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1.
J Am Coll Radiol ; 21(6S): S3-S20, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38823952

RESUMO

This review focuses on the initial imaging in the reproductive age adult population with acute pelvic pain, including patients with positive and negative beta-human chorionic gonadotropin (ß-hCG) levels with suspected gynecological and nongynecological etiology. For all patients, a combination of transabdominal and transvaginal pelvic ultrasound with Doppler is usually appropriate as an initial imaging study. If nongynecological etiology in patients with negative ß-hCG is suspected, then CT of the abdomen and pelvis with or without contrast is also usually appropriate. In patients with positive ß-hCG and suspected nongynecological etiology, CT of the abdomen and pelvis with contrast and MRI of the abdomen and pelvis without contrast may be appropriate. In patients with negative ß-hCG and suspected gynecological etiology, CT of the abdomen and pelvis with contrast, MRI of pelvis without contrast, or MRI of pelvis with and without contrast may be appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.


Assuntos
Dor Pélvica , Adulto , Feminino , Humanos , Gravidez , Dor Aguda/diagnóstico por imagem , Dor Aguda/etiologia , Medicina Baseada em Evidências , Dor Pélvica/diagnóstico por imagem , Sociedades Médicas , Estados Unidos
2.
J Am Coll Radiol ; 21(6S): S144-S167, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38823942

RESUMO

Initial imaging evaluation of hydronephrosis of unknown etiology is a complex subject and is dependent on clinical context. In asymptomatic patients, it is often best conducted via CT urography (CTU) without and with contrast, MR urography (MRU) without and with contrast, or scintigraphic evaluation with mercaptoacetyltriglycine (MAG3) imaging. For symptomatic patients, CTU without and with contrast, MRU without and with contrast, MAG3 scintigraphy, or ultrasound of the kidneys and bladder with Doppler imaging are all viable initial imaging studies. In asymptomatic pregnant patients, nonionizing imaging with US of the kidneys and bladder with Doppler imaging is preferred. Similarly, in symptomatic pregnant patients, US of the kidneys and bladder with Doppler imaging or MRU without contrast is the imaging study of choice, as both ionizing radiation and gadolinium contrast are avoided in pregnancy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.


Assuntos
Medicina Baseada em Evidências , Hidronefrose , Sociedades Médicas , Humanos , Hidronefrose/diagnóstico por imagem , Estados Unidos , Feminino , Gravidez , Diagnóstico por Imagem/métodos , Meios de Contraste
3.
J Am Coll Radiol ; 21(6S): S292-S309, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38823951

RESUMO

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. A search for the underlying cause of infection typically includes radiological imaging as part of this investigation. This document focuses on thoracic and abdominopelvic causes of sepsis. In 2017, the global incidence of sepsis was estimated to be 48.9 million cases, with 11 million sepsis-related deaths (accounting for nearly 20% of all global deaths); therefore, understanding which imaging modalities and types of studies are acceptable or not acceptable is imperative. The 5 variants provided include the most commonly encountered scenarios in the setting of sepsis along with recommendations and data for each imaging study. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.


Assuntos
Medicina Baseada em Evidências , Sepse , Sociedades Médicas , Humanos , Sepse/diagnóstico por imagem , Estados Unidos , Diagnóstico por Imagem/normas
4.
Abdom Radiol (NY) ; 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38744702

RESUMO

Photon counting detector CT (PCD-CT) is the newest major development in CT technology and has been commercially available since 2021. It offers major technological advantages over current standard-of-care energy integrating detector CT (EID-CT) including improved spatial resolution, improved iodine contrast to noise ratio, multi-energy imaging, and reduced noise. This article serves as a foundational basis to the technical approaches and concepts of PCD-CT technology with primary emphasis on detector technology in direct comparison to EID-CT. The article also addresses current technological challenges to PCD-CT with particular attention to cross talk and its causes (e.g., Compton scattering, fluorescence, charge sharing, K-escape) as well as pile-up.

