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There is a lack of data regarding the baseline hemodynamic blood flow parameters of the wrist and digits. Therefore, we aimed to quantify the digital and radial artery blood flow parameters using ultrasound and assess the influence of patient characteristics on hemodynamics. We analyzed ultrasonographic data from 25 patients (50 hands) between October 2019 and December 2021. Variables of interest included dimensions of the radial artery and index finger (IF) ulnar and radial digital arteries at the palmodigital crease and their corresponding flow parameters. We compared variables among men and women and patients with and without diabetes using Wilcoxon Rank Sum test. Our cohort consisted of 18 women (36 hands) and three participants with diabetes (six hands). The mean diameter of the IF radial digital artery was 7 mm, and that of the ulnar digital artery was 10 mm. The average peak systolic velocity for the radial digital artery was 21.31 cm/sec, and for the ulnar digital artery, it was 30.03 cm/sec. Comparing men and women, the only significant difference found was in the time-averaged mean velocity for the ulnar digital artery (men:5.66 cm/sec vs. women:9.68 cm/sec, P = 0.02) and volume of flow for the ulnar digital artery (men:10.87cc/min vs. women:18.58cc/min, P = 0.03). We found no differences in blood flow parameters comparing participants with and without diabetes. These data provide a baseline measurement of digital flow hemodynamics that can be used in future studies to model vascular flow after replantation. [ABSTRACT FROM AUTHOR]

There has been a rapid increase in the number of shoulder arthroplasties, including partial or complete humeral head resurfacing, hemiarthroplasty, total shoulder arthroplasty, and reverse total shoulder arthroplasty, performed in the United States over the past two decades. Imaging can play an important role in diagnosing the complications that can occur in the setting of these shoulder arthroplasties. This review is divided into two parts. The first part provides a general discussion of various imaging modalities, comprising radiography, CT, MRI, ultrasound, and nuclear medicine, and their role in providing useful, treatment-guiding information. The second part focuses on the most appropriate imaging algorithms for shoulder arthroplasty complications such as aseptic loosening, infection, fracture, rotator cuff tendon tear, and nerve injury. The evidence-based ACR Appropriateness Criteria guidelines offered in this report were reached via an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) for rating the appropriateness of imaging and treatment procedures for specific clinical scenarios. Further analysis and review of the guidelines were performed by a multidisciplinary expert panel. In those instances in which there was insufficient or equivocal data for recommending the appropriate imaging algorithm, expert opinion may have supplemented the available evidence. [ABSTRACT FROM AUTHOR]

Osteonecrosis of the hip (Legg-Calvé-Perthes) is a common disease, with 10,000-20,000 symptomatic cases annually in the United States. The disorder affects both adults and children and is most frequently associated with trauma and corticosteroid usage. The initial imaging evaluation of suspected hip osteonecrosis is done using radiography. MRI is the most sensitive and specific imaging modality for diagnosis of osteonecrosis of the hip. The clinical significance of hip osteonecrosis is dependent on its potential for articular collapse. The likelihood of articular collapse is significantly increased with involvement of greater than 30%-50% of the femoral head area, which is optimally evaluated by MRI, often in the sagittal plane. Contrast-enhanced MRI may be needed to detect early osteonecrosis of the hip in pediatric patients, revealing hypoperfusion. In patients with a contraindication for MRI, use of either CT or bone scintigraphy with SPECT (single-photon emission CT) are alternative radiologic methods of assessment. Imaging helps guide treatment, which may include core decompression, osteotomy, and ultimately, need for joint replacement. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare four 3-dimensional (3D) computed tomography (CT) methods of measuring glenoid bone loss with the arthroscopic estimation of glenoid bone loss.Methods: Twenty patients with recurrent anterior shoulder instability underwent bilateral shoulder CT scans and were found to have glenoid bone loss. Arthroscopic estimation of glenoid bone loss was performed in all patients. Three-dimensional CT reconstruction was performed on the CT scans of each patient. The glenoid bone loss of each patient was measured using the surface area, Pico, ratio, and anteroposterior distance-from-bare area methods. The mean percent loss calculated with each method was compared with arthroscopy to determine the reliability of arthroscopy in the measurement of glenoid bone loss.Results: The mean percent bone loss calculated with arthroscopic estimation, surface area, Pico, ratio, and anteroposterior distance-from-bare area methods was 18.13% ± 11.81%, 12.15% ± 8.50% (P = .005), 12.77% ± 8.17% (P = .002), 9.50% ± 8.74% (P < .001), and 12.44% ± 10.68% (P = .001), respectively. Repeated-measures analysis of variance showed that the 3D CT methods and arthroscopy were significantly different (F4,76 = 13.168, P = .02). The estimate using arthroscopy is 55% greater than the average of the 3D CT methods.Conclusions: Our findings suggest that arthroscopy significantly overestimates glenoid bone loss compared with CT and call into question its validity as a method of measurement. A more internally consistent and accurate method for the measurement of glenoid bone loss is necessary to appropriately diagnose and treat shoulder instability.Level Of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

