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Kaewlai R, Chatpuwaphat J, Butnian K, Thusneyapan K, Panrong N, Lertpipopmetha W, Wongpongsalee T. Thoracic Inlet in Cervical Spine CT of Blunt Trauma Patients: Prevalence of Pathologies and Importance of CT Interpretation. TOMOGRAPHY (ANN ARBOR, MICH.) 2022; 8:2772-2783. [PMID: 36412690 PMCID: PMC9680416 DOI: 10.3390/tomography8060231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The thoracic inlet of blunt trauma patients may have pathologies that can be diagnosed on cervical spine computed tomography (CT) but that are not evident on concurrent portable chest radiography (pCXR). This retrospective investigation aimed to identify the prevalence of thoracic inlet pathologies on cervical spine CT and their importance by measuring the diagnostic performance of pCXR and the predictive factors of such abnormalities. METHODS This investigation was performed at a level-1 trauma center and included CT and concurrent pCXR of 385 consecutive adult patients (280 men, mean age of 47.6 years) who presented with suspected cervical spine injury. CT and pCXR findings were independently re-reviewed, and CT was considered the reference standard. RESULTS Traumatic, significant nontraumatic and nonsignificant pathologies were present at 23.4%, 23.6% and 58.2%, respectively. The most common traumatic diagnoses were pneumothorax (12.7%) and pulmonary contusion (10.4%). The most common significant nontraumatic findings were pulmonary nodules (8.1%), micronodules (6.8%) and septal thickening (4.2%). The prevalence of active tuberculosis was 3.4%. The sensitivity and positive predictive value of pCXR was 56.67% and 49.51% in diagnosing traumatic and 8.89% and 50% in significant nontraumatic pathologies. No demographic or pre-admission clinical factors could predict these abnormalities. CONCLUSIONS Several significant pathologies of the thoracic inlet were visualized on trauma cervical spine CT. Since a concurrent pCXR was not sensitive and no demographic or clinical factors could predict these abnormalities, a liberal use of chest CT is suggested, particularly among those experiencing high-energy trauma with significant injuries of the thoracic inlet. If chest CT is not available, a meticulous evaluation of the thoracic inlet in the cervical spine CT of blunt trauma patients is important.
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Affiliation(s)
- Rathachai Kaewlai
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Jitti Chatpuwaphat
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Krittachat Butnian
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Kittipott Thusneyapan
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Nutthanun Panrong
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Wanicha Lertpipopmetha
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Thongsak Wongpongsalee
- Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
- Correspondence: ; Tel.: +66-86-015-5915
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Evans CS, Arthur R, Kane M, Omofoye F, Chung AE, Moreton E, Moore C. Incidental Radiology Findings on Computed Tomography Studies in Emergency Department Patients: A Systematic Review and Meta-Analysis. Ann Emerg Med 2022; 80:243-256. [PMID: 35717273 DOI: 10.1016/j.annemergmed.2022.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/16/2022] [Accepted: 03/30/2022] [Indexed: 11/01/2022]
Abstract
STUDY OBJECTIVE An incidental finding is defined as a newly discovered mass or lesion detected on imaging performed for an unrelated reason. The identification of an incidental finding may be an opportunity for the early detection of a serious medical condition, including a malignancy. However, little is known about the prevalence of incidental findings in the emergency department (ED) setting and the strategies that can be used to mitigate the risk associated with them in the ED. This study aimed to estimate the overall prevalence of incidental findings and to summarize the currently described measures to mitigate the risks associated with incidental findings. METHODS On November 22, 2020, a systematic literature search of PubMed, EMBASE, and Scopus was performed for studies that were published in peer-reviewed journals and reported the prevalence of incidental findings in computed tomography (CT) scans in patients in the ED. Patients who received CT scans that included the head, neck, chest, or abdomen/pelvis were included. The study characteristics, overall prevalence of incidental findings, prevalence of incidental findings by body region, and prespecified subgroups were extracted. The criteria used for risk stratification within individual studies were also extracted. Pooled estimates were calculated using a random-effects meta-analysis. RESULTS A total of 1,385 studies were identified, and 69 studies met the inclusion criteria. The included studies represented 147,763 ED encounters or radiology reports across 16 countries, and 83% of studies were observational, cross-sectional studies. A total of 35 studies (50.7%) were in trauma patients. A large degree of heterogeneity was observed across the included studies. The overall pooled prevalence estimate for any incidental finding was 31.3% (95% confidence interval 24.4% to 39.1%). We found great variation in the methods described to mitigate the risk associated with incidental findings, including a lack of standardized risk stratification, inconsistent documentation practices, and only a small subset of studies describing prospective interventions aimed at improving the recognition and management of incidental findings from the ED. CONCLUSION In patients in the ED receiving CT scans, incidental findings are commonly encountered across a broad range of ED chief complaints. This review highlights the existence of great heterogeneity in the definitions used to classify incidental findings. Future studies are needed to determine a clinically feasible categorization standard or terminology for commonly encountered incidental findings in the ED setting to standardize classification and documentation.
