ACR appropriateness criteria Myelopathy: 2021 update

Myelopathy is a clinical diagnosis with localization of the neurological findings to the spinal cord, rather than the brain or the peripheral nervous system, and then to a particular segment of the spinal cord. Myelopathy can be the result of primary intrinsic disorders of the spinal cord or from secondary conditions, which result in extrinsic compression of the spinal cord. While the causes of myelopathy may be multiple, the acuity of presentation and symptom onset frame a practical approach to the differential diagnosis. Imaging plays a crucial role in the evaluation of myelopathy with MRI the preferred modality. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

ACR appropriateness criteria radiologic management of portal hypertension

Cirrhosis is a heterogeneous disease that cannot be studied as a single entity and is classified in two main prognostic stages: compensated and decompensated cirrhosis. Portal hypertension, characterized by a pathological increase of the portal pressure and by the formation of portal-systemic collaterals that bypass the liver, is the initial and main consequence of cirrhosis and is responsible for the majority of its complications. A myriad of treatment options exists for appropriately managing the most common complications of portal hypertension, including acute variceal bleeding and refractory ascites. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

ACR appropriateness criteria head trauma: 2021 update

Head trauma (ie, head injury) is a significant public health concern and is a leading cause of morbidity and mortality in children and young adults. Neuroimaging plays an important role in the management of head and brain injury, which can be separated into acute (0-7 days), subacute (<3 months), then chronic (>3 months) phases. Over 75% of acute head trauma is classified as mild, of which over 75% have a normal Glasgow Coma Scale score of 15, therefore clinical practice guidelines universally recommend selective CT scanning in this patient population, which is often based on clinical decision rules. While CT is considered the first-line imaging modality for suspected intracranial injury, MRI is useful when there are persistent neurologic deficits that remain unexplained after CT, especially in the subacute or chronic phase. Regardless of time frame, head trauma with suspected vascular injury or suspected cerebrospinal fluid leak should also be evaluated with CT angiography or thin-section CT imaging of the skull base, respectively. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Neuroendocrine Tumor Diagnosis and Management: 68Ga-DOTATATE PET/CT.

OBJECTIVE: The purpose of this article is to provide a review of the use of 68Ga tetraazacyclododecanetetraacetic acid-DPhe1-Tyr3-octreotate (DOTATATE) PET/CT, a functional imaging modality for assessment of well-differentiated neuroendocrine tumors (NETs). It has become the preferred imaging modality for initial diagnosis, selection of patients for peptide receptor radionuclide therapy, and localization of unknown primary tumors. The National Comprehensive Cancer Network guideline has added 68Ga-DOTATATE PET/CT as an appropriate test in the management of NETs. CONCLUSION: In combination with FDG PET/CT, 68Ga-DOTATATE PET/CT can noninvasively assess tumor heterogeneity, especially in G2 and G3 NETs, for personalized management of patients.

Use of botulinum toxin type A for the treatment of masseteric muscle hypertrophy.

We investigated the effectiveness of botulinum toxin A intramuscular injection for the management of masseteric muscle hypertrophy. Five patients with masseteric muscle hypertrophy were treated with botulinum toxin A (Dysport, Beaufour Ipsen, France). Clinical photographs were obtained before and between 3 and 6 months after application. Four patients are pleased with their present facial appearance. However, one patient reported mild discomfort about his appearance. Neither local nor general adverse effects were noted. Botulinum toxin A is a safe, easy-to-use, and effective nonsurgical option in the management of masseteric muscle hypertrophy. Its use is associated with a high degree of patient and physician satisfaction.

Magnetic resonance imaging (MRI) in penile metastases of extragenitourinary cancers.

BACKGROUND: The aim of present study is to evaluate the efficacy of magnetic resonance imaging (MRI) in different types of penile metastases. MATERIALS AND METHODS: In this report, we present three cases of penile metastases that have been developed secondary to extragenitourinary malignancies. Two of them did not have any primary malignancy history. RESULTS: Penile biopsies were performed in all patients and metastatic penile tumours were found due to extragenitourinary malignancies. Penile MRI was performed before biopsies. The findings of MRI were correlated with histopathologic diagnosis. Moreover, penile MRI was found to be more sensitive in the evaluation of the lesions than ultrasonography. CONCLUSION: MRI can be accepted as a reliable non-invasive method for the evaluation of the extent of penile metastases and involvement of tunica albuginea or urethral.

CT assessment of the effect of fluticasone propionate aqueous nasal spray treatment on lower turbinate hypertrophy due to vasomotor rhinitis.

CONCLUSION: Fluticasone propionate (FP) aqueous nasal spray was objectively found to be effective and safe for the treatment of lower turbinate enlargement in patients with vasomotor rhinitis. OBJECTIVE: To assess the efficacy of FP aqueous nasal spray treatment in lower turbinate hypertrophy due to vasomotor rhinitis using CT. MATERIAL AND METHODS: Of 35 patients with hypertrophic lower turbinates due to vasomotor rhinitis, 20 were treated twice daily with FP aqueous nasal spray (200 microg/day) for 3 months continuously and 15 were treated with placebo vehicle as a control group. The local effect of the nasal spray was studied using CT and visual analog scales. RESULTS: Treatment with FP provided significantly greater relief from the symptom of nasal obstruction compared with placebo over the entire 3-month treatment period (p < 0.001). When the change from baseline was compared between the two groups, FP produced statistically significant reductions in the mucosal area of the lower turbinates and in the thickness of the nasal mucosa after 3 months (p < 0.05).

