Emergency Radiology最新文献

{"title":"Diagnostic yield and clinical predictors of blunt cerebrovascular injury: A CTA utilization review at a level I trauma center.","authors":"Pharis B Sasa, Tasneem Zaihra Rizvi, Sandra Mackey, Nathan Cuttita, Eric Mahoney","doi":"10.1007/s10140-026-02530-x","DOIUrl":"https://doi.org/10.1007/s10140-026-02530-x","url":null,"abstract":"<p><strong>Purpose: </strong>Blunt cerebrovascular injury (BCVI) is a potentially devastating complication of high-energy trauma that can lead to ischemic stroke if undetected. Computed tomography angiography (CTA) is the primary screening modality, though optimal patient selection criteria remain debated. Rising CTA utilization at our institution prompted a quality improvement review to evaluate the diagnostic yield and identify clinical predictors of BCVI.</p><p><strong>Methods: </strong>A retrospective review was conducted of trauma patients who underwent CTA of the head and neck at a Level I trauma center between January and December 2023.Clinical variables were compared between patients with and without BCVI on univariate analysis, and independent predictors were identified using multivariate logistic regression.</p><p><strong>Results: </strong>Among 305 patients screened, BCVI was identified in 40 patients (13.1%), with a total of 44 injuries due to multivessel involvement in 4 patients. Vertebral artery injuries predominated (34/44,77.3%), with Grade 1 being most common (18/44,40.9%). Loss of consciousness (OR 2.96; 95% CI 1.43-6.29; p = 0.003) and cervical spine fracture (OR 8.06; 95% CI 3.86-17.9; p < 0.001) were independent predictors of BCVI on multivariate analysis. The multivariate model demonstrated good discriminatory performance (AUROC = 0.788; 95% CI 0.707-0.868).</p><p><strong>Conclusions: </strong>In a screened trauma cohort, LOC at the scene was a strong independent predictor of BCVI, a relationship not previously incorporated into formal screening criteria. These findings support prospective evaluation of LOC as a clinically accessible adjunct to existing risk-stratification tools.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757907","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":"Tibial-sided PCL avulsion fractures in children: the importance of diagnosing concomitant injuries.","authors":"Lauren May, Rebecca J Schultz, Zina Smadi, Krishna Chandra, Jason Z Amaral, Siddharth P Jadhav, Megan Severson, Indranil Kushare","doi":"10.1007/s10140-026-02529-4","DOIUrl":"10.1007/s10140-026-02529-4","url":null,"abstract":"<p><strong>Purpose: </strong>Tibial-sided posterior cruciate ligament (PCL) avulsion fractures are a variant of PCL injury. Current literature on tibial-sided PCL injuries consists of small case reports or series in adults. There are no studies in the pediatric population describing the associated injuries and if concomitant injuries impact clinical decision-making. This study aims to identify common concomitant injuries in pediatric patients with tibial-sided PCL avulsion fractures and determine the utility of MRI in identification of concomitant injuries.</p><p><strong>Methods: </strong>A retrospective review of the electronic medical record identified all patients presenting to a single tertiary pediatric hospital with tibial-sided PCL avulsion fractures 1/2012-6/2024. MRI exams were reviewed by a musculoskeletal pediatric radiologist. Operative reports and clinical encounter notes were reviewed by a pediatric orthopedic surgeon.</p><p><strong>Results: </strong>Twenty-seven patients met the inclusion criteria, and 26 concomitant injuries were identified in 16 (59%) patients. Twenty of 27 (74%) of patients had a preoperative MRI; 23/26 (88%) injuries were identified on MRI, and 2/26 (8%) injuries were identified clinically without MRI. One concomitant injury was identified at the time of surgery but not on preoperative MRI. The most common concomitant finding on MRI was posterolateral corner injury (7/26, 27%). Eight of 26 (31%) of the concomitant injuries required surgical intervention.</p><p><strong>Conclusion: </strong>Concomitant injuries occurred in the majority of patients with tibial-sided PCL avulsion fractures. Posterolateral corner injury was the most common injury and anterior cruciate ligament tear was the most common requiring surgical intervention. Radiologists and surgeons should be cognizant of the association of concomitant injury.