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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Natural history of pediatric morphine leukoencephalopathy on CT and MRI.

Emergency Radiology

An increased awareness of opioids and the imaging appearance in opioid overdose-related leukoencephalopathy has rapidly become crucial with respect...

Know your way around acute unenhanced CT during global iodinated contrast crisis: a refresher to ED radiologists.

Emergency Radiology

Due to a contrast shortage crisis resulting from the decreased supply of iodinated contrast agents, the American College of Radiology (ACR) has iss...

Rare metabolic disease mimicking COL4A1/COL4A2 fetal brain phenotype.

Ultrasound in Obstetrics and Gynecology

Pathogenic variants of COL4A1/COL4A2 genes are causing various phenotypic anomalies including intracerebral hemorrhage and a wide spectrum of devel...

New data on efficacy of valaciclovir in secondary prevention of maternal-fetal transmission of CMV.

Ultrasound in Obstetrics and Gynecology

Congenital cytomegalovirus (CMV) infection is the leading cause of non-genetic hearing and neurological deficits. The aim of our study was to evaluate the efficacy and safety of valaciclovir (VCV) in prevention of CMV transmission to the fetus after maternal primary infection.

Retrospective, multicenter study evaluating the rate of CMV maternal-fetal transmission in patients with a primary CMV infection treated with VCV at a dosage of 8g per day (VCV group) compared to a group of untreated women. Each case was assessed virologically to confirm maternal primary infection and to provide accurate dating. The primary endpoint was the presence of congenital CMV infection diagnosed on urine samples at birth. The efficacy of VCV treatment was assessed using logistic regression analysis adjusted for a propensity score.

143 patients were included in the final analysis, 59 in the VCV group, and 84 in the control group. After propensity score adjusted analysis, VCV treatment was significantly associated with an overall reduction in the rate of maternal-fetal transmission (OR = 0.40; 95% CI 0.18-0.90, p=0.03). After periconceptional primary infection, the rate of maternal-fetal transmission at birth was 7% (1/14) in the VCV group vs 10% (1/10) in the control group (p=1.00); 22% (8/36) vs 41% (19/46) after 1st trimester maternal primary infection (p=0.07) and 25% (2/8) vs 52% (14/27) after 2nd trimester maternal primary infection (p=0.24). When analyzing efficacy of treatment according to maternal viremia at treatment initiation, there was a trend towards greater efficacy when viremia was positive (21% vs 43%, p=0.07) compared to when viremia was negative (22% vs 17%, p=0.66). Maternal treatment side effects are reported.

VCV treatment of pregnant women with primary CMV infection in the first and second trimesters reduces the risk of transmission to the fetus. This article is protected by copyright. All rights reserved.

Outcomes in pediatric patients with documented delays between ileocolic intussusception diagnosis and therapeutic enema attempt: evaluation of reduction efficacy and complication rate.

Emergency Radiology

Ileocolic intussusception is considered a pediatric emergency, with concerns for risk of significant morbidity in children with a prolonged intussusception state. Emergent therapy is standard of care, as prior studies have shown poor outcomes in patients with long delays (> 24 h) before intervention. Various factors can result in shorter delays, and there are limited studies evaluating outcomes in these patients. This study aimed to determine if there were differences in reduction success rates associated with short in-hospital time delays.

This study is to determine enema success rate and morbidity in patients with documented time delays between intussusception diagnosis and therapeutic enema.

A retrospective evaluation of pediatric patients with intussusception at a single children's hospital between 2007 and 2019 was performed. Patient's records were reviewed for time of symptom onset, radiologic diagnosis, and attempted enema. Ultrasounds and radiographs were reviewed for bowel obstruction, free peritoneal fluid, trapped fluid around the intussusceptum, and absent bowel wall perfusion. Patients were evaluated for efficacy of reduction attempt, requirement for surgical reduction, and complications including bowel resection and bowel perforation.

There were 175 cases of ileocolic intussusception requiring enema reduction. Successful reduction occurred in 72.2% (13/18) of cases performed within 1 h of diagnosis; 74.3% (78/105) between 1 and3 h; 73.2% (30/41) between 3 and 6 h; and 81.2% (9/11) with greater than 6 h. Need for bowel resection was not associated with short delays between diagnosis and reduction attempts (p = .07).

There was no difference in intussusception reduction efficacy or complication rate in patients with increasing time between imaging diagnosis of ileocolic intussusception and reduction attempt, including delay intervals up to 8 h.

Rapidly progressive interstitial lung disease in patients with anti-melanoma differentiation-associated gene 5-positive dermatomyositis: serial changes on HRCT.

Emergency Radiology

Anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibodies in patients with dermatomyositis are associated with rapidly progressive interstitial lung disease (RP-ILD). Computed tomography (CT) plays a central role in the diagnosis of RP-ILD and may help characterize the temporal changes.

We report five anti-MDA5-positive dermatomyositis patients with serial CT scans spanning their acute RP-ILD disease course.