Introduction: Lateral epicondylitis, commonly known as tennis elbow, is the most common cause of lateral elbow pain and the second most frequently diagnosed musculoskeletal disorder in the neck and upper limb in a primary care setting. Many therapeutic options, including conservative, surgical, and minimally invasive procedures, have been advocated for the treatment of lateral epicondylitis. Although numerous small studies have been performed to assess the efficacy of various treatments, there are conflicting results with no clear consensus on the optimal treatment. In an economic environment with limited health care resources, it is paramount that optimal cost-effective therapies with favorable patient-important outcomes be identified. Methods and Analysis: This is a protocol paper which outlines a multicenter, multidisciplinary, single-blinded, four-arm randomized controlled trial, comparing platelet-rich plasma (PRP), whole blood injection, dry needle tendon fenestration, and sham injection with physical therapy alone for the treatment of lateral epicondylitis. Patients are screened based on pre-established eligibility criteria and randomized to one of the four study groups using an Internet-based system. The patients are followed at 6-week, 12-week, 24-week, and 52-week time points to assess the primary and secondary outcomes of the study. The primary outcome is pain. Secondary outcomes include health-related quality of life and ultrasound appearance of the common extensor tendon. Two university centers (McMaster University and the University of Michigan) are currently recruiting patients. We have planned a sample size of 100 patients (25 patients per arm) to ensure over 80% power to detect a three-point difference in pain scores at 52 weeks of follow-up. Ethics and Dissemination: This study has ethics approval from the McMaster University Research Ethics Board (REB# 12-146) and the University of Michigan Institutional Review Board (IRB# HUM00067750). Successful completion of this proposed study will significantly impact clinical practice and enhance patients' lives. More broadly, this trial will develop a network of collaboration from which further high-quality trials in ultrasound-guided interventions will follow. [ABSTRACT FROM AUTHOR]

Abstract: Ultrasonography has many important advantages over other imaging modalities and many important applications in sports medicine. This article presents an evidence-based discussion of the use of ultrasound technology to diagnose and treat common musculoskeletal disorders, with emphasis on the shoulder, elbow, hip, knee, and foot and ankle. Topics include basic principles, scan artifacts, the appearance of musculoskeletal structure characteristics and pathologies, and various diagnostic and therapeutic applications in sports medicine. [Copyright &y& Elsevier]