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Affiliation(s)
- Christopher S Evans
- Clinical Informatics Fellowship Program, UNC Hospitals, Chapel Hill, NC; Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Rodney Arthur
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael Kane
- Clinical Informatics Fellowship Program, UNC Hospitals, Chapel Hill, NC; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Fola Omofoye
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Arlene E Chung
- Clinical Informatics Fellowship Program, UNC Hospitals, Chapel Hill, NC; Department of Biostatistics & Bioinformatics, Duke School of Medicine, Durham, NC
| | - Elizabeth Moreton
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Carlton Moore
- Clinical Informatics Fellowship Program, UNC Hospitals, Chapel Hill, NC; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Enlarged Parathyroid Glands on Trauma Computed Tomography: Frequency and Assessment for Possible Primary Hyperparathyroidism. J Comput Assist Tomogr 2021; 45:926-931. [PMID: 34407058 DOI: 10.1097/rct.0000000000001214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of the study were to determine the frequency of enlarged parathyroid glands among patients undergoing trauma computed tomography (CT) who fall within the typical primary hyperparathyroidism (PHPT) age range and to assess for evidence of PHPT. METHODS For this retrospective study of 336 emergency department patients, concurrent cervical spine CT and neck CT angiography (CTA) examinations were reviewed for visible parathyroid glands. When visible, estimated weight was calculated, and a PHPT likelihood category was assigned after medical record review. RESULTS At least 1 parathyroid gland was visible in 17 patients (5%) and enlarged (estimated weight > 60 mg) in 11 (3%). Patients classified as "highly likely" or "likely" of having PHPT exhibited larger glands (median, 355 mg) than those classified as "unlikely" or "highly unlikely" (median, 47 mg; P = 0.01). CONCLUSIONS Parathyroid glands were enlarged in 3% of our cohort. Although PHPT likelihood seems to increase with gland size, definitive determination requires both serum calcium and serum parathyroid hormone.
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Gottesman M, Patel RR, Parnes G, Ortiz AO. Preparing for the Unexpected: A Review of Incidental Extraspinal Findings on Computed Tomography/Magnetic Resonance Imaging of the Spine. Radiol Clin North Am 2021; 59:511-523. [PMID: 34053602 DOI: 10.1016/j.rcl.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Potentially clinically important incidental/unexpected extraspinal findings occur with sufficient frequency in cross-sectional imaging of the spine to warrant the radiologist's careful consideration, regardless of whether the interpreter is a neuroradiologist, a musculoskeletal radiologist, an emergency radiologist, or a generalist. Awareness of the commonly encountered incidentalomas and the anatomy contained within the field of view of cervical, thoracic, and lumbar spine cross-sectional imaging examinations, respectively, assists radiologists in their efficient and accurate analysis. This article familiarizes radiologists with some of the potential relevant extraspinal findings that may be encountered, and recommends an extraspinal search pattern for each spinal segment.
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Affiliation(s)
- Michael Gottesman
- Department of Radiology, Jacobi Medical Center, 1400 Pelham Parkway South Building #1, Room #4N15, Bronx, NY 10461, USA.
