranial hypertension by venous sinus stenting Authors: Charles J. Miranda*, Suresh Chhetri, Nicholas Chua, Hemant Sonwalkar, Siddhartha Wuppalapati Purpose: Idiopathic intracranial hypertension (IIH) is an uncommon condition that if untreated, can lead to permanent visual loss. An evidence based patient pathway could select patients in order to improve outcomes and prevent unnecessary intervention in individuals refractory to stenting. Methods and materials: An evidence based patient pathway detailed the assessment of 7 inclusion criteria. All of these had to be met prior to intervention. Patients meeting the criteria had a vascular stent placed across a focal venous sinus stenosis before follow up at 3 and 12 month intervals. Those excludedwere followed for 12months or until surgical management. Results: 19 women (average age 38 years) were referred for the management of IIH. 7 patients were excluded but remained under follow-up. In the treatment group, there was 1 complication (haemorrhagic stroke). 3 patients continued to require treatment by CSF drainage. 2 patients had a lumbar peritoneal CSF shunt inserted. In the non-treatment group, 2 were eventually discharged from follow-up. 4 underwent a lumbar peritoneal CSF shunt insertion.1 continues to be treated by intermittent CSF drainage. Conclusion: Initial results suggest that an evidence based patient selection protocol may reduce the incidence of vascular intervention, and accompanying radiation dosage, for patients referred with IIH, that are unlikely to benefit. Does early removal of inferior vena caval filters improve success rate? A four-year retrospective review Authors: Chuku-Dima Spencer*, Nagendra Thayur Purpose: The British Society of Interventional Radiology recommends retrieval of temporary vena caval filters within nine weeks to improve successful retrieval and minimize complications. Currently, our established practice is to attempt retrieval of these optional retrievable filters at four weeks from placement. Methods and materials: A four year (August 2008 to June 2012) retrospective search of our Health Software System Clinical Research Information System (HSS CRIS) database and in-house interventional radiology implant register was carried out. We queried patients admitted into Trust for temporary vena caval placements. Admission dates and retrieval dates
Databáze: OpenAIRE
Externí odkaz: