Emergency Radiology最新文献

Purpose: To evaluate the diagnostic utility of bile duct attenuation measured on contrast-enhanced computed tomography (CT) in differentiating choledocholithiasis, malignant biliary obstruction, benign biliary obstruction, and cholangitis.

Methods: This retrospective study included 208 patients who underwent contrast-enhanced abdominal CT followed by endoscopic retrograde cholangiopancreatography (ERCP) within three days. Intraductal bile attenuation was measured using two region of interest (ROI) techniques (elliptical and 4-point), with all measurements obtained strictly from bile-filled ductal segments. Secondary morphologic features were also assessed. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis, and multivariate logistic regression identified independent predictors of malignancy.

Results: Mean attenuation values were significantly higher in malignant obstruction and choledocholithiasis than in benign biliary obstruction and cholangitis (p < 0.001). For malignant obstruction, the 4-point method yielded 96% sensitivity and 81% specificity at a cut-off of ≥ 29 HU (AUC: 0.97), while the elliptical method yielded 100% sensitivity and 80% specificity at ≥ 60 HU (AUC: 0.95). Elliptical ROI attenuation and bile duct wall thickness were independent predictors of malignancy (p = 0.010 and p < 0.001, respectively). Interobserver agreement was excellent for both techniques (ICC > 0.89).

Conclusion: When measured strictly within bile-filled ductal segments, CT-based attenuation provides useful quantitative information for differentiating common causes of biliary obstruction. Combined with ductal wall thickness and secondary morphologic features, attenuation analysis may enhance the diagnostic value of routine contrast-enhanced CT, particularly in settings where advanced imaging modalities are limited or delayed.

Purpose: To assess the appropriateness of emergency department (ED) on-call medical imaging requests and the corresponding radiology reports.

Methods: Two researchers reviewed all CT, MRI, and ultrasound scans ordered from January 1 to December 31, 2022 by ED physicians during on-call hours at a major Canadian hospital network (estimated 2.5 million catchment population). Scan indications were evaluated for: (1) containing any clinical history and (2) providing a clinical question and/or specific differential diagnosis. Radiology report impressions were categorized as either: (1) normal (including chronic and/or stable findings); (2) positive for the clinical question and/or differential diagnosis provided; (3) positive for a condition that could reasonably explain the provided clinical history/question; or (4) only containing incidental findings unrelated to the indication. Inter-rater reliability for the scoring was assessed with the κ statistic.

Results: Among 85,066 scans ordered during ED encounters in 2022, 18,201 met inclusion criteria including 248 (1.4%) MRI, 3587 (19.7%) US, and 14,366 (78.9%) CT scans. Most requests (74.2%) provided clinical history and a differential diagnosis; a minority provided only clinical history (15.0%) or only a clinical question/differential diagnosis (10.7%). Most imaging studies contained only normal or chronic findings (62.0%). Approximately 12.5% of studies were positive for the specified differential diagnosis, 4.1% were positive for a condition that could reasonably explain the provided clinical history/question, and 21.3% identified unrelated incidental findings.

Conclusion: The high percentage of negative scans may be an unavoidable consequence of modern medicine's growing dependence on imaging. However, ensuring that imaging tests are appropriately ordered and automating routine steps of the image acquisition workflow may mitigate strains on radiology departments.

Background: Traumatic brain injury (TBI) is a global health challenge associated with high morbidity and mortality. Non-contrast computed tomography (NCCT) remains the first-line imaging modality due to its accessibility and speed, yet its diagnostic and prognostic utility across diverse populations remains underexplored.

Purpose: To systematically evaluate and quantify the diagnostic accuracy and prognostic value of NCCT in acute TBI patients worldwide.

Evidence acquisition: Following PRISMA 2020 guidelines, a systematic literature search was conducted in PubMed, Embase, Cochrane Library, and Scopus up to April 2025. Studies assessing the diagnostic or prognostic performance of NCCT in acute TBI were included. QUADAS-2 was used for quality assessment. Meta-analyses were performed using random-effects models.

Evidence synthesis: Out of 2,132 articles screened, 41 studies met inclusion criteria, encompassing over 76,000 patients. The pooled sensitivity and specificity for NCCT detecting intracranial hemorrhage were 0.92 (95% CI: 0.89-0.95) and 0.87 (95% CI: 0.82-0.91), respectively. Prognostically, features like midline shift > 5 mm and compressed basal cisterns showed a significant association with in-hospital mortality (OR: 3.6, 95% CI: 2.4-5.1). Subgroup analyses by age, GCS, and scan timing confirmed robust diagnostic consistency.

Conclusion: NCCT demonstrates high diagnostic accuracy in detecting intracranial hemorrhage and offers substantial prognostic insights in acute TBI. It remains a cornerstone imaging tool, particularly valuable in time-sensitive emergency settings.

Clinical impact: NCCT should be prioritized in emergency protocols for early diagnosis and risk stratification in TBI, particularly in resource-constrained environments lacking advanced neuroimaging.

The growing demand for after-hours imaging and rapid turnaround times-particularly for trauma and acute care patients- as well as institutional moves toward requiring finalized attending reports overnight, has intensified reliance on emergency radiologists, leading to increased workloads, shift-related fatigue, and rising burnout rates. This review examines the multifaceted challenges faced by emergency radiologists, including disrupted circadian rhythms, cognitive decline, professional isolation, unpredictable spikes in imaging volume, and physical and psychological health risks. Additional concerns such as gender disparities, medico-legal pressures, and limited opportunities for career advancement further exacerbate these issues. The paper highlights both personal coping strategies and institutional reforms-such as optimized scheduling, improved staffing models, and wellness initiatives-aimed at enhancing job satisfaction, supporting long-term career sustainability, and ensuring high-quality patient care in emergency radiology.

Systemic vasculitides are rare, multi-organ inflammatory disorders involving blood vessels, classified by the size of the affected vessels. When abdominal arteries are involved, diagnosis becomes particularly challenging due to nonspecific symptoms such as fever, fatigue, and abdominal pain, which can mimic other acute conditions and hinder identification in emergency settings. Examples include Takayasu arteritis (large vessels), polyarteritis nodosa (medium vessels), and lupus-associated or drug-induced vasculitis (small vessels), each exhibiting distinct imaging features. Imaging techniques, particularly contrast-enhanced computed tomography (CECT) and computed tomography angiography (CTA), are vital for evaluating acute presentations and identifying characteristic abnormalities. Part 1 of this pictorial essay presents illustrative cases of abdominal vasculitis, incorporating advanced imaging modalities such as CECT, CTA, 3D volume rendering, and 3D cinematic rendering to emphasize key diagnostic features. Early recognition of these imaging findings by radiologists is crucial to ensure accurate diagnosis, guide appropriate treatment, and assess the need for surgical intervention. By enhancing awareness and understanding of these rare vascular pathologies, this review aims to facilitate timely diagnosis, improve clinical decision-making, and optimize patient outcomes.

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.