CT Esophagography for Evaluation of Esophageal Perforation.

Esophageal emergencies such as rupture or postoperative leak are uncommon but may be life threatening when they occur. Delay in their diagnosis and treatment may significantly increase morbidity and mortality. Causes of esophageal injury include iatrogenic (including esophagogastroduodenoscopy and stent placement), foreign body ingestion, blunt or penetrating trauma to the chest or abdomen, and forceful retching, also called Boerhaave syndrome. Although fluoroscopic esophagography remains the imaging study of choice according the American College of Radiology appropriateness criteria, CT esophagography has been shown to be at least equal to if not superior to fluoroscopic evaluation for esophageal injury. In addition, CT esophagography allows diagnosis of extraesophageal abnormalities, both as the cause of the patient's symptoms as well as incidental findings. CT esophagography also allows rapid diagnosis since the examination can be readily performed in most clinical settings and requires no direct radiologist supervision, requiring only properly trained technologists and a CT scanner. Multiple prior studies have shown the limited utility of fluoroscopic esophagography after a negative chest CT scan and the increase in accuracy after adding oral contrast agent to CT examinations, although there is considerable variability of CT esophagography protocols among institutions. Development of a CT esophagography program, utilizing a well-defined protocol with input from staff from the radiology, gastroenterology, emergency, and general surgery departments, can facilitate more rapid diagnosis and patient care, especially in overnight and emergency settings. The purpose of this article is to familiarize radiologists with CT esophagography techniques and imaging findings of emergent esophageal conditions. Online supplemental material is available for this article. ©RSNA, 2021.

Informatics in radiology: radiology gamuts ontology: differential diagnosis for the Semantic Web.

The Semantic Web is an effort to add semantics, or "meaning," to empower automated searching and processing of Web-based information. The overarching goal of the Semantic Web is to enable users to more easily find, share, and combine information. Critical to this vision are knowledge models called ontologies, which define a set of concepts and formalize the relations between them. Ontologies have been developed to manage and exploit the large and rapidly growing volume of information in biomedical domains. In diagnostic radiology, lists of differential diagnoses of imaging observations, called gamuts, provide an important source of knowledge. The Radiology Gamuts Ontology (RGO) is a formal knowledge model of differential diagnoses in radiology that includes 1674 differential diagnoses, 19,017 terms, and 52,976 links between terms. Its knowledge is used to provide an interactive, freely available online reference of radiology gamuts ( www.gamuts.net ). A Web service allows its content to be discovered and consumed by other information systems. The RGO integrates radiologic knowledge with other biomedical ontologies as part of the Semantic Web.

Update on multidetector computed tomography angiography of the abdominal aorta.

Multidetector computed tomography angiography (MDCTA) allows high spatial resolution, including nearly isotropic submillimeter resolution in the X, Y, and Z planes, and rapid image acquisition in a single breath hold, with greatly enhanced diagnostic capabilities over conventional CT. MDCTA has largely replaced digital subtraction angiography because it is faster, less invasive, and provides more information. When technical parameters are optimized, it provides the radiologist with the information needed to diagnose life threatening diseases of the aortoiliac system, gives critical information for the vascular surgeon or interventional radiologist to treat that disease, and identifies subsequent complications related to therapy. This article briefly discusses the technical components and optimization of MDCTA of the abdominal aorta and iliac arteries (aortoiliac system) and examines the diseases of the aortoiliac system evaluated by MDCTA.

Evidence-based radiology: a primer in reading scientific articles.

OBJECTIVE: In this article we provide a basic guide to reading scientific articles that we hope will improve the reader's ability to read and critically appraise the primary literature. CONCLUSION: We provided a series of guidelines and questions to consider when reading the primary literature. This guide is intended to help individuals read and critically appraise the primary literature and participate more fully in journal clubs and evidence-based radiology.

Prospective and retrospective ECG gating for thoracic CT angiography: a comparative study.

OBJECTIVE: The objective of our study was to compare radiation dose, contrast load, thoracic aortic attenuation value, and image quality parameters of MDCT thoracic aortography performed with prospective and retrospective cardiac gating. MATERIALS AND METHODS: Studies were performed on 80 patients (prospective ECG gating, n = 40; retrospective ECG gating, n = 40) either being evaluated for thoracic aortic aneurysm (n = 23) or aortic dissection (n = 36) or undergoing postsurgical or postintervention follow-up (n = 21). Image acquisition parameters and radiation dose (CT dose index volume [CTDI(vol)] and dose-length product [DLP]) were obtained from image archival data. Contrast load and aortic attenuation values were obtained from a data registry. The comparative degrees of motion artifact and banding artifact were assessed on parasagittal maximum-intensity-projection (MIP) images and reformatted images in the plane of the aortic valve. RESULTS: CTDI(vol) and DLP in the prospective ECG-gating group was 28.8 +/- 2.12 mGy (mean +/- SD) and 833.7 +/- 115.77 mGy/cm, respectively, which are significantly lower (p < 0.001) than those values in the retrospective ECG-gating group (74.7 +/- 13.42 mGy and 2,547.3 +/- 553.27 mGy/cm). The average contrast load in the prospective gating group was 109.1 +/- 14.74 mL and in the retrospective gating group, 101.3 +/- 10.45 mL (p < 0.05). The average aortic attenuation values (in Hounsfield units) for the prospective and retrospective ECG-gated groups were 447.6 and 350.2 HU, respectively, for the mid ascending aorta, 413.6 and 325.7 HU for the mid aortic arch, 418.2 and 327.6 HU for the mid descending aorta, and 355.0 and 306.2 HU for the supraceliac aorta. Subjective scores of motion artifact and banding artifact were equivalent between the two groups. CONCLUSION: Compared with retrospective ECG-gated thoracic CT angiography, prospective ECG-gated thoracic CT angiography was associated with a lower radiation dose, slightly increased contrast load, increased aortic attenuation values, and equivalent image quality.

Sonographic differentiation of digital tendon rupture from adhesive scarring after primary surgical repair.

PURPOSE: After the surgical repair of finger tendons finger range of motion may be limited by tendon rupture or adhesive scarring. Differentiating tendon rupture from adhesive scarring may be difficult clinically. Digital tendon sonography allows the evaluation of tendon integrity in a dynamic setting. Our objective was to determine if sonography could differentiate tendon rupture from adhesive scarring in patients who have had primary tendon repair. METHODS: A retrospective review was performed of the radiographic, clinical, and surgical records of patients referred for finger sonography over a 2-year period. Twenty-eight digits in 21 patients were evaluated for finger tendon disruption after primary surgical repair. The diagnosis of complete tendon rupture was made when 1 or more of the following was identified: a gap separating the proximal and distal tendon margins, visualization of only the proximal tendon margin, or visualization of only the distal tendon margin. Adhesive scarring was diagnosed if the tendon appeared intact with abnormal peritendinous soft tissue abutting or partially encasing the tendon, with synovial sheath thickening, or with restricted tendon motion during dynamic evaluation. RESULTS: Sonography correctly identified tendon rupture or adhesive scarring in 27 of 28 digits with 1 false-positive case (sensitivity, 100%; specificity, 93%; positive-predictive value, 93%; negative-predictive value, 100%; accuracy, 96%). CONCLUSIONS: Sonography is an accurate modality for differentiating tendon rupture from adhesive scarring in patients with prior surgical tendon repair. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic, Level I.