Detection of soft-tissue foreign bodies by plain radiography, xerography, computed tomography, and ultrasonography

doi:10.1016/S0196-0644(05)82483-7

Annals of Emergency Medicine

Volume 19, Issue 6, June 1990, Pages 701-703

https://doi.org/10.1016/S0196-0644(05)82483-7 Get rights and content

Detection of a soft-tissue foreign body is common yet often difficult, particularly when the foreign material is not radiopaque. Various imaging modalities have been advocated for detecting foreign bodies that are not revealed by plain radiography. The abilities of plain radiography, xerography, computed tomography, and ultrasonography to detect glass, wooden, and plastic foreign bodies in an in vitro preparation are compared. While all of these imaging techniques demonstrated a glass foreign body, only ultrasonography clearly identified wooden and plastic foreign bodies.

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Citation Excerpt :
Each imaging modality has different advantages and disadvantages in the detection of foreign objects, and availability also has to be considered [18]. Previous studies used various cadaver models with limitations of each study depending on the respective experimental setup [13,15,16,19–24]. To rule out any limitations based on the experimental setup, a phantom gel was used in this study, mainly focusing on the material rather than on the anatomical location.
To evaluate the effectiveness of plain radiography (X-ray. XR), computed tomography (CT) and magnetic resonance imaging (MR) in visualising commonly seen foreign bodies. A special focus was put on objects relevant to head and neck surgery.
Thirty-four commonly encountered objects of different compositions including wood, plastic, and glass were embedded in a gelatin gel phantom and imaged using XR, CT and MR. The success rates of radiologists in detecting and correctly identifying the foreign objects were evaluated. Subjective visibility was rated on a 4-point Likert scale. Objective visibility was analysed using region of interest-based contrast for CT.
Sensitivity in foreign bodies detection was highest in MR (97.1 %) followed by CT (86.0 %) and x-ray (61.8 %). Success rates for the correct identification of the objects and material types were highest in MR (33.3 % and 39.2 %, respectively) followed by CT (25.5 % for both) and XR (16.7 % and 15.7 %). Overall, subjective visibility was rated higher in CT and MR imaging (“good visibility”), as compared to XR (“poor visibility”). Interreader agreement was high across modalities (Kendall’s W = 0.935, 0.834 and 0.794 for XR, MR and CT, respectively).
Detection and identification of non-ferromagnetic objects was most successful in MR followed by CT imaging in this experimental setup.
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Radiolucent foreign bodies of the hand are frequent and may lead to pain, infection, hematoma and/or migration. Their diagnosis and removal can be difficult. The goal of this study was to assess the usefulness of intraoperative ultrasound imaging for detecting translucent foreign bodies in the hand to facilitate their removal. Our single-center retrospective study included 19 patients with preoperatively radiolucent but echogenic foreign bodies. An intraoperative ultrasound was performed to assist with and confirm the removal of the foreign body. The foreign bodies were vegetal in 15 cases, made of glass in 2 cases, rock in 1 case and undetermined in 1 case. The average length was 4.65 mm (min 1, max 16) and the average width 1.02 mm. All foreign bodies were visible during the intraoperative ultrasound and were no longer visible after their removal. Because intraoperative ultrasound imaging was able to guide the removal of all radiolucent foreign bodies in our study, it can be a useful tool for the removal of radiolucent foreign bodies.
Les corps étrangers radiotransparents de la main sont fréquents et peuvent se compliquer de douleur, d’infection, d’hématome et/ou de migration. Leur diagnostic et leur extraction sont parfois difficiles. Le but de cette étude était de vérifier si l’échographie peropératoire était utile au repérage de corps étrangers radiotransparents de la main pour en faciliter l’extraction. Notre série monocentrique et rétrospective comprenait 19 patients présentant en préopératoire des étrangers radiotransparents mais échogènes. Une échographie peropératoire a été réalisée pour guider l’ablation du corps étranger, puis en vérifier la disparition. La nature des corps étrangers était 15 fois végétale, 2 fois en verre, 1 fois un caillou, et 1 fois indéterminée. Leur longueur moyenne était de 4,65 mm (min 1, max 16) et leur largeur moyenne de 1,02 mm. Tous les corps étrangers étaient visibles à l’échographie peropératoire avant ablation et invisibles après ablation. L’échographie peropératoire ayant permis de guider l’extraction de tous les corps étrangers radiotransparents de notre série, elle peut être considérée comme utile à l’extraction de corps étrangers radiotransparents.

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: Presented at the Society for Academic Emergency Medicine Annual Meeting in San Diego, May 1989.

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Original contributionDetection of soft-tissue foreign bodies by plain radiography, xerography, computed tomography, and ultrasonography

Am J Surg

Int J Oral Maxillofac Surg

J Am Acad Dermatol

Injuries of the hand by puncture wounds and foreign bodies

Surg Clin North Am

Primary mycetoma infection of the distal tibia secondary to an occult foreign body

Foot Ankle

Delayed median nerve injury due to retained glass fragments

J Bone Joint Surg

Original contribution
Detection of soft-tissue foreign bodies by plain radiography, xerography, computed tomography, and ultrasonography