Using an artificial intelligence software improves emergency medicine physician intracranial haemorrhage detection to radiologist levels.

BACKGROUND: Tools to increase the turnaround speed and accuracy of imaging reports could positively influence ED logistics. The Caire ICH is an artificial intelligence (AI) software developed for ED physicians to recognise intracranial haemorrhages (ICHs) on non-contrast enhanced cranial CT scans to manage the clinical care of these patients in a timelier fashion. METHODS: A dataset of 532 non-contrast cranial CT scans was reviewed by five board-certified emergency physicians (EPs) with an average of 14.8 years of practice experience. The scans were labelled in random order for the presence or absence of an ICH. If an ICH was detected, the reader further labelled all subtypes present (ie, epidural, subdural, subarachnoid, intraparenchymal and/or intraventricular haemorrhage). After a washout period, the five EPs reviewed again the scans individually with the assistance of Caire ICH. The mean accuracy of the EP readings with AI assistance was compared with the mean accuracy of three general radiologists reading the films individually. The final diagnosis (ie, ground truth) was adjudicated by a consensus of the radiologists after their individual readings. RESULTS: Mean EP reader accuracy significantly increased by 6.20% (95% CI for the difference 5.10%-7.29%; p=0.0092) when using Caire ICH to detect an ICH. Mean accuracy of the EP cohort in detecting an ICH using Caire ICH was found to be more accurate than the radiologist cohort prior to discussion; this difference, however, was not statistically significant. CONCLUSION: The Caire ICH software significantly improved the accuracy and sensitivity of detecting an ICH by the EP to a level comparable to general radiologists. Further prospective research with larger numbers will be needed to understand the impact of Caire ICH on ED logistics and patient outcomes.

Deep Learning System Boosts Radiologist Detection of Intracranial Hemorrhage.

BACKGROUND: Intracranial hemorrhage (ICH) requires emergent medical treatment for positive outcomes. While previous artificial intelligence (AI) solutions achieved rapid diagnostics, none were shown to improve the performance of radiologists in detecting ICHs. Here, we show that the Caire ICH artificial intelligence system enhances a radiologist's ICH diagnosis performance. METHODS: A dataset of non-contrast-enhanced axial cranial computed tomography (CT) scans (n=532) were labeled for the presence or absence of an ICH. If an ICH was detected, its ICH subtype was identified. After a washout period, the three radiologists reviewed the same dataset with the assistance of the Caire ICH system. Performance was measured with respect to reader agreement, accuracy, sensitivity, and specificity when compared to the ground truth, defined as reader consensus. RESULTS: Caire ICH improved the inter-reader agreement on average by 5.76% in a dataset with an ICH prevalence of 74.3%. Further, radiologists using Caire ICH detected an average of 18 more ICHs and significantly increased their accuracy by 6.15%, their sensitivity by 4.6%, and their specificity by 10.62%. The Caire ICH system also improved the radiologist's ability to accurately identify the ICH subtypes present. CONCLUSION: The Caire ICH device significantly improves the performance of a cohort of radiologists. Such a device has the potential to be a tool that can improve patient outcomes and reduce misdiagnosis of ICH.

Outcome of PET-Negative Solid Pulmonary Nodules: A Retrospective Study.

OBJECTIVE: It was observed that malignancy had been found on follow-up in patients with PET-negative solid solitary pulmonary nodules (SPN). A retrospective analysis was performed to observe the natural history and malignant potential of these lesions, which, in routine practice, are presumed to be inactive. MATERIALS AND METHODS: Patients with an incidentally-discovered solid solitary pulmonary nodule who then had a negative follow-up PET/CT from 2005 to 2015 were identified using a text-based search methodology. These patients' charts were mined to determine the rate of development of subsequent malignancy from these index nodules. RESULTS: Of the patients with initially PET-negative solitary pulmonary nodule (n = 62, 43.5% women, mean age 65), 44 had clinical follow-up of the index lesion. 8 (7 pathology-proven) subsequent malignancies were identified with a mean time to diagnosis of 37.6 (±31.3) months. There were no statistically significant predictors of subsequent development of cancer (including age, gender, and smoking status). CONCLUSION: Upon follow up, 18.2% of the initially queried solid PET-negative nodules developed subsequent malignancy at an average time of 37.6 months, suggesting the continued need for follow-up of these initially PET-negative nodules beyond the 2 years currently suggested in popular guidelines. Importantly, these findings also remind radiologists that a negative PET/CT is not a surrogate for tissue diagnosis in the case of non-FDG avid SPN.

Utility of ultrasound after a negative CT abdomen and pelvis in the emergency department.

PURPOSE: The purpose of this study is to assess the utility of an abdominal and/or pelvic ultrasound (US) performed within 24 h after a negative CT of the abdomen and pelvis (CTAP) in the emergency department (ED). The secondary endpoint is to assess whether there is a significant increase in length of stay (LOS) in the ED due to immediate US reimaging. METHOD: We reviewed the imaging reports of 335 patients over the course of 3 years in our ED who had an US within 24 h after a negative CTAP. We then assessed type of US and whether the US showed any acute findings. We also evaluated LOS in the ED. RESULTS: Out of 335 patients, there were only three US cases suspicious for acute surgical pathology (3/335 or 0.9%). On 30-day clinical follow-up, only one of the three cases was confirmed as cholecystitis on pathology. The most common non-surgical findings on US not initially reported on CTAP were ovarian cysts (29/83) and gallstones (9/83). Additionally, the LOS for patients who received both a CTAP and US was 119 min longer than patients who only received a CTAP. CONCLUSION: US abdomen and/or pelvis reimaging within 24 h following a negative CTAP is unlikely to change surgical management in the acute setting. US reimaging can still be useful in diagnosing non-surgical pathology, which could serve to explain the patient's pain. US reimaging after negative CTAP is associated with an average increase in the ED LOS.