5.
AJR Am J Roentgenol ; 221(6): 720-730, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37073900

RESUMO

Among explored applications of dual-energy CT (DECT) in the abdomen and pelvis, the genitourinary (GU) tract represents an area where accumulated evidence has established the role of DECT to provide useful information that may change management. This review discusses established applications of DECT for GU tract assessment in the emergency department (ED) setting, including characterization of renal stones, evaluation of traumatic injuries and hemorrhage, and characterization of incidental renal and adrenal findings. Use of DECT for such applications can reduce the need for additional multiphase CT or MRI examinations and reduce follow-up imaging recommendations. Emerging applications are also highlighted, including use of low-energy virtual monoenergetic images (VMIs) to improve image quality and potentially reduce contrast media doses and use of high-energy VMIs to mitigate renal mass pseudoenhancement. Finally, implementation of DECT into busy ED radiology practices is presented, weighing the trade-off of additional image acquisition, processing time, and interpretation time against potential additional useful clinical information. Automatic generation of DECT-derived images with direct PACS transfer can facilitate radiologists' adoption of DECT in busy ED environments and minimize impact on interpretation times. Using the described approaches, radiologists can apply DECT technology to improve the quality and efficiency of care in the ED.


Assuntos
Imagem Radiográfica a Partir de Emissão de Duplo Fóton , Radiologia , Humanos , Tomografia Computadorizada por Raios X/métodos , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Radiografia , Meios de Contraste , Serviço Hospitalar de Emergência
6.
Abdom Radiol (NY) ; 48(2): 796-805, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36383241

RESUMO

BACKGROUND: Risk stratification is challenging in the growing population of geriatric patients requiring emergency surgery. Sarcopenia, which assesses muscle bulk, is a surrogate for frailty and predicts 1-year mortality, but does not incorporate potentially valuable additional information about muscle quality. OBJECTIVE: To describe five different CT methods of measuring sarcopenia and muscle quality and to determine which method has the greatest sensitivity for predicting 1-year mortality following emergency abdominal surgery in elderly patients. METHODS: This retrospective study includes 297 patients 70 years and older who underwent "urgent" or "emergent" laparotomy or laparoscopy for acute abdominal disease between 2006 and 2011 at a single quaternary academic medical center. All patients received a CT abdomen and pelvis with intravenous contrast within 1 month of surgery. Five different methods were applied to the psoas muscles on CT: method 1 (total psoas index TPI, which is total psoas area TPA normalized by height), method 2 ("pseudoarea" = anterior-posterior × transverse dimensions), method 3 (average HU), method 4 (TPA × HU), and method 5 ("pseudoarea" × HU). RESULTS: For all five CT measures, mortality was greatest for the lowest quartile by univariate and adjusted Cox proportional hazard analyses at all time points up to 1-year. The C-statistic was highest for Method 4, using a composite index of TPA and Hounsfield Units, indicating the greatest predictive ability to estimate mortality at all time points. CONCLUSION: Muscle quality and muscle size can be used in tandem to refine risk assessment of older patients undergoing emergency abdominal surgery. Routine calculation of the composite score of psoas cross-sectional area and HU in the emergency room setting may provide surgeons and patients valuable insight on the risk of 1-year mortality to guide preoperative decision-making and counseling. CLINICAL IMPACT: Muscle quality and size, both strong independent predictors of surgical outcomes in older patients undergoing emergency abdominal surgery, may be used in tandem to refine risk assessment. A composite score of psoas muscle cross-sectional area and Hounsfield units on CT may provide insight on 1-year mortality in this patient population.


