Emergency Radiology最新文献

{"title":"Author response to letter titled \"Assessing MRI utility in pediatric tibial-sided PCL avulsion fractures: the reference standard matters\".","authors":"Lauren May, Rebecca J Schultz, Zina Smadi, Krishna Chandra, Jason Z Amaral, Siddharth P Jadhav, Megan Severson, Indranil Kushare","doi":"10.1007/s10140-026-02557-0","DOIUrl":"https://doi.org/10.1007/s10140-026-02557-0","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing MRI utility in pediatric tibial-sided PCL avulsion fractures: the reference standard matters.","authors":"Ercan Yılmaz, Zeynep Yamancan Yılmaz","doi":"10.1007/s10140-026-02556-1","DOIUrl":"10.1007/s10140-026-02556-1","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpreting the 42% displacement threshold in pediatric proximal humerus fractures: age still matters.","authors":"Ercan Yılmaz, Zeynep Yamancan Yılmaz","doi":"10.1007/s10140-026-02552-5","DOIUrl":"https://doi.org/10.1007/s10140-026-02552-5","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: Interpreting the 42% displacement threshold in pediatric proximal humerus fractures: age still matters.","authors":"Julian Forero-Millan, Wondwossen T Lerebo, Vandan S Patel, Lewis Fanney, Alexandre Arkader, Jie C Nguyen","doi":"10.1007/s10140-026-02551-6","DOIUrl":"https://doi.org/10.1007/s10140-026-02551-6","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultra-high-resolution photon-counting CT argues against a suspected bilateral carotid web: a case report.","authors":"Eliel Ben-David, Naama R Bogot, Yehonathan Berrebi, Tamar Tetro, Roni Eichel, Michael Teitcher","doi":"10.1007/s10140-026-02555-2","DOIUrl":"https://doi.org/10.1007/s10140-026-02555-2","url":null,"abstract":"<p><strong>Purpose: </strong>Carotid web is diagnosed almost entirely from a shelf-like filling defect at CT angiography (CTA), yet the posterolateral carotid bulb at which webs arise is also a site of flow separation in which blood of differing contrast density mixes. We describe a bilateral web-like appearance at this site and determine whether it arose from reconstruction or acquisition.</p><p><strong>Methods: </strong>A 75-year-old woman with a right-hemispheric transient ischemic attack had three carotid CTA examinations: a dual-energy energy-integrating-detector CT (EID-CT) angiogram five months before presentation, a stroke-protocol photon-counting-detector CT (PCD-CT) angiogram at presentation, and a dedicated ultra-high-resolution PCD-CT angiogram three days later. Each photon-counting acquisition was additionally reconstructed with other section thicknesses, kernels or energies, and attenuation across the appearance was measured.</p><p><strong>Results: </strong>A bilateral shelf-like filling defect closely simulating a carotid web was present on the EID-CT and presenting PCD-CTF angiograms but absent on the ultra-high-resolution study. The tested reconstructions neither abolished the appearance nor elicited it. The ultra-high-resolution study was acquired 16.6 s after the end of injection at less than half the table speed, versus 10.3 s on the presenting study. Attenuation at the corresponding position measured 62%, 54% and 87% of luminal attenuation, respectively. No carotid intervention was undertaken.</p><p><strong>Conclusion: </strong>An acquisition-dependent bilateral carotid bulb pseudolesion can mimic a carotid web on both EID-CT and PCD-CT angiography and is most consistent with flow-related mixing of blood of differing contrast density. A slower repeat acquisition of the carotid bulb with a few seconds more delay may prevent unnecessary revascularization.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and independent regional validation of a dynamic ultrasound appendicitis score for suspected acute appendicitis: a prospective multicenter study.","authors":"Mohammed Mohaibes, Kasim O Hussein Al-Ali, Mohammed Mohammed, Heba Al-Gariri, May Salem, Jassim Najim","doi":"10.1007/s10140-026-02554-3","DOIUrl":"https://doi.org/10.1007/s10140-026-02554-3","url":null,"abstract":"<p><strong>Background: </strong>Acute appendicitis is the most common surgical emergency. Although CT is highly accurate, radiation exposure is a major concern in children, young adults, and pregnant women. Ultrasound is radiation-free but operator-dependent, and current scores rely on static weights without accounting for important patient-finding interactions.</p><p><strong>Objective: </strong>To develop and independently validate a Dynamic Ultrasound Appendicitis Score (Dynamic UAS) with interaction effects to improve risk stratification and potentially avoid unnecessary CT examinations.</p><p><strong>Methods: </strong>A prospective multicenter study collected development (n = 802) and independent regional external validation (n = 262) data. The Dynamic UAS was derived using multivariable logistic regression with interaction terms and internally validated using bootstrapping (1000 resamples).