How do radiologists evaluate osteonecrosis?

OBJECTIVES: Management of patients with osteonecrosis of the hip remains controversial and challenging. Because the prognosis and treatment are determined in large part by the stage and extent of the disease, it is important to use a reliable and efficient method for evaluation and staging. The objective of this study was to determine how musculoskeletal (MSK) radiologists evaluate osteonecrosis and whether this evaluation is adequate. MATERIALS AND METHODS: A 12-part questionnaire was designed to determine how MSK radiologists evaluate patients with osteonecrosis of the femoral head (ONFH). This was sent to 888 members of the Society of Skeletal Radiology. RESULTS: One hundred and twenty-one members responded to essentially all questions. Patients were evaluated using plain radiographs and MRI. All agreed that it is clinically important to determine the extent of necrosis and joint involvement, and 115 (95 %) stated that this should be part of the radiologists' evaluation. However, only 55 (46 %) said that in practice they used a specific system of classification, and most of these used the Ficat and Arlet classification, which does not indicate the extent of involvement. One hundred and seven (88 %) respondents included a simple visual estimate of the extent of involvement, and a small number added a specific measurement of lesion size. The majority indicated that they were infrequently consulted about which imaging studies should be obtained. CONCLUSIONS: Although radiologists recognize the clinical importance of determining the extent of necrosis and joint involvement in patients with ONFH, in practice the methods used to evaluate these patients often do not accomplish this satisfactorily. The use of an effective classification, which includes both stage and extent of involvement, should be stressed, as it will lead to improved treatment of patients with ON. Physicians who order imaging studies for patients with ON should be encouraged to consult routinely with their radiology colleagues regarding which studies to request, as well as on the interpretation of these studies.

Imaging features of pseudoaneurysms of the hand in children and adults.

OBJECTIVE: Our objective was to review the imaging features of pseudoaneurysms of the hand in 25 patients. The patients presented with a mass, peripheral paresthesia, or ischemia. Pseudoaneurysm of the hand is a rare and often clinically unsuspected diagnosis. Correct diagnosis is important because there are risks for distal embolic disease with ischemia or gangrene of the fingers, ulnar or digital nerve dysfunction, rupture, or bone erosion and joint destruction. Scant reports appear in the world literature, and this report is the first review, to our knowledge, of the imaging features. The cause may be a history of a single direct trauma or chronic trauma, as seen in patients with hypothenar or thenar hammer syndrome. CONCLUSION: Awareness of the specific imaging appearances of pseudoaneurysms of the hand and their complications may improve the accuracy of radiologic diagnosis, advance the preoperative workup, and prevent possible clinical complications such as digital gangrene, nerve dysfunction, and aneurysm rupture.

Reliability of soft-copy versus hard-copy interpretation of emergency department radiographs: a prototype study.

OBJECTIVE: The purpose of this study was to compare the diagnostic reliability of hard-copy and soft-copy interpretation of radiographs obtained in the emergency department using a methodology for evaluating imaging systems when independent proof of the diagnosis is not available. MATERIALS AND METHODS: We collected radiographs from a stratified sample of 100 patients seen in the emergency department. The images were obtained using computed radiography, and the digital images were printed on film and stored for display on a workstation. A group of seven experienced radiologists reported the cases using both film and the workstation display. The results were analyzed using mixture distribution analysis (MDA). RESULTS: The reliability expressed as the percentage of agreement of a typical observer relative to the majority was computed from the MDA. The result was 90% for both hard copy and soft copy with bootstrap confidence intervals of 86-94%. CONCLUSION: We conclude that, in the emergency department, soft-copy interpretation is as reliable as hard-copy interpretation. The strength of this conclusion depends on the validity of the MDA approach as well as the extent to which the observer sample and case sample are representative of the emergency department.