Current problems in diagnostic radiology最新文献

{"title":"Multivariate analysis of radiological signs for the differential diagnosis of pulmonary infections.","authors":"M Canals","doi":"10.1067/j.cpradiol.2026.08.004","DOIUrl":"https://doi.org/10.1067/j.cpradiol.2026.08.004","url":null,"abstract":"<p><p>This study addressed the challenging task of etiological diagnosis in pulmonary infections, which requires the integration of epidemiological knowledge, clinical history, and radiological semiology. The aim was to quantify the diagnostic value of radiological findings described in the literature for differentiating pulmonary infections. Radiological features of 39 pulmonary infections were reviewed, including 19 bacterial, 13 fungal, and 7 viral etiologies; 56 publications were analyzed. Overall, six imaging patterns and 27 radiological signs were identified. Multivariate analysis was performed using Factor Analysis of Mixed Data (FAMD) to define a diagnostic space, followed by cluster analysis of diagnoses and radiological signs, and least absolute shrinkage and selection operator (LASSO)-regularized logistic regression models. Within the FAMD diagnostic space, Dimension 1 separated chronic and indolent infections-mainly mycobacterial and fungal infections-from acute bacterial and viral pneumonias, whereas Dimension 2 distinguished bacterial from viral etiologies. Cluster analysis identified five major groups: (1) non-tuberculous mycobacterial infections, (2) fungal and fungoid bacterial infections, (3) viral infections and atypical pneumonias, (4) typical bacterial pneumonias, and (5) primary tuberculosis and other specific infections. Comparison between acute bacterial and chronic/fungal infections showed moderate separation. When acute bacterial and viral infections were compared, models based on radiological signs showed limited-to-moderate discrimination; however, imaging patterns alone substantially improved diagnostic performance. Interstitial-alveolar and reticulonodular patterns were strongly associated with viral etiology. This finding highlights the diagnostic value of global pattern recognition, consistent with the radiological principle that diffuse, low-contrast abnormalities are better appreciated when the chest radiograph is viewed from a distance or through a minifying lens. These findings provide quantitative evidence supporting the classical semeiological approach to the differential diagnosis of pulmonary infections, reinforcing the complementary role of individual radiological signs and global imaging patterns in chest imaging.</p>","PeriodicalId":93969,"journal":{"name":"Current problems in diagnostic radiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868258","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 heterogeneity in granulomatous inflammation: High-resolution computed tomography imaging patterns and histopathological concordance.","authors":"Jawad Ali Memon, Mohammad Sibtain Shah, Zubair Ali Memon, Uzma Malik","doi":"10.1067/j.cpradiol.2026.08.002","DOIUrl":"https://doi.org/10.1067/j.cpradiol.2026.08.002","url":null,"abstract":"<p><strong>Background: </strong>Granulomatous inflammation presents substantial diagnostic complexity in tuberculosis-endemic regions. Radiological-histopathological concordance for distinguishing granulomatous diseases in resource-limited South Asian healthcare settings remains poorly characterized. Whether specific HRCT phenotypes reliably predict causative etiologies has not been systematically evaluated.</p><p><strong>Methods: </strong>Cross-sectional diagnostic study enrolling 300 participants with suspected granulomatous inflammation at a tertiary care center. Participants underwent HRCT chest imaging and tissue sampling with histopathological confirmation. Primary outcome was radiological-histopathological concordance assessed by Spearman's correlation and weighted kappa. Secondary outcomes included diagnostic accuracy by etiology, inter-rater reliability for radiologists and pathologists, and specific HRCT predictor features. All analyses reported sensitivity, specificity, and 95% confidence intervals.</p><p><strong>Results: </strong>Of 300 enrolled participants (mean age 48.2 years; 68.0% male), radiological-histopathological concordance was strong: Spearman's ρ = 0.72 (95% CI 0.64-0.79; p<0.001), weighted kappa κ_w = 0.68 (95% CI 0.61-0.75). Sensitivity 81.3% (95% CI 75.2%-86.8%), specificity 78.6% (95% CI 71.4%-85.1%). Diagnostic accuracy: tuberculosis 88.5%, sarcoidosis 79.2%, malignancy 81.8%, fungal disease 72.2%. Upper lobe predominance (adjusted OR 6.42) and cavitation (OR 5.24) strongly predicted tuberculosis.</p><p><strong>Conclusions: </strong>Specific HRCT features demonstrated strong concordance with histopathological diagnosis and high accuracy for granulomatous etiologies, particularly tuberculosis. However, diagnostic performance varied substantially by etiology and radiological complexity. System-level barriers to biopsy access remain critical limitations. These findings support evidence-based radiological-pathological diagnostic algorithms in resource-limited settings.