Osteochondral Lesions of the Ankle and Foot.

Osteochondral lesions (OCLs) in the ankle are more common than OCLs of the foot, but both share a similar imaging appearance. Knowledge of the various imaging modalities, as well as available surgical techniques, is important for radiologists. We discuss radiographs, ultrasonography, computed tomography, single-photon emission computed tomography/computed tomography, and magnetic resonance imaging to evaluate OCLs. In addition, various surgical techniques used to treat OCLs-debridement, retrograde drilling, microfracture, micronized cartilage-augmented microfracture, autografts, and allografts-are described with an emphasis on postoperative appearance following these techniques.

Postoperative Ankle Imaging, 2022.

Postoperative ankle imaging requires knowledge of the underlying surgical techniques, the usefulness of various imaging modalities, as well as an appreciation for the desired clinical outcomes. Surgical procedures discussed in this article are tibiotalar fracture fixation, tibiotalar, subtalar, and tibiotalocalcaneal arthrodesis, total ankle arthroplasty, talar osteochondral lesion repair and grafting, lateral ligamentous repair and reconstruction, and peroneal and Achilles tendon repair and reconstruction. Imaging can play a vital role in determining if the expected outcome has been achieved and identifying complications, with particular emphasis placed on the use of radiographs, computed tomography (including weight-bearing), magnetic resonance imaging, and ultrasonography.

Calcific Tendinosis Reduces Diagnostic Performance of Magnetic Resonance Imaging in the Detection of Rotator Cuff Tears.

OBJECTIVE: This study aimed to investigate the effect of calcific tendinosis on the diagnosis of rotator cuff tears (RCTs) on magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA). MATERIALS AND METHODS: Calcific tendinosis was confirmed radiographically. Two musculoskeletal radiologists then retrospectively and independently reviewed the MRI/MRA examinations, with surgery or arthroscopy performed within 90 days of the MRI. Rotator cuffs were categorized as no tear, partial-thickness tear, and full-thickness tear. Partial-thickness tear/full-thickness tear groups were combined for analysis. RESULTS: Forty-eight MRI (mean age, 63.4 years; range, 37-83 years; female-to-male ratio, 29:19) and 7 MRA (mean age, 49.2 years; range, 25-60 years; female-to-male ratio, 4:3) patients were included. Reader 1 and reader 2 sensitivity/specificity values for RCTs on MRI were 95%/50% and 89%/30%, and the values on MRA were 100%/67% and 100%/100%, respectively. Overall agreement was present in 87% (48 of 55; κ = 0.55 [95% confidence interval, 0.26-0.85]). CONCLUSIONS: Magnetic resonance imaging has decreased specificity in diagnosing RCTs when calcific tendinosis is present. Magnetic resonance arthrography performed better in this population and could be considered.

Performance of an algorithm for diagnosing acute cholecystitis using clinical and sonographic parameters.

PURPOSE: Identify an algorithm using clinical and ultrasound (US) parameters with high diagnostic performance for acute cholecystitis. METHODS: Consecutive emergency department (ED) patients from 4/1/2019 to 12/31/2019 were retrospectively reviewed to record non-US parameters and make US observations. Outcomes were categorized as either: (1) acute cholecystitis; or (2) negative acute cholecystitis. Pivot tables identified parameter combinations either not found with acute cholecystitis or with predictive value for acute cholecystitis to establish the algorithm. US Division radiologists finalized an US report prior to ED disposition without use of the algorithm. Radiologist impression and algorithm prediction for acute cholecystitis were categorized as either (1) acute cholecystitis; (2) negative acute cholecystitis; or (3) inconclusive. RESULTS: Three hundred and sixty-six studies on 357 patients (mean age, 51 yrs ± 20 yrs; 215 women) met the inclusion criteria. 10.9% (40/366) of US studies had acute cholecystitis, 12.6% (46/366) had pathologically identified chronic cholecystitis without acute cholecystitis, and 76.5% (280/366) were negative acute cholecystitis. Algorithm compared to radiologist diagnostic performance was as follows: (1) sensitivity: 90.0% vs. 55.0%, p < 0.001; (2) augmented sensitivity (defined as when inconclusive categorization is considered consistent with acute cholecystitis): 100% vs. 85.0%, p < 0.001; (3) specificity: 93.6% vs. 94.8%, p = 0.50; (4) diagnostic rate (opposite of inconclusive rate): 96.4% vs. 93.2%, p = 0.04; (5) adverse outcome rate: 0.0% vs. 1.6%, p undefined. CONCLUSION: For acute cholecystitis, an algorithm using non-binary ultrasound and clinical assessments had higher sensitivity, higher diagnostic rate, and fewer adverse outcomes, than subspecialty radiologist impressions.

Identification of Concomitant Iatrogenic Lower Extremity Lymphedema and Pelvic Lymphatic Leak on Lymphoscintigraphy and SPECT/CT.

Pelvic lymphatic leakage and lower extremity lymphedema are well-known complications of pelvic surgery or radiation therapy. We report a cervical carcinoma patient who, after hysterectomy and lymphadenectomy, developed concomitant lymphedema of the left lower extremity and a pelvic lymphatic leak identified on lymphoscintigraphy and SPECT/CT.