Evaluation of Missed Radiological Diagnosis in Multiple Trauma Patients With Full-Body Computed Tomography in the Emergency Department.

INTRODUCTION: This observational, cross-sectional, and retrospective study was conducted at the Dokuz Eylül University Emergency Department in Izmir, Turkey, after obtaining ethical consent (Dokuz Eylül University Medical Faculty Ethics Committee, approval no. 2019/15-37). In this study, we aimed to determine missed radiological diagnoses and their effects on mortality and morbidity by comparing the ED diagnoses of patients and radiology reports of these patients who presented to the emergency department (ED) with multiple traumas and scanned full-body computed tomography (CT). MATERIALS AND METHODS: This observational, cross-sectional, and retrospective study was conducted at the Dokuz Eylül University Emergency Department in Izmir, Turkey. Adult patients who presented to the ED with trauma between July 1, 2016 and June 30, 2018 and who had a full-body CT were included in the study. Radiology reports of CTs and ED electronic file information were compared. Missed diagnoses were determined for all body parts. RESULTS: In this study, 1,358 patients who had scanned full-body CT in the ED were evaluated. A total of 369 diagnoses were missed in 248 (18.3%) of the patients. The diagnosis-to-patient ratio was 0.27. In the process of individually evaluating pathological diagnoses in all body regions, it was low only in brain edema, pneumomediastinum, bladder injury, and mesentery injury. At least, there was one missed diagnosis in 88 (9.7%) of 907 (66.8%) discharged patients. At least, there was one missed diagnosis in 18/23 (78.3%) patients who died within the first 48 hours. Among the patients who have missed diagnosis, the rate of the discharged patients was 35.5%, patients called back from home was 1.2%, intensive care unit admission was 20.2%, hospitalization was 65.7%, and death was 8.9%. Among the patients who did not have missed diagnosis, the rates were 73.8%, 0%, 5%, 26.9%, and 0.8%, respectively. CONCLUSION:  Thoracic region pathologies are the most frequently missed pathologies, and orthopedics was the most frequently consulted department related to the missed diagnoses. Patients who have a missed diagnosis had lesser discharging from the ED than the other patients and had higher rates of in-hospital deaths, hospitalization, and intensive care unit admission.

MRI-based Texture Analysis in Differentiation of Benign and Malignant Vertebral Compression Fractures.

INTRODUCTION: The diagnosis and characterization of vertebral compression fractures are very important for clinical management. In this evaluation, which is usually performed with diagnostic (conventional) imaging, the findings are not always typical or diagnostic. Therefore, it is important to have new information to support imaging findings. Texture analysis is a method that can evaluate information contained in diagnostic images and is not visually noticeable. This study aimed to evaluate the magnetic resonance images of cases diagnosed with vertebral compression fractures by the texture analysis method, compare them with histopathological data, and investigate the effectiveness of this method in the differentiation of benign and malignant vertebral compression fractures. METHODS: Fifty-five patients with a total of 56 vertebral compression fractures were included in the study. Magnetic resonance images were examined and segmented using Local Image Feature Extraction (LIFEx) software, which is an open-source program for texture analysis. The results were compared with the histopathological diagnosis. RESULTS: The application of the Decision Tree algorithm to the dataset yielded impressively accurate predictions (≈95% in accuracy, precision, and recall). CONCLUSION: Interpreting tissue analysis parameters together with conventional magnetic resonance imaging findings can improve the abilities of radiologists, lead to accurate diagnoses, and prevent unnecessary invasive procedures. Further prospective trials in larger populations are needed to verify the role and performance of texture analysis in patients with vertebral compression fractures.

Manual and semi-automated computed tomography volumetry significantly overestimates the right liver lobe graft weight: a single-center study with adult living liver donors.

PURPOSE: Preoperative evaluation of donor liver volume is indispensable in living donor liver transplantation to ensure sufficient residual liver and graft-to-recipient weight ratio. This study aims to evaluate the accuracy of two computed tomography (CT) volumetry programs, an interactive manual and a semi-automated one, in the preoperative estimation of the right lobe graft weight. METHODS: One hundred and nine right liver lobe living donors between January 2008 and January 2020 were enrolled in this retrospective study. Two radiologists measured the liver graft volumes independently using manual and semi-automated CT volumetry, and the interaction time was recorded. Actual graft weight (AGW) measured intraoperatively served as the reference standard. The paired samples t-test was used to compare the estimated graft weight (EGW) and the AGW. Inter-user and inter-method agreements were assessed with Bland-Altman plots. RESULTS: Both manual and semi-automated CT volumetry significantly overestimated the graft weight (EGW manual: 893 ± 155 mL vs. AGW manual: 787 ± 128 g, P < 0.001, EGW semi-automated: 879 ± 143 mL vs. AGW semi-automated, P < 0.001). The junior radiologist measured higher volumes than the senior radiologist with either method (P < 0.001). The Bland-Altman analysis revealed mean difference and standard deviation for inter-method agreement of 7 ± 48 cc for the senior radiologist, and 34 ± 54 cc for the junior radiologist. The mean difference and standard deviation for inter-method agreement was 63 ± 59 cc in manual volumetry and 22 ± 38 cc in semi-automated volumetry. The mean interaction time was 27.3 ± 14.2 min for manual volumetry and 6.8 ± 1.4 min for semi-automated volumetry (P < 0.001). CONCLUSION: Both manual and semi-automated CT volumetry significantly overestimated the right liver graft weight, while semi-automated volumetry significantly reduced the interaction time.