Assuntos
Sarcopenia , Humanos , Idoso , Projetos Piloto , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/diagnóstico por imagem , Sarcopenia/epidemiologia , Abdome/cirurgia , Tomografia
7.
Radiol Clin North Am ; 61(1): 23-35, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36336389

RESUMO

Computed tomography (CT) plays an important role in trauma because imaging findings directly impact management. Advances in CT technology, specifically multienergy CT, have allowed for simultaneous acquisition of images at low and high kilovolt peaks. This technique allows for differentiation of materials given that materials have different absorption behaviors. Various multienergy CT postprocessing applications are helpful in the setting of trauma, including bone subtraction, virtual monoenergetic imaging, iodine-selective imaging, and virtual noncontrast imaging. These techniques have been applied from head to toe and have been used to improve image quality and increase conspicuity of injuries, which increases diagnostic confidence.


Assuntos
Iodo , Tomografia Computadorizada por Raios X , Humanos , Tomografia Computadorizada por Raios X/métodos
8.
Radiol Clin North Am ; 61(1): xv, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36336395
9.
Radiol Clin North Am ; 60(5): 745-754, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35989042

RESUMO

The liver is one of the most commonly injured organ in the abdomen and pelvis. Hepatobiliary trauma is best assessed by contrast-enhanced CT in hemodynamically stable patients. Prompt and accurate diagnosis of hepatobiliary traumatic injuries and associated vascular injuries guides management and allows for successful nonsurgical management of the traumatic injuries. CT can accurately detect and characterize hepatobiliary traumatic injuries and the associated vascular injuries in addition to evaluating delayed complications. We will review hepatobiliary trauma and associated vascular injuries as well as their associated complications.


Assuntos
Traumatismos Abdominais , Lesões do Sistema Vascular , Ferimentos não Penetrantes , Abdome , Traumatismos Abdominais/diagnóstico por imagem , Meios de Contraste , Diagnóstico por Imagem , Humanos , Fígado/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem
10.
Emerg Radiol ; 29(5): 915-923, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35710648

RESUMO

Colonoscopy is one of the most commonly performed endoscopic procedures and remains the most commonly used screening modality method for colorectal cancer (CRC) screening in the USA. Although serious complications of fiberoptic colonoscopy are uncommon due to technical advances, due to increasing number of colonoscopy procedures, post-procedural complications are not uncommonly encountered in the routine clinical practice. Also, as some of the post-colonoscopy complications are life threatening, it is important to diagnose them early so that timely treatment measures can be taken to decrease mortality and morbidity. In this review, we present a case-based illustration of the utility of CT to detect complications of colonoscopy including bowel perforation, hemorrhage, splenic injury, and postpolypectomy syndrome.


Assuntos
Neoplasias Colorretais , Perfuração Intestinal , Colonoscopia , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/prevenção & controle , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/etiologia , Programas de Rastreamento/métodos , Tomografia Computadorizada por Raios X
11.
J Surg Res ; 276: 31-36, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35334381

RESUMO

INTRODUCTION: Necrotizing soft tissue infections (NSTIs) are surgical emergencies associated with high morbidity and mortality. Identifying risk factors for poor outcome is a critical part of preoperative decision-making and counseling. Sarcopenia, the loss of lean muscle mass, has been associated with an increased risk of mortality and can be measured using cross-sectional imaging. Our aim was to determine the impact of sarcopenia on mortality in patients with NSTI. We hypothesized that sarcopenia would be associated with an increased risk of mortality in patients with NSTI. METHODS: This is a retrospective cohort study of NSTI patients admitted from 1995 to 2015 to two academic institutions. Operative and pathology reports were reviewed to confirm the diagnosis in all cases. Average bilateral psoas muscle cross-sectional area at L4, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography (CT). Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was in-hospital mortality. Multivariate logistic regression was performed to assess the association between sarcopenia and in-hospital mortality. RESULTS: There were 115 patients with preoperative imaging, 61% male and a median age of 57 y interquartile range (IQR 46.6-67.0). Overall in-hospital mortality was 12.1%. There was no significant difference in sex, body mass index (BMI), comorbidities and American Society of Anesthesiologists classification (Table 1). After multivariate analysis, sarcopenia was independently associated with increased in-hospital mortality (Odds ratio, 3.5; 95% Confidence Interval [CI], 1.05-11.8). CONCLUSIONS: Sarcopenia is associated with increased risk of in-hospital mortality in patients with NSTIs. Sarcopenia identifies patients with higher likelihood of poor outcomes, which can possibly help surgeons in counseling their patients and families.


