Emergency Radiology最新文献

{"title":"Correction to: Artificial intelligence in emergency and trauma radiology: ASER AI/ML expert panel Delphi consensus statement on research guidelines, practices, and priorities.","authors":"David Dreizin, Garvit Khatri, Pedro V Staziaki, Karen Buch, Mathias Unberath, Mohammed Mohammed, Aaron Sodickson, Bharti Khurana, Anjali Agrawal, James Stephen Spann, Nicholas Beckmann, Zachary DelProposto, Christina A LeBedis, Melissa Davis, Gabrielle Dickerson, Michael Lev","doi":"10.1007/s10140-025-02312-x","DOIUrl":"10.1007/s10140-025-02312-x","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"305-306"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002263","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":"Tips and challenges for clinical use and interpretation of low field portable MRI in neuroimaging.","authors":"Yingming Amy Chen, Shobhit Mathur, Amy Lin, Edmond Knopp, Matthew S Rosen, Aditya Bharatha","doi":"10.1007/s10140-025-02323-8","DOIUrl":"10.1007/s10140-025-02323-8","url":null,"abstract":"<p><p>Low field portable MRI (LF pMRI) is a new imaging tool that holds promise in offering a safe, cost-effective, point-of-care imaging solution in neuroimaging. There are however unique interpretive challenges and operational factors and limitations in its implementation in clinical practice. This paper aims to provide a comprehensive guide on the tips and tricks of interpreting LF pMRI, specifically the Hyperfine Swoop® MRI system, which operates at 0.064 T and is currently the only FDA and Health Canada approved LF pMRI system. This paper explores the operational aspects and interpretation challenges of low-field MRI, such as patient positioning, protocol selection, and the appearance of artifacts and common pathologies. Using illustrative examples, we aim to guide current and future operators of LF pMRI to optimize performance, provide accurate diagnoses, and avoid common pitfalls.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"279-289"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457343","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":"Acute splenic pathology on CT in patients with babesiosis.","authors":"John J Hines, Sarah Byun, Adrian Popp, Douglas S Katz","doi":"10.1007/s10140-024-02277-3","DOIUrl":"10.1007/s10140-024-02277-3","url":null,"abstract":"<p><strong>Purpose: </strong>To better understand the occurrence of splenic disease as a potential manifestation of babesiosis by retrospectively estimating the frequency of acute splenic injury on abdominal and pelvic CT in a cohort of patients with active babesia infection.</p><p><strong>Materials and methods: </strong>In a search of our single institution, suburban teaching community hospital database, 57 patients were found to have positive babesia infection between the years 2021-2023. 29 of these patients underwent abdominal and pelvic CT (22 with and 7 without intravenous contrast), and 3 underwent abdominal ultrasound without any CT. The imaging was reviewed for the presence or absence of splenic abnormalities, and for follow-up imaging. Parasitemia levels at the time of imaging were also reviewed; parasitemia levels < 4% are associated with mild to moderate disease, whereas parasitemia levels > 4% are associated with severe disease.</p><p><strong>Results: </strong>21/32 (66%) patients who underwent any type of abdominal imaging (ultrasound, MRI, and CT) had splenomegaly. Of the 22 patients who had IV contrast-enhanced CT scans, 6 were found to have splenic infarction (27%). One of these 22 patients had multiple rounded non-peripheral hypoenhancing foci on both CT and MRI which did not meet criteria for infarction, in association with splenomegaly, and which resolved after treatment. 0/6 patients in the splenic infarction group had parasitemia levels greater than 4%, while 4 of the 16 patients (4/16) without infarction had parasitemia levels of greater than 4%.</p><p><strong>Conclusion: </strong>Our study showed that splenic disease in patients with babesiosis mostly took the form of splenomegaly, and in a substantial minority of patients as splenic infarction. There were no cases of splenic rupture and perisplenic hematoma in our case series, likely reflecting a limitation of the relatively small study size. Concordant with prior studies, we found no identifiable association between parasitemia levels and the presence of splenic infarction.