Emergency Radiology最新文献

{"title":"Flank pain, hypertension, and hematuria: CT and 3D cinematic rendering in the evaluation of renal artery emergencies-a pictorial essay.","authors":"Mohammad Yasrab, Elliot K Fishman, Linda C Chu","doi":"10.1007/s10140-024-02279-1","DOIUrl":"10.1007/s10140-024-02279-1","url":null,"abstract":"<p><p>Non-traumatic acute renal artery emergencies encompass a spectrum of etiologies, including renal artery stenosis, arteriovenous malformations, aneurysms and pseudoaneurysms, dissections, thrombosis, and vasculitis. Prompt and accurate diagnosis in the emergency setting is crucial due to the potential for significant morbidity and mortality. Computed tomography (CT) and CT angiography (CTA) are the mainstay imaging modalities, offering rapid acquisition and high diagnostic accuracy. The integration of 3D postprocessing techniques, such as 3D cinematic rendering (CR), improves the diagnostic workflow by providing photorealistic and anatomically accurate visualizations. This pictorial essay illustrates the diagnostic utility of CT and CTA, supplemented by 3D CR, through a series of 10 cases of non-traumatic renal artery emergencies. The added value of 3D CR in improving diagnostic confidence, surgical planning, and understanding of complex vascular anatomy is emphasized.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"925-936"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046517","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":"Clinical management of active bleeding: what the emergency radiologist needs to know.","authors":"Ryan T Whitesell, Cory R Nordman, Sean K Johnston, Douglas H Sheafor","doi":"10.1007/s10140-024-02289-z","DOIUrl":"10.1007/s10140-024-02289-z","url":null,"abstract":"<p><p>Active bleeding is a clinical emergency that often requires swift action driven by efficient communication. Extravasation of intravenous (IV) contrast on computed tomography (CT) is a hallmark of active hemorrhage. This can be seen on exams performed for a variety of indications and can occur anywhere in the body. As both traumatic and non-traumatic etiologies of significant blood loss are clinical emergencies, exams demonstrating active bleeding are often performed in emergency departments and read by emergency radiologists. Prompt communication of these findings to the appropriate emergency medicine and surgical providers is crucial. Although many types of active hemorrhage can be managed by interventional radiology techniques, endoscopic and surgical management or clinical observation may be appropriate in certain cases. To facilitate optimal care, it is important for emergency radiologists to understand the scope of indications for embolization of bleeding by interventional radiologists (IR) and when an IR consultation is warranted. Similarly, timely comprehensive diagnostic radiology reporting including pertinent positive and negative findings tailored for IR colleagues can expedite the appropriate intervention.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"903-918"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460768","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":"Pleural and pericardial effusions as prognostic factors in patients with acute pulmonary embolism: a multicenter study.","authors":"Hans-Jonas Meyer, Constantin Ehrengut, Anar Aghayev, Mattes Hinnerichs, Dominik Schramm, Felix G Meinel, Jan Borggrefe, Alexey Surov","doi":"10.1007/s10140-024-02281-7","DOIUrl":"10.1007/s10140-024-02281-7","url":null,"abstract":"<p><strong>Purpose: </strong>The prognostic role of pleural and pericardial effusion in patients with acute pulmonary embolism (PE) is still unclear with a trend for worse clinical outcome. The aim of the present study was to demonstrate the prognostic role of pleural and pericardial effusion in patients with acute PE in a large multicentre setting.</p><p><strong>Methods: </strong>The investigated patient sampled was retrospectively comprised of 1082 patients (494 female, 45.7%) with a mean age of 63.8 years ± 15.8. In every case, contrast enhanced computed tomography (CT) pulmonalis angiography was analyzed to diagnose and quantify the pleural and pericardial effusion. The 30-day mortality was the primary endpoint of this study.</p><p><strong>Results: </strong>A total of 127 patients (11.7%) died within the 30-day observation period. Pleural effusion was identified in 438 patients (40.5%) and pericardial effusion was identified in 196 patients (18.1%). The presence of pleural effusion was associated with 30-day mortality, HR = 2.78 (95%CI1.89-4.0), p < 0.001 (univariable analysis), and HR = 2.52 (95%CI1.69-3.76), p < 0.001 (multivariable analysis). The pleural effusion width and density were not associated with 30-day mortality. The presence of pericardial effusion was not associated with 30-day mortality in multivariable analysis, HR = 1.28 (95%CI 0.80-2.03), p = 0.29.