Emergency Radiology最新文献

{"title":"Hematuria in the ER patient: optimizing detection of upper tract urothelial cancer - A pictorial essay.","authors":"Mohammad Yasrab, Charles K Crawford, Linda C Chu, Satomi Kawamoto, Elliot K Fishman","doi":"10.1007/s10140-024-02308-z","DOIUrl":"10.1007/s10140-024-02308-z","url":null,"abstract":"<p><p>Upper tract urothelial carcinoma (UTUC) is a rare and challenging subset of the more frequently encountered urothelial carcinomas (UCs), comprising roughly 5-7% of all UCs and less than 10% of all renal tumors. Hematuria is a common presenting symptom in the emergency setting, often prompting imaging to rule out serious etiologies, with UTUC especially posing as a diagnostic challenge. These UTUC lesions of the kidney and ureter are often small, mimicking other pathologies, and are more aggressive than typical UC of the bladder, emphasizing the importance of timely and accurate diagnosis. Multidetector computed tomography urography (CTU) is the standard imaging modality for diagnosis, tumor staging, and surgical planning. Various postprocessing techniques like multiplanar reconstructions, maximal intensity projection (MIP) images, and 3D volumetric rendering technique (VRT) are crucial for accurate detection. In addition, 3D cinematic rendering (CR) is a novel technique that employs advanced illumination models, producing images with realistic shadows and increased surface detail, outperforming traditional VRT. We will review the distinctive imaging features between UTUC and infiltrating mimicking lesions on CTU in patients who presented with hematuria, in conjunction with advanced postprocessing techniques, ultimately improving diagnostic confidence and preoperative planning in the emergency context.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"267-277"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983082","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":"Prognostication and integration of bedside lung ultrasound and computed tomography imaging findings with clinical features to Predict COVID-19 In-hospital mortality and ICU admission.","authors":"Mohammad Reza Maghsoudi, Amirhesam Alirezaei, Atena Soltanzadi, Sepehr Aghajanian, Arvin Naeimi, Ayad Bahadori Monfared, Fateme Mohammadifard, Mahmood Bakhtiyari","doi":"10.1007/s10140-025-02320-x","DOIUrl":"10.1007/s10140-025-02320-x","url":null,"abstract":"<p><strong>Introduction: </strong>Bedside lung ultrasound (LUS) and computed tomography (CT) imaging are valuable modalities in screening and diagnosis of pulmonary diseases. This study aims to investigate the prognostic value of integrating LUS and CT imaging findings with clinical features to predict poor outcomes upon ER admission in COVID-19.</p><p><strong>Methods: </strong>Patients visiting the study center with clinical presentation and laboratory findings compatible with COVID-19 between April 2020 to January 2022 were considered for this study. Several imaging findings (ground glass opacity, consolidation, atelectatic bands, mosaic attenuation, ARDS pattern, crazy paving, pleural thickening in CT and A-line, comet-tail artifact, confluent B-Line in BLUS, pleural thickening and Consolidation in both modalities) were evaluated, alongside clinical assessments upon admission, to assess their prognostic value. The top radiological, LUS findings, and clinical signs were integrated in a nomogram for predicting mortality.</p><p><strong>Results: </strong>A total of 1230 patients were included in the analyses. Among the findings, consolidation in BLUS and CT imaging, and absence of A-lines were associated with mortality. In addition to these findings, ground-glass opacities, atelectatic band, mosaic attenuation, crazy paving, and confluent B-line were also associated with ICU hospitalization. Although, the prognostic value of individual markers was poor and comparable (AUC < 0.65), the combined use of top clinical and imaging findings in the associated nomogram led to a high accuracy in predicting mortality (Area under curve: 87.3%).</p><p><strong>Conclusions: </strong>BLUS and CT imaging findings alone provide limited utility in stratifying patients for higher mortality and ICU admission risk and should not be used for risk stratification alone outside the context of each patient and their clinical presentations in suspected COVID-19 patients.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"255-266"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440238","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":"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":"Spontaneous rupture of solid pseudopapillary neoplasm (SPN) of the Pancreas - imaging insights and review of the literature.","authors":"Hajra Arshad, Linda C Chu, Elliot K Fishman, Satomi Kawamoto","doi":"10.1007/s10140-025-02332-7","DOIUrl":"https://doi.org/10.1007/s10140-025-02332-7","url":null,"abstract":"<p><p>Solid pseudopapillary neoplasm (SPN) of the pancreas, are rare low-grade malignant pancreatic tumors, most commonly occurring in young women during their second or third decade of life. They can present with vague abdominal symptoms like pain, discomfort, and nausea, or it can be incidentally discovered on imaging studies. There has been limited literature on ruptured SPN, which can be spontaneous or traumatic. In this paper, we present three cases of ruptured SPN, one traumatic and two spontaneous, to add to the scarcity of knowledge regarding this condition and its radiologic features, along with a detailed review of current literature.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663017","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}