Emergency Radiology最新文献

Purpose: Multicontrast ultrafast MRI brain is increasingly explored to triage acute intracranial emergencies. Since residents are at the forefront of emergency radiology in academic centers, it is critical to understand the suitability of ultrafast MRI for resident trainees. Further, structured radiology reportings have found foothold to communicate to the referring services and it will be beneficial to understand the capability of ultrafast MRI to facilitate such a structured reporting.

Methods: A retrospective analysis of 104 cases with multicontrast ultrafast MRI was performed in inpatient and emergency settings. Images were assessed independently by blinding to all charts by a second-year diagnostic radiology resident and a board-certified neuroradiology attending with over 20 years of experience. Fifteen anatomical variables were evaluated to emulate the structured reporting used in standard MRI brain studies. Clinical summary at discharge served as the reference standard to correlate the presence of acute intracranial emergency on ultrafast MRI.

Results: Inter-rater agreements for fifteen imaging variables ranged between 0.33 to 0.74 and Cohen's kappa of 0.92 (p < .001) to triage acute emergency. Percentage agreement for six anatomical landmarks ranged from 98 to 100%. The accuracy to distinguish acute from non-acute conditions was 96.2% for the resident and 99% for the experienced reviewer.

Conclusions: Multicontrast ultrafast MRI brain shows promise to triage acute intracranial emergencies with resident-level training. It can facilitate structured analysis of a majority of anatomical landmarks.

Purpose Our purpose is to highlight the importance of advanced imaging for evaluation of adrenal abscesses along with pathological findings, facilitating an accurate differential diagnosis for acute abdomen presentations. Methods We performed a retrospective review of the available literature on adrenal abscesses, acute abdomen presentations, and abdominal imaging modalities. We highlight the five documented cases of adrenal abscesses since January 2023. We also review two cases of adrenal abscesses from our institution that demonstrate their clinical relevance in patients presenting with abdominal masses. Results Adrenal abscesses are very rare in practice with few cases documented in the literature. They most frequently occur due to disseminated infection, presenting with acute abdominal pain, weight loss, lightheadedness, and fever. Their presentation on imaging is characterized by a large, multiloculated lesion with peripheral enhancement. Treatment options include antimicrobial agents, surgical intervention, and percutaneous abscess drainage. Conclusion Adrenal abscesses may closely mimic other malignant and benign adrenal and abdominal masses. Due to their extreme rarity, they are often not included in the differential diagnosis of large abdominal masses. However, these lesions should be considered in acute abdomen presentations, especially with history of infection, to facilitate accurate and timely diagnosis and management.

Background: Appropriate utilization of imaging in the emergency department (ED) remains an important determinant of health care expenditures and patient throughput. LLMs have demonstrated potential as clinical decision support tools, and may aid in cost-conscious imaging triage in the ED. We aim to evaluate the effectiveness of LLMs in providing accurate, cost-conscious imaging recommendations for ED patients with lower back pain.

Methods: 422 patients presented between December 2017 and June 2018 to the ED of a ~ 1000-bed major urban academic medical center with a chief complaint of lower back pain and received a lumbar spine MRI. The primary outcomes were Hoy et al. (Best Pract Res Clin Rheumatol 24(6):769-781, 2010) alignment of Generative Pre-Trained Transformer 4 (GPT-4)-generated imaging recommendations with ACR criteria, by raw accuracy and Cohen's κ, and Hoy et al. (Arthritis Rheum 64(6):2028-2037, 2012) professional service resource utilization quantified in work relative value units (wRVUs) under real-world clinical decisions, GPT-4 recommendations, and hypothetical 100% ACR adherence scenarios. GPT-4 was compared with real-world clinical decisions for imaging of lower back pain based on ED triage notes. Resource utilization was analyzed to assess potential savings from GPT-4 recommendations.

Results: GPT-4 model generated ACR-concordant recommendations for 72.0% (304/422) of cases and demonstrated significant alignment with ACR criteria as measured by Cohen's κ (0.42,95% CI: [0.35,0.48], p < 0.05). Actual resource utilization was 629 wRVUs. GPT-4 would have used 481.74 wRVUs. 100% adherence to the ACR criteria would have used 481.86 wRVUs.

Conclusions: Our results support LLMs as possible tools for cost-conscious radiologic decision making in ED back pain evaluation.

Pancreaticoduodenectomy, also known as the classic Whipple procedure, is the most common surgical treatment for pancreatic adenocarcinoma. Postoperative complications are common and occur in approximately 50% of patients. Prompt detection and management of these complications is vital for improving patient outcomes. As such, radiologists must be familiar with the expected postoperative anatomy in these patients and adept at leveraging optimal imaging techniques to detect complications. This pictorial essay will provide radiologists in all practice settings a systematic approach in the evaluation of the post-pancreaticoduodenectomy CT.

