Computed Tomography Scan Findings Research Articles

Radiographs demonstrate poor accuracy for evaluation of postoperative osseous integration of osteochondral allografts in the knee

PurposeTo evaluate the interrater reliability and accuracy of radiographs in assessing healing of osteochondral allografts (OCA) in the knee compared to computed tomography (CT) imaging. MethodsA retrospective review patients who underwent OCA transplantation of the knee was conducted. Postoperatively, knee radiographs were obtained at three and six months, and CT scans were obtained at six months. Three board-eligible orthopaedic surgeons independently graded postoperative radiographs, utilizing the grading scale established by Oladeji et al 2017, and the CT scans utilizing the grading scale established by Gelber et al 2021. Their consensus measurements served as a comparative gold standard. ResultsAmong 44 prospectively imaged grafts, 13 (29.5%) had radiographs at three months and 28 (63.6%) had radiographs available for evaluation at six months. Assessment of radiographic integration demonstrated low reliability (ICC: -0.02 to 0.14). On CT scan, this improved to fair reliability (k=0.29, p<0.001). However, Spearman rho between CT and XR grading demonstrated poor correlation (ρ = -0.23, p=0.04). Among six-month postoperative radiographs, accuracy of cyst identification was negatively correlated to greater degree of cystic changes from 90.9% (30/33 correct; no cystic changes) to 19.4% (7/36 correct; small cystic changes) and 33.3% (5/15 correct; large cystic changes). Overall true positive cyst detection rates on radiographs were 27.8% to 46.7%. ConclusionRadiographs demonstrate poor interrater reliability and accuracy in evaluation of healing after OCA transplantation of the knee. Notably, there was a high rate of missed cystic changes on radiographic analysis, as well as poor correlation of integration assessment with CT scan findings.

Diagnostic accuracy of double density sign on CT scan of para-nasal sinuses for fungal sinusitis taking microbiology culture as gold standard.

To compare double-density sign on non-contrast computed tomography scan of paranasal sinuses with fungal sinusitis on histopathology. This prospective study was conducted at the Shifa International Hospital, Islamabad, Pakistan, from July 1, 2021, to June 30, 2023, and comprised patients of either gender aged 20-60 years who were set to undergo functional endoscopic sinus surgery. Demographic characteristics and non-contrast computed tomography scan findings were recorded preoperatively, while microbiological and histopathology results were recorded post-operatively. The microbiological finding was taken as the gold standard. Data was analysed using SPSS 23. Of the 201 patients, 123(61.2%) were males and 78(38.8%) were females. The overall mean age was 41.62±8.52 years. The diagnostic accuracy of a double-density sign on computed tomography scan showed sensitivity 90%, specificity 90.8%, positive predictive value 84%, and negative predictive value 94.4%. A higher rate of sensitivity and specificity indicated that non-contrast computed tomography scan was an effective modality that could be used for the diagnosis of fungal sinusitis.

The role of radiological imaging in the management of severe and difficult-to-treat asthma.

Radiological imaging has proven to be a useful tool in the assessment of asthma, its comorbidities and potential complications. Characteristic chest radiograph and computed tomography scan findings can be seen in asthma and in other conditions that can coexist with or be misdiagnosed as asthma, including chronic rhinosinusitis, inducible laryngeal obstruction, excessive dynamic airway collapse, tracheobronchomalacia, concomitant COPD, bronchiectasis, allergic bronchopulmonary aspergillosis, eosinophilic granulomatosis with polyangiitis, and eosinophilic pneumonia. The identification of the characteristic radiological findings of these conditions is often essential in making the correct diagnosis and provision of appropriate management and treatment. Furthermore, radiological imaging modalities can be used to monitor response to therapy.

