Emergency Radiology最新文献

{"title":"Diagnostic utility of abdominal radiography in emergency departments with high guideline compliance: a retrospective cohort study.","authors":"Fraser I Riddoch, Morven McNab, Ben Keatley, Kirsty McNeil","doi":"10.1007/s10140-026-02536-5","DOIUrl":"10.1007/s10140-026-02536-5","url":null,"abstract":"<p><strong>Purpose: </strong>Abdominal radiography (AXR) remains widely used in emergency departments (EDs) despite concerns about diagnostic performance, often attributed to inappropriate use. We evaluated appropriateness, diagnostic yield and 48-hour abdominopelvic CT utilisation in two Scottish EDs with high Royal College of Radiologists (RCR) iRefer adherence.</p><p><strong>Methods: </strong>Retrospective multi-centre cohort study of 866 adults (median age 65 years, 49.5% female) undergoing AXR during ED attendance at two Scottish acute hospitals in 2024. Requests were classified against RCR iRefer (2017) criteria. Primary outcomes were RCR compliance and CT utilisation within 48 h; secondary outcomes were AXR yield by compliance, CT positivity by AXR result, AXR-CT concordance, and disposition.</p><p><strong>Results: </strong>RCR compliance was 88.3%. Despite this, 67.9% of AXRs were normal and 35.6% of patients underwent CT within 48 h. Among patients proceeding to CT, clinically significant pathology was identified after 80.0% (136/170) of normal and 95.7% (132/138) of abnormal AXRs. Compliant requests had higher AXR yield (33.6% vs. 20.8%, p = 0.01) but compliance did not predict CT utilisation (p = 0.67). CT provided discordant or additive information beyond AXR in 12.7% and 28.6% of paired examinations, respectively. Of patients undergoing CT, 98.1% were admitted irrespective of result.</p><p><strong>Conclusions: </strong>Exemplary guideline adherence did not overcome AXR's diagnostic limitations. A normal AXR did not exclude significant pathology, and abnormal AXRs frequently required CT for characterisation. These findings support prospective evaluation of direct-to-CT pathways for selected acute abdominal presentations, including patient-safety, workflow and economic outcomes.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1007-1015"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817744","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":"Beyond diagnostic yield: do alternative findings justify CT pulmonary angiography?","authors":"Güney Sarıoğlu","doi":"10.1007/s10140-026-02539-2","DOIUrl":"10.1007/s10140-026-02539-2","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1265-1266"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879425","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":"Shortening MRI scanning time for acute ischemic stroke: analysis of the effect of 3.0T MRI compressed sensing deep learning reconstruction.","authors":"Xinxin Jiang, Feixiang Shang, Junqi Liu, Qiuzi Qin, Pei Li, Zhentao Chen, Li Li, Weijun Qian","doi":"10.1007/s10140-026-02496-w","DOIUrl":"10.1007/s10140-026-02496-w","url":null,"abstract":"<p><strong>Background: </strong>Acute ischemic stroke requires rapid and accurate MRI diagnosis. This study aimed to evaluate whether 3.0T brain MRI with compressed sensing deep learning reconstruction (CS‑DLR) can reduce scanning time while maintaining diagnostic image quality.</p><p><strong>Methods: </strong>We retrospectively enrolled 69 patients with acute ischemic stroke who underwent 3.0T MRI. Conventional images and CS‑DLR reconstructed images at three acceleration rates (R3, R4, R5) were compared for AX T2WI, AX T1WI, and AX T2W FLAIR sequences. Two radiologists performed qualitative evaluation (5‑point scale: overall quality, noise, clarity). Quantitative assessment included signal‑to‑noise ratio (SNR) and contrast‑to‑noise ratio (CNR). Statistical analysis was performed using generalized estimating equation (GEE).</p><p><strong>Results: </strong>CS‑DLR significantly reduced scanning time. Quantitative analysis showed that SNR and CNR were significantly higher in the CS‑DLR groups than in the conventional group (P < 0.05). Qualitative scores for overall quality, noise, and clarity were significantly better in CS‑DLR R3 and R4 than in the conventional group (P < 0.05). CS‑DLR R5 showed similar overall image quality (P > 0.05) but significantly lower clarity (P < 0.05).</p><p><strong>Conclusion: </strong>CS‑DLR markedly shortens 3.0T MRI scanning time for acute ischemic stroke. CS‑DLR R3 and R4 provide superior image quality compared with conventional MRI, whereas R5 achieves comparable overall quality. CS‑DLR is clinically feasible and valuable for rapid emergency neuroimaging.