Emergency Radiology最新文献

Purpose: To determine if there is a comparative measurement on bilateral sunrise view radiographs that can help predict acute transient patellar dislocation (ATPD).

Methods: A retrospective chart review from a single institution was conducted of two patient groups, a case group with ATPD diagnosed by MRI, and a control group with knee injury not involving the patella or medial retinaculum. Three readers blinded to the MRI diagnosis reviewed the sunrise view radiographs and reported three values for both knees: (1) medial trochlea - medial patella distance (MT-MP); (2) lateral trochlea -medial patella distance (LT-MP); and (3) medial patellofemoral angle (MPFA), (Image 2). Diagnostic accuracy was assessed utilizing empirical ROC curves and their corresponding area under the curves (AUC). Inter-reader reliability was determined using intraclass correlation coefficients (ICC). Sensitivity and specificity were calculated for varying differences in MPFA and MT-MP between affected knee and unaffected knee.

Results: Of the three measurements, increased MPFA measured on the injured knee was the most accurate predictor of ATPD with substantial inter-reader reliability (AUC 0.765, ICC 0.681). MT-MP (AUC 0.707, ICC 0.586) and LT-MP (AUC 0.593, 0.189) distances were less accurate and less reliable predictors. Asymmetric difference in the MPFA or MT-MP between affected knee and unaffected knee was a very specific, albeit not sensitive indicator of ATPD.

Conclusion: Comparative sunrise view knee radiographs can help predict the diagnosis of ATPD with high specificity, prompting early MRI evaluation for definitive diagnosis, helping expedite treatment planning.

Objective: Globe rupture presents a diagnostic challenge because of potentially vision-threatening outcomes. Although computed tomography (CT) is critical for assessment, a structured interpretation approach is often lacking. This study introduces the novel "FLAP CONE" mnemonic to assist radiologists in evaluating globe rupture.

Methods: This was a retrospective study of 143 patients (151 eyes) with suspected globe rupture between January 2015 and December 2020. The male-to-female ratio was 3:1, with a median age of 22 years. Demographics and mechanisms of injury were recorded. CT scans were independently reviewed by two radiologists using the FLAP CONE mnemonic, encompassing Fractures/Foreign bodies, scleral Lacerations/Lens abnormalities, Anterior chamber changes, Posterior segment abnormalities, eye Contour distortion, Orbital apex hematoma, Neurovascular bundle abnormalities, and Extraocular muscles (EOM)/Emphysema. Findings were documented as binary variables. The diagnostic accuracy, sensitivity, specificity, and interobserver agreement (κ) were calculated.

Results: Sharp objects (39%) and falls (25%) were the leading causes of penetrating and blunt trauma, respectively. Use of the mnemonic achieved 91.9% diagnostic accuracy, with 88.3% sensitivity and 98.5% specificity. Orbital emphysema (43%) was the most frequent finding. Postseptal foreign body and the "flat tire" sign were associated with the highest diagnostic performance (sensitivity of 100% and 97.2%, respectively; specificity, 100%; and PPV, 100%). Kappa values ranged from 0.15 (orbital apex hematoma) to 1.0 (postseptal foreign body), with an overall κ = 0.85. Four clinically confirmed ruptures were missed because of subtle scleral defects and the presence of intraocular gas.

Conclusion: The FLAP CONE mnemonic demonstrates excellent diagnostic accuracy and interobserver reliability, providing a systematic and efficient approach to the CT evaluation of globe rupture.

Primary small bowel malignancies are rare, often presenting with nonspecific symptoms or as acute emergencies, which can delay diagnosis. Contrast-enhanced CT is the primary imaging modality in the emergency setting, but detection and characterization of small bowel tumors remain challenging. Cinematic rendering (CR) is a recently developed three-dimensional post-processing technique that produces photorealistic images from CT data, enhancing visualization of small bowel pathology. This pictorial review outlines the CT imaging features of major small bowel malignancies, including adenocarcinoma, carcinoid tumor, gastrointestinal stromal tumor, lymphoma, and sarcoma, and describes features that highlight the utility of CR in augmenting traditional imaging. CR offers improved visualization of mucosal abnormalities, tumor extent, vascular involvement, and textural differences, potentially increasing diagnostic confidence, supporting presurgical planning, and facilitating communication among clinicians and patients. By emphasizing the added value of CR, we aim to provide radiologists with practical guidance for identifying small bowel neoplasms and suggest that integrating advanced 3D visualization into routine CT evaluation can support timely diagnosis and management in acute care settings.

Medical imaging plays a central role in the management of trauma patients. Analytic morphomics (AM) through enabling measurement of specific biological markers of body composition from medical images is emerging as a potential tool to predict patient outcomes across multiple medical and surgical disciplines. We sought to provide a comprehensive review of the utility of AM in predicting outcomes in trauma patients. A systematic review with a narrative synthesis was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines and checklists. PubMed, Embase, Scopus, The Cochrane Library as well as Web of Science and Trip database were searched for studies that assessed the relationship between computed tomography-based AM parameters and clinical outcomes in patients from a trauma cohort. Multiple AM domains, including lumbar muscle quantity and quality, adiposity, craniofacial measurements, and opportunistic bone mineral density (BMD), were consistently associated with adverse outcomes including mortality, length of stay, complications, and functional recovery. CT-derived AM metrics provide valuable prognostic information in trauma populations, extending beyond conventional measures such as chronological age and injury severity scores.Registration: PROSPERO Registration ID: CRD420251112652.

Purpose: Intracranial dermoid cysts are rare, benign congenital lesions that can rupture spontaneously, leading to dissemination of fatty contents within the subarachnoid or ventricular spaces. Though often asymptomatic, rupture can produce a range of neurological symptoms and distinct imaging features. We aim to evaluate the clinical presentation, imaging characteristics, and outcomes of patients with ruptured intracranial dermoid cysts.

Methods: We conducted a retrospective review of patients diagnosed with ruptured intracranial dermoid cysts at a tertiary academic medical center from July 1997 to July 2024. Rupture was confirmed by the presence of fat droplets in the CSF spaces on CT and/or MRI. Imaging findings were independently reviewed by two radiologists.

Results: Twenty-two patients (14 female, 8 male; mean age 51.7 years) met inclusion criteria. The most common presenting symptoms were headaches (31.8%). Imaging revealed intraventricular fat in 72.7% of cases and subarachnoid fat in 81.8%, with visible primary cysts in 31.8%. MRI findings included T1 hyperintense fat droplets in all cases, hypointense rims on T2 in 35% of cases, and susceptibility signal loss on SWI in 71%. Follow-up imaging (available in 14 cases) did not show complete resolution of fat droplets, though a reduction in the number of droplets was observed over time.

Conclusion: Ruptured intracranial dermoid cysts are rare but recognizable by their characteristic imaging features, particularly on T1-weighted MRI. While symptoms often improve, residual fat globules persist for years.