Emergency Radiology最新文献

Purpose: This study proposes and evaluates the Universal Thorax ARDS Modification Index (UTAMI), a new method based on chest x-ray findings, for rapid ICU admission prediction in pneumonia with ARDS. Clinical and laboratory variables are analyzed to find potential predictors.

Method: A cross-sectional study at Fatmawati Central General Hospital (2022-2023) compared the diagnostic accuracy of UTAMI method against the gold standard for ARDS diagnosis; Berlin Definition. We analyzed 318 patients' data that were hospitalized for pneumonia. Clinical and laboratory predictors of ARDS were also analyzed.

Results: Neutrophil levels, CRP, D-dimer, oxygen saturation, and respiratory rate can predict ARDS diagnosis according to the Berlin Definition. The patient cohort showed that those with moderate-severe ARDS were admitted to the ICU. With ARDS categorized as ARDS requiring ICU admission (ARDS ICU) and ARDS not requiring ICU admission, the UTAMI method requires only history of coronary artery disease (CAD), CRP, and oxygen saturation as key predictors. CRP was a predictor in both the Berlin Definition (PR 1.28) and the UTAMI method (PR 1.71). In the AUROC test, the Berlin Definition distinguished moderate-severe ARDS with 81.2% accuracy using chest radiographs, clinical and laboratory values. The UTAMI method, based solely on chest radiographs achieved 79.6% accuracy, showing fair discrimination against the gold standard.

Conclusion: UTAMI Score is a viable tool for predicting the risk of ARDS in pneumonia. Utilizing UTAMI method, ARDS can be predicted using only chest radiograph, making it easier for clinicians to be alerted earlier. Predicting ARDS ICU from UTAMI method requires only 3 variables; CAD comorbid, laboratory CRP and peripheral oxygen saturation.

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.

Introduction: 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.

Methods: 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.

Results: 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%).

Conclusions: 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.

Purpose: B-lines in lung ultrasound have been a critical clue for detecting pulmonary edema. However, distinguishing B-lines from other artifacts is a challenge, especially for novice point of care ultrasound (POCUS) practitioners. This study aimed to determine the efficacy of automatic detection of B-lines using artificial intelligence (Auto B-lines) for detecting pulmonary edema.

Methods: A retrospective study was conducted on dyspnea patients treated at the emergency department between January 2023 and June 2024. Ultrasound documentation and electronic emergency department medical records were evaluated for sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of auto B-lines in detection of pulmonary edema.

Results: Sixty-six patients with a final diagnosis of pulmonary edema were enrolled, with 54.68% having positive B-lines in lung ultrasound. Auto B-lines had 95.6% sensitivity (95% confidence interval [CI]: 0.92-0.98) and 77.2% specificity (95% CI: 0.74-0.80). Physicians demonstrated 82.7% sensitivity (95% CI: 0.79-0.97) and 63.09% sensitivity (95% CI: 0.58-0.69).

Conclusion: The auto B-lines were highly sensitive in diagnosing pulmonary edema in novice POCUS practitioners. The clinical integration of physicians and artificial intelligence enhances diagnostic capabilities.

Purpose: To illustrate the imaging findings of orbital compartment syndrome (OCS) in patients with orbital mucormycosis and to identify the red flag signs on imaging for prompt diagnosis and timely intervention.

Methods: We conducted a retrospective analysis of CT and MRI scans from patients diagnosed with sino-nasal mucormycosis within three months of a confirmed COVID-19 infection. Microbiologically proven cases of mucormycosis were included. Images were analysed for: Route of spread; proptosis; tenting of globe, Retro-orbital fat/extraocular muscle (EOM) nonenhancement; Intra-orbital abscess, superior ophthalmic vein (SOV) thrombosis, stretching/thickening/enhancement/diffusion restriction of optic nerve, orbital coat, and EOM. Descriptive statistics were elaborated in the form of mean/standard deviations for continuous variables and frequencies and percentages for categorical variables.

