Nomenclature of Subchondral Nonneoplastic Bone Lesions.

OBJECTIVE. The purpose of this article is to summarize the nomenclature of nonneoplastic conditions affecting subchondral bone through a review of the medical literature and expert opinion of the Society of Skeletal Radiology Subchondral Bone Nomenclature Committee. CONCLUSION. This consensus statement summarizes current understanding of the pathophysiologic characteristics and imaging findings of subchondral nonneoplastic bone lesions and proposes nomenclature to improve effective communication across clinical specialties and help avoid diagnostic errors that could affect patient care.

Magnetic resonance imaging patterns of mononeuropathic denervation in muscles with dual innervation.

Magnetic resonance imaging (MRI) of mononeuropathy in muscles with dual innervation depicts geographic denervation corresponding to the affected nerve. Knowledge of the normal distribution of a muscle's neural supply is clinically relevant as partial muscle denervation represents a potential imaging pitfall that can be confused with other pathology, such as muscle strain. This article reviews the normal innervation pattern of extremity muscles with dual supply, providing illustrative examples of mononeuropathy affecting such muscles.

Comparing the accuracy of ultrasound versus fluoroscopy in glenohumeral injections: a systematic review and meta-analysis.

OBJECTIVE: We performed a systematic review with meta-analysis to compare the accuracy of fluoroscopic-guided glenohumeral injections with that of ultrasound-guided glenohumeral injections as reported in prior studies. METHODS: We reviewed the databases of MEDLINE, PubMed, and Google Scholar using combinations of the keywords "ultrasound," "fluoroscopy," "injection," and "shoulder" for articles reporting the injection accuracy, confirmed by imaging, of the first attempt under either fluoroscopic or ultrasound guidance. A meta-analysis was performed to assess the accuracy of fluoroscopic-guided glenohumeral injections versus ultrasound-guided glenohumeral injections. RESULTS: Five of 42 pertinent studies met our inclusion criteria for a total of 406 glenohumeral injections, of which 115 were fluoroscopy-guided and 291 were ultrasound-guided. The meta-effect estimates for the proportion of joints successfully injected with ultrasound and fluoroscopic guidance were 93% (95% CI, 86% to 98%) and 80% (95% CI, 63% to 93%), respectively, which did not reach statistical significance (Q[df] = 2.55 [1], p = 0.11). CONCLUSIONS: Our meta-analysis indicates that glenohumeral injections guided by ultrasound are more accurate than injections guided by fluoroscopy but this difference did not reach statistical significance. As the use of ultrasound does not expose the patient or practitioner to radiation, its similar accuracy may make it the preferred modality for image-guided glenohumeral joint injections. Limitations to our analysis include the retrospective nature, limited number of studies included, and the potential generalizability of our findings to regions outside of those included in our study.

Communicating findings: a justification and framework for direct radiologic disclosure to patients.

OBJECTIVE: Radiologists' delivery of imaging results to patients remains controversial. One model of communication suggests limiting disclosure to normal results. We argue that disclosing radiologic findings to patients is justified in all categories of results. CONCLUSION: Once a doctor-patient relationship has been established, we claim that it is morally justifiable for radiologists to communicate findings directly to their patients. The practice guidelines that we advocate employ a sliding scale based on the diagnostic confidence of imaging results.

An evaluation of scooter injury and injury patterns following widespread adoption of E-scooters in a major metropolitan area.

OBJECTIVE: Despite the increasing use of e-scooters globally, the pattern of injuries on diagnostic imaging had not been well-documented to date. We performed a retrospective study utilizing our health system's radiology database to characterize the injury distribution and imaging features of scooter injuries. METHODS: We utilized our radiology report database searching for any imaging report containing the word "scooter", beginning September 1, 2017, when scooters were first introduced to our area through December 1, 2018. RESULTS: Our search yielded a total of 54 patients with 105 imaging studies. The injuries predominantly affected the musculoskeletal system, with a predilection to the upper extremity. We had no cases of visceral or neurotrauma. CONCLUSION: Musculoskeletal injuries were the predominant form of scooter injury. The lack of visceral injury suggests that emergency physicians should consider having a higher clinical threshold for ordering these studies in patients with scooter injuries.

Characteristics of musculoskeletal radiology job postings to guide radiology trainees.