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"7-11"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970826","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":"Off-console automated artificial intelligence enhanced workflow enables improved emergency department CT capacity.","authors":"John McMenamy, Sergey Kochkine, Mark Bernstein, Anthony Lucero, Randy Miles, Adam Schwertner, Ashesh Thaker, David M Naeger","doi":"10.1007/s10140-024-02297-z","DOIUrl":"10.1007/s10140-024-02297-z","url":null,"abstract":"<p><strong>Purpose: </strong>Increasing CT capacity to keep pace with rising ED demand is critical. The conventional process has inherent drawbacks. We evaluated an off-console automated AI enhanced workflow which moves all final series creation off-console. We hypothesized the off-console workflow would 1) decrease overall ED CT exam begin to end times and decrease length and variability of time CT is occupied at the individual exam level.</p><p><strong>Methods: </strong>Study population was identified retrospectively and included all CT exams done on all ED adult patients. 3 months of data was collected using the conventional workflow and 3 months of data was collected after implementation of the off-console workflow. Exam begin and the exam end timestamps were collected from the EMR. Additionally, 4 subgroups from the above conventional and off-console workflows were identified retrospectively with an Emergency Severity Index level 1, undergoing one of the four most common CT exam set(s) performed on ESI level 1 patients.</p><p><strong>Results: </strong>6,795 ED adult patients underwent ED CT in the 3 months immediately prior to implementation of the off-console workflow and 6,708 adult ED patients underwent CT in the 3 months after complete implementation. The off-console workflow demonstrated a 36% decrease in median exam begin to end times (P < 0.001). 4 subgroups demonstrated 56-75% decreases in median CT occupied time (P < 0.001) and decreases in variability in ¾ subgroups.</p><p><strong>Discussion: </strong>This off-console workflow enables increased CT capacity to meet rising ED demand. Similar improvements could be expected across most exam sets and imaging settings if broadly implemented.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"65-72"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806480","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":"A practical approach to the post esophagectomy CT: expected postoperative anatomy and anatomical approach to associated complication.","authors":"Sam Nowicki, Laura C Jorgenson, Michael LaVere, Sherry Wang, Ahmad Parvinian, Sabarish Narayanasamy, Ceylan Colak, James Boyum, Alex Chan","doi":"10.1007/s10140-024-02292-4","DOIUrl":"10.1007/s10140-024-02292-4","url":null,"abstract":"<p><p>This pictorial review aims to provide a structured approach to the interpretation of post esophagectomy CT by reviewing the major esophagectomy surgeries and conduit reconstructions, along with their associated complications at key anatomical landmarks. This paper combines an image rich experience and evidence-based approach to common and rare complications. The paper begins with an overview of the conventional Ivor Lewis esophagectomy and the expected postoperative imaging appearance (with separate detailed tables on additional surgical reconstructions), followed by a focused review of various complications at specific anatomical sites in a systematic fashion. By the conclusion of this review, radiologists will be equipped to employ a systematic approach to post-esophagectomy CT interpretation, confidently identifying both common and uncommon complications.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"113-124"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521398","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":"Outcome of follow-up computed tomography of suspected occult scaphoid fracture after normal radiography.","authors":"Mats Geijer, Eirikur Gunnlaugsson, Linnea Arvidsson, Elin Österhed, Magnus Tägil","doi":"10.1007/s10140-024-02307-0","DOIUrl":"10.1007/s10140-024-02307-0","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the rate of missed scaphoid fractures on follow-up computed tomography (CT) for suspected occult scaphoid fracture after normal radiography with residual radial-sided wrist pain.</p><p><strong>Methods: </strong>In a retrospective analysis, wrist CT during a five-year period was analyzed. The CT examinations and radiological reports were re-evaluated. Available clinical findings and radiologic follow-up performed during a period of a minimum of three years served as outcome reference.</p><p><strong>Results: </strong>In total, 178 examinations had been performed on 174 patients for suspect scaphoid fracture, 67 men and 107 women, showing 15 and 6 scaphoid fractures, respectively; a statistically significant sex difference (p = 0.0024). In 157 examinations, no scaphoid fracture was detected on CT, instead 29 other wrist or carpal bone fractures were found. On follow-up, no missed scaphoid fractures were found. Before CT, 124 of the 157 patients had been treated with a cast. After CT, 35 patients continued with cast treatment for a median of 14 days.</p><p><strong>Conclusions: </strong>CT appears to be a reliable method for evaluating suspect scaphoid fracture as part of a diagnosis-treatment regimen including pain immobilization with a plaster cast.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"51-57"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946590","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}