Incidental findings in brain CT scans of patients with head trauma

Objective: Incidental findings (IFs) are newly discovered abnormal findings unrelated to the primary purpose of imaging. Brain computed tomography (CT) scan is one of the most essential and initial imaging evaluations for head trauma patients, which may also have nontraumatic IFs. We aim to investigate the prevalence and nature of IFs in brain CT scans of head trauma patients. Methods: We conducted a cross-sectional study to evaluate brain CT scans of 1006 head trauma patients over one year (April 2021 to March 2022), to identify incidental findings by consensus agreement of two radiologists. We categorized the incidental findings into four categories based on appropriate follow-up recommendations. Results: We included 1006 head trauma patients who underwent brain CT scan, of which 126 incidental findings were discovered in brain CT scan of 107 patients. The prevalence of incidental findings was 10.6% (107/1006). The most common incidental finding was brain atrophy (n=15, 11.9%). The mean age of patients with IFs was significantly higher than those without IFs, but there was no difference between the two groups regarding gender. Conclusion: The discovery rate of incidental findings of brain CT scans in head trauma patients was considerable. Serious medical findings that need immediate evaluation were found in 5.6% of patients, mostly over the age of 40. Therefore, patients who have clinically significant incidental findings need improved documentation and follow-up to evaluate the long-term outcomes and reliability of imaging results.

Contrast-enhanced point of care ultrasound for the evaluation of stable blunt abdominal trauma by the emergency physician: A prospective diagnostic study.

Clinical examination alone cannot reliably rule out significant traumatic abdominal injury. Computed tomography (CT) has become the primary method for evaluating blunt abdominal trauma and clinicians rely heavily on it to rule out abdominal injury. Ultrasound examination may miss significant abdominal injury particularly in stable patients. The use of a contrast agent improves ultrasound sensitivity to visceral abdominal injuries. The objective of this diagnostic study is to compare bedside contrast enhanced ultrasound (CEUS) performed by emergency physicians to CT in hemodynamically stable adults for the assessment of blunt abdominal trauma and evaluate CEUS accuracy outcomes. Hemodynamically stable patients with blunt trauma were prospectively enrolled in the trauma bay. After initial evaluation, we included patients at risk of abdominal injury and for whom an abdominal CT was planned by the trauma leader. Ultrasonography was performed prospectively and at the bedside by the emergency physician followed by abdominal CT used as a reference standard. Thirty-three patients were enrolled in the study; among them, 52% showed positive traumatic findings in abdominal CT scans, and 42% were diagnosed with solid organ lesions. Compared to CT, a focused abdominal sonography (FOCUS) examination, looking for free fluid or perirenal hematoma, showed limited performance for traumatic findings with a sensitivity of 65% (95% confidence interval [CI]: 38%-86%), a specificity of 75% (95% CI: 48%-93%), a negative likelihood ratio (NLR) of 0.47 (95% CI: 0.23-0.95), and a positive likelihood ratio (PLR) of 2.59 (95% CI: 1.03-6.48). When combining FOCUS with CEUS, the sensitivity of the sonography increased to 94% (95% CI: 71%-100%) with a specificity of 75% (95% CI: 48%-93%). The PLR was 3.76 (95% CI: 1.6-8.87) and the NLR was 0.08 (95% CI: 0.01-0.54). In our population, abdominal sonography with contrast failed to identify a single positive abdominal CT with a grade 1 kidney injury. A FOCUS examination shows limited sensitivity and specificity to detect positive abdominal CT in stable adults with abdominal trauma. With the addition of contrast and careful inspection of solid organs, abdominal sonography with contrast performed by the emergency physician improves the ability to rule out traumatic findings on abdominal CT. CEUS performed by emergency physicians may miss injuries, especially in the absence of free fluid, in cases of low-grade injuries, simultaneous injuries, or poor-quality examinations.

Risk Factors for Post-traumatic Epilepsy in Patients with Traumatic Brain Injuries

Background: Post-traumatic epilepsy (PTE) is one of the types of epilepsy, which is a complication of traumatic brain injury (TBI) that occurs after TBI or 7 days later. Objectives: The present study aimed to determine the risk factors for PTE in patients with TBI. Methods: The computed tomography (CT)-scan results of all TBI patients were investigated in this retrospective study. At first, initial evaluation, including the examination of airways, vital signs, and breathing, was performed, and the level of consciousness was checked according to the Glasgow Coma Scale (GCS) for all traumatic patients. Then, the results of all CT scans were evaluated by a neurologist. If the patient had PTE, she/he was included in the study. Data analysis was carried out using descriptive statistics in SPSS software (version 16). Results: The results showed that mild, moderate, and severe GCS scores were reported in 8 (14.3%), 30 (52.5%), and 18 (32.2%) participants, respectively. Vehicle accidents were the main cause of TBI (n = 34, 60%), and the lowest TBI rate was due to other cases (n = 4, 7.2%). The most and least frequent CT-scan finding was epidural hemorrhage (EH) (n = 24, 42.3%) and midline shift and intracerebral hemorrhage (n = 6, 10.8%), respectively. A total of 24 patients (42.3%) had tonic epilepsy, and 10 patients (17.9%) had epilepsy duration of more than 10 minutes. Conclusions: The most frequent risk factors included vehicles, falling from a height, and strikes, respectively. Additionally, the most common CT scan findings included EH and subarachnoid hemorrhage (SH). Motor vehicle accidents account for the highest rate of TBI-related PTE. For this reason, it is necessary to take preventive measures in this regard.