Results: Out of 138 patients with mucormycosis, 49 had orbital involvement, OCS was present in 16 orbits. The mean age was 48.6 years with M: F of 2.75:1. Adjacent sinuses were involved in all patients. Spread along nerves and nasolacrimal duct was seen in 94% patients. Globe tenting was seen in all and thickening/coat enhancement in 53.3%. Optic nerve (ON) was thickened in 87.5%, diffusion restriction of ON and EOM in 78.5% cases. Non enhancement of retro-orbital fat was seen in 50% and intra-orbital abscess in 62.5% cases.

Conclusions: OCS is a vision-threatening orbital emergency, leading to OIS and permanent blindness, if not managed promptly. Imaging features that warrant immediate clinical/ surgical intervention to avoid permanent loss of vision are distorted globe, posterior tenting of the globe, stretching of the optic nerve, non-enhancement of retro-bulbar fat and extra-ocular muscles (EOMs).

Background and purpose: Non-enhanced computed tomography (NECT) and computed tomography angiography (CTA) are useful for detecting aneurysmal subarachnoid hemorrhage (SAH) but challenging to identify ruptured aneurysms in cases of multiple aneurysms. We aimed to determine if the hypoattenuating berry sign (HBS) can identify ruptured aneurysms in SAH patients with multiple aneurysms.

Methods: Patients who had multiple aneurysms and underwent NECT were retrospectively recruited. The HBS, blood score, size and location of aneurysm were independently analyzed. The attenuation value of HBS and surrounding SAH were recorded. The independent factors of HBS in determination of ruptured aneurysms were analyzed using multivariable logistic regression.

Results: Fifty-three patients (mean age 64.2 ± 10.9 years, 83.0% female) with 112 aneurysms were enrolled. In the univariate analysis, aneurysm size, aneurysm status (ruptured), and blood score were significantly correlated with the occurrence of HBS. In the multivariate analysis, only aneurysm status showed a significant association with HBS. Aneurysms with HBS were larger than those without (6.8 ± 4.2 mm versus 4.2 ± 1.2 mm, P < 0.001), and those measured via NECT were larger than those measured via DSA (7.2 ± 3.8 mm vs. 6.8 ± 4.2 mm, P < 0.001). HBS was found in 51.8% of all aneurysms and in 87.7% of ruptured aneurysms on NECT. Raters had high agreement on aneurysm size (ICC = 0.829), HBS presence (kappa = 0.928), and blood score (kappa = 0.780).

Conclusions: The HBS can be used to detect ruptured aneurysm in patient with SAH and multiple aneurysms.

Purpose: This study aimed to evaluate the clinical outcomes, technical success, and complications associated with the placement of Abre™ venous stents for central venous stenosis/occlusion (CVS/CVO).

Materials and methods: A retrospective review was conducted, identifying 21 patients who underwent Abre™ venous stent placement for SVC syndrome at a single institution. Demographic and clinical data were collected, including stent configurations, procedural details, and follow-up outcomes. Primary stent patency, symptom resolution, and survival rates were analyzed. Survival curves were generated using Kaplan-Meier analysis, and complications were recorded.

Results: Facial and/or upper extremity edema was present in all patients, and malignancy accounted for SVC syndrome in 71.4% of cases, with lung cancer as the predominant etiology (66.6%). The technical success rate was 100%. Clinical symptom resolution was achieved in all patients. The 30-day mortality rate was 23.8%, with all cases involving oncology patients. At six months, cross-sectional imaging showed a primary stent patency rate of 93%, and this remained stable through 12 months. The mean survival time for the cancer subgroup was 337.2 ± 343 days, while the overall cohort mean was 885.8 ± 453.7 days.

Conclusion: The Abre™ venous stent demonstrates potential as an effective stent for SVC syndrome, achieving high symptom relief and patency rates. However, further long-term studies and randomized controlled trials are necessary to validate these findings.

Purpose: 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.

Materials and methods: 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.

Results: 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%.

Conclusion: 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.

Purpose: 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.

Methods: 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.

Results: 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.

Discussion: 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.

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.