Emergency Radiology最新文献

Purpose: To quantify the diagnostic yield of neuroimaging in adult emergency department (ED) patients presenting with vertigo, and to identify clinical predictors of acute central pathology that can inform imaging decisions.

Methods: This retrospective study reviewed all neuroimaging examinations performed for vertigo at 14 EDs within our health network between May 2016 and January 2025. Adult ED patients (n=4,135; mean age 62.5 years; 62% female) who underwent imaging (n=5,445 exams, approximately 89% CT and 11% MR) were included. Imaging exams with potentially clinically relevant findings were flagged for further review (n=291 exams and patients); these patients were separated into four separate groups based on their imaging findings: 1) acute actionable contributory to vertigo, 2) acute actionable non-contributory to vertigo, 3) non-acute actionable, or 4) non-actionable. Vertigo quality (constant, intermittent/resolved spontaneously, no vertigo), acuity, neurological examination (including cerebellar signs and the Head-Impulse, Nystagmus, and Test-of-Skew [HINTS] exam), and intervention rates were analyzed within these subgroups using Fisher's exact and chi-square tests.

Results: Of 5,445 exams, 291 (5.3%) were flagged with potentially relevant imaging findings. Of these exams, only 115 (2.1%) yielded actionable findings, and just 65 (1.2%) revealed acute central causes contributing to vertigo. In patients with positive imaging findings, constant vertigo was strongly associated with acute contributory pathology (98.5% in this group vs. 6.0% in other groups, p<0.0001). Acute onset was more frequent in acute contributory cases (63.1% vs. 40.8%, p=0.0006), as were abnormal HINTS or cerebellar signs (44.6% vs. 6.0%, p<0.0001). Most patients with acute contributory findings received specialty consultations resulting in intervention (95.4%). Intermittent or resolved vertigo was commonly seen in patients with benign peripheral diagnoses.

Conclusion: Neuroimaging frequently yields normal results in ED vertigo cases; acute actionable central findings deemed contributory to vertigo are rare. Only approximately 2% of patients had acute actionable imaging findings and only 1.3% had a stroke. In patients with acute actionable imaging findings, clinical features-especially constant vertigo, acute onset, and abnormal neurological exam-are strongly associated with central causes and should guide selective imaging in the ED.

Background: Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Current risk stratification tools have limitations in predicting short-term outcomes. Radiological parameters such as thrombus density, measured in Hounsfield Units (HU) on computed tomography pulmonary angiography (CTPA), may provide additional prognostic information.

Objective: This study aims to assess the association between pulmonary artery thrombus density on CTPA and 30-day mortality in patients with intermediate-risk PE.

Methods: This retrospective cohort study included patients diagnosed with acute PE by contrast-enhanced CTPA in the emergency department of a single tertiary center between January 1, 2022, and December 31, 2024. Only patients classified as intermediate-risk according to European Society of Cardiology guidelines were included. HU values were measured from predefined pulmonary artery locations. The primary outcome was 30-day all-cause mortality. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed to identify independent predictors and assess discriminative ability.

Results: A total of 121 patients (mean age: 70 ± 14.5 years; 58.5% male) were analyzed. The 30-day mortality rate was 26.4%. Thrombus HU values were significantly higher in deceased patients compared to survivors (median 76 vs. 56, p = 0.001). In multivariate analysis, HU value (OR: 1.03; 95% CI: 1.001-1.06; p = 0.04) and sPESI score (OR: 1.70; 95% CI: 1.04-2.78; p = 0.03) were independent predictors. AUCs were 0.702 for HU and 0.731 for sPESI.

Conclusions: Thrombus density on CTPA was independently associated with 30-day mortality in intermediate-risk PE. HU measurement may serve as a practical imaging biomarker for early prognostic assessment.

Purpose: Several prior international studies have examined radiology resident reporting discrepancy rates, with a range of 1-10% quoted. Limited data exists specifically for the after-hours setting, where residents are often staffed at training institutions and report most, or all, studies. Our aims are to determine after-hours resident CT report discrepancy rates at our institution, determine the clinical significance of discrepancies, and assess factors affecting resident performance.

Methods: A retrospective review of 2000 after-hours resident CT reports (April through July 2022) was conducted. Preliminary resident reports were compared to attending radiologist finalised reports, with discrepancies categorized into 15 sub-categories; including those that were minor, major and clinically significant. Patient electronic medical records (EMR) were reviewed to assess clinical significance. Statistical analyses were performed using XLStat.

Results: The overall resident CT report discrepancy rate was 44.3% (885/2000), with most discrepancies considered minor changes (67.8%). The rate of major discrepancies was 19.9% (398/2000), while the rate of clinically significant discrepancies was 2.45% (49/2000). The most common major discrepancies included diagnostic misses (16.9%) and overcalls (5.7%). Discrepancies were highest among 2nd-year residents. Significant differences were observed when comparing 2nd- vs. 3rd-year residents (48.1% vs. 39.3%, p < 0.001), early evening vs. overnight shifts (49.5% vs. 38.5%, p < 0.001), and weekdays vs. weekends (49% vs. 38.2%, p < 0.001). No significant differences were found between major or clinically significant discrepancies.

