Emergency Radiology最新文献

Purpose: Splenic artery embolization (SAE) has emerged as a promising alternative for managing variceal bleeding secondary to portal hypertension (PH). This study aims to elucidate the significance of SAE in managing esophageal variceal bleeding in patients with PH, providing an overview of its efficacy, safety, and role in PH management.

Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA standards. EMBASE, PubMed, Scopus, and Web of Science databases were searched from inception until April 14, 2024. Original observational and clinical studies on SAE in managing variceal bleeding due to PH were included. Meta-analyses were performed using a random-effects model, and publication bias was assessed using regression and rank correlation tests for funnel plot asymmetry.

Results: Eighteen studies met the inclusion criteria, encompassing 531 patients. The meta-analysis revealed a significant reduction in variceal bleeding post-SAE (RD = -0.86; 95% CI: -0.97, -0.75; p < 0.001). Complete resolution of varices was observed in 26% of patients (95% CI: 11%, 45%; p = 0.006), and 78% showed improvement in variceal grade (95% CI: 43%, 88%; p < 0.001). SAE significantly increased platelet counts (SMD = 1.15; 95% CI: 0.63, 1.68; p < 0.001). Common complications included post-embolization syndrome, and the overall complication rate was low.

Conclusions: This systematic review and meta-analysis study supports the efficacy and safety of SAE in managing variceal bleeding due to PH, demonstrating significant reductions in bleeding, improvements in variceal grade, and increases in platelet counts.

Purpose: To investigate the correlation between pediatric and adult trauma center status and radiology resident performance on pediatric trauma cases using the WIDI SIM exam.

Materials and methods: The WIDI SIM is a validated computer-aided simulation that assesses radiology residents' preparedness for independent call duty. It includes 65 cases across various imaging modalities derived from actual patient encounters. Faculty score free-text responses using a standardized 0-10 scale rubric. We analyzed 8,488 WIDI SIM exam scores from 35 pediatric trauma cases across 52 programs. A negative binomial regression model adjusting for resident level, imaging modality, and case specialty was employed to evaluate the impact of pediatric and adult trauma center status on resident performance.

Results: Both pediatric trauma center status (p = 0.0005) and adult trauma center status (p = 0.0003) were significant predictors of higher resident scores. Resident level was also significant, with higher-level residents performing better than first-year residents (p < 0.001). Residents performed worse on MR and US modalities compared to CT, and performance varied by case specialty.

Conclusion: Radiology residents' pediatric trauma imaging skills are significantly linked to pediatric and adult trauma center status. Given most pediatric traumas occur outside pediatric trauma centers, targeted training strategies should be considered to ensure residents develop essential diagnostic skills.

Objective: To assess the reliability and reproducibility of AO/OTA, Frykman and Fernandez classification systems for distal radius fractures on CT.

Materials and methods: Four radiologists, including one radiology resident, two musculoskeletal radiology fellows and one radiology consultant independently evaluated CT scans of 115 patients with distal radius fractures and classified the fractures according to AO/OTA, Frykman and Fernandez classification system. To assess reproducibility, a second set of reading was done by two observers after an interval of six weeks. Interobserver reliability was calculated for each classification system using intraclass correlation coefficient (ICC) and using Light's modification of kappa. Intraobserver agreement was calculated using Cohen's kappa.

Results: Interobserver reliability using ICC showed fair agreement for AO/OTA (0.447) and Frykman (0.432) classification system and poor agreement for Fernandez (0.196) classification system. Interobserver agreement using kappa was moderate for AO/OTA fracture (0.447) classification into either of three types, while it was only slight for complete classification into type, group and subgroup (0.177). Interobserver agreement using kappa was slight for Fernandez (0.196) classification systems and moderate for Frykman classification system (0.406). Intraobserver agreement for AO/OTA classification system was moderate for observer 1 (0.449) and slight for observer 2 (0.162). Intraobserver agreement for Frykman classification system was substantial for observer 1(0.754) and moderate for observer 2 (0.496). Intraobserver agreement for Fernandez classification system was moderate for both the observers (0.333, 0.320).

Conclusion: Currently there is no classification system that is fully reproducible. AO/OTA and Frykman classification systems performed better than Fernandez classification system in terms of interobserver reliability. However, Frykman classification system performed better than both AO/OTA and Fernandez classification system in terms of intraobserver reproducibility. Fernandez classification system had worst inter and intraobserver reliability in present study. Reliability and reproducibility of AO/OTA classification system decreased when fractures were divided into subgroups.

Purpose: The Canadian Cervical Spine Rule (CCR) was based on patient data from 25 years ago and recommended cervical spine computed tomography (CSCT) for trauma patients aged 65 and older. We sought to determine the differences in rate of symptomatic and asymptomatic fractures of trauma patients ≥ 65 and < 65 years old, given the changing demographics and heterogeneity in today's elderly population.

Methods: This retrospective study of CSCT results from two hospitals in our health system included 5 years of trauma patient data. In addition to the primary variable of fracture rates, we separated the patients into symptomatic / asymptomatic groups and ≥ 65 and < 65 years of age.

Results: In the ≥ 65 age group, 190 fractures among 9455 CSCTs (2.0%) were identified (112 females = 58.9%); 29 (0.3%) were in asymptomatic patients. In patients < 65, there were 199 (1.6%) fractures out of 12,531 CSCTs of which 19 (0.15%) were asymptomatic and 46 were female (23.1%). The rates of fractures in the older cohort (2.0%) were substantially different than those reported in the original CCR articles (5.2% and 6.6%). However, the fracture rates reported for those < 65 (1.4% and 1.7% historically) were similar to the current findings (1.6%).

