Ultra-low-dose computed tomography and chest X-ray in follow-up of high-grade soft tissue sarcoma-a prospective comparative study.

Ultra-low-dose computed tomography (ULD-CT) may combine the high sensitivity of conventional computed tomography (CT) in detecting sarcoma pulmonary metastasis, with a radiation dose in the same magnitude as chest X-ray (CXR). Fifty patients with non-metastatic high-grade soft tissue sarcoma treated with curative intention were recruited. Their follow-up involved both CXR and ULD-CT to evaluate their different sensitivity. Suspected findings were confirmed by conventional CT if necessary. Patients with isolated pulmonary metastases were treated with surgery or stereotactic body radiation therapy (SBRT) with curative intent if possible. The median effective dose from a single ULD-CT study was 0.27 mSv (range 0.12 to 0.89 mSv). Nine patients were diagnosed with asymptomatic lung metastases during the follow-up. Only three of them were visible in CXR and all nine in ULD-CT. CXR had therefore only a 33% sensitivity compared to ULD-CT. Four patients were operated, and one had SBRT to all pulmonary lesions. Eight of them, however, died of the disease. Two patients developed symptomatic metastatic recurrence involving extrapulmonary sites+/-the lungs between two imaging rounds. ULD-CT has higher sensitivity for the detection of sarcoma pulmonary metastasis than CXR, with a radiation dose considerably lower than conventional CT.Clinical trial registration: NCT05813808. 04-14-2023.

The clinical significance of magnetic resonance imaging of the hand: an analysis of 318 hand and wrist images referred by hand surgeons.

Magnetic resonance imaging (MRI) is a common diagnostic tool in hand surgery. However, there is limited knowledge on the kind of findings that are relevant in treatment planning. We analysed the findings and utility of arm, wrist, metacarpal, and finger MRIs taken in a tertiary hand surgery clinic of 318 consecutive images from 316 patients referred by a hand surgeon or hand surgeon resident. Ganglions (28%), findings on the extensor carpi ulnaris tendon (18%) and on the triangular fibrocartilage (18%) were the most common findings and increased with patient age; the clinical significance of these findings was minimal. The correlation between the clinical scaphoid shift test or the fovea sign test and MRI was also non-significant. Despite findings on MRI, the diagnosis remained unsolved in 76 (24%) cases. However, MRI had a role in reassuring the patient, and in 70% of the cases, further follow-up was unnecessary. This study demonstrates that the indications for wrist and hand MRI must be considered thoroughly and interpretation of the MRI report requires knowledge.

In Vivo Evaluation of the Potential of High-Frequency Ultrasound for Arthroscopic Examination of the Shoulder Joint.

OBJECTIVE: Accurate arthroscopic evaluation of cartilage lesions could significantly improve the outcome of repair surgery. In this study, we investigated for the first time the potential of intra-articular ultrasound as an arthroscopic tool for grading cartilage defects in the human shoulder joint in vivo and compared the outcome to results from arthroscopic evaluation and magnetic resonance imaging findings. DESIGN: A total of 26 sites from 9 patients undergoing routine shoulder arthroscopy were quantitatively evaluated with a clinical intravascular (40MHz) ultrasound imaging system, using the regular arthroscopy portals. Reflection coefficient (R), integrated reflection coefficient (IRC), apparent integrated backscattering (AIB), and ultrasound roughness index (URI) were calculated, and high-resolution ultrasound images were obtained per site. Each site was visually graded according to the International Cartilage Repair Society (ICRS) system. "Ultrasound scores" corresponding to the ICRS system were determined from the ultrasound images. Magnetic resonance imaging was conducted and cartilage integrity at each site was classified into 5 grades (0 = normal, 4 = severely abnormal) by a radiologist. RESULTS: R and IRC were lower at sites with damaged cartilage surface (P = 0.033 and P = 0.043, respectively) and correlated with arthroscopic ICRS grades (r s = -0.444, P = 0.023 and r s = -0.426, P = 0.03, respectively). Arthroscopic ICRS grades and ultrasound scores were significantly correlated (rs = 0.472, P = 0.015), but no significant correlation was found between magnetic resonance imaging data and other parameters. CONCLUSION: The results suggest that ultrasound arthroscopy could facilitate quantitative clinical appraisal of articular cartilage integrity in the shoulder joint and provide information on cartilage lesion depth and severity for quantitative diagnostics in surgery.

