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The pediatric hip undergoes significant changes from infancy through adolescence. Proper maturation is crucial for the development of a stable and functional hip joint. Imaging interpretation of the pediatric hip requires distinguishing normal variants and maturation patterns from pathology. We review femoral ossification centers, variants, and conditions that affect the proximal femur, such as Legg-Calvé-Perthes disease; the acetabulum, such as developmental hip dysplasia; the acetabular labrum, such as femoroacetabular impingement; and synovial pathology in children through adolescence. Understanding the spectrum of hip conditions and using advanced imaging techniques are essential for the accurate diagnosis and effective management of pediatric hip disorders., Competing Interests: None declared., (Thieme. All rights reserved.)

The diagnosis and management of chronic nonspinal osteomyelitis can be challenging, and guidelines regarding the appropriateness of performing percutaneous image-guided biopsies to acquire bone samples for microbiological analysis remain limited. An expert panel convened by the Society of Academic Bone Radiologists developed and endorsed consensus statements on the various indications for percutaneous image-guided biopsies to standardize care and eliminate inconsistencies across institutions. The issued statements pertain to several commonly encountered clinical presentations of chronic osteomyelitis and were supported by a literature review. For most patients, MRI can help guide management and effectively rule out osteomyelitis when performed soon after presentation. Additionally, in the appropriate clinical setting, open wounds such as sinus tracts and ulcers, as well as joint fluid aspirates, can be used for microbiological culture to determine the causative microorganism. If MRI findings are positive, surgery is not needed, and alternative sites for microbiological culture are not available, then percutaneous image-guided biopsies can be performed. The expert panel recommends that antibiotics be avoided or discontinued for an optimal period of 2 weeks prior to a biopsy whenever possible. Patients with extensive necrotic decubitus ulcers or other surgical emergencies should not undergo percutaneous image-guided biopsies but rather should be admitted for surgical debridement and intraoperative cultures. Multidisciplinary discussion and approach are crucial to ensure optimal diagnosis and care of patients diagnosed with chronic osteomyelitis., (© RSNA, 2024.)

Background Investigation of the use of preoperative MRI for providing prognostic information regarding clinical outcome following rotator cuff repair has been limited. Purpose To determine whether patients with more severe rotator cuff tears of the shoulder at preoperative MRI have a greater degree of residual pain and disability after rotator cuff repair. Materials and Methods This retrospective study included a cohort of 141 patients who underwent surgical repair of a full-thickness rotator cuff tear at a single institution between April 16, 2012, and September 3, 2015. The mean patient age was 56.8 years, and there were 100 men (mean age, 56.1 years) and 41 women (mean age, 56.3 years). Patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) survey (lower score indicates less pain and disability) before and 1 year after surgery. One musculoskeletal radiologist blinded to the DASH scores measured the maximal anterior-posterior width and medial-lateral retraction of the rotator cuff tear on the preoperative MRI and assessed tendon degeneration and composite muscle atrophy and fatty infiltration using categorical grading scales (grade 0 indicates no tendon degeneration or muscle atrophy and fatty infiltration, and higher grades indicate incrementally more severe tendon degeneration or muscle atrophy and fatty infiltration). Generalized estimating equation models were used to determine the association between preoperative MRI findings and the postoperative DASH score. Results There was a significant positive association ( P < .05) between the measured tear width (estimate, 2.05), measured tear retraction (estimate, 3.52), and tendon degeneration grade (estimate, 1.59) and the postoperative DASH score. There was no significant association ( P = .49) between the composite muscle atrophy and fatty infiltration grade (estimate, 0.31) and the postoperative DASH score. Conclusion Patients with larger rotator cuff tears, more tendon retraction, and more severe tendon degeneration have worse clinical outcome scores 1 year after rotator cuff repair. © RSNA, 2019.

Purpose To determine the feasibility of using a deep learning approach to detect cartilage lesions (including cartilage softening, fibrillation, fissuring, focal defects, diffuse thinning due to cartilage degeneration, and acute cartilage injury) within the knee joint on MR images. Materials and Methods A fully automated deep learning-based cartilage lesion detection system was developed by using segmentation and classification convolutional neural networks (CNNs). Fat-suppressed T2-weighted fast spin-echo MRI data sets of the knee of 175 patients with knee pain were retrospectively analyzed by using the deep learning method. The reference standard for training the CNN classification was the interpretation provided by a fellowship-trained musculoskeletal radiologist of the presence or absence of a cartilage lesion within 17 395 small image patches placed on the articular surfaces of the femur and tibia. Receiver operating curve (ROC) analysis and the κ statistic were used to assess diagnostic performance and intraobserver agreement for detecting cartilage lesions for two individual evaluations performed by the cartilage lesion detection system. Results The sensitivity and specificity of the cartilage lesion detection system at the optimal threshold according to the Youden index were 84.1% and 85.2%, respectively, for evaluation 1 and 80.5% and 87.9%, respectively, for evaluation 2. Areas under the ROC curve were 0.917 and 0.914 for evaluations 1 and 2, respectively, indicating high overall diagnostic accuracy for detecting cartilage lesions. There was good intraobserver agreement between the two individual evaluations, with a κ of 0.76. Conclusion This study demonstrated the feasibility of using a fully automated deep learning-based cartilage lesion detection system to evaluate the articular cartilage of the knee joint with high diagnostic performance and good intraobserver agreement for detecting cartilage degeneration and acute cartilage injury. © RSNA, 2018 Online supplemental material is available for this article .

