Controversies Surrounding the BMD Reporting Standard for the Determination of 10-Year Absolute Fracture Risk: A Canadian Perspective.

The Canadian Association of Radiologists and Osteoporosis Canada currently endorse a fracture risk prediction tool called CAROC. It has been used in Canada since 2005 with an update in 2010. It is an integral part of bone mineral densitometry reporting across the country. New osteoporosis guidelines from Osteoporosis Canada (OC) are expected in the near future. There has been pressure on radiologists to report fracture risk using an alternative fracture risk prediction platform called FRAX. In addition, OC collaborated in the development of the Canadian FRAX model and has been copromoting both FRAX and CAROC, raising the prospect that new guidelines may seek to replace CAROC with FRAX for fracture risk determination. A number of concerns have been raised about FRAX, including: (1) FRAX has not released its algorithms to the public domain with the consequence that it is impossible to verify results for an individual patient; (2) FRAX has incorrectly claimed that it was developed by the World Health Organization (WHO) and has used this affiliation to promote itself until recently ordered by the WHO to desist; (3) FRAX requires collection of additional clinical information beyond that needed for CAROC, and this patient-reported medical data is prone to substantial error; and (4) despite claims to the contrary, there are no valid studies comparing FRAX to CAROC. We believe it is important that radiologists be aware of these issues in order to provide input into future Technical Standards for Bone Mineral Densitometry Reporting of the Canadian Association of Radiologists.

Transvaginal sonography as an adjunct to endorectal sonography in the staging of rectal cancer in women.

OBJECTIVE: The purpose of this study was to evaluate the contribution of transvaginal sonography (TVS) in the staging of rectal cancer in women. MATERIALS AND METHODS: Sixty women with rectal tumors underwent TVS. Forty-five of the 60 women also underwent endorectal sonography. Forty-nine of the women had rectal carcinoma; nine, tubulovillous adenoma; and two, gastrointestinal stromal tumor confirmed at surgical pathologic examination (n = 41) and biopsy before chemoradiation therapy (n = 19). Four of the 49 rectal carcinomas were T1; seven, T2; 35, T3; and three, T4. Images from TVS and endorectal sonography were shown independently to two blinded reviewers, who staged the tumors and assessed examination adequacy for tumor presence, size, and depth and nodal status. Staging results with TVS were compared with those obtained with endorectal sonography and histopathologic examination. RESULTS: All tumors were seen with TVS. In 30 of the 49 rectal carcinomas confirmed at surgical pathologic examination TVS tumor staging was accurate in 25 (83.3%) of the cases. Two (6.7%) of the 30 tumors were understaged, and 3 (10%) were overstaged. All tumors selected for chemoradiation (n = 19) were correctly staged T3. Endorectal sonography was suboptimal for tumors that were stenotic (n = 3), large (n = 2), high at the rectosigmoid junction (n = 4), or low at the anal canal (n = 3). In these 12 cases, TVS successfully depicted the lesion, and the images gave enough information for prediction of stage. In interpretation of the images of 45 patients who underwent both TVS and endorectal sonography, the blinded reviewers had good agreement and comparable accuracy for staging in adequate examinations with each technique. Four of the nine villous adenomas were overstaged as T1 on TVS. Gastrointestinal stromal tumors manifested as intramural vascular masses. CONCLUSION: TVS is an excellent adjunct to endorectal sonography in the staging of rectal cancer in women. It helps resolve the findings after endorectal sonography has been unsuccessful because the tumors are stenotic or in a high or low position.