</p>","PeriodicalId":93969,"journal":{"name":"Current problems in diagnostic radiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835705","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":"Challenges in implementing ultrasound-guided hydrostatic reduction of intussusception: Perspectives from radiologists trained and practicing in resource-limited settings.","authors":"Bethelhem Belachew, Samuel Sisay Hailu, Biniyam Beyene Tabor, Eyasu Wakjira Korsa, Abass Noor, Kassa Darge, Hansel J Otero","doi":"10.1067/j.cpradiol.2026.08.005","DOIUrl":"https://doi.org/10.1067/j.cpradiol.2026.08.005","url":null,"abstract":"<p><strong>Background: </strong>While non-operative management has long been the standard of care for intussusception in many settings, surgical intervention remains predominant in sub-Saharan Africa. Ultrasound-guided hydrostatic reduction has emerged as a viable alternative for uncomplicated cases in the region. However, the practical challenges hindering its broader adoption remain underexplored.</p><p><strong>Objective: </strong>We aimed to assess the practice of ultrasound-guided hydrostatic reduction among recently trained Ethiopian radiologists and the barriers to its implementation.</p><p><strong>Materials and methods: </strong>This study used a cross-sectional survey composed of a custom-designed, pilot-tested questionnaire on demographics, training exposure, confidence, current practice, perceived barriers, and proposed solutions. It was distributed through Radiological Society of Ethiopia's online group to reach all radiology residency graduates in Ethiopia from 2015 to 2024 (N ≈ 365). Descriptive statistics, logistic regression, and chi-square tests were used for analysis, with significance set at p < 0.05. Ethical approval was obtained, and informed consent was secured from all participants.</p><p><strong>Results: </strong>We received 178 responses (48.8% response rate). While 70.7% (n = 106/150) of trained respondents had performed ultrasound-guided hydrostatic reduction post-graduation, only 58.6% (n = 88/150) of total respondents reported currently practicing the procedure. Most respondents (86.5%, n = 154/178) supported ultrasound-guided hydrostatic reduction as the first-line treatment for pediatric intussusception. Confidence was significantly associated with current practice (p < 0.001) but not with graduation year(p = 0.95). Key barriers included lack of protocols (69.1%, 123/178), delayed presentation (46.6%, 83/178), and limited surgical support (38.7%, 69/178).</p><p><strong>Conclusion: </strong>This study underscores the complex and multifactorial challenges in implementing ultrasound-guided hydrostatic reduction in resource-limited settings. Effectively addressing these challenges requires targeted training programs, better resource allocation, and stronger interdisciplinary collaboration.</p>","PeriodicalId":93969,"journal":{"name":"Current problems in diagnostic radiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842427","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":"Factors associated with corticotomy in children with osteomyelitis.","authors":"Danika Baskar, Brianna Vey, Andrew Jergel, Kiery Braithwaite, Ashishkumar Parikh","doi":"10.1067/j.cpradiol.2026.08.006","DOIUrl":"https://doi.org/10.1067/j.cpradiol.2026.08.006","url":null,"abstract":"<p><strong>Background: </strong>This study evaluates critical associations between clinical, laboratory, and imaging findings with corticotomy status in children with osteomyelitis to learn what factors guide the decision to perform a corticotomy during surgical debridement.</p><p><strong>Methods: </strong>A retrospective review of children (<18 years old) with osteomyelitis was performed in a single health system. Demographic data and lab values were reviewed in addition to pre-procedure contrast-enhanced MRI imaging findings to detect the presence of intraosseous abscess or necrosis and operative reports for corticotomy status. Statistical analysis was performed using Wilcoxon rank sum, Pearson's Chi-squared, and Fisher's exact test where appropriate with a p-value of <0.05 considered statistically significant.</p><p><strong>Results: </strong>124 patients with confirmed osteomyelitis were analyzed, of which 81% (100/124) underwent a corticotomy during surgical debridement. 63% (63/100) of patients who underwent corticotomy had confirmed osseous abscess or necrosis on MRI compared to only 21% (5/24) who did not (p < 0.001). Most patients who had intraosseous abscess or necrosis on contrast-enhanced MRI (93% or 63/68 patients) underwent corticotomy. Patients who underwent corticotomy were found to have a higher median age than those who did not (8.0 years versus 2.0 years respectively, p = 0.001) and those who underwent corticotomy had lower WBC counts than those who did not (9.12 cells/µL versus 11.10 cells/µL respectively, p = 0.007).</p><p><strong>Conclusions: </strong>There is a significant association between the presence of osseous abscess or necrosis on contrast-enhanced MRI and surgical corticotomies performed during debridement in pediatric patients. These findings highlight the importance of both imaging-guided diagnosis and clinical intraoperative assessment in treating pediatric osteomyelitis.