Objectives: To correlate radiographic findings of osteoarthritis on axial knee radiographs with arthroscopic findings of articular cartilage degeneration within the patellofemoral joint in patients with chronic knee pain., Subjects and Methods: The study group consisted of 104 patients with osteoarthritis of the patellofemoral joint and 30 patients of similar age with no osteoarthritis of the patellofemoral joint. All patients in the study group had an axial radiograph of the knee performed prior to arthroscopic knee surgery. At the time of arthroscopy, each articular surface of the patellofemoral joint was graded using the Noyes classification system. Two radiologists retrospectively reviewed the knee radiographs to determine the presence of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts. The sensitivity and specificity of the various radiographic features of osteoarthritis for the detection of articular cartilage degeneration within the patellofemoral joint were determined., Results: The sensitivity of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts for the detection of articular cartilage degeneration within the patellofemoral joint was 73%, 37%, 4%, and 0% respectively. The specificity of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts for the detection of articular cartilage degeneration within the patellofemoral joint was 67%, 90%, 100%, and 100% respectively., Conclusion: Marginal osteophytes were the most sensitive radiographic feature for the detection of articular cartilage degeneration within the patellofemoral joint. Joint-space narrowing, subchondral sclerosis, and subchondral cysts were insensitive radiographic features of osteoarthritis, and rarely occurred in the absence of associated osteophyte formation.

Objective: The purpose of this study was to use the Kellgren-Lawrence, Ahlback, and Brandt grading scales to correlate radiographic grade of osteoarthritis with the actual degree of articular cartilage degeneration within the tibiofemoral joint in patients with chronic knee pain., Subjects and Methods: The study group consisted of 125 patients with symptomatic osteoarthritis of the tibiofemoral joint. For all patients, standing anteroposterior radiographs of the knee were obtained before arthroscopic knee surgery. Each articular surface of the tibiofemoral joint was graded at arthroscopy. Two radiologists retrospectively reviewed the knee radiographs without knowledge of the arthroscopic findings to determine the presence and severity of osteoarthritis of the tibiofemoral joint using the Kellgren-Lawrence, Ahlback, and Brandt grading scales. Correlation coefficients describing the relation between grade of osteoarthritis and severity of articular cartilage degeneration were calculated for each grading scale., Results: The correlation coefficients for the Kellgren-Lawrence, Ahlback, and Brandt grading scales were 0.49, 0.41, and 0.56, respectively. The differences between the correlation coefficients for the Kellgren-Lawrence and Ahlback grading scales and the correlation coefficients for the Brandt and Ahlback grading scales were statistically significant (p < 0.05). Many patients with no radiographic findings of osteoarthritis had significant articular cartilage degeneration within the tibiofemoral joint., Conclusion: The Kellgren-Lawrence and Brandt grading scales were equally effective in defining the presence of and estimating the severity of osteoarthritis of the tibiofemoral joint but had only a moderately strong correlation with the actual degree of articular cartilage degeneration.

Study Design: In this phantom study, rotations of a vertebral body calculated from computerized tomography (CT) were compared to the actual rotations provided by a specially designed device incorporating a reduction gear., Objective: The objective was to measure the accuracy of the CT and an automated software program to calculate rotations of lumbar vertebral bodies., Background: Rotations of individual vertebrae secondary to a change in position or load can be measured in select patients by roentgen stereophotogrammetry or by using CT and a specially constructed table that creates the rotation of the torso. The purpose of this study was to measure the precision and accuracy of rotation measurements made with a CT scanner and an automated program to calculate rotation., Methods: We constructed a phantom with a lumbar vertebra that can be rotated within a CT scanner. CT of the vertebra were obtained at angular positions of 0, 0.360 degrees , 1.080 degrees , 2.520 degrees , 5.400 degrees , 11.160 degrees , 29.160 degrees , 29.340 degrees , 29.520 degrees , 29.610 degrees , 29.700 degrees , 29.790 degrees , 29.880 degrees , and 29.889 degrees . With an automated program based on a pixel-shift algorithm, we calculated rotations of the vertebra between pairs of images. Accuracy was calculated as mean difference between the actual and the calculated rotation, and precision was calculated as the standard deviation of the differences., Results: Differences between actual and calculated rotations varied from -0.083 degrees to 0.132 degrees . For rotations less than 15 degrees , mean error (accuracy) was -0.039 degrees , and the standard deviation (precision) was 0.029 degrees . For rotations greater than 15 degrees , the accuracy was 0.086 degrees , and the precision was 0.023 degrees ., Conclusions: This study shows that rotations of lumbar vertebrae may be measured with CT, and an automated program to an accuracy and precision better than 0.1 degrees , comparable to that of roentgen stereophotogrammetry.

Rationale and Objectives: The purpose of this study was to test the effectiveness of resident-prepared, independent learning cases in teaching residents chest radiology., Materials and Methods: Three 2nd-year residents (one each from the University of Wisconsin, the Oregon Health Sciences University, and the University of Michigan) prepared four chest radiology teaching cases each (total, 12 cases). Radiology residents from each institution were randomly divided into control (n = 30) and experimental (n = 35) groups. Residents from both groups took a pretest of 36 multiple-choice questions covering the material from the 12 teaching cases. Residents in the experimental group reviewed these cases independently, and both groups took the same test (posttest) immediately after the teaching cases had been reviewed and again 3 months later (final test)., Results: Test scores were similar across institutions (P > .05) but differed across time and treatment groups (experimental vs control) (P < .0001). Mean differences in test scores between the experimental and control groups at pretest, posttest, and final test were -0.4, +9.0, +4.0, respectively, demonstrating increased performance at posttesting that was still present (though somewhat attenuated) 3 months later at final testing., Conclusion: Independent study of resident-prepared chest radiology teaching cases increases the resident's knowledge for as long as 3 months after instruction.