The latest medical research on Radiology
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about radiology gathered by our medical AI research bot.
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Diagnostic dilemma in an infant with stridor: ultrasound to the rescue!Emergency Radiology
Stridor is one of the most important signs of partial or complete upper airway obstruction. Subglottic hemangioma (SGH) is a well-recognized howeve...
Efficacy of the scatter correction algorithm in portable chest radiography.Emergency Radiology
Portable chest radiographs (CXRs) continue to be a vital diagnostic tool for emergency and critical care medicine. The scatter correction algorithm (SCA) is a post-processing algorithm aiming to reduce scatter within portable images. This study aimed to assess whether the SCA improved image quality (IQ) in portable CXRs.
Objective and subjective IQ assessments were undertaken on both phantom and clinical images, respectively. For objective analysis, attenuators were placed on the anterior surface of the patient's thorax to simulate pathologies present within uniform regions of the phantom's lung and heart. Phantom CXRs were acquired with three different tube-current-times (mAs). Phantom images were processed with different SCA strengths. Contrast to noise ratios (CNR) within the attenuator were determined for each algorithm strength and compared to non-SCA images. For subjective analysis, two independent radiologists graded 30 clinical images with and without the SCA activated. The images were graded for IQ in different anatomical structures and overall diagnostic confidence.
Objectively, most strengths of the SCA improved the CNR in both regions. However, a detrimental effect was recorded for some algorithm strengths in regions of high contrast. Subjectively, both observers recorded the SCA significantly improved IQ in clinical CXRs in all anatomical regions. Observers indicated the greatest improvement in the lung and hilar regions, and least improvement in the chest wall and bone. All images with and without the SCA were deemed diagnostic.
This study shows the potential radiation dose neutral IQ improvement when using an SCA in clinical patient CXRs.
Cut-off point of CT-assessed epicardial adipose tissue volume for predicting worse clinical burden of SARS-CoV-2 pneumonia.Emergency Radiology
To identify a cut-off value of epicardial adipose tissue (EAT) volume quantified by CT associated with a worse clinical outcome in patients with SARS-CoV-2 pneumonia.
In this retrospective study, sixty patients with a diagnosis of laboratory-confirmed COVID-19 pneumonia and a chest CT exam on admission were enrolled. Based on a total severity score (range 0-20), patients were divided into two groups: ordinary group (total severity score < 7) and severe/critical group (total severity score > 7). Clinical results and EAT volume were compared between the two groups.
The severe/critical patients, compared to the ordinary ones, were older (66.83 ± 11.72 vs 58.57 ± 16.86 years; p = 0.031), had higher body mass index (27.77 ± 2.11 vs 25.07 ± 2.80 kg/m2; p < 0.001) and higher prevalence of comorbidities. EAT volume was higher in severe/critical group, compared with the ordinary group (151.40 ± 66.22 cm3 vs 92.35 ± 44.46 cm3, p < 0.001). In severe/critical group, 19 (73%) patients were admitted in intensive care unit (ICU), compared with 6 (20%) patients in the ordinary group (p < 0.001). The area under the ROC curve (AUC) is equal to 0.781 (p < 0.001) (95% CI: 0.662-0.900). The cut-off found, in correspondence with the highest value of the Youden Index, is 97 cm3: the sensitivity is equal to 83.3%, while the specificity is equal to 70% for predicting a worse outcome. The risk (odds ratio) of belonging to the severe/critical group in this population due to EAT ≥ 97 cm3 is 11.667 (95% CI: 3.384-40.220; p < 0.001).
An EAT volume of 97 cm3 has good sensitivity and specificity to predict a greater extent of pulmonary involvement and therefore a worse clinical outcome in patients with SARS-CoV-2 pneumonia.
Detecting total hip arthroplasty dislocations using deep learning: clinical and Internet validation.Emergency Radiology
Periprosthetic dislocations of total hip arthroplasty (THA) are time-sensitive injuries, as the longer diagnosis and treatment are delayed, the more difficult they are to reduce. Automated triage of radiographs with dislocations could help reduce these delays. We trained convolutional neural networks (CNNs) for the detection of THA dislocations, and evaluated their generalizability by evaluating them on external datasets.
We used 357 THA radiographs from a single hospital (185 with dislocation [51.8%]) to develop and internally test a variety of CNNs to identify THA dislocation. We performed external testing of these CNNs on two datasets to evaluate generalizability. CNN performance was evaluated using area under the receiving operating characteristic curve (AUROC). Class activation mapping (CAM) was used to create heatmaps of test images for visualization of regions emphasized by the CNNs.
Multiple CNNs achieved AUCs of 1 for both internal and external test sets, indicating good generalizability. Heatmaps showed that CNNs consistently emphasized the THA for both dislocated and located THAs.