Assuntos
Sarcopenia , Infecções dos Tecidos Moles , Feminino , Humanos , Masculino , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/patologia , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/complicações , Sarcopenia/diagnóstico por imagem , Infecções dos Tecidos Moles/complicações , Infecções dos Tecidos Moles/patologia
12.
Abdom Radiol (NY) ; 46(12): 5466-5470, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34086092

RESUMO

The Society of Abdominal Radiology (SAR) has grown rapidly in the last decade and with growth comes opportunity. The purpose of this article is to highlight the many potential ways in which early career radiologists (those within the first 7 years of their career) can become involved with the SAR, both at the annual meeting and throughout the year. At the annual meeting, there are opportunities for presentation of scientific sessions as well as submission of clinically oriented workshops. Workshops are a great way to develop presentation skills and highlight subspecialty clinical expertise. Disease focus panels (DFPs) and Emerging Technology Committees (ETCs) meet at the annual meeting but continue their work throughout the year, targeting improvements in clinical care and research. Finally, a variety of volunteer staffed committees are essential to the fulfillment of the mission of the SAR, and several of these are targeted at involving early career members, providing opportunities for leadership and exposure to other members of the society.


Assuntos
Liderança , Radiologia , Humanos , Radiologistas , Sociedades Médicas , Tecnologia
13.
Radiology ; 299(1): 122-130, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33529133

RESUMO

Background Treatment of blunt splenic trauma (BST) continues to evolve with improved imaging for detection of splenic vascular injuries. Purpose To report on treatments for BST from 11 trauma centers, the frequency and clinical impact of splenic vascular injuries, and factors influencing treatment. Materials and Methods Patients were retrospectively identified as having BST between January 2011 and December 2018, and clinical, imaging, and outcome data were recorded. Patient data were summarized descriptively, both overall and stratified by initial treatment received (nonoperative management [NOM], angiography, or surgery). Regression analyses were used to examine the primary outcomes of interest, which were initial treatment received and length of stay (LOS). Results This study evaluated 1373 patients (mean age, 42 years ± 18; 845 men). Initial treatments included NOM in 849 patients, interventional radiology (IR) in 240 patients, and surgery in 284 patients. Rates from CT reporting were 22% (304 of 1373) for active splenic hemorrhage (ASH) and 20% (276 of 1373) for contained vascular injury (CVI). IR management of high-grade injuries increased 15.6%, from 28.6% (eight of 28) to 44.2% (57 of 129) (2011-2012 vs 2017-2018). Patients who were treated invasively had a higher injury severity score (odds ratio [OR], 1.04; 95% CI: 1.02, 1.05; P < .001), lower temperature (OR, 0.97; 95% CI: 0.97, 1.00; P = .03), and a lower hematocrit (OR, 0.96; 95% CI: 0.93, 0.99; P = .003) and were more likely to show ASH (OR, 8.05; 95% CI: 5.35, 12.26; P < .001) or CVI (OR, 2.70; 95% CI: 1.64, 4.44; P < .001) on CT images, have spleen-only injures (OR, 2.35; 95% CI: 1.45, 3.8; P < .001), and have been administered blood product for fewer than 24 hours (OR, 2.35; 95% CI: 1.58, 3.51; P < .001) compared with those chosen for NOM, after adjusting for key demographic and clinical variables. After adjustment, factors associated with a shorter LOS were female sex (OR, 0.84; 95% CI: 0.73, 0.96; P = .009), spleen-only injury (OR, 0.72; 95% CI: 0.6, 0.86; P < .001), higher admission hematocrit (OR, 0.98; 95% CI: 0.6, 0.86; P < .001), and presence of ASH at CT (OR, 0.74; 95% CI: 0.62, 0.88; P < .001). Conclusion Contained vascular injury and active splenic hemorrhage (ASH) were frequently reported, and rates of interventional radiologic management increased during the study period. ASH was associated with a shorter length of stay, and patients with ASH had eight times the odds of undergoing invasive treatment compared with undergoing nonoperative management. © RSNA, 2021 See also the editorial by Patlas in this issue.