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1067-1074"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155660","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":"CT-defined orbital wall burden and early visual dysfunction in acute orbital trauma: A retrospective cohort study.","authors":"Tugay Usta, Osman Faruk Bayramlar, Servet Yüce, Elif Nur Koçak, Türker Demirtakan, Eren Sert, Serkan Doğan, Fatma Esin Özdemir, Ece Yalçındağ, İbrahim Koçak, Hüseyin Bayramlar","doi":"10.1007/s10140-026-02498-8","DOIUrl":"10.1007/s10140-026-02498-8","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether computed tomography (CT)-defined orbital wall burden (OWB) is associated with early visual dysfunction in patients with acute orbital trauma and to assess the clinical relevance of CT-derived structural and focal imaging findings for early risk stratification.</p><p><strong>Methods: </strong>This retrospective cohort study included consecutive patients with CT-confirmed orbital trauma at a tertiary emergency referral center between January 1 and December 31, 2023. Visual dysfunction was defined as worst visual acuity (VA_worst) ≤ 0.8 during index hospitalization. OWB was categorized as 0, 1, or ≥ 2 fractured orbital walls. Additional imaging variables included intracranial involvement and retrobulbar hematoma. Univariable analyses, trend testing, and multivariable logistic regression were performed.</p><p><strong>Results: </strong>A total of 328 patients were included, and visual dysfunction occurred in 88 (26.8%). Visual dysfunction increased across OWB categories (24.9% for OWB = 0, 38.1% for OWB = 1, and 60.0% for OWB ≥ 2; trend p < 0.001). In multivariable analysis, increasing age (adjusted OR 1.03, 95% CI 1.02-1.04; p < 0.001) and retrobulbar hematoma (adjusted OR 11.34, 95% CI 1.29-100.02; p = 0.029) were associated with visual dysfunction, although the latter estimate was imprecise due to limited event numbers. OWB and intracranial involvement were not independently associated with the outcome after adjustment. Model discrimination was moderate (AUC = 0.69).</p><p><strong>Conclusion: </strong>In acute orbital trauma, CT-derived structural findings demonstrate a graded association with early visual dysfunction at the crude level but do not independently predict outcome after adjustment. Instead, OWB appears to function as a marker of cumulative injury burden, whereas retrobulbar hematoma represents a focal, clinically critical imaging finding associated with visual compromise. These results support a radiology-oriented framework in which CT contributes to early risk stratification by differentiating overall injury severity from time-sensitive vision-threatening lesions.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1123-1133"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148148880","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":"Improved computer-aided detection performance for pulmonary embolism on CTPA with higher noise reduction reconstruction.","authors":"Eline Langius-Wiffen, Nikki Hendriks, Ingrid M Nijholt, Erwin de Boer, Stefan Walen, Jan Wk van den Berg, Pim A de Jong, Martijn F Boomsma","doi":"10.1007/s10140-026-02500-3","DOIUrl":"10.1007/s10140-026-02500-3","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate whether a higher image noise reduction improves the diagnostic accuracy of Computer-Aided Detection (CAD) software to detect pulmonary embolism (PE) on CT pulmonary angiography (CTPA).</p><p><strong>Methods: </strong>We retrospectively included 238 consecutive CTPAs of patients with suspected PE obtained between 01/09/2014 and 06/03/2014. Hybrid iterative reconstruction (HIR) was performed using either iDose⁴ level 3 or level 4 with 23% vs. 29% noise reduction, respectively. CAD software marked all potential PE. Two radiologists evaluated CAD markers and classified them as either true positive (TP) or false positive (FP). The reference standard was determined by a consensus reading of two experienced radiologists.</p><p><strong>Results: </strong>In total, 110 scans made use of iDose⁴ level 3 HIR and 128 scans made use of iDose⁴ level 4 HIR. PE was present in 34 patients in the iDose⁴ level 3 group (30.9%) and in 39 patients in the iDose⁴ level 4 group (30.5%). Sensitivity of CAD software was not significantly different between noise reduction groups level 3 and level 4 (100% and 92.3% respectively, p = 0.24). Specificity was significantly higher in the level 4 group compared to the level 3 group (48.3% vs. 11.8%, p < 0.001). CNR was significantly higher in CT images with level 4 noise reduction (12.0 vs. 9.8, p < 0.001).