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As the number of conventional radiographic examinations in pediatric emergency departments increases, so, too, does the number of reading errors by radiologists.The aim of this study is to investigate the ability of artificial intelligence (AI) to improve the detection of fractures by radiologists in children and young adults.A cohort of 300 anonymized radiographs performed for the detection of appendicular fractures in patients ages 2 to 21 years was collected retrospectively. The ground truth for each examination was established after an independent review by two radiologists with expertise in musculoskeletal imaging. Discrepancies were resolved by consensus with a third radiologist. Half of the 300 examinations showed at least 1 fracture. Radiographs were read by three senior pediatric radiologists and five radiology residents in the usual manner and then read again immediately after with the help of AI.The mean sensitivity for all groups was 73.3% (110/150) without AI; it increased significantly by almost 10% (P0.001) to 82.8% (125/150) with AI. For junior radiologists, it increased by 10.3% (P0.001) and for senior radiologists by 8.2% (P=0.08). On average, there was no significant change in specificity (from 89.6% to 90.3% [+0.7%, P=0.28]); for junior radiologists, specificity increased from 86.2% to 87.6% (+1.4%, P=0.42) and for senior radiologists, it decreased from 95.1% to 94.9% (-0.2%, P=0.23). The stand-alone sensitivity and specificity of the AI were, respectively, 91% and 90%.With the help of AI, sensitivity increased by an average of 10% without significantly decreasing specificity in fracture detection in a predominantly pediatric population.

We aimed to perform an external validation of an existing commercial AI software program (BoneView™) for the detection of acute appendicular fractures in pediatric patients.In our retrospective study, anonymized radiographic exams of extremities, with or without fractures, from pediatric patients (aged 2-21) were included. Three hundred exams (150 with fractures and 150 without fractures) were included, comprising 60 exams per body part (hand/wrist, elbow/upper arm, shoulder/clavicle, foot/ankle, leg/knee). The Ground Truth was defined by experienced radiologists. A deep learning algorithm interpreted the radiographs for fracture detection, and its diagnostic performance was compared against the Ground Truth, and receiver operating characteristic analysis was done. Statistical analyses included sensitivity per patient (the proportion of patients for whom all fractures were identified) and sensitivity per fracture (the proportion of fractures identified by the AI among all fractures), specificity per patient, and false-positive rate per patient.There were 167 boys and 133 girls with a mean age of 10.8 years. For all fractures, sensitivity per patient (average [95% confidence interval]) was 91.3% [85.6, 95.3], specificity per patient was 90.0% [84.0,94.3], sensitivity per fracture was 92.5% [87.0, 96.2], and false-positive rate per patient in patients who had no fracture was 0.11. The patient-wise area under the curve was 0.93 for all fractures. AI diagnostic performance was consistently high across all anatomical locations and different types of fractures except for avulsion fractures (sensitivity per fracture 72.7% [39.0, 94.0]).The BoneView™ deep learning algorithm provides high overall diagnostic performance for appendicular fracture detection in pediatric patients.

Background Missed fractures are a common cause of diagnostic discrepancy between initial radiographic interpretation and the final read by board-certified radiologists. Purpose To assess the effect of assistance by artificial intelligence (AI) on diagnostic performances of physicians for fractures on radiographs. Materials and Methods This retrospective diagnostic study used the multi-reader, multi-case methodology based on an external multicenter data set of 480 examinations with at least 60 examinations per body region (foot and ankle, knee and leg, hip and pelvis, hand and wrist, elbow and arm, shoulder and clavicle, rib cage, and thoracolumbar spine) between July 2020 and January 2021. Fracture prevalence was set at 50%. The ground truth was determined by two musculoskeletal radiologists, with discrepancies solved by a third. Twenty-four readers (radiologists, orthopedists, emergency physicians, physician assistants, rheumatologists, family physicians) were presented the whole validation data set (

Osteoarthritis (OA) of the hip and knee is among the most common joint disorders. Intra-articular corticosteroid (IACS) injections are frequently performed to treat OA and other joint-related pain syndromes; however, there is conflicting evidence on their potential benefit. There is a lack of prospective and large retrospective studies evaluating potential joint findings, including increased risk for accelerated OA progression or adverse joint events, after treatment with IACS injection. Four main adverse joint findings have been structurally observed in patients after IACS injections: accelerated OA progression, subchondral insufficiency fracture, complications of osteonecrosis, and rapid joint destruction, including bone loss. Physicians, including radiologists, should be familiar with imaging findings and patient characteristics that may help them identify potential joints at risk for such events. The purpose of this report is to review the existing literature, describe observed adverse joint events after IACS injections, and provide an outlook on how this may affect clinical practice. Additional research endeavors are urgently needed to better understand and identify risk factors prior to intervention and to detect adverse joint events after injection as early as possible to prevent or minimize complications.