Postoperative spinal ultrasonography findings in spinal dysraphia.

Diastematomyelia is a form of spinal dysraphism involving sagittal clefting of the spinal cord, conus medullaris, and/or filum terminale into two hemicords. It can be an isolated finding or can be associated with meningomyelocele or meningocele. In this report, we present postoperative spinal ultrasonography findings in a patient with diastematomyelia and a tethered cord.

Volume of components of labyrinth: magnetic resonance imaging study.

OBJECTIVE: To determine total inner ear fluid volume and cochlear and semicircular canal/vestibule volumes of a normal population to form a base for dimensional abnormalities of inner ear structures. STUDY DESIGN: Cross-sectional. SETTING: Academic otology and radiology practices. PATIENTS: Twenty-nine healthy volunteers (13 male patients and 16 female patients with an average age of 31 yr) without any known history of intrauterine infection or any exposure to ototoxic agents and no abnormality at physical examination from the standpoint of hearing loss were included. INTERVENTIONS: Twenty-nine volunteers underwent magnetic resonance imaging of the temporal region by means of thin-section T2-weighted sequences. The images were evaluated by the radiologist for the presence of any gross configurational abnormality. Fluid volume of each inner ear and components of labyrinth (cochlea, semicircular canals/vestibule) were calculated with the help of an online work station. MAIN OUTCOME MEASURE: To determine the volume of components of the labyrinth and total inner ear fluid, which may form a base for future studies about sensorineural hearing loss. RESULTS: The volumes of total inner ear fluid, cochlea, and semicircular canals/vestibule were calculated. The mean and standard deviation of total inner ear fluid volume, cochlear volume, and semicircular canal/vestibule volume were obtained for each volunteer. Results were assessed with the help of statistical tests. CONCLUSION: There was no statistically significant difference between right and left inner ear fluid volumes of male and female subjects. There was also no statistical difference between right and left inner ear volumes when age and sex were not concerned. During evaluation of volumes according to sex, the difference between right and left inner ear fluid volumes was also assessed. Left semicircular canal/vestibule volume of female subjects were found to be higher than that of male subjects. The difference between right and left semicircular canal/vestibule volumes of female subjects was higher than the difference between right and left semicircular canal/vestibule volumes of male subjects.

Multifocal osteoarticular tuberculosis: a case report.

Osteoarticular tuberculosis is a quite uncommon form of extrapulmonary tuberculosis. Difficulties in diagnosis often lead to delayed treatment, sometimes with devastating consequences for patients. We report herein a case of multifocal osteoarticular tuberculosis of insidious onset with no history of prior health problems or constitutional signs and symptoms. Despite widespread osteoarticular involvement, the outcome of the patient was favorable after the management. Osteoarticular tuberculosis must be considered in patients with insidious musculoskeletal symptomatology.

The use of computed tomography to determine femoral component size: a study of cadaver femora.

Computed tomography is used to assess whether ideal femoral component size in knee arthroplasty can be made more accurately. Ideal femoral component size was measured on radiography, computed tomography, and by direct measurement of 20 cadaver femora and analyzed statistically. There was no significance between the tomographically anticipated ideal femoral component size and ideal femoral size values (Wilcoxon W 388.5; p 0.565). There was difference between radiographically anticipated ideal femoral size and ideal femoral size values (Wilcoxon W 324.5; p 0.020). Anticipating the ideal femoral size can be made more precisely with computed tomography than radiographs in cadaver femora. Anticipating the ideal femoral component size by computed tomography may solve the problems in "in-between sizes." Future total knee designs may be manufactured in more anatomic sizes.

Color Doppler imaging in optic neuritis with multiple sclerosis.

PURPOSE: To evaluate the retrobulbar hemodynamics in eyes with optic neuritis with multiple sclerosis and to compare these values with those of the unaffected fellow eyes and healthy control eyes. METHODS: Thirty-four eyes of 17 patients with unilateral optic neuritis and multiple sclerosis and 16 eyes of 16 normal healthy subjects were recruited from the Departments of Ophthalmology and Neurology. The peak systolic and end-diastolic blood flow velocities and resistivity indices of the ophthalmic artery, posterior ciliary arteries and central retinal artery were measured in each eye with optic neuritis, using color Doppler imaging. Then, they were compared with those of the unaffected fellow eyes and healthy control eyes using paired and unpaired Student's t-tests, respectively. RESULTS: The mean retrobulbar blood flow velocities and mean resistivity index in the ophthalmic artery in the eyes with optic neuritis were not significantly different from the unaffected fellow eyes and healthy control eyes, as well (P>0.05). The mean end-diastolic blood flow velocity in the central retinal artery (P=0.04) was lower and mean resistivity indices in the central retinal (P=0.02) and posterior ciliary arteries (P=0.009) were higher in the eyes with optic neuritis than in the control eyes. In patients with multiple sclerosis, the eyes with optic neuritis had higher resistivity indices in the posterior ciliary (P=0.02) and central retinal arteries (P=0.04) than did the unaffected fellow eyes. The retrobulbar blood flow velocities and resistivity indices of all vessels in the unaffected fellow eyes did not significantly differ from the control eyes (P>0.05). CONCLUSIONS: This study suggests that optic neuritis with multiple sclerosis is associated with impaired retrobulbar hemodynamics, especially in the posterior ciliary and central retinal arteries when compared with the contralateral unaffected eyes as well as healthy control eyes.