Our case series highlights the variable imaging pattern that can manifest in this setting, including diffuse alveolar damage and nonspecific interstitial pneumonia patterns. Three patients in our series died within 4 months of their disease onset, whereas the other two patients survived.

The serial CT changes in anti-MDA5 disease are dynamic and variable; therefore, it is imperative to maintain a broad differential when faced with these HRCT patterns to improve the diagnosis and management of this underrecognized entity.

Coronary artery calcification-does it predict the CAD-RADS category?

Emergency Radiology

Coronary calcium scores (CCSs) in cardiac-gated computed tomography (CCT) are diagnostic for coronary artery disease (CAD). This study aims to investigate if CCSs can foretell CAD-reporting and data system (CAD-RADS) without performing computed tomography angiography (CTA).

Profiles of 544 patients were studied who had gone through CCT and CTA; the number of calcified regions of interest (ROIs), the Agatston, area, volume, and mass CCSs were calculated. Among the CAD-RADS categories (1 to 5), the mean values were compared for each CCS separately. A cut-offfor each CCS was declared using ROC curve analysis, more than which could predict significant CAD (CAD-RADS 3 to 5). Also, logistic regression models indicated the most probable CAD-RADS category based on the CCSs. P < 0.05 was considered significant.

Among 53% male and 47% female participants with a mean (SD) age of 62.57 (0.84) years, numbers of calcified ROIs were significantly different between each pair of CAD-RADS categories. While other CCSs did not show a significant difference between CAD-RADS 1 and 2 or 2 and 3. All CCSs were significantly different between the non-significant and significant CAD groups; cut-offs for the number of calcified ROIs, the Agatston, area, volume, and mass scores were 9, 128, 44mm2, 111mm3, and 22 mg, respectively. Formulae A and B predicted the most probable CAD-RADS category (accuracy: 79%) and the probability of significant/non-significant CAD (accuracy: 81%), respectively.

CCSs could predict CAD-RADS with an accuracy of 80%. Further studies are needed to introduce more predictive calcium indices.

Body computed tomography in sepsis: predictors of CT findings and patient outcomes in a retrospective medical ICU cohort study.

Emergency Radiology

Sepsis is a life-threatening condition that requires immediate focus identification and control. However, international sepsis guidelines do not provide information on imaging choice.

To identify predictors of CT findings and patient outcomes in a population of septic patients from a medical ICU.

A full-text search in the radiological information system (RIS) retrieved 227 body CT examinations conducted to identify infectious sources in 2018. CT reports were categorized according to identified foci and their diagnostic certainty. Diagnostic accuracy of CT was compared to microbiological results. Clinical and laboratory information was gathered. Statistical analysis was performed using nonparametric tests and logistic regression analysis.

CT revealed more positive infectious foci 52.4% (n = 191/227) than microbiological tests 39.3% (n = 79/201). There were no significant differences between focus-positive CT scans with regard to positive microbiological testing (p = 0.32). Sequential organ failure assessment (SOFA) scores were slightly but nonsignificantly higher in patients with a focus-positive CT, odds ratio (OR) = 0.999 (95% CI 0.997-1.001) with p = 0.52. Among C-reactive protein (CRP), procalcitonin (PCT), and leukocytes, in focus-positive versus focus-negative CT scans, CRP showed a minor but statistically significant elevation in the group with focus-positive CT scans (OR = 1.004, 95% CI = 1.000-1.007, p = 0.04). No significant association was found for PCT (OR = 1.007, 95% CI = 0.991-1.023; p = 0.40) or leukocytes (OR = 1.003, 95% CI = 0.970-1.038; p = 0.85). In 33.5% (n = 76/227) of cases, the CT findings had at least one therapeutic consequence. In 81.6% (n = 62/76), the CT findings resulted in one consequence, in 14.5% (n = 11/76) in two consequences, and in 3.9% (n = 3/76) in three consequences. There was no significant association between focus-positive CT scans and mortality (p = 0.81).

In this population of septic patients in medical intensive care, microbiological analysis complemented CT findings. Both clinical and laboratory parameters were not predictive of CT findings. While therapeutic consequences of CT findings in this study population underline the role of CT for decision making in septic patients, CT findings do not predict patient outcomes in this retrospective analysis.

Multicenter survey clarifying phrases in emergency radiology reports.

Emergency Radiology

Interactions between radiologists and emergency physicians are often diminished as imaging volume increases and more radiologists read off site. We explore how several commonly used phrasings are perceived by radiologists and emergency physicians to decrease ambiguity in reporting.

An anonymous survey was distributed to attendings and residents at seven academic radiology and emergency departments across the USA via a digital platform as well as to an email group consisting of radiologists across the country with an interest in quality assurance. Physicians were asked to assign a percent score to probabilistic phrases such as, "suspicious of," or "concerned for." Additional questions including, "how often the report findings are reviewed," "what makes a good radiology report," and "when is it useful to use the phrase 'clinical correlation are recommended.'" Median scores and confidence intervals were compared using an independent Student's T-test.

