RPS 1517 - Novel approaches in emergency imaging strategies

Author Block: H-J. Meyer, V. Sotikova, T. Denecke, M. Struck; Leipzig/DE
Purpose: The role of the inferior vena cava (IVC) volume measurement in trauma patients is not yet fully understood. The aim of the present study was to identify associations between the IVC volume and red blood cell (RBC) transfusion and massive transfusion (≥10 RBC) within 24 hours after admission, as well as 24-hour and 30-day mortality in trauma patients.
Methods or Background: A retrospective analysis was conducted on all consecutive trauma patients who required emergency tracheal intubation and mechanical ventilation before initial whole-body CT imaging at a level-1 trauma center over a 12-year period. The IVC volume was determined in the initial trauma CT scan.
Results or Findings: A total of 438 patients (75.3% male) with a median age of 50 years, and a median injury severity score (ISS) of 26 points were included in the analysis. Median IVC volume was 36.25 cm3, and RBC transfusion and massive transfusion were performed in 197 and 90 patients, respectively. The 24-hour and 30-day mortality rates were 7.3% and 23.3%, respectively. IVC volume was found to be independently associated with the necessity of RBC transfusion and 24-hour mortality (HR 0.98, 95% CI 0.96–0.99, p =0.01 and HR 0.96, 95% CI 0.93–0.99, p =0.025, respectively), while associations with massive transfusion and 30-day mortality were not statistically significant in multivariable analyses.
Conclusion: The initial IVC volume may serve as a predictor of the general need for RBC transfusion, although it does not reach the prognostic threshold for massive transfusion. The association with 24-hour mortality rather than 30-day mortality suggests the possibility of its diagnostic efficacy in short-term outcomes.
Limitations: First, it is a single center retrospective study. Second, there might be bias induced by infusion therapy before the CT.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics committee at the Medical Faculty of Leipzig University, Leipzig, Germany (IRB00001750, project ID 441/15ek, September 14, 2020)

Author Block: L. J. Pavan, N. Ouamrane, G. Paesani, P-A. Ranc, K. Desalos, T. Vivarrat-Perrin, M-E. Amoretti, N. Amoretti; Nice/FR
Purpose: Patients who suffered a high energy trauma with pelvic ring fracture usually come to whole-body CT-room with a pelvic binder that improves outcome but may mask an active bleeding during CT contrast injection.
Aim of study was to evaluate the importance of removing pelvic binder in the early imaging of pelvic ring fracture.
Methods or Background: All consecutive post-traumatic whole-body CT-scans performed in our emergency department from January 2022 to December 2023 were reviewed. Patients with pelvic ring fracture and a 3-phase CT evaluation (non-contrast, late arterial and portal venous) were included. CT-scan were directly performed without pelvic binder for hemodynamically stable patients. For hemodynamically unstable patients a first acquisition was performed with a tighten pelvic binder, and if no bleeding was found a second 2-phase contrast injection was realized after loosening the pelvic binder to reveal any possible hidden bleeding.
Results or Findings: Out of 847 whole-body CT scan performed in the considered period, a total of 149 patients (87 men, 62 women, mean age 43,6±17 years) with a pelvic ring fracture (78 Tile-A, 42 Tile-B, 29 Tile-C) were included. Seven patients were hemodynamically unstable, requiring a first CT examination with tighten pelvic binder and a second acquisition with loosen pelvic binder. Of these, 2 patients (2/7, 29%) showed a pelvic active bleeding only with loosen pelvic binder.
Of the 142 hemodynamically stable patients who directly underwent CT without binder, 10 presented an active bleeding.
Conclusion: Pelvic binders are a useful tool but may interfere with CT imaging, masking an active pelvic bleed. An acquisition with loosen pelvic binder should always be performed in order to avoid false negative examination.
Limitations: The retrospective design of the study.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: None since observational and retrospective