OBJECTIVE: To review current musculoskeletal (MSK) job market postings to define the listed requirements for practice in order to provide insight to guide residents pursuing fellowship training in MSK radiology to best meet the needs of potential future employers. METHODS: Utilizing the ACR (American College of Radiology) Career Center, a review of the ACR job postings began 6/1/2018 focusing on jobs labeled as musculoskeletal (MSK) subspecialty. E-mail notifications from the career center were reviewed, and jobs were tracked prospectively for 1 year. Data was collected regarding the number of positions, the location, the practice type, and required skills both within musculoskeletal radiology and within the remainder of the radiology subspecialties. RESULTS: 456 postings met the inclusion criteria. Approximately 19% were for a dedicated MSK radiologist, 25% sought a combination of MSK and a general skill set, and 56% were specifically for a general radiologist position. Approximately 29% of jobs require some combination of mammography and/or light interventional radiology (IR). DISCUSSION: Our results indicate that majority of job postings for musculoskeletal radiology require a practice that is not specifically limited to MSK, mirroring trends in other radiology subspecialties. Radiology trainees and program directors should be aware of the needs being demanded by the job market to help guide trainees to individualize their training to best meet the needs of their future employment.

Preventing Overdiagnosis of Acetabular Labral "Tears" in 40-Plus-year-old Patients: Shouldn't these be called Labral "Fissures" Instead?

Acetabular labral tears represent a common finding on magnetic resonance imaging of the hip. Labral tears can arise from a multitude of underlying pathological processes or they may be an asymptomatic incidental finding. The prevalence of labral tears and their lack of specificity make this an area vulnerable to potential overdiagnosis. The overdiagnosis of labral tears leads to overtreatment by exposing patients to unnecessary surgeries as well as complications ranging from unsatisfying outcomes to deep venous thrombosis. This risk is compounded by the tabloid popularization of labral surgeries by celebrities such as Lady Gaga, which could potentiate patient perception of a two-tiered level of health care. Following a similar situation with spine nomenclature, one solution to this issue is to reclassify "labral tears" as "labral fissures" in some or all cases to mitigate the acute traumatic connotation of the term "tear."

Intracranial aneurysms: a game of millimeters.

RATIONALE AND OBJECTIVES: In this review we will discuss the historic development of intracranial aneurysms as a pathologic entity and the potential for overdiagnosis. MATERIALS AND METHODS: We conducted a literature search to assess the prevalence, rupture rate, and treatment of intracranial aneurysms. RESULTS: Intracranial aneurysms represent a necessary example of overdiagnosis. CONCLUSIONS: A change in the nomenclature of small aneurysms is a possible solution to mitigate patient anxiety from a diagnosis of intracranial aneurysm.

Pigmented villonodular synovitis: dedicated PET imaging findings.

Pigmented villonodular synovitis (PVNS) is an uncommon entity, which has the potential to cause severe pain. The gold standard for evaluation is MRI, and previous PET findings associated with PVNS have only been documented in the setting of concurrent malignancy. In the setting of recurrent disease, PET is being used to evaluate prebiological and postbiological treatment responses. Recurrent PVNS demonstrates greater hypermetabolic activity than previously documented, supporting the case as a potential mimic of malignant/metastatic disease. Post-treatment evaluations demonstrate decreased metabolic activity, which suggests response to treatment. This behaviour further supports the contention that there is a neoplastic origin to PVNS.

The hot rim sign on hepatobiliary scintigraphy (HIDA) with CT correlation.

An older male with multiple medical comorbidities presented to the emergency room after 3 days of worsening right upper quadrant pain. The patient had an elevated white blood cell count and mildly elevated liver functions. Initial ultrasound was equivocal and further imaging with CT scan was obtained. The CT scan was read as suggestive of cholecystitis, however a hepatobiliary scintigraphy (HIDA) scan was ordered for confirmation, as the patient was a poor operative candidate. The HIDA demonstrated no bile duct or small bowel activity on initial images or delays, however a classic 'hot rim' sign was present, confirming acute cholecystitis. The patient ultimately underwent percutaneous cholecystostomy with drainage for treatment where acute cholecystitis was confirmed. Upon retrospective review, the CT demonstrated hyperaemia surrounding the gallbladder fossa, which is the CT scan equivalent of a scintigraphic 'hot rim' sign. This is an uncommon example of a radiologic sign correlation between multiple imaging modalities.

A leiomyoma in a cachectic woman presenting as a giant abdominal mass.

Fibroids are the most common gynecologic tumors. Our case discusses the outcome of a 47-year-old woman who presented to our clinic with cachexia, and a giant abdominal mass. An initial diagnostic imaging workup consisted of X-Ray, CT, and ultrasound and indicated a possible diagnosis of leiomyosarcoma. However, after surgical evaluation, she was diagnosed pathologically with an atypical presentation of a uterine leiomyoma. Our case reviews the epidemiology and presentation of both pathologies, along with the imaging workup, and the operative correlation in our patient.