</p><p><strong>Conclusion: </strong>CAD software produced significantly fewer FP PE markers in images with higher CNR, reconstructed using a higher noise-reduction setting. The noise reduction level 4 images had significantly higher CNR values, indicating that image quality has a substantial impact on the performance of CAD software.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"991-998"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224061","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":"Occult fractures of the tibial plateau: 3D augmented X-ray pilot study.","authors":"Luis Fandiño, Matthew Simpson, Brad Wright, Patrick Kobes, Maryam Soltanolkotabi, Megan Mills, Frederic Noo, Dell P Dunn","doi":"10.1007/s10140-026-02501-2","DOIUrl":"10.1007/s10140-026-02501-2","url":null,"abstract":"<p><strong>Purpose: </strong>Tibial plateau fractures are commonly missed on conventional radiographs (CR), particularly when subtle or nondisplaced. This study evaluates the diagnostic performance of Multitom Rax, a novel cone-beam computed tomography (CBCT)-based 3D augmented X-ray system that provides multiplanar tomographic reconstructions alongside CR, for the detection of tibial plateau (TP) fractures in the emergency setting.</p><p><strong>Methods: </strong>Over a four-month period, 23 emergency department patients with suspected knee fractures underwent 3D Augmented X-ray (Multitom RAX, Siemens Healthineers). Four blinded radiologists with varying experience levels sequentially interpreted conventional radiographs and 3D tomographic images. Reader confidence in presence or absence of fracture was rated on a five-point Likert scale. Reference standard was established by MRI, standard CT, surgery or consensus of three expert musculoskeletal radiologists. Diagnostic performance was evaluated via area under the receiver operating characteristic curve (AUC) and compared between modalities. Differences in AUC between modalities were assessed using confidence interval-based comparison at a 95% significance level (α = 0.05) with the null hypothesis of no difference in AUC.</p><p><strong>Results: </strong>Five occult TP fractures were identified among 23 patients (21.7%, 95% CI: 7.5-43.7%). Only two were detected using CR by the most experienced reader, whereas all five were correctly identified on 3D reconstructions without false positives by more experienced radiologists. The per reader-averaged AUC across patients increased from 0.748 ± 0.087 with CR to 0.933 ± 0.043 with 3D. The difference in AUC (mean 0.185, 95% CI: [0.019, 0.369]) was significant at the 95% level (p = 0.023).</p><p><strong>Conclusion: </strong>3D Augmented X-ray demonstrated superior sensitivity and diagnostic confidence in detecting subtle TP fractures compared to CR. These preliminary findings support the potential value of 3D CBCT-based imaging in the evaluation of acute knee trauma and warrant validation in larger studies.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1117-1121"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270772","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":"Predictive role of ultrasonography in the early diagnosis of Hirschsprung's disease in neonates and infants: an observational diagnostic study.","authors":"Masoud Mahdavi Rashed, Armin Doostparast, Maryam Ghandhari, Sajjad Sadeghpour, Abbas Boskabadi, Seyed Ali Alamdaran, Mobina Ameri","doi":"10.1007/s10140-026-02515-w","DOIUrl":"10.1007/s10140-026-02515-w","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to evaluate the diagnostic performance of conventional transabdominal ultrasound (US) in detecting Hirschsprung's disease (HD).</p><p><strong>Materials and methods: </strong>This cross-sectional observational study enrolled infants (≤ six months) with clinical suspicion of HD. They subsequently underwent a standardized transabdominal US, followed by a confirmatory rectal biopsy. US parameters included the presence and location of a transition zone (TZ), proximal colonic dilation, upstream and downstream bowel lumen diameter and wall thickness, and luminal diameter ratio (LDR). Diagnostic performance metrics were calculated using histopathology as the reference standard.</p><p><strong>Results: </strong>Of 72 infants (mean age: 25.9 ± 31.6 days; 37 (51.4%) females), 40 (55.6%) were diagnosed with HD. TZ on US showed the highest diagnostic performance (area under the curve (AUC) = 0.73 [0.63-0.83], sensitivity = 92%, specificity = 53%), followed by LDR (AUC = 0.66 [0.53-0.79], sensitivity = 82%, specificity = 56%) and upstream bowel wall thickness (AUC = 0.66 [0.52-0.79], sensitivity = 80%, specificity = 56%). Both LDR and upstream wall thickness were significantly higher in HD compared to non-HD infants (P = 0.02 for both). Demographic and perinatal characteristics did not differ significantly between groups (P > 0.05).