Emergency Radiology最新文献

Spontaneous coronary artery dissection (SCAD) is a rare and underdiagnosed entity that can lead to acute coronary syndrome. This condition has a gender predilection, predominantly affecting women, especially those with known risk factors such as pregnancy and the postpartum period. Hormonal changes and hemodynamic stress during these stages significantly contribute to the occurrence of SCAD. Recognizing and understanding this entity, as well as its imaging findings, have a favorable impact on patient prognosis. Accurate diagnosis through imaging techniques such as coronary angiography and computed tomography is crucial for the appropriate management of SCAD, allowing for early and specific interventions that can significantly improve clinical outcomes and reduce associated mortality. Continuous education and awareness about this condition are essential to improve detection rates and effective treatment.

Artificial intelligence (AI) and its recent increasing healthcare integration has created both new opportunities and challenges in the practice of radiology and medical imaging. Recent advancements in AI technology have allowed for more workplace efficiency, higher diagnostic accuracy, and overall improvements in patient care. Limitations of AI such as data imbalances, the unclear nature of AI algorithms, and the challenges in detecting certain diseases make it difficult for its widespread adoption. This review article presents cases involving the use of AI models to diagnose intracranial hemorrhage, spinal fractures, and rib fractures, while discussing how certain factors like, type, location, size, presence of artifacts, calcification, and post-surgical changes, affect AI model performance and accuracy. While the use of artificial intelligence has the potential to improve the practice of emergency radiology, it is important to address its limitations to maximize its advantages while ensuring the safety of patients overall.

Purpose: Damage Control Surgery (DCS) refers to a staged laparotomy performed in patients who have suffered severe blunt or penetrating abdominopelvic trauma with the goal of managing critical injuries while avoiding life threatening metabolic derangements. Within 24 h of the initial laparotomy, computed tomography (CT) is used to assess the full extent of injuries. The purpose of this study was to assess the incidence of clinically significant unknown abdominopelvic injuries which required further dedicated surgical or interventional radiology management and failed surgical repairs identified on CT following initial laparotomy.

Methods: CT findings were correlated with surgical findings from the initial and subsequent staged laparotomy to determine known and unknown injuries. Frequency and percentage analyses was performed.

Results: Out of 63 patients who underwent DCS with an open abdomen following initial laparotomy and subsequent CT within 24 h, a total of 13 clinically significant abdominopelvic injuries were identified in 12 patients. Seven clinically significant injuries were identified in seven patients (11.1% of patients) in surgically explored areas. Six clinically significant injuries were identified in six patients (9.5%) in surgically unexplored areas. Four instances of failed initial surgical repair were identified in four patients (6.3%) involving the liver and gastrointestinal tract. Overall, 23.8% of the DCS patient population had an actionable finding on the post laparotomy CT.

Conclusion: CT demonstrated value for identifying the extent of clinically significant abdominopelvic injuries and evidence of failed initial surgical repair, which informed surgical planning for subsequent laparotomy. The authors advocate for performing CT in post-DCS patients with an open abdomen as soon as possible following correction of metabolic and hemodynamic derangements.

Objective: To assess the reliability and reproducibility of AO/OTA, Frykman and Fernandez classification systems for distal radius fractures on CT.

Materials and methods: Four radiologists, including one radiology resident, two musculoskeletal radiology fellows and one radiology consultant independently evaluated CT scans of 115 patients with distal radius fractures and classified the fractures according to AO/OTA, Frykman and Fernandez classification system. To assess reproducibility, a second set of reading was done by two observers after an interval of six weeks. Interobserver reliability was calculated for each classification system using intraclass correlation coefficient (ICC) and using Light's modification of kappa. Intraobserver agreement was calculated using Cohen's kappa.

Results: Interobserver reliability using ICC showed fair agreement for AO/OTA (0.447) and Frykman (0.432) classification system and poor agreement for Fernandez (0.196) classification system. Interobserver agreement using kappa was moderate for AO/OTA fracture (0.447) classification into either of three types, while it was only slight for complete classification into type, group and subgroup (0.177). Interobserver agreement using kappa was slight for Fernandez (0.196) classification systems and moderate for Frykman classification system (0.406). Intraobserver agreement for AO/OTA classification system was moderate for observer 1 (0.449) and slight for observer 2 (0.162). Intraobserver agreement for Frykman classification system was substantial for observer 1(0.754) and moderate for observer 2 (0.496). Intraobserver agreement for Fernandez classification system was moderate for both the observers (0.333, 0.320).

Conclusion: Currently there is no classification system that is fully reproducible. AO/OTA and Frykman classification systems performed better than Fernandez classification system in terms of interobserver reliability. However, Frykman classification system performed better than both AO/OTA and Fernandez classification system in terms of intraobserver reproducibility. Fernandez classification system had worst inter and intraobserver reliability in present study. Reliability and reproducibility of AO/OTA classification system decreased when fractures were divided into subgroups.

Purpose: The use of thermal insulations reduces the risk of hypothermia, therefore decreases the risk of death in trauma victims. The aim of the study was to assess whether thermal insulations cause artifacts, which may hinder the diagnosis of injuries, and how the used thermo-systems alter the radiation dose in polytrauma computed tomography.