Assuntos
Serviço Hospitalar de Emergência , Baço/irrigação sanguínea , Baço/lesões , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/terapia , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Sociedades Médicas , Estados Unidos
14.
J Digit Imaging ; 34(2): 397-403, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33634414

RESUMO

The Protecting Access to Medicare Act (PAMA) mandates clinical decision support mechanism (CDSM) consultation for all advanced imaging. There are a growing number of studies examining the association of CDSM use with imaging appropriateness, but a paucity of multicenter data. This observational study evaluates the association between changes in advanced imaging appropriateness scores with increasing provider exposure to CDSM. Each provider's first 200 consecutive anonymized requisitions for advanced imaging (CT, MRI, ultrasound, nuclear medicine) using a single CDSM (CareSelect, Change Healthcare) between January 1, 2017 and December 31, 2019 were collected from 288 US institutions. Changes in imaging requisition proportions among four appropriateness categories ("usually appropriate" [green], "may be appropriate" [yellow], "usually not appropriate" [red], and unmapped [gray]) were evaluated in relation to the chronological order of the requisition for each provider and total provider exposure to CDSM using logistic regression fits and Wald tests. The number of providers and requisitions included was 244,158 and 7,345,437, respectively. For 10,123 providers with ≥ 200 requisitions (2,024,600 total requisitions), the fraction of green, yellow, and red requisitions among the last 10 requisitions changed by +3.0% (95% confidence interval +2.6% to +3.4%), -0.8% (95% CI -0.5% to -1.1%), and -3.0% (95% CI 3.3% to -2.7%) in comparison with the first 10, respectively. Providers with > 190 requisitions had 8.5% (95% CI 6.3% to 10.7%) more green requisitions, 2.3% (0.7% to 3.9%) fewer yellow requisitions, and 0.5% (95% CI -1.0% to 2.0%) fewer red (not statistically significant) requisitions relative to providers with ≤ 10 requisitions. Increasing provider exposure to CDSM is associated with improved appropriateness scores for advanced imaging requisitions.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Idoso , Humanos , Imageamento por Ressonância Magnética , Medicare , Encaminhamento e Consulta , Estados Unidos
15.
Emerg Radiol ; 28(1): 103-117, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32483665

RESUMO

Dual energy computed tomography (DECT), also known as spectral CT, refers to advanced CT technology that separately acquires high and low energy X-ray data to enable material characterization applications for substances that exhibit different energy-dependent x-ray absorption behavior. DECT supports a variety of post-processing applications that add value in routine clinical CT imaging, including material selective and virtual non-contrast images using two- and three-material decomposition algorithms, virtual monoenergetic imaging, and other material characterization techniques. Following a review of acquisition and post-processing techniques, we present a case-based approach to highlight the added value of DECT in common clinical scenarios. These scenarios include improved lesion detection, improved lesion characterization, improved ease of interpretation, improved prognostication, inherently more robust imaging protocols to account for unexpected pathology or suboptimal contrast opacification, length of stay reduction, reduced utilization by avoiding unnecessary follow-up examinations, and radiation dose reduction. A brief discussion of post-processing workflow approaches, challenges, and solutions is also included.