Andrew Kompel,1 Prashanth H Haran,1 Akira M Murakami,1 Lars Engebretsen,2– 4 Mohamed Jarraya,1,5 Frank Roemer,1,6,* Ali Guermazi1,7,* 1Department of Radiology, Boston University School of Medicine, Boston, MA, USA; 2Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland; 3Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway; 4Department of Orthopedic Surgery, Oslo University Hospital, University of Oslo, Oslo, Norway; 5Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA; 6Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg, & Universitätsklinikum Erlangen, Erlangen, Germany; 7Department of Radiology, VA Boston Health System, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Andrew KompelDepartment of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USATel +1 617 638-6610Fax +1 617 638-6616Email Andrew.Kompel@bmc.orgPurpose: Describe the frequency and severity of knee ligament sprains diagnosed by MRI in athletes participating at the 2016 Summer Olympic Games, their association with certain sports and assess correlations with additional knee structural injury.Patients and Methods: All knee MRIs performed in the Olympic Village and polyclinics during the 2016 Olympics were retrospectively, blindly reviewed for ligament sprains and associated knee injuries. In addition to the absence or presence of these abnormalities, athletes were stratified by age, gender and sport.Results: 11,274 athletes participated in the 2016 Olympic Games: 113 athletes received at least one knee MRI with some having bilateral or repeat MRI on the same knee. Anterior cruciate and medial collateral ligament (ACL/MCL) sprains were most common, accounting for 32 of the 43 sprains (74.4%). Wrestling (10), hockey (7), athletics (7), and judo (5) accounted for over half of ligament sprains. ACL sprains showed a significant positive correlation with medial, lateral meniscal tears and bone contusions. The positive correlation between posterior cruciate ligament (PCL) sprains with MCL/lateral collateral ligament sprain, and popliteus tendon tear was statistically significant with 50% of total PCL sprains occurring in hockey. When athletes were stratified by gender, ligament sprains had a similar occurrence and distribution between men and women.Conclusion: Knee ligament sprains, at the Rio 2016 Games, were most common in wrestling, hockey, athletics and judo with ACL and MCL sprains most frequent. Meniscal tears and bone contusions occurred often with ACL sprains. PCL sprains tended to be multi-ligamentous injuries. Sustained ligament sprains had similar occurrence between genders, while men had a peak incidence of sprains at a younger age and women at an older age.Keywords: Olympics, knee, ligament, sprain, MRI

Background Patellofemoral joint (PFJ) disease is a common ailment in elite athletes. Our aim is to report the frequency of superolateral Hoffa’s fat pad (SHFP) edema, and PFJ cartilage damage and bone marrow lesions (BML), among Olympian athletes, and to study the association between measurements of trochlear morphology and vertical patellar position and a) PFJ cartilage damage or BML, and b) SHFP edema. Methods All knee MRI, performed in the Olympic Village and polyclinics, of participating athletes in the 2016 Olympic Games of Rio de Janeiro were included. MRI were scored for PFJ cartilage damage and BML, and SHFP edema. Trochlear morphology measurements included sulcus angle, trochlear angle, lateral trochlear inclination, and medial trochlear inclination. Insall-Salvati ratio was also assessed. Results One hundred twenty-one knee MRIs were included (62 female, 51.2 %). The highest frequencies of PFJ cartilage damage, combination of PFJ cartilage damage and BML, and SHFP edema were found among Beach Volleyball and Volleyball athletes. SHFP edema was more common among female compared to male Olympian athletes. We found no statistically significant associations between different measurements of trochlear morphology/vertical patellar position, and 1. SHFP edema, and 2. PFJ cartilage damage/BML. Conclusion SHFP edema and the combination of PFJ cartilage damage and BML are highly frequent among Olympic athletes especially those competing in Beach volleyball and Volleyball. SHFP edema is more common among female athletes. Further studies are needed to determine whether PFJ cartilage damage has a stronger association to sports disciplines rather than trochlear morphology.

