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Introduction : In controversial fashion, the presence of an enlarged external occipital protuberance has been recently linked to excessive use of handheld electronic devices. We sought to determine the prevalence of this protuberance in a diverse age group of adults from two separate time periods, before and approximately 10 years after the release of the iPhone, to further characterize this theory, as if indeed valid, such a relationship could direct preventative behavior. Materials and Methods : Eighty-two cervical spine radiographs between March 7, 2007 through June 29, 2007 and 147 cervical spine radiographs between October 25, 2017 through January 1, 2018 were reviewed for the presence or absence of an exophytic external occipital protuberance. Influence of sex and age were also assessed. Results : There were 41/82 (50%) patients within the 2007 pre-iPhone group with an exophytic external occipital protuberance, ranging from 2.7-33.8 mm in length. Twenty-seven out of 82 (32.9%) had an external occipital protuberance at or above 10 mm. There were 49/147 (33.3%) patients within the 2017 post-iPhone group with an exophytic external occipital protuberance, ranging from 4.4-53.8 mm in length. Thirty-three out of 147 (22.4%) had an external occipital protuberance at or above 10 mm. When considering accessibility to the iPhone, sex, and age to the presence of an exophytic external occipital protuberance, only sex has a statistically significant association, p=0.000000033. Conclusion : We found no significant association with iPhone accessibility and an exophytic external occipital protuberance. Due to inherent limitations in the retrospective nature of the study, future research is needed to better examine the association of handheld electronic devices with exophytic external occipital protuberances., (Copyright ©2021, Yale Journal of Biology and Medicine.)

Objective: Classifying acetabular fractures can be an intimidating topic. However, it is helpful to remember that there are only three basic types of acetabular fractures: column fractures, transverse fractures, and wall fractures. Within this framework, acetabular fractures are classified into two broad categories: elementary or associated fractures. We will review the osseous anatomy of the pelvis and provide systematic approaches for reviewing both radiographs and CT scans to effectively evaluate the acetabulum., Conclusion: Although acetabular fracture classification may seem intimidating, the descriptions and distinctions discussed and shown in this article hopefully make the topic simpler to understand. Approach the task by recalling that there are only three basic types of acetabular fractures: column fractures (coronally oriented on CT images), transverse fractures (sagittally oriented on CT images), and wall fractures (obliquely oriented on CT images). We have provided systematic approaches for reviewing both conventional radiographs and CT scans to effectively assess the acetabulum. The clinical implications of the different fracture patterns have also been reviewed because it is critically important to include pertinent information for our clinical colleagues to provide the most efficient and timely clinical care.

Objective: This article provides a review of anterior cruciate ligament (ACL) reconstruction procedures and their normal postoperative appearance. Then, we review commonly encountered complications: those associated with decreased range of motion (impingement, arthrofibrosis, intraarticular bodies, ganglion cysts) and those associated with laxity (graft tearing, graft stretching). Finally, we review some miscellaneous complications., Conclusion: Given the number of patients undergoing ACL reconstruction, it is important for radiologists to be familiar with the different reconstruction surgeries and their common complications.

Objective: The purpose of this study was to correlate skeletal pathologic findings quantified by MRI-based bone marrow burden score with genotype and spleen status and other clinical parameters, including liver size and duration of enzyme replacement therapy, in patients with Gaucher's disease., Materials and Methods: Two radiologists retrospectively reviewed MR images of 47 patients with Gaucher's disease and determined bone marrow burden scores by consensus on the basis of previously published criteria. The bone marrow burden scores were correlated with genotype, liver volume, spleen status, age, and cumulative duration of enzyme replacement therapy., Results: Subjects with compound heterozygous N370S alleles had significantly higher overall, lumbar spinal, and femoral bone marrow burden scores than did N370S homozygotes. There was a significant positive correlation between an enlarged or surgically absent spleen and bone marrow burden score. There were no significant associations between bone marrow burden score and liver volume, age, cumulative duration of enzyme replacement therapy, or cumulative duration of untreated disease. Femoral and lumbar spinal bone marrow burden scores had a weak but significant positive correlation across all patients., Conclusion: Skeletal pathologic findings in Gaucher's disease encapsulated as bone marrow burden score correlate significantly with the number of copies of the N370S allele, which has an ameliorative effect on bone marrow disease. Splenectomy or splenomegaly is associated with greater risk of bone marrow disease. Femoral and lumbar spinal bone marrow burden scores, although only weakly correlated, independently illustrated both the protective role of the N370S allele and the unfavourable implication of splenectomy. This finding suggests that axial and appendicular bone marrow burdens are related but distinct and justifies multiple-compartment evaluation in Gaucher's disease.