Background: In this study, we examined the potential role of V/Q scintigraphy in distinguishing acute PE (APE) from chronic PE (CPE).

Materials and methods: From 2020 to 2023, 36 patients diagnosed with APE and 24 patients diagnosed with CPE were included in the study. Location (segmental, subsegmental, lobar), number and appearance (wedge/patch) of mismatch perfusion defects on V/Q scintigraphy were recorded, and data were compared between the two groups.

Results: The number of mismatch segmental defects on V/Q scintigraphy was higher in the APE group (p = 0.042). The number of wedge-shaped defects was higher in the APE group (p = 0.003), while patchy defects were more common in the CPE group (p < 0.001). A negative correlation (p = 0.002) was observed between CPE and the number of wedges, whereas a positive correlation (p < 0.001) was found between CPE and the number of patches. Pulse oxygen saturation negatively correlated with the number of patches (p = 0.012). A negative correlation also existed between the number of mismatch segmental defects and CPE (p = 0.041). APE was indicated when the number of wedges was ≥1.5 (75% sensitivity,62% specificity, p = 0.03), while CPE was indicated when the number of patches was ≥0.5 (88% sensitivity, 61% specificity, p < 0.001). Patchy defects were found to be an independent risk factor for CPE (p = 0.008, OR: 2.1, 95% CI: 1.2-3.7).

Conclusion: Patchy defects serve as an independent risk factor for CPE and correlate with the severity of hypoxemia.

Background: Adnexal torsion diagnosis in children relies heavily on ultrasound, but existing literature lacks standardization of technique and handling of equivocal results.

Purpose: To assess the accuracy of transabdominal ultrasound (US) in diagnosing adnexal torsion in pediatric patients and evaluate optimal clinical decision-making for equivocal US reads.

Materials and methods: Retrospective review of pelvic US exams and surgical data for girls aged 1-18 years from 2015 to 2019 at a pediatric quaternary care hospital. US reports were coded as positive, negative, or equivocal for torsion. Surgical findings were used to confirm final diagnosis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated under various scenarios for handling equivocal reads.

Results: This study included 4,396 ultrasound exams from 3,707 patients (median age, 15.2 years [IQR: 12.8-16.8]). Ovarian visualization rate was 97-98%. US was read as positive for torsion in 1% of adnexae, negative in 95%, and equivocal in 4%. Among 179 surgical cases, torsion was present in 52%. Sensitivity of US for torsion was highest (86.0%) when equivocal cases were considered positive (EqP), but PPV was lowest (29.9%) under this condition. Area under the ROC curve was greatest (0.8651) when equivocal US were counted as positive. US reads were more likely to be true positive for isolated ovarian torsion compared to when tubal torsion was present (p = 0.003).

Conclusion: A standardized transabdominal US protocol yields high ovarian visualization rates, and treating equivocal reads as positive can optimize diagnostic accuracy when combined with clinical decision-making. US maybe be less accurate in detecting tubal torsion compared to isolated ovarian torsion, but this finding should be interpreted with caution given the small sample size. Overall, these results provide clinically relevant insights to guide management and future research in pediatric adnexal torsion.

Purpose: To understand the afterhours radiology workforce and views towards imaging volumes, compensation, overnight challenges, and work-from-home.  METHODS: Survey questions focusing on the afterhours radiology workforce were created. The survey was administered by the American College of Radiology (ACR) and the data analysis performed by the ACR in partnership with an independent market research agency. The confidence level was set at 95%, with an error rate of +/- 2.2%.  RESULTS: A total of 1109 out of 1844 (60.1%) survey participants responded to the afterhours survey. A majority of respondents (56%) had worked an afterhours shift while a minority had worked a late-evening (18%) or overnight shift (13%). Irrespective of practice type, the majority of radiologists thought afterhours volumes were not manageable, and afterhours compensation was not equitable. Less than half of those who worked overnight shifts believed they were given adequate compensatory time-off for recovery. The majority of respondents supported work-from-home for afterhours shifts.

Conclusions: As the largest survey to date on after-hours radiology, these findings should be carefully considered by practices aiming to successfully recruit and retain radiologists in this critical niche.

Orthopedic surgery is the most common intervention performed on the lower limb. Although rare (0.005-0.5%), the incidence of iatrogenic arterial injuries is increasing due to the rising use of prosthetic implants and broader surgical indications in aging populations. Imaging findings are diverse and include hemorrhage, pseudoaneurysm, hemarthrosis, endomedullary bleeding, retraction-induced microvascular injury, stenosis, and occlusion. However, evaluation is often complicated by artifacts from metallic hardware. This pictorial review illustrates the radiological spectrum of these injuries, offers practical tips to optimize imaging quality, and proposes a structured algorithm to guide timely and effective diagnosis and management.