The purpose of this article is to describe knee abnormalities and the occurrence of MRI-detected sports-related knee abnormalities by evaluating MRI examinations performed during the Rio de Janeiro Olympic Games held in August 2016.There were 11,274 athletes at the Rio 2016 Olympic Games, and 113 of them underwent at least one knee MRI in the Olympic Village. Cartilage abnormalities, followed by meniscal tears and ligament sprains, were the most frequent abnormalities.

Highlights • Cartilage damage is frequently observed on MRI in Olympic Athletes. • Patellofemoral cartilage damage is most common and associated with certain sports including volleyball and weightlifting. • Meniscal tears are associated with localized cartilage damage. • Trend for prevalence of cartilage damage to increase with increasing age of the athlete., Purpose To report the MRI patterns of knee cartilage damage and concomitant internal derangement in athletes participating at the Rio de Janeiro 2016 Olympic Games. Methods Knee MRIs obtained at the core imaging facility of the International Olympic Committee were blindly, retrospectively reviewed by a board-certified musculoskeletal radiologist for meniscal, ligamentous, and tendon abnormalities. Cartilage assessment was based on the modified Outerbridge criteria. Results Of 122 athletes who received a knee MRI, 64 (52.4 %) had cartilage damage. Cartilage damage was more prevalent in the patellofemoral compartment (52 athletes, 42.6 %), followed by lateral (23 athletes, 18.9 %) and medial tibiofemoral compartments (12 athletes, 9.8 %). Patellofemoral cartilage damage was most prevalent in beach-volleyball (100 %), followed by volleyball (8 athletes, 66.7 %) and weightlifting (7 athletes, 70 %). Patellofemoral cartilage damage was most prevalent with quadriceps (8 athletes, 72.7 %) and patellar tendinosis (11 athletes, 61.1 %). Medial and lateral tibiofemoral cartilage damage was significantly associated with medial (8 athletes, 29.6 %) and lateral meniscal tears (16 athletes, 55.2 %), respectively. There was a trend for the percentage of athletes with cartilage damage to increase with age. Conclusion The majority of athletes at the 2016 Rio Summer Olympics who had a knee MRI showed cartilage damage. Patellofemoral compartment cartilage damage was most common and frequently observed in certain sports including volleyball, beach volleyball, and weightlifting. Overuse in these sports can contribute to patellofemoral cartilage damage and subsequent development of anterior knee pain. Cartilage damage was also observed with concomitant meniscal tears and older age.

Background: The cause of mucoid degeneration (MD) of the anterior cruciate ligament (ACL), which is commonly observed on magnetic resonance imaging (MRI) of patients with knee pain, has yet to be elucidated. Despite the limited evidence on the relationship between ACL lesions (injury and MD) and tibial morphologic features (ie, posterior tibial slope), the potential association between the presence of ACL MD and medial and lateral tibial slope (MTS and LTS) has not been well-established. Purpose: To investigate whether MTS and LTS measurements are associated with the presence of ACL MD. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Consecutive knee MRI examinations of patients referred by an orthopaedic surgeon for potential internal joint derangements were identified within a 4-year period. The presence of ACL MD and the MTS/LTS values were assessed by independent expert observers in consensus in a blinded fashion. From 413 consecutive knee MRI scans, a sample of 80 knees, including 32 knees with ACL MD (cases) and 48 knees with normal ACL (controls), were selected using propensity score matching method for age, sex, body mass index, and presence of severe medial tibiofemoral compartment cartilage damage. The association between ACL MD and MTS/LTS was evaluated using conditional regression models. Results: Knees with ACL MD had higher values of LTS (mean ± SD, 7.18° ± 3.58°) in comparison with control knees (5.32° ± 3.35°). Conditional regression analysis revealed a significant association between LTS measurements (not MTS) and ACL MD; every 1° increase in LTS was associated with a 17% (95% CI, 1%-35%) higher probability of having ACL MD. Conclusion: Excessive LTS was associated with the presence of ACL MD, independent of participants’ age, sex, BMI, and cartilage damage severity.