{"title":"Brain microbleeds resulting from presumed extensive fat emboli in a patient with bone marrow necrosis following a sickle cell disease vaso-occlusive crisis.","authors":"Gary Amseian, Maria Ortiz-Fernández, Pamela Doti, Anna Massuet, Pedro Castro, Camilo Pineda","doi":"10.1007/s10140-024-02283-5","DOIUrl":"10.1007/s10140-024-02283-5","url":null,"abstract":"<p><p>Acute manifestations of sickle cell disease (SCD) are numerous and multisystemic. Cerebral fat embolism (CFE) is a rare but serious complication of SCD caused by bone marrow necrosis (BMN) during vaso-occlusive crises (VOC). We present the case of a 41-year-old man with SCD who developed severe VOC and multi-organ dysfunction. He subsequently experienced neurological deterioration with decreased consciousness and diffuse encephalopathy on serial electroencephalograms. Bone marrow aspiration confirmed BMN. Brain MRI revealed extensive diffuse leukoencephalopathy, vasogenic and cytotoxic edema in the white matter, patchy edema in the cranial vault bone marrow on fat-suppressed FLAIR sequence (a finding consistent with the confirmed BMN), and multiple cerebral microbleeds on susceptibility-weighted imaging consistent with CFE. The management of acute neurological complications of SCD varies depending on the specific complication. Brain MRI plays a crucial role in the accurate diagnosis of these complications to guide appropriate treatment.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"125-129"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343853","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":"Exploring the role of CT scouts in expediting MRI in acute stroke.","authors":"Rahul B Singh, Ahmed K Ahmed, Gabriel M Virador, Yassine Alami Idrissi, Alok A Bhatt, Dhairya A Lakhani, Merrie W Oei, Neethu Gopal, Cameron Overfield, Colin Rowell, Dinesh Rao, Prasanna Vibhute, Robert E Watson, Sukhwinder J S Sandhu","doi":"10.1007/s10140-024-02282-6","DOIUrl":"10.1007/s10140-024-02282-6","url":null,"abstract":"<p><strong>Purpose: </strong>For acute stroke patients requiring MR examination and unable to provide a reliable history, screening for potentially MRI-incompatible objects (PMIOs) typically necessitates the use of plain-film radiographs (PFRs). However, using a whole body CT scout at the time of non-contrast head CT scans can preclude critical delays. Here, we aim to compare the effectiveness of PFRs and CT scouts in detecting PMIOs.</p><p><strong>Methods: </strong>A case-control study was conducted at a tertiary care institution, involving 408 imaging studies from 200 patients, half of which contained PMIOs. The diagnostic performances of CT scouts and PFRs were evaluated by six blinded readers, including two board-certified neuroradiologists, one neuroradiology fellow, and three radiology residents.</p><p><strong>Results: </strong>2448 interpretations from the 6 readers were analyzed. The diagnostic performance of combined CT scout images (full-body and regional) was not significantly different from that of PFRs for all six readers (p = 0.06). However, PFRs outperformed full-body CT scouts in PMIO detection (p = 0.01), with no significant differences observed between PFRs and regional CT scouts (p = 0.4). Notably, the diagnostic accuracy of the radiology residents was found to be equivalent to radiologists across all imaging techniques.</p><p><strong>Conclusion: </strong>Integrating CT scouts in acute stroke protocols may help expedite MRI screening. The scouts should include the head, neck, chest, upper arms, abdomen, pelvis, and thighs. Including radiology residents in the screening process for PMIOs may be an avenue for resource optimization in acute care settings.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"41-50"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282203","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":"Diagnostic performance of ChatGPT in tibial plateau fracture in knee X-ray.","authors":"Mohammadreza Mohammadi, Sara Parviz, Parinaz Parvaz, Mohammad Mahdi Pirmoradi, Mohammad Afzalimoghaddam, Hadi Mirfazaelian","doi":"10.1007/s10140-024-02298-y","DOIUrl":"10.1007/s10140-024-02298-y","url":null,"abstract":"<p><strong>Purpose: </strong>Tibial plateau fractures are relatively common and require accurate diagnosis. Chat Generative Pre-Trained Transformer (ChatGPT) has emerged as a tool to improve medical diagnosis. This study aims to investigate the accuracy of this tool in diagnosing tibial plateau fractures.