</p><p><strong>Conclusion: </strong>Conventional transabdominal US demonstrates high sensitivity but moderate specificity for detecting HD in neonates and young infants. TZ, increased upstream bowel wall thickness, and elevated LDR are significant sonographic predictors. Therefore, although US may serve as a useful non-invasive triage or screening adjunct in clinically suspected cases of HD, it should not be considered a standalone diagnostic test, and rectal biopsy remains essential for definitive diagnosis.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1037-1046"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410897","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":"CT in adult patients with Polytrauma: current practices, protocol optimization, structured reporting and future directions.","authors":"Kirthi Sathyakumar, Vijayan Purushothaman, Joses Dany James, Vignesh Kumar","doi":"10.1007/s10140-026-02512-z","DOIUrl":"10.1007/s10140-026-02512-z","url":null,"abstract":"<p><p>Computed tomography [CT] is the frontline imaging modality for the assessment of polytrauma patients because of its speed, diagnostic accuracy and influence on immediate management. Ever since whole-body CT [WB-CT or \"pan-scan\"] was adopted, there has been ongoing debate about patient selection, optimal protocols and acquisition strategies, radiation safety, and its integration into streamlined trauma workflows. Evidence suggests that WB-CT shortens time-to-diagnosis and improves injury detection compared with region-specific selective CT, although mortality benefits are variable across studies and the radiation dose remains marginally higher. Newer protocol variants, such as the split-bolus single-pass technique, dual-energy CT [DECT], dose-reduced and hybrid timing strategies, monophasic acquisition in select patients aim to optimize diagnostic accuracy while reducing dose and contrast. Structured reporting using trauma-specific templates improve completeness and diagnostic performance, particularly among less experienced radiologists. Emerging tools such as artificial intelligence [AI] triage/flagging systems, photon-counting and spectral CT, and automated structured reporting can potentially improve the trauma workflow efficiency. This article reviews current guidelines, compares WB-CT with selective CT, discusses existing WB-CT protocols, proposes a practical optimized WB-CT protocol termed - 'IMPACT Protocol [Integrated Multiphase Polytrauma Assessment CT]',and offers recommendations for structured reporting and future implementation.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1159-1175"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316289","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 case series on ultrasonographic findings in pediatric testicular rupture: a comparison with surgical findings.","authors":"Reiko Okamoto, Mikiko Miyasaka, Ayako Imai, Yoshiyuki Tsutsumi, Shunsuke Nosaka, Yuichi Hasegawa, Satoko Uematsu, Osamu Miyazaki","doi":"10.1007/s10140-026-02511-0","DOIUrl":"10.1007/s10140-026-02511-0","url":null,"abstract":"<p><strong>Purpose: </strong>Pediatric testicular rupture is rare, and detailed descriptions of its ultrasonographic (US) findings with operative correlation remain limited. This paper reviews the characteristic ultrasonographic findings of pediatric testicular rupture and correlates them with operative findings and postoperative outcomes.</p><p><strong>Methods: </strong>Among 27 male patients who underwent US for suspected testicular trauma over a 23-year period, four cases with surgically confirmed testicular rupture were retrospectively reviewed. Clinical presentation, physical examination findings, timing of presentation and surgery, preoperative US findings, operative findings, and postoperative outcomes were evaluated.