OBJECTIVE. The purpose of this article is to review the biomechanical properties of the rotator cuff and glenohumeral joint and the pathophysiology, imaging characteristics, and treatment options of rotator cuff tear arthropathy (RCTA). CONCLUSION. Although multiple pathways have been proposed as causes of RCTA, the exact cause remains unclear. Increasing knowledge about the clinical diagnosis, imaging features, and indicators of severity improves recognition and treatment of this pathologic condition.

Background: To use Magnetic Resonance Imaging (MRI) to characterize the severity, location, prevalence, and demographics of shoulder injuries in athletes at the Rio de Janeiro 2016 Summer Olympic Games. Methods: This was a retrospective analysis of all routine shoulder MRIs obtained from the Olympic Village Polyclinic during the Rio 2016 Summer Olympics. Imaging was performed on 1.5 T and 3 T MRI, and interpretation was centrally performed by a board-certified musculoskeletal radiologist. Images were assessed for tendon, muscle, bone, bursal, joint capsule, labral, and chondral abnormality. Results: A total of 11,274 athletes participated in the Games, of which 55 (5%) were referred for a routine shoulder MRI. Fifty-three (96%) had at least two abnormal findings. Seven (13%) had evidence of an acute or chronic anterior shoulder dislocation. Forty-nine (89%) had a rotator cuff partial tear and / or tendinosis. Subacromial / subdeltoid bursitis was present in 29 (40%). Thirty (55%) had a tear of the superior labrum anterior posterior (SLAP). Conclusion: Our study demonstrated a high prevalence of both acute and chronic shoulder injuries in the Olympic athletes receiving shoulder MRI. The high rates of bursal, rotator cuff, and labral pathology found in these patients implies that some degree of glenohumeral instability and impingement is occurring, likely due to fatigue and overuse of the dynamic stabilizers. Future studies are needed to better evaluate sport-specific trends of injury.

Injuries to the labrum, joint capsule (in particular the inferior glenohumeral ligament), cartilage, and glenoid periosteum are associated with anterior shoulder instability. The goal of this review is to provide common radiographic images and findings in patients with anterior shoulder instability. Furthermore, we will demonstrate the best methods for measuring anterior glenoid bone loss. Magnetic resonance (MR) imaging is highly relied upon for evaluating anterior shoulder instability and can diagnose soft tissue injuries with high sensitivity. While 3D computed tomography (CT) scan has been considered the optimal tool for evaluating osseous defects, certain MR imaging sequences have been shown to have similar diagnostic accuracy. Repair of Bankart lesions is critical to stabilizing the shoulder, and in the recent years, there has been an increasing focus on imaging to accurately characterize and measure glenoid bone loss to properly indicate patients for either arthroscopic repair or anterior bony reconstruction. Furthermore, Hill-Sachs lesions are commonly seen with shoulder instability, and importance must be placed on measuring the size and depth of these lesions along with possible engagement, as these factors will dictate management. The labral-ligamentous complex and rotator cuff are primary stabilizers of the shoulder. With anterior shoulder instability, the labrum is frequently injured. MRI with an arthrogram or provocative maneuvers is the gold standard for diagnosis. Various imaging modalities and methods can be performed to identify and measure Bankart and Hill-Sachs lesions, which can then be used for surgical planning and treating shoulder instability.

Objective Nerve growth factor antibodies (NGF-ab) have shown promising analgesic efficacy. Aim was to describe reader training efforts and present reliability data focusing on radiographic eligibility in the tanezumab program. Methods A multi-step process was used for reader calibration and reliability testing. First, a reference standard set of cases was created and diagnostic performance was evaluated. A second exercise focused on agreement of ordinal assessment (Kellgren–Lawrence grading) of radiographic osteoarthritis. Subsequently, 11 readers were trained and read a test set of 100 cases focused on eligibility assessments. Additional reliability testing and calibration of five core readers assessing eligibility of 30 cases was performed 3 and 6 months after study start. Results Sensitivity for the reference standard readings ranged from 0.50 to 0.90 and specificity from 0.40 to 0.83. Overall agreement for Kellgren–Lawrence grading ranged from 71.4% to 82.9%. For the 11 reader exercise, in 76% of cases at least 8 of 11 readers agreed on eligibility status. For the reliability testing 3 months after study start, in 80.0% of cases at least 4 of 5 readers agreed on eligibility with a κ = 0.43 (95% CI: 0.32–0.54). For the reliability testing after 6 months, in 83.3% of cases at least 4 of 5 readers agreed on eligibility with a κ = 0.52 (95% CI: 0.41–0.63). Conclusions After intense efforts spent in the development of an imaging program for an NGF-ab clinical program, the achieved reliability for eligibility assessment is substantial but not perfect. Ongoing efforts of calibration prior to including additional readers to the program and during study conduct between current readers will be needed to ensure agreement on potential adverse events and radiographic disease severity.

