The imaging features of tape suture: a contemporary surgical material.

OBJECTIVE: To offer an adjunctive imaging tool to MRI for evaluating tape suture related rotator cuff repairs. MATERIALS AND METHODS: A two-part pilot study was performed to assess visibility of tape suture following imaging with various modalities. Institutional research ethics board approval was obtained prior to cadaveric studies. Two tape sutures, FiberTape® and TigerTape®, were evaluated in each experiment. The first experiment assessed the tape suture's presence in a gelatin mold following exposure to X-ray, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) without contrast. The second experiment assessed tape suture's visibility in a cadaveric shoulder model following a standard of care, double-row, transosseous equivalent rotator cuff repair. The same imaging protocols and equipment were used for each part of the study with the addition of MR arthrography-tailored images on the cadaveric specimen. All images were assessed by a musculoskeletal trained radiologist. RESULTS: The gelatin study demonstrated that the tape suture was visible via ultrasound only. X ray, CT, and MRI did not show tape suture material. In the ultrasound component of the cadaveric study, distinct echogenic textural detail of the tape suture was easily identified, compatible with the simulated rotator cuff repair. X ray and unenhanced CT did not show the tape suture material or the rotator cuff. MRI without intraarticular gadolinium contrast did not adequately image the suture tape; however, faint artifact in the repair region was visualized. MRI with intra-articular contrast did not show the tape suture material in detail; however, the intraarticular gadolinium did provide an advantageous background of high T1 signal that contrasted with the cuff/suture construct. CONCLUSION: Ultrasound proved to be an effective imaging modality to visualize tape suture in both the gelatin and cadaveric parts of the pilot study. Ultrasound may be a useful tool to evaluate post-operative tape suture-related repairs in patients that cannot obtain MRIs or when the MRI findings are equivocal.

MR diagnosed chronic exertional compartment syndrome successfully treated by endoscopically-assisted fasciotomy.

Chronic exertional compartment syndrome is a subset of compartment syndrome that most frequently affects the lower extremities, often in athletic persons. It is most often characterized by calf pain shortly after the initiation of exercise and resolution of the pain soon after rest. While the pathophysiology is not completely understood, it is believed that compartment a lack of fascial compliance and increased compartment fluid leads to increased pressure, ultimately leading to a reversible ischemic state. Chronic exertional compartment syndrome was once considered a diagnosis of exclusion; however, needle manometry is an invasive way to measure intracompartmental pressure. Similarly, fasciotomy is the treatment of choice but is not without complications. We describe a case of chronic exertional compartment syndrome diagnosed by two-stage MRI and successfully treated by endoscopically-assisted fasciotomy.

Manubriosternal Joint Involvement as a Presenting Feature of Axial Spondyloarthritis.

Anterior chest wall pain is a feature of axial spondyloarthritis that is understudied. It is rarely the presenting symptom, and when present, may suggest severe disease. We present the case of a 35-year-old female with recurring presentations of debilitating chest pain, subsequently diagnosed with axial spondyloarthritis. Awareness of this presentation can lead to earlier diagnosis and treatment of patients presenting with manubriosternal joint involvement as their initial symptom of axial spondyloarthritis.

MRI of myositis and other urgent muscle-related disorders.

Myositis has many etiologies, and it can be encountered in the acute or chronic setting. Our goal is to increase the radiologist's knowledge of myositis and other urgent muscle disorders encountered in the emergent or urgent setting. We review the clinical presentation, the MRI appearance, and the complications that can be associated with these entities. Since myositis can affect multiple muscle compartments, we review how to differentiate the compartments of the appendicular skeletal in order to generate reports that relay important anatomic information to the treating physician. Given the poor sensitivity and positive predictive value of the clinical signs and symptoms used to diagnosing acute compartment syndrome, we discuss the potential use of MRI in cases of suspected but clinically equivocal compartment syndrome in the future.

The TechnoPhysics Year: Transformation of Diagnostic Radiology's Clinical Year as a Matter of Necessity.

