The norm of the small bowel on computed tomography

Purpose of the study. Determination of normal thickness and contrast of the wall of the small bowel (SB) depending on the phase of digestion on computed tomography (CT).Material and methods. We examined 358 patients aged 20 to 88 years. According to the results of the survey, patients are divided into two groups. The main group consisted of patients examined on an empty stomach (n = 329), and an additional group consisted of patients examined after eating (n = 29). A CT scan of the abdomen was performed with a cut-off thickness of not more than 2 mm and a bolus contrast enhancement (CE) with a nonionic contrast medium. The results of measurements of the wall thickness of the SB and the intensity of its contrast were subjected to grouping and statistical processing.Results and discussion. According to the results of our study, the average value of the wall thickness of the SB is normally 3.1 ± 1.2 mm, with a tendency to decrease this indicator in the distal direction. The regularities of changes in the thickness and intensity of contrasting of the wall of the SB in the norm depending on the age and the last meal were determined. With increasing age, diffuse thinning of the SB wall occurs. Normally, after eating, there is a thickening of the SB wall to 4.6 ± 1.8 mm and an increase in the intensity of contrast, mediated by an increase in blood supply, with a density gradient of + 10%. After CE, the proximal sections of the SB are contrasting brighter than the distal. The gradient of contrastion of the proximal and distal parts of the SB increases after meals, is maximum in young patients and decreases with age.Conclusion. In order to reliably differentiate the pathological thickening and change the contrasting of the SB wall from the physiological one, it is imperative to ascertain the time and nature of the last meal and to take into account the age of the patient. In "non-contact" patients, an indirect orientation is possible according to the degree of filling of the stomach and SB.

Detection of Intravascular Injection During Cervical Transforaminal Epidural Injection: A Comparison of Digital Subtraction Angiography and Real Time Fluoroscopy

Background: Transforaminal epidural injection (TFEI) with local anesthetics and steroids are effective in treating spinal radicular pain. However, inadvertent intravascular injection can lead to severe neurologic complications. To reduce complications of intravascular injection, use of imaging modality, such as real-time fluoroscopy (RTF) or digital subtraction angiography (DSA), has been recommended. DSA is an imaging technique that can clearly visualize the blood vessels from surrounding bones or dense soft tissues by subtracting the pre-contrast image from the image after injecting contrast medium. Objective: In this study, we investigated whether there is a difference between RTF and DSA in the detection of intravascular injection during cervical TFEI. Study Design: Clinical study. Setting: Pain clinic in South Korea. Methods: We prospectively examined 137 cervical TFEIs on 128 patients who have a radiating pain from spinal stenosis and herniated nucleus pulposus. The needle position was confirmed using biplanar fluoroscopy and 2 mL of nonionic contrast medium was injected at the rate of 0.5 mL/sec under RTF. Thirty seconds later, 2 mL of nonionic contrast medium was injected at the rate of 0.5 mL/sec under DSA. Intravascular injection was defined as contrast medium spreading throughout the vascular channel during injection of contrast medium under RTF and DSA. This study is registered in the ClinicalTrials.gov (NCT03040648). Results: The detection rate of intravascular injection in RTF was not statistically different compared to that in DSA (30.7 % vs. 34.3%, P > 0.05). Limitations: We injected 2 mL of contrast medium at the rate of 0.5 mL/sec. Further studies about the ideal injection speed and volume of contrast medium for improvement of detection of intravascular injection during TFEI are needed. This study was a single center study. Therefore, multi-center studies are needed to obtain the high level of evidence. Additionally, the procedural pain physician was not blinded to the type of imaging modality, such as RTF and DSA, to detect intravascular injection. To minimize this confirmation bias and provide homogenous procedural conditions for TFEI, the same procedural physician performed all 137 injections. Conclusions: In this study, there is no significant difference in detection rate of intravascular injection between RTF and DSA during cervical TFEI. Key words: Analgesia, bleeding, clinical trials, complications, diagnostic equipment, epidural, radiculopathy, spine

Contrast-Induced Neurotoxicity following Cardiac Catheterization

We report a case of probable contrast-induced neurotoxicity that followed a technically challenging cardiac catheterization in a 69-year-old woman. The procedure had involved the administration of a large cumulative dose of an iodinated, nonionic contrast medium into the innominate artery: twelve hours following the catheterization, the patient developed a seizure followed by a left hemiplegia, and an initial computed tomography (CT) scan showed sulcal effacement in the right cerebral hemisphere due to cerebral swelling. The patient’s clinical symptoms resolved within 24 hours, and magnetic resonance imaging at 32 hours showed resolution of swelling. Contrast-induced neurotoxicity should be found in the differential diagnosis of acute neurological deficits occurring after radiological procedures involving iodinated contrast media, whether ionic or nonionic.

Malignant Cerebral Edema following CT Myelogram Using Isovue-M 300 Intrathecal Nonionic Water-Soluble Contrast: A Case Report

Lumbar myelogram utilizing nonionic contrast is a commonly performed procedure to identify spinal pathology. Complication rates are low. Cerebral edema has been shown to occur following intrathecal injection of ionic contrast; however, no current literature has documented this complication relating to the ubiquitously used nonionic contrast medium. We report a case of a patient who developed malignant cerebral edema following a lumbar myelogram with Isovue-M 300 nonionic water-soluble intrathecal contrast. We believe this is the first reported case of cerebral edema resulting from the use of a nonionic contrast.