Conclusions: Most resident after-hours CT discrepancies are minor. Our institution demonstrates a low rate of clinically significant discrepancies, which is at the lower end of rates quoted in prior studies. Our findings support high resident performance and reinforce the effectiveness of our current after-hours model in reducing the clinical impact of resident reporting errors.

Purpose: Older adult self-neglect, the inability to perform essential self-care, is an emerging public health problem. We aimed to evaluate imaging utilization and outcomes of patients with self-neglect compared to matched controls.

Methods: This IRB-approved retrospective study, conducted at two major academic medical centers, utilized the enterprise data warehouse to identify patients of > 60 years receiving a self-neglect mandate in the emergency department (ED) during 2019. Our study cohort consisted of 108 cases and 108 matched controls by age, gender, race, and time of ED presentation.

Results: During the index visit, cases had significantly higher imaging utilization (p < 0.001). Revisit and readmission rates over the 5-year study period were significantly higher among cases (526 versus 290 revisits (p < 0.001) and 254 versus 88 readmissions (p < 0.001)), with increased imaging utilization on follow-up for CT (p < 0.0001), X-ray (p < 0.0001), US (p < 0.0001), and MRI (p = 0.003). There were 44 deaths among cases versus 7 among controls. Subgroup analysis revealed that noncompliant cases had significantly higher CT use and an elevated mortality risk over the 5-year study period (both p = 0.02). Significantly higher number of cases lived alone (p < 0.001), had a higher substance use (p = 0.044), and had a higher prevalence of psychiatric illness (p < 0.001).

Conclusions: Older adult self-neglect patients experience increased ED revisits/readmissions and use more imaging services yet exhibit poorer clinical outcomes, particularly those who do not adhere to discharge recommendations. Identifying at-risk patients and implementing early interventions can mitigate healthcare burdens and improve patient outcomes.

Purpose: This study investigates how involuntary patient mis-centering affects dose distribution and image quality in computed tomography (CT), with the goal of reducing radiation exposure while preserving diagnostic performance.

Methods: Mis-centering was performed by shifting a Sun Nuclear CTDI phantom vertically and laterally, with dose recorded in specific phantom holes using a 10X6-3CT ionization chamber (Radcal). Measurements were performed on three CT scanners (Philips, FUJIFILM, Hitachi) under identical acquisition parameters. Additionally, a Philips system paired with a Catphan-503 phantom was used to assess image-quality changes. Dose ratios, calculated from absorbed dose measurements in multiple phantom holes, quantified the effect of off-center positioning.

Results: Peripheral doses were highly sensitive to displacement: a vertical offset above the isocenter reduced the dose by up to 35% at the point above the isocenter, while an increase was observed at symmetrical points, while a lateral offset reduced it by up to 18% at points in the direction of displacement. Image-quality metrics were affected to a lesser degree, likely because modern reconstruction algorithms partially compensate for mis-centering.

Conclusion: These findings suggest that deliberate mis-centering may be considered during follow-up CT examinations to spare radiation-sensitive regions without clinically significant loss of image quality.

Purpose: To evaluate whether admission C-reactive protein (CRP) can triage patients with suspected renal colic to low dose non contrast CT KUB or contrast enhanced CT of the abdomen and pelvis (CTAP) at first presentation.

Methods: Retrospective single centre diagnostic accuracy study in a United Kingdom emergency department. Index test was admission CRP with a prespecified cut-off of 5 mg/L (positive if CRP ≥ 5 mg/L). Reference standard was CT classified a priori as: A normal, B simple calculus, C complicated calculus, D alternative acute diagnosis. The target condition for accuracy analyses was C or D. We constructed a 2 × 2 table and calculated sensitivity, specificity, predictive values and likelihood ratios with 95% confidence intervals.

Results: Of 1,096 CT examinations during the study window, 233 were for suspected renal colic; 58 patients met eligibility and had admission CRP available (29 with CRP < 5 mg/L and 29 with CRP ≥ 5 mg/L). The target condition was present in 26/58 (44.8%). Using CRP ≥ 5 mg/L, sensitivity was 0.73 (95% CI 0.54-0.86), specificity 0.69 (0.51-0.82), positive predictive value 0.66 (0.47-0.80), negative predictive value 0.76 (0.58-0.88), likelihood ratio positive 2.34 (1.16-4.70) and likelihood ratio negative 0.39 (0.20-0.77).

Conclusion: CRP provided modest but clinically interpretable probability shifts for complicated stones or alternative acute pathology. A CRP first approach may support initial imaging selection between CTAP and CT KUB. Prospective multicentre validation is required.

