MRI Features of Pelvic Nerve Involvement in Endometriosis.

Endometriosis is a common condition that mostly affects people assigned as female at birth. The most common clinical symptom of endometriosis is pain. Although the mechanism for this pain is poorly understood, in some cases, the nerves are directly involved in endometriosis. Endometriosis is a multifocal disease, and the pelvis is the most common location involved. Nerves in the pelvis can become entrapped and involved in endometriosis. Pelvic nerves are visible at pelvic MRI, especially when imaging planes and sequences are tailored for neural evaluation. In particular, high-spatial-resolution anatomic imaging including three-dimensional isotropic imaging and contrast-enhanced three-dimensional short inversion time inversion-recovery (STIR) fast spin-echo sequences are useful for nerve imaging. The most commonly involved nerves are the sciatic, obturator, femoral, pudendal, and inferior hypogastric nerves and the inferior hypogastric and lumbosacral plexuses. Although it is thought to be rare, the true incidence of nerve involvement in endometriosis is not known. Symptoms of neural involvement include pain, weakness, numbness, incontinence, and paraplegia and may be constant or cyclic (catamenial). Early diagnosis of neural involvement in endometriosis is important to prevent irreversible nerve damage and chronic sensorimotor neuropathy. Evidence of irreversible damage can also be seen at MRI, and radiologists should evaluate pelvic nerves that are commonly involved in endometriosis in their search pattern and report template to ensure that this information is incorporated into treatment planning.

Preoperative cryoablation of a hypervascular bone metastasis: A case of effective devascularization before preoperative embolization.

Image-guided cryoablation has become a common approach for the palliative treatment of painful metastatic bone lesions, and indications for this procedure have expanded to include local control of bone metastases. We report a case in which cryoablation was performed on a large hypervascular renal cell carcinoma bone metastasis before surgical fixation of an impending fracture. In this case, cryoablation reduced the patient's pain but also appeared to result in devascularization of the tumor, thus obviating the need for preoperative embolization. This case raises the possibility that image-guided cryoablation may represent an alternative to preoperative embolization for vascular tumors while also serving a palliative function.

Percutaneous ultrasonic tenotomy with the TX-1 device versus surgical tenotomy for the treatment of common extensor tendinosis.

OBJECTIVE: To compare outcomes in patients treated for chronic common extensor tendinosis with percutaneous ultrasonic tenotomy (TX-1 device) versus surgical tenotomy. MATERIALS AND METHODS: Outcomes from consecutive patients who underwent percutaneous tenotomy with the TX-1 device were compared with outcomes from consecutive patients who underwent surgical tenotomy. Patients were contacted to retrospectively assess their outcomes at 4 time points: before treatment, 2 weeks after treatment, 3 to 6 months after treatment, and 12 months after treatment. Outcomes were assessed using the quick disabilities of the arm, shoulder, and hand score (QuickDASH) and the Oxford elbow score (OES). Student's t tests were used to compare postprocedural versus preprocedural scores and percutaneous versus surgical tenotomy scores. RESULTS: Response rates were 23 of 43 and 10 of 47 for surveyed percutaneous and surgical tenotomy patients, respectively. There were significant improvements from preprocedural scores in all primary outcome measures at 3-to-6-month and 12-month time points for both procedures. No significant changes from preprocedural scores were seen for either procedure at 2 weeks after treatment or between percutaneous and surgical tenotomy in preprocedural or postprocedural scores for any outcome measure. At 2 weeks, improved percutaneous tenotomy scores approached significance compared with percutaneous preprocedural QuickDASH (p = 0.060) and surgical 2-week OES function domain (p = 0.074) scores. CONCLUSION: Ultrasonic percutaneous tenotomy with the TX-1 device and surgical tenotomy have similar outcomes for chronic common extensor tendinosis, with significant symptomatic improvement occurring after 3 to 6 months. Larger studies are needed to assess for differences at 2 weeks.

Artificial Intelligence in Radiology Residency Training.

Artificial intelligence (AI) is an emerging technology that brings a wide array of new tools to the field of radiology. AI will certainly have an impact on the day-to-day work of radiologists in the coming decades, thus training programs must prepare radiology residents adequately for their future careers. Radiology training programs should aim to give residents an understanding of the fundamentals and types of AI in radiology, the broad areas AI can be applied in radiology, how to assess AI applications in radiology, and resources available to build their knowledge in IA applications in radiology.

Technically successful ultrasound-guided percutaneous sural nerve needle biopsy in a patient with indeterminate peripheral neuropathy.

OBJECTIVE: To determine whether ultrasound-guided percutaneous sural nerve needle biopsy yields sufficient tissue for analysis in a patient with suspected vasculitis-related peripheral neuropathy. MATERIALS AND METHODS: With real-time ultrasound guidance, a hydrodissection of the sural nerve from the adjacent small saphenous vein was first performed. A 14-gauge biopsy needle was then manipulated under real-time ultrasound guidance to obtain two transverse samples of the sural nerve at the lateral distal calf. RESULTS: The biopsy was technically successful and yielded adequate tissue for routine processing. The specimen showed mild epineurial perivascular chronic inflammation with marked loss of myelinated axons. These histologic findings are not diagnostically definitive for vasculitis-related peripheral neuropathy but were supportive of the diagnosis in combination with the patient's physical examination, laboratory, and electromyography findings. The patient suffered no immediate complications after the procedure. CONCLUSIONS: This ultrasound-guided sural nerve needle biopsy, like many surgical biopsies, did not yield a definitive result in a patient with suspected vasculitis-related peripheral neuropathy; however, the procedure was technically successful. Given that percutaneous needle procedures offer many advantages over surgical procedures, we believe that this procedure warrants further investigation.

