Proceedings of the Joint Meeting RBRS Bone Section and Nederlandse Vereniging Voor Skeletaradiologie, Leiden, The Netherlands, 25.0.3.2011-Part II. Tumors and tumorlike conditions of the calcaneous: the usual and the unusual.

The calcaneus is an uncommon site for involvement by tumors or tumorlike conditions of bone, although any lesion may involve the calcaneus. The purpose of this paper is to highlight the imaging features of common and uncommon tumors and tumorlike conditions occurring in the calcaneus. Typical case studies will illustrate the imaging findings on different imaging modalities.

Grading and characterization of soft tissue tumors on magnetic resonance imaging: the value of an expert second opinion report.

OBJECTIVE: To retrospectively compare the accuracy of the initial MRI (magnetic resonance imaging) report of referring radiologists and the second opinion report. MATERIAL AND METHODS: MRI of 155 patients presenting with a soft tissue tumor (STT) in a single large community center were referred for inclusion in the Belgian Soft Tissue Neoplasm Registry (BSTNR). The initial report and the second opinion report were made independently. Histopathology (gold standard) was obtained in 90 patients (group 1). In 65 patients, the diagnosis was made by the combination of clinical findings and/or follow-up (group 2). In group 1, the concordance in grading and tissue-specific (TS) diagnosis between the referring center (RC) and expert center (EC) was reviewed. RESULTS: In group 1, MR grading yields a sensitivity of 100% and a specificity of 89% in the EC. The sensitivity was 88% and the specificity 81% in the RC. The accuracy was significantly higher in the EC (92%) compared to the RC (83%) (p = 0.039). The TS diagnosis was correct in 50% versus 38.5% of malignant tumors and in 71.8% versus 51.6% of benign tumors in the EC and RC respectively. CONCLUSION: A second opinion report increases the accuracy in the diagnosis of STT on MRI. MAIN MESSAGES: • A second opinion MRI report increases the overall accuracy in the diagnosis of soft tissue tumors. • There is a good overall agreement in MR grading between the referring and expert institution. • In the expert center, there were fewer false-negative and false-positive diagnoses. • MRI performs better in the tissue-specific diagnosis of benign versus malignant STT.

Structured reporting: if, why, when, how-and at what expense? Results of a focus group meeting of radiology professionals from eight countries.

PURPOSE: To determine why, despite growing evidence that radiologists and referring physicians prefer structured reporting (SR) to free text (FT) reporting, SR has not been widely adopted in most radiology departments. METHODS: A focus group was formed consisting of 11 radiology professionals from eight countries. Eight topics were submitted for discussion. The meeting was videotaped, transcribed, and analyzed according to the principles of qualitative healthcare research. RESULTS: Perceived advantages of SR were facilitation of research, easy comparison, discouragement of ambiguous reports, embedded links to images, highlighting important findings, not having to dictate text nobody will read, and automatic translation of teleradiology reports. Being compelled to report within a rigid frame was judged unacceptable. Personal convictions appeared to have high emotional value. It was felt that other healthcare stakeholders would impose SR without regard to what radiologists thought of it. If the industry were to provide ready-made templates for selected examinations, most radiologists would use them. CONCLUSION: If radiologists can be convinced of the advantages of SR and the risks associated with failing to participate actively in its implementation, they will take a positive stand. The industry should propose technology allowing SR without compromising accuracy, completeness, workflows, and cost-benefit balance. MAIN MESSAGES: Structured reporting offers radiologists opportunities to improve their service to other stakeholders. • If radiologists can be convinced of the advantages of structured reporting, they may become early adopters. • The healthcare industry should propose technology allowing structured reporting. • Structured reporting will fail if it compromises accuracy, completeness, workflows or cost-benefit balance.

Magnetic resonance imaging in teenagers and young adults with limited haemophilic arthropathy: baseline results from a prospective study.