Author Block: S. Gautam, R. Gupta, A. Sharma; New Delhi/IN
Purpose: To compare the image quality in single-pass split-bolus abdominal computed tomography (CT) and conventional biphasic CT in abdominal trauma patients.
Methods or Background: 66 consecutive patients of abdominal trauma referred for CT were randomized into two groups: the study group (n = 33) scanned using the split-bolus technique; and the control group (n = 33) scanned using the conventional biphasic technique. CT image quality was analyzed subjectively by two observers based on a 5-point Likert scale. The images were also analyzed quantitatively for attenuation values achieved by region of interest (ROI) placements in major arteries, veins and solid organs. In addition, radiation dose in terms of Dose Length Product (DLP) was compared in the two groups.
Results or Findings: The image quality in both groups ranged from good to excellent in most cases. There was no statistically significant difference in subjective image quality in both the groups as assessed by Likert score. Attenuation values in solid organs and major venous structures were significantly higher in the split-bolus group (p <0.001). Arterial attenuation values were significantly higher in the control group (p <0.001) but diagnostic levels were achieved in all patients. There was a reduction of 31.1% in DLP in the split-bolus group.
Conclusion: Split-bolus technique offers comparable image quality and higher solid organ and venous enhancement than conventional biphasic protocol at a reduced radiation dose.
Limitations: The sample size was limited, excluding pediatric patients. The split-bolus protocol used a fixed 120 ml contrast dose, unlike the weight-based regime in dual-phase CT. Most patients were young males, so the average contrast in the dual-phase group was similar. Although whole-body CT is increasingly used in trauma centers, we applied both protocols only for abdominal scans.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Abstract is approved by institutional ethics committee

Author Block: G. G. De Almeida, O. Krzystek, J. Heimer, T. Niemann, A. Euler; Baden/CH
Purpose: CT angiography (CTA) is the gold standard for diagnosing pulmonary artery embolism (PE). Optimal scan timing is crucial for homogeneous enhancement of the pulmonary arteries (PA). Clinical differentiation between PE and aortic dissection is not always clear. This study tested whether bolus tracking in the ascending aorta provides sufficient diagnostic enhancement of the PA, whilst improving enhancement in the thoracic aorta in patients with suspected PE, with the objective of allowing additional diagnostic information within the same exam.
Methods or Background: Retrospective image analysis of 200 patients scanned for PE between 03.2024 and 07.2024 was conducted. Patients were imaged using a third-generation dual-source CT with application of 70 mL of iodinated contrast medium and bolus tracking triggering in either the pulmonary trunk (A) or the ascending aorta (B). A fixed trigger delay of 7 seconds and automatic tube voltage selection were applied. CT attenuation and contrast-to-noise ratio (CNR) were measured at the pulmonary trunk, main pulmonary arteries, segmental superior lobe arteries, ascending, and descending aorta. A mixed-effects model and post-hoc tests were applied.
Results or Findings: No significant difference in CNR was found when comparing both techniques for the pulmonary tree (all p>.05). Mean CNR at the pulmonary trunk, main pulmonary artery, and segmental pulmonary arteries were 13.8, 12.9, 12.5 for group A and 13.9, 13.6, 13.6 for group B, respectively. In the ascending and descending aorta, CNR was significantly higher in group B when compared to group A (13.1 vs. 8.8 and 11.8 vs. 6.9; both p<.001).
Conclusion: Bolus tracking in the ascending aorta showed similar contrast enhancement of the pulmonary tree compared to triggering in the pulmonary trunk while improving enhancement in the thoracic aorta, allowing simultaneous evaluation of both regions.
Limitations: Single center, rectrospective study.
Funding for this study: No dedicated funding
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Rectrospective study with anonymised patient data.

Author Block: N. Finardi, F. Cicchetti, E. Xhepa, C. Lanza, A. M. Ierardi, G. Carrafiello; Milan/IT
Purpose: Spleen injuries are common in abdominal trauma. While FAST and contrast-enhanced CT are commonly used to detect parenchymal or vascular spleen lesions, contrast-enhanced ultrasound (CEUS) is emerging as a radiation-sparing alternative. CEUS can detect lesions within minutes using microbubble agents, providing a fast and safe method for monitoring damage. This study aims to develop a CEUS protocol for monitoring spleen trauma cases managed non-operatively.
Methods or Background: A prospective, single-center observational cohort study was conducted at the Radiology Department of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico in Milan. The study involves 28 patients who presented to the emergency department with abdominal trauma and were diagnosed with parenchymal or vascular spleen injuries managed non-operatively. Initial assessments included contrast-enhanced CT and subsequent follow-up evaluations using contrast-enhanced ultrasound (CEUS) at 48 hours, 12-15 days, 30 days, and 60 days post-trauma to monitor lesion progression and healing.
Results or Findings: The primary endpoint was to evaluate the diagnostic accuracy of CEUS in detecting complications following non-operative management of splenic trauma. Among 28 patients, 25 (89.3%) underwent embolization, with CEUS at 48 hours revealing splenic infarcts in 10 (35.7%). No increased free fluid, vascular lesions, or hematoma progression cases were observed in 22 patients (78.6%).
Conclusion: CEUS proved to be a reliable, radiation-free tool for early detection of complications in non-operatively managed splenic trauma. Its high diagnostic accuracy, particularly at 48 hours, supports its use as a valuable alternative to CT in follow-up care.
Limitations: Small population and short follow-up.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Pending approval by the ethics committee.

