Emergency Radiology最新文献

Purpose: Occipital condyle fractures (OCFs) are classified by the Anderson and Montesano system into Type I (comminuted, minimally displaced), Type II (stable, associated with basilar skull fractures), and Type III (unstable avulsion fractures). We retrospectively analyzed 24,986 cervical spine CT examinations of emergency department patients over five years to determine the incidence and characteristics of OCFs, mechanism of injury, and associated intracranial and cervical spine injuries.

Methods and materials: The study was IRB-approved and HIPAA compliant. We retrospectively reviewed the CT brain and CT cervical spine reports performed from July 2018 to August 2023. Variables collected included age, sex, clinical presentation, coincident brain and cervical spine injuries, treatments, and OCF classifications.

Results: Sixty-three of 24,986 patients (0.25%) had OCFs, predominantly male (41 males, 22 females), with an average age of 51.1 years; 22/63 (34.9%) occurred in asymptomatic patients. Concurrent injuries included cervical spine fractures (33.3%) at C1 and C2 and intracranial injuries (47.6%), mostly subarachnoid and subdural hemorrhages. OCFs were categorized into Anderson-Montesano Type I (9 cases), Type II (24 cases), and Type III (30 cases), with unstable Type III fractures more common in MVC victims; stable fractures had higher rates of intracranial injuries. There were no significant differences in morbidity, mortality, or concurrent cervical spine or chest/abdominal/pelvic findings between stable and unstable OCFs.

Conclusion: The study highlights the importance of comprehensive imaging and evaluation in trauma cases to identify OCFs, even in asymptomatic patients, with a high rate of concurrent C1-2 and intracranial injuries.

Clinical relevance/application: Being aware of occipital condyle fractures, types, and complications is important in the emergency radiology evaluation of trauma patients, especially given high rates of C1-2 fractures and intracranial bleeds.

Objectives: To evaluate the predictive value of two radiological markers, the spot sign and leakage sign, for spontaneous intracranial hematoma expansion and their association with clinical outcomes, including neurological deterioration and in-hospital mortality.

Materials & methods: This prospective single-center study included 94 adult patients with spontaneous intraparenchymal hemorrhagic stroke, confirmed by non-enhanced CT (NECT) and contrast-enhanced CT (CECT) in the arterial phase. Hematoma volumes and spot/leakage signs were assessed using standardized imaging protocols and analyzed by two blinded neuroradiologists. Clinical and radiological data were evaluated using multivariate analyses, with survival outcomes compared via Kaplan-Meier curves. Statistical significance was set at p ≤ 0.05.

Results: Among 94 patients, hematoma expansion occurred in 42%, neurological deterioration in 15.5%, and mortality in 39.4%. The leakage sign was the strongest independent predictor of hematoma expansion (OR: 9.27, 95% CI: 2.95-29.20), neurological deterioration (OR: 26.67, 95% CI: 1.62-47.39), and mortality (OR: 7.56, 95% CI: 2.97-19.25). The spot and leakage signs demonstrated high specificity for predicting outcomes, with the leakage sign showing greater sensitivity for hematoma expansion. Patients with a positive leakage sign had significantly lower median survival (6 days) compared to those with a positive spot sign alone (54 days) or no signs (110 days, p < 0.001).

Conclusion: The leakage sign demonstrated greater sensitivity and comparable specificity to the spot sign for predicting hematoma expansion. Both signs were associated with neurological deterioration and in-hospital mortality, with the leakage sign showing a stronger predictive value.

Purpose: The aim of our study was to assess the frequency and detection rate of dental trauma and maxillofacial injuries (DTMI) in high-energy polytrauma patients undergoing total-body computed tomography (TBCT) and to estimate how often they are correctly reported by the radiologists.

Methods: This retrospective study included 611 patients who underwent TBCT following high-energy trauma between July 2024 and February 2025. DTMI findings were analyzed based on initial radiology reports and retrospective image review.

Results: DTMI was identified in 124 of 611 patients (20.2%), of which only 76 cases (61%) were reported at admission. Dental trauma was significantly underreported (76% missed rate), with only 12 of 50 cases (24%) initially recognized. In contrast, maxillofacial injuries were detected in 75 of 97 cases (77,3%). Most DTMI-positive patients (82/124, 66%) had additional traumatic findings, including cranial or spinal injuries (33/124, 26.6%) and multi-district trauma (29/124, 23.4%). Only 20 patients (16%) presented with isolated facial trauma. A small subgroup (18/124, 14.5%) had DTMI with no other traumatic findings, suggesting possible oversight in the absence of overt injury. Underreporting rates were slightly higher during night shifts (55%) compared to daytime (48%), though not statistically significant (χ² = 0.654, p > 0.05). DTMI was more common in males (ratio 1.79:1).

Conclusion: DTMI, especially dental trauma, is frequently underdiagnosed in the acute trauma setting. Improved detection may be achieved through dedicated imaging protocols, increased radiologists awareness, and AI-based support tools.