Evaluation of computed tomography (CT) findings in patients with symptomatic deviated nasal septum and their correlation with intraoperative findings

AimTo evaluate the computed tomography (CT) findings in patients having a symptomatic deviated nasal septum (DNS) and their comparison with intraoperative findings.MethodsCross-sectional, observational study done in the department of ENT and HNS at a tertiary care center, over a period of 16 months. Patients presenting with nasal obstruction as the chief complaint and findings of deviated nasal septum on anterior rhinoscopy without clinical features of chronic rhinosinusitis (CRS) were included in the present study. All patients underwent CT scans of paranasal sinuses (PNS) as per the govt. scheme for approval of surgery. Surgery was planned as per the indication based on history, clinical examination, and non-contrast CT scan PNS findings. The average duration from CT scan to surgery was 4.5 weeks.ResultsAll 200 (100%) patients had DNS with inferior turbinate hypertrophy in 103 (52.5%), concha bullosa in 22 (11.0%), pneumatized superior turbinate in 6 (3.0%), and PMT (paradoxical middle turbinate) in 22 (11.0%). On comparing CT scan findings with intraoperative findings, it was found that maxillary sinus involvement had been seen in 28 (14.0%) patients on CT scan and only 8 (4.0%) patients intraoperatively. Similarly, CT scan involvement compared to and intraoperative involvement of anterior ethmoidal sinus was seen in 20 (10.0%) compared to 6 (3.0%) patients intraoperatively, posterior ethmoid in 12 (6.0%) compared to 3 (1.5%) frontal sinus in 4 (2.0%) compared to 1 (0.5%), sphenoid in 11 (5.5%) compared to 2 (1.0%), and osteomeatal complex (OMC) in 27 (13.5%) compared to 6 (3.0%) patients intraoperatively. Involvement of PMT, enlarged inferior, and concha bullosa was similar on CT scan and intraoperatively.ConclusionFrom this study, we concluded that a preoperative CT scan is a poor tool in predicting sinus disease in patients without clinical features of sinus disease and has a limited role in patients with symptomatic DNS. Insurance companies and government agencies should review their policies of ordering CT scans for approving septal surgeries.

Role of Computed Tomography in Differentiating between Benign and Malignant Gallbladder Masses with Histopathological Correlation

A cross-sectional study was done to evaluate computed tomography (CT) scans as a diagnostic tool for distinguishing between benign and malignant gallbladder masses corroborated by histopathological findings. The study was conducted in the Department of Radiology &amp; Imaging of Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, between January and December of 2013. The study included a total of 45 patients who were ultrasonographically diagnosed with gallbladder masses. Later, those patients underwent CT scans using a 16-slice helical CT scan machine. All CT scan findings were interpreted by the specialist radiologists, focusing on lesion involvement, contrast enhancement characteristics, and invasion into adjacent structures. Postoperative tissues were examined histopathologically, and these findings were correlated with the CT scan results. The study revealed a higher prevalence of GBC in females (73.33%) and in the age group of 40-60 years. CT scans indicated malignancy in 84.44% of cases, which was confirmed as adenocarcinoma in 88.89% of cases through histopathology. The sensitivity, specificity, and accuracy of CT scans for detecting malignant gallbladder masses were 90.24%, 75.00%, and 88.89%, respectively. For benign masses, the corresponding values were 75.00%, 90.24%, and 88.89%. The positive predictive value was notably high at 97.37% for malignant masses but lower at 42.86% for benign masses. CT scans demonstrated high sensitivity and specificity in the diagnosis of malignant gallbladder masses, corroborated by histopathological findings. The study underscores the utility of CT scans as an effective, non-invasive diagnostic tool for early detection and management of gallbladder masses, although caution is advised in interpreting benign results due to a lower positive predictive value. CBMJ 2024 January: vol. 13 no. 01 P: 22-27

Surgical Treatment of Trigonocephaly, Simplified Technique for Moderate Cases.