MDCT findings after elbow dislocation: a retrospective study of 140 patients.

OBJECTIVE: To assess the number and anatomical location of fractures associated with elbow dislocation, to study the correlation between the direction of dislocation and the trauma energy, and to assess radiographs' diagnostic performance characteristics for fractures using MDCT as a reference standard. MATERIALS AND METHODS: A retrospective study was performed at a level 1 trauma center, finding a total of 140 patients who had sustained an elbow dislocation and who had undergone a subsequent MDCT examination. The CT and radiographs of the patient were reviewed by two musculoskeletal radiologists. CT images were analyzed for the site and size of the fracture fragments. In addition, the primary direction of the dislocation, patients' age, and gender were recorded. Trauma energy was also assessed. RESULTS: One hundred and thirty-four out of 140 patients (96%) had a fracture that was seen on the correlative CT examination. The most common anatomical fracture locations were the coronoid process of the ulna 84 out of 140 (60%), the radial head 75 out of 140 (54%), and the humeral capitellum 57 out of 140 (41%). Multiple fractures were seen in 71 out of 134 (53%) patients with fractures. The left elbow was more commonly dislocated than the right one. The overall sensitivity of the radiographs was 62% and the specificity 96%. CONCLUSION: Small fractures and impaction fractures are almost invariably present in elbow dislocations, and half of the patients have more than one fracture. Radiographs have a sensitivity of only 62%. MDCT is an invaluable method for determining the extent of bony injury and revealing occult fractures.

Quality of chest radiograph reports.

BACKGROUND: Examination requests and imaging reports are the most important communication instruments between clinicians and radiologists. An accurate and clear report helps referring physicians make care decisions for their patients. PURPOSE: To evaluate the contents of initial and re-reported chest reports, assess the inter-observer agreement, and evaluate the clarity of the report contents from the viewpoint of the referring physicians. MATERIAL AND METHODS: The content and agreement of the reports were analyzed by comparing the initial reports with re-reports prepared by a chest radiologist. The referring physicians evaluated the contents of 50 reports regarding their medical facts, clarity, and intelligibility. The results were analyzed using cross-over tables, the Pearson Chi-Square, and kappa statistics. RESULTS: Radiologists mostly addressed the questions posed by the referring physicians. General radiologists included separate conclusions in their reports more frequently (22%) than the chest radiologist in her re-reports. Reports prepared by the chest radiologist contained nearly 50% more findings than the general radiologists' reports. Inter-observer agreement between the initial and specialist re-reported reports was 66%, but the kappa value was 0.31. The reports were considered clear/intelligible by the referring physicians in 68% of the initial reports by the general radiologists and in 94% of the re-reported studies by the chest radiologist. CONCLUSION: Radiology report quality was rather high despite their contents varying depending on the radiologist. Inter-observer agreement of the chest radiographs was low due to the non-structured reports containing different quantities of information, thus complicating the comparison. Referring physicians considered both short and long radiology reports to be clear.

Feasibility of abdominal plain film images in evaluation suspected drug smuggler.