Massive haemoptysis is a medical emergency with high mortality if not promptly addressed. This pictorial essay aims to guide clinicians through the selection and execution of life-saving endovascular interventions tailored to the underlying vascular etiology. Emphasis is placed on clinical presentation, imaging clues, and procedural decision-making to enhance understanding among trainees and practicing radiologists. We present a curated series of cases of life-threatening haemoptysis managed with bronchial artery embolization (BAE), pulmonary artery embolization (PAE), embolization of acquired aortopulmonary collaterals (APCs), and thoracic endovascular aortic repair (TEVAR). Each case is dissected to highlight the clinical scenario, angiographic findings, interventional technique, and outcome. Endovascular management of haemoptysis should be guided by the underlying etiology and vascular anatomy. A structured approach to imaging interpretation, selective angiography, and tailored endovascular management can drastically reduce mortality. This educational overview bridges the gap between diagnosis and intervention, reinforcing practical decision-making in pulmonary vascular emergencies.

Purpose: Missed fractures are the primary cause of interpretation errors in emergency radiology, and artificial intelligence has recently shown great promise in radiograph interpretation. This study compared the diagnostic performance of two AI algorithms, BoneView and RBfracture, in detecting traumatic abnormalities (fractures and dislocations) in MSK radiographs.

Methods: AI algorithms analyzed 998 radiographs (585 normal, 413 abnormal), against the consensus of two MSK specialists. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and interobserver agreement (Cohen's Kappa) were calculated. 95% confidence intervals (CI) assessed robustness, and McNemar's tests compared sensitivity and specificity between the AI algorithms.

Results: BoneView demonstrated a sensitivity of 0.893 (95% CI: 0.860-0.920), specificity of 0.885 (95% CI: 0.857-0.909), PPV of 0.846, NPV of 0.922, and accuracy of 0.889. RBfracture demonstrated a sensitivity of 0.872 (95% CI: 0.836-0.901), specificity of 0.892 (95% CI: 0.865-0.915), PPV of 0.851, NPV of 0.908, and accuracy of 0.884. No statistically significant differences were found in sensitivity (p = 0.151) or specificity (p = 0.708). Kappa was 0.81 (95% CI: 0.77-0.84), indicating almost perfect agreement between the two AI algorithms. Performance was similar in adults and children. Both AI algorithms struggled more with subtle abnormalities, which constituted 66% and 70% of false negatives but only 20% and 18% of true positives for the two AI algorithms, respectively (p < 0.001).

Conclusions: BoneView and RBfracture exhibited high diagnostic performance and almost perfect agreement, with consistent results across adults and children, highlighting the potential of AI in emergency radiograph interpretation.

Purpose: The purpose of this retrospective study is to evaluate imaging features of sinonasal NK/T-cell lymphoma, potentially aiding early diagnosis and improving patient outcomes through timely biopsy evaluation and treatment.

Materials & methods: This study was designed as a retrospective review. Imaging characteristics in a total of 28 patients with histology confirmed sinonasal NK/T-cell lymphoma were evaluated by two radiologists. Demographic data and clinical features were extracted from the electronic medical record.

Results: Among 28 patients, 84.6% presented with nasal cavity involvement and 88.5% with an isoattenuating lesion on CT and 63.6% with T2 hypointensity on MRI. Notably, 57.7% showed osseous destruction and 27.3% had devascularized tissue, highlighting significant radiologic features that may overlap with non-neoplastic etiologies.

Conclusion: Sinonasal NK/T-cell lymphoma should be in the differential diagnosis in patients presenting with chronic sinonasal symptoms and imaging findings of tissue necrosis, osseous destruction, and adjacent fat infiltration. Imaging features overlap with entities such as aggressive fungal sinusitis and granulomatosis with polyangiitis.

Among radiologists, the scalp is a frequently overlooked region, and the literature offers little guidance regarding the imaging spectrum of scalp abnormalities in acute trauma. The severity of scalp abnormalities on imaging can be a harbinger of significant intracranial trauma. In this pictorial essay, we discuss a myriad of traumatic scalp lesions that are infrequently encountered on imaging.

Multi-energy detector spectral CT is a specialized form of dual-energy CT, an imaging technique that takes full advantage of the entire X-ray spectrum applied during CT scans, enabling superior differentiation of materials that may be indistinguishable on traditional CT. Contrary to source-based dual-energy CT, the benefits of detector-based spectral CT are always available with every scan, without needing to preemptively manually select dual source technique at the time of scanning. In cases of questionable findings on conventional CT images that require enhanced material differentiation, "spectral" data collected alongside CT images scanned utilizing this technique can be instantly analyzed to improve diagnostic confidence, without needing to re-scan the patient. While applicable to various patient populations and clinical scenarios, spectral CT is particularly useful for neuroradiology in the often fast-paced emergency department. The authors' facility uses the Philips Healthcare IQon Spectral CT in its own emergency department. This paper strives to briefly introduce some ways that spectral CT can be utilized to improve patient care in this setting.

Spontaneous hemoperitoneum (SH) is defined as the presence of blood within the peritoneal cavity from a non-traumatic origin. The absence of clinical suspicion and its low frequency render it a challenging diagnosis in the emergency setting. As it is a potentially life-threatening condition, radiologists play a fundamental role in the identification and location of the source of bleed, both essential to be able to deliver the best care possible for the patient. This review article aims to facilitate a practical approach to SH: We will begin by reviewing key imaging modalities of significant value for the detection and characterization of SH. Relevant anatomy and important CT signs to know will be mentioned. We will summarize the potential causes of SH in order of frequency, with a brief mention of differential diagnoses to consider. Finally, we will illustrate this review with a collection of cases from our hospital to showcase relevant diagnoses to consider when facing a patient with SH, focusing on key imaging elements that should not be overlooked.