Emergency Radiology最新文献

{"title":"Evaluating the diagnostic value of ultrasound in meniscal injury detection: current evidence and future directions.","authors":"Reza Gerami, Amir Nezami Asl, Mostafa Shahrezaee, Jalal Kargar, Farshad Riahi","doi":"10.1007/s10140-025-02395-6","DOIUrl":"https://doi.org/10.1007/s10140-025-02395-6","url":null,"abstract":"<p><strong>Purpose: </strong>Meniscal injuries are a common cause of knee dysfunction and healthcare utilization, with magnetic resonance imaging (MRI) being the diagnostic gold standard. However, MRI's cost, limited accessibility, and contraindications of MRI have prompted interest in ultrasound (US) as a more affordable, portable, and radiation-free alternative. This review aimed to synthesize the current evidence on the diagnostic accuracy of US for meniscal tears and to define its role alongside MRI and arthroscopy in clinical practice.</p><p><strong>Methods: </strong>We conducted a systematic review following the PRISMA guidelines, searching PubMed from January 2020 to March 2025 for English-language studies of adult patients (>18 years) undergoing US assessment of suspected meniscal injuries. Eligible studies used MRI or surgical (arthroscopic or open) findings as reference standards. Two reviewers independently screened the titles, abstracts, and full texts, extracted the study characteristics and diagnostic metrics, and tabulated the results.</p><p><strong>Results: </strong>Six studies comprising 499 participants met the inclusion criteria. US sensitivity for detecting meniscal tears ranged from 63% to 92.9%, and specificity from 63.6% to100%, with higher performance for medial than for lateral tears. Point-of-care US in emergency settings demonstrated sensitivities up to 92.9% and specificities up to 88.9%. Community-based US yielded specificity ≥97% for medial tears.</p><p><strong>Conclusion: </strong>US exhibits clinically acceptable diagnostic accuracy for meniscal injury, particularly when high-frequency probes and experienced operators are used. However, future research should focus on large-scale standardized trials to refine scanning protocols, quantify learning curves, and develop guidelines for integrating US into meniscal injury trajectories.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250490","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":"Hidden dangers: the radiologist's role in diagnosing arterial injuries after orthopaedic surgery of the lower limb.","authors":"Emanuele Barabino, Marta Verda, Michele Tosques, Arianna Nivolli, Giulia Pittaluga, Giulio Bovio, Diego Ivaldi, Francesca Lacelli, Giuseppe Cittadini","doi":"10.1007/s10140-025-02392-9","DOIUrl":"https://doi.org/10.1007/s10140-025-02392-9","url":null,"abstract":"<p><p>Orthopedic surgery is the most common intervention performed on the lower limb. Although rare (0.005-0.5%), the incidence of iatrogenic arterial injuries is increasing due to the rising use of prosthetic implants and broader surgical indications in aging populations. Imaging findings are diverse and include hemorrhage, pseudoaneurysm, hemarthrosis, endomedullary bleeding, retraction-induced microvascular injury, stenosis, and occlusion. However, evaluation is often complicated by artifacts from metallic hardware. This pictorial review illustrates the radiological spectrum of these injuries, offers practical tips to optimize imaging quality, and proposes a structured algorithm to guide timely and effective diagnosis and management.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250413","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":"Transabdominal ultrasound for positive, negative, and equivocal ovarian and tubal torsion in girls.","authors":"Julian Lopez-Rippe, Maria Camila Velez-Florez, Rosa Hwang, Wondwossen Lerebo, Gary Nace, Aaron E Chen, J Christopher Davis, Eron Friedlaender, Summer L Kaplan","doi":"10.1007/s10140-025-02399-2","DOIUrl":"https://doi.org/10.1007/s10140-025-02399-2","url":null,"abstract":"<p><strong>Background: </strong>Adnexal torsion diagnosis in children relies heavily on ultrasound, but existing literature lacks standardization of technique and handling of equivocal results.</p><p><strong>Purpose: </strong>To assess the accuracy of transabdominal ultrasound (US) in diagnosing adnexal torsion in pediatric patients and evaluate optimal clinical decision-making for equivocal US reads.</p><p><strong>Materials and methods: </strong>Retrospective review of pelvic US exams and surgical data for girls aged 1-18 years from 2015 to 2019 at a pediatric quaternary care hospital. US reports were coded as positive, negative, or equivocal for torsion. Surgical findings were used to confirm final diagnosis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated under various scenarios for handling equivocal reads.</p><p><strong>Results: </strong>This study included 4,396 ultrasound exams from 3,707 patients (median age, 15.2 years [IQR: 12.8-16.8]). Ovarian visualization rate was 97-98%. US was read as positive for torsion in 1% of adnexae, negative in 95%, and equivocal in 4%. Among 179 surgical cases, torsion was present in 52%. Sensitivity of US for torsion was highest (86.0%) when equivocal cases were considered positive (EqP), but PPV was lowest (29.9%) under this condition. Area under the ROC curve was greatest (0.8651) when equivocal US were counted as positive. US reads were more likely to be true positive for isolated ovarian torsion compared to when tubal torsion was present (p = 0.003).