Chronic lesser tuberosity avulsion in an adolescent with an associated biceps pulley injury.

We report a case of a 15-year-old boy with chronic intermittent left shoulder pain due to an undiagnosed lesser tuberosity avulsion fracture, an associated biceps pulley injury and intra-articular dislocation of the long head of the biceps tendon. Lesser tuberosity avulsion fractures are rare injuries that are difficult to detect on clinical exam and radiographically, which may lead to delayed diagnosis and chronic shoulder instability. Few reports describe dislocations or subluxations of the biceps tendon in association with lesser tuberosity avulsions in children. We utilize this case to emphasize the importance of MR not only in detecting lesser tuberosity avulsions, but also in evaluating biceps pulley injuries, which are a rarely reported, but clinically important, association.

Volvulus of the entire small bowel with normal bowel fixation simulating malrotation and midgut volvulus.

BACKGROUND: Midgut volvulus is a complication of malrotation of bowel and mesenteric malfixation. In contrast, primary volvulus of the small bowel is a distinctly different and rare entity characterized by torsion of the entire small bowel with normal mesenteric fixation. OBJECTIVE: To present the clinical and imaging findings in four infants with primary small bowel volvulus and normal bowel fixation in order to improve awareness of this entity among clinicians and radiologists and to discuss the potential etiologies of this entity to distinguish it from other causes of small bowel volvulus. MATERIALS AND METHODS: A retrospective review of imaging studies (two ultrasounds and four upper gastrointestinal series) in four infants (three full-term and one premature) from three institutions with surgically proven volvulus of the entire small bowel and normal bowel fixation were reviewed by three board-certified pediatric radiologists and correlated with clinical and surgical reports when available. RESULTS: The infants presented during the first week to 6 months of life and were acutely ill. The upper gastrointestinal series showed complete duodenal obstruction with beaking in one and partial duodenal obstruction in three. All studies were interpreted as highly suspicious for malrotation and midgut volvulus. Emergent laparotomy demonstrated primary small bowel volvulus with normal mesenteric fixation in all infants. The base of the small bowel mesentery was described by the operating surgeon as smaller than normal in one infant (case 3). There was no mesenteric defect or other abnormality predisposing to volvulus in the other three. In both infants who had abdominal US, a retroperitoneal position of the third portion of the duodenum was demonstrated. All infants survived. One infant required resection of the necrotic small bowel and currently has short gut syndrome, one has malabsorption and two were lost to follow-up. CONCLUSION: Primary small bowel volvulus with normal fixation is indistinguishable from malrotation with midgut volvulus in the acutely ill infant or child. Radiographic diagnosis can be difficult in patients with intermittent or incomplete small bowel volvulus without malrotation. In these patients, neither an upper gastrointestinal series demonstrating a normal position of the duodenojejunal junction nor the sonographic demonstration of a retromesenteric third portion of the duodenum excludes the diagnosis. In young infants, the clinical and imaging findings may mimic necrotizing enterocolitis. Sonography may be useful to evaluate the bowel for signs of bowel wall compromise or a whirlpool sign.

Benefits and unexpected artifacts of biplanar digital slot-scanning imaging in children.

Biplanar digital slot-scanning allows for relatively low-dose orthopedic imaging, an advantage in imaging children given the growing concerns regarding radiosensitivity. We have used this system for approximately 1 year for orthopedic imaging of the spine and lower extremities. We have noted advantages of using the digital slot-scanning system when compared with computed radiographic and standard digital radiographic imaging systems, but we also found unexpected but common imaging artifacts that are the direct result of the imaging method and that have not been reported. This pictorial essay serves to familiarize radiologists with the advantages of the digital slot-scanning system as well as imaging artifacts common with this new technology.

Selecting the Best Radiology Workflow Efficiency Applications.

In the rapidly evolving digital radiology landscape, a surge in solutions has emerged including more than 500 artificial intelligence applications that have received 510 k clearance by the FDA. Moreover, there is an extensive number of non-regulated applications, specifically designed to enhance workflow efficiency within radiology departments. These efficiency applications offer tremendous opportunities to resolve operational pain points and improve efficiency for radiology practices worldwide. However, selecting the most effective workflow efficiency applications presents a major challenge due to the multitude of available solutions and unclear evaluation criteria. In this article, we share our perspective on how to structure the broad field of workflow efficiency applications and how to objectively assess individual solutions. Along the different stages of the radiology workflow, we highlight 31 key operational pain points that radiology practices face and match them with features of workflow efficiency apps aiming to address them. A framework to guide practices in assessing and curating workflow efficiency applications is introduced, addressing key dimensions, including a solution's pain point coverage, efficiency claim strength, evidence and credibility, ease of integration, and usability. We apply this framework in a large-scale analysis of workflow efficiency applications in the market, differentiating comprehensive workflow efficiency ecosystems seeking to address a multitude of pain points through a unified solution from workflow efficiency niche apps following a targeted approach to address individual pain points. Furthermore, we propose an approach to quantify the financial benefits generated by different types of applications that can be leveraged for return-on-investment calculations.