CNNs can be trained to recognize THA dislocation with high diagnostic performance, which supports their potential use for triage in the emergency department. Importantly, our CNNs generalized well to external data from two sources, further supporting their potential clinical utility.
Blunt thoracic trauma: role of chest radiography and comparison with CT - findings and literature review.Emergency Radiology
In the setting of acute trauma where identification of critical injuries is time-sensitive, a portable chest radiograph is broadly accepted as an i...
Prediction of extensive necrotic change in acute gangrenous cholecystitis.Emergency Radiology
Gangrenous cholecystitis (GC) is a severe type of acute cholecystitis that implies higher mortality and morbidity rates than uncomplicated cholecystitis. The characteristics of GC are various for each case. However, preoperative predictors of GC with extensive necrotic change have not been investigated well.
A total of 239 patients who were pathologically diagnosed with GC underwent laparoscopic cholecystectomy at our hospital between January 2013 and December 2021. Of these, 135 patients were included in this study and were subdivided into the extensive necrosis group (patients with necrotic change extending to the neck of the gallbladder, n = 18) and the control group (patients with necrotic change limited to the fundus or body, not extending to the neck, n = 117) according to each operation video. Patient characteristics and perioperative factors predicting extensive necrotic change were investigated.
Pericholecystic fat stranding (83.3 vs. 53.8%, p = 0.018) and absence of wall enhancement on preoperative CT images (50.0 vs. 24.7%, p = 0.026) were significantly associated with extensive necrosis. Seven of 18 patients in the extensive necrosis group showed necrotic changes beyond the infundibulum. The absence of wall enhancement on preoperative CT images (71.4 vs. 28.8%, p = 0.018) was significantly associated with necrotic changes beyond the infundibulum.
Pericholecystic fat stranding and absence of wall enhancement on preoperative enhanced CT are predictors of extensive necrotic change in patients with GC. In addition, the absence of wall enhancement also predicts the presence of necrotic changes beyond the infundibulum.
International and multicenter prospective diagnostic accuracy of transvaginal ultrasound for endometriosis using the International Deep Endometriosis Analysis (IDEA) terminology: pilot study.Ultrasound in Obstetrics and Gynecology
To evaluate the diagnostic accuracy of transvaginal ultrasound (TVS) to predict ovarian endometriomas (OE), overall deep endometriosis (DE), and DE locations by following the International Deep Endometriosis Analysis (IDEA) consensus statement.
This was an international, multicenter prospective diagnostic accuracy study involving eight centers across six countries (August 2018-November 2019). Consecutive participants were enrolled. Only participants with suspected endometriosis based on clinical symptoms or historical diagnosis of endometriosis were included. The index test was TVS performed pre-operatively in accordance with the IDEA consensus statement. At each center, the index test was interpreted by a single sonologist. The reference standards used were 1) direct visualization of endometriosis at laparoscopy as determined by a non-blinded surgeon with expertise in endometriosis surgery and 2) histological assessment of biopsied/excised tissue. All surgeries were performed within 12 months of the index test TVS. Accuracy (Acc), sensitivity (Sens), specificity (Spec), positive and negative predictive values (PPV/NPV), and positive and negative likelihood ratios (LR+/LR-) of TVS were measured.
273 participants were included in the study with complete clinical, TVS, laparoscopic, and histological data. 256/273 (93.8%) participants were confirmed to have endometriosis histologically. Based on surgical visualization, 139/273 (50.9%) had an OE and 207/273 (75.8%) had DE. 190/273 (69.6%) had DE confirmed histologically. For overall DE, diagnostic performance of TVS based on surgical visualization as a reference was as follows: Acc 86.1%; Sens 88.4%; Spec 78.8%; PPV 92.9%; NPV 68.4%; LR+ 4.17; LR- 0.15. Diagnostic performance of TVS based on histology as a reference standard was as follows: Acc 85.9%; Sens 89.8%; Spec 75.9%; PPV 90.4%; NPV 74.6%; LR+ 3.71; LR- 0.14.
A systematic approach to DE TVS is paramount, and the IDEA consensus approach allows for strong diagnostic accuracy. This study has found a higher TVS detection rate of overall DE than reported by the most recent meta-analysis on the topic (sensitivity 79%) but a lower specificity. This article is protected by copyright. All rights reserved.
Diffusion tensor imaging in fetal brain: review to understand principles, potential and limitations of promising technique.Ultrasound in Obstetrics and Gynecology
Human brain development is a complex process that begins in the third week of gestation. During early development, the fetal brain undergoes dynami...
Traumatic spondylolisthesis of axis: clinical and imaging experience at a level one trauma center.Emergency Radiology
Traumatic spondylolisthesis of the axis (TSA) with bilateral pars interarticularis fracture (a pattern also known as Hangman's fractures) accounts for 4-5% of all cervical fractures. Various classification systems have been described to assist therapeutic decision-making. The goal is to reassess the utility of these classifications for treatment strategy and evaluate additional imaging associations.