Effects of Inspiratory Muscle Training in Patients With Pulmonary Hypertension.

The study aimed to examine the effects of inspiratory muscle training (IMT) in patients with pulmonary hypertension (PH). A total of 24 patients with PH were included in the randomized controlled evaluator-blind study. IMT was performed at 40% to 60% of the maximal inspiratory pressure for 30 min/d, 7 d/wk (1 day supervised) for 8 weeks. Respiratory muscle strength, dyspnea, diaphragm thickness (DT), pulmonary functions, 24-hour ambulatory blood pressure (BP), arterial stiffness, exercise capacity, upper extremity functional exercise capacity, physical activity levels, fatigue, anxiety-depression levels, activities of daily living (ADL), and quality of life were evaluated. A total of 24 patients (treatment = 12, control = 12) completed the 8-week follow-up. There was no significant difference between the patient groups in terms of demographic and clinical characteristics (p >0.05). Considering the change between the groups in the treatment and control groups, brachial and central BP, dyspnea, respiratory muscle strength, DT in total lung capacity, knee extension muscle strength, functional exercise capacity, upper extremity functional exercise capacity, physical activity, ADL, fatigue, anxiety, and quality of life improved in favor of the IMT group (p <0.05). In conclusion, IMT has improved brachial and central BP, dyspnea, respiratory muscle strength, DT in total lung capacity, knee extension muscle strength, functional exercise capacity, upper extremity functional exercise capacity, physical activity, ADL, fatigue, anxiety, and quality of life compared with the control group. IMT is an effective method in cardiopulmonary rehabilitation for patients with PH.

Effects of high intensity interval-based inspiratory muscle training in patients with heart failure: A single-blind randomized controlled trial.

BACKGROUND: Given the promising effects of inspiratory muscle training (IMT), determining the most appropriate IMT protocol will optimize the training benefits. OBJECTIVES: The objective of this study was to determine the effects of high intensity interval-based inspiratory muscle training (H-IMT) on cardiovascular, pulmonary, physical, and psychosocial functions in patients with heart failure and reduced ejection fraction (HFrEF). METHODS: Thirty-four patients with HFrEF were randomly assigned to the H-IMT or control group for 3 days/week, 8 weeks training period. The H-IMT group performed IMT at least 70% of the maximal inspiratory pressure, whereas the control group performed unloaded IMT. Each session occurred 7 sets with a total of 21 min consisting of 2-min training and 1-min interval. Heart rate variability (HRV), arterial stiffness, respiratory muscle strength and endurance, diaphragm thickness, quadriceps strength, functional capacity, frailty, dyspnea, fatigue, disease-specific health-related quality of life (HRQoL), and generic HRQoL were evaluated at baseline and after 8 weeks training period by blinded assessors. RESULTS: Statistically significant between-group differences were observed in the time domain parameters of HRV, arterial stiffness, inspiratory and quadriceps muscle strength, respiratory muscle endurance, diaphragm thickness, functional capacity, frailty, dyspnea, fatigue, and disease-specific HRQoL in favor of the H-IMT group (p<0.05). CONCLUSIONS: H-IMT is an effective protocol for improving cardiac autonomic function, arterial stiffness, inspiratory and quadriceps muscle strength, respiratory muscle endurance, diaphragm thickness, functional capacity, frailty, dyspnea, fatigue, and disease-specific quality of life in patients with HFrEF. CLINICAL TRIAL REGISTRATION: NCT04839211.

Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study

PURPOSE: To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. METHODS: This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. RESULTS: Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. CONCLUSION: Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19.

Lung density analysis using quantitative computed tomography in children with pectus excavatum.

PURPOSE: To evaluate the mean lung density in children with pectus excavatum (PE) and to assess the correlation between the cardiac rotation angle, Haller index, pulmonary function test, and lung density. MATERIAL AND METHODS: This retrospective study included 33 children with PE and 31 healthy controls. The densities of lung parenchyma were evaluated by quantitative computed tomography (CT). Three lung levels were determined: T4 vertebra level, T10 vertebra level, and the level of the measurement of the cardiac rotation angle. The cardiac rotation angle and the Haller index were calculated. All measurements were done by 2 radiologists, independently. Student's t-test or the Mann-Whitney U test, intraclass correlation coefficients, Pearson or Spearman's rank correlation coefficient, and Kruskal-Wallis test were used for statistical analysis. A p-value less than 0.05 was considered as statistically significant. RESULTS: All the lung levels in the PE group had lower mean densities than healthy children, with statistical significance in the right lung at the T10 vertebra level (-818.60 ± 33.49 HU, -798.45 ± 40.24 HU; p = 0.028). There was a correlation between the cardiac rotation angle and the Haller index (r = 0.593; p < 0.001). There were no correlations between mean lung density and cardiac rotation angle, Haller index, and pulmonary function tests. CONCLUSIONS: The lower mean lung densities were found in PE, especially in the right lower lobe. The parenchymal aeration should be considered independently from the severity of PE.