Generally, there was agreement between radiologists and emergency room physicians in how they interpret probabilistic phrases except for the phrases, "compatible with," and "subcentimeter liver lesions too small to characterize." Radiologists consider a useful report to answer the clinical question, be concise, and well organized. Emergency physicians consider a useful report to be concise, definitive or include a differential diagnosis, answer the clinical question, and recommend a next step. Radiologists and emergency physicians did not agree on the usefulness of the phrase, "clinical correlation recommended," in which radiologists found the phrase more helpful under particular circumstances.

The survey demonstrated a wide range of answers for probabilistic phrases for both radiologists and emergency physicians. While the medians and means of the two groups were often different by statistical significance, the actual percent difference was minor. These wide range of answers suggest that use of probabilistic phrases may sometimes lead to misinterpretation between radiologist and emergency room physician and should be avoided or defined if possible.

Pediatric trauma and the role of the interventional radiologist.

Emergency Radiology

While interventional radiologists occupy a critical role in adult trauma management, the role of interventionalist in pediatric trauma continues to evolve. The indications for transarterial embolization (TAE) are significantly different in pediatric patients in whom non-operative management (NOM) has a much more prominent role than in adults. Contrast extravasation on imaging may not require acute surgical or interventional management as it would in an adult. There are also areas in which pediatric interventional radiology is increasingly useful such as pelvic TAE in failed management, or splenic embolization to treat bleeding without the loss of splenic function inherent to surgical splenectomy. The rapid evolution of techniques and devices in pediatric patients is also changing what interventions are possible in pediatric trauma management which necessitates frequent reassessment of the guidelines and interventional radiology's role in caring for these patients.

This review seeks to consolidate the recent literature to describe the evolving role of the interventional radiologist in pediatric trauma management.

Single left superior vena cava antenatal diagnosis, associations and outcomes.

Ultrasound in Obstetrics and Gynecology

To describe the associated cardiac and extracardiac findings and estimate the prevalence of single left superior vena cava (LSVC) among fetuses referred for fetal echocardiography.

This is a retrospective case series study of fetuses diagnosed with situs solitus and single LSVC at the Brompton Centre for Fetal Cardiology, from October 2006 to December 2020. Prenatal and postnatal outcome data were collected. Prenatal diagnosis was based on abnormal vessel alignment at the 3-vessel view (3VV) and/or 3-vessel and trachea view (3VT), showing a vessel to the left of the pulmonary artery, the LSVC, and absence of the usual vessel to the right of the ascending aorta, the right superior vena cava (RSVC), and further visualisation of the LSVC draining to the coronary sinus.

Amongst 19,968 fetal echocardiograms, 34 cases were identified (prevalence 0.17%). There were 32 livebirths, 1 lost to follow up and one fetal demise. Single LSVC was isolated in most cases. No major CHD was identified. One fetus showed mild isthmus hypoplasia, with no aortic coarctation postnatally. Two fetuses had umbilical vessel abnormalities. Genetic abnormality was found in one case.

Antenatal diagnosis of single LSVC in situs solitus is usually a benign isolated finding. Nevertheless, investigation of other cardiac, extracardiac and genetic disorders should be considered. This article is protected by copyright. All rights reserved.

3D transvaginal ultrasound vs magnetic resonance imaging for preoperative staging of myometrial and cervical invasion in patients with endometrial cancer: systematic review and meta-analysis.

Ultrasound in Obstetrics and Gynecology

To evaluate and compare the diagnostic accuracy of 3D-transvaginal ultrasound (3D-TVS) and magnetic resonance imaging (MRI) for detecting deep myometrial infiltration (DMI) and cervical invasion (CI) for preoperative staging and surgery planning in patients with endometrial cancer (EC).

A literature search of relevant papers was performed using Medline, Scopus, Embase, Science direct, Cochrane library, published between January 2000 to December 2021. Quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.

We included 5 studies for a total of 450 patients: 5 studies compared 3D-TVS versus MRI for DMI, 3 papers compared 3D-TVS versus MRI for CI. Overall pooled sensitivity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) for detecting DMI were 77% (95% CI 66% to 85%), 4.28 and 0.28 for 3D-TVS, respectively; and 80% (95% CI 73% to 86%), 4.21 and 0.25 for MRI, respectively. Bivariate meta-regression indicated similar accuracy for 3D-TVS and MRI (p=0.80) for the correct identification of DMI. A pooled logarithm of DOR for detecting of CI were 3.11 (95% CI 2.09 to 4.14) for 3D-TVS and 2.36 (9%% CI 0.90 to 3.83) for MRI. The risk of bias was low for most 4 domains assessed in QUADAS-2.

3D-TVS demonstrated a good diagnostic accuracy in term of sensitivity and specificity for the evaluation of DMI and CI, resulting comparable to MRI. So, we confirmed the potential role of 3D-TVS in the preoperative staging and surgery planning in patients with EC. This article is protected by copyright. All rights reserved.