Emergency Radiology最新文献

{"title":"Altered renal corticomedullary differentiation on CT, Part I: A pictorial review of non-neoplastic causes.","authors":"Felipe Lopez-Ramirez, Erin Gomez, Satomi Kawamoto, Linda C Chu, Elliot K Fishman","doi":"10.1007/s10140-026-02484-0","DOIUrl":"10.1007/s10140-026-02484-0","url":null,"abstract":"<p><p>The renal corticomedullary interface represents a physiologic differentiation in perfusion between the highly vascular cortex and the medulla. On computed tomography (CT), the corticomedullary phase (CMP), typically acquired 25-35 s after contrast administration, provides an optimal window for evaluating these perfusion differences during the early phase of contrast enhancement. Although often discussed in the context of neoplastic disease, the loss of corticomedullary differentiation (CMD) most commonly occurs across a variety of nonmalignant processes and can serve as an early indicator of underlying renal pathology, including vascular insults, infectious etiologies, functional disturbances related to acute kidney injury, and fibrotic or infiltrative processes seen in chronic kidney disease. A structured approach to evaluating CMD, recognizing characteristic enhancement patterns of pathology, and correlating them with clinical context can enable radiologists to differentiate among the most common presentations. In this pictorial review, we illustrate the normal appearance and enhancement dynamics of the CMP and highlight characteristic imaging patterns of CMD loss across key nonmalignant entities. These imaging patterns underscore the sensitivity of altered CMD in detecting renal pathologies and may improve diagnostic confidence and guide timely clinical management.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"933-944"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812502","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 novel CT-based scoring system for appendicoliths and its prognostic value in acute appendicitis: a retrospective cohort study.","authors":"Jian Xiao, Suxia He, Zexu Zhang, Guomin Zhu","doi":"10.1007/s10140-026-02491-1","DOIUrl":"10.1007/s10140-026-02491-1","url":null,"abstract":"<p><strong>Background: </strong>Appendicoliths are recognized risk factors for complicated appendicitis and adverse surgical outcomes. However, current preoperative assessments lack a standardized method to evaluate appendicoliths beyond simply documenting their presence. This study aimed to develop and validate a CT-based appendicolith scoring system incorporating both location and morphological characteristics to predict postoperative outcomes in patients with acute appendicitis.</p><p><strong>Methods: </strong>We retrospectively analyzed 241 adult patients with acute appendicitis and radiologically confirmed to have appendicoliths who underwent appendectomy between August 2021 and December 2023. Two researchers, blinded to clinical outcomes, independently scored appendicoliths based on location (root = 3, mid-section = 2, tip = 1) and morphology (granular = 3, rod-shaped = 2, sediment-like = 1). Total scores (range 2-6) were calculated as the sum of the location score and the morphology score (Location + Morphology=Total), and inter-observer agreement was assessed. Patients were stratified into three groups: low-risk (2-3 points), intermediate-risk (4 points), and high-risk (5-6 points). Clinical characteristics, operative outcomes, and postoperative complications were compared across groups. Univariate regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate the scoring system's predictive performance.</p><p><strong>Results: </strong>The cohort comprised 130 males and 111 females (median age 35 years). Inter-observer agreement for the total score was excellent (κ = 0.937). High-risk patients (n = 129) demonstrated significantly larger appendiceal diameters compared with low-risk (n = 41) and intermediate-risk (n = 71) groups (P < 0.001), with a positive correlation between score and diameter (γ = 0.298, P = 0.003). High-risk patients also exhibited significantly longer hospital stays (median 7.0 vs. 6.0 days, P = 0.003), higher rates of prolonged flatus (> 48 h, 58.9% vs. 40.9-43.9%, P = 0.030), and increased postoperative complications (14.7% vs. 4.2-4.9%, P = 0.043). Univariate analysis showed that the appendicolith severity grade was significantly associated with postoperative complications (Crude OR = 2.164, 95% CI: 1.014-4.617, P = 0.046). ROC analysis demonstrated moderate predictive utility for postoperative complications (AUC = 0.641, 95% CI: 0.533-0.748) and prolonged hospitalization (AUC = 0.636, 95% CI: 0.558-0.714), with an optimal cutoff of ≥ 4.5 points.</p><p><strong>Conclusion: </strong>This CT-based appendicolith scoring system provides a simple, reproducible, and clinically useful tool for preoperative risk stratification in acute appendicitis. Higher scores correlate with increased inflammatory severity, prolonged recovery, and an increased risk of postoperative complications, potentially guiding perioperative management decisions.