Author Block: U. G. Müller-Lisse, K. Donij, S. G. Priglinger, S. Otto, C. R. Hintschich; Munich/DE
Purpose: Measuring ocular protrusion (OP) on MDCT-images is particularly useful in cranio-facial trauma. We step-wisely performed multi-planar reconstruction of MDCT-images (MPR) for CT-exophthalmometry and investigated if results differ between physicians and between different MPR-programs.
Methods or Background: One dentist and one radiologist independently reformatted MDCT-images from primary multidetector-row-CT reconstructions and measured inter-frontozygomatic base-length and OP, applying two commercial and one freely available post-processing programs for MPR, respectively, in fifteen consecutive patients with cranio-facial trauma (five female, age 24-88 years), with ethics-committee approval. Ease of patient-and-exam selection, 3D-reconstruction, alignment of orbits, fine adjustment, and measurements were rated 1-10 for each MPR-program. Wilcoxon-matched-pairs-signed-ranks-tests and two-tailed Student-T-tests for paired data compared MPR-steps and distance-measurements, respectively (significance-level, p<0.05).
Results or Findings: All MPR-programs allowed physician-generated MPR-reformatting and measurements of base-length and OP, although with different levels of ease (range, 5-10). Results of distance measurements varied by 0.2-0.4 mm, correlated highly (Pearson-r=0.9411-0.9956) and did not differ significantly between different MPR-programs and different observers with few exceptions.
Conclusion: CT-exophthalmometry results appear highly reproducible and stable between different MPR-programs when different physicians independently reformatted CT-images and measured base-length and ocular protrusion.
Limitations: The study is limited to three exemplary post-processing programs, two independent observers with different training background and a small number of consecutive patients. However, it demonstrates that the principles of observer-performed multiplanr reconstruction of MDCT-images and measurements relating to CT-exophthalmometry transfer between different post-processing programs and Physicians with different subspecialty training.
Funding for this study: No funding has been obtained for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics committee of the Medical Faculty, LMU Ludwig-Maximilians-Universität München, Vote No. 20-633 KB

Author Block: R. Chopra, K. Patel, B. Rosner, O-P. Hamnvik, B. Khurana; Boston, MA/US
Purpose: Given the high risk of violence with significant underreporting among transgender and gender diverse patients, this study aims to investigate the prevalence and disparities in injuries and potential violence between transgender female and cisgender female patients by analyzing radiology reports.
Methods or Background: We utilized our hospital's Research Patient Data Registry to identify 263 transgender female patients and 525 age, race, and ethnicity-matched cisgender women. Adjusted incidence rate ratios (aIRR) and Odds ratios were calculated to compare imaging and injury patterns. Two radiologists blinded to the study's purpose assessed the likelihood of intimate partner violence (IPV) based on radiology reports. EMRs were reviewed for violence documentation in all patients with radiologically evident injuries.
Results or Findings: In our cohort, 25.4% (67/263) of cases sustained 141 injuries, compared to 14.7% (77/525) of controls who sustained 98 injuries. Injury rates were higher in cases (aIRR: 3.3 [2.5-4.3] P<0.0001), particularly for cranial (7.8 [2.1-29.1] P<0.0001), facial (36.4 [8.6-153.8] P<0.0001), and thoracic injuries (4.9 [1.4-17] P=0.01), with 78.9% of facial fractures (15/19) involving the midface. The percentage of imaging studies in emergency departments was significantly higher in the cases than in the controls (OR = 5.3 [3.3, 8.3]) (P<0.0001). Radiologists suspected IPV in 12 cases and 1 control, with 75% of cases confirming violence and 50% reporting IPV. A higher number of cases with radiologically evident injuries reported experiencing IPV (OR 6.5; [2.7-15.9]; P<0.0001) compared to controls.
Conclusion: Transgender females experience significantly higher injury rates, particularly to the head, face, and chest, with frequent presentations to emergency departments, indicating an elevated risk of violence and gaps in preventive care. By recognizing these patterns, radiologists can help identify at-risk patients and facilitate timely IPV screening and support.
Limitations: Retrospective single-institution, self-reporting by patient.
Funding for this study: National Institute of Biomedical Imaging and Engineering (NIBIB), National Institute of Health
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Approved by Mass General Brigham IRB