This is an IRB approved, retrospective analysis of patients with imaging diagnosis of TSA from 2016 to 2019. Consensus reads were performed classifying TSA into various Levine and Edwards subtypes and typical vs. atypical fractures. Other imaging findings such as additional cervical fractures, traumatic brain injury, spinal cord injury, and vertebral artery injury were recorded. Treatment strategy and outcome were reviewed from clinical charts. Fisher exact test was used for statistical analysis.
A total of 58 patients were included, with a mean age of 62.7 ± 25 years, and male to female ratio of 1:1.2. Motor vehicle collision was the most common cause of TSA. Type I and III injuries were the most and the least common injuries, respectively. Patients with type I injuries were found to have good healing rates with conservative management (p < 0.001) while type IIa and III injuries were managed with surgical stabilization (p = 0.04 and p = 0.01, respectively). No statistical difference was observed in the treatment strategy for type II fractures (p = 0.12) and its prediction of the associated injuries. Atypical fractures were not found to have a higher incidence of SCI (p = 0.31). A further analysis revealed significantly higher-grade vertebral artery injuries (grades III and IV according to Biffl grading) in patients with type IIa and III injuries (p = 0.001) and an 11-fold increased risk of TBI compared to type I and type II fractures (p = 0.013).
TSA fracture types were not associated with any clinical outcome. Levine and Edwards type II classification itself is not enough to guide the treatment plan and does not account for associated injuries. Additional imaging markers may be needed.
Variation in CTA evaluation of ED patients suspected of aortic dissection.Emergency Radiology
This study was performed to investigate the variation in CTA imaging for AoD in an ED to determine if limiting the scanned region to the chest can effectively rule-out AoD without delaying care.
A retrospective chart review was performed for all patients belonging to a geographically isolated health maintenance organization who underwent CTA evaluation for possible acute AoD in the emergency department between 2016 and 2020. We evaluated for the regions included in the CTA, the presence of an acute AoD, and clinical outcomes. For those who were ruled-out of an AoD with a CTA limited to the chest, we investigated clinical follow-up up to 6 months after their initial presentation.
Over the study period, there were 1143 CT scans ordered by ED physicians to evaluate for AoD in patients without a history of AoD. Only 23.0% of screening studies were of the chest only. There were 29 acute AoDs diagnosed (14 type A and 15 type B) making for a prevalence of 2.5%. Only one patient with an acute AoD detected on a chest-only CTA required farther imaging, which did not delay clinical care. No patients ruled-out for acute AoD with a chest-only CTA had a return ED visit or repeat CTA within 6 months diagnosing a missed AoD. There were no AoDs limited to the abdominal aorta that would have been missed on a chest-only study.
In patients in the ED with suspected new acute AoD, a CTA limited to the chest can effectively evaluate the condition without delaying care in this integrated healthcare system with 24/7 CT availability.
Traumatic arterial injuries in upper and lower limbs: what every radiologist should know.Emergency Radiology
Traumatic arterial injuries of the extremities are a rare but potentially fatal event. Computed tomography (CT) angiography of the extremities has ...
Facial injury patterns in victims of intimate partner violence.Emergency Radiology
To evaluate the imaging findings of facial injuries in patients reporting intimate partner violence (IPV).
A retrospective review of radiology studies performed for 668 patients reporting IPV to our institution's violence prevention support program identified 96 patients with 152 facial injuries. Demographics, imaging findings, and clinical data obtained from a review of the electronic medical records (EMR) were analyzed to categorize injury patterns.
The study cohort consisted of 93 women and 3 men with a mean age of 35 years (range 19-76; median 32). At the time of presentation, 57 (59.3%) patients reported IPV as the mechanism of injury. The most frequent site of injury was the midface, seen in 65 (67.7%) patients. The most common fracture sites were the nasal bones (45/152, 29.6%), followed by the mandible (17/152, 11.1%), and orbits (16/152, 10.5%). Left-sided injuries were more common (90/152; 59.2%). A vast majority of fractures (94.5%) showed minimal or no displacement. Over one-third of injuries (60/152, 39.4%) demonstrated only soft tissue swelling or hematoma without fracture. Associated injuries were seen most frequently in the upper extremity, occurring synchronously in 11 (11.4%) patients, and preceding the index facial injury in 20 (21%) patients.
/advances in knowledge. The midface was the most frequent location of injury in victims of intimate partner violence, and the nasal bone was the most commonly fractured facial bone. Recognizing these injury patterns can help radiologists suspect IPV and prompt them to discuss the possibility of IPV with the clinical providers.