Clinical management of active bleeding: what the emergency radiologist needs to know.

Active bleeding is a clinical emergency that often requires swift action driven by efficient communication. Extravasation of intravenous (IV) contrast on computed tomography (CT) is a hallmark of active hemorrhage. This can be seen on exams performed for a variety of indications and can occur anywhere in the body.

Pre-hospital emergency medicine: a spectrum of imaging findings.

The goal of emergency medical services (EMS) is to provide urgent medical care and stabilization prior to patient transport to a healthcare facility for definitive treatment. The number and variety of interventions performed in the field by EMS providers continues to grow as early management of severe injuries and critical illness in the pre-hospital setting has been shown to improve patient outcomes. The sequela of many field interventions, including those associated with airway management, emergent vascular access, cardiopulmonary resuscitation (CPR), patient immobilization, and hemorrhage control may be appreciated on emergency department admission imaging.

Qualitative and quantitative spermatic cord abnormalities at CT predict symptomatic scrotal pathology.

Purpose: To evaluate quantitative and qualitative spermatic cord CT abnormalities and presence of unilateral or bilateral symptomatic scrotal pathology (SSP) at ultrasound.

Methods: This retrospective study included 122 male patients (mean age 47.8 years) undergoing scrotal ultrasound within 24 h of contrast-enhanced CT (n = 85), non-contrast CT (NECT, n = 32) or CT-Urogram (n = 5).

Non-contrast and portal venous phase computed tomography in breast cancer hepatic metastases: comparison of tumor measurements and impact on response assessment.

Background: For many common malignancies, including breast cancer, evaluation for metastatic disease using multiphase computed tomography (CT) has fallen out of favor and been replaced by studies performed only in the portal venous phase. However, differences in tumor vascularity could produce differences in appearance on post-contrast imaging.

Purpose: To assess non-contrast phase and portal venous phase computed tomography in detection and measurement of hepatic metastases from breast carcinoma.

Impact of low-kVp scan technique on oral contrast density at abdominopelvic CT.

Purpose: To assess quantitative and qualitative effects of kVp on oral contrast density.

Materials And Methods: Three readers retrospectively reviewed 100 CT scans performed at a range of high- and low-energy settings, independently determining their preferred window and level settings for evaluation of the oral-contrast-opacified bowel. Contrast density was also assessed quantitatively in the stomach, jejunum, and ileum.

Trends in the timing of inpatient ERCP relative to cholecystectomy: a nationwide database studied longitudinally.

Background And Aims: ERCP has largely replaced common bile duct exploration for therapy of common bile duct pathology, yet its use as a purely diagnostic test has declined. Among inpatients, we hypothesized that timing between ERCP and cholecystectomy (CCY) has changed. The objectives were to measure temporal trends in the timing between inpatient ERCP and CCY and to examine factors associated with delays.

A noise-optimized virtual monoenergetic reconstruction algorithm improves the diagnostic accuracy of late hepatic arterial phase dual-energy CT for the detection of hypervascular liver lesions.

Objectives: To assess the image quality and diagnostic accuracy of a noise-optimized virtual monoenergetic imaging (VMI+) algorithm compared with standard virtual monoenergetic imaging (VMI) and linearly-blended (M_0.6) reconstructions for the detection of hypervascular liver lesions in dual-energy CT (DECT).

Methods: Thirty patients who underwent clinical liver MRI were prospectively enrolled.

Metrix Matrix: A Cloud-Based System for Tracking Non-Relative Value Unit Value-Added Work Metrics.

Purpose: In the era of value-based medicine, it will become increasingly important for radiologists to provide metrics that demonstrate their value beyond clinical productivity. In this article the authors describe their institution's development of an easy-to-use system for tracking value-added but non-relative value unit (RVU)-based activities.

Methods: Metrix Matrix is an efficient cloud-based system for tracking value-added work.

Differentiating biliary cystadenomas from benign hepatic cysts: Preliminary analysis of new predictive imaging features.

Objective: To identify performance of imaging features in differentiating hepatic cysts from biliary cystadenomas of the liver.

Methods: 25 pathologically confirmed hepatic cystic lesions (hepatic cysts or biliary cystadenomas) were evaluated retrospectively and predetermined imaging features assessed for performance in differentiation.

Results: Any septation which arose from a cyst wall without external indentation had a very high association with biliary cystadenoma, while the presence of a thick septation had only a moderate association.

Diagnosis of abnormally invasive posterior placentation: the role of MR imaging.

Abnormally invasive placentation is becoming more common with a recent increase in cesarean sections and maternal age, among other risk factors. Ultrasonography is the first line-imaging, but it can be difficult to diagnose when limiting factors are present. Failure to recognize this serious placental abnormality precludes us from making the appropriate plan for the delivery and consequently can lead to fatal results.

Improved characterization of focal liver lesions with liver-specific gadoxetic acid disodium-enhanced magnetic resonance imaging: a multicenter phase 3 clinical trial.

Objectives: To evaluate the safety of gadoxetic acid disodium (Gd-EOB-DTPA) magnetic resonance imaging (MRI) and its efficacy in characterizing liver lesions.

Methods: Lesion characterization and classification using combined (unenhanced and Gd-EOB-DTPA-enhanced) MRI were compared with those using unenhanced MRI and contrast-enhanced spiral computed tomography (CT) using on-site clinical and off-site blinded evaluations for patients with focal liver lesions.

