Comparative accuracy of magnetic resonance imaging and ultrasonography in confirming clinically diagnosed patellar tendinopathy.

BACKGROUND: Diagnosis of patellar tendinopathy is based primarily on clinical examination; however, it is commonplace to image the patellar tendon for diagnosis confirmation, with the imaging modalities of choice being magnetic resonance imaging (MRI) and ultrasonography (US). The comparative accuracy of these modalities has not been established. HYPOTHESIS: Magnetic resonance imaging and US have good (>80%) accuracy and show substantial agreement in confirming clinically diagnosed patellar tendinopathy. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Magnetic resonance imaging and US (gray scale [GS-US] and color Doppler [CD-US]) features of 30 participants with clinically diagnosed patellar tendinopathy and 33 activity-matched, asymptomatic participants were prospectively compared. Accuracy, sensitivity, specificity, positive and negative predictive values, and the likelihood of positive and negative test results were determined for each technique. RESULTS: The accuracy of MRI, GS-US, and CD-US was 70%, 83%, and 83%, respectively (P = .04; MRI vs GS-US). The likelihood of positive MRI, GS-US, and CD-US was 3.1, 4.8, and 11.6, respectively. The MRI and GS-US had equivalent specificity (82% vs 82%; P = 1.00); however, the sensitivity of GS-US was greater than MRI (87% vs 57%; P = .01). Sensitivity (70% vs 87%; P = .06) and specificity (94% vs 82%; P = .10) did not differ between CD-US and GS-US. CONCLUSIONS: Ultrasonography was more accurate than MRI in confirming clinically diagnosed patellar tendinopathy. GS-US and CD-US may represent the best combination for confirming clinically diagnosed patellar tendinopathy because GS-US had the greatest sensitivity, while a positive CD-US test result indicated a strong likelihood an individual was symptomatic.

MRI of stress reaction of the distal humerus in elite tennis players.

OBJECTIVE: The purpose of this study was to describe the MRI appearance of stress reaction in the distal humerus in 12 elite tennis players. In addition, we aimed to determine whether any MRI findings were associated with changes in recovery times. CONCLUSION: Stress injury to the distal humerus is a cause of chronic arm pain among elite tennis players and may be exacerbated during full competition. The degree of marrow edema on STIR MRI may be predictive of time to return to competition.

Painful diabetic mastopathy as a reason for mastectomy.

A 34 year old woman with longstanding insulin-dependent diabetes mellitus experienced disabling bilateral breast pain and tenderness associated with the benign breast lesions of diabetic mastopathy. Diabetic mastopathy is typically associated with nontender lesions, however we present a case where disabling pain and tenderness lead to bilateral mastectomy, as requested by the patient. This relieved the patient of her symptoms.

False-positive breast screening due to fat necrosis following mammography.

Traumatic fat necrosis can result in a spectrum of imaging appearances that range from characteristically benign to those indistinguishable from malignancy. In such cases, biopsy might be required for diagnosis. The present case demonstrates a suspicious mammographic mass lesion appearing following a haematoma caused by a previous screening mammogram.