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683814","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 agreement between emergency medicine residents after dedicated appendix ultrasound training and radiologists in the ultrasonographic evaluation of suspected acute appendicitis.","authors":"Senol Ardic, Suna Ibrahimoglu, Eser Bulut, Ozgen Gonenc Cekic, Mustafa Cicek, Recep Dede","doi":"10.1007/s10140-026-02527-6","DOIUrl":"https://doi.org/10.1007/s10140-026-02527-6","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the diagnostic agreement between emergency medicine residents after dedicated appendix ultrasound training and radiologists in the ultrasonographic evaluation of suspected acute appendicitis.</p><p><strong>Methods: </strong>This prospective, single-center observational study included patients presenting to a tertiary emergency department with non-traumatic abdominal pain and clinical suspicion of acute appendicitis between March 2020 and May 2021. Clinical suspicion was based on right lower quadrant pain or tenderness and supportive clinical, laboratory, or scoring findings. Emergency medicine residents performed focused right lower quadrant ultrasonography after dedicated appendix ultrasound training, followed by radiologist-performed abdominal ultrasonography using the same device. Radiologists were not informed of the resident-performed ultrasound findings. Agreement was assessed using Cohen's kappa coefficient. Diagnostic accuracy was calculated against the final diagnosis, which was established using pathology, computed tomography when available, surgical consultation, and 30-day follow-up.</p><p><strong>Results: </strong>Of 260 enrolled patients, 250 were included in the final analysis. Acute appendicitis was confirmed in 66 patients (26.4%). The appendix was visualized by emergency medicine residents in 77 patients (30.8%) and by radiologists in 94 patients (37.6%; McNemar p = 0.027). Agreement for appendix visualization was moderate (κ = 0.531; 95% CI, 0.417-0.638). Agreement for ultrasonographic diagnosis in the overall cohort was substantial (κ = 0.759; 95% CI, 0.638-0.859) and reached an almost perfect level when both groups visualized the appendix (κ = 0.965; 95% CI, 0.888-1.000). In the overall cohort, resident-performed ultrasonography showed 56.1% sensitivity and 98.9% specificity. In conclusive scans, sensitivity and specificity increased to 94.9% and 94.7%, respectively.</p><p><strong>Conclusion: </strong>Resident-performed ultrasonography after dedicated appendix ultrasound training appears highly reliable when the appendix is identified; however, non-diagnostic examinations require further clinical and radiologic assessment.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673130","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":"Early vs. late computed tomography angiography in blunt cerebrovascular injuries: a national analysis of clinical outcomes across injury grade and location.","authors":"Youssef Nasef, Yusra Othman, Alexander Brown, Sukriti Prashar, Shervin Eskandari, Dimpal Kasabwala, Ian Bundschu, Adel Elkbuli","doi":"10.1007/s10140-026-02526-7","DOIUrl":"https://doi.org/10.1007/s10140-026-02526-7","url":null,"abstract":"<p><strong>Purpose: </strong>Blunt cerebrovascular injury (BCVI) is a potentially devastating complication of trauma. This study aims to evaluate the impact of Computed Tomography Angiography (CTA) timing on stroke and outcomes in BCVI, and to identify predictors of stroke.</p><p><strong>Methods: </strong>The ACS-TQIP database (2017-2024) was used to analyze the effect of CTA timing on outcomes and to identify predictors of stroke using multivariable regression models in adult polytrauma patients with moderate-severe BCVI. Patients were stratified by injury type, grade, and concomitant traumatic brain injury (TBI). The primary outcome was stroke occurrence, and secondary outcomes included mortality, complications, ICU-LOS, VFDs, and discharge disposition.</p><p><strong>Results: </strong>Early CTA was associated with reduced stroke (aOR: 0.394, p < 0.001), decreased complications, and reduced intensive care unit length of stay (ICU-LOS) (β: -2.425, p < 0.001), but increased mortality. Among patients with isolated carotid or vertebral injuries, early CTA reduced strokes without increasing mortality. Low-grade injuries experienced reduced stroke (aOR: 0.396, p < 0.001) and shorter ICU-LOS (β: -1.769, p = 0.006). In contrast, high-grade injuries and concomitant moderate-severe TBI were accompanied by increases in mortality. Advanced age (aOR: 1.352, p = 0.047), high-grade injuries (aOR: 2.297, p < 0.001), severe injury severity score (aOR: 2.791, p < 0.001), and concomitant TBI (aOR: 1.522, p < 0.001) were predictors of stroke.</p><p><strong>Conclusion: </strong>Early CTA is associated with reduced stroke risk and improved outcomes, including fewer complications and shorter ICU stay. Benefits are greatest in low-grade injuries and isolated carotid or vertebral involvement. In contrast, high-grade injuries and concomitant moderate-severe TBI show reduced stroke but increased mortality, likely reflecting greater injury severity.