Results: Gadoxetic acid disodium was well tolerated in this study.

[CT colonography: evaluation of two 3D algorithms in a screening population].

Purpose: The purpose of this multicenter study was to compare a dissection display and an endoluminal display for CT colonography (CTC) by means of detection rates and evaluation time in a screening collective.

Materials And Methods: 4 blinded readers evaluated CTC datasets from 42 patients with 55 endoscopically confirmed polyps. The datasets were read in a randomized order using two different 3D visualization methods (endoluminal view vs.

Pseudoenhancement of simple renal cysts: a comparison of single and multidetector helical CT.

Purpose: The purpose of this work was to compare the extent of pseudoenhancement (artifactual increase in measured attenuation of a simple cyst after contrast medium administration) in a phantom model on single detector and multidetector helical CT scanners.

Method: The phantom consisted of four water-filled spheres varying in size from 8 to 28 mm, suspended in an aqueous contrast medium bath. Iodine concentration in the bath was varied: 0, 6, 12, and 24 mg/ml corresponding to attenuation values of 0, +108, +180, and +300 HU.

Liver: single breath-hold dynamic subtraction CT with multi-detector row helical technology feasibility study.

Fifty-two patients with known or suspected hypervascular malignancy were examined to determine the technical feasibility of performing single-breath-hold dynamic subtraction computed tomography (CT) of the liver with multi-detector row helical CT. The precontrast and hepatic arterial CT scans, which were acquired during the same breath hold, were subtracted. The mean liver-to-muscle contrast ratio on the precontrast, hepatic arterial, and subtracted images was 1.

Biliary cystadenocarcinoma: seven year follow-up and the role of MRI and MRCP.

Biliary cystadenomas and their malignant counterparts, biliary cystadenocarcinomas, are rare cystic tumors that arise from hepatobiliary epithelium. Ultrasound (US) and computed tomography (CT) are the initial imaging modalities used for the evaluation of biliary cystic tumors, but are not specific. MRI and MRCP, because of increased contrast and spatial resolution, may be a more specific imaging modality in the detection of biliary cystic neoplasms.

Sonographically guided thrombin injection of iatrogenic femoral pseudoaneurysms: further experience of a single institution.

Objective: In September 1998, we began to treat iatrogenic femoral pseudoaneurysms with direct thrombin injection under sonographic guidance. Our purpose was to determine the success and complication rate of this technique.

Subjects And Methods: We treated 114 consecutive patients who had iatrogenic femoral pseudoaneurysms using direct thrombin injection.

Nonstenotic internal carotid arteries: effects of age and blood pressure at the time of scanning on Doppler US velocity measurements.

Purpose: To assess the effects of age and blood pressure at the time of scanning on internal carotid artery velocities and cross-sectional diameter at Doppler ultrasonography (US).

Materials And Methods: During 12 months, 1,020 consecutive patients underwent internal carotid artery Doppler US. No or minimal arterial disease was found in 142 patients (67 women, 75 men).

CT fluoroscopy--guided interventional procedures: techniques and radiation dose to radiologists.

Purpose: To determine the radiation dose to radiologists who perform computed tomographic (CT) fluoroscopic interventional procedures by using a quick-check method and a low-milliampere technique.

Materials And Methods: Two hundred twenty CT fluoroscopy--guided interventional procedures were performed in 189 patients. Procedures included 57 spinal injections, 17 spinal biopsies, 24 chest biopsies, 20 abdominal aspirations, 44 abdominal biopsies, and 58 abdominal drainages.

Two-dimensional multiplanar and three-dimensional volume-rendered vascular CT in pancreatic carcinoma: interobserver agreement and comparison with standard helical techniques.

Objective: The purpose of this study was to compare two-dimensional curved multiplanar and three-dimensional reconstructions, routine axial presentations, and combined techniques in the assessment of vascular involvement by pancreatic malignancy.

Materials And Methods: For 44 patients with known pancreatic malignancy a total of 56 arterial phase helical CT scans were obtained. Targeted pancreatic imaging was performed, and reformatted images were generated.

Air insufflation: a useful adjunct to the single contrast barium enema for the evaluation of the rectum.

We examined whether insufflation of a small volume of air after a single-contrast barium enema would improve evaluation of the rectum. Eighty patients presenting for barium enema by single-contrast technique underwent examination of the colon including spot films with fluoroscopy and palpation during introduction of the barium and filled overhead views, using standard apparatus and technique. The examination was completed by draining barium from the rectum only, following which air in the barium enema bag was squeezed back into the rectum and three views of the rectum obtained (lateral, left posterior oblique, and frontal).

An electronic device for needle placement during sonographically guided percutaneous intervention.

An electronic device for guiding needle placement during sonographically directed percutaneous intervention was tested in a phantom and then in patients. In the phantom, targeting accuracy was similar for use of the needle guide alone, the needle guide with the device, and freehand techniques with the device, but all were superior to the freehand technique alone (P <.001).

Nonenhanced helical CT and US in the emergency evaluation of patients with renal colic: prospective comparison.

Purpose: To compare nonenhanced helical computed tomography (CT) with ultrasonography (US) for the depiction of urolithiasis.

Materials And Methods: During 9 months, 45 patients (mean age, 44 years; mean weight, 92.5 kg) prospectively underwent both nonenhanced helical CT (5-mm collimation; pitch of 1.