Conclusion: The cervical spine fracture rate at our institution for patients ≥ 65, at 2.0%, was higher than those patients < 65 (1.6%) and favored female (58.9-23.1%) patients. The findings were much lower than those CCR percentages that led to scanning trauma patients who are 65 and older. Asymptomatic fractures are rarer still (0.15-0.30%).

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.

Purpose: To determine if difference in Hounsfield Units (HU) of the medullary bone between the injured and non-injured femurs in patients with greater trochanteric fractures is associated with occult intertrochanteric (IT) extension.

Methods: Retrospective review was performed of 81 patients (age range 54-102, 54 females and 27 males) who underwent CT and subsequent MRI after identification of a greater trochanteric fracture without evidence of IT extension on radiography and/or CT. Hounsfield units of the injured and non-injured femurs on CT were recorded at the level of the base of the greater trochanter centrally (ROI1) and the level of the upper border of the lesser trochanter posteromedially (ROI2). The difference between the injured and non-injured femur for each ROI1 and ROI2 were calculated. Absence or presence, and if present, extent of IT extension was assessed on MRI. Analysis was performed to determine if there is correlation of difference in density with presence, and extent of occult IT fractures.

Results: 81 cases met inclusion criteria, 14 (17%) had no IT extension, 11 (14%) had less than 50% IT extension and 56 (69%) had 50% or greater IT extension. There was statistical significance between presence and absence of IT extension between the injured and non-injured femur for ROI1 (HU) no IT extension median (IQR): 18.8(4-40), ROI1 (HU) present IT extension median (IQR): 65.5(46-90) p < .0001, and for ROI2 no IT extension median (IQR): 3(-8-25.5) and ROI2 present IT extension 51(40.5-76), p < .0001. There was statistical significance of the extent of IT extension: ROI1 less than 50% IT extension median (IQR): 37.5(27.5-57), ROI1 50% or greater IT extension median (IQR): 72.3(53.5-91.3), p < .0001, and for ROI2 less than 50% IT extension median (IQR): 17.5(8-49), and ROI2 50% or greater IT extension median (IQR): 55.8(45.3-81.5), p < .0001. A threshold ROI2 difference of 50 HU resulted in specificity of 92% and sensitivity 60.7% of for IT extension 50% or greater.

Conclusion: Patients presenting with greater trochanteric fractures, an asymmetric increased density measured by ROI differences within the medullary space of the IT region between the injured and non-injured femur is associated with occult IT extension.

Rationale and objectives: Interpreting CT studies of facial trauma is challenging, and there are often substantial differences in the characterization of complex facial trauma between radiologists and surgeons. We designed a collaborative multidisciplinary project to reconcile differences in facial fracture interpretation through an educational intervention. The effectiveness of this intervention was evaluated through surgeon feedback on radiology reports.

Materials and methods: Radiology residents, neuroradiology fellows, and neuroradiology attendings were recruited as participants at a single tertiary care academic center. Otolaryngology residents were recruited as evaluators. Participants completed surveys and provided preliminary reports for example cases of facial trauma before and after attending an educational session. Evaluators performed a blinded review of these preliminary reports based on ideal reports developed by surgical and neuroradiology attendings.

Results: 26 participants (20 residents, 1 neuroradiology fellow, 5 neuroradiology attendings) completed the study. Six otolaryngology residents participated as evaluators. To assess interrater reliability, three evaluators graded a shared set of 15 reports and demonstrated substantial agreement with a Kendall's W of 0.71. Participants demonstrated significant improvement in overall report accuracy, clarity, and organization. In subunit analysis, there were significant improvements in reporting Le Fort, nasoseptal, and nasoorbitoethmoid fractures. No significant improvements occurred in the reporting of upper face, zygomaticomaxillary complex, or mandibular fractures. In contrast, survey analysis demonstrated significantly improved confidence in interpreting trauma involving all facial subunits.

Conclusion: Compared with survey results, surgeon assessment of radiology reports better demonstrated areas of improvement after an educational intervention. A multidisciplinary approach to assessing educational efforts may better evaluate the practical effectiveness of educational interventions.

Purpose: Damage Control Surgery (DCS) refers to a staged laparotomy performed in patients who have suffered severe blunt or penetrating abdominopelvic trauma with the goal of managing critical injuries while avoiding life threatening metabolic derangements. Within 24 h of the initial laparotomy, computed tomography (CT) is used to assess the full extent of injuries. The purpose of this study was to assess the incidence of clinically significant unknown abdominopelvic injuries which required further dedicated surgical or interventional radiology management and failed surgical repairs identified on CT following initial laparotomy.

Methods: CT findings were correlated with surgical findings from the initial and subsequent staged laparotomy to determine known and unknown injuries. Frequency and percentage analyses was performed.

Results: Out of 63 patients who underwent DCS with an open abdomen following initial laparotomy and subsequent CT within 24 h, a total of 13 clinically significant abdominopelvic injuries were identified in 12 patients. Seven clinically significant injuries were identified in seven patients (11.1% of patients) in surgically explored areas. Six clinically significant injuries were identified in six patients (9.5%) in surgically unexplored areas. Four instances of failed initial surgical repair were identified in four patients (6.3%) involving the liver and gastrointestinal tract. Overall, 23.8% of the DCS patient population had an actionable finding on the post laparotomy CT.

Conclusion: CT demonstrated value for identifying the extent of clinically significant abdominopelvic injuries and evidence of failed initial surgical repair, which informed surgical planning for subsequent laparotomy. The authors advocate for performing CT in post-DCS patients with an open abdomen as soon as possible following correction of metabolic and hemodynamic derangements.