</p><p><strong>Methods: </strong>A secondary analysis was performed on 111 knee radiographs from emergency department patients, with 29 confirmed fractures by computed tomography (CT) imaging. The X-rays were reviewed by a board-certified emergency physician (EP) and radiologist and then analyzed by ChatGPT-4 and ChatGPT-4o. The diagnostic performances were compared using the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and likelihood ratios were also calculated.</p><p><strong>Results: </strong>The results indicated a sensitivity and negative likelihood ratio of 58.6% (95% CI: 38.9 - 76.4%) and 0.4 (95% CI: 0.3-0.7) for the EP, 72.4% (95% CI: 52.7 - 87.2%) and 0.3 (95% CI: 0.2-0.6) for the radiologist, 27.5% (95% CI: 12.7 - 47.2%) and 0.7 (95% CI: 0.6-0.9) for ChatGPT-4, and 55.1% (95% CI: 35.6 - 73.5%) and 0.4 (95% CI: 0.3-0.7) for ChatGPT4o. The specificity and positive likelihood ratio were 85.3% (95% CI: 75.8 - 92.2%) and 4.0 (95% CI: 2.1-7.3) for the EP, 76.8% (95% CI: 66.2 - 85.4%) and 3.1 (95% CI: 1.9-4.9) for the radiologist, 95.1% (95% CI: 87.9 - 98.6%) and 5.6 (95% CI: 1.8-17.3) for ChatGPT-4, and 93.9% (95% CI: 86.3 - 97.9%) and 9.0 (95% CI: 3.6-22.4) for ChatGPT4o. The area under the receiver operating characteristic curve (AUC) was 0.72 (95% CI: 0.6-0.8) for the EP, 0.75 (95% CI: 0.6-0.8) for the radiologist, 0.61 (95% CI: 0.4-0.7) for ChatGPT-4, and 0.74 (95% CI: 0.6-0.8) for ChatGPT4-o. The EP and radiologist significantly outperformed ChatGPT-4 (P value = 0.02 and 0.01, respectively), whereas there was no significant difference between the EP, ChatGPT-4o, and radiologist.</p><p><strong>Conclusion: </strong>ChatGPT-4o matched the physicians' performance and also had the highest specificity. Similar to the physicians, ChatGPT chatbots were not suitable for ruling out the fracture.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"59-64"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754819","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":"Quantitative ROI differences for assessment of occult intertrochanteric extension of greater trochanteric fractures on pelvis CT.","authors":"Meghan A Moriarty, Dimitri G Stefanov, Michael S Brown, Daniel M Walz, Pamela J Walsh","doi":"10.1007/s10140-024-02293-3","DOIUrl":"10.1007/s10140-024-02293-3","url":null,"abstract":"<p><strong>Purpose: </strong>To determine if difference in Hounsfield Units (HU) of the medullary bone between the injured and non-injured femurs in patients with greater trochanteric fractures is associated with occult intertrochanteric (IT) extension.</p><p><strong>Methods: </strong>Retrospective review was performed of 81 patients (age range 54-102, 54 females and 27 males) who underwent CT and subsequent MRI after identification of a greater trochanteric fracture without evidence of IT extension on radiography and/or CT. Hounsfield units of the injured and non-injured femurs on CT were recorded at the level of the base of the greater trochanter centrally (ROI1) and the level of the upper border of the lesser trochanter posteromedially (ROI2). The difference between the injured and non-injured femur for each ROI1 and ROI2 were calculated. Absence or presence, and if present, extent of IT extension was assessed on MRI. Analysis was performed to determine if there is correlation of difference in density with presence, and extent of occult IT fractures.</p><p><strong>Results: </strong>81 cases met inclusion criteria, 14 (17%) had no IT extension, 11 (14%) had less than 50% IT extension and 56 (69%) had 50% or greater IT extension. There was statistical significance between presence and absence of IT extension between the injured and non-injured femur for ROI1 (HU) no IT extension median (IQR): 18.8(4-40), ROI1 (HU) present IT extension median (IQR): 65.5(46-90) p < .0001, and for ROI2 no IT extension median (IQR): 3(-8-25.5) and ROI2 present IT extension 51(40.5-76), p < .0001. There was statistical significance of the extent of IT extension: ROI1 less than 50% IT extension median (IQR): 37.5(27.5-57), ROI1 50% or greater IT extension median (IQR): 72.3(53.5-91.3), p < .0001, and for ROI2 less than 50% IT extension median (IQR): 17.5(8-49), and ROI2 50% or greater IT extension median (IQR): 55.8(45.3-81.5), p < .0001. A threshold ROI2 difference of 50 HU resulted in specificity of 92% and sensitivity 60.7% of for IT extension 50% or greater.</p><p><strong>Conclusion: </strong>Patients presenting with greater trochanteric fractures, an asymmetric increased density measured by ROI differences within the medullary space of the IT region between the injured and non-injured femur is associated with occult IT extension.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"13-22"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497217","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}