Interobserver and Intraobserver Reliability of an MRI-Based Classification System for Injuries to the Ulnar Collateral Ligament.

BACKGROUND: Despite improvements in understanding biomechanics and surgical options for ulnar collateral ligament (UCL) tears, there remains a need for a reliable classification of UCL tears that has the potential to guide clinical decision making. PURPOSE: To assess the intra- and interobserver reliability of the newly proposed magnetic resonance imaging (MRI)-based classification for UCL tears. Secondary objectives included assessing the effect of additional views, discrimination between distal and nondistal tears, and correlation of imaging reads with intraoperative findings of the UCL. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Nine fellowship-trained specialists from 7 institutions independently completed 4 surveys consisting of 60 elbow MRI scans with UCL tears using a newly proposed 6-stage classification system. The first and third surveys contained 60 coronal images, while the second and fourth contained the same images with coronal and axial views presented in a random order to assess intraobserver variability via the weighted kappa value and the effect of additional imaging views. Weighted kappa values were also calculated for each of the 4 surveys to acquire interobserver reliability. Reliability analysis was repeated through a 2-group classification analysis for distal and nondistal tears. Observer readings were compared with intraoperative UCL findings. RESULTS: For the newly proposed 6-stage MRI-based classification, intra- and interobserver reliability demonstrated near perfect and substantial agreement, respectively. These values increased only when substratified into the 2-group distal and nondistal tear classification ( P < .05). The additional axial view did not statistically improve the agreement within and among readers. When compared with intraoperative findings from 30 elbows, observer readings were accurate for tear grade (partial and complete), proximal location, and distal location but not midsubstance tears. CONCLUSION: The newly proposed 6-stage MRI-based classification utilizing grade and location of the injury had substantial to near perfect agreement among and within fellowship-trained observers.

Musculoskeletal ultrasonography basics.

Utrasonography is emerging as a core method to evaluate musculoskeletal problems. It is best used for imaging superficial structures limited to 1 quadrant of a joint. It has several advantages over other imaging methods: lower cost, ability to perform dynamic examinations, higher spatial resolution of superficial structures, better patient comfort, and essentially no contraindications.

Clinical Utility of High-Frequency Musculoskeletal Ultrasonography in Foot and Ankle Pathology: How Ultrasound Imaging Influences Diagnosis and Management.

The use of high-frequency (high-resolution) musculoskeletal ultrasonography is increasing and has shown promising utility in many areas of medicine. The utility of musculoskeletal ultrasonography for foot and ankle complaints has not been widely investigated, however. Although some conditions of the foot and ankle are easily diagnosed by physical examination, others can have nonspecific examination findings, making optimal treatment decisions difficult. We hypothesized that high-resolution musculoskeletal ultrasound scanning of the foot and ankle can affect the diagnosis and/or treatment for patients presenting with foot or ankle complaints. Retrospectively, the cases of 98 patients who had undergone musculoskeletal ultrasound scanning of the foot or ankle were reviewed. The pre-ultrasound clinical diagnosis and treatment were compared with the post-ultrasound diagnosis and treatment. In 64% of the patients, the diagnosis or treatment changed after the ultrasound examination. In 43% of patients, both the diagnosis and the treatment changed after ultrasound scanning. For those patients for whom the diagnosis and treatment were unchanged after the ultrasound examination, the ultrasound findings were concordant with the pre-ultrasound clinical diagnosis for 100% of the patients. These results suggest that in a large proportion of patients, high-resolution musculoskeletal ultrasonography of the foot or ankle can facilitate appropriate diagnosis and management.

Magnetic resonance imaging of cartilage repair procedures.

Cartilage injuries in the knee are common and can be a persistent source of pain or dysfunction. Many new surgical strategies have been developed to treat these lesions. It is important for the radiologist to have an understanding of these procedures and their appearance on magnetic resonance (MR) imaging. This article provides the radiologist with an overview of the surgical strategies for repairing cartilage lesions in the knee followed by a discussion of their postoperative appearance on MR imaging in normal and abnormal cases. Guidelines for adequate reporting of the MR imaging findings after cartilage repair in the knee are also included.

Magnetic resonance imaging of inflammatory arthropathies of peripheral joints.

As the treatment of inflammatory arthropathies has advanced with new therapies that can slow or even halt the development of disabling disease, early and accurate diagnosis has become imperative. Magnetic resonance (MR) imaging has proved to be very sensitive in the detection of erosions, but more importantly, it can demonstrate pre-erosive changes. Detection of synovitis and edema-like bone marrow lesions for initial diagnosis and as an indicator of disease progression can provide crucial information leading to therapeutic interventions before permanent joint damage occurs. Understanding the characteristic intra-articular and extra-articular MR imaging findings of the inflammatory arthritides allows the radiologist to provide appropriate consultations in the care of these patients. The MR appearances of both intra-articular and extra-articular findings of inflammatory arthritis are presented. Despite the advances in imaging, however, many of the MR findings remain nonspecific, and radiologists must avoid overdiagnosis by synthesizing all of the clinical information available into their interpretations.