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"855-864"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971356","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":"Photon-counting CT versus energy-integrating CT of the chest in acute respiratory distress syndrome: A retrospective observational study of image quality and radiation exposure.","authors":"Daniel Rosok, Marcel Opitz, Denise Bos, Laura Klüner, Marcel Drews, Luca Salhöfer, Johannes Harmes, Nina Pirschtat, Simon Dubler, Michael Forsting, Johannes Haubold, Sebastian Zensen","doi":"10.1007/s10140-026-02490-2","DOIUrl":"10.1007/s10140-026-02490-2","url":null,"abstract":"<p><strong>Purpose: </strong>Chest CT is central to the diagnosis and monitoring of acute respiratory distress syndrome (ARDS). Photon-counting detector CT (PCD-CT) may improve image quality and enable radiation dose optimization compared with Energy-integrating detector CT (EID-CT). However, evidence in critically ill ARDS patients undergoing contrast-enhanced chest imaging is limited. The purpose of this study was to intraindividually compare image quality and radiation exposure between PCD-CT and EID-CT in ARDS patients.</p><p><strong>Methods: </strong>This retrospective study included patients with ARDS who underwent both contrast-enhanced chest PCD-CT and EID-CT between April 2023 and May 2025. CT dose index volume (CTDIvol), dose-length product (DLP), effective and organ doses were extracted from dose monitoring software. Subjective image quality and diagnostic acceptability were rated independently by two radiologists using a Likert scale; inter-reader agreement was assessed with Cohen's κ. Objective image quality was assessed using signal-to-noise ratios in representative anatomical regions. Intraindividual comparisons were performed using the Wilcoxon signed-rank test.</p><p><strong>Results: </strong>Among 531 ARDS patients, 80 (15.1%) underwent chest PCD-CT, including 59 (73.8%) contrast-enhanced examinations (median age: 51.7 years (IQR: 41.6-59.5); 62.7% male). Intraindividual imaging was performed in 32 patients (54.2%). PCD-CT demonstrated significantly higher subjective and objective image quality than EID-CT (p < 0.005), with moderate inter-reader agreement. Median CTDIvol and DLP were not significantly different between PCD-CT (8.2 mGy; 435 mGycm) and EID-CT (7.7 mGy; 297 mGycm).</p><p><strong>Conclusion: </strong>In contrast-enhanced chest CT of ARDS patients, PCD-CT provides superior image quality without a significant difference in radiation dose, potentially facilitating more precise diagnostic assessment in this critically ill population.</p><p><strong>Trial registration: </strong>DRKS-ID: DRKS00037916, 15 September 2025, retrospectively registered.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"833-843"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927667","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":"Advances in abdominal wall imaging: The potential role of cinematic rendering.","authors":"Zahra F Rahmatullah, Elliot K Fishman","doi":"10.1007/s10140-026-02463-5","DOIUrl":"10.1007/s10140-026-02463-5","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"923-931"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of artificial intelligence for identification of cervical spine fractures: a systematic review and meta-analysis.","authors":"Ali Gholamrezanezhad, Mehrdad Farrokhi, Sami Almasri, Hadis Askari, Ali Askari, Seyed Arshia Mirjafarifiroozabadi, Mohammad Amin Nochian, Eashan Kosaraju","doi":"10.1007/s10140-026-02477-z","DOIUrl":"10.1007/s10140-026-02477-z","url":null,"abstract":"<p><strong>Purpose: </strong>This meta-analysis aimed to evaluate how effectively artificial intelligence (AI) models can diagnose cervical spine fractures.</p><p><strong>Methods: </strong>A systematic search from inception to July 2025 in databases of Medline, Scopus, and Web of Science was performed to retrieve studies applying AI models for diagnosis of cervical spine fractures. Deduplication, study screening, and full-text evaluations were performed using EndNote by two independent authors. Statistical analyses were conducted using MIDAS and Metaprop packages in Stata and Meta-Disc software.</p><p><strong>Results: </strong>Sixteen studies reporting 69 AI models were analyzed. The estimated sensitivity was 0.93 (95% CI, 0.92-0.94) and specificity was found to be 0.97 (95% CI, 0.97-0.97). The combined positive and negative likelihood ratios were 26.34 (95% CI, 15.93-43.56) and 0.07 (95% CI, 0.03-0.16), respectively. The overall accuracy was 0.96 (95% CI, 0.95-0.98), with summary receiver operating characteristic curve (AUROC) suggesting of 0.99 area under curve.</p><p><strong>Conclusion: </strong>Our meta-analysis showed that AI models demonstrate high diagnostic accuracy (0.96) for the early identification of cervical spine fractures. While our analysis suggests that AI models may achieve similar diagnostic performance using either CT or radiography, this finding should be interpreted with caution due to the limited number of X-ray studies and the high degree of heterogeneity. Given the scarcity of independent peer-reviewed validation studies and the variability in performance across AI models and study settings, the generalizability of these findings across different patient populations and clinical environments remains uncertain. Further research is required to confirm these results and account for study design variations.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"889-902"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812447","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":"Pneumatosis intestinalis revisited: associated imaging findings, clinical correlation, management, risk stratification and future perspectives.","authors":"Kathy Truong, Waseem Wahood, Cibele Luna, Austin Dosch, Yamilé Blain","doi":"10.1007/s10140-026-02472-4","DOIUrl":"10.1007/s10140-026-02472-4","url":null,"abstract":"<p><strong>Background: </strong>Pneumatosis intestinalis (PI) is the imaging finding of air within the bowel wall. It constitutes a diagnostic challenge due to its broad differential and overlap in imaging appearances between benign and serious causes. A multidisciplinary approach is essential for accurate diagnosis and timely intervention, to optimize outcomes and minimize unnecessary procedures.