Author Block: C. Loberg, L. Küsters, A. Gisevius, D. Roggenland, E. Yilmaz, T. Schildhauer, C. Kruppa, M. Aach; Bochum/DE
Purpose: Traumatic ligamentous injury is common in trauma of spine and can be overlooked easily. Patients outcome is based on fast diagnosis and surgery. MRI is the standard of care in evaluation of ligamentous injury. We invested if an abbreviated protocol (AP) consisting only of one T2wSTIR acquisition is suitable for detection of ligamentous injury.
Methods or Background: A cohort of 100 patients with underlying spinal trauma who underwent MRI were selected. Full MRI protocol (FP) comprised T1w, T2w, T2wSTIR sequences at 1.5T. For abbreviated MRI protocol (AP) we chose a rapid protocol that ensures the acquisition of maximum of contrast and maximum spatial-resolution images based on T2wSTIR acquisition. Two radiologist with 5 years and 16 years of experience reviewed the images to characterize ligaments, fracture, spinal instability and traumatic disc herniation.
Results or Findings: MRI acquisition for FP was 23 minutes versus 4.12 for the AP. Average time to read the single T2wSTIR and complete FP was 3.4 minutes versus 14.3 minutes. 42 ligamentous injuries were detected. Specificity and positive predictive value (PPV) of AP versus FDP were equivalent (96.5% to 94.2% and 23.9% v 23.2%).
Conclusion: An MRI acquisition of 4.20 minutes and expert radiologist reading time of 3.40 minutes are sufficient to confirm ligamentous injury of spine. With a reading time < 4 minutes diagnostic accuracy was equivalent to that of the FDP.
Limitations: This was a retrospective single center study.
Funding for this study: There was no funding
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethic Comittee Ruhr University Hospital Bochum 178/ 24

Author Block: C. Booz¹, T. Vogl¹, V. Koch¹, L. D. Gruenewald¹, A-I. Nica¹, T. D'Angelo², M. Dimitrova¹, G. M. Bucolo¹, I. Yel¹; ¹Frankfurt/DE, ²Messina/IT
Purpose: To evaluate diagnostic accuracy and time efficiency of a deep learning-based pipeline using a Dense U-net architecture for the assessment of intracranial hemorrhage (ICH) in unenhanced head CT scans.
Methods or Background: This retrospective study included 1004 CT scans of 1004 patients (mean age, 71 ± 11 years; 496 men and 508 women) who had undergone an unenhanced head CT scan for the assessment of ICH. All CT scans were analyzed by the algorithm and a board-certified radiologist independently for the presence of ICH. In case of ICH presence, ICH had to be defined as intraparenchymal hemorrhage (IPH), intraventricular hemorrhage (IVH), subarachnoid hemorrhage (SAH), subdural hemorrhage (SDH) and epidural hemorrhage (EDH). Additionally, the time until first temporary diagnosis of ICH was measured. Three experienced board-certified radiologists analyzed the CT scans in consensus reading sessions to establish the standard of reference for hemorrhage presence and classification.
Results or Findings: The reference standard revealed a total of 1108 different ICH presences (IPH, n=344; IVH, n=52; SAH, n=326; SDH, n=356; EDH, n=30). The algorithm showed a high diagnostic accuracy for the assessment of ICH with a sensitivity of 92%, specificity of 95% and an accuracy of 93%. Concerning the most frequently present different ICH types in this study, the sensitivity was 92%, 93% and 93% (IPH, SAH and SDH, respectively), and the specificity was 95%, 96% and 95% (IPH, SAH and SDH, respectively). Regarding analysis time, the algorithm was significantly faster compared to the temporary report of the assigned radiologist (16 ± 3 s vs 273 ± 11 s, p < 0.001).
Conclusion: A novel deep learning algorithm provides high diagnostic accuracy combined with time efficiency for the identification and classification of ICH in unenhanced CT scans.
Limitations: Single-center retrospective study
Funding for this study: No funding was received.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The local IRB approved this study.