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673152","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":"Comparative accuracy of photon-counting and dual energy CT pulmonary angiography perfusion mapping using V/Q scans as reference standard.","authors":"Alexis Ogbonna, Jordan H Chamberlin, Dhiraj Baruah, Cesar Lopez Rodriguez, Ian Mencken, Jeremy R Burt, Saeed Elojeimy, Ismail M Kabakus","doi":"10.1007/s10140-026-02479-x","DOIUrl":"10.1007/s10140-026-02479-x","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"743-753"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765974","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":"Routine repeat computed tomography of the head in patients with mild traumatic brain injury: is it really necessary?","authors":"Anastasios A Politis, Kyriacos Evangelou, Evgenia Lani, Mary Solou, Panagiotis Zemperligkos, Evangelos Papadopoulos, Stamatis Banos, Maria Gavra, Georgios Savvanis, Ioannis Ydreos, Nikolaos Haliasos, Pantelis Stavrinou, Aristotelis Kalyvas, Efstathios J Boviatsis, Lampis C Stavrinou","doi":"10.1007/s10140-026-02476-0","DOIUrl":"10.1007/s10140-026-02476-0","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"733-741"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766000","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":"Single-sequence low-field 3D T1-weighted MRI for scaphoid fracture detection compared to radiography: prospective diagnostic accuracy pilot study.","authors":"Claudia Neubauer, Christopher Schuppert, Carolin S Reidelbach, Horst Zajonc, Filip Simunovic, Sebastian M Goerke, Fabian Bamberg, Sebastian Wirtz, Maximilian F Russe, Thierno D Diallo, Jakob Neubauer","doi":"10.1007/s10140-026-02481-3","DOIUrl":"10.1007/s10140-026-02481-3","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the diagnostic accuracy of a novel high-resolution 3D T1-weighted gradient-echo sequence in low-field MRI for detecting scaphoid fractures compared with radiography.</p><p><strong>Methods: </strong>In this prospective single-center study, patients with suspected scaphoid injury underwent wrist radiography and 0.31 T extremity MRI including a 4-min 3D gradient-echo sequence (3D SST1). Three musculoskeletal radiologists independently evaluated radiographs and the isolated 3D sequence in separate sessions, rating fracture presence, displacement/stability, diagnostic confidence (five-point Likert scale), and need for additional imaging. The reference standard was based on CT and standard MRI sequences, evaluated by two experienced musculoskeletal radiologists.</p><p><strong>Results: </strong>Forty patients with 11 scaphoid fractures were included. Across readers, AUC for scaphoid fracture detection was 1.000 for 3D MRI and 0.823 for radiography (AUC-difference 0.177, 95% CI: -0.004-0.359, p = 0.056). For 3D MRI, sensitivity and NPV were 1.000 for all readers. Specificity (0.931-0.966 vs 0.655-0.862) and PPV (0.846-0.917 vs 0.444-0.667) were higher than for radiography. Diagnostic confidence was excellent (median score 1) with near-perfect inter-rater agreement (κ = 0.961). Additional imaging was not recommended in 40/36/37 cases (reader 1/2/3).</p><p><strong>Conclusion: </strong>A single 4-min high-resolution 3D low-field MRI sequence enabled highly accurate detection of scaphoid fractures with perfect sensitivity and NPV, a high reader confidence, and an improved performance compared to radiography in this small pilot cohort. This approach may facilitate rapid, radiation-free screening in acute wrist trauma.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"775-784"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812611","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":"Spot sign as a predictor of hematoma expansion and poor functional outcomes after intracerebral hemorrhage: a systematic review and meta-analysis.","authors":"Maria Clara Nery Cardoso, Davi Chaves Rocha de Souza, Bruna Rios Beserra, Theo Cardoso Ribeiro, Vinicius Rodrigues Oliveira Alves, Amanda Cerqueira Marcolino, Maria Fernanda Nery Cardoso","doi":"10.1007/s10140-026-02493-z","DOIUrl":"10.1007/s10140-026-02493-z","url":null,"abstract":"<p><strong>Purpose: </strong>The Spot Sign (SS) is a radiological finding on computed tomography angiography (CTA) in patients with intracerebral hemorrhage (ICH). This meta-analysis aimed to evaluate the association between the SS and both hematoma expansion (HE) and functional outcomes by comparing ICH patients with and without SS.