</p><p><strong>Conclusions: </strong>Pleural effusion is a common finding in patients with acute pulmonary embolism, occurring in 40.5% of cases, and is a prognostic imaging finding associated with 30-day mortality. The presence of pleural effusion alone, regardless of volume or density, has been shown to be prognostic and should be included in CT reports. The prognostic role of pericardial effusion is limited.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"815-821"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11625069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105499","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":"Multimodality imaging of coronary artery dissection: a pictorial essay.","authors":"Paola Sánchez, Sergio Vergara, Germán Carmona, Nicolás Bastidas","doi":"10.1007/s10140-024-02280-8","DOIUrl":"10.1007/s10140-024-02280-8","url":null,"abstract":"<p><p>Spontaneous coronary artery dissection (SCAD) is a rare and underdiagnosed entity that can lead to acute coronary syndrome. This condition has a gender predilection, predominantly affecting women, especially those with known risk factors such as pregnancy and the postpartum period. Hormonal changes and hemodynamic stress during these stages significantly contribute to the occurrence of SCAD. Recognizing and understanding this entity, as well as its imaging findings, have a favorable impact on patient prognosis. Accurate diagnosis through imaging techniques such as coronary angiography and computed tomography is crucial for the appropriate management of SCAD, allowing for early and specific interventions that can significantly improve clinical outcomes and reduce associated mortality. Continuous education and awareness about this condition are essential to improve detection rates and effective treatment.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"919-924"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388966","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":"Potential strength and weakness of artificial intelligence integration in emergency radiology: a review of diagnostic utilizations and applications in patient care optimization.","authors":"Mobina Fathi, Reza Eshraghi, Shima Behzad, Arian Tavasol, Ashkan Bahrami, Armin Tafazolimoghadam, Vivek Bhatt, Delaram Ghadimi, Ali Gholamrezanezhad","doi":"10.1007/s10140-024-02278-2","DOIUrl":"10.1007/s10140-024-02278-2","url":null,"abstract":"<p><p>Artificial intelligence (AI) and its recent increasing healthcare integration has created both new opportunities and challenges in the practice of radiology and medical imaging. Recent advancements in AI technology have allowed for more workplace efficiency, higher diagnostic accuracy, and overall improvements in patient care. Limitations of AI such as data imbalances, the unclear nature of AI algorithms, and the challenges in detecting certain diseases make it difficult for its widespread adoption. This review article presents cases involving the use of AI models to diagnose intracranial hemorrhage, spinal fractures, and rib fractures, while discussing how certain factors like, type, location, size, presence of artifacts, calcification, and post-surgical changes, affect AI model performance and accuracy. While the use of artificial intelligence has the potential to improve the practice of emergency radiology, it is important to address its limitations to maximize its advantages while ensuring the safety of patients overall.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"887-901"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072291","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 imaging of clinically significant abdominopelvic injuries in the damage control surgery patient.","authors":"Zohaib Y Ahmad, Julian M N McDonald, Armonde A Baghdanian, Stephan W Anderson, Christina A LeBedis","doi":"10.1007/s10140-024-02287-1","DOIUrl":"10.1007/s10140-024-02287-1","url":null,"abstract":"<p><strong>Purpose: </strong>Damage Control Surgery (DCS) refers to a staged laparotomy performed in patients who have suffered severe blunt or penetrating abdominopelvic trauma with the goal of managing critical injuries while avoiding life threatening metabolic derangements. Within 24 h of the initial laparotomy, computed tomography (CT) is used to assess the full extent of injuries. The purpose of this study was to assess the incidence of clinically significant unknown abdominopelvic injuries which required further dedicated surgical or interventional radiology management and failed surgical repairs identified on CT following initial laparotomy.