Emergency Radiology最新文献

Autologous breast reconstruction using donor-site flaps such as the deep inferior epigastric perforator (DIEP) flap, transverse rectus abdominis myocutaneous (TRAM) flap, latissimus dorsi flap, profunda artery perforator (PAP) flap, and autologous fat grafting is a cornerstone of post-mastectomy reconstruction, offering durable results and significant psychosocial benefits. Despite these advantages, donor site complications are common and can pose diagnostic challenges for radiologists. This pictorial review illustrates the spectrum of these complications, including seroma, hematoma, infection, fat necrosis, abdominal wall bulges and hernias, wound dehiscence focusing on their characteristic appearances across variety of modalities, primarily focused on computed tomography (CT), though also including radiography, ultrasound, and magnetic resonance imaging (MRI). By integrating surgical context with multimodality imaging features, this review provides practical guidance to distinguish expected postoperative changes from clinically significant complications, thereby improving diagnosis and facilitating early intervention for patients undergoing autologous breast reconstruction.

Background: Pediatric traumatic brain injury (TBI) accounts for a significant proportion of emergency department (ED) visits, with an estimated global incidence of up to 200 cases per 100,000 children each year. Despite clinical guidelines, imaging is often overused, particularly in mild cases, exposing children to unnecessary radiation. In Latin America, evidence regarding the appropriateness of imaging requests (AIR) and their diagnostic value remains scarce.

Objective: To assess the association between the AIR and final radiologic findings in traumatic brain injury, and to explore predictors through multivariable analysis.

Methods: This retrospective, multicentric, cross-sectional study included 719 neuroimaging studies (CT and skull radiography -SR-) performed in 2023 at two high-complexity private hospitals in Santiago, Chile. AIR was classified using the ACR Appropriateness Criteria® and the PECARN algorithm. Confirmatory findings included hemorrhages, skull fractures, and other traumatic lesions. Exploratory multivariable models were applied to evaluate factors associated with final diagnosis.

Results: Only 2.9% of imaging requests were deemed appropriate. Among CTs (n = 317), the adjusted probability of a confirmatory result was 48.0% (95% CI: 26.3-69.8) for appropriate requests versus 7.0% (95% CI: 4.1-9.9) for inappropriate ones, an absolute difference of 41 percentage points (p < 0.01). Inappropriate requests were associated with a 13-fold lower relative probability of identifying clinically relevant findings. All SRs were considered inappropriate and had a diagnostic yield of only 1%.

Conclusion: A significant gap exists between clinical practice and guideline-based imaging for pediatric TBI in Chile. Reinforcing validated decision tools may help optimize imaging use and minimize unnecessary radiation exposure.

Purpose: This study aimed to evaluate the necessity of whole-body computed tomography (CT) in patients with acute ischemic stroke (AIS) and to assess the usefulness of a simple imaging protocol combining brain CT perfusion (CTP) and whole-body CT using low-tube voltage and split-bolus injection (SPBI).

Methods: We retrospectively analyzed 123 patients with suspected AIS who underwent both brain CTP and whole-body CT between April 2022 and May 2025. Image quality, vascular and parenchymal CT values, diagnostic findings, and incidence of post-contrast acute kidney injury (PC-AKI) were assessed. A control group of 115 patients who underwent dynamic contrast-enhanced CT of the chest and abdomen was used for comparison.

Results: The proposed protocol achieved high CT values (≥ 350 HU) in major vessels and comparable CT enhancement in organs compared to the control group. Visual assessment yielded very high scores (vessels, 4.975; organs, 3.725) and complete inter-reader agreement (vessels, k = 0.98; organs, k = 0.877). Only one patient (0.8%) who underwent mechanical thrombectomy developed PC-AKI. Whole-body CT revealed clinically significant vascular disease (including aortic dissection, pulmonary embolism, and severe carotid stenosis) in 14.6% of cases and incidental suspected malignancy in 5.7% of cases.

Conclusion: Following brain CTP, whole-body CT enables the detection of significant vascular and incidental findings in patients with suspected AIS and provides valuable diagnostic information. This protocol, which utilizes low-tube voltage and SPBI, is a simple, time-efficient, and safe method that enhances vascular and organ contrast, supporting its clinical utility in AIS diagnosis.

