Addition of CT to Improve the Diagnostic Confidence for the Detection of Sacroiliac Joint Erosions in Patients with Equivocal MRI Findings.

PURPOSE: To determine if CT can improve the diagnostic confidence for the detection of sacroiliac joint (SIJ) erosions in patients with equivocal MRI findings. METHODS: A retrospective analysis of adult patients who had an SIJ MRI and a subsequent SIJ CT within 12 months was conducted. Using a 5-point Likert scale, two reviewers evaluated the de-identified MRI and CT images in randomized order and in separate sessions to answer the question: "Does the patient have SIJ erosions?". A Fisher's exact test was used to analyze the difference in diagnostic confidence, and intraclass correlation coefficient (ICC) was used to determine interrater reliability. RESULTS: 54 patients were included in the analysis (average age, 43.9 years). The average time interval between initial SIJ MRI and subsequent CT was 14.4 weeks (range, 5.6-50.3 weeks). CT resulted in significantly more cases with definitive diagnostic confidence than cases with probable or equivocal confidence compared to MRI (P < .001). Amongst cases with equivocal findings on MRI, 73.2% of cases had definitive diagnoses on CT. There was moderate interrater agreement for MRI, with an ICC of .490 [95% CI, .258-.669], and excellent agreement for CT, with an ICC of .832 [95% CI, .728-.899]. CONCLUSION: Overall, CT led to significantly increased diagnostic confidence and higher interrater reliability for the detection of SIJ erosions compared to MRI. Judicious use of CT may be useful in detecting SIJ erosions in patients with equivocal MRI findings.

Juvenile idiopathic arthritis of the axial joints: a systematic review of the diagnostic accuracy and predictive value of conventional MRI.

OBJECTIVE: Our objective was to evaluate the diagnostic accuracy and reliability of MRI and its ability to depict responsiveness to treatment for the evaluation of the axial joints (temporomandibular joint [TMJ], spinal joints, and sacroiliac joints) in juvenile idiopathic arthritis (JIA). CONCLUSION: There is fair (grade B) evidence that MRI is an accurate diagnostic method for evaluating early and intermediate changes in the TMJ in JIA and insufficient evidence to indicate MRI is an accurate diagnostic method for detecting JIA in the spinal (grade I) and sacroiliac (grade I) joints.

Variability in quantifying the Hill-Sachs lesion: A scoping review.

Background: Currently, is there no consensus on a widely accepted measurement technique for calculating the Hill-Sachs lesion (HSL). The purpose of this review is to provide an overview of the techniques and imaging modalities to assess the HSL pre-operatively. Methods: Four online databases (PubMed, Embase, MEDLINE, and COCHRANE) were searched for literature on the various modalities and measurement techniques used for quantifying HSLs, from data inception to 20 November 2021. The Methodological Index for Non-Randomized Studies tool was used to assess study quality. Results: Forty-five studies encompassing 3413 patients were included in this review. MRA and MRI showed the highest sensitivity, specificity, and accuracy values. Intrarater and interrater agreement was shown to be the highest amongst MRA. The most common reference tests for measuring the HSL were arthroscopy, radiography, arthro-CT, and surgical techniques. Conclusion: MRA and MRI are reliable imaging modalities with good test diagnostic properties for assessment of HSLs. There is a wide variety of measurement techniques and imaging modalities for HSL assessment, however a lack of comparative studies exists. Thus, it is not possible to comment on the superiority of one technique over another. Future studies comparing imaging modalities and measurement techniques are needed that incorporate a cost-benefit analysis.

Beyond the bones: Extraskeletal osteosarcoma of the thigh.

Extraskeletal osteosarcoma (ESOS) is a rare malignant mesenchymal soft tissue tumor that usually arises in the lower extremities. It is typically a high-grade malignancy that represents only around 1%-2% of all soft tissue sarcomas and 2%-4% of all osteosarcomas. In this report, we describe a case of a 67-year-old female who presented with a 4-day history of a painless lump in her posterior right thigh. Workup utilizing different imaging modalities yielded a diagnosis of ESOS. The radiologic features of ESOS, as well as the current treatment paradigm and prognosis of this rare malignancy, will be discussed based on a review of the literature.

Synovial Sarcoma: A Clinical Review.

