Emergency Radiology最新文献

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.

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.

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.

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.

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: 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.

Introduction: Computed tomography (CT) angiography is commonly utilized to quickly identify vascular injuries caused by blunt cervical trauma. It is often conducted alongside a cervical spine CT, based on established criteria. This study assessed the prevalence of cervical vascular injuries identified via CT angiography (CTA) in patients who had negative findings on cervical CT scans.

Materials and methods: A retrospective study was performed on patients who experienced blunt trauma from January 2020 to December 2022 and underwent both cervical CT and CTA. The sample size was determined using the formula: n = (Z^2 * P * (1 - P)) / E^2, assuming a 99% confidence interval, a 2% margin of error, and a proportion of 0.05.

Results: A total of 1,165 patients presented with acute blunt trauma to the head and neck during the study period. Out of those, 800 patients (68.7%) had negative cervical CT scans and only 5 patients (0.6%) were found to have vascular injuries on CTA, with an average age of 44.2 years. Regarding the severity of the injuries, three were classified as grade I and two as grade II. On the other hand, of the 365 patients with positive cervical CT, 44 patients (12%) had vascular injury on CTA, including 16 patients (4.5%) with grades III and IV injuries.

Conclusion: The findings of this study suggest that CTA in patients with negative cervical CT scans seldom reveals vascular injuries, with no injuries exceeding grade II. This highlights the selective utility of CTA in this patient group.