Purpose: The purpose of this study was to retrospectively investigate magnetic resonance (MR) arthrography imaging findings associated with capsular laxity of the hip joint found at surgery. Methods: After institutional review board approval, 27 patients who had arthroscopy reports that described the presence or absence of capsular laxity of the hip joint were identified over a 2-year period. Preoperative MR images were retrospectively reviewed by 2 blinded radiologists. The following observations were recorded: (1) thickness, signal intensity, and defects of the anterior joint capsule; (2) thickness and signal intensity of the zona orbicularis; (3) width of the anterior and posterior joint recesses at the level of the femoral head; (4) presence of synovitis in the anterior joint recess; and (5) volume of intra-articular contrast and degree of hip rotation. Intrarater and inter-rater agreement was assessed. Results: Of the 27 patients, 17 were positive and 10 were negative for hip joint laxity at arthroscopy. The mean thickness of the anterior hip capsule was significantly different (P = .0043), measuring 2.5 mm (95% confidence interval [CI], 2.3 to 2.8 mm) in those with hip laxity and 3.3 mm (95% CI, 2.8 to 3.8 mm) in those without laxity. The mean width of the anterior joint recess was 5.8 mm (95% CI, 5.4 to 6.3 mm) in those with laxity and 3.6 mm (95% CI, 3.3 to 3.9 mm) in those without laxity and was significantly different (P < .0001). No other variables were considered useful because of a lack of significant differences between the 2 patient groups or low inter-rater agreement. Conclusions: On the basis of 95% CIs, hip joint laxity at MR arthrography is associated with widening of the anterior hip joint recess (>5 mm) and thinning of the adjacent joint capsule (<3 mm) lateral to the zona orbicularis. Level of Evidence: Level III, case-control study. [Copyright &y& Elsevier]

The article discusses the benefits of ultrasonography (US) of the shoulder whose diagnostic accuracy in evaluating rotator cuff tears is comparable with magnetic resonance imaging (MRI). It notes that US is an excellent way of evaluating patients who are not candidates for MRI especially those who are claustrophobic, cannot lie flat or with implanted devices incompatible with magnetized environment. Advantages of US over MRI include portability, high resolution and dynamic assessment.

Background: The purpose of this study was to determine the intra- and inter-rater reliability of detecting full- and partial-thickness tears of the supraspinatus intramuscular central tendon on magnetic resonance imaging (MRI) by orthopaedic shoulder surgeons. Full-thickness tears of this tendon have previously been associated with the failure of nonsurgical management of rotator cuff tears. Methods: Shoulder MRIs from 40 patients entered into a prospective rotator cuff disease database were independently reviewed by two musculoskeletal (MSK) radiologists in order to determine if there was a partial- or full-thickness tear of the supraspinatus central tendon. The MRIs were randomly sorted and distributed to 16 fellowship-trained shoulder surgeons. The surgeons then similarly diagnosed each patient. After a 1-month interval, surgeons repeated the evaluation with the same set of randomly reordered MRIs. Surgeon intra- and inter-rater reliability was determined with the kappa statistic. Agreement and inter-rater reliability were also determined between the shoulder surgeons and MSK radiologists. Results: For full-thickness tears, the intra-rater reliability was excellent (0.86 ± 0.1, 95% confidence interval (CI): 0.81, 0.91) and the agreement was 93.4% ± 4.6, 95% CI: 91.1, 95.8. Inter-rater reliability for both rounds was also excellent (0.77 and 0.74). The agreement between the shoulder surgeons and MSK radiologists was 92.9% ± 3.9, 95% CI: 90.9, 94.9, and the kappa was 0.85 ± 0.08, 95% CI: 0.81, 0.89. Including partial-thickness tears resulted in agreement of 65-92% and kappa values of 0.59-0.72. Conclusion: The reliability for the MRI detection of full thickness tears of the supraspinatus central tendon among shoulder surgeons and between shoulder surgeons and MSK radiologists was excellent. [Copyright &y& Elsevier]