</p><p><strong>Methods: </strong>We searched PubMed, Embase and Cochrane Library for studies of intracranial hemorrhage reporting the SS. The primary outcomes examined were functional status and hematoma expansion, secondary outcomes were mortality and initial hematoma volume. Statistical analysis was performed using RStudio (version 4.5.2), and heterogeneity was assessed with I² statistics. In addition, sensitivity analyses were performed, and publication bias was assessed through funnel plots and Egger's regression test.</p><p><strong>Results: </strong>We included 10 observational studies with a total of 2,832 patients with spontaneous ICH. Of these, 613 had SS, while 2,219 did not. The mean age was 66.31 ± 13.81 and 1,367 (58.6%) were male. Poor functional outcomes (OR 4.06, 95% CI 2.66─6.20, p < 0.0001, I² = 0.0%) and hematoma expansion (OR 7.17, 95% CI: 5.65─9.09, p < 0.0001, I² = 0.0%) were substantially higher in patients with SS, as well as the overall mortality rate (OR 4.14, 95% CI 2.45-6.99, p < 0.0001, I² = 65.4%). However, the initial hematoma volume (MD 11.54, 95% CI -11.43─34.52, p = 0.2082, I² = 80.1%) was not statistically different between groups. Furthermore, the leave-one-out sensitivity analyses showed that no single study exerted a disproportionate influence on the overall effect for the examined outcomes, and Egger's linear regression tests were not statistically significant for both primary outcomes.</p><p><strong>Conclusion: </strong>The presence of the SS is associated with higher rates of poor functional outcomes and hematoma expansion. Therefore, the SS represents a relevant radiological marker with potential to support early risk stratification and optimize patient management and treatment selection.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"911-921"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041627","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":"Improved interobserver agreement for perihematomal edema measurement using dual-layer spectral CT electron density imaging in intracerebral hemorrhage.","authors":"Qiaoying Zhang, Wei Du, Wenhua Zhao, Pengfeng Sun, Jiayu Wu, Mingyue Ma, Yan Dong, Xiaoping Wu","doi":"10.1007/s10140-026-02473-3","DOIUrl":"10.1007/s10140-026-02473-3","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"711-717"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722344","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":"Comparative evaluation of ultrasound and computed tomography in the detection of imaging findings and complications of acute cholecystitis: a retrospective cohort study.","authors":"Ahmad Mahamid, Abdel-Rauf Zeina, Rawi Hazzan, Randa Taher Natour, Dorin Nicola, Oren Gal, Fadi Abu Baker","doi":"10.1007/s10140-026-02487-x","DOIUrl":"10.1007/s10140-026-02487-x","url":null,"abstract":"<p><strong>Background: </strong>Gallstones (cholelithiasis) are common, with a significant portion of affected individuals developing acute cholecystitis, which can lead to severe complications. While ultrasound (US) is typically the first imaging method used, multidetector computed tomography (MDCT) may be better at detecting more complex scenarios. This study aimed to compare the detection of imaging features and complications of acute cholecystitis between US and MDCT in a cohort of confirmed cases, and to evaluate their complementary roles in clinical practice.</p><p><strong>Methods: </strong>A retrospective study was conducted including 134 adults with clinically suspected acute cholecystitis who underwent same-day US and MDCT, with subsequent confirmation by pathology or intervention. Two radiologists independently reviewed all imaging studies, and the detection of imaging features and complications was compared.</p><p><strong>Results: </strong>US showed significantly higher detection rates than MDCT for gallbladder wall thickening (98.5% vs. 66.4%, P < 0.001), sludge (35.1% vs. 14.9%, P < 0.001), and pericholecystic fluid (75.4% vs. 47.8%, P < 0.001). Conversely, MDCT more frequently identified complications such as choledocholithiasis (8.2% vs. 2.2% by US, P = 0.041) and liver abscesses (6.7% vs. 1.5% by US, P = 0.035). MDCT also identified findings consistent with cholecystitis in 7 patients (5.2%) not detected by US and was associated with a change in management of 20 patients (14.9%).</p><p><strong>Conclusions: </strong>US remains effective as a first-line modality for detecting acute cholecystitis, while MDCT offers additional value in identifying complications and influencing management. Together, these findings support a complementary, rather than substitutive, role for the two modalities.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"793-799"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835117","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}