</p><p><strong>Conclusion: </strong>A standardized transabdominal US protocol yields high ovarian visualization rates, and treating equivocal reads as positive can optimize diagnostic accuracy when combined with clinical decision-making. US maybe be less accurate in detecting tubal torsion compared to isolated ovarian torsion, but this finding should be interpreted with caution given the small sample size. Overall, these results provide clinically relevant insights to guide management and future research in pediatric adnexal torsion.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250453","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":"Post-trauma cervical spine imaging in patients 65 and older.","authors":"David M Yousem","doi":"10.1007/s10140-025-02405-7","DOIUrl":"https://doi.org/10.1007/s10140-025-02405-7","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244237","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":"Risk factors for misdiagnosis of interstitial ectopic pregnancy.","authors":"Christana O Ajewole, Batsheva R Rubin, Gabrielle H Cherfane, Joseph A Politch, Ann Doherty, Neha Khemani, Andrew Barakat, Christina LeBedis, Alexis K Gadson, Yeon Woo Lee, Justina J Wang, Wendy Kuohung","doi":"10.1007/s10140-025-02391-w","DOIUrl":"https://doi.org/10.1007/s10140-025-02391-w","url":null,"abstract":"<p><strong>Purpose: </strong>To identify factors contributing to misdiagnosis of interstitial ectopic pregnancy (IEP).</p><p><strong>Methods: </strong>Retrospective chart review identified patients who presented to Boston Medical Center with suspected and/or true IEP from January 1, 2012 to April 30, 2019. Final diagnoses identified two IEP diagnosis groups: correct initial diagnosis and incorrect initial diagnosis. Data collected included age, gravidity, parity, body mass index (BMI), estimated gestational age, anatomic anomalies of the reproductive tract, smoking status, and history of pelvic surgery, sexually transmitted infections, pelvic inflammatory disease, or adnexal lesions. Continuous variables were analyzed using analysis of covariance and unpaired t-tests. Fisher's exact tests were used for discrete variables.</p><p><strong>Results: </strong>Of 53 patients with suspected and/or true IEP, 15 (28%) were correctly diagnosed at initial presentation while 38 (72%) were initially incorrectly diagnosed. Patient age was significantly associated with diagnostic group (p = 0.04). Patients in the correctly diagnosed group (Mean ± SD = 35.1 ± 4.2) were significantly older than those incorrectly diagnosed (Mean ± SD = 30.4 ± 4.2) when controlled for gravidity. In univariate analysis, gravidity was associated with diagnostic group, but this association was not significant when controlled for age. Parity demonstrated a similar trend as gravidity but also did not reach significance. Other variables analyzed were not significantly associated with accuracy of initial diagnosis.</p><p><strong>Conclusion: </strong>Younger women are more likely to have an incorrect initial diagnosis of IEP at presentation to care. Anecdotally, higher tolerance of invasive imaging procedures by older patients with reproductive experience may result in increased accuracy of transvaginal ultrasound examination.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238247","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":"Can multicontrast ultrafast brain MRI assist residents to triage intracranial emergencies with structured reporting?","authors":"Chase Dougherty, Ashley Spencer, Puneet Kochar, Krishnamoorthy Thamburaj","doi":"10.1007/s10140-025-02398-3","DOIUrl":"https://doi.org/10.1007/s10140-025-02398-3","url":null,"abstract":"<p><strong>Purpose: </strong>Multicontrast ultrafast MRI brain is increasingly explored to triage acute intracranial emergencies. Since residents are at the forefront of emergency radiology in academic centers, it is critical to understand the suitability of ultrafast MRI for resident trainees. Further, structured radiology reportings have found foothold to communicate to the referring services and it will be beneficial to understand the capability of ultrafast MRI to facilitate such a structured reporting.</p><p><strong>Methods: </strong>A retrospective analysis of 104 cases with multicontrast ultrafast MRI was performed in inpatient and emergency settings. Images were assessed independently by blinding to all charts by a second-year diagnostic radiology resident and a board-certified neuroradiology attending with over 20 years of experience. Fifteen anatomical variables were evaluated to emulate the structured reporting used in standard MRI brain studies. Clinical summary at discharge served as the reference standard to correlate the presence of acute intracranial emergency on ultrafast MRI.</p><p><strong>Results: </strong>Inter-rater agreements for fifteen imaging variables ranged between 0.33 to 0.74 and Cohen's kappa of 0.92 (p < .001) to triage acute emergency. Percentage agreement for six anatomical landmarks ranged from 98 to 100%. The accuracy to distinguish acute from non-acute conditions was 96.2% for the resident and 99% for the experienced reviewer.</p><p><strong>Conclusions: </strong>Multicontrast ultrafast MRI brain shows promise to triage acute intracranial emergencies with resident-level training. It can facilitate structured analysis of a majority of anatomical landmarks.