The shoulder joint is a complex array of muscles, tendons, and capsuloligamentous structures that has the greatest freedom of motion of any joint in the body. Acute (<2 weeks) shoulder pain can be attributable to structures related to the glenohumeral articulation and joint capsule, rotator cuff, acromioclavicular joint, and scapula. The foundation for investigation of acute shoulder pain is radiography. Magnetic resonance imaging is the procedure of choice for the evaluation of occult fractures and the shoulder soft tissues. Ultrasound, with appropriate local expertise, is an excellent evaluation of the rotator cuff, long head of the biceps tendon, and interventional procedures. Fluoroscopy is an excellent modality to guide interventional procedures. Computed tomography is an excellent modality for characterizing complex shoulder fractures. Computed tomographic arthrography or fluoroscopic arthrography may be alternatives in patients for whom MR arthrography is contraindicated. A multimodal approach may be required to accurately assess shoulder pathology. The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. [Copyright &y& Elsevier]

Appropriate imaging modalities for screening, staging, and surveillance of patients with suspected and documented metastatic disease to bone include 99mTc bone scanning, MRI, CT, radiography, and 2-[18F]fluoro-2-deoxyglucose–PET. Clinical scenarios reviewed include asymptomatic stage 1 breast carcinoma, symptomatic stage 2 breast carcinoma, abnormal bone scan results with breast carcinoma, pathologic fracture with known metastatic breast carcinoma, asymptomatic well-differentiated and poorly differentiated prostate carcinoma, vertebral fracture with history of malignancy, non-small-cell lung carcinoma staging, symptomatic multiple myeloma, osteosarcoma staging and surveillance, and suspected bone metastasis in a pregnant patient. No single imaging modality is consistently best for the assessment of metastatic bone disease across all tumor types and clinical situations. In some cases, no imaging is indicated. The recommendations contained herein are the result of evidence-based consensus by the ACR Appropriateness Criteria® Expert Panel on Musculoskeletal Radiology. [Copyright &y& Elsevier]

Purpose: The purpose of this study was to determine whether dynamic ultrasound (US) would be able to differentiate posterolateral corner knee injuries that would require surgical intervention. Methods: This is a single-group cohort study. A knee sonogram was obtained in patients referred to us with suspected posterolateral knee injury. In addition to static US imaging, a dynamic US stress test was performed by placement of maximum varus stress on the knee at 30° of flexion. The tibiofemoral separation was then measured with US. Results from US and surgery were then compared. Results: Sixteen patients had US and underwent surgery, and twelve patients had surgical findings requiring surgical intervention to the posterolateral knee structures. With regard to static US images, the sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 92%, 75%, 92%, 75%, and 88%, respectively, for the lateral collateral ligament; 33%, 100%, 100%, 33%, and 50%, respectively, for the popliteus; and 67%, 75%, 67%, 75%, and 69%, respectively, for the popliteofibular ligament. The dynamic US stress test showing 10.5 mm of lateral joint space width or more during varus stress showed a sensitivity of 83% and specificity of 100% for injury to the lateral collateral ligament and posterolateral corner structures, with a positive predictive value of 100%, negative predictive value of 75%, and accuracy of 88%. Conclusions: A positive dynamic US stress test (≥10.5 mm) positively predicted the need for posterolateral knee surgery in 100% of patients in this study who required posterolateral corner repair or reconstruction. Level of Evidence: Level I, testing of previously developed diagnostic criteria in series of consecutive patients with universally applied gold standard. [Copyright &y& Elsevier]

