Emergency Radiology最新文献

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.

Purpose: To evaluate whether the appropriateness of imaging requests (AIR) for acute abdominal pain (AAP) in two private hospitals in Santiago (2023) was associated with higher diagnostic yield, and to explore predictors through a multivariable model.

Methods: A retrospective cross-sectional study included patients aged ≥ 15 years presenting with AAP who underwent US, CT, or MRI. AIR was classified according to the ACR Appropriateness Criteria, and radiology reports were categorized as confirmatory or normal. A multivariable logistic regression model, incorporating interactions between AIR, imaging modality, and age, was applied to identify predictors of diagnostic yield.

Results: A total of 189 imaging studies were analyzed (75 US, 62 CT, 52 MRI). Overall, 57.7% of requests were appropriate. Confirmatory findings occurred in 66.1% of cases, significantly more frequent in appropriate requests (84.4%) than in inappropriate ones (41.3%; p < 0.01). Inappropriateness reduced diagnostic yield from 78.3% to 17.4% in US and from 91.5% to 25.9% in CT, with no significant difference for MRI (86% vs. 81.3%). Older age was independently associated with higher probabilities of confirmatory findings. Epigastric pain and acute gastroenteritis were disproportionately linked to overuse, while hepatobiliary conditions showed predominantly appropriate use. The model demonstrated high discriminatory performance (AUC = 0.88).

Conclusion: Adherence to ACR criteria was strongly associated with improved diagnostic yield in AAP, particularly for CT and US. Age and local epidemiology, including high biliary disease prevalence, influenced modality performance. These findings support context-sensitive decision-support tools and prospective studies to refine imaging strategies and enhance patient safety in emergency care.

Purpose: Traumatic adrenal gland hemorrhage (TAH) is an uncommon injury which can be managed conservatively in most cases. There are limited studies assessing the interval follow-up and resolution of conservatively managed TAH. The aim of our study was to evaluate the relationship between resolution of TAH, follow-up imaging interval and initial hematoma size. A key objective was to assess the incidence of underlying adrenal masses that may mimic or contribute to hemorrhage.

Methods: Single centre retrospective cross-sectional study of all trauma patients with radiologically reported adrenal hemorrhage from January 1, 2009 to January 1, 2025. Patients were identified through radiology database search, with demographic, imaging and hematoma data collected to analyse associations between resolution, follow-up timing and initial hematoma size.

Results: Of the 246 patients identified, 125 (51%) underwent at least 1 follow-up CT. The first follow-up occurred at a mean interval of 66.9 days; At this time, 60 patients (48%) showed complete resolution, 53 (42%) showed partial resolution and 12 (10%) demonstrated persistent hemorrhage. An underlying adrenal lesion was identified in 1% of patients. There were statistically significant associations between follow-up imaging time interval and hematoma resolution (p = 0.0025), and between the initial hematoma size and the resolution outcome (p < 0.000001).

Conclusion: Complete resolution of TAH occurred more frequently in patients with follow-up imaging at ≥ 30 days post injury. Hematomas measuring < 27 mm on initial imaging were more likely to resolve completely. Underlying adrenal lesions were rare. These findings may assist trauma centres in refining follow-up imaging strategies for conservatively managed TAH.

Purpose: To identify factors contributing to misdiagnosis of interstitial ectopic pregnancy (IEP).

Methods: Retrospective chart review identified patients who presented to Boston Medical Center with suspected and/or true IEP from January 1, 2012 to April 30, 2019. Final diagnoses identified two IEP diagnosis groups: correct initial diagnosis and incorrect initial diagnosis. Data collected included age, gravidity, parity, body mass index (BMI), estimated gestational age, anatomic anomalies of the reproductive tract, smoking status, and history of pelvic surgery, sexually transmitted infections, pelvic inflammatory disease, or adnexal lesions. Continuous variables were analyzed using analysis of covariance and unpaired t-tests. Fisher's exact tests were used for discrete variables.