The clinical relevance of subtle changes on magnetic resonance imaging (MRI) for evaluating haemophilia treatment is unknown. To determine the relationship of findings on MRI with joint function and bleeding in joints with apparently very mild arthropathy, a prospective study was performed. Knees and ankles of 26 patients, 13-26 years, were scanned. Two blinded radiologists scored the MRI (IPSG consensus score) and the radiography [Pettersson score (PS)]. Clinical function (HJHS) was scored by one physiotherapist. Life-time number of bleeds was collected from patient files. Of 104 joints scanned, three were excluded because of previous arthrodesis or trauma. Remaining 101 MRI scores correlated weakly with clinical function (r = 0.27, P = 0.01) and less with lifetime number of bleeds (r = 0.16, P = 0.14). MRI scores were 0 in 58 joints, including 27 with major bleeds. In three joints of patients playing intensive sports MRI showed minor changes (MRI score = 1) in the absence of bleeds. Agreement was reasonable between PS and MRI score (r = 0.41, P < 0.01). In 30% of joints, MRI detected abnormalities in soft-tissue and cartilage, while PS was 0 points. No evidence of occult haemorrhages was found. Instead, we found no abnormalities on MRI in 43 joints with a history of repeated joint bleeding. Haemosiderin seemed associated with the time between assessment and last bleed; joints that had suffered a bleed long before MRI had hardly haemosiderin, while those with a recent bleed showed haemosiderin, suggesting joint damage may be reversible. Abnormalities detected by MRI, but not by PS were minor and their clinical implications are not yet clear.

Ewing's sarcoma: imaging features.

AIM: To define an imaging prototype of Ewing's sarcoma (ES). MATERIALS AND METHODS: Sixty-four patients with a histopathologically and/or genetically proven diagnosis of ES were analyzed for clinical parameters (age, gender and location), radiographic and CT appearance (distribution, matrix, margins, periosteal reaction, articular extension, cortical reaction and the presence of a pathologic fracture). Size, local extension, signal intensity, degree and pattern of enhancement, and the presence of skip metastases were evaluated on MRI. Distant metastases were recorded on bone scintigraphy and chest CT scan. RESULTS: Patient's age ranged between 7-67 (mean 17.9). Male/female ratio was 2.4/1. Location in the pelvis was most frequent (31%), followed by the femur (20%) and tibia (11%). Most tumors were mixed lytic-sclerotic (75%), and purely lytic in 25%. Plain films and CT scan showed a spiculated periosteal reaction in 50%. A Codman's triangle was seen in 27%. Articular extension was difficult to assess on radiographs. Cortical permeation and destruction is seen in respectively 31 and 42%, whereas cortical thickening is seen in 20%. Pathologic fracture occurred in 7.8%. MRI showed a large mass, with a soft tissue component of more than 50% in 67%. Degree and pattern of enhancement pattern was variable. Signal intensity on T1- and T2-WI was non-specific. Joint involvement was seen in 23%. Isolated involvement of the soft tissue (extraskeletal ES) was seen in 1.5%. Skip metastases at initial presentation were present at initial presentation in 14% and distant metastases in 22%. CONCLUSIONS: ES occurs in young patients. On radiographs/CT, 37.5% are located in the axial skeleton and 62.5% in the peripheral skeleton. ES is mostly mixed sclerotic-lytic. A spiculated periosteal reaction is most frequent. The most characteristic finding on MRI is the presence of a large soft tissue mass.

Clip migration after vacuum-assisted stereotactic breast biopsy: a pitfall in preoperative wire localization.

Vacuum-assisted stereotactic breast biopsy has become an irreplaceable instrument in the management of suspicious mammographic lesions. If the initial mammographic lesion becomes obscured or absent following the biopsy, a clip is commonly placed by interventional breast radiologists at the biopsy site. This enables future wire localization if atypical or malignant histology warrants excision. Currently, clip malposition or migration has become increasingly recognized in the literature as a possible complication of stereotactic breast biopsy. As in this case, recognition of migration of the clip was crucial in the planning of the patient's subsequent wire localization procedure. This article aims to increase the awareness of radiologists and surgeons of this potential pitfall to prevent false-negative biopsies and minimize positive surgical margins after wire-guided breast conservation surgery. Routine evaluation of pre- and postbiopsy mammograms and prospective identification of inaccurate clip placement before stereotactic wire localization and excision should be performed.

Vascular disease of the spleen.

A wide range of vascular disorders can affect the spleen. Although clinical presentation is often nonspecific, early diagnosis and treatment are mandatory in most conditions. Noninvasive imaging techniques are well suited to meet these objectives. Familiarity with normal macroscopic and microscopic vascular anatomy is a prerequisite to understand the pathophysiology of vascular disorders of the spleen. This article deals with diseases of the splenic vasculature (aneurysms, arteriovenous fistula, splenic vein thrombosis, collateral circulation in portal hypertension) as well as vascular disorders affecting the splenic parenchyma (splenic infarct, Gamna-Gandy bodies). Primary vascular tumors and tumor-like conditions of the spleen will be discussed very briefly.