The prevalence of trigonocephaly has increased worldwide over the past 2 decades. Early identification and appropriate treatment are critical. The aim of this study is to evaluate the outcomes and the effect of metopic suture excision, perisutural frontal bone shave, and bilateral pericranial flap method on the shape of the forehead after surgical correction in infants with moderate trigonocephaly. The present study was performed as a cross-sectional study on 40 infants of 3 to 12 months old with trigonocephalus who underwent metopic suture excision and pericardial flap surgery in Mofid Pediatric Hospital from 2016 to 2022. The definitive diagnosis of patients' trigonocephaly was made based on clinical signs and computed tomography scan findings by a plastic surgeon. Overall in 40 patients operated by this technique, 23 (57.5%) of cases were males, and 17 (42.5%) were females. The mean age of patients was 7.86 ± 2.22 months. Hospital stay was 2 to 4 days (mean: 3d), intensive care unit admission was in 33 cases for 24 hours, and no intensive care unit admission for 7 cases. Blood was transfused during surgery for 25 patients, and 15 patients did not require blood transfusion use. Results were evaluated in 6 to 12 months after surgery by 3 independent plastic surgeons, with pre and postoperative photos. Satisfaction with the results of forehead shape was excellent for 60% of patients, good for 37.5%, and moderate for 2.5%. Only one female patient had a recurrence after the surgery. This study showed that the pericranial flap method after full metopic suture excision and frontal shave was very effective in the treatment of infants with moderate trigonocephaly.

Preoperative Orbital CT Scan Findings in Patients with Nasolacrimal Duct Obstruction and its Impact on Surgical Planning

Background: External dacryocystorhinostomy (DCR) failure is sometimes due to pathologies located within the nasal cavity. Preoperative computerized tomography (CT) scan is useful in the assessment of nasolacrimal drainage and adjacent anatomical structures; however, it is not routinely performed before DCR. The present study evaluates abnormal findings in CT scans of patients with nasolacrimal duct obstruction (NLDO) and its effect on changing treatment approaches. Methods: This prospective descriptive cross-sectional study included 162 patients with NLDO. All the patients underwent a supine axial CT scan. Patients with signs of rhinosinusitis, sinus mucositis, nasal septal deviation, nasal polyps or masses, and turbinate deformities were referred to an otolaryngologist. The rest of the patients underwent external DCR. The demographics and radiologic characteristics of the patients undergoing CT scan and their effect on changing treatment approaches were evaluated. Results: The study participants included 162 patients with a mean±SD age of 62.5±14.0 years (age range of 35-93 years). The percentage of endonasal DCR in cases with an abnormal nasal cavity on CT scan was almost 30% higher compared to those without this problem (59.6% vs. 30.2%). Septum deviation and turbinate deformity led to 3.6-fold and 3.9-fold changes in the surgical approach, respectively. Conclusion: A significant association existed between the sinonasal pathologies in patients with NLDO and changing surgical approaches. It is believed that a preoperative CT scan is necessary to detect such pathologies and manage them appropriately.

Leukopenia and leukocytosis as strong predictors of COVID-19 severity: A cross-sectional study of the hematologic abnormalities and COVID-19 severity in hospitalized patients.

