Paraneoplastic musculoskeletal disorders: review and update for radiologists.

Rheumatic paraneoplastic syndromes are rare syndromes that occur at distant sites from the underlying tumor and may involve the bones, joints, fasciae, muscles, or vessels. In the absence of a known tumor, early recognition of a rheumatic syndrome as paraneoplastic permits dedicated work-up for, and potentially early treatment of an occult malignancy. Although there is a continuously growing list of paraneoplastic rheumatic disorders, not all of these disorders have a well-established association with a neoplastic process. The goals of this article are to review the clinical characteristics, diagnostic work-up, and imaging findings of well-documented rheumatic paraneoplastic disorders.

Surgical techniques for management of acromioclavicular joint separations: review and update for radiologists.

Imaging plays a central role in the postoperative management of acromioclavicular (AC) joint separations. There are more than 150 described techniques for the surgical management of AC joint injuries. These procedures can be categorized as varying combinations of the following basic techniques: a) soft-tissue repair, b) trans-articular AC joint fixation, c) coracoclavicular (CC) fixation, d) non-anatomic reconstruction of the CC ligaments, e) anatomic reconstruction of the CC ligaments, f) distal clavicle resection, and g) dynamic muscle transfer. The goals of this article are to describe the basic techniques for the surgical management of AC joint separations with an emphasis on technique-specific complications and postoperative imaging assessment.

Clinical Evaluation, Imaging, and Management of Adolescent Idiopathic and Adult Degenerative Scoliosis.

We provide a comprehensive review of the clinical presentation, imaging evaluation, classification, and management of adolescent idiopathic and adult degenerative scoliosis.

Gadolinium Contrast Enhancement Improves Confidence in Diagnosing Recurrent Soft Tissue Sarcoma by MRI.

RATIONALE AND OBJECTIVES: To determine how utilization of postgadolinium magnetic resonance imaging (MRI) influenced reader accuracy and confidence at identifying postoperative soft tissue sarcoma (STS) recurrence among readers with various levels of expertise. MATERIALS AND METHODS: This retrospective study was institutional review board approved and Health Insurance Portability and Accountability Act compliant. Postoperative MRI from 26 patients with prior STS resection (13 patients with confirmed recurrence, 13 without recurrence) was reviewed. Four blinded readers of varying expertise (radiology resident, fellow, attending, and orthopedic oncologist) initially evaluated only the precontrast images and rated each MRI for recurrence on a 5-point confidence scale. Assessment was repeated with the addition of contrast-enhanced sequences. Diagnostic accuracy based on confidence ratings was evaluated using the area under the receiver operating characteristic curve (AUC). Changes in confidence ratings were calculated using Wilcoxon signed-rank test. RESULTS: All readers demonstrated good diagnostic accuracy both with and without contrast-enhanced images (AUC >0.98 for each reader). When contrast-enhanced images were made available, the resident recorded improved confidence with both assigning (P = 0.031) and excluding recurrence (P = 0.006); the fellow showed improved confidence only with assigning recurrence (P = 0.015); and the surgeon showed improved confidence in excluding recurrence (P = 0.003). The addition of contrast-enhanced images did not significantly influence the diagnostic confidence of the attending radiologist. CONCLUSIONS: Diagnostic accuracy of MRI was excellent in evaluating postoperative STS recurrence, and reader confidence improved depending on expertise when postgadolinium imaging was included in the assessment.

CT and MR Imaging of the Postoperative Ankle and Foot.