Methods: Computed tomography scans were made using the road accident victim body wrapped consecutively with 7 different covers. 14 injury areas were listed and evaluated by 22 radiologists. The radiation dose was measured using a dosimeter placed on the victim in the abdominal area.

Results: No significant artifacts in any of the tested covers were observed. The presence of few minor artifacts did not hinder the assessment of injuries. Certain materials increased (up to 19,1%) and some decreased (up to -30,3%) the absorbed radiation dose.

Conclusions: Thermal insulation systems tested in this study do not cause significant artifacts hindering assessment of injuries in CT scans. Concern for artifacts and increased radiation dose should not be a reason to remove patients' thermal insulation during performing trauma CT-scanning.

Rationale and objectives: Interpreting CT studies of facial trauma is challenging, and there are often substantial differences in the characterization of complex facial trauma between radiologists and surgeons. We designed a collaborative multidisciplinary project to reconcile differences in facial fracture interpretation through an educational intervention. The effectiveness of this intervention was evaluated through surgeon feedback on radiology reports.

Materials and methods: Radiology residents, neuroradiology fellows, and neuroradiology attendings were recruited as participants at a single tertiary care academic center. Otolaryngology residents were recruited as evaluators. Participants completed surveys and provided preliminary reports for example cases of facial trauma before and after attending an educational session. Evaluators performed a blinded review of these preliminary reports based on ideal reports developed by surgical and neuroradiology attendings.

Results: 26 participants (20 residents, 1 neuroradiology fellow, 5 neuroradiology attendings) completed the study. Six otolaryngology residents participated as evaluators. To assess interrater reliability, three evaluators graded a shared set of 15 reports and demonstrated substantial agreement with a Kendall's W of 0.71. Participants demonstrated significant improvement in overall report accuracy, clarity, and organization. In subunit analysis, there were significant improvements in reporting Le Fort, nasoseptal, and nasoorbitoethmoid fractures. No significant improvements occurred in the reporting of upper face, zygomaticomaxillary complex, or mandibular fractures. In contrast, survey analysis demonstrated significantly improved confidence in interpreting trauma involving all facial subunits.

Conclusion: Compared with survey results, surgeon assessment of radiology reports better demonstrated areas of improvement after an educational intervention. A multidisciplinary approach to assessing educational efforts may better evaluate the practical effectiveness of educational interventions.

Since the 2021 FDA approval of the first monoclonal antibody (MAB) therapy for Alzheimer's disease (AD), treatment has progressed from symptom management to targeting and reducing amyloid β plaque burden. While these therapies offer hope of altering the disease course, they come with risks, such as amyloid-related imaging abnormalities (ARIA), which include ARIA-E (edema and effusion) and ARIA-H (hemorrhage). This report details the case of a 64-year-old woman undergoing donanemab treatment who developed severe ARIA, characterized by extensive vasogenic edema and multiple microhemorrhages. The increasing use of MABs necessitates heightened awareness and expertise among emergency radiologists to identify findings of ARIA effectively, ensuring timely and appropriate care for patients undergoing these novel therapies.

Traumatic upper extremity injuries are a common cause of emergency department visits, comprising between 10-30% of traumatic injury visits. Timely and accurate evaluation is important to prevent severe complications such as permanent deformities, ischemia, or even death. Computed tomography (CT) and CT angiography (CTA) are the favored non-invasive imaging techniques for assessing upper extremity trauma, playing a crucial role in both the treatment planning and decision-making processes for such injuries. In CT postprocessing, a novel 3D rendering method, cinematic rendering (CR), employs sophisticated lighting models that simulate the interaction of multiple photons with the volumetric dataset. This technique produces images with realistic shadows and improved surface detail, surpassing the capabilities of volume rendering (VR) or maximal intensity projection (MIP). Considering the benefits of CR, we demonstrate its use and ability to achieve photorealistic anatomic visualization in a series of 11 cases where patients presented with traumatic upper extremity injuries, including bone, vascular, and skin/soft tissue injuries, adding to diagnostic confidence and intervention planning.

Background: Mesenteric panniculitis is a rare condition and refers to benign and nonspecific inflammation of mesenteric fat.

Objectives: This study aimed to evaluate the hypothesis of a greater prevalence of mesenteric panniculitis in patients with urolithiasis.

Materials and methods: In this cross-sectional study, abdominopelvic CT scans of 500 patients were reviewed for the presence of urolithiasis and mesenteric panniculitis. The inclusion criteria were patients who were referred with acute abdominal pain and were suspected of having urolithiasis or other urinary conditions and who had undergone abdominopelvic CT scan. Subcutaneous fat thickness was measured, and pain intensity was recorded by patient evaluation.

Results: Mesenteric panniculitis was found in 10 patients, all of whom (100%) had urinary stones (ureter or kidney or both), and none of them had previous surgeries or known malignancies. The prevalence of panniculitis was significantly greater in the group with urolithiasis. In the urolithiasis group, subcutaneous fat thickness was greater in patients with panniculitis, although the difference was not statistically significant. In the subgroup analysis, pain intensity was not significantly greater in patients with panniculitis.

Conclusion: Mesenteric panniculitis is more prevalent among patients with urolithiasis, but it seems that it does not change the intensity of the pain.