Predicting severe disease is important in provocative decision-making for the management of patients with the coronavirus disease 2019 (COVID-19); However, there are still some controversies about the COVID-19's severity predicting factors. This study aimed to investigate the relationships between clinical and laboratory findings regarding COVID-19's severity in patients admitted to a tertiary hospital in Mashhad, Iran. A cross-sectional study was conducted on patients with documented COVID-19 infection based on the reverse transcription-polymerase chain reaction test. Clinical symptoms, vital signs, and medical history of the patients were recorded from their medical records. Laboratory findings and computed tomography (CT) study findings were documented. Disease severity was defined based on CT scan findings. A total of 564 patients (58.8 ± 16.8 years old) were evaluated. The frequency of severe disease was 70.4%. There was a significant difference in heart rate (p = 0.0001), fever (p = 0.002), dyspnea (p = 0.0001), chest pain (p = 0.0001), diarrhea (p = 0.021), arthralgia (p = 0.0001), and chills (p = 0.044) as well as lymphopenia (p = 0.014), white blood cell count (p = 0.001), neutrophil count (p < 0.0001), lymphocyte count (p < 0.0001), and prothrombin time (p = 0.001) between disease severity groups. Predictors of severe COVID-19 were pulse rate (crude odds ratio [cOR] = 1.014, 95% confidence interval [CI] for cOR: 1.001, 1.027) and leukopenia (cOR = 3.910, 95% CI for cOR: 1.294, 11.809). Predictors for critical COVID-19 were pulse rate (cOR = 1.075, 95% CI for cOR: 1.046, 1.104), fever (cOR = 2.516, 95%CI for cOR: 1.020, 6.203), dyspnea (cOR = 4.190, 95% CI for cOR: 1.227, 14.306), and leukocytosis (cOR = 3.866, 95% CI for cOR: 1.815, 8.236). Leukopenia and leukocytosis have the strongest correlation with the COVID-19 severity. These findings could be a valuable guild for clinicians in COVID-19 patient management in the inpatient setting.

Clinical decision rules in predicting computed tomography scan findings and need for neurosurgical intervention in mild traumatic brain injury: a prospective observational study.

In this study, we will compare the diagnostic values of head CT decision rules in predicting the findings of CT scans in a prospective multicenter study in university emergency departments in Iran. The primary outcome was any traumatic lesion findings in brain CT scans, and the secondary outcomes were death, the need for mechanical ventilation, and neurosurgical intervention. Decision rules including the Canadian CT Head Rule (CCHR), New Orleans Criteria (NOC), National Institute for Health and Clinical Excellence (NICE), National Emergency X-Radiography Utilization Study (NEXUS), and Neurotraumatology Committee of the World Federation of Neurosurgical Societies (NCWFNS) were compared for the main outcomes. In total, 434 mild TBI patients were enrolled in the study. The NCWFNS had the highest sensitivity (91.14%) and the lowest specificity (39.42%) for predicting abnormal finding in CT scan compared to other models. While the NICE obtained the lowest sensitivity (79.75%), it was associated with the highest specificity (66.67%). All model performances were improved when administered to predict neurosurgical intervention among patients with GCS 13-15. NEXUS (AUC 0.862, 95% CI 0.799-0.924) and NCWFNS (AUC 0.813, 95% CI 0.723-0.903) had the best performance among all evaluated models. The NCWFNS and the NEXUS decision rules performed better than the CCHR and NICE guidelines for predicting any lesion in the CT imaging and neurosurgical intervention among patients with mTBI with GCS 13-15. For a subset of mTBI patients with GCS 15, the NOC criteria havehigher sensitivity for abnormal CT imaging, but lower specificity and more requested CTs.

Computerized Tomography Scan Findings in Pediatric Patients with Coronavirus Disease 2019

Background: This study aimed to ascertain the computerized tomography findings of 56 children diagnosed with coronavirus disease 2019 (COVID-19) at Ali Ibn Abitalib Hospital in Zahedan, Iran. Methods: This descriptive, cross-sectional study was conducted on 56 pediatric patients with laboratory-confirmed COVID-19 who were treated at Ali Ibn Abitalib Hospital in Zahedan from March to August 2020. The computerized tomography (CT) scans were performed for these children because they did not show signs of improvement, had decreased oxygen levels during the treatment, had severe respiratory symptoms, or had a breathing disorder. The CT findings were reviewed to determine the frequency of normal and abnormal scans. The distribution of lesions (unilateral, bilateral, peripheral, central), type of opacity (consolidation, ground glass, etc.), and presence or absence of bronchiectasis, effusion, cavity, and lymphadenopathy were recorded. The frequency of each type of lesion was then calculated. Results: Of the patients, 30.36% had a normal CT scan. The most common CT scan finding was ground-glass opacity (42.86%), followed by consolidation (35.71%). The distribution of lesions was mostly bilateral (64.10%) and mainly peripheral (66.67%). Conclusions: One-third of children with COVID-19 had normal CT features. Ground-glass opacity and consolidation were more common than cavity or pneumatocele, pleural effusion, bronchiectasis, and lymphadenopathy.