Purpose: The widespread and growing use of computed tomography (CT) in emergency care across Morocco has raised critical concerns about radiation safety, particularly in the absence of national Diagnostic Reference Levels (DRLs). Without DRLs tailored to specific clinical indications, it becomes difficult to identify unjustified dose variations and ensure safe practices. This study aims to establish Morocco's first national, clinical indication-based DRLs for adult head CT examinations, promoting radiation dose optimization and alignment with international safety standards.

Methods: A retrospective multicenter analysis was performed on 1,299 adult head CT examinations across 20 Moroccan hospitals. Clinical indications were categorized into seven groups: stroke, acute neurological symptoms, post-contrast imaging (tumor/abscess), CT angiography, oncology planning, sinus and temporal bone imaging. Key parameters and dose metrics were extracted and the 75th percentile (third quartile) of volumetric CT dose index (CTDIvol) and dose-length product (DLP) distribution per indication was used to propose DRLs.

Results: DLP varied significantly across protocols (highest: oncology [1794.8 ± 128.8 mGy·cm]; lowest: temporal bone [398.4 ± 20.3 mGy·cm]). Geographic disparities emerged, with Agadir (2211 mGy·cm) and Al Hoceima (2204 mGy·cm) showing the highest doses versus Dakhla (790 mGy·cm). Stroke DLPs (880.7 ± 70.5 mGy·cm) were lower than some international benchmarks, reflecting protocol and regional differences in Moroccan practice.

Conclusion: The study establishes the first set of national, indication-specific DRLs for adult head CT. These benchmarks provide a foundational tool for dose optimization, helping radiology departments evaluate current practices, reduce unnecessary exposure and promote compliance with international guidelines.

Acute enterocolitis encompasses a broad spectrum of conditions affecting the small and large bowel, frequently presenting with nonspecific symptoms such as abdominal pain, diarrhea, fever, and vomiting. Given the clinical overlap among infectious, inflammatory, immune-mediated, vascular, and miscellaneous etiologies, imaging plays a pivotal role in refining the differential diagnosis, identifying complications, and guiding timely management. Computed tomography (CT), owing to its accessibility and rapid acquisition, remains the cornerstone of imaging evaluation in acute settings. CT enables detailed assessment of bowel wall morphology, disease distribution, vascular involvement, and extraintestinal manifestations. While ancillary imaging modalities have a role in select scenarios, this review emphasizes a CT-focused approach tailored for acute care. We present a comprehensive, pattern-based review of the CT imaging features across various forms of acute enterocolitis, highlighting diagnostic hallmarks, interpretive pitfalls, and clinically relevant mimics. The included cases were encountered by the radiologists in their day-to day practice and included based on their ability to highlight the majority representative features of each pathology. Through the integration of structured tables, illustrative cases, and diagnostic tips, this article aims to enhance the radiologist's ability to recognize key imaging signatures, avoid diagnostic errors, and contribute meaningfully to multidisciplinary patient care.

Objective: To compare the diagnostic performance of radiology residents and attending radiologists in detecting retained surgical items (RSIs) on intraoperative radiographs.

Methods: In this pilot study, 100 de-identified intraoperative radiographic cases (18 positive for RSIs, 82 negative) were reviewed. For each case, upper-level radiology resident (PGY-3 to PGY-5) and attending radiologist participants recorded the presence or absence of an RSI, their confidence on a three-point scale, and their decision time. We compared accuracy, sensitivity, specificity, confidence, and interpretation time between the two groups. We fit a multivariable logistic regression (fixed-effects GLM) to identify predictors of a correct interpretation, followed by a mixed-effects logistic regression (GLMM) with random intercepts for reader and case to account for clustering.

Results: A total of 1,178 interpretations were analyzed (619 from residents, 559 from attendings). There was no significant difference in diagnostic accuracy between residents (94.2%) and attendings (94.3%) (Fisher's exact p = 0.84 for accuracy, 0.82 for sensitivity, and 0.74 for specificity). Attendings were slightly faster (median time 16.4s vs. 18.8s; p = 0.0038) and reported higher confidence (mean 2.65 vs. 2.52; p < 0.001). In the fixed-effects GLM, participant type was not associated with accuracy (resident vs. attending AOR 0.92, 95% CI 0.52-1.59, p = 0.76). Compared with 'unsure,' being 'somewhat confident' (AOR 9.75, 95% CI 4.72-20.4) and 'very confident' (AOR 20.9, 95% CI 9.71-46.4) markedly increased the odds of a correct interpretation (both p < 0.001). Longer response times were associated with lower odds of correctness (AOR 0.66, 95% CI 0.46-0.94, p = 0.020). Aside from non-significant associations with response time and foreign-body type, findings were otherwise consistent in the mixed-effects model.

Conclusion: Upper-level radiology residents demonstrate diagnostic accuracy for detecting retained surgical items that is statistically indistinguishable from that of attending radiologists. These preliminary findings suggest that a resident-led preliminary interpretation model for RSI studies at the point of service is a feasible and potentially efficient approach that would not compromise patient safety.