Compartment syndrome of the hand: A case report and review of literature.

Elevation of pressure within tightly bound myofascial compartments has detrimental consequences if not treated promptly, leading to a loss of circulation, ischemia, myonecrosis, nerve damage, and limb loss. They are commonly seen in the distal upper and lower extremities; however, compartment syndrome of the hand is rarely encountered and prompt recognition can prevent permanent damage and tissue loss. This case study presents a complicated case of compartment syndrome of the hand and discusses the interrelationship between compartment syndrome and rhabdomyolysis. An emphasis is placed on pathophysiology of this relationship to allow a better understanding of the imaging features as well as early clinical recognition of compartment syndrome. Magnetic resonance imaging findings are specifically discussed as it remains the best imaging tool to evaluate the extent of the damage and surgical planning.

Rare imaging of a known entity: fat embolism seen on CT in lower extremity vein after trauma.

Fat embolism occurs in the vast majority of patients who have had trauma (approximately 90%). The most common occurrence is after long bone fracture. It has also been noted in cases after orthopedic surgery. Fat embolism is most often diagnosed when the clinical manifestations of fat embolism syndrome become apparent. Reported cases of fat emboli in transit are unusual. In our case, we present the rare finding of fat embolism seen on computed tomography in the lower extremity after a trauma.

Reproducibility of cine displacement encoding with stimulated echoes (DENSE) in human subjects.

OBJECTIVES: To test the hypothesis that two-dimensional (2D) displacement encoding via stimulated echoes (DENSE) is a reproducible technique for the depiction of segmental myocardial motion in human subjects. MATERIALS AND METHODS: Following the approval of the institutional review board (IRB), 17 healthy volunteers without documented history of cardiovascular disease were recruited. For each participant, 2D DENSE were performed twice (at different days) and the images were obtained at basal, midventricular and apical levels of the left ventricle (LV) with a short-axis view. The radial thickening strain (Err), circumferential strain (Ecc), twist and torsion were calculated. The intra-, inter-observer and inter-study variations of DENSE-derived myocardial motion indices were evaluated using coefficient of variation (CoV) and intra-class correlation coefficient (ICC). RESULTS: In total, there are 272 pairs of myocardial segments (data points) for comparison. There is good intra- and inter-observer reproducibility for all DENSE-derived measures in 17 participants. There is good inter-study reproducibility for peak Ecc (CoV=19.64%, ICC=0.8896, p<0.001), twist (CoV=33.11%, ICC=0.9135, p<0.001) and torsion (CoV=13.96%, ICC=0.8684, p<0.001). There is moderate inter-study reproducibility for Err (CoV=38.89%, ICC=0.7022, p<0.001). CONCLUSION: DENSE is a reproducible technique for characterizing LV regional systolic myocardial motion on a per-segment basis in healthy volunteers.

Heart deformation analysis: the distribution of regional myocardial motion patterns at left ventricle.

The aim of the present study was to test the hypothesis that heart deformation analysis (HDA) is able to discriminate regional myocardial motion patterns on the left ventricle (LV). Totally 21 healthy volunteers (15 men and 6 women) without documented cardiovascular diseases were recruited. Cine MRI was performed on those subjects at four-chamber, two-chamber, and short-axis views. The variations of segmental myocardial motion indices of the LV, which were measured with the HDA tool, were investigated. Regional displacement, velocity, strain and strain rate were compared between lateral wall and septal wall using t tests. There are significant variations (CoV = 18.0-72.4%) of myocardial motion indices (average over 21 subjects) among 16 myocardial segments. There are significant differences (p < 0.05) between displacement, velocity, strain and strain rate measured at lateral and septal areas of the LV. In conclusion, HDA is able to present different regional LV motion patterns from multiple aspects in healthy volunteers.

Imaging appearance of benign multicystic peritoneal mesothelioma: a case report and review of the literature.

Benign multicystic peritoneal mesothelioma (BMPM) is a rare entity with fewer than 150 reported cases in the literature. Here we discuss a case of BMPM in a 22-year old female as presented to our urban community hospital, review epidemiology and clinical presentations of this entity, and perform a comprehensive literature review of various CT, US, and MR imaging features of BMPM.

Rare presentation of subcapsular hepatic steatosis in a woman with uncontrolled diabetes without peritoneal dialysis: a case report.

BACKGROUND: Subcapsular hepatic steatosis is a rare atypical pattern of fatty deposition of the liver reported in patients with diabetic nephropathy receiving peritoneal dialysis with intraperitoneal insulin. To date, there has been only one pediatric and zero adult cases of subcapsular hepatic steatosis with no history of continuous ambulatory peritoneal dialysis. We report the first published case of subcapsular hepatic steatosis in an adult diabetic patient without any history of peritoneal dialysis or evidence of chronic renal disease. CASE PRESENTATION: A 46-year-old Caucasian woman with type 2 diabetes mellitus without renal disease presented to our emergency department with vague abdominal symptoms and vomiting. Her blood glucose levels were poorly controlled with a range of 400 to 500 mg/dL. She was diagnosed as having subcapsular hepatic steatosis based on magnetic resonance imaging. Of note, after improved glucose control her subcapsular hepatic steatosis had nearly resolved. CONCLUSIONS: Subcapsular hepatic steatosis has been exclusively described in patients with continuous ambulatory peritoneal dialysis and those on intraperitoneal insulin, except for one pediatric case, which was probably due to incorrect insulin administration. Our case demonstrates that a diagnosis of subcapsular hepatic diagnosis should not be restricted to those getting continuous ambulatory peritoneal dialysis, but rather expanded to all patients with uncontrolled blood glucose levels.