Emergency Radiology最新文献

Acute manifestations of sickle cell disease (SCD) are numerous and multisystemic. Cerebral fat embolism (CFE) is a rare but serious complication of SCD caused by bone marrow necrosis (BMN) during vaso-occlusive crises (VOC). We present the case of a 41-year-old man with SCD who developed severe VOC and multi-organ dysfunction. He subsequently experienced neurological deterioration with decreased consciousness and diffuse encephalopathy on serial electroencephalograms. Bone marrow aspiration confirmed BMN. Brain MRI revealed extensive diffuse leukoencephalopathy, vasogenic and cytotoxic edema in the white matter, patchy edema in the cranial vault bone marrow on fat-suppressed FLAIR sequence (a finding consistent with the confirmed BMN), and multiple cerebral microbleeds on susceptibility-weighted imaging consistent with CFE. The management of acute neurological complications of SCD varies depending on the specific complication. Brain MRI plays a crucial role in the accurate diagnosis of these complications to guide appropriate treatment.

Purpose: To evaluate the rate of missed scaphoid fractures on follow-up computed tomography (CT) for suspected occult scaphoid fracture after normal radiography with residual radial-sided wrist pain.

Methods: In a retrospective analysis, wrist CT during a five-year period was analyzed. The CT examinations and radiological reports were re-evaluated. Available clinical findings and radiologic follow-up performed during a period of a minimum of three years served as outcome reference.

Results: In total, 178 examinations had been performed on 174 patients for suspect scaphoid fracture, 67 men and 107 women, showing 15 and 6 scaphoid fractures, respectively; a statistically significant sex difference (p = 0.0024). In 157 examinations, no scaphoid fracture was detected on CT, instead 29 other wrist or carpal bone fractures were found. On follow-up, no missed scaphoid fractures were found. Before CT, 124 of the 157 patients had been treated with a cast. After CT, 35 patients continued with cast treatment for a median of 14 days.

Conclusions: CT appears to be a reliable method for evaluating suspect scaphoid fracture as part of a diagnosis-treatment regimen including pain immobilization with a plaster cast.

Purpose: For acute stroke patients requiring MR examination and unable to provide a reliable history, screening for potentially MRI-incompatible objects (PMIOs) typically necessitates the use of plain-film radiographs (PFRs). However, using a whole body CT scout at the time of non-contrast head CT scans can preclude critical delays. Here, we aim to compare the effectiveness of PFRs and CT scouts in detecting PMIOs.

Methods: A case-control study was conducted at a tertiary care institution, involving 408 imaging studies from 200 patients, half of which contained PMIOs. The diagnostic performances of CT scouts and PFRs were evaluated by six blinded readers, including two board-certified neuroradiologists, one neuroradiology fellow, and three radiology residents.

Results: 2448 interpretations from the 6 readers were analyzed. The diagnostic performance of combined CT scout images (full-body and regional) was not significantly different from that of PFRs for all six readers (p = 0.06). However, PFRs outperformed full-body CT scouts in PMIO detection (p = 0.01), with no significant differences observed between PFRs and regional CT scouts (p = 0.4). Notably, the diagnostic accuracy of the radiology residents was found to be equivalent to radiologists across all imaging techniques.

Conclusion: Integrating CT scouts in acute stroke protocols may help expedite MRI screening. The scouts should include the head, neck, chest, upper arms, abdomen, pelvis, and thighs. Including radiology residents in the screening process for PMIOs may be an avenue for resource optimization in acute care settings.

Purpose: Tibial plateau fractures are relatively common and require accurate diagnosis. Chat Generative Pre-Trained Transformer (ChatGPT) has emerged as a tool to improve medical diagnosis. This study aims to investigate the accuracy of this tool in diagnosing tibial plateau fractures.

Methods: A secondary analysis was performed on 111 knee radiographs from emergency department patients, with 29 confirmed fractures by computed tomography (CT) imaging. The X-rays were reviewed by a board-certified emergency physician (EP) and radiologist and then analyzed by ChatGPT-4 and ChatGPT-4o. The diagnostic performances were compared using the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and likelihood ratios were also calculated.