</p><p><strong>Results: </strong>A web-based calculator was developed. A sensitivity analysis addressed limitations of the reference standard, non-visualized appendix, and missing data. Appendicitis prevalence was 33.3% (development) and 32.8% (validation). The Dynamic UAS performed excellently in diagnosing acute appendicitis (AUC 0.96 and 0.94) and outperformed known scores (AUC 0.81 to 0.91). At the ≥ 6 level, sensitivity was 91.7%/90.7%, and specificity was 97.1%/96.0%. Calibration was good (slope 0.89, Brier 0.098). In non-visualized appendix cases, the AUC was 0.89 (95% CI: 0.84 to 0.93) in the external validation cohort and 0.90 (95% CI: 0.85 to 0.94) in the development cohort. The model is not very useful for distinguishing complicated from uncomplicated appendicitis (AUC 0.72).</p><p><strong>Conclusions: </strong>The Dynamic UAS is a novel, independently validated tool that may reduce unnecessary CT use in radiation-sensitive populations and resource-limited settings. Future studies in different international settings are needed.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI of acute appendicitis in pregnancy: navigating diagnostic pitfalls and challenges.","authors":"Boeun Lee, Jieun Byun","doi":"10.1007/s10140-026-02553-4","DOIUrl":"https://doi.org/10.1007/s10140-026-02553-4","url":null,"abstract":"<p><p>Non-contrast magnetic resonance imaging (MRI) is the preferred cross-sectional imaging modality for suspected appendicitis in pregnancy, yet its interpretation is uniquely challenging. This pictorial review moves beyond simple appendiceal diameter thresholds to the practical pitfalls encountered in daily practice. We show how the enlarging gravid uterus displaces the appendix and how physiologic changes mask inflammatory signs. We also address the diagnostic uncertainty of the equivocal appendix and the need to recognize subtle secondary features on MRI. We then detail several important entities that may confound interpretation, either by mimicking an inflamed appendix or by obscuring a normal one: pelvic venous engorgement, terminal ileitis, cecal diverticulitis, ovarian torsion, and ectopic pregnancy. For each, we highlight the features that help distinguish them. Finally, we discuss technical limitations such as field inhomogeneity and motion artifacts. We present a stepwise approach to locating the appendix paired with a problem-solving strategy that combines non-fat-suppressed and fat-suppressed T2-weighted sequences. By recognizing these multifaceted pearls and pitfalls, radiologists can improve diagnostic confidence and optimize care in this challenging population.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Agreement between emergency medicine residents and a radiologist in ultrasonographic detection and grading of hydronephrosis in patients with suspected renal colic: a prospective study.","authors":"Alper Yıldırım, Senol Ardic, Mustafa Cicek, Maksude Esra Kadıoğlu, Ozgen Gonenc Cekic, Samil Akyuz, Suleyman Turedi","doi":"10.1007/s10140-026-02521-y","DOIUrl":"10.1007/s10140-026-02521-y","url":null,"abstract":"<p><strong>Background: </strong>Suspected renal colic is a frequent emergency department presentation. Bedside hydronephrosis assessment may support early triage, consultation, and disposition decisions.</p><p><strong>Objectives: </strong>This study evaluated whether emergency medicine residents can reliably detect hydronephrosis and classify its severity using bedside urinary ultrasonography in adults with suspected renal colic.</p><p><strong>Methods: </strong>This prospective observational agreement study included 272 adults with suspected renal colic. Bedside urinary ultrasonography was performed by 16 emergency medicine residents with at least two years of residency training and structured ultrasonography education. Before enrollment, residents completed standardized theoretical, hands-on, and supervised radiologist-guided renal ultrasonography training focused on hydronephrosis assessment. Radiologist-performed ultrasonography was completed within 2 h of emergency department admission by an experienced radiologist blinded to residents' findings. Both groups used the same severity categories: absent, mild, moderate, and severe. Diagnostic performance, agreement, and severity-level concordance were analyzed at the patient level. Computed tomography (CT)-based analyses were exploratory and evaluated CT-detected hydronephrosis rather than stone detection.</p><p><strong>Results: </strong>Hydronephrosis was detected in 81 patients by both residents and the radiologist. Overall agreement was 91.18%, with a Cohen's kappa of 0.789. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 85.19%, 93.72%, 85.19%, 93.72%, and 91.18%, respectively. Exact severity-level agreement was 87.87%, with a linear weighted kappa of 0.813. In the CT subgroup, residents' ultrasonography for CT-detected hydronephrosis showed 81.63% sensitivity, 86.05% specificity, and 83.70% accuracy.</p><p><strong>Conclusion: </strong>Emergency medicine residents with structured ultrasonography training demonstrated substantial agreement with radiologist-performed ultrasonography for detecting hydronephrosis and strong agreement for severity classification. These findings apply to trained residents and may not be generalizable to clinicians without similar training or supervision.