Carpal tunnel syndrome (CTS) is primarily a clinical diagnosis; however, recent advances in diagnostic imaging have increased the relevance of magnetic resonance imaging (MRI) and ultrasound (US) in the clinical evaluation. There are a variety of imaging findings of CTS that are well depicted on both modalities that have varied sensitivities and specificities. In MRI, the most commonly used criteria for CTS are increased median nerve size, median nerve flattening, median nerve signal change, and flexor retinaculum bowing. In ultrasound, measuring the cross-sectional area of the nerve at the level of the pisiform or carpal tunnel inlet detects CTS with a sensitivity and specificity that is similar to electrodiagnostic tests (EDTs). Both CT and ultrasound can aid in identifying alternative causes of nerve compression, such as ganglion cysts, masses, or flexor tenosynovitis. Future research in CTS imaging will include the use of MRI diffusion tensor imaging and ultrasound elastography.

Many pathologies of the musculoskeletal system involve nontraumatic causes. MR imaging is used in the diagnosis because of its high sensitivity and specificity compared with other modalities. Osteomyelitis, osteonecrosis of the femoral head, and stress fractures are pathologies of bone where early diagnosis and intervention usually lead to an improved outcome. Joint aspiration and culture is the standard for diagnosing septic arthritis. MR imaging can support the diagnosis and allows evaluation for adjacent abscess and osteomyelitis. Early in the disease process, necrotizing fasciitis may not be clinically suspected and imaging may provide the first indication of the presence of this potentially deadly infection.

American football games are a centerpiece of sports culture in the United States. The excitement and physicality make the sport attractive to fans, and yet the athletes put themselves at risk for injury with every snap of the football. While this is true for many sports, gridiron football has the highest rate of injury among all major sports. Catastrophic injuries have declined with improvements in equipment, coaching, and rule modification. At the same time, however, advancements in training methods over the past few decades have led to bigger, stronger, and faster players. The result is harder tackles and quicker cutting and pivoting movements that make the game more exciting to watch but lead to frequent musculoskeletal injuries. Lower extremity injuries are the most common, with the knee and ankle the most frequently injured. Sprains and strains occur more often than bone injuries or concussions. Given that more injuries involve the soft tissues, MRI has a distinct advantage over radiography and CT for direct evaluation of the injury. The high accuracy of MRI in diagnosis has lead to its increased utilization especially among professional athletes. In addition, concomitant injuries may be discovered that were unsuspected on physical exam and radiography. Ultimately, the player is the main determinant when deciding when to return to play from an injury, although imaging can assist in the treatment algorithm and help estimate the number of potential missed games.

SummaryObjectiveTo assess the prevalence of anterior cruciate ligament (ACL) mucoid degeneration in patients referred for routine knee magnetic resonance (MR) imaging, and its association with age and structural joint damage.MethodFour independent radiologists assessed 413 consecutive knee MR examinations for the presence of a normal or ruptured ACL, or ACL mucoid degeneration. Knees with ACL mucoid degeneration were frequency matched by age, sex, and MR field strength with consecutive control knees with a normal ACL (1:2 ratio). Differences in meniscal and cartilage damage of the tibiofemoral compartments, as determined by the Whole-Organ MR Imaging Score (WORMS) system, were compared by Mann–Whitney U tests. Multivariable logistic regression analysis identified the association of ACL mucoid degeneration with severe MTFC cartilage damage (WORMS≥5).ResultsPatients with ACL mucoid degeneration (n = 36; 36% males; median age 55.5 years, range: 26–81) were older than patients with a normal (P 50 years.