Grading the severity of the rotator cuff tendinosis on MRI: Assessment of inter-observer agreement and evaluation of a novel objective assessment tool.

INTRODUCTION: MRI is generally considered the modality of choice for the assessment of rotator cuff pathology including tendinosis. Assessment of severity is currently subjective primarily based on tendon morphology and signal intensity. Limited data are available evaluating the inter-observer agreement regarding the assessment of tendinosis severity. METHODS: One hundred and twenty-four patients were prospectively enrolled in the study. Patients included were referred to two private radiology practices for shoulder MRI for any reason. Two musculoskeletal radiologists assessed the severity of tendinosis independently. Supraspinatus tendon signal was evaluated with a ROI and compared to the adjacent deltoid muscle signal, generating a ratio of tendon: muscle signal, termed the 'objective TM ratio'. The relationship between the subjective assessment of tendinosis severity and objective ratio was examined. Inter-observer agreement was also calculated. RESULTS: Tendinosis severity was graded as normal in 36 and 11 patients by readers 1 and 2, respectively, mild in 45 and 48 patients, moderate in 26 and 48 patients and severe in 10 and 10 patients. Inter-observer agreement is classified as fair (0.31 kappa co-efficient). Mean objective TM ratio increased on both the PD and TS F2 sequences as the subjective grade of tendinosis severity increased. CONCLUSION: A novel means of evaluating rotator cuff tendinosis severity is presented, demonstrated to correlate with the subjective grade of tendinosis severity. Further research is required to assess the utility of such objective measurements across varying imaging protocols whilst understanding the inherent limitations with quantifying signal intensity on MRI.

Endovascular management of recurrent hemarthrosis of the knee: a case series.

BACKGROUND: Recurrent hemarthrosis of the knee is an uncommon but potentially debilitating occurrence with multiple etiologies, including previous total knee replacement. The purpose of this study is to present data of a group of patients undergoing angiography and embolization for recurrent hemarthrosis of the knee. Patient characteristics, angiographic findings, safety and efficacy of the procedure are reported. METHODS: A retrospective single centre review of patients undergoing angiography and embolization at a tertiary referral centre in Sydney, Australia from March 2006 to April 2018 was performed. A total of 25 patients undergoing a total of 29 procedures were identified (20 female, 5 male; mean age 67), the majority of which (23/25, 92%) had a history of total knee arthroplasty. Embolization was performed in 28 of the 29 procedures (97%). The embolic agent used was either polyvinyl alcohol particles (23/28), gelatin foam (3/28), detachable microcoils (1/28) or a combination of particles and coils (1/28). RESULTS: The most commonly identified dominant vascular abnormality was periarticular synovial hypervascularity (23/25, 92%). A pseudoaneurysm was demonstrated in two patients (8%). Technical success (elimination of angiographic abnormalities) was achieved in 27 of 29 procedures (93%). There were 6 episodes of recurrence (25%) following a single embolization procedure, three of which were managed successfully with repeat embolization. There were no complications relating to skin or periarticular ischemia. CONCLUSION: Angiography and embolization is a safe and effective tool for the management of recurrent hemarthrosis of the knee following arthroplasty and should be considered first line treatment following failure of conservative management. LEVEL OF EVIDENCE: Level 4, Case Series.

Evaluation of the effect of double reporting on test accuracy in screening and diagnostic imaging studies: A review of the evidence.

Diagnostic error in radiology is not uncommon, with rates of clinically significant error reported to be as high as 20%. Radiological errors are often multifactorial, however, perceptual factors are thought to be mainly responsible. One way of reducing perceptual error is that of double reporting, which refers to the interpretation of radiological investigations by two observers, with strategies of arbitration and consensus available to settle discordant reports. Independent double reporting, where observers have no knowledge of each other's reports, is generally considered to be the most effective form. The impact of double reporting on diagnostic efficacy has been primarily explored in screening mammography, where it has consistently been shown to improve sensitivity, cancer detection rate and depending on local policy, have a positive influence on recall rates. Subsequently, the adoption of double reporting is reported as standard practice in many national and regional breast cancer-screening programmes. To a lesser extent, the impact of double reporting has also been investigated for neuroradiology, thoracic and gastrointestinal imaging, with small-scale studies in these fields showing promising results. With the widespread implementation of digitisation and the ease of access to images, the efficacy and cost-effectiveness of double reporting for other common radiological investigations requires attention. The review will evaluate the evidence regarding the effect of double interpretation of diagnostic imaging studies on test accuracy.