Purpose: To quantify the diagnostic yield of neuroimaging in adult emergency department (ED) patients presenting with vertigo, and to identify clinical predictors of acute central pathology that can inform imaging decisions.

Methods: This retrospective study reviewed all neuroimaging examinations performed for vertigo at 14 EDs within our health network between May 2016 and January 2025. Adult ED patients (n=4,135; mean age 62.5 years; 62% female) who underwent imaging (n=5,445 exams, approximately 89% CT and 11% MR) were included. Imaging exams with potentially clinically relevant findings were flagged for further review (n=291 exams and patients); these patients were separated into four separate groups based on their imaging findings: 1) acute actionable contributory to vertigo, 2) acute actionable non-contributory to vertigo, 3) non-acute actionable, or 4) non-actionable. Vertigo quality (constant, intermittent/resolved spontaneously, no vertigo), acuity, neurological examination (including cerebellar signs and the Head-Impulse, Nystagmus, and Test-of-Skew [HINTS] exam), and intervention rates were analyzed within these subgroups using Fisher's exact and chi-square tests.

Results: Of 5,445 exams, 291 (5.3%) were flagged with potentially relevant imaging findings. Of these exams, only 115 (2.1%) yielded actionable findings, and just 65 (1.2%) revealed acute central causes contributing to vertigo. In patients with positive imaging findings, constant vertigo was strongly associated with acute contributory pathology (98.5% in this group vs. 6.0% in other groups, p<0.0001). Acute onset was more frequent in acute contributory cases (63.1% vs. 40.8%, p=0.0006), as were abnormal HINTS or cerebellar signs (44.6% vs. 6.0%, p<0.0001). Most patients with acute contributory findings received specialty consultations resulting in intervention (95.4%). Intermittent or resolved vertigo was commonly seen in patients with benign peripheral diagnoses.

Conclusion: Neuroimaging frequently yields normal results in ED vertigo cases; acute actionable central findings deemed contributory to vertigo are rare. Only approximately 2% of patients had acute actionable imaging findings and only 1.3% had a stroke. In patients with acute actionable imaging findings, clinical features-especially constant vertigo, acute onset, and abnormal neurological exam-are strongly associated with central causes and should guide selective imaging in the ED.

Background: Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Current risk stratification tools have limitations in predicting short-term outcomes. Radiological parameters such as thrombus density, measured in Hounsfield Units (HU) on computed tomography pulmonary angiography (CTPA), may provide additional prognostic information.

Objective: This study aims to assess the association between pulmonary artery thrombus density on CTPA and 30-day mortality in patients with intermediate-risk PE.

Methods: This retrospective cohort study included patients diagnosed with acute PE by contrast-enhanced CTPA in the emergency department of a single tertiary center between January 1, 2022, and December 31, 2024. Only patients classified as intermediate-risk according to European Society of Cardiology guidelines were included. HU values were measured from predefined pulmonary artery locations. The primary outcome was 30-day all-cause mortality. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed to identify independent predictors and assess discriminative ability.

Results: A total of 121 patients (mean age: 70 ± 14.5 years; 58.5% male) were analyzed. The 30-day mortality rate was 26.4%. Thrombus HU values were significantly higher in deceased patients compared to survivors (median 76 vs. 56, p = 0.001). In multivariate analysis, HU value (OR: 1.03; 95% CI: 1.001-1.06; p = 0.04) and sPESI score (OR: 1.70; 95% CI: 1.04-2.78; p = 0.03) were independent predictors. AUCs were 0.702 for HU and 0.731 for sPESI.

Conclusions: Thrombus density on CTPA was independently associated with 30-day mortality in intermediate-risk PE. HU measurement may serve as a practical imaging biomarker for early prognostic assessment.

Purpose: Several prior international studies have examined radiology resident reporting discrepancy rates, with a range of 1-10% quoted. Limited data exists specifically for the after-hours setting, where residents are often staffed at training institutions and report most, or all, studies. Our aims are to determine after-hours resident CT report discrepancy rates at our institution, determine the clinical significance of discrepancies, and assess factors affecting resident performance.