Results: The results indicated a sensitivity and negative likelihood ratio of 58.6% (95% CI: 38.9 - 76.4%) and 0.4 (95% CI: 0.3-0.7) for the EP, 72.4% (95% CI: 52.7 - 87.2%) and 0.3 (95% CI: 0.2-0.6) for the radiologist, 27.5% (95% CI: 12.7 - 47.2%) and 0.7 (95% CI: 0.6-0.9) for ChatGPT-4, and 55.1% (95% CI: 35.6 - 73.5%) and 0.4 (95% CI: 0.3-0.7) for ChatGPT4o. The specificity and positive likelihood ratio were 85.3% (95% CI: 75.8 - 92.2%) and 4.0 (95% CI: 2.1-7.3) for the EP, 76.8% (95% CI: 66.2 - 85.4%) and 3.1 (95% CI: 1.9-4.9) for the radiologist, 95.1% (95% CI: 87.9 - 98.6%) and 5.6 (95% CI: 1.8-17.3) for ChatGPT-4, and 93.9% (95% CI: 86.3 - 97.9%) and 9.0 (95% CI: 3.6-22.4) for ChatGPT4o. The area under the receiver operating characteristic curve (AUC) was 0.72 (95% CI: 0.6-0.8) for the EP, 0.75 (95% CI: 0.6-0.8) for the radiologist, 0.61 (95% CI: 0.4-0.7) for ChatGPT-4, and 0.74 (95% CI: 0.6-0.8) for ChatGPT4-o. The EP and radiologist significantly outperformed ChatGPT-4 (P value = 0.02 and 0.01, respectively), whereas there was no significant difference between the EP, ChatGPT-4o, and radiologist.

Conclusion: ChatGPT-4o matched the physicians' performance and also had the highest specificity. Similar to the physicians, ChatGPT chatbots were not suitable for ruling out the fracture.

Background and aim: The potential intricacy of skull fractures as well as the complexity of underlying anatomy poses diagnostic hurdles for radiologists evaluating computed tomography (CT) scans. The necessity for automated diagnostic tools has been brought to light by the shortage of radiologists and the growing demand for rapid and accurate fracture diagnosis. Convolutional Neural Networks (CNNs) are a potential new class of medical imaging technologies that use deep learning (DL) to improve diagnosis accuracy. The objective of this systematic review and meta-analysis is to assess how well CNN models diagnose skull fractures on CT images.

Methods: PubMed, Scopus, and Web of Science were searched for studies published before February 2024 that used CNN models to detect skull fractures on CT scans. Meta-analyses were conducted for area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. Egger's and Begg's tests were used to assess publication bias.

Results: Meta-analysis was performed for 11 studies with 20,798 patients. Pooled average AUC for implementing pre-training for transfer learning in CNN models within their training model's architecture was 0.96 ± 0.02. The pooled averages of the studies' sensitivity and specificity were 1.0 and 0.93, respectively. The accuracy was obtained 0.92 ± 0.04. Studies showed heterogeneity, which was explained by differences in model topologies, training models, and validation techniques. There was no significant publication bias detected.

Conclusion: CNN models perform well in identifying skull fractures on CT scans. Although there is considerable heterogeneity and possibly publication bias, the results suggest that CNNs have the potential to improve diagnostic accuracy in the imaging of acute skull trauma. To further enhance these models' practical applicability, future studies could concentrate on the utility of DL models in prospective clinical trials.

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.

Purpose: Accurate placement of medical devices is crucial in critical care to prevent severe complications. This study aims to evaluate radiology residents' proficiency in identifying four specific critical misplacements of medical devices using the Wisdom in Diagnostic Imaging Simulation (WIDI SIM).

