Emergency Radiology最新文献

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.

Background/purpose: Isolated oculomotor nerve palsy (ONP) following mild traumatic brain injury (TBI) is rare and often presents diagnostic challenges. Typically associated with diffuse axonal injury and poor prognosis, ONP lacks comprehensive radiological documentation when no skull base fractures along the course of the 3rd Nerve or brainstem injuries are evident. This study explores the diagnostic utility of contrast-enhanced magnetic resonance imaging (CEMRI) in identifying ONP cases in mild TBI patients.

Methods: A retrospective analysis was conducted on six patients diagnosed with isolated ONP after mild TBI, with no evident skull base fractures along the course of the 3rd Nerve or brainstem findings. All patients underwent CE-MRI to identify structural or vascular anomalies along the course of the third cranial nerve. Clinical presentations, imaging findings, and outcomes were meticulously documented and reviewed by a neuroradiologist.

Results: CE-MRI findings revealed consistent abnormalities in all cases. Thickening, blooming, and post-contrast enhancement of the cisternal portion of the third cranial nerve were observed, with two cases demonstrating extension into orbital segments. Despite the absence of fractures or direct injuries, partial recovery was noted in most cases, facilitated by targeted steroid therapy in some instances. These imaging patterns suggest indirect mechanisms such as traction, vascular compromise, or intraneural hemorrhage as potential causes of ONP.

Conclusions: High-resolution CE-MRI proves instrumental in diagnosing isolated ONP in mild TBI patients, even without conventional radiological indicators. Early imaging and intervention may improve recovery outcomes. This study underscores the significance of including CE-MRI in evaluation protocols for ONP. It highlights the importance of further research to unravel the underlying pathophysiology and optimize therapeutic approaches for these patients.

Purpose: Meniscal injuries are a common cause of knee dysfunction and healthcare utilization, with magnetic resonance imaging (MRI) being the diagnostic gold standard. However, MRI's cost, limited accessibility, and contraindications of MRI have prompted interest in ultrasound (US) as a more affordable, portable, and radiation-free alternative. This review aimed to synthesize the current evidence on the diagnostic accuracy of US for meniscal tears and to define its role alongside MRI and arthroscopy in clinical practice.

Methods: We conducted a systematic review following the PRISMA guidelines, searching PubMed from January 2020 to March 2025 for English-language studies of adult patients (>18 years) undergoing US assessment of suspected meniscal injuries. Eligible studies used MRI or surgical (arthroscopic or open) findings as reference standards. Two reviewers independently screened the titles, abstracts, and full texts, extracted the study characteristics and diagnostic metrics, and tabulated the results.

Results: Six studies comprising 499 participants met the inclusion criteria. US sensitivity for detecting meniscal tears ranged from 63% to 92.9%, and specificity from 63.6% to100%, with higher performance for medial than for lateral tears. Point-of-care US in emergency settings demonstrated sensitivities up to 92.9% and specificities up to 88.9%. Community-based US yielded specificity ≥97% for medial tears.

Conclusion: US exhibits clinically acceptable diagnostic accuracy for meniscal injury, particularly when high-frequency probes and experienced operators are used. However, future research should focus on large-scale standardized trials to refine scanning protocols, quantify learning curves, and develop guidelines for integrating US into meniscal injury trajectories.

Purpose: To assess the prognostic value of automated quantitative chest CT metrics in predicting in-hospital mortality among patients with COVID-19 pneumonia admitted through the emergency department in a resource-limited setting in Gaza.

Methods: This retrospective study included 300 adult patients with RT-PCR-confirmed COVID-19 pneumonia who underwent non-contrast chest CT upon hospital admission. Automated quantitative lung metrics were derived using LungCTAnalyzer, an open-source 3D Slicer extension. Metrics included functional lung volume, affected lung volume, and the COVID-Q index (affected-to-functional lung ratio). Patients were stratified by survival status, and outcomes were analyzed using ROC curves, Kaplan-Meier survival analysis, and log-rank testing.

Results: Among the cohort, 112 patients (37.3%) died during hospitalization. Non-survivors were older and more likely to require advanced respiratory support (p < 0.001). Quantitative CT analysis revealed significantly reduced functional lung volume (47.2% vs. 73.9%) and increased affected lung volume (52.8% vs. 26.1%) in non-survivors (p < 0.001). The COVID-Q index was markedly higher in the deceased group. ROC analysis showed good predictive performance for total affected lung volume (AUC = 0.756; 95% CI: 0.696-0.815), with an optimal threshold of approximately 42%. Right lung involvement was associated with the poorest survival outcomes (log-rank = 67.6, p < 0.001).

Conclusion: Automated quantitative chest CT provides objective, reproducible metrics for early mortality risk stratification in COVID-19 pneumonia. The use of open-source tools like LungCTAnalyzer may assist emergency radiologists in prioritizing care in resource-constrained and conflict-affected healthcare systems.