Accessory soleus muscle.

Accessory soleus muscle is an uncommon anatomical variant that may present as a soft-tissue mass in the posteromedial region of the ankle. It is congenital in origin but usually presents in the second or third decade of life. Although it is a rare entity, accessory soleus muscle should be included in the differential diagnosis of soft-tissue swelling of the ankle. Awareness of the clinical presentation and specific findings of computed tomography, magnetic resonance imaging, and electromyography help with diagnosis without surgical exploration. We describe a 30-year-old patient with accessory soleus muscle. Magnetic resonance imaging features of the case are described, and the literature is briefly reviewed.

Suprasellar germ cell tumor with subarachnoid seeding MRI and MR spectroscopy findings.

A case of suprasellar germinoma with subarachnoid seeding is presented. Patient had a history of depression unresponsive to drug therapy and recently developed diabetes insipidus. MR imaging revealed a huge suprasellar mass, heterogenous in signal intensity due to cystic components. MR spectroscopy of the mass showed prominent lipid peak suggesting high malignant potential.

Magnetic resonance imaging of cochlear modiolus: determination of mid-modiolar area and modiolar volume.

Modiolar deficiency has been reported as representing the mildest form of cochlear dysplasia. In this study the authors aimed to determine baseline values of the mid-modiolar area and modiolus volume in normal subjects. In this way they aimed to improve the detection of previously underdiagnosed subtle cochlear dysplasia in patients with sensorineural hearing loss.

[The effect of aging on the apparent diffusion coefficient of normal appearing white and gray matter]. / MRG ile normal görünümlü beyaz ve gri cevherde yaslanmanin etkilerinin ADC degerleri ile saptanabilirligi.

PURPOSE: To test if the apparent diffusion coefficient (ADC) values reflect the ultrastructural changes of normal appearing white and gray matter with advancing age. MATERIALS AND METHODS: We selected 45 patients with normal MRI and DW imaging findings. DW and MRI imaging was performed and for each patient the average ADC on trace images of the frontal and occipital white matter and the thalamus were compared with increasing patient age. RESULTS: The average ADC value was 0.753+/-0.054 x 10-3 mm2/sec in frontal white matter, 0.673+/-0.085 x 10-3 mm2/sec in occipital white matter, and 0.763+/-0.063 x 10-3 mm2/sec in the thalamus. For white matter, ADC values increased with advancing age. Although ADC tended to increase with age, comparison of individual thalamic ADC and patient ages did not reach statistical significance. CONCLUSION: Advancing age is associated with a small but statistically significant increase of water diffusibility in human white matter. This increase may reflect mild structural changes with normal aging.

Intraosseous malignant peripheral nerve sheath tumor with local recurrence, lung metastases and death.

Malignant peripheral nerve sheath tumor (MPNST) is almost always seen in soft tissue. Skeletal involvement by MPNST is uncommon and usually results from secondary invasion. Primary MPNSTs are exceptionally rare. We report a surgically proven case of intraosseous MPNST, with local recurrence and lung metastasis during follow-up. The imaging and histological features of the case are described and the literature on the subject briefly reviewed.

Clavicular osteoma associated with bronchial osteomas.

Osteoma is a rare benign tumor, composed of bony tissues. It predominantly involves the skull but rarely the long bones. In this report we present a case of clavicular osteoma associated with bronchial osteomas. This association has not previously been reported. There was no evidence of Gardner's syndrome.

Imaging in the diagnosis of symptomatic forearm muscle herniation.

Muscle herniation can be defined as protrusion of a portion of muscle through an acquired or congenital defect of enclosing fascia. Although it is usually a cosmetic problem, it can lead to local pain and tenderness after prolonged exertion. In this report, we present a case of flexor digitorum superficialis muscle herniation in a 58-year-old man. The radiographic, ultrasonographic and magnetic resonance imaging findings are described with dynamic examination, permitting demonstration of muscle herniation through the fascial defect during muscle contraction.

Desmoplastic fibroma of bone: case report.

Desmoplastic fibroma of bone is an exceedingly rare tumor that was first described by Jaffe in 1958 [1]. It has a high incidence of local recurrence after surgical resection. It is usually seen in young patients and involves mandible and long bones. It has histological resemblance to the desmoid tumor of the abdominal wall. We report a surgically proven case of desmoplastic fibroma of bone with local aggressiveness and recurrence during follow-up. The radiograph, CT imaging features, radiological and pathological differential diagnosis of the case are described, and literature is briefly reviewed.