Cadaveric Classification of the Genicular Arteries, with Implications for the Interventional Radiologist.

PURPOSE: To document and assess the genicular arterial variation in a large multicenter cadaveric sample and to generate an anatomical classification with implications for genicular artery embolization (GAE). MATERIALS AND METHODS: A total of 212 dissected donor body lower limbs from 3 medical school institutions were included. The descending genicular artery (DGA), superior lateral genicular artery, superior medial genicular artery, middle genicular artery, inferior lateral genicular artery, inferior medial genicular artery, and anterior tibial recurrent artery were identified for gross anatomical appearance, location of origin, diameter of vessels, and variation in branching patterns. RESULTS: A total of 198 DGAs, 204 popliteal-origin genicular arteries, and 183 anterior tibial recurrent arteries were adequately preserved and reviewed. Three types (A: 26%, B: 71%, and C: 5%) of DGA branching patterns were proposed along with 6 types (I: 28%, II: 22%, III: 15%, IV: 15%, V: 10%, and VI: 6%) of popliteal-origin genicular artery branching variants. Right versus left comparisons did not reveal clinically significant differences in the vessel distance (P = .30 to .82). CONCLUSIONS: Despite the large number of possible anatomical variations of the genicular arteries, 6 main patterns corresponded to >96% of the cases. The description and classification of the genicular arterial anatomy may provide useful information to the interventional radiologist and add to the technical nuances of GAE.

Diffuse Paget's Disease of the Skull with Intense Uptake of Technetium-99m-Labeled Diphosphonate Tracer in Bone Scintigraphy.

Imaging in patients with Paget's disease of bone is very important clinically to show the presence of Pagetic abnormalities, assess disease progression, and identify adversely affected structures throughout disease course. Abnormalities and progression may be seen on radiographs, computed tomography, magnetic resonance imaging, and nuclear imaging. Herein, we report a case Paget's disease of bone showing diffuse characteristic pathology using technetium-99m-labelled diphosphonate tracer in bone scintigraphy (nuclear imaging). This case emphasizes the ability of nuclear imaging to rapidly visualize and assess progressive distribution of Pagetic involvement in a patient previously diagnosed with pituitary adenoma and mild Paget's disease of the skull.

Adnexal carcinoma of the scalp: aggressive sebaceous differentiation with invasion of the orbital wall and thoracic vertebra.

Tumors of the scalp are characterized by a heterogeneous clinical spectrum with site-specific features. A wide variety of tumors that arise in the scalp include neoplasms, hamartomas, malformations, and both benign and malignant cysts. Most scalp tumors are benign (98-99%) with only an estimated 1-2% of diagnosed cases reported as being malignant. Of these, adnexal carcinoma is reported in less than 1% of cases. Herein, we report a 65-year-old woman who presented with pain and numbness in her hands with past medical history significant only for a chronic posterior head mass that had never received workup. Computerized topography (CT), magnetic resonance imaging (MRI), and local biopsy demonstrated a large, pedunculated malignant occipital mass that had metastasized to the orbital walls and cervical spine. To our knowledge, this is the largest sebaceous carcinoma to be reported occurring in the scalp. The present case emphasizes the need for older patients with benign scalp lesions to be closely monitored with frequent CT scans for signs of malignant transformation. Furthermore, it is important to diagnose malignant scalp tumors early as they tend to metastasize and cause diffuse symptomatology, which may ultimately result in increased patient mortality.

Comparing Perioperative Outcomes of Uterine Artery Embolization and Hysterectomy in Insurer and Demographically Diverse Populations: A Retrospective, Multi-Center Database Study.

INTRODUCTION: Past studies comparing perioperative outcomes of hysterectomy (HYST) and uterine artery embolization (UAE) do not control for demographically and insurer diverse populations. This study sought to identify the 30­day readmission, 15­day complication, and minimum 1­year surveillance reintervention rates of diverse, propensity matched patients undergoing UAE or HYST for uterine leiomyoma. METHODS: Adults from the New York's Statewide Planning and Research Cooperative System (SPARCS) database 2009­2013 who underwent HYST or UAE for uterine leiomyoma were retrospectively reviewed and 1:1 propensity matched. Univariate analysis compared demographics, complications, readmissions, and reintervention rates. Binary logistic and linear regression models identified independent predictors of outcomes. RESULTS: A total of 682 patients were identified, where the number (n) of patients in each cohort was n=341, HYST, and n=341, UAE. Significance levels are shown with p values. No significant differences were identified between HYST and UAE demographics, complication (2.60% HYST vs 2.90% UAE, p=0.816) or readmission rates (3.20% HYST vs 3.80% UAE, p=0.678); 0.30% of UAE patients had a reintervention UAE and 2.90% of UAE patients had reintervention hysterectomy. HYST patients had a significantly longer average length of stay (2.59 days HYST vs 1.63 days UAE, p<0.001). The Deyo-Charlson (Deyo) comorbidity score positively predicted any complication with odds ratio=34.262, 95% confidence interval [4.938, 237.725], and p<0.001, but did not predict readmissions. CONCLUSION: HYST patients had significantly longer hospital stays. UAE and HYST had comparable readmission and complication rates. The Deyo comorbidity score was a significant predictor of any complication. This study supports the safety and efficacy of UAE when compared to HYST in demographic and insurer diverse populations.