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"959-969"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of blunt trauma outcomes with pulmonary contusion quantification.","authors":"Ashwin Jain, Erik DiGiacomo, Pedro V Staziaki, Matthew Diamond, Donghoon Shin, Celina L Duran, Oam Bhate, Myoung Jin Kim, Stephan W Anderson, Tejal S Brahmbhatt, Christina A LeBedis","doi":"10.1007/s10140-026-02525-8","DOIUrl":"10.1007/s10140-026-02525-8","url":null,"abstract":"<p><strong>Objectives: </strong>To assess for associations between pulmonary contusion volume and complications of thoracic trauma.</p><p><strong>Materials and methods: </strong>Consecutive patients were retrospectively identified as sustaining thoracic trauma in a single tertiary level 1 trauma center from January 1, 2013 to October 31, 2017. Individuals ≥ 16 years old presenting with blunt thoracic trauma who underwent computed tomography (CT) within 24 hours of admission and Injury Severity Score (ISS) ≥ 15 were included. Exclusion criteria were penetrating injury, death before CT, intracranial injury, or unavailable imaging. A body fellowship-trained radiologist with more than 12 years of clinical experience manually measured pulmonary contusion, blinded to clinical data using the three largest orthogonal dimensions in axial and sagittal planes. Outcomes included mortality, severe hypoxemia, and ventilator-associated pneumonia (VAP). Logistic regression was used to evaluate the association between outcome variables and pulmonary contusion volume.</p><p><strong>Results: </strong>Of the 1,116 patients, 153 were included in the study. The number of pulmonary lobes injured on CT was associated with severe hypoxemia (p= 0.0047). For every 100 mL increase in contusion volume, the odds of death increased by 20% (p = 0.04), and the odds of severe hypoxemia increased by 21% prior to adjustment for ISS (p = 0.015).</p><p><strong>Conclusion: </strong>Pulmonary contusion volume was associated with severe hypoxemia prior to adjustment for ISS and mortality. Flail chest, the number of pulmonary lobes injured, and the number of ribs fractured were associated with mortality, severe hypoxemia, and VAP, respectively.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1101-1107"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of virtual monoenergetic images on the assessability of lower extremity arteries in (Poly-) trauma photon-counting detector CT.","authors":"Daniel Dillinger, Christian Bauer, Hanns L Kaatsch, Achim Neufang, Achim Hagen, Stephan Waldeck, Daniel Overhoff","doi":"10.1007/s10140-026-02502-1","DOIUrl":"10.1007/s10140-026-02502-1","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography (CT) is state of the art imaging modality in patients after severe trauma. A double-bolus contrast media protocol can be used to combine both arterial and parenchymal contrast in one scan. In case of lower extremity trauma, the CT scans can be extended to include the legs in order to rule out vascular pathologies. Virtual monoenergetic (VME) images derived from a Photon-Counting detector CT (PCDCT) proved to be helpful in vascular diagnostics and could therefore also add information in these extended trauma scans. Aim of this study was to determine the VME reconstructions with sufficient vascular contrast (> 200 Hounsfield Units) and to examine, which VME level has best specificity and sensitivity as well as best subjective vascular visibility.</p><p><strong>Methods: </strong>In a retrospective analysis, we identified 34 patients undergoing extended whole-body trauma scans including lower extremities on a PCDCT with pathologies of the lower extremity arteries (extravasation, dissection etc.) and paired them with 34 patients without vascular pathologies. We measured CT values and noise of six vascular segments on energy levels 40 to 190 keV and calculated signal to noise (SNR) and contrast to noise (CNR) ratio. Subjective ratings for vascular visibility were performed on a five point Likert scale and two readers analyzed the images for vascular lesions across four energy levels (40, 70, 90 and 110 keV).</p><p><strong>Results: </strong>CT attenuation was measured above 200 HU below 88 keV in the common femoral artery, below 86 keV in the superficial femoral artery and below 85 keV in the popliteal artery. For the tibial arteries, we found higher CT values above 200 HU at the energy levels below 87 keV. Noise was highest at 40 keV for all energy levels, SNR and CNR for common femoral artery was highest at 40 keV. Sensitivity peaked at 40 keV (78.4%) and showed decreasing values for higher energy levels. Specificity increased with higher keV levels up to 91.7%. 40 keV showed the highest sum of Likert ratings regarding vascular visibility.</p><p><strong>Conclusion: </strong>PCDCT derived VME reconstructions below 86 keV showed sufficient vascular contrast in extended whole-body trauma scans after double-bolus contrast media administration. Smaller vessel depiction can be hampered by increased noise on lower energy levels resulting in decreased image parameters. Lower energy levels have the potential to improve the detection of vascular pathologies, such as bleeding and vascular occlusions.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"981-990"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}