Use of Artificial Intelligence in Radiology: Impact on Pediatric Patients, a White Paper From the ACR Pediatric AI Workgroup.

In this white paper, the ACR Pediatric AI Workgroup of the Commission on Informatics educates the radiology community about the health equity issue of the lack of pediatric artificial intelligence (AI), improves the understanding of relevant pediatric AI issues, and offers solutions to address the inadequacies in pediatric AI development. In short, the design, training, validation, and safe implementation of AI in children require careful and specific approaches that can be distinct from those used for adults. On the eve of widespread use of AI in imaging practice, the group invites the radiology community to align and join Image IntelliGently (www.imageintelligently.org) to ensure that the use of AI is safe, reliable, and effective for children.

Sporadic adenocarcinoma of the colon in children: case series and review of the literature.

BACKGROUND: Adenocarcinoma of the colon is rare in pediatric patients and thus not much is known about its clinical and imaging characteristics. OBSERVATIONS: We present 4 adolescents with an average age of 15 years who present with several month histories of significant weight loss and abdominal pain. All had an abdominal and pelvic computed tomography scan, which revealed an adenocarcinoma in the colon. One patient had metastatic disease at diagnosis. The main treatment was primary resection and chemotherapy. Two of the children had a family history of colon cancer. Our case series depicts similarities and differences in disease presentation, tumor location, pattern of metastasis, genetics, management between adults and children and conducts a review of the relevant literature concerning adenocarcinoma in the pediatric population. CONCLUSIONS: In children, this disease has more aggressive histologies and presents more frequently in an advanced stage. This is because it is not a diagnosis often considered, leading to poorer outcomes. When patients present in the correct clinical context, the possibility of colonic adenocarcinoma should be considered in the differential diagnosis, which may in turn lead to better outcomes.

The vomiting neonate: a review of the ACR appropriateness criteria and ultrasound's role in the workup of such patients.

Ultrasound (US) plays a central role in the diagnostic imaging workup for infantile vomiting. This paper reviews the major causes of vomiting in the first months of life and the use of US and other modalities for their imaging assessment. The differential diagnostic possibilities are reviewed by examining 3 clinical scenarios of bilious vomiting during the first days of life, nonbilious vomiting since birth, and projectile vomiting first occurring after several weeks of life. These are the 3 scenarios that were used for the American College of Radiology (ACR) Appropriateness Criteria for Vomiting in Infants up to 3 Months of Age.

Cutaneous and subcutaneous imaging on FDG-PET: benign and malignant findings.

F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) has been shown to be useful in the evaluation of many tumors due to its high sensitivity and specificity. However, false-positive interpretations may occur from benign subcutaneous and cutaneous etiologies. At our institution we have encountered FDG-PET scans which demonstrated a variety of cutaneous and subcutaneous lesions including stomas, hernias, rhinophyma, dose infiltrations, physiologic muscle uptake, and tophaceous gout. Additionally, malignant cutaneous and subcutaneous malignant lesions may also demonstrate substantial F-18 FDG uptake on PET scans, including lymphoma, skin metastases, and melanoma. The purpose of this atlas article is to demonstrate and review key features of various cutaneous and subcutaneous lesions, both benign and malignant, which can result in hypermetabolism on FDG-PET or PET-CT scans.

The sonographic double-track sign: not pathognomonic for hypertrophic pyloric stenosis; can be seen in pylorospasm.

OBJECTIVE: The "double-track" sign has previously been reported as specific for hypertrophic pyloric stenosis when noted on an upper gastrointestinal series. The sign has been noted on sonographic examinations as well. We sought to determine whether this sign can also be seen in cases of pylorospasm diagnosed by sonography, proving it not to be pathognomonic for hypertrophic pyloric stenosis. METHODS: The data obtained prospectively from 91 consecutive patients studied between 1999 and 2002 by sonography for projectile vomiting were retrospectively reviewed. Cases with diagnoses of hypertrophic pyloric stenosis or pylorospasm were reviewed for the imaging finding of the double-track sign. RESULTS: Thirty-seven patients had a sonographic diagnosis of hypertrophic pyloric stenosis that was confirmed surgically. Twenty-six (70.2%) showed a sonographic double-track sign. Thirty-four patients had a sonographic diagnosis of pylorospasm that was confirmed by close clinical follow-up. Eighteen (52.9%) showed a sonographic double-track sign. CONCLUSIONS: The sonographic double-track sign can be seen in cases of pylorospasm as well as hypertrophic pyloric stenosis. It is not pathognomonic for hypertrophic pyloric stenosis.