Emergency Radiology最新文献

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.

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.