| | - Roshni R Patel
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Sherman 231, Boston, MA 02215, USA
| | - Gregory Parnes
- Albert Einstein College of Medicine, 1400 Pelham Parkway South Building #1, Room #4N15, Bronx, NY 10461, USA
| | - A Orlando Ortiz
- Albert Einstein College of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South Building #1, Room #4N15, Bronx, NY 10461, USA
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Sherbaf FG, Chen B, Pomeranz T, Shahriari M, Adin ME, Mirbagheri S, Beheshtian E, Jalilianhasanpour R, Pakpoor J, Lazor JW, Kamali A, Yousem DM. Value of Emergent Neurovascular Imaging for "Seat Belt Injury": A Multi-institutional Study. AJNR Am J Neuroradiol 2021; 42:743-748. [PMID: 33541893 PMCID: PMC8041015 DOI: 10.3174/ajnr.a6992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/09/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Screening for blunt cerebrovascular injury in patients after motor vehicle collision (MVC) solely based on the presence of cervical seat belt sign has been debated in the literature without consensus. Our aim was to assess the value of emergent neurovascular imaging in patients after an MVC who present with a seat belt sign through a large-scale multi-institutional study. MATERIALS AND METHODS The electronic medical records of patients admitted to the emergency department with CTA/MRAs performed with an indication of seat belt injury of the neck were retrospectively reviewed at 5 participating institutions. Logistic regression analysis was used to determine the association among age, sex, and additional trauma-related findings with blunt cerebrovascular injury. RESULTS Five hundred thirty-five adult and 32 pediatric patients from June 2003 until March 2020 were identified. CTA findings were positive in 12/567 (2.1%) patients for the presence of blunt cerebrovascular injury of the vertebral (n = 8) or internal carotid artery (n = 4) in the setting of acute trauma with the seat belt sign. Nine of 12 patients had symptoms, signs, or risk factors for cervical blunt cerebrovascular injury other than the seat belt sign. The remaining 3 patients (3/567, 0.5%) had Biffl grades I-II vascular injury with no neurologic sequelae. The presence of at least 1 additional traumatic finding or the development of a new neurologic deficit was significantly associated with the presence of blunt cerebrovascular injury among adult patients, with a risk ratio of 11.7 (P = .001). No children had blunt cerebrovascular injury. CONCLUSIONS The risk of vascular injury in the presence of the cervical seat belt sign is small, and most patients diagnosed with blunt cerebrovascular injury have other associated findings. Therefore, CTA based solely on this sign has limited value (3/567 = a 0.5% positivity rate). We suggest that in the absence of other clinical findings, the seat belt sign does not independently justify neck CTA in patients after trauma.
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Affiliation(s)
- F G Sherbaf
- From the Division of Neuroradiology (F.G.S., E.B., R.J., D.M.Y.), Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - B Chen
- Department of Diagnostic and Interventional Imaging (B.C., A.K.), Division of Neuroradiology, University of Texas Health Science Center at Houston, Houston, Texas
| | - T Pomeranz
- Department of Radiology (T.P., J.P., J.W.L.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Shahriari
- Department of Radiology (M.S.), Christiana Care Health System, Newark, Delaware
| | - M E Adin
- Department of Radiology and Biomedical Imaging (M.E.A.), Yale University School of Medicine, New Haven, Connecticut
| | - S Mirbagheri
- Department of Diagnostic Radiology (S.M.), Mount Sinai Beth Israel, New York, New York
| | - E Beheshtian
- From the Division of Neuroradiology (F.G.S., E.B., R.J., D.M.Y.), Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - R Jalilianhasanpour
- From the Division of Neuroradiology (F.G.S., E.B., R.J., D.M.Y.), Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - J Pakpoor
- Department of Radiology (T.P., J.P., J.W.L.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - J W Lazor
- Department of Radiology (T.P., J.P., J.W.L.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - A Kamali
- Department of Diagnostic and Interventional Imaging (B.C., A.K.), Division of Neuroradiology, University of Texas Health Science Center at Houston, Houston, Texas
| | - D M Yousem
- From the Division of Neuroradiology (F.G.S., E.B., R.J., D.M.Y.), Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Automatic detection of cervical lymph nodes in patients with oral squamous cell carcinoma using a deep learning technique: a preliminary study. Oral Radiol 2020; 37:290-296. [PMID: 32506212 DOI: 10.1007/s11282-020-00449-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/16/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To apply a deep learning object detection technique to CT images for detecting cervical lymph nodes metastasis in patients with oral cancers, and to clarify the detection performance. METHODS One hundred and fifty-nine metastatic and 517 non-metastatic lymph nodes on 365 CT images in 56 patients with oral squamous cell carcinoma were examined. The images were arbitrarily assigned to training, validation, and testing datasets. Using the neural network, 'DetectNet' for object detection, the training procedure was conducted for 1000 epochs. Testing image datasets were applied to the learning model, and the detection performance was calculated. RESULTS The learning curve indicated that the recall (sensitivity) for detecting metastatic and non-metastatic lymph nodes reached 90% and 80%, respectively, while the model performance recall by applying the test dataset was 73.0% and 52.5%, respectively. The recall for detecting level IB and Level II metastatic lymph nodes was relatively high. CONCLUSIONS A system that has the potential to automatically detect cervical lymph nodes was constructed.
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