</p><p><strong>Methods: </strong>CT findings were correlated with surgical findings from the initial and subsequent staged laparotomy to determine known and unknown injuries. Frequency and percentage analyses was performed.</p><p><strong>Results: </strong>Out of 63 patients who underwent DCS with an open abdomen following initial laparotomy and subsequent CT within 24 h, a total of 13 clinically significant abdominopelvic injuries were identified in 12 patients. Seven clinically significant injuries were identified in seven patients (11.1% of patients) in surgically explored areas. Six clinically significant injuries were identified in six patients (9.5%) in surgically unexplored areas. Four instances of failed initial surgical repair were identified in four patients (6.3%) involving the liver and gastrointestinal tract. Overall, 23.8% of the DCS patient population had an actionable finding on the post laparotomy CT.</p><p><strong>Conclusion: </strong>CT demonstrated value for identifying the extent of clinically significant abdominopelvic injuries and evidence of failed initial surgical repair, which informed surgical planning for subsequent laparotomy. The authors advocate for performing CT in post-DCS patients with an open abdomen as soon as possible following correction of metabolic and hemodynamic derangements.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"797-805"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460769","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":"Reliability of distal radius fracture classification systems: a CT based study.","authors":"Madhurima Sharma, Shayeri Roy Choudhury, Raghuraman Soundararajan, Rishabh Sheth, Anindita Sinha, Mahesh Prakash","doi":"10.1007/s10140-024-02294-2","DOIUrl":"10.1007/s10140-024-02294-2","url":null,"abstract":"<p><strong>Objective: </strong>To assess the reliability and reproducibility of AO/OTA, Frykman and Fernandez classification systems for distal radius fractures on CT.</p><p><strong>Materials and methods: </strong>Four radiologists, including one radiology resident, two musculoskeletal radiology fellows and one radiology consultant independently evaluated CT scans of 115 patients with distal radius fractures and classified the fractures according to AO/OTA, Frykman and Fernandez classification system. To assess reproducibility, a second set of reading was done by two observers after an interval of six weeks. Interobserver reliability was calculated for each classification system using intraclass correlation coefficient (ICC) and using Light's modification of kappa. Intraobserver agreement was calculated using Cohen's kappa.</p><p><strong>Results: </strong>Interobserver reliability using ICC showed fair agreement for AO/OTA (0.447) and Frykman (0.432) classification system and poor agreement for Fernandez (0.196) classification system. Interobserver agreement using kappa was moderate for AO/OTA fracture (0.447) classification into either of three types, while it was only slight for complete classification into type, group and subgroup (0.177). Interobserver agreement using kappa was slight for Fernandez (0.196) classification systems and moderate for Frykman classification system (0.406). Intraobserver agreement for AO/OTA classification system was moderate for observer 1 (0.449) and slight for observer 2 (0.162). Intraobserver agreement for Frykman classification system was substantial for observer 1(0.754) and moderate for observer 2 (0.496). Intraobserver agreement for Fernandez classification system was moderate for both the observers (0.333, 0.320).</p><p><strong>Conclusion: </strong>Currently there is no classification system that is fully reproducible. AO/OTA and Frykman classification systems performed better than Fernandez classification system in terms of interobserver reliability. However, Frykman classification system performed better than both AO/OTA and Fernandez classification system in terms of intraobserver reproducibility. Fernandez classification system had worst inter and intraobserver reliability in present study. Reliability and reproducibility of AO/OTA classification system decreased when fractures were divided into subgroups.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"873-879"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582566","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":"Thermal insulation does not hamper assessment of injuries in trauma CT scans.","authors":"Tomasz Sanak, Aleksandra Skowronek, Konrad Mendrala, Tomasz Darocha, Grzegorz Liszka, Robert Chrzan, Krzysztof Jerzy Woźniak, Grzegorz Staskiewicz, Paweł Podsiadło","doi":"10.1007/s10140-024-02272-8","DOIUrl":"10.1007/s10140-024-02272-8","url":null,"abstract":"<p><strong>Purpose: </strong>The use of thermal insulations reduces the risk of hypothermia, therefore decreases the risk of death in trauma victims. The aim of the study was to assess whether thermal insulations cause artifacts, which may hinder the diagnosis of injuries, and how the used thermo-systems alter the radiation dose in polytrauma computed tomography.