</p><p><strong>Objective: </strong>This article aims to synthesize the literature to lay out the current state of the art in diagnosing and managing PI and discuss future perspectives. We review a series of associated imaging features including portomesenteric venous gas, vascular thrombosis, abnormal bowel wall enhancement, and bowel wall thickening or thinning. We also discuss less specific but commonly seen findings like pneumoperitoneum, ascites and fat stranding, emphasizing their context-dependent significance. We review nuances in clinical interpretation of the severity of PI, discuss the discordance in interpretation of certain clinical markers, and important considerations in specific populations. To finish, we describe ongoing efforts related to risk stratification and its importance in PI management.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"873-887"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812603","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":"Musculoskeletal imaging findings of xylazine-associated wounds.","authors":"Alvaro A Ordonez, John D Karp, Peter Qiao, Chantal Chahine, Waqas Bari, Nogah Shabshin","doi":"10.1007/s10140-026-02480-4","DOIUrl":"10.1007/s10140-026-02480-4","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"755-763"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766004","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":"Early non-contrast CT morphology at emergency admission in acute pancreatitis: real-world associations with clinical course.","authors":"Bartosz Molasy, Wiktoria Zawolik-Kosek, Agata Gronowska, Stanisław Głuszek","doi":"10.1007/s10140-026-02475-1","DOIUrl":"10.1007/s10140-026-02475-1","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the clinical associations of admission non-contrast CT morphology in acute pancreatitis within a real-world emergency workflow.</p><p><strong>Materials and methods: </strong>This retrospective observational cohort study included 264 consecutive adult patients admitted with acute pancreatitis to two surgical centers between 2019 and 2024. Patients were categorized according to the first imaging modality obtained at admission into an ultrasound-first (US-first) or computed tomography-first (CT-first) pathway. Baseline characteristics and in-hospital outcomes were compared between pathways. In the CT-first subgroup, all examinations were performed without intravenous contrast, and morphologic severity was assessed using the Balthazar classification. Associations between CT morphology and clinical outcomes were evaluated using univariable analyses.</p><p><strong>Results: </strong>Of the 264 patients, 143 (54.2%) were managed within a US-first pathway and 121 (45.8%) underwent CT as the initial imaging modality. Baseline demographic and etiologic characteristics were comparable between pathways. Patients in the CT-first pathway demonstrated numerically higher rates of adverse clinical outcomes at admission, including a longer length of hospital stay (median 8 vs. 6 days; p = 0.01) and numerically higher rates of severe acute pancreatitis and in-hospital mortality. Within the CT-first cohort, non-contrast CT morphology demonstrated heterogeneous inflammatory severity. Higher Balthazar grades were associated with stepwise numerical increases in rates of severe disease, complications, and length of hospital stay. When dichotomized, advanced morphologic severity (Balthazar grades D-E) showed higher odds of adverse outcomes compared with grades A-C, although these associations did not reach statistical significance.</p><p><strong>Conclusion: </strong>In routine emergency practice, selection of ultrasound-first or CT-first imaging pathways appears largely driven by triage and organizational factors rather than predefined imaging strategies. In patients undergoing non-contrast CT at admission, higher Balthazar grades demonstrated consistent numerical gradients toward more severe clinical courses; however, these associations did not reach statistical significance. Early non-contrast CT morphology should therefore be interpreted as contextual inflammatory assessment rather than a standalone prognostic tool.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"815-825"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147867222","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 distribution patterns of traumatic pneumothorax in blunt thoracic trauma: implications for targeted emergency imaging.","authors":"Latife Jabbari, Jaleh Dashtian, Leila Azizkhani, Saeed Hayati","doi":"10.1007/s10140-026-02466-2","DOIUrl":"10.1007/s10140-026-02466-2","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"727-732"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766044","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":"National trends in CT angiography use for dizziness in U.S. emergency departments: an Epic Cosmos analysis, 2016-2025.","authors":"Dhairya A Lakhani, David M Yousem","doi":"10.1007/s10140-026-02482-2","DOIUrl":"10.1007/s10140-026-02482-2","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"765-773"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766002","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}