Pulmonary Invasive Fungal Disease: Ultrasound and Computed Tomography Scan Findings.

The importance of ultrasound in diagnosing pulmonary invasive fungal diseases (IFD) has yet to be assessed. Thus, this study aimed to evaluate the frequency of sonographic findings in patients suspected of an invasive pulmonary fungal infection. This prospective longitudinal study examined all patients with lung lesions in imaging modalities and suspected IFDs referred to Dr. Sheikh and Akbar pediatric hospitals from 2019 to 2022. Considered variables were the halo sign in the computed tomography (CT) scan; the target sign in the ultrasound and contrast-enhanced CT scan; the cavity; wedge-shaped consoli- dation; and pleuritis and extrapulmonary invasion to the chest wall or subdiaphragmatic invasion in both modalities. All patients who underwent lung CT scans and ultrasounds until the final diagnosis were followed up. The degree of agreement between ultrasound and CT scan findings and the sensitivity, specificity, and diagnostic accuracy of these signs were assessed. This study involved 40 patients with an average age of 7.16 ± 4.23 years. Acute leukemia was the commonest underlying dis- ease detected in 17 (42.5%) cases. The target sign in ultrasound (61.9%) and the halo sign in CT scan (71.4%) had the highest frequency among the variables in patients with IFD. Cohen's kappa coefficient agreement in both modalities was 0.5 for the cavity, with significant relation (P = .02). The Cohen's kappa was less than .17 for other findings (P > .05). The diagnostic criteria in the simultaneous examina- tion of the fungus target in ultrasound and halo in CT scan showed a sensitivity of 82.4% and specificity of 76.5%, respectively. Combining the characteristic findings of ultrasound and CT-scan provides a higher value in diagnosing pulmonary invasive fungal disease.

Invasive aspergillosis in liver transplant recipients, an infectious complication with low incidence but significant mortality.

Infections, including invasive fungal infections (IFIs), are among the leading causes of mortality in liver transplant recipients during the first year post-transplantation. To investigate the epidemiology, clinical manifestations, risk factors, treatment outcomes, and mortality rate of post-liver transplantation invasive aspergillosis (IA). In this case-control study, 22 patients with IA were identified by reviewing the archived and electronic medical records of 850 patients who received liver transplants at the Imam Khomeini Hospital complex in Tehran, Iran, between 2014 and 2019. The control group comprised 38 patients without IA infection matched for age and sex. The information obtained included the baseline characteristics of liver transplant patients, operative reports, post-transplantation characteristics of both groups and information about the fungal infection of the patient group. The prevalence rate of IA among liver transplant recipients at Imam Khomeini Hospital was 2.7%. The risk factors of IA among studied patients included high serum creatinine levels before and post-transplant, renal replacement therapy, antithymocyte globulin induction therapy, post-transplant bile leakage, post-transplant hepatic artery thrombosis, repeated surgery within 30 d after the transplant, bacterial pneumonia before the aspergillosis diagnosis, receiving systemic antibiotics before the aspergillus infection, cytomegalovirus infection, and duration of post-transplant hospitalization in the intensive care unit. The most prevalent form of infection was invasive pulmonary aspergillosis, and the most common chest computed tomography scan findings were nodules, pleural effusion, and the halo sign. In the case group, prophylactic antifungal therapy was administered more frequently than in the control group. The antifungal therapy response rate at 12 wk was 63.7%. The 3- and 12- mo mortality rates of the patients with IA were 36.4% and 45.4%, respectively (compared with the mortality rate of the control group in 12 mo, which was zero). In this study, the prevalence of IA among liver transplant recipients was relatively low. However, it was one of the leading causes of mortality following liver transplantation. Targeted antifungal therapy may be a factor in the low incidence of infections at our facility. Identifying the risk factors of IFIs, maintaining an elevated level of clinical suspicion, and initiating early antifungal treatment may significantly improve the prognosis and reduce the mortality rate of liver transplant recipients.

Correlation of clinical features with neuroimaging in children with mild head injury.