Author Block: S. K. Kondapavuluri, S. K. Patan, R. P. Yadav; Vijayawada/IN
Purpose: This study evaluates the diagnostic utility of susceptibility-weighted imaging (SWI) in status epilepticus (SE), focusing on its role in identifying cerebral perfusion and oxygenation changes, particularly when conventional MRI sequences (diffusion, T2, FLAIR) appear normal. SWI’s superior resolution for detecting subtle venous and metabolic changes makes it a better alternative to arterial spin labelling (ASL) in certain clinical settings. The study aims to demonstrate SWI’s value as both a practical and superior tool in perfusion imaging.
Methods or Background: This observational study involved 50 patients with confirmed SE who underwent MRI within 6 hours of seizure onset. The imaging protocol included diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR), SWI, and ASL. SWI patterns of venous oxygenation were compared with ASL perfusion maps to assess concordance in detecting hyper- and hypo-perfused regions, particularly in cases where conventional MRI sequences were unremarkable.
Results or Findings: SWI revealed distinct patterns of cerebral venous changes, categorised into four groups: Group 1 (20 patients) exhibited generalised hyperperfusion on ASL with globally diminished cortical veins on SWI, indicating global hyperoxygenation. Group 2 (13 patients) showed focal hyperperfusion with focally diminished cortical veins, reflecting focal hyperoxygenation. Group 3 (10 patients) displayed focal hyperperfusion with focally prominent cortical veins due to focal deoxygenation. Group 4 (7 patients) demonstrated generalised hyperperfusion with globally prominent veins, indicating global deoxygenation.
Conclusion: SWI is a valuable tool for detecting oxygenation changes in SE, even when conventional MRI sequences appear normal. Its superior resolution and availability make it a better alternative for detecting subtle venous and metabolic changes, supporting its broader adoption as a complementary or standalone tool in epilepsy management.
Limitations: Not applicable
Funding for this study: No funding was provided for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics approval for this observational study was obtained from the relevant ethics committee. Informed consent was secured from all participants, ensuring compliance with ethical standards for research involving human subjects. The study adhered to the principles outlined in the Declaration of Helsinki.

Author Block: A. Ammirabile, E. Desiato, A. M. A. Lucia, S. Giudici, M. Francone, D. Del Fabbro, E. Lanza; Milan/IT
Purpose: This study aimed to identify the CT imaging features associated with the failure of conservative management using oral water-soluble contrast medium in patients presenting to the Emergency Room with Adhesive Small Bowel Obstruction (ASBO).
Methods or Background: This retrospective single-center study included all consecutive patients admitted to the ER from February 2019 to February 2023 with ASBO, who underwent contrast-enhanced CT at diagnosis and received conservative treatment. The assessed CT findings were type and location of the transition zone, ASBO severity, presence of fat notch sign, beak sign, small bowel feces sign, peritoneal free fluid, and pneumatosis intestinalis. Univariable and multivariable logistic regression analyses were performed to evaluate the association between these radiological parameters and treatment outcomes.
Results or Findings: Among the 106 patients included (median age 74.5 years), conservative management succeeded in 59 cases (55.7%), while 47 patients (44.3%) required surgery after initial non-operative treatment failure. Failure was more common in patients with previous ASBO episodes (p = 0.03), female gender (p = 0.04), and was associated with a longer hospital stay (p < 0.001). At multivariable analysis, the fat notch sign (OR = 2.95; p = 0.04) and the beak sign (OR = 3.42; p = 0.04) were significantly associated with conservative treatment failure.
Conclusion: Two CT features - the fat notch sign and the beak sign - were significantly correlated with the failure of conservative management in ASBO. These findings highlight the importance of an early identification of patients who may benefit from undelayed surgical intervention.
Limitations: The limitations of the study are the retrospective, single-center design and the evaluation of a limited number of CT signs and laboratory values.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: The study is retrospective.