Methods: A retrospective analysis was conducted on 1,102 responses from radiology residents who participated in the WIDI SIM between 2010 and 2022. The majority were first- and second-year residents from multiple institutions. The simulation presented four specific cases featuring misplacements of an endotracheal tube in the esophagus, an intrauterine device embedded in the myometrium, a peripherally inserted central catheter in the right internal jugular vein, and an umbilical venous catheter in the splenic vein. Residents provided free-text interpretations scored on a 0-10 scale by subspecialty radiologists. Errors were categorized as observational (failure to identify misplacement) or interpretive (misinterpretation of identified misplacement). Statistical analyses were performed using Kruskal-Wallis and Dunn's multiple comparisons tests.

Results: Across all cases, residents' average scores did not meet the acceptable standard of 7 points. Observational errors were predominant, indicating a failure to recognize these specific device misplacements. Effective report rates were low: 58% for the endotracheal tube case, 35% for the intrauterine device, 19% for the peripherally inserted central catheter, and 25% for the umbilical venous catheter. Significant performance improvements were observed between first- and second-year residents in three of the four cases (p-values ranging from < 0.0001 to 0.0238), but overall proficiency remained suboptimal even among senior residents.

Conclusion: This study reveals gaps in radiology residents' ability to identify these specific misplaced lines, tubes, and devices accurately. The consistent pattern of underperformance, primarily due to observational errors, suggests a need for targeted educational interventions to improve resident proficiency in this aspect of emergency radiology.

Background: Diagnosis of child abuse in children evaluated for a blunt abdominal trauma can be challenging due to overlapping types of injuries.

Objective: Identify clinical characteristics and CT findings that differentiate children evaluated for accidental abdominal trauma (AcAT) and abusive abdominal trauma (AbAT).

Materials and methods: Retrospective (1/2010 to 6/2024) study on children < 3 years-old who had an abdominal CT scan for AcAT or AbAT. Demographic, clinical, and imaging variables were compared between CT-positive child abuse, and accidental trauma.

Results: Abdominal CT positive for trauma was found in 26.5% (82/309) children that were evaluated for AAT and in 28.8% (42/146) for AcAT. Children with positive CT for AbAT were significantly younger (average age 0.9 ± 0.9 versus 1.8 ± 0.9 years), and most (70.7%) were younger than one year old. Most children evaluated for AbAT with positive CT (70.7%) had an unknown cause of injury. The most common mechanism provided for abused children was low height fall (18/82, 22.0%) as compared with no low height fall in accidental trauma (p < 0.001). Rib fractures were identified on CT in 5049/82 children (61.059.8%) evaluated for AbAT as compared with 4/42 (9.5%) in children evaluated for AcAT (p < 0.001).

Conclusion: In children evaluated for blunt abdominal trauma, presence of rib fractures should alert radiologists to the possibility of child abuse. Abused children were mostly younger than one year, with an unknown mechanism of injury or a fall from a low height.

Purpose: This study aimed to identify the radiological CT findings that are significantly correlated with the outcome of conservative management with oral water-soluble contrast medium in patients presenting with Adhesive Small Bowel Obstruction (ASBO) to the Emergency Room.

Methods: In this retrospective single-center study, we considered all consecutive patients admitted to the ER from February 2019 to February 2023 for ASBO with an available contrast-enhanced CT scan performed at diagnosis and treated with conservative management. The investigated CT findings were type and location of transition zone, ASBO degree, fat notch sign, beak sign, small bowel feces sign, presence of peritoneal free fluid and pneumatosis intestinalis. Radiological parameters were analyzed using univariable and multivariable logistic regression to test the significant association between the CT parameters and the target.

Results: Among the 106 included patients (median age 74.5 years), conservative treatment was effective in 59 (55.7%) and failed in 47 (44.3%), needing delayed surgery. In the failure group, there was a higher prevalence of patients who had previous ASBO episodes (p = 0.03), a greater proportion of females (p = 0.04) and a longer hospital stay (p < 0.001). At multivariable analysis, two CT findings were significantly correlated with failure of conservative treatment: fat notch sign (OR = 2.95; p = 0.04) and beak sign (OR = 3.42; p = 0.04).

Conclusions: Two radiological signs correlate with failure of non-operative management in ASBO, suggesting their importance in surgical decision-making. Patients presenting with these signs are at higher risk of unsuccessful conservative treatment and may require undelayed surgical intervention.