Mild head injury is defined as a pediatric Glasgow Coma Scale (GCS) score of 13-15 at admission following head trauma. There are no clear indications for neuroimaging in such children. The aim of our study was to analyze the correlation of symptoms commonly encountered following mild head injury with any abnormality on the computed tomography (CT) scan. This is a retrospective and observational study done in a tertiary care hospital. Records of all the children fulfilling the inclusion criteria were retrieved. Demographic details such as age, gender, and type of injury (hit by a blunt object, fall from height, and road traffic accident), symptoms such as presence and number of episodes of vomiting, presence and duration of loss of consciousness (LOC), presence of drowsiness, headache, giddiness, seizures, focal deficits and the GCS score, and CT scan findings were noted in a predesigned proforma. A CT scan with any of the following abnormalities such as skull fracture, cerebral edema, intracranial bleed (epidural hematoma, subdural hematoma, intracerebral hematoma, and subarachnoid hemorrhage), and cerebral contusion was considered as abnormal. Any neurosurgical intervention done was also noted. A total of 134 children in the age group of 1 month to 18 years with mild head injury were included in this study. The median (interquartile range) age of the children was 5 (2, 8) years, with majority being males. Road traffic accidents (34.3%) were the most common cause of injury, followed by fall from lesser than 3 feet height (31.3%). The most common symptoms were vomiting (43.6%), scalp/facial abrasions (37.2%), and LOC (31.9%). CT scan was abnormal in 53.7% of the cases, with skull fracture (35.1%) being the most common finding, followed by cerebral edema (13.4%). Among all the symptoms, ear/nosebleed or cerebrospinal fluid (CSF) otorrhea/rhinorrhea had a statistically significant association with a positive CT scan with P = 0.05 and an odds ratio of 1.4 (95% confidence interval, 1-1.9). Children with mild head injury presenting with clinical features such as bleeding from the ear or nose and CSF otorrhea/rhinorrhea are more likely to have an abnormal CT scan. Hence, such children require close neurological observation and prompt intervention if necessary. However, abnormality on CT scan cannot be reliably ruled out based on the symptoms alone.

Computed Tomographic Evaluation of Renal Mass with Histopathological Correlation

Renal cell carcinoma (RCC) is the seventh most common cancer and the most common primary renal malignant neoplasm in adults. Computed Tomography (CT) is of a great value in differentiating malignant from benign masses of RCC. This cross-sectional study was conducted among 61 clinically suspected cases of renal mass at Sir Salimullah Medical College and Mitford Hospital (SSMC and Mitford Hospital) in the Department of Radiology and Imaging in collaboration with the Department of Urology and Pathology, from July ’2011 to June’ 2013. However, in 05 cases, histopathological reports were not available and 07 patients refused surgery after enrolling. Finally, histopathology reports were collected from 49 patients and they were considered as study subjects. Aim of the study was to evaluate the accuracy of CT scan findings in compere with the histopathological report for the diagnosis of renal mass and to differentiate its benign and malignant forms. The age range of the patients was 2 to 73 years, where more than two-third (69.38%) were male and rest of them were female. Maximum number of malignant cases observed in the age range of 50-59 years. In comparison, inflammatory and benign conditions dominate in early age group, mostly before 40 years. Among 49 cases, 41 (83.68%) cases were diagnosed as malignant renal mass by CT scan, 01 (2.04) case was missed, which was confirmed by histopathology. Rest 07 (14.28%) patients were diagnosed as benign both in CT scan and histopathology. The sensitivity of CT for malignant renal mass was found 97.62% and specificity was 100%. The positive and negative predictive values of CT were 87.5% and 97.59% respectively. Computed tomography is a valid diagnostic modality for differentiating benign and malignant renal mass. Bangladesh Med J. 2021 Sept; 51(1): 41-46

Use of National Institute for Health and Care Excellence head injury guidelines among patients with delayed presentation after head trauma can lead to missed traumatic brain injury: a 5-year institutional review.