Assuntos
Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Meios de Contraste , Humanos , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador
16.
Clin Imaging ; 69: 349-353, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33065461

RESUMO

The COVID-19 pandemic has disrupted standard hospital operations and diagnostic radiology resident education at academic medical centers across the country. Deferment of elective surgeries and procedures coupled with a shift of resources toward increased inpatient clinical needs for the care of COVID-19 patients has resulted in substantially decreased imaging examinations at many institutions. Additionally, both infection control and risk mitigation measures have resulted in minimal on-site staffing of both trainees and staff radiologists at many institutions. As a result, residents have been placed in nonstandard learning environments, including working from home, engaging in a virtual curriculum, and participating in training sessions in preparation for potential reassignment to other patient care settings. Typically, for residents to gain the necessary knowledge, skills, and experience to practice independently upon graduation, radiology training programs must provide an optimal balance between resident education and clinical obligations. We describe our experience adapting to the challenges in educational interruptions and clinical work reassignments of 41 interventional and diagnostic radiology residents at a large academic center. We highlight opportunities for collaboration and teamwork in creatively adjusting and planning for the short and long-term impact of the pandemic on resident education. This experience shows how the residency educational paradigm was shifted during a pandemic and can serve as a template to address future disruptions.


Assuntos
COVID-19 , Internato e Residência , Radiologia , COVID-19/epidemiologia , Humanos , Pandemias , Radiologia/educação , SARS-CoV-2
19.
J Am Coll Radiol ; 17(11S): S459-S471, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33153557

RESUMO

Postpartum hemorrhage (PPH) can be categorized as primary or early if occurring in the first 24 hours after delivery, whereas late or delayed PPH occurs between 24 hours and 6 weeks. Most of the causes of PPH can be diagnosed clinically, but imaging plays an important role in the diagnosis of many causes of PPH. Pelvic ultrasound (transabdominal and transvaginal with Doppler) is the imaging modality of choice for the initial evaluation of PPH. Contrast-enhanced CT of the abdomen and pelvis and CT angiogram of the abdomen and pelvis may be appropriate to determine if active ongoing hemorrhage is present, to localize the bleeding, and to identify the source of bleeding. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Hemorragia Pós-Parto , Diagnóstico por Imagem , Medicina Baseada em Evidências , Feminino , Humanos , Hemorragia Pós-Parto/diagnóstico por imagem , Gravidez , Sociedades Médicas , Ultrassonografia , Estados Unidos
20.
Radiographics ; 40(3): 859-874, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32364883

RESUMO

Dual-energy CT is increasingly being used in the emergency department to help diagnose acute conditions. Its applications include demonstrating bone marrow edema (BME) seen in the setting of occult fractures and other acute conditions. Dual-energy CT acquires data with two different x-ray energy spectra and is able to help differentiate materials on the basis of their differential energy-dependent x-ray absorption behaviors. Virtual noncalcium (VNCa) techniques can be used to suppress the high attenuation of trabecular bone, thus enabling visualization of subtle changes in the underlying attenuation of the bone marrow. Visualization of BME can be used to identify occult or mildly displaced fractures, pathologic fractures, metastases, and some less commonly visualized conditions such as ligamentous injuries or inflammatory arthritis. The authors' major focus is use of dual-energy CT as a diagnostic modality in the setting of trauma and to depict subtle or occult fractures. The authors also provide some scenarios in which dual-energy CT is used to help diagnose other acute conditions. The causes and pathophysiology of BME are reviewed. Dual-energy CT image acquisition and VNCa postprocessing techniques are also discussed, along with their applications in emergency settings. The authors present potential pitfalls and limitations of these techniques and their possible solutions.©RSNA, 2020.


Assuntos
Doenças da Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Serviço Hospitalar de Emergência , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Tomografia Computadorizada por Raios X/métodos , Doenças da Medula Óssea/fisiopatologia , Edema/fisiopatologia , Humanos , Interpretação de Imagem Radiográfica Assistida por Computador
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