Emergency Radiology最新文献

To compare the diagnostic accuracy and radiation doses of ultra-low-dose CT (ULD-CT) versus standard-dose CT (SD-CT) in patients with suspected limb joint fractures.

Methods: A systematic review and meta-analysis were conducted following 2020 PRISMA guidelines. Five databases (PubMed, Cochrane, Embase, Scopus, Web of Science) were screened for studies directly comparing ULD-CT to SD-CT diagnostic accuracy for limb joint fractures. Studies used 320-row detector CT scanners with ULD-CT protocols (80 kVp, 4-52 mAs) versus conventional protocols (120 kVp, 50-150 mAs). Bivariate random effects meta-analysis was used to pool sensitivity and specificity estimates. Dose-length product (DLP) reductions were compared directly.

Results: Four prospective studies comprising 674 patients met inclusion criteria. ULD-CT demonstrated pooled sensitivity of 97.6% and specificity of 99.6% (AUC 99.0%), while SD-CT showed sensitivity of 99.4% and specificity of 99.1% (AUC 98.9%). Subgroup analysis revealed no significant differences in sensitivity (p = 0.300) or specificity (p = 0.486). ULD-CT achieved radiation dose reductions of 87-99% across all anatomical regions.

Conclusions: ULD-CT offers significant radiation dose reduction with diagnostic accuracy comparable to SD-CT for limb joint fracture detection. Further multicenter studies are warranted to consolidate evidence across anatomical regions.

Teratomas fall under a broader category of germ cell tumors and can occur nearly in any organ in the body. They may present in an asymptomatic manner or with a sinister complication. Few of the common complications associated with teratomas include torsion, rupture, hemorrhage, secondary infection, and malignant transformation. This article reviews the characteristic imaging appearances of teratomas on different imaging modalities, focusing particularly on various emergency presentations of teratomas including uncommon but clinically relevant complications like autoimmune encephalitis, the importance of timely identification of these complications and current standard of care in a nutshell.

Non-thrombotic pulmonary embolism (NTPE) is a diverse and under recognized condition caused by various non-thrombotic emboli in the pulmonary artery circulation. The embolic agents, which may include biological, infectious, foreign, or particulate materials, originate from trauma, medical procedures, malignancies, infections, or foreign body migration. Due to its frequently nonspecific clinical manifestations and variable radiologic findings, NTPE presents a major diagnostic challenge. As NTPE can lead to severe complications, early recognition and accurate diagnosis are critical for appropriate management. By integrating recent literature, radiologic findings, and illustrative case examples, this review provides valuable insights into the diagnostic approach and imaging features of NTPE, contributing to improved awareness and clinical decision-making.

Traumatic pseudoaneurysms of the vertebrobasilar artery are rare and may occur without skull fractures. Standard CTA may miss or misinterpret these lesions due to technical limitations and low clinical suspicion, leading to significant diagnostic and medicolegal errors; We present two cases of fatal isolated traumatic subarachnoid hemorrhage (iTSAH), where optimized thin-slice CTA, identified pseudoaneurysms of the PICA and VA (V4 segment), confirmed by histopathology.

Purpose: Subarachnoid hemorrhage (SAH) due to a ruptured intracranial aneurysm is a neurologic emergency with diagnostic and management challenges. While traditional imaging techniques such as CT angiography and digital subtraction angiography remain essential, they may be inconclusive at identifying the culprit aneurysm when multiple aneurysms are present.

Methods/results: We present a patient with SAH and four intracranial aneurysms identified on initial CT angiogram. MR vessel wall imaging (VW-MRI) played a pivotal role: it revealed focal wall enhancement in the basilar tip aneurysm, guiding successful targeted balloon assisted coiling.

Conclusion: This case illustrates the value of VW-MRI in identifying ruptured aneurysms by assessing wall abnormality rather than just lumen morphology. VW-MRI employs high-resolution, black-blood MR techniques to visualize vessel wall pathology. Our findings support integrating VWI into acute management algorithms when conventional imaging is inconclusive, potentially improving diagnostic accuracy and outcomes in patients with complex aneurysmal SAH presentations.

Autologous breast reconstruction using donor-site flaps such as the deep inferior epigastric perforator (DIEP) flap, transverse rectus abdominis myocutaneous (TRAM) flap, latissimus dorsi flap, profunda artery perforator (PAP) flap, and autologous fat grafting is a cornerstone of post-mastectomy reconstruction, offering durable results and significant psychosocial benefits. Despite these advantages, donor site complications are common and can pose diagnostic challenges for radiologists. This pictorial review illustrates the spectrum of these complications, including seroma, hematoma, infection, fat necrosis, abdominal wall bulges and hernias, wound dehiscence focusing on their characteristic appearances across variety of modalities, primarily focused on computed tomography (CT), though also including radiography, ultrasound, and magnetic resonance imaging (MRI). By integrating surgical context with multimodality imaging features, this review provides practical guidance to distinguish expected postoperative changes from clinically significant complications, thereby improving diagnosis and facilitating early intervention for patients undergoing autologous breast reconstruction.

Background: Pediatric traumatic brain injury (TBI) accounts for a significant proportion of emergency department (ED) visits, with an estimated global incidence of up to 200 cases per 100,000 children each year. Despite clinical guidelines, imaging is often overused, particularly in mild cases, exposing children to unnecessary radiation. In Latin America, evidence regarding the appropriateness of imaging requests (AIR) and their diagnostic value remains scarce.

Objective: To assess the association between the AIR and final radiologic findings in traumatic brain injury, and to explore predictors through multivariable analysis.

Methods: This retrospective, multicentric, cross-sectional study included 719 neuroimaging studies (CT and skull radiography -SR-) performed in 2023 at two high-complexity private hospitals in Santiago, Chile. AIR was classified using the ACR Appropriateness Criteria® and the PECARN algorithm. Confirmatory findings included hemorrhages, skull fractures, and other traumatic lesions. Exploratory multivariable models were applied to evaluate factors associated with final diagnosis.

Results: Only 2.9% of imaging requests were deemed appropriate. Among CTs (n = 317), the adjusted probability of a confirmatory result was 48.0% (95% CI: 26.3-69.8) for appropriate requests versus 7.0% (95% CI: 4.1-9.9) for inappropriate ones, an absolute difference of 41 percentage points (p < 0.01). Inappropriate requests were associated with a 13-fold lower relative probability of identifying clinically relevant findings. All SRs were considered inappropriate and had a diagnostic yield of only 1%.

Conclusion: A significant gap exists between clinical practice and guideline-based imaging for pediatric TBI in Chile. Reinforcing validated decision tools may help optimize imaging use and minimize unnecessary radiation exposure.