Methods: A retrospective review of 2000 after-hours resident CT reports (April through July 2022) was conducted. Preliminary resident reports were compared to attending radiologist finalised reports, with discrepancies categorized into 15 sub-categories; including those that were minor, major and clinically significant. Patient electronic medical records (EMR) were reviewed to assess clinical significance. Statistical analyses were performed using XLStat.

Results: The overall resident CT report discrepancy rate was 44.3% (885/2000), with most discrepancies considered minor changes (67.8%). The rate of major discrepancies was 19.9% (398/2000), while the rate of clinically significant discrepancies was 2.45% (49/2000). The most common major discrepancies included diagnostic misses (16.9%) and overcalls (5.7%). Discrepancies were highest among 2nd-year residents. Significant differences were observed when comparing 2nd- vs. 3rd-year residents (48.1% vs. 39.3%, p < 0.001), early evening vs. overnight shifts (49.5% vs. 38.5%, p < 0.001), and weekdays vs. weekends (49% vs. 38.2%, p < 0.001). No significant differences were found between major or clinically significant discrepancies.

Conclusions: Most resident after-hours CT discrepancies are minor. Our institution demonstrates a low rate of clinically significant discrepancies, which is at the lower end of rates quoted in prior studies. Our findings support high resident performance and reinforce the effectiveness of our current after-hours model in reducing the clinical impact of resident reporting errors.

Purpose: Older adult self-neglect, the inability to perform essential self-care, is an emerging public health problem. We aimed to evaluate imaging utilization and outcomes of patients with self-neglect compared to matched controls.

Methods: This IRB-approved retrospective study, conducted at two major academic medical centers, utilized the enterprise data warehouse to identify patients of > 60 years receiving a self-neglect mandate in the emergency department (ED) during 2019. Our study cohort consisted of 108 cases and 108 matched controls by age, gender, race, and time of ED presentation.

Results: During the index visit, cases had significantly higher imaging utilization (p < 0.001). Revisit and readmission rates over the 5-year study period were significantly higher among cases (526 versus 290 revisits (p < 0.001) and 254 versus 88 readmissions (p < 0.001)), with increased imaging utilization on follow-up for CT (p < 0.0001), X-ray (p < 0.0001), US (p < 0.0001), and MRI (p = 0.003). There were 44 deaths among cases versus 7 among controls. Subgroup analysis revealed that noncompliant cases had significantly higher CT use and an elevated mortality risk over the 5-year study period (both p = 0.02). Significantly higher number of cases lived alone (p < 0.001), had a higher substance use (p = 0.044), and had a higher prevalence of psychiatric illness (p < 0.001).

Conclusions: Older adult self-neglect patients experience increased ED revisits/readmissions and use more imaging services yet exhibit poorer clinical outcomes, particularly those who do not adhere to discharge recommendations. Identifying at-risk patients and implementing early interventions can mitigate healthcare burdens and improve patient outcomes.

Purpose: This study investigates how involuntary patient mis-centering affects dose distribution and image quality in computed tomography (CT), with the goal of reducing radiation exposure while preserving diagnostic performance.

Methods: Mis-centering was performed by shifting a Sun Nuclear CTDI phantom vertically and laterally, with dose recorded in specific phantom holes using a 10X6-3CT ionization chamber (Radcal). Measurements were performed on three CT scanners (Philips, FUJIFILM, Hitachi) under identical acquisition parameters. Additionally, a Philips system paired with a Catphan-503 phantom was used to assess image-quality changes. Dose ratios, calculated from absorbed dose measurements in multiple phantom holes, quantified the effect of off-center positioning.

Results: Peripheral doses were highly sensitive to displacement: a vertical offset above the isocenter reduced the dose by up to 35% at the point above the isocenter, while an increase was observed at symmetrical points, while a lateral offset reduced it by up to 18% at points in the direction of displacement. Image-quality metrics were affected to a lesser degree, likely because modern reconstruction algorithms partially compensate for mis-centering.

Conclusion: These findings suggest that deliberate mis-centering may be considered during follow-up CT examinations to spare radiation-sensitive regions without clinically significant loss of image quality.