Objective: The objective of our study was to identify the clinical and technical factors associated with positive or negative culture results in histologically positive cases of osteomyelitis obtained from imaging-guided bone biopsies., Materials and Methods: A retrospective review was performed of 800 consecutive patients undergoing imaging-guided core bone biopsies at two institutions. Seventy-five biopsies were performed for suspected osteomyelitis and 41 patients had histologically proven osteomyelitis. A chart review was performed to determine whether the following factors affected the culture result: histologic type of osteomyelitis, antibiotic therapy before biopsy, fever (temperature > or = 38.0 degrees C), elevated WBC count (> or = 10 x 10(3) microL), elevated erythrocyte sedimentation rate (ESR) (> or = 10 mm/h), elevated C-reactive protein value (CRP) (> or = 6 mg/L), the size of the biopsy needle, and the amount of purulent fluid obtained at biopsy., Results: Of the 41 cases of osteomyelitis, 14 (34%) had positive cultures. Eighteen (44%) of 41 cases were chronic osteomyelitis. Seventeen (41%) of 41 patients received antibiotics before biopsy, seven (17%) were febrile, five (12%) had an elevated WBC count, 16 (39%) had an elevated ESR, and six (15%) had an elevated CRP value. The biopsy needle size ranged from 11- to 18-gauge. These factors did not have any significant association with positive or negative culture results. Purulent fluid was aspirated in 10 (24%) of the 41 cases. In six (15%) of the cases, > or = 2 mL of purulent fluid was aspirated and five (83%) of the six cases were associated with positive culture (p = 0.02)., Conclusion: The rate of positive culture results in histologically proven cases of osteomyelitis obtained from imaging-guided bone biopsies is low. Aspirating > or = 2 mL of purulent fluid is associated with a significantly higher rate of positive cultures.

Objective: The purpose of this article is to characterize current informed consent practices for diagnostic CT scans at U.S. academic medical centers., Materials and Methods: We surveyed 113 radiology chairpersons associated with U.S. academic medical centers using a survey approved by our institutional review board. The need for informed consent for this study was waived. Chairpersons were asked if their institutions have guidelines for nonemergent CT scans (by whom; oral and/or written), if patients are informed of the purpose of their scans (by whom), what specific risks are outlined (allergic reaction, radiation risk and dose, others; by whom), and if patients are informed of alternatives to CT., Results: The study response rate was 81% (91/113). Of the respondents, two thirds (60/90) currently have guidelines for informed consent regarding CT scans. Radiology technologists were most likely to inform patients about CT (38/60, 63%) and possible risks (52/91, 57%), whereas ordering physicians were most likely to inform patients about CT's purpose (37/66, 56%). Fifty-two percent (30/58) of sites provided verbal information and 5% (3/58) provided information in written form. Possible allergic reaction to dye was explained at 84% (76/91) of sites, and possible radiation risk was explained at 15% (14/91) of sites. Nine percent (8/88) of sites informed patients of alternatives to CT., Conclusion: Radiology technologists are more likely to inform patients about CT and associated risks than their physician counterparts. Although most academic medical centers currently have guidelines for informed consent regarding CT, only a minority of institutions inform patients about possible radiation risks and alternatives to CT.