Given that artificial intelligence and machine learning is now a reality of modern existence, rapidly being applied to medicine, and especially radiology, we submit a new educational perspective. By codifying technology education during the diagnostic radiology internship, we believe it is not only possible but necessary, to reframe the identity of diagnostic radiology. This paper describes the restructuring of the radiology clinical internship, limiting clinical rotations to high-yield essentials, thereby allowing for the introduction of data and technology science, and comprehensive medical physics training. By linking modality-immersion based training with the physics of each technology, we postulate a more thorough understanding and, ultimately, the mastery of current and future technological innovations. Concurrently we advocate for the study of artificial intelligence and machine learning in order to understand how radiologists can apply this technology to help patients on the precision and population health levels. This training would allow interns to spend the majority of their time under the umbrella of a radiology department, in lieu of multiple rotations on an assortment of clinical services. An in-depth technology and physics exam at the end of the internship would be a natural transition to the start of the R1 year, allowing for the application of this newly attained knowledge throughout their residency. Diagnostic radiologists have led medicine into the digital era, and now we should lead the medical community into this transformational era as the "Data-Driven Physician" of the 21st century.

Radiation-Induced Rib Fractures on Magnetic Resonance Imaging Following Proton Therapy for Breast Cancer With Pencil Beam Scanning.

Radiation-induced rib fractures (RIRF) are long-term complications associated with irradiation of the chest/chest wall. RIRFs are commonly seen in lung- or breast-cancer patients treated with stereotactic body radiotherapy (SBRT) or conventional external beam radiation therapy (EBRT), respectively. We report a case of a 31-year-old female presenting with pathological fractures of the third, fourth, and fifth ribs discovered on magnetic resonance imaging (MRI) as a complication from pencil beam scanning (PBS) proton therapy (PT), of the whole left breast and regional lymph nodes. To our knowledge, this presentation is the first to be initially reported on MRI in radiological literature.

MR imaging findings of calcinosis cutis in primary Sjogren syndrome, a rare manifestation.

Soft tissue calcifications associated with various connective tissue diseases such as dermatomyositis and scleroderma have been well documented Plaque-like sheets of subcutaneous calcifications presenting as an indurated soft tissue mass in a patient with primary Sjogren syndrome have been rarely documented in the literature. We present the magnetic resonance and conventional radiographic findings of calcinosis cutis and calcinosis circumscripta of a 47-year-old woman with biopsy proven Sjogren syndrome. We also delineate various types of soft tissue calcification, histopathology of calcinosis cutis, and current treatment options. Recognizing the magnetic resonance characteristics of this phenomenon may prove useful to radiologists, especially in the absence of clinical history and conventional radiographs.

The Dark Side of Gadolinium: A Study of Arthrographic Contrast at Extreme Concentrations.

Magnetic resonance arthrography is used to optimally image the detailed intraarticular anatomy of the joint space. A common iatrogenic complication of arthrography is the extra-articular injection of the gadolinium solution in the periarticular tissues; however, a less common complication involves the abnormal concentration of gadolinium within the prepared injectate. The following describes the inadvertent injection of a hyper-concentrated intraarticular solution of gadolinium and the subsequent appearance that resulted in the post-procedure magnetic resonance imaging examination. In addition, an in-vitro experiment was performed to determine the exact etiology of the abnormal magnetic resonance imaging findings that resulted in this case. The subsequent discussion revisits the signal intensity of gadolinium at extreme concentration ranges and proposes modifications of procedure protocol to mitigate the chance of a repeat event.

Candida Parapsilosis associated rice bodies in the extensor compartment of the wrist--an emerging finding.

Candida parapsilosis has been considered an emerging pathogen with increasing incidence reported in the literature. As a normal commensal of human skin, it is likely that Candida species could gain access to soft tissues of the hand and wrist by direct inoculation, resulting in an infectious tenosynovitis. With the increased prevalence of intravenous drug use (IVDU), users are at increasing risk for musculoskeletal infections including soft tissue abscesses, cellulitis, tenosynovitis, and septic arthritis. Chronic tenosynovitis, with rice body formation in particular, is a comparatively rare musculoskeletal infection. Knowledge of this entity, the related pathogens, imaging findings, and the treatment plan is important not only to the treating clinician, but also to radiologists as the physiological and anatomic consequences can be detrimental to patient recovery.

Intramuscular hemorrhage and fluid extravasation into the anterior compartment secondary to intraosseous resuscitation, the "Nicked-Cortex" sign.

Intraosseous needle access is a reliable method of vascular access used for rapid fluid resuscitation and delivery of medications in certain emergent settings. Fluid extravasation is a possible complication of intraosseous needle access that can lead to compartment syndrome. To our knowledge, imaging findings resulting from this complication have not been described. In this case report, we demonstrate conventional radiograph, computed tomography, and magnetic resonance image findings due to extravasation of resuscitation fluids following the aberrant insertion of an intraosseous needle in an unstable adult trauma patient. We also describe a new radiographic sign associated with this iatrogenic complication, the "Nicked-Cortex" sign.