Spontaneous or atraumatic rupture of the spleen is an uncommon but potentially fatal abdominal emergency, often overshadowed by trauma-related etiologies. However, a wide range of infectious, neoplastic, vascular, autoimmune, and iatrogenic conditions can predispose the spleen to rupture without direct trauma. Multidetector computed tomography (MDCT) is the preferred modality for evaluating these cases, offering rapid, high-resolution assessment of hemorrhage-with or without active bleeding-and associated parenchymal abnormalities. This pictorial review highlights the diverse spectrum of underlying causes and characteristic imaging findings through 13 cases. It also outlines CT acquisition protocols, postprocessing techniques, and key clinical features that radiologists must be aware of to reach timely diagnoses and guide management. Early recognition and identification of the underlying pathology are critical in improving patient outcomes and directing appropriate interventions.

Purpose: Controversy exists regarding analgesia premedication prior to right upper quadrant ultrasound (RUQUS) in the setting of abdominal pain when evaluating for acute cholecystitis (AC). The purpose of this study was to examine the effect of opioid and non-opioid analgesia (OA and NOA, respectively) on the sonographic Murphy sign (maximal tenderness when an ultrasound transducer probe is pressed over the visualized gallbladder) and the radiologic accuracy of diagnosing AC.

Methods: A retrospective cohort chart review analyzed 686 adult patients in two groups and the effect on diagnosis of AC in the emergency department: those who received OA versus control and another group comparing NOA versus control.

Results: OA resulted in an increased rate of indeterminate sonographic Murphy sign and diagnoses in the treatment group compared to control (7.9% vs. 3.0%, respectively). This resulted in 24 cases of radiology-missed AC. However, there was no statistically significant difference in false-negative AC diagnosis between the NOA group compared to control (4.6% vs. 3.7%, respectively). Patients receiving OA within 30 minutes of their RUQUS examination were more likely to be given a false-negative diagnosis compared to control (8.5% vs 3.0%, respectively). Even morphine-equivalent doses <4mg were associated with increased false-negatives compared to control (8.0% vs 3.0%, respectively).

Conclusions: Clinicians should consider delaying OA until after the RUQUS or consider delaying the study at least 30 minutes after the administration of OA due to increased risk of false-negative results. Additionally, our results suggest that administration of NOA is a viable alternative analgesic option for many patients without sacrificing diagnostic accuracy.

Calcaneal tuberosity avulsion fractures are often treated differently depending on several factors, including imaging diagnosis and classification. Timely identification of imaging findings, accurate interpretation, and effective communication can help avert serious clinical complications, including the necessity for soft tissue coverage and amputation. This article reviews the anatomy of the calcaneus, as well as the clinical and imaging findings of calcaneal tuberosity fractures. Imaging interpretation and clinical management of these fractures are discussed.

Non-contrast head CT (NCHCT) remains the first-line imaging modality for acute neurologic presentations, but subtle yet critical pathologies can be missed due to its inherent technical limitations. This pictorial review provides a systematic, anatomy-based framework covering all major anatomical compartments visible on emergency NCHCT, serving as a practical educational guide for radiology residents and emergency physicians. The review summarizes key imaging patterns, relevant clinical contexts, and technical optimization methods that aid in detecting subtle intracranial pathologies across anatomical regions. The anatomical areas covered are: Intra-axial: Cerebral hemispheres, deep gray nuclei, brainstem, cerebellum, and the periventricular region. Extra-axial: Subdural, subarachnoid, and meningeal abnormalities, including cranial nerve pathologies. Vascular structures, sellar/parasellar regions, osseous structures, and extracranial soft tissues. A disciplined, systematic interpretation that extends beyond the brain parenchyma to all visible structures, combined with technical optimization and clinical correlation, is crucial for minimizing diagnostic errors and improving patient outcomes.

Purpose: To validate the Simplified Chest CT Severity Score (SCCTSS) for prognostic stratification of COVID-19 pneumonia in a resource-limited Gaza cohort and compare its diagnostic accuracy and interobserver reliability against the established Chest CT Score (CCTS).

Materials and methods: In this retrospective cohort study, 360 adult patients with RT-PCR-confirmed COVID-19 underwent non-contrast chest CT within 72 h of admission (September 2020-June 2022). SCCTSS assessed three parameters, opacity type, extent, and distribution, with scores ranging from 0 to 7 and classified into no involvement (0), mild (3), moderate (4-5), and severe (6-7) disease. CCTS scores ranged from 0 to 25 and were categorized as no involvement (0), mild (1-8), moderate (9-16), and severe (17-25). Interobserver agreement was measured by Cohen's kappa. Diagnostic accuracy for mortality prediction was evaluated via sensitivity, specificity, ROC curves, and Kaplan-Meier survival analyses.

Results: SCCTSS demonstrated almost perfect interobserver reliability (κ = 0.883), comparable to CCTS (κ = 0.870). Mortality was significantly associated with higher SCCTSS categories; 58.5% of non-survivors had severe scores (6-7), compared to 3.7% of survivors (p < 0.001). At the optimal cutoff (≥ 3.5), SCCTSS sensitivity was 93.2%, specificity 90.1%, with AUC 0.933. CCTS (cutoff ≥ 8.5) showed 89.8% sensitivity, 93.4% specificity, and AUC 0.948. Kaplan-Meier analysis confirmed significantly reduced 30-day survival in patients with scores above these thresholds (p < 0.001).

Conclusions: SCCTSS is a simple, reproducible, and effective CT scoring tool for COVID-19 prognostication, suitable for rapid risk stratification in resource-limited environments.