Rationale and Objectives: Ultrasound is a proven method for examining soft tissue structures, including tendons, and recently quantitative ultrasound has become more prevalent in research settings. However, limited reliability data have been published for these new quantitative ultrasound measures. The main objective of this study was to quantify the reliability and measurement error of multiple quantitative ultrasound imaging protocols for the biceps and supraspinatus tendons. Materials and Methods: Two examiners captured ultrasound images of the non-dominant long head of the biceps tendon and supraspinatus tendon from 15 able-bodied participants and five manual wheelchair users. Each examiner captured two images per subject under two different preparations, which included subject positioning and reference marker placement. Image processing (reading) was performed twice to compute nine quantitative ultrasound measures of grayscale tendon appearance using first-order statistics and texture analysis. Generalizability theory was applied to compute interrater and intrarater reliability using the coefficient of dependability (Φ) for multiple study design protocols. Results: Interrater reliability was generally low (0.26 < Φ < 0.82), and it is recommended that a single evaluator capture all images for quantitative ultrasound protocols. Most of the quantitative ultrasound measures (n = 14 of 18) exhibited at least moderate (Φ > 0.50) intrarater reliability for a single image captured under one preparation and read once. Conclusion: By following a protocol designed to minimize measurement error, one can increase the reliability of quantitative ultrasound measures. An appropriately designed protocol will allow quantitative ultrasound to be used as an outcome measure to identify structural changes within tendons. [Copyright &y& Elsevier]

Rationale and Objectives: The aim of this study was to evaluate the magnetic resonance imaging (MRI) interpretation proficiency of musculoskeletal fellows in training. Materials and Methods: Between July 2003 and June 2007, 14 musculoskeletal fellows were independently tested with 20 MRI studies of the knee and shoulder at four separate time points during their fellowship years. Trends in true-positive and false-positive interpretation results were evaluated. Fellows who completed their residencies at the fellowship institution (internal fellows) were compared with those from other residencies (external fellows). Results: There was a significant improvement in proficiency between the initial and final (9-month) evaluations (P < .0001). At the initial evaluation, there was a mean of 52.8% (41.7 of 79) true-positive results (range, 32–51); at 9 months, there was a mean of 71.0% (56.1 of 79; range, 40–72). The number of false-positive results also declined during this time period from a mean of 8.1 (range, 2–13) at initial evaluation to 4.7 (range, 2–8) at 9 months (P < .001). External fellows had more incorrect diagnoses initially but showed greater improvement than internal fellows at 9 months. Conclusion: Fellows continued to improve their MRI interpretation skills throughout the first 9 months of their fellowships. External fellows were slightly less proficient at the start of their fellowships but slightly more proficient at 9 months compared to internal fellows. [Copyright &y& Elsevier]

Imaging of the diabetic foot is among the most challenging areas of radiology. The authors present a consensus of the suggested tests in several clinical scenarios, such as early neuropathy, soft-tissue swelling, skin ulcer, and suspected osteomyelitis. In most of these situations, magnetic resonance imaging (MRI) with or without contrast is the examination of choice. Most other imaging tests have complementary roles. For soft-tissue swelling or an ulcer, radiography and MRI with or without contrast are suggested. Bone scintigraphy with white blood cell scanning is used when MRI is contraindicated. In patients with diabetes without ulcers, radiography and MRI with or without contrast are suggested; bone scanning may be used when MRI is contraindicated. [Copyright &y& Elsevier]

Purpose: To evaluate the clinical and radiographic outcomes of a consecutive series of patients who had internal fixation of an acute, nondisplaced scaphoid waist fracture via a limited dorsal approach. Methods: Twenty consecutive patients had surgical fixation of a nondisplaced scaphoid waist (Herbert B2) fracture via a limited dorsal approach. Eighteen patients were available for follow-up evaluation at a mean duration of 98 weeks after surgery (range, 12–272 wk). Fifteen males and 3 females with a mean age of 25 years (range, 16–62 y) were examined. Wrist range of motion; grip strength; visual analog and numeric pain scores; and a Disabilities of the Arm, Shoulder, and Hand (DASH) outcomes questionnaire were assessed. Postoperative radiographs were reviewed in a blinded fashion to assess the fracture union and screw position. Results: Seventeen of 18 fractures healed at a mean duration of 8 weeks. No case of proximal pole avascular necrosis occurred. All patients were satisfied and returned to their pre-injury level of employment. Five of 6 collegiate or professional athletes returned to play without limitations. The mean subjective and visual analog pain scores were 0.3 and 0.4 (maximum of 10 for each scale). The mean DASH score was 6.12 (out of 100), which is consistent with an excellent functional outcome. Central axis screw position was achieved on anteroposterior and lateral radiographs in 17 of 18 patients. Conclusions: Fixation of an acute, nondisplaced scaphoid waist fracture via a limited dorsal approach is safe and effective. The limited dorsal approach allows for accurate insertion of the screw in the central scaphoid, which is biomechanically advantageous for fracture union and early restoration of function. Type of study/level of evidence: Therapeutic IV. [Copyright &y& Elsevier]