</p>","PeriodicalId":93969,"journal":{"name":"Current problems in diagnostic radiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842409","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 attenuation as a biomarker of mild-to-moderate anemia: development of a non-contrast chest CT prediction model.","authors":"Parisa Pishdad, Mitra Ataee Kachuee, Rezvan Ravanfar Haghighi, Pouria Vadipour, Mohsen Salimi","doi":"10.1067/j.cpradiol.2026.08.001","DOIUrl":"https://doi.org/10.1067/j.cpradiol.2026.08.001","url":null,"abstract":"<p><strong>Purpose: </strong>Non-contrast thoracic computed tomography (CT) may incidentally demonstrate imaging features associated with anemia and could complement laboratory testing, particularly in mild-to-moderate cases that are often clinically unrecognized. This study aimed to evaluate the relationship between visual signs and attenuation-based measurements on non-contrast chest CT and mild-to-moderate anemia, and to develop a combined prediction model using these imaging features.</p><p><strong>Materials and methods: </strong>This retrospective study included 141 adult patients who underwent non-contrast thoracic CT and hemoglobin testing within a 6-hour interval. Qualitative CT features, including the aortic ring sign and interventricular septum sign, were assessed together with quantitative attenuation measurements of the left ventricular cavity and descending aorta, expressed in Hounsfield units (HU). The diagnostic performance of individual imaging features was evaluated using receiver operating characteristic (ROC) analysis. A multivariable logistic regression model incorporating selected imaging parameters was constructed, followed by internal validation using a 7:3 training-validation split. A nomogram was derived from the final model.</p><p><strong>Results: </strong>The aortic ring and interventricular septum signs demonstrated moderate discriminative performance, with AUCs of 0.748 (95% CI: 0.659-0.838) and 0.763 (95% CI: 0.672-0.853), respectively. Quantitative attenuation measurements showed higher discrimination, with AUCs of 0.903 (95% CI: 0.842-0.963) for left ventricular attenuation and 0.917 (95% CI: 0.861-0.972) for descending aortic attenuation. The combined nomogram yielded AUCs of 0.980 in the training cohort and 0.953 in the validation cohort, with acceptable calibration.</p><p><strong>Conclusion: </strong>Non-contrast thoracic CT may provide imaging information associated with mild-to-moderate anemia and could support incidental detection during routine examinations.</p>","PeriodicalId":93969,"journal":{"name":"Current problems in diagnostic radiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876846","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 angiography in blunt thoracic aortic injury: An evidence-mapped review and structured reporting framework.","authors":"Farbod Khosravi, Ali Nabipoor, Sanaz Asadian, Nastaran Sadat Hosseini, Arash Bedayat, Majid Chalian, Bahar Mansoori, Hamid Chalian","doi":"10.1067/j.cpradiol.2026.08.003","DOIUrl":"https://doi.org/10.1067/j.cpradiol.2026.08.003","url":null,"abstract":"<p><p>Blunt thoracic aortic injury (BTAI) is a life-threatening consequence of high-energy deceleration trauma, most often involving the aortic isthmus. Computed tomography angiography (CTA) is the first-line imaging examination in contemporary trauma practice, but interpretation may be complicated by subtle minimal injuries, motion-related pseudo-lesions of the aortic root and ascending aorta, and inconsistent application of available grading systems. This educational review synthesizes the published CTA literature on BTAI and presents a structured reporting and triage framework that aligns lesion characterization with established Society for Vascular Surgery (SVS), Vancouver, and Harborview classification schemes. Representative cases are used to illustrate minimal aortic injury, intramural hematoma, pseudoaneurysm, transection, common interpretive pitfalls, and selected post-thoracic endovascular aortic repair (TEVAR) appearances. We summarize published imaging features that may justify escalation of management, highlight situations in which repeat ECG-gated or high-pitch targeted imaging may reduce false-positive interpretation, and provide a practical checklist for standardized CTA reporting. Rather than proposing a new grading system, this review translates fragmented evidence into a reproducible imaging workflow intended to improve diagnostic consistency, multidisciplinary communication, and management-oriented reporting in patients with suspected BTAI.</p>","PeriodicalId":93969,"journal":{"name":"Current problems in diagnostic radiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842402","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":"Radiology quick cash? Kickbacks, compliance, and consequences.","authors":"Robert Optican, Richard Duszak","doi":"10.1067/j.cpradiol.2024.05.020","DOIUrl":"10.1067/j.cpradiol.2024.05.020","url":null,"abstract":"<p><p>The Anti-Kickback Statute was passed by Congress in the 1970s to reduce the overuse of government-reimbursed medical services. It attempts to eliminate fraud, abuse, and waste of medical services by outlawing the incentive of personal gain when referring patients for government-funded services. Although safe harbors were written into the law to maintain transactions beneficial to society, they require strict adherence. Anti-Kickback Statute violations are subject to the whistleblower provision of the False Claims Act, and violations can yield significant civil and criminal penalties.</p>","PeriodicalId":93969,"journal":{"name":"Current problems in diagnostic radiology","volume":" ","pages":"677-678"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961173","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}