Pelvic Fractures and Associated Genitourinary and Vascular Injuries: A Multisystem Review of Pelvic Trauma.

OBJECTIVE. Blunt pelvic trauma is associated with injuries to the musculoskeletal, lower genitourinary, and vascular systems, leading to significant morbidity and mortality. This article provides a comprehensive review of these injuries, reviews classification systems that are helpful in predicting prognosis, describes the most appropriate imaging tests for injury detection, and emphasizes the role that interventional radiology plays in the setting of pelvic trauma. CONCLUSION. Blunt pelvic injuries can involve the musculoskeletal, genitourinary, and vascular systems, often concomitantly, making it imperative for radiologists to recognize injury patterns and understand implications for management. Injury classifications can be helpful in determining management and predicting prognosis. Contrast-enhanced CT is the imaging modality test of choice in evaluating pelvic trauma, and protocols should be optimized for best detection of injuries. Transcatheter arterial embolization plays a critical role in stopping acute hemorrhage and improving clinical outcomes.

Normal and Injured Ankle Ligaments on Ultrasonography With Magnetic Resonance Imaging Correlation.

Ultrasonography (US) has been increasingly used in the evaluation of ankle ligamentous injuries given its advantages as a dynamic, efficient, noninvasive, and cost-effective imaging method. Understanding the anatomy of the ankle ligaments is critical for correct diagnosis and treatment. This pictorial essay describes and illustrates the US scanning technique and potential pitfalls in evaluating the ankle ligaments and also provides an overview of the US appearance of normal and injured ankle ligaments with magnetic resonance imaging correlation. Highlighted structures include the lateral complex, medial/deltoid complex, spring (calcaneonavicular) ligament complex, and syndesmosis.

The 9 Habits of Highly Effective Radiologists.

Stephen R. Covey's landmark work in the field of effectiveness and professional development delineated first 7, then ultimately eight, habits of highly effective people with applicability to all professions.1 This article describes the eight habits in specific relation to the radiologist, and proposes a ninth habit to help one bring a positive and centered approach during the journey to effectiveness and beyond.

US of the Knee: Scanning Techniques, Pitfalls, and Pathologic Conditions.

Pain and other disorders of the knee are a common presenting complaint in the ambulatory setting. Although the cornerstones of imaging evaluation of the knee are radiographs and magnetic resonance (MR) imaging, ultrasonography (US) is less expensive than MR imaging, easily available, and of comparable accuracy in the evaluation of certain pathologic conditions of the knee. The benefits of US include portability, low cost, high spatial resolution, dynamic imaging, and ability to guide percutaneous interventions when indicated. US also allows direct patient contact, facilitating immediate clinical correlation and the ability to compare with the contralateral knee. US evaluation of the knee can be targeted to a specific region on the basis of the complaint or be a comprehensive review. For comprehensive evaluation, the knee is divided into anterior, medial, lateral, and posterior compartments for structured evaluation of the tendons, ligaments, joint space, osseous structures, as well as peripheral nerves and vasculature. US is particularly well suited for evaluating injuries of the quadriceps and patellar tendons, injuries of the medial and lateral collateral ligaments, joint effusions, and fluid collections around the knee. There is additional utility in evaluation of the distal hamstrings tendons, the iliotibial tract, the superficial patellar cortex, the common peroneal nerve, the popliteal vessels, and juxta-articular cystic collections including Baker cyst. In-depth appreciation of relevant sonographic anatomy, common pathologic conditions, knowledge of important pitfalls, and mastery of US technique will allow one to effectively use this powerful bedside tool for the evaluation of a wide variety of knee disorders. ©RSNA, 2016.

Diagnostic Accuracy of Ultrasound, Contrast-enhanced CT, and Conventional MRI for Differentiating Leiomyoma From Leiomyosarcoma.

RATIONALE AND OBJECTIVES: This study aimed to determine whether uterine leiomyoma can be distinguished from uterine leiomyosarcoma on ultrasound (US), computed tomography (CT), and/or magnetic resonance imaging (MRI) without diffusion-weighted imaging. MATERIALS AND METHODS: Institutional review board approval was obtained and informed consent was waived for this Health Insurance Portability and Accountability Act-compliant retrospective case-control diagnostic accuracy study. All subjects with resected uterine leiomyosarcoma diagnosed over a 17-year period (1998-2014) at a single institution for whom pre-resection US (n = 10), CT (n = 11), or MRI (n = 7) was available were matched by tumor size and imaging modality with 28 subjects with resected uterine leiomyoma. Six blinded radiologists (three attendings, three residents) assigned 5-point Likert scores for the following features: (1) margins, (2) necrosis, (3) hemorrhage, (4) vascularity, (5) calcifications, (6) heterogeneity, and (7) likelihood of malignancy (primary end point). Mean suspicion scores were calculated and receiver operating characteristic curves were generated. The ability of individual morphologic features to predict malignancy was assessed with logistic regression. RESULTS: Mean suspicion scores were 2.5 ± 1.2 (attendings) and 2.4 ± 1.3 (residents) for leiomyoma, and 2.7 ± 1.3 (attendings) and 2.7 ± 1.4 (residents) for leiomyosarcoma. The areas under the receiver operating characteristic curves (range: 0.330-0.685) were not significantly different from chance, either overall (P = .36-.88) or by any modality (P = .28-.96), for any reader. Reader experience had no effect on diagnostic accuracy. No morphologic parameter was significantly predictive of malignancy (P = .10-.97). CONCLUSIONS: Uterine leiomyoma cannot be differentiated accurately from leiomyosarcoma on US, CT, or MRI without diffusion-weighted imaging.