Results: Of 53 patients with suspected and/or true IEP, 15 (28%) were correctly diagnosed at initial presentation while 38 (72%) were initially incorrectly diagnosed. Patient age was significantly associated with diagnostic group (p = 0.04). Patients in the correctly diagnosed group (Mean ± SD = 35.1 ± 4.2) were significantly older than those incorrectly diagnosed (Mean ± SD = 30.4 ± 4.2) when controlled for gravidity. In univariate analysis, gravidity was associated with diagnostic group, but this association was not significant when controlled for age. Parity demonstrated a similar trend as gravidity but also did not reach significance. Other variables analyzed were not significantly associated with accuracy of initial diagnosis.

Conclusion: Younger women are more likely to have an incorrect initial diagnosis of IEP at presentation to care. Anecdotally, higher tolerance of invasive imaging procedures by older patients with reproductive experience may result in increased accuracy of transvaginal ultrasound examination.

Purpose: Optimizing radiation protection in pediatric computed tomography (CT) requires diagnostic reference levels (DRLs) adapted to local practice and clinical indication. This study establishes the first Moroccan pediatric CT DRLs stratified by anatomical protocol and diagnostic purpose.

Methods: A descriptive-analytical study was conducted at a single center including 224 children (≤ 15 years) who underwent CT examinations across four main protocols: head, thorax, abdomino-pelvic and thoraco-abdomino-pelvic (TAP). Dosimetric indices (CTDI_vol, DLP) and effective doses (E) were analyzed per ICRP recommendations, and DRLs were derived from the 75th percentile of patient-level dose data by clinical indication.

Results: Head CT was the most frequent (54%), dominated by trauma (63.6%) with optimized exposure (median CTDI_vol 21.5 mGy; E 3.1 mSv). Structural pathologies showed lower doses (E 2.2 mSv), while infectious cases reached the highest (E 7.2 mSv) due to extended protocols. Thoracic CT exhibited variability, with cardiovascular/malformative cases showing the highest exposures (E 5.8 mSv) and functional respiratory cases the lowest (E 4.0 mSv). Abdomino-pelvic CT delivered the highest doses in tumoral imaging (E 23.6 mSv) and TAP protocols showed comparable DRLs for tumoral and traumatic cases (~ 15-16 mSv).

Conclusion: Clinical indication significantly influences pediatric CT dose, with up to five-fold variation across subgroups. The DRLs established here provide the first national benchmarks for Morocco, supporting protocol optimization, radioprotection policy development and ALARA-compliant pediatric imaging practice.

Purpose: To evaluate diagnostic performance of split-bolus single-pass CT (SBSP-CT) for splenic vascular injury (SVI) and clinically relevant splenic vascular injury requiring treatment (CR-SVI) in trauma patients with splenic injury.

Methods: This retrospective observer study included 111 consecutive trauma patients (76% male), mean age 37 years (9-81), median ISS 27 (interquartile range (IQR) 26-33), with splenic injury and primary SBSP-CT at a level-1 trauma center between December 2012 and December 2018. Four radiologists independently scored CTs for SVI presence and likelihood. Consensus reference standards for SVI and CR-SVI were based on clinical, imaging and 3-month follow-up data. Image adequacy was assessed quantitively and qualitatively and diagnostic performance and interobserver agreement analyzed.

Results: 37 of 111 (33.3%) patients had SVI and 27 (24.3%) had CR-SVI requiring treatment. Five patients died prior to SVI treatment from unrelated injuries; no mortality was attributed to undetected SVI. Two patients had delayed splenic rupture, both survived. Median attenuation was 292 HU (IQR 250-348) in the aorta and 130 HU (IQR 114-150) in splenic parenchyma. Images were adequate in 107 of 111 (96.4%) patients. Interobserver agreement for SVI was substantial (0.741; 95% CI: 0.67-0.82). NPV for SVI ranged from 89.2 to 94.4% (95% CI: 89.2-97.4) and for CR-SVI from 94.4 to 97.1% (95% CI: 88.5-98.9). AUROC for SVI ranged from 0.825 to 0.862 and for CR-SVI from 0.825 to 0.862.

Conclusion: SBSP-CT provides adequate image quality and high diagnostic confidence for evaluating splenic vascular injury with high negative predictive value for relevant splenic vascular injuries.