Objective: The purpose of our study was to compare reviewer confidence and interobserver agreement in the evaluation of MR images of periprosthetic structures around zirconium total knee prostheses and cobalt chrome prostheses., Materials and Methods: Three board-certified radiologists blinded to prosthesis type used identical MRI protocols to independently evaluate 21 total knee prostheses: 14 zirconium prostheses and seven cobalt chrome prostheses. The radiologists evaluated the following eight parameters: integrity of the medial and lateral collateral ligaments, the quadriceps and the patellar tendons, presence of a joint effusion, and for evidence of periprosthetic osseous signal abnormality around each of the three components. The reviewers gave their degree of confidence in evaluating each of the findings on a five-point scale, 0 being no confidence and 4 being high confidence in the finding. The degree of confidence was used as the vehicle for comparing the two groups of patients., Results: The confidence ratings for all MRI variables were significantly higher for the zirconium group than for the cobalt chrome group. The confidence ratings varied less for the zirconium group than for the cobalt chrome group with an SD of 0.45 versus 0.95, respectively. There was greater interobserver agreement in the zirconium group (coefficient of interobserver agreement, 0.82 vs 0.35). The reviewers had the highest degree of confidence when examining for joint effusion in both groups (3.9 for the zirconium group; 3.7 for the cobalt chrome group). The greatest discrepancies between the two groups were in evaluation of periprosthetic osseous signal changes with the greatest difference being between the femoral component of each group with an average confidence rating of 3.3 for the zirconium group and 0.8 for the cobalt chrome group., Conclusion: Reviewers had significantly more confidence, less variability, and greater interobserver agreement in MRI evaluation of periprosthetic structures around zirconium knee prostheses than those around cobalt chrome knee prostheses.

Objective: Our purpose was to evaluate the accuracy of MRI in identifying articular cartilage abnormalities in the distal radius, scaphoid, lunate, and triquetrum of patients with wrist pain., Materials and Methods: Eighty-six MRI examinations of the wrist in 85 patients (41 indirect MR arthrograms and 45 unenhanced [nonarthrographic] MR images) were evaluated. The study population consisted of 47 male (54.7%) and 38 female (45.3%) patients with an average age of 37.5 years (range, 7-62 years). Three experienced musculoskeletal radiologists who were unaware of surgical findings retrospectively evaluated the MRI examinations for cartilage abnormalities in the distal radius, scaphoid, lunate, and triquetrum. All patients underwent arthroscopy of the radiocarpal joint with inspection of the articular surfaces of the distal radius, scaphoid, lunate, and triquetrum. The articular cartilage was evaluated on the basis of the 5-point scale of the Outerbridge classification system., Results: When at least two of the three radiologists had concordant interpretations, sensitivity for abnormalities in the distal radius was 27%; the scaphoid, 31%; the lunate, 41%; and the triquetrum, 18%. Specificity for the distal radius was 91%; the scaphoid, 90%; the lunate, 75%; and the triquetrum, 93%. Weighted kappa values among the three observers showed only fair agreement (0.279-0.360). High-grade more extensive cartilage lesions were no more accurately identified than low-grade lesions. Indirect MR arthrograms were not statistically more sensitive, specific, or accurate than unenhanced studies. No bone was more frequently or less frequently graded correctly or incorrectly with statistical significance. The variables of sex, age, and the presence of multiple bones with lesions did not affect accuracy., Conclusion: Our findings suggest that MRI of the wrist with the techniques described is not adequately sensitive or accurate for diagnosing cartilage defects in the distal radius, scaphoid, lunate, or triquetrum.

Objective: Our objective was to determine the accuracy of MR arthrography for identification of tears of anterior cruciate ligament reconstruction grafts and for detection of localized anterior arthrofibrosis and impingement., Materials and Methods: We retrospectively identified 27 patients (mean age, 31 years; range, 18-45 years) with anterior cruciate ligament reconstruction who had undergone MR arthrography followed by arthroscopy within 1 year. Three radiologists independently reviewed the MR arthrograms for the presence or absence of graft tear, localized anterior arthrofibrosis, and impingement., Results: Graft tears were identified with 100% sensitivity by all three reviewers with specificities of 100%, 89%, and 94%. Localized anterior arthrofibrosis was identified with 100% sensitivity by all reviewers, with specificities of 79%, 71%, and 38%. Impingement was detected with sensitivities and specificities of 83% and 100%, 83% and 52%, and 33% and 90% by the three reviewers, respectively. Interobserver agreement was almost perfect for detection of graft tear (kappa = 0.83, 0.92, and 0.83), was fair to moderate for detection of localized anterior arthrofibrosis (kappa = 0.50, 0.32, and 0.22), and was slight to fair for detection of impingement (kappa = 0.40, 0.08, and 0.35)., Conclusion: MR arthrography can accurately depict the presence of anterior cruciate ligament graft tears. Localized anterior arthrofibrosis and graft impingement were less accurately detected and showed greater observer variability.