A variety of surgical procedures exist for repair of both traumatic and degenerative osseous and soft-tissue pathologic conditions involving the foot and ankle. It is necessary for the radiologist to be familiar with these surgical procedures, so as to assess structural integrity, evaluate for complicating features, and avoid diagnostic pitfalls. Adequate interpretation of postoperative changes often requires access to surgical documentation to evaluate not only the surgery itself but the expected timeline for resolution of normal postoperative changes versus progressive disease. Appropriate use of surgical language in radiology reports is another important skill set to hone and is instrumental in providing a high-quality report to the referring surgeons. The pathophysiology of a myriad of surgical complaints, beginning from the Achilles tendon and concluding at the plantar plate, are presented, as are their common appearances at computed tomography and magnetic resonance imaging. Commonly encountered entities include Achilles tendon tear, spastic equinus, nonspastic equinus, talar dome osteochondral defect, tarsal tunnel syndrome, plantar fasciitis, pes planovalgus, pes cavovarus, peroneal tendinosis, lateral ligament complex pathology, Morton neuroma, plantar plate tear, and metatarsophalangeal joint instability. Computer-generated three-dimensional models are included with many of the procedures to provide a more global view of the surgical anatomy. Correlation with intraoperative photographs is made when available. When appropriate, discussion of postoperative complications, including entities such as infection and failure of graft integration, is presented, although a comprehensive review of postoperative complications is beyond the scope of this article. Notably absent from the current review are some common foot and ankle procedures including hallux valgus and hammertoe corrections, as these are more often evaluated radiographically than with cross-sectional imaging. ©RSNA, 2016.

Bilateral pigmented villonodular synovitis of the knee.

Pigmented villonodular synovitis is a disorder resulting in a villous, nodular, or villonodular proliferation of the synovium, with pigmentation related to the presence of hemosiderin. These lesions are almost exclusively benign with rare reports of malignancy. Pigmented villonodular synovitis can occur in a variety of joints and at any age but most often occurs within the knee in the young adult. Pigmented villonodular synovitis is a rare disease entity, and bilateral synchronous or metachronous involvement of a joint is even more uncommon, with few reports previously described in the literature. We present a case of pigmented villonodular synovitis involving both the right and left knee in the same patient, with radiographic imaging, magnetic resonance imaging, photograph and video intraoperative imaging, and pathologic correlation.

Misquotation of a commonly referenced hand surgery study.

PURPOSE: Novel clinical studies often define how we practice hand surgery. Proper referencing of these articles is therefore critical. Since the publication of Knirk and Jupiter's 1986 study analyzing intra-articular distal radius fractures in young adults, citations of this article have appeared to be inconsistent in the biomedical literature. We believe that analysis of studies referencing the Knirk and Jupiter article will reveal notable discrepancies with respect to the original data. METHODS: We carefully reviewed Knirk and Jupiter's original article, "Intra-articular Fractures of the Distal End of the Radius in Young Adults" (J Bone Joint Surg 1986;68A:647-659) and formulated a comprehensive tabular outline of results and conclusions made in the article for reference. An electronic search was performed using the Institute for Scientific Information Scientific Citation Index for all articles written in English referencing the Knirk and Jupiter article from 1986 through 2002. Of the 159 articles found in the ISI database, 154 were retrieved and reviewed by 2 hand surgeons. Each article referencing the work was classified into 1 or more of 12 separate categories and rated as accurate, inaccurate, or equivocal with respect to Knirk and Jupiter's original data. RESULTS: Of the 154 articles examined, 63 have at least 1 inaccurate reference of the Knirk and Jupiter article. In general, articles referencing Knirk and Jupiter's classification system, protocol, or tables are accurate (59 of 63), whereas a majority of the articles addressing the value of 2 mm of articular incongruity after a distal radius fracture are inaccurate (43 of 57). CONCLUSIONS: Conclusions drawn from the Knirk and Jupiter article, especially regarding the value of 2 mm of articular incongruity of the radiocarpal joint at the time of fracture union, vary from one author to the next. Care must be taken in referencing biomedical literature, particularly articles that have a potentially profound impact on clinical patient management.

Reference accuracy in the Journal of Hand Surgery.

PURPOSE: An accurate listing of cited references in journal articles is important for the reader. Many studies have revealed errors in the references cited in a variety of subspecialty journals. We believe that a similar amount of errors, relative to other subspecialty journals, exists in the Journal of Hand Surgery. METHODS: One hundred randomly selected references from each of the 1985 and 1995 Journal of Hand Surgery volumes were analyzed for accuracy of the journal name, title, author name(s), year, volume, and page number(s). References were considered without error if they matched the original article exactly. RESULTS: In 1985, 30% of the references examined contained one or more errors as compared with 11% in 1995. CONCLUSIONS: These error rates are similar to those found in studies of other biomedical journals. Perhaps the decrease in the quantity of errors present in 1995 versus that of 1985 is related to the implementation of a more stringent, revised set of instructions to submitting authors imposed in 1995.