Kaposi Sarcoma mimicking pedal osteomyelitis in a patient with HIV.

Kaposi Sarcoma (KS) is an angio-proliferative mesenchymal neoplasm that typically affects the skin. In the setting of AIDS, it is usually disseminated, commonly involving noncutaneous sites like oral cavity, lymph nodes, pulmonary, and gastrointestinal systems. Musculoskeletal system involvement by KS is rare, and when encountered, it typically involves the axial skeleton (vertebrae, ribs, sternum, and pelvis) and/or maxillofacial bones. This report describes an unusual case of a 44-year old patient with HIV, who presented with a foot ulcer that fit the typical clinical features of osteomyelitis until MRI of the foot demonstrated atypical findings that challenged the original clinical diagnosis. This case highlights the role that advanced diagnostic imaging plays in the diagnosis of musculoskeletal Kaposi Sarcoma and serves as a reminder to radiologists to include Kaposi Sarcoma in the differential of multifocal osteolytic lesions in patients with HIV.

Catamenial Rectus Abdominis Pain Associated with Scar Endometriosis Status-post Low Transverse Cesarean Section.

Endometriosis is the presence of endometrial tissue outside of the uterine cavity. Scar endometriosis (SE), a rare occurrence, results from inadvertent extrapelvic transplantation of endometrial tissue to an incision site, such as from a low transverse cesarean section (LTCS). The reported incidence of abdominal wall scar endometriosis status-post cesarean section is 0.03 - 0.6%. We present a case of rectus abdominis scar endometriosis diagnosed four years following an LTCS. Our case report discusses the history/presentation, imaging findings, histopathology, and pertinent literature concerning abdominal wall scar endometriosis.

Brace yourself: an unusual case of knee pain, an extradigital glomangioma of the knee.

The differential diagnosis for knee pain is extensive. Glomus tumors comprise approximately 1.6% of soft-tissue tumors in the extremities. Classic subungual tumors occur more frequently in women, whereas ectopic locations are more common in men. Unusual locations include the stomach; lungs; trachea; bones; intestines; fallopian tubes; and intraneural, neuromal, and intravenous locations. We present the case of a 50-year-old man with a 12-year history of enlarging right knee mass found to be a glomangioma. This case report discusses the incidence, presentation, imaging characteristics, histology, and management of glomus tumors of the knee.

Metallosis and Metal-Induced Synovitis Following Total Knee Arthroplasty: Review of Radiographic and CT Findings.

Metallosis and metal-induced synovitis are well-recognized complications of metal-backed polyethylene joint prostheses and have been frequently described in the orthopedic surgery literature; however, relatively fewer articles discussing the radiologic aspects of this complication have been published. To illustrate the importance of radiologic findings in the diagnosis and management of these patients, we present a case of metallosis and metal-induced synovitis complicating two revisions of a total knee arthroplasty, caused by polyethylene liner wear and dissociation of the polyethylene liner from the metal-backed patellar prosthesis. Specific attention is given to reviewing signs that aid in diagnosis, such as the "bubble sign," "cloud sign," and "metal-line signs."

Verrucous carcinoma of the foot and enhancement assessment by MRI.

Verrucous carcinoma (VC), also known as epithelioma cuniculatum, of the foot is an uncommon low-grade squamous cell carcinoma with slow, progressive local invasion with minimal dysplasia and low potential for metastasis. We report on a case of VC and the enhancement pattern associated with it on magnetic resonance (MR) imaging. MR imaging revealed a plantar ulcer with an interesting pattern of enhancement at the base of the mass. The interface between the mass and the normal stroma exhibited a fine-filamentous pattern of enhancement, analogous to teased cotton wool, with impressive correlation to the histological appearance of our specimen. It is our opinion that VC could be included in the differential of a plantar ulcer associated with a mass that exhibits this enhancement pattern.

Secondary Tumoral Calcinosis with Intraosseous Penetration.

We report a case of a 55-year-old woman with chronic renal failure and secondary tumoral calcinosis with rare intraosseous penetration of the humerus. Typical lobulated calcifications with associated layering "milk of calcium" were present about the right shoulder and elbow on conventional radiographs, computed tomography images and magnetic resonance images. Rare appearance of cortical destruction and intraosseous extension of tumoral calcinosis into the medullary space was observed in the proximal humerus on CT and MR images. Since there is concern for pathologic fracture, radiologists should be aware of this rare complication of chronic renal disease.