</p><p><strong>Results: </strong>The patients ranged in age from 11 to 14 years, with two right-sided and two left-sided injuries. Mechanisms of injury included sports-related trauma (n = 2) and physical assault (n = 2). Presenting symptoms included scrotal swelling, scrotal/lower abdominal pain, and vomiting. Physical examination demonstrated scrotal tenderness in all patients, scrotal swelling in three, and erythema in one. The interval from injury to presentation ranged from 2 to 60 h (median, 34 h), and the interval from injury to surgery ranged from 28 to 130 h (median, 54 h). All patients demonstrated characteristic US findings suggestive of testicular rupture, including discontinuity of the tunica albuginea, poorly defined testicular margins, heterogeneous echotexture of the extruded testicular parenchyma, and decreased blood flow in the extruded area. Associated findings included intratesticular or scrotal hematoma and scrotal wall thickening. Operative findings confirmed rupture of the tunica albuginea in all cases and correlated well with preoperative US findings. During follow-up (mean, 9 months), ipsilateral testicular atrophy developed in three patients, whereas one patient showed preserved testicular volume without abnormal US findings.</p><p><strong>Conclusion: </strong>Pediatric testicular rupture demonstrates characteristic ultrasonographic findings that correlate well with operative findings. Recognition of these findings may facilitate early diagnosis and prompt surgical consultation. Because postoperative testicular atrophy may occur despite testicular preservation, continued ultrasonographic follow-up is important.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1029-1036"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316309","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":"Computed tomography detection and localization of gastrointestinal tract injury in blunt abdominal trauma: a retrospective single-center series.","authors":"Amirreza Eftekhari, Samin Rostamzadeh, Yasin Farrokhi","doi":"10.1007/s10140-026-02542-7","DOIUrl":"10.1007/s10140-026-02542-7","url":null,"abstract":"<p><strong>Purpose: </strong>To determine how often contrast-enhanced computed tomography (CT) localizes a definite gastrointestinal tract injury after blunt trauma, how accurately the named segment matches operative findings, and whether indirect CT signs are present when no segment can be localized.</p><p><strong>Methods: </strong>Single-center retrospective series of 23 patients with blunt abdominal trauma who underwent portal venous phase contrast-enhanced abdominopelvic CT during the index admission and exploratory laparotomy between October 2022 and October 2024. Two radiologists with 10 years of trauma center experience independently re-read all 23 examinations, irrespective of the original report or operative diagnosis, and were blinded to operative findings; disagreements were resolved by consensus. CT was considered localization-positive only when consensus named at least one definite injured gastrointestinal segment; indirect signs were recorded separately. Proportions are reported with Wilson 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Gastrointestinal tract injury was confirmed at laparotomy in 22 of 23 patients (95.7%), with multi-segment injury in six. CT localized at least one injured segment in 16 of 22 patients (localization-based sensitivity 72.7%; 95% CI 51.8-86.8). All six patients without segment localization nevertheless had extraluminal air, indicating indirect evidence of injury. The only patient without operative gastrointestinal tract injury had no CT-localized bowel segment; because only one such patient was included, specificity and predictive values were not estimated. Among the 16 localization-positive examinations, the segment named on CT matched the operative finding exactly in 15 (93.8%; 95% CI 71.7-98.9) and was incomplete in one. Localization was lowest for ileal (6/9) and rectal (0/1) injury. Free fluid was present in 18 patients (78.3%) and extraluminal air in 15 (65.2%). Diagnosis was delayed in three patients (13.0%).</p><p><strong>Conclusion: </strong>In this surgically selected cohort, CT localized an injured segment in approximately three-quarters of affected patients and was usually exact when localization was possible. Failure to localize did not mean absence of CT evidence: all six unlocalized injuries had extraluminal air. No false-positive segment localization occurred, but only one patient lacked operative gastrointestinal tract injury. In this series, readers reviewed both soft-tissue and lung windows, and every unlocalized injury nonetheless showed extraluminal air on this dual-window review, supporting routine use of lung windows to aid recognition of subtle extraluminal gas; failure to localize ileal injury should not override clinical concern; the apparent poor localization of rectal injury is based on a single case and should be interpreted with caution.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1057-1065"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944487","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}