Rationale and Objectives: One mission of an academic radiology department is to teach. The greatest teaching effort is directed at radiology residents. As clinical work demands increase, informal, non-revenue-generating, teaching may suffer. We sought to determine the economic consequences of teaching. Materials and Methods: With the use of a picture archiving and communications system, 6 radiology faculty members independently interpreted and dictated digitally acquired bone and chest radiographs for 1 hour alone and again 10-12 weeks later with a first-year resident. During the second session, the quality of teaching was graded by independent observers. The number of cases, relative value units (RVUs), and reimbursement for each session were calculated. Results: The difference in number of cases dictated working alone (mean, 44.7) and with a first-year resident (mean, 23.5) was significant (P = 0.007). The difference between RVUs generated by faculty alone (mean, 9.0) and with a resident (mean, 4.5) also was significant (P = 0.006), and the difference in dollars billed when working alone (mean, $1558.45) and with a resident (mean, $777.65) was significant (P = 0.007). As teaching quality increased, the number of cases interpreted, dollars billed, and RVUs trended lower. Conclusion: Informal resident teaching significantly reduces clinical throughput, reducing examination volume, RVUs, and dollars billed by approximately half. [ABSTRACT FROM AUTHOR]

Purpose: To sonographically characterize pseudoerosions and dorsal joint recess and capsule morphology of the hand and wrist in 100 asymptomatic subjects.Method: The metacarpal heads, and dorsal aspects of the lunate, triquetrum, and ulna were evaluated for pseudoerosions including measurements and sonographic characterization. The dorsal recesses of the metacarpophalangeal, radiocarpal, and midcarpal joints were also characterized with regards to echogenicity, fibrillar pattern, hyperemia, and measurements.Results: 100 subjects were included (average age 47 years, range 19-82 years; 52% male, 48% female). Pseudoerosions of metacarpophalangeal heads were seen in every subject, in all metacarpal heads, but most commonly the second and third (99% were bilateral, 97% were multiple); 81.5% involved at least three metacarpal heads; 99% were central with maximum depth of 2.6 mm. At the wrist, in 92% of subjects a bilateral pseudoerosion was present at the dorsal triquetrum, lunate, or ulna. Dorsal joint capsules and recesses at the metacarpophalangeal joints were isoechoic to subdermal fat and fibrillar measuring 3.1-6.3 mm in maximal thickness. The dorsal capsules and recesses of the radiocarpal and midcarpal joints were hypoechoic to subdermal fat, non-fibrillar and with maximal thickness of 3.9 and 3.4 mm, respectively. No hyperemia on color Doppler imaging was noted.Conclusions: Pseudoerosions are common at the dorsal metacarpal heads, lunate, triquetrum, and ulna, which should not be mistaken for true inflammatory erosions. The characteristic appearances of dorsal joint capsules and recesses should not be confused with synovial hypertrophy. [ABSTRACT FROM AUTHOR]

Evaluation for suspected inflammatory arthritis as a cause for chronic extremity joint pain often relies on imaging. This review first discusses the characteristic osseous and soft tissue abnormalities seen with inflammatory arthritis and how they may be imaged. It is essential that imaging results are interpreted in the context of clinical and serologic results to add specificity as there is significant overlap of imaging findings among the various types of arthritis. This review provides recommendations for imaging evaluation of specific types of inflammatory arthritis, including rheumatoid arthritis, seronegative spondyloarthropathy, gout, calcium pyrophosphate dihydrate disease (or pseudogout), and erosive osteoarthritis. 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. [ABSTRACT FROM AUTHOR]