In 2014, traumatic brain injury (TBI) caused 3 million ER visits, hospitalizations, and deaths in the US. The National Institute for Health and Care Excellence (NICE) guidelines, initially generated using data from patients presenting within 24h of head trauma, are used to determine the need for head computed tomography (CT) scan in patients after 24h. The authors wanted to determine the proportion of CT scans for head trauma performed at our center in late presenters (>24h after head trauma), the incidence of intracranial pathology in early (24h) versus late (>24h) presenters, and the sensitivity of the NICE guidelines for TBI in these two subpopulations. A retrospective chart review was conducted at a tertiary care center in Karachi. All people (>16) who had a head CT for head trauma from 2010 to 2015 were included. Age, sex, primary diagnosis, comorbid disorders, mechanism-of-injury, duration (in hours) from head trauma to presentation, site, and extent of injury (injury severity scale), hospital stay, number and details of surgical procedures, CT scan findings, other injuries, and mortality were recorded. Means were compared using the Independent Sample t-test, while categorical variables were compared using χ2. Multivariate logistic regression analyses were used to identify TBI predictors. The authors found 2009 eligible patients; seven were excluded due to incomplete medical records. The final statistical analysis comprised 2002 head trauma patients. Overall, 52% of early and late presenters had severe injuries, and 2.3% died. 32.2% of patients with head trauma had CT after 24h. Early presenters were 46.7% traumatized, while late presenters were 63%. The NICE guidelines were 93% sensitive for early presenters and 83% for late presenters with traumatic intracranial injury. Patients coming to the emergency department after 24h of head trauma are a large proportion of the overall head trauma population. The NICE guidelines for late-presenting head injuries are less sensitive and may overlook intracranial injuries if imaging is not performed.

Impact of Fatigue on Emergency Physicians' Decision-making for Computed Tomographic Scan Requests and Inpatient Referrals: An Observational Study from a Tertiary Care Medical Center of the Sultanate of Oman.

Multiple factors contribute to decision fatigue experienced by emergency physicians (EPs). This study examines the association between decision fatigue and the frequency of computed tomographic (CT) scan requests and inpatient referrals among EPs. This retrospective database analysis was done for 3 months. Scans and inpatient referral requests were coded and analyzed to assess the impact of physician fatigue on decision-making. Subsequently, the outcomes were evaluated. The majority of patients (n = 481; 51.1%) had a CT brain request. Among these requests, the morning shift (8:00 a.m.-3:00 p.m.) accounted for the highest number (n = 400; 42.5%), followed by the evening shift (3:00-11:00 p.m.) (n = 345; 36.7%). Approximately one-third of the patients (n = 301; 31.9%) had positive CT scan findings. Statistical analysis comparing the first and the second halves of each shift did not reveal significant variations in the percentage of negative CT results (p-value: 0.093). Inpatient referral was necessary for over half of the patients (n = 1,048; 52.7%), and the majority of these referrals (n = 778; 74.2%) were deemed necessary for treatment under various surgical or medical specialties. There was a statistically significant difference in the proportion of negative inpatient referrals between the first and the second halves of the afternoon shift (p-value < 0.001). Fatigue among EPs was observed, leading to more frequent consultations without inpatient admission during the latter half of the afternoon shift. However, the study found no significant impact of decision fatigue on CT scan decision-making. Al-Arimi AH, Hazra D, Al-Alawi AKA. Impact of Fatigue on Emergency Physicians' Decision-making for Computed Tomographic Scan Requests and Inpatient Referrals: An Observational Study from a Tertiary Care Medical Center of the Sultanate of Oman. Indian J Crit Care Med 2023;27(9):620-624.

Investigating the Compatibility of Lung CT Scan Findings and Molecular Diagnosis Test of Patients With COVID-19 in Shahid Beheshti Hospital in Hamedan

Background: This study aimed to investigate the diagnostic value of computed tomography (CT) scan based on the results of reverse transcription polymerase chain reaction (RT-PCR) molecular diagnosis test in the diagnosis of COVID-19 diseases. Methods: In this study, 451 files related to hospitalized patients with initial diagnosis of COVID-19 were examined. Demographic information, symptoms, and results of both tests were extracted from the files. After collecting information by sampling method, the data were analyzed by SPSS software. In order to describe the data, mean and standard deviation statistics were used for qualitative data. Moreover, the Kappa test was used to measure the compatibility of the three methods. Results: The concordance rate of PCR and CT scan was calculated at 66%, of which 55.3% were positive, and 10.7% were negative. The results were obtained with an accuracy of 68.9%, a precision of 91.5%, a sensitivity of 69.1%, a specificity of 68%, and an F1-score of 95.10%. In general, based on the statistical criteria, the calculated percentage is an acceptable value. Conclusion: According to the appropriate matching percentage of CT scan and RT-PCR molecular diagnosis test, both techniques can be used as a diagnosis criterion according to the patient’s symptoms.