Synovial sarcomas (SS) represent a unique subset of soft tissue sarcomas (STS) and account for 5-10% of all STS. Synovial sarcoma differs from other STS by the relatively young age at diagnosis and clinical presentation. Synovial sarcomas have unique genomic characteristics and are driven by a pathognomonic t(X;18) chromosomal translocation and subsequent formation of the SS18:SSX fusion oncogenes. Similar to other STS, diagnosis can be obtained from a combination of history, physical examination, magnetic resonance imaging, biopsy and subsequent pathology, immunohistochemistry and molecular analysis. Increasing size, age and tumor grade have been demonstrated to be negative predictive factors for both local disease recurrence and metastasis. Wide surgical excision remains the standard of care for definitive treatment with adjuvant radiation utilized for larger and deeper lesions. There remains controversy surrounding the role of chemotherapy in the treatment of SS and there appears to be survival benefit in certain populations. As the understanding of the molecular and immunologic characteristics of SS evolve, several potential systematic therapies have been proposed.

Diagnostic Yield for Cancer and Diagnostic Accuracy of Computed Tomography-guided Core Needle Biopsy of Subsolid Pulmonary Lesions.

PURPOSE: We aimed to determine the diagnostic yield for cancer and diagnostic accuracy of computed tomography-guided core needle biopsy (CTNB) in subsolid pulmonary lesions. MATERIALS AND METHODS: Fifty-two biopsies of 52 subsolid lesions in 51 patients were identified from a database of 912 lung biopsies and analyzed for the diagnostic yield for cancer and diagnostic accuracy of core CTNB diagnosis as well as complication rates. RESULTS: When indeterminate biopsy results were included in the analysis, the diagnostic yield for cancer was 80.8% and the diagnostic accuracy of core needle biopsy was 84.6% (n=52). It was 85.7% and 91.7%, respectively, when indeterminate results were excluded (n=48) and 82.4% and 82.4%, respectively, for biopsies with surgical confirmation (n=17). Attenuation was statistically significant for diagnostic yield for cancer (P=0.028) and diagnostic accuracy of core needle biopsy (P=0.001) when the indeterminate results were excluded (n=48). Attenuation and size were not statistically significant for diagnostic yield for cancer and diagnostic accuracy of needle biopsy (n=52), and size was not statistically significant for either when the indeterminate results were excluded. These results were achieved without any major complications as per the Society of Interventional Radiology Standards of Practice. CONCLUSIONS: CTNB offers a high yield in establishing a histopathologic diagnosis of subsolid pulmonary lesions, with both ground-glass and solid-predominance. The pure ground-glass category of lesions requires further research to determine the true diagnostic yield and diagnostic accuracy of core needle biopsies.

Atrial thrombi detection prior to pulmonary vein isolation: diagnostic accuracy of cardiac computed tomography versus transesophageal echocardiography.

BACKGROUND: Patients routinely undergo transesophageal echocardiography (TEE) prior to pulmonary vein isolation (PVI) in order to rule out the presence of intra-atrial thrombi. Cardiac computed tomography (CCT) is also routinely conducted prior to the procedure to determine cardiac anatomy. Although it has been demonstrated that CCT can also rule out intra-atrial thrombi, the use of CCT for thrombi detection is controversial. The primary objective was to determine the utility of CCT for detection of atrial thrombi as compared to TEE. METHODS: Patients who underwent PVI between 2010 and 2011 with CTs and TEEs complet-ed within 3 days of each other were retrospectively identified. TEE reports were analyzed, while CCTs were interpreted by a cardiologist specializing in CCTs. Severe spontaneous echo contrast or thrombus detected on TEE were considered positive, as were filling defects found on CCT. RESULTS: A total of 51 patients undergoing PVI (mean age 59.4 ± 9.5 years; 75% male; ejection fraction 60 ± 12%) had both TEE and CCT in timely fashion. By TEE, 0 left atrial ap-pendage (LAA) thrombi were identified with mild to moderate spontaneous echo contrast in 4 patients. By CCT, 2 definite LAA thrombi were identified and thrombi in 4 patients could not be ruled out. Specificity, positive predictive value, and negative predictive value for CCT were 88%, 0%, and 100%, respectively. CONCLUSIONS: CCT is an effective tool in ruling out atrial thrombi prior to PVI. TEE should be completed only if CCT is positive.