Stress fractures, including both fatigue and insufficiency types, are frequently encountered in clinical practice as a source of pain in both athletes and patients with predisposing conditions. Radiography is the imaging modality of choice for baseline diagnosis. MRI has greatly improved our ability to diagnose radiographically occult stress fractures. Tc-99m bone scan and CT may also be useful as diagnostic tools. Although fatigue and insufficiency fractures can be self-limited and go onto healing even without diagnosis, there is usually value in initiating prompt therapeutic measures as incomplete stress fractures have the potential of progressing to completion and requiring more invasive treatment or delay in return to activity. This is particularly important in the setting of stress fractures of the femoral neck. Accuracy in the identification of these injuries is also relevant because the differential diagnosis includes entities that would otherwise be treated significantly different (ie, osteoid osteoma, osteomyelitis, and metastasis). 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. [ABSTRACT FROM AUTHOR]

Abstract: In the present article, we correlate MR imaging studies of cadavers, volunteers and patients with cadaveric dissection and sectioning. First anatomy at wrist level is discussed. In a next section, we address the midhand with the flexor and extensor tendons, and interosseous and lumbricalis muscles. The dorsal hood at the level of the metacarpophalangeal joint is also addressed. An overview of the anatomy of the thenar is provided. Finally, the flexor system of the fingers with pulleys and volar plates, as well as the central and distal insertion of the finger extensor tendons is discussed. [Copyright &y& Elsevier]

There are various causes of calf pain. The differential diagnoses affecting the lower leg include cystic lesions, trauma-related lesions, infection or inflammation, vascular lesions, neoplasms, and miscellaneous entities. Ultrasound (US) provide detailed anatomical information of the calf structures, and it offers the ability to confirm, other calf abnormalities, particularly when deep vein thrombosis (DVT) is ruled out. The purpose of this article is to review the causes of a painful calf presenting as DVT and incidental findings found as part of the work-up of DVT, and to provide a broad overview of US findings and clinical features of these pathologies. [ABSTRACT FROM AUTHOR]

Background Doxorubicin and ifosfamide (AI) is standard therapy for high-risk soft tissue sarcoma (STS) but often causes severe toxicities resulting in hospitalisation. Gemcitabine and docetaxel (GD) has efficacy in metastatic STS and may be better tolerated. We conducted a study to compare toxicities and efficacies of these regimens. Methods This open-label, phase II, single institution trial randomised 80 patients with localised, resectable, high grade STS ⩾5 cm to either neo/adjuvant AI or GD. AI was doxorubicin (75 mg/m 2 ) and ifosfamide (2.5 g/m 2 /d) on days 1–3 with mesna 500 mg/m 2 /dose. GD was gemcitabine 900 mg/m 2 on days 1, 8 and docetaxel 100 mg/m 2 day 8. Both arms included filgrastim. The primary end-point was hospitalisation rate. Secondary end-points included disease-free survival (DFS) and overall survival (OS). Results Between November 2004 and August 2012, 80 evaluable patients were randomised, 37 to AI and 43 to GT. In the AI arm, 13/37 (35%) patients were hospitalised versus 11/43 (26%) in the GD arm ( p = 0.25). Hospitalisation rates were not significantly different after adjusting for age, gender, location, chemotherapy and number of cycles ( p = 0.17). The 2-year and median DFS in the AI arm were 57% and 37 months, respectively, and 74% and not yet reached, respectively, in the GD arm. The most common serious adverse events with AI were haematologic. Metabolic derangements and constitutional symptoms were most common with GD. Conclusions Hospitalisation rate was less with GD but not statistically significant. There was a trend towards longer DFS with GD, and the regimen was tolerable, suggesting GD merits further study. Funding Eli Lilly and Sanofi-Aventis. [ABSTRACT FROM AUTHOR]

