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This review will describe the indications for the various small bowel containing transplants. The importance of early referral will be highlighted. Radiologists play a central role in assessing these complex patients prior to transplantation. Furthermore, in the postoperative period, radiologists play an important part in diagnosing and treating complications., (Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Aims: To test the hypothesis that the improved resolution afforded by 16-detector computed tomography (CT) would translate to better stress fracture detection when compared with skeletal scintigraphy., Materials and Methods: Thirty-three cases of suspected stress fractures in 26 patients were investigated using skeletal scintigraphy and 16-detector CT performed on the same day. Planar images of the lower limbs were taken 3h post-injection of 400MBq (99m)Tc-methylene diphosphonate ((99m)Tc-MDP). (99m)Tc-MDP uptake was quantified at suspected fracture sites. CT was performed using a 16-detector multisection machine employing 0.75mm detectors and images reconstructed in 0.5mm increments. Examinations were reported independently and discordant results were compared at follow-up., Results: At initial reporting scintigraphy identified fractures in 13 of the 33 cases and CT identified four of the 33. In one case, on review of the CT images, a fracture was present in the distal fibula that was not initially identified. This resulted in eight scintigraphic-positive CT-negative discordant cases. The (99m)Tc-MDP uptake was significantly lower in the discordant fracture group compared with the concordant group (p<0.01)., Conclusions: Despite technological advances in CT, scintigraphy appeared to detect more stress fractures. As such, multidetector CT should not be used as a routine initial investigation in stress fracture detection. The potential use of (99m)Tc-MDP quantification at fracture sites is of interest and may be worth further investigation.

To compare the measured uptake of 99Tcm-methylene diphosphonate (99Tcm-MDP) in those scaphoid fractures seen on both 16 detector multislice CT and scintigraphy, with those seen only on scintigraphy. Over a 12 month period a total of 51 patients with suspected fracture underwent both conventional 99Tcm-MDP scintigraphy and 16 detector multislice CT on the same day. The 99Tcm-MDP uptake was then quantified in patients with identified fracture. This was measured by placing a region of interest (ROI) over the fracture site and the mean and maximum number of counts were compared with those in a similar size ROI placed over background bone activity. A total of 23 fractures were identified on scintigraphy of which 16 were also detected on CT (concordant). In seven cases the fracture was not seen on CT, even in retrospect (discordant). In the discordant cases, follow-up radiographs and MRI (where available) also failed to demonstrate a fracture. The mean fracture count to background bone activity ratio averaged 7.7 (range 3.2-18.5) for concordant fractures and 3.8 (range 1.7-5.3) for discordant fractures (t-test p=0.04). The maximum fracture count to background bone activity ratio averaged 12.7 (range 4.3-27.7) for concordant fractures and 6.3 (range 2.6-9.5) for discordant fractures (t-test p=0.03). It is speculated whether these discordant fractures with less 99Tcm-MDP uptake may represent a less severe injury such as bone bruise.

Objective: Our objective was to assess the potential use of MDCT in the detection of occult scaphoid fractures. Fifty-one patients with suspected radiographically occult scaphoid fractures at 10-14 days after trauma were investigated prospectively with skeletal scintigraphy and CT on the same day. Planar images of the wrist were taken 3 hr after IV injection of 400 MBq of (99m)Tc-methylene diphosphonate using a single-head gamma camera. CT was performed on a 16-MDCT machine using 0.75-mm detectors and reconstruction in 0.5-mm slices. Multiplanar reformatted images were then viewed in interactive cine mode. The examinations were reported independently, and discordant results were compared at follow-up. CT was positive for wrist fracture in 14 (27.4%) of 51 patients and skeletal scintigraphy in 23 (45.1%) of 51 patients. Even after retrospective review, there were seven discrepant cases (13.7%), all of which were positive for wrist fracture on scintigraphy but negative on CT. Four of these seven patients with discordant findings underwent further radiography at 6 weeks, which did not show fracture., Conclusion: Although CT was preferred by most patients and was quicker, scintigraphy appears to detect bony abnormality more frequently. However, there appears to be an interesting group of patients (7/51) with normal initial radiography findings but positive scintigraphy findings who would normally be considered to have a fracture but for whom CT results were negative. In some of these patients, the results of follow-up radiography at 6 weeks were also negative, suggesting that this group of patients warrants further study.

We discuss a case of a 19-year-old man with scaphoid trauma. We describe the imaging findings on three sets of radiographs, bone scintigraphy, CT and MRI. CT failed to identify a scaphoid fracture, which was present on 6 week radiographs, MRI and scintigraphy. The case illustrates that despite multidetector technology, CT still relies upon cortical and or trabecular displacement to demonstrate fractures.