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225232","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":"Split-bolus single-pass CT in splenic injury: does it miss relevant vascular injury? : Article type: original research.","authors":"Sadia R Qamar, Ferco H Berger, Tjarda N Tromp, Digna R Kool, Ludo F M Beenen, Bernd P Teunissen, Maeke J Scheerder, Michael J R Edwards, Monique Brink","doi":"10.1007/s10140-025-02389-4","DOIUrl":"https://doi.org/10.1007/s10140-025-02389-4","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate diagnostic performance of split-bolus single-pass CT (SBSP-CT) for splenic vascular injury (SVI) and clinically relevant splenic vascular injury requiring treatment (CR-SVI) in trauma patients with splenic injury.</p><p><strong>Methods: </strong>This retrospective observer study included 111 consecutive trauma patients (76% male), mean age 37 years (9-81), median ISS 27 (interquartile range (IQR) 26-33), with splenic injury and primary SBSP-CT at a level-1 trauma center between December 2012 and December 2018. Four radiologists independently scored CTs for SVI presence and likelihood. Consensus reference standards for SVI and CR-SVI were based on clinical, imaging and 3-month follow-up data. Image adequacy was assessed quantitively and qualitatively and diagnostic performance and interobserver agreement analyzed.</p><p><strong>Results: </strong>37 of 111 (33.3%) patients had SVI and 27 (24.3%) had CR-SVI requiring treatment. Five patients died prior to SVI treatment from unrelated injuries; no mortality was attributed to undetected SVI. Two patients had delayed splenic rupture, both survived. Median attenuation was 292 HU (IQR 250-348) in the aorta and 130 HU (IQR 114-150) in splenic parenchyma. Images were adequate in 107 of 111 (96.4%) patients. Interobserver agreement for SVI was substantial (0.741; 95% CI: 0.67-0.82). NPV for SVI ranged from 89.2 to 94.4% (95% CI: 89.2-97.4) and for CR-SVI from 94.4 to 97.1% (95% CI: 88.5-98.9). AUROC for SVI ranged from 0.825 to 0.862 and for CR-SVI from 0.825 to 0.862.</p><p><strong>Conclusion: </strong>SBSP-CT provides adequate image quality and high diagnostic confidence for evaluating splenic vascular injury with high negative predictive value for relevant splenic vascular injuries.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205855","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":"Letter to the Editor: Rapid abdominal MRI for appendicitis for evaluation of ovarian torsion in children.","authors":"Ahmet Gürkan Erdemir","doi":"10.1007/s10140-025-02371-0","DOIUrl":"10.1007/s10140-025-02371-0","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"817-818"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658738","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":"Response to the letter to the editor: rapid abdominal MRI for appendicitis for evaluation of ovarian torsion in children.","authors":"Sharon W Gould, Arabinda Choudhary","doi":"10.1007/s10140-025-02372-z","DOIUrl":"10.1007/s10140-025-02372-z","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"815"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648854","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":"Improving the management of acute subdural hematomas; identifying characteristics associated with acute subdural hematoma size and expansion.","authors":"Caline Azzi, Mahla Radmard, Armin Tafazolimoghadam, Soyeb Aftab, Chi Trinh, Anthony Bishara, Risheng Xu, Arjun Chanmugam, David Yousem","doi":"10.1007/s10140-025-02378-7","DOIUrl":"10.1007/s10140-025-02378-7","url":null,"abstract":"<p><strong>Purpose: </strong>The incidence of subdural hematomas (SDHs) is increasing due to the aging population, frequent use of anticoagulants/antiplatelets, and fall-related trauma. While some acute SDHs remain stable and require no intervention, others expand, necessitating neurosurgical management. Our study objective was to better identify predictors of acute SDH enlargement to guide clinical management.</p><p><strong>Methods: </strong>This retrospective study analyzed 32,401 noncontrast CT brain scans over six years. We identified 262 patients with acute SDHs and evaluated demographic, clinical, and radiologic factors associated with hematoma enlargement and the need for surgical intervention. Statistical analyses, including univariate analyses, logistic regression and receiver operating characteristic curves, were performed to determine predictors of SDH growth and surgery.</p><p><strong>Results: </strong>SDH enlargement occurred in 58/232 (25%) of patients with follow-up imaging. Larger initial SDH size, concurrent subarachnoid hemorrhage, hypertension, convexity location, and midline shift were significantly associated with hematoma expansion (p < 0.05). No patient with an initial SDH ≤ 3 mm required surgery initially or in follow-up, although 8/72 (11.1%) enlarged (maximum width 10 mm). An 8.5-mm initial SDH size threshold best predicted the need for surgical intervention (AUC 0.81).</p><p><strong>Conclusions: </strong>Initial SDH size, hypertension, SAH, initial midline shift, and convexity location are key predictors of hematoma expansion. Although patients' with SDHs ≤ 3 mm rarely expanded, they never required surgery. A prospective study to determine a more judicious use of hospital-based resources, especially for those patients with initial SDH size > 3 mm who have risk factors for expansion, would be an important step in the management of SDHs.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"737-750"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859064","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}