Abstract: Loss of bone mass due to disease, such as osteoporosis and metastatic cancer to the bone, is a leading cause of orthopedic complications and hospitalization. Onset of bone loss resulting from disease increases the risk of incurring fractures and subsequent pain, increasing medical expenses while reducing quality of life. Although current standard CT-based protocols provide adequate prognostic information for assessing bone loss, many of the techniques for evaluating CT scans rely on measures based on whole-bone summary statistics. This reduces the sensitivity at identifying local regions of bone resorption, as well as formation. In this study, we evaluate the effectiveness of a voxel-based image post-processing technique, called the Parametric Response Map (PRM), for identifying local changes in bone mass in weight-bearing bones on CT scans using an established animal model of osteoporosis. Serial CT scans were evaluated weekly using PRM subsequent to ovariectomy or sham surgeries over the period of one month. For comparison, bone volume fraction and mineral density measurements were acquired and found to significantly differ between groups starting 3weeks post-surgery. High resolution ex vivo measurements acquired four weeks post-surgery validated the extent of bone loss in the surgical groups. In contrast to standard methodologies for assessing bone loss, PRM results were capable of identifying local decreases in bone mineral by week 2, which were found to be significant between groups. This study concludes that PRM is able to detect changes in bone mineral with higher sensitivity and spatial differentiation than conventional techniques for evaluating CT scans, which may aid in clinical decision making for patients suffering from bone loss. [Copyright &y& Elsevier]

Abstract: It was hypothesized that the use of internal finger structure as imaged using commercially available ultrasound (US) scanners could act as a supplement to standard methods of biometric identification, as well as a means of assessing physiological and cardiovascular status. Anatomical structures in the finger including bone contour, tendon and features along the interphalangeal joint were investigated as potential biometric identifiers. Thirty-six pairs of three-dimensional (3D) gray-scale images of second to fourth finger (index, middle and ring) data taken from 20 individuals were spatially registered using MIAMI-Fuse© software developed at our institution and also visually matched by four readers. The image-based registration met the criteria for matching successfully in 14 out of 15 image pairs on the same individual and did not meet criteria for matching in any of the 12 image pairs from different subjects, providing a sensitivity and specificity of 0.93 and 1.00, respectively. Visual matching of all image pairs by four readers yielded 96% successful match. Power Doppler imaging was performed to calculate the change in color pixel density due to physical exercise as a surrogate of stress level and to provide basic physiological information. (E-mail: gnarayan@umich.edu) [Copyright &y& Elsevier]

Prostate cancer (PCa) is the most commonly diagnosed cancer in American men with a subset inevitably presenting with metastatic disease to the bone. A well-recognized limitation in evaluating new treatments for metastatic PCa is the inability to use imaging to objectively assess response therapy. In this study, we evaluated the feasibility of clinically translating the functional diffusion map (fDM) imaging biomarker for quantifying the spatiotemporal effects of bone tumor response in a patient treated for metastatic PCa with bone metastases. A patient beginning therapy was scanned using MRI before treatment and again at 2 and 8 weeks post--treatment initiation to quantify changes in tumor diffusion values. Three metastatic lesions were identified for fDM analysis, all of which all demonstrated an early increase in diffusion values at 2 weeks, which increased further at 8 weeks post--treatment initiation. This finding correlated with a decrease in the patient's prostate-specific antigen (PSA) levels suggestive of patient response. CT, bone scans, and anatomic MRI images obtained posttreatment were found to be uninformative for the assessment of treatment effectiveness. This study presents the feasibility of fDM measurements in osseous lesions over time and shows that changes in fDM values were consistent with therapeutic response. Thus, the fDM imaging biomarker may provide a quantifiable therapeutic endpoint to assess response in patients with metastatic bone cancer. [ABSTRACT FROM AUTHOR]