Imaging algorithms for evaluating suspected rotator cuff disease: Society of Radiologists in Ultrasound consensus conference statement.

The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to reach a consensus about the recommended imaging evaluation of painful shoulders with clinically suspected rotator cuff disease. The panel met in Chicago, Ill, on October 18 and 19, 2011, and created this consensus statement regarding the roles of radiography, ultrasonography (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography. The consensus panel consisted of two co-moderators, a facilitator, a statistician and health care economist, and 10 physicians who have specialty expertise in shoulder pain evaluation and/or treatment. Of the 13 physicians on the panel, nine were radiologists who were chosen to represent a broad range of skill sets in diagnostic imaging, different practice types (private and academic), and different geographical regions of the United States. Five of the radiologists routinely performed musculoskeletal US as part of their practice and four did not. There was also one representative from each of the following clinical specialties: rheumatology, physical medicine and rehabilitation, orthopedic surgery, and nonoperative sports medicine. The goal of this conference was to construct several algorithms with which to guide the imaging evaluation of suspected rotator cuff disease in patients with a native rotator cuff, patients with a repaired rotator cuff, and patients who have undergone shoulder replacement. The panel hopes that these recommendations will lead to greater uniformity in rotator cuff imaging and more cost-effective care for patients suspected of having rotator cuff abnormality.

Clavicle morphometry revisited: a 3-dimensional study with relevance to operative fixation.

BACKGROUND: The advocacy for operative fixation of midshaft clavicle fractures has prompted a reemergence of interest in clavicle anatomy. Three-dimensional (3D) anatomical studies provide more information than 2-dimensional studies, but are currently rare. MATERIAL AND METHODS: Twenty-five skeletonized clavicles were digitized using a laser scanner. Three-dimensional computer software was used to analyze the data. Clavicles were divided into medial, middle, and lateral segments based on the medial and lateral apices of curvature and their lengths and midpoint cortical diameter measured. The angles of medial and lateral curvatures were measured in standardized axial and coronal planes. The medial and lateral curvatures were fitted with circles and the radii of curvature measured. Correlations between the intrinsic dimensions of the clavicle were assessed. RESULTS: The mean length was 136.7 mm. The medial, middle, and lateral segments had mean lengths of 48, 56, and 32.7 mm, respectively. In the axial plane, the mean medial and lateral angles were 149.5° and 145.8°, respectively. In the coronal plane, the mean medial and lateral angles were 178.2° and 174.2°, respectively. The mean midpoint cortical diameter was 10.9 mm. The mean medial and lateral radii of curvature were 66.4 and 33.5 mm, respectively. The length and cortical diameter and length and medial radius of curvature were found to positively correlate, R(2) = .355 and .184, respectively. CONCLUSION: Using standardized measurements, we were able to accurately characterize the dimensions of the clavicle. We found that the length of the clavicle correlates with the midpoint cortical diameter and with the radius of medial curvature.

ACR appropriateness criteria on metastatic bone disease.

Appropriate imaging modalities for screening, staging, and surveillance of patients with suspected and documented metastatic disease to bone include (99m)Tc bone scanning, MRI, CT, radiography, and 2-[(18)F]fluoro-2-deoxyglucose-PET. Clinical scenarios reviewed include asymptomatic stage 1 breast carcinoma, symptomatic stage 2 breast carcinoma, abnormal bone scan results with breast carcinoma, pathologic fracture with known metastatic breast carcinoma, asymptomatic well-differentiated and poorly differentiated prostate carcinoma, vertebral fracture with history of malignancy, non-small-cell lung carcinoma staging, symptomatic multiple myeloma, osteosarcoma staging and surveillance, and suspected bone metastasis in a pregnant patient. No single imaging modality is consistently best for the assessment of metastatic bone disease across all tumor types and clinical situations. In some cases, no imaging is indicated. The recommendations contained herein are the result of evidence-based consensus by the ACR Appropriateness Criteria((R)) Expert Panel on Musculoskeletal Radiology.

Percutaneous cholecystostomy catheter removal and incidence of clinically significant bile leaks: a clinical approach to catheter management.

OBJECTIVE: We sought to determine the incidence of bile leaks upon removal of small-bore percutaneous cholecystostomy catheters and to evaluate clinical and imaging guidelines to ensure safe catheter removal. MATERIALS AND METHODS: A retrospective evaluation of all gallbladder drainages performed over a 5-year period revealed 163 patients (range, 7-98 years) who underwent percutaneous cholecystostomy catheter placement. Medical records and imaging studies were reviewed to assess the events at catheter removal (e.g., inadvertent removal, controlled removal with cholangiography without tract imaging, or controlled removal with cholangiography with tract imaging) and the incidence of major and minor bile leaks. RESULTS: The events at catheter removal were assessed in 66 patients. Group 1 was 45 patients whose catheters were removed after a minimum of approximately 3 weeks with a cholangiogram that established cystic and common duct patency and no imaging of the tract. Catheters were not removed until the patient recovered from acute illnesses that contributed to acalculous cholecystitis. Group 2 was 11 patients managed similarly to group 1 except that tract imaging was performed at catheter removal. Group 3 was 10 patients whose tubes came out inadvertently without cholangiogram or tract imaging. Two major (group 2 and group 3) and two minor (group 2) bile leaks occurred. No bile leaks occurred in group 1 (p = 0.006). CONCLUSION: Major bile leaks occurred in 3% of patients, and minor leaks occurred with equal frequency. Tract imaging may not be necessary in patients with small-bore gallbladder catheters who have recovered from critical illness, show patent cystic and common ducts, and have had catheters for 3-6 weeks.