</p><p><strong>Methods: </strong>Computed tomography scans were made using the road accident victim body wrapped consecutively with 7 different covers. 14 injury areas were listed and evaluated by 22 radiologists. The radiation dose was measured using a dosimeter placed on the victim in the abdominal area.</p><p><strong>Results: </strong>No significant artifacts in any of the tested covers were observed. The presence of few minor artifacts did not hinder the assessment of injuries. Certain materials increased (up to 19,1%) and some decreased (up to -30,3%) the absorbed radiation dose.</p><p><strong>Conclusions: </strong>Thermal insulation systems tested in this study do not cause significant artifacts hindering assessment of injuries in CT scans. Concern for artifacts and increased radiation dose should not be a reason to remove patients' thermal insulation during performing trauma CT-scanning.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"791-796"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11625065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141765743","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":"Facial trauma education in radiology: using surgeon feedback as the benchmark for success.","authors":"William T Malouf, Geeth Kondaveeti, Jacline G Phillips, Kunjan Patel, Justin A Hall, Torrey L Fourrier, Nelson May, Nuwan T Meegalla, Kevin J Reger, Christopher M Runyan, Kevin D Hiatt","doi":"10.1007/s10140-024-02288-0","DOIUrl":"10.1007/s10140-024-02288-0","url":null,"abstract":"<p><strong>Rationale and objectives: </strong>Interpreting CT studies of facial trauma is challenging, and there are often substantial differences in the characterization of complex facial trauma between radiologists and surgeons. We designed a collaborative multidisciplinary project to reconcile differences in facial fracture interpretation through an educational intervention. The effectiveness of this intervention was evaluated through surgeon feedback on radiology reports.</p><p><strong>Materials and methods: </strong>Radiology residents, neuroradiology fellows, and neuroradiology attendings were recruited as participants at a single tertiary care academic center. Otolaryngology residents were recruited as evaluators. Participants completed surveys and provided preliminary reports for example cases of facial trauma before and after attending an educational session. Evaluators performed a blinded review of these preliminary reports based on ideal reports developed by surgical and neuroradiology attendings.</p><p><strong>Results: </strong>26 participants (20 residents, 1 neuroradiology fellow, 5 neuroradiology attendings) completed the study. Six otolaryngology residents participated as evaluators. To assess interrater reliability, three evaluators graded a shared set of 15 reports and demonstrated substantial agreement with a Kendall's W of 0.71. Participants demonstrated significant improvement in overall report accuracy, clarity, and organization. In subunit analysis, there were significant improvements in reporting Le Fort, nasoseptal, and nasoorbitoethmoid fractures. No significant improvements occurred in the reporting of upper face, zygomaticomaxillary complex, or mandibular fractures. In contrast, survey analysis demonstrated significantly improved confidence in interpreting trauma involving all facial subunits.</p><p><strong>Conclusion: </strong>Compared with survey results, surgeon assessment of radiology reports better demonstrated areas of improvement after an educational intervention. A multidisciplinary approach to assessing educational efforts may better evaluate the practical effectiveness of educational interventions.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"807-814"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11625054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460771","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":"Correction to: Emergency imaging protocols for pregnant patients: a multiinstitutional and multi- specialty comparison of physician education.","authors":"Liesl Eibschutz, Max Yang Lu, Payam Jannatdoust, Angela C Judd, Claire A Justin, Brandon K K Fields, Natalie L Demirjian, Madan Rehani, Sravanthi Reddy, Ali Gholamrezanezhad","doi":"10.1007/s10140-024-02290-6","DOIUrl":"10.1007/s10140-024-02290-6","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"943"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11625051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617087","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}