Learning from Gamers: Integrating Alternative Input Devices and AutoHotkey Scripts to Simplify Repetitive Tasks and Improve Workflow.

Radiologists rely heavily on the digital radiology workstation. They spend most of their time interacting with software applications that use multiple input devices, including mice, keyboards, and microphones. The efficiency of this relationship depends on the interface of the different software applications, their interoperability, and input device effectiveness. Because of the repetition of a radiologic workflow, even small inefficiencies can accumulate into significant losses of time and productivity and contribute to user fatigue. Alternative input devices (AIDs) with onboard memory can be used as ergonomic human-computer interfaces. These devices can also be coupled with AutoHotkey scripts to complete complex tasks in one keystroke. Radiologists can use modern AIDs and simple scripts to minimize frustration, improve and personalize their routines, and streamline interactions with the workstation. The authors discuss hardware and software features that do not require support from information technology professionals and can be implemented with any software that relies on user input.Online supplemental material is available for this article.©RSNA, 2020.

Primary bone lymphoma of patella: A case report and review of literature.

Primary bone lymphoma (PBL) is rare bone disease that accounts for very small number of all primary bone tumors. Among the described sites of PBLs, the patella is an extremely rare example. To date, only a few cases of PBL affecting the patella have been reported. Clinically, these tumors have very similar presentation of pain, decreased range of motion and swelling and, sometimes, pathologic fractures. On radiographs, skeletal lymphoma commonly manifests as osteolytic lesions with ill-defined margins affecting the metaphysis of axial long bones. We present a rare case of patellar adult T-cell lymphoma/leukemia in a 58-year-old female who presented with left-knee pain and swelling. Computed tomography and magnetic resonance imaging revealed diffuse marrow replacement by a lesion with aggressive features. PET scan demonstrated neoplastic range hypermetabolic FDG uptake within this lesion. Ultrasound-guided biopsy was consistent with PBL.

Superficial siderosis: Chronic sequelae following brain hemorrhage.

Superficial siderosis is a rare disease of the central nervous system. It is caused by hemosiderin deposition usually following subarachnoid hemorrhage. We report a 67-year-old man with history of motor vehicle accident in 1974 who presents with tremors, worsening ataxia, and impaired auditory, olfactory, and gustatory sensation. The patient was evaluated with magnetic resonance imaging of the brain that showed areas of superficial low T2 signal throughout the posterior fossa, ventricles, sulci, and cisterns, most conspicuous on the gradient-recalled echo T2* susceptibility-weighted sequence. These findings are compatible with old blood products (hemosiderin) and the diagnosis of superficial siderosis.

Thirty-day outcomes of emergency department patients undergoing electrical cardioversion for atrial fibrillation or flutter.

OBJECTIVES: While the short-term (<7-day) safety and efficiency of electrical cardioversion for emergency department (ED) patients with atrial fibrillation or flutter have been established, the 30-day outcomes with respect to stroke, thromboembolic events, or death have not been investigated. METHODS: A two-center cohort of consecutive ED patients undergoing cardioversion for atrial fibrillation or flutter between January 1, 2000, and September 30, 2007, was retrospectively investigated. This cohort was probabilistically linked with both a regional ED database and the provincial health registry to determine which patients had a subsequent ED visit or hospital admission, stroke, or thromboembolic event or died within 30 days. In addition, trained reviewers performed a detailed chart abstraction on 150 randomly selected patients, with emphasis on demographics, vital signs, medical treatment, and predefined adverse events. Hemodynamically unstable patients or those whose condition was the result of an underlying acute medical diagnosis were excluded. Data were analyzed by descriptive methods. RESULTS: During the study period, 1,233 patients made 1,820 visits for atrial fibrillation or flutter to the ED. Of the 400 eligible patients undergoing direct-current cardioversion (DCCV), no patients died, had a stroke, or had a thromboembolic event in the following 30 days (95% confidence interval [CI] = 0.0 to 0.8% for all outcomes). A total of 141 patients were included in the formal chart review, with five patients (3.5%, 95% CI = 0.5% to 6.6%) failing cardioversion, six patients (4.3%, 95% CI = 0.9% to 7.6%) having a minor adverse event that did not change disposition, and five patients (3.5%, 95% CI = 0.5% to 6.6%) admitted to hospital at the index visit. CONCLUSIONS: Cardioversion of patients with atrial fibrillation or flutter in the ED appears to have a very low rate of long-term complications.