OBJECTIVE: Drug smuggling in the gastrointestinal tract has soared within the last 20 years. Though illegal substances in the gastrointestinal tract can be visualized with ultrasound, MRI and CT, the abdominal radiograph has by far remained the most frequently used way of detecting smuggled drugs. The purpose of the study was to evaluate the inter-radiologist interpretation error and the reliability of the abdominal radiograph in detecting smuggled drugs. MATERIALS AND METHODS: A total of 279 abdominal radiographs of suspected smugglers were classified by three radiologists as clearly positive or negative for drug smuggling. All available information about the cases was collected from the customs officers and police. RESULTS: Out of these cases 203 (73%) were interpreted as negative and 35 (13%) as positive by all three radiologists. In 86% of the cases there was, therefore, an inter-radiological agreement in interpreting the images. In 41 (14%) cases, however, there was an inter-radiologist disagreement. Kappa-value for inter-observer variability was 0.70. CONCLUSIONS: In up to a seventh of the abdominal radiographs the interpretation can be challenging even for an experienced radiologist. False positive interpretation can lead to innocent passengers being detained in vain. As negatively interpreted images usually result in releasing of the suspect, there is no way of knowing how many false negative occur. This makes the abdominal radiograph a suboptimal examination, and low dose CT should be considered as the screening modality for gastrointestinal drug smugglers.

Comparison of 1.5T and 3T MRI scanners in evaluation of acute bone stress in the foot.

BACKGROUND: Bone stress injuries are common in athletes and military recruits. Only a minority of bone stress changes are available on plain radiographs. Acute bone stress is often visible on MRI as bone marrow edema, which is also seen in many other disease processes such as malignancies, inflammatory conditions and infections. The purpose of this study was to investigate the ability of radiographs, 1.5T and 3T MRI to identify acute bone marrow changes in the foot. METHODS: Ten patients with 12 stress fractures seen on plain radiographs underwent MRI using 1.5T and 3T scanners. T1 FSE and STIR axial, sagittal, and coronal view sequences were obtained. Two musculoskeletal radiologists interpreted the images independently and by consensus in case of disagreement. RESULTS: Of the 63 acute bone stress changes seen on 3T images, 61 were also seen on 1.5T images. The sensitivity of 1.5T MRI was 97% (95% CI: 89%-99%) compared with 3T. The 3T MRI images where, therefore, at least equally sensitive to 1.5T scanners in detection of bone marrow edema. On T1-weighted sequences, 3T images were slightly superior to 1.5T images in visualizing the demarcation of the edema and bone trabeculae. The kappa-value for inter-observer variability was 0.86 in the MRI indicating substantial interobserver agreement. CONCLUSIONS: Owing to slightly better resolution of 3T images, edema characterization is easier, which might aid in the differential diagnosis of the bone marrow edema. There was, however, no noteworthy difference in the sensitivity of the 1.5T and 3T images to bone marrow edema. Routine identification of acute bone stress changes and suspected stress injuries can, therefore, be made with 1.5T field strength.

Bone stress injuries of the ankle and foot: an 86-month magnetic resonance imaging-based study of physically active young adults.

BACKGROUND: No comprehensive studies of bone stress injuries in the ankle and foot based on magnetic resonance imaging findings have been published. PURPOSE: Using magnetic resonance imaging findings to assess incidence, location, and type of bone stress injuries of the ankle and foot in military conscripts with ankle and/or foot pain. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All patients with ankle or foot pain, negative findings on plain radiography, and magnetic resonance images obtained of the ankle or foot were included in this 86-month study. Magnetic resonance images with bone stress injury findings were re-evaluated regarding location and injury type. Based on the number of conscripts within the hospital catchment area, the person-based incidence of bone stress injuries was calculated. RESULTS: One hundred thirty-one conscripts displayed 378 bone stress injuries in 142 ankles and feet imaged, the incidence being 126 per 100 000 person-years. This incidence represents the stress injuries not diagnosable with radiographs and requiring magnetic resonance images. Of injuries, 57.7% occurred in the tarsal and 35.7% in the metatarsal bones. Multiple bone stress injuries in 1 foot were found in 63% of the cases. The calcaneus and fifth metatarsal bone were usually affected alone. Injuries to the other bones of the foot were usually associated with at least 1 other stress injury. The talus and calcaneus were the most commonly affected single bones. High-grade bone stress injury (grade IV-V) with a fracture line on magnetic resonance images occurred in 12% (talus, calcaneus), and low-grade injury (grade I-III) presented only as edema in 88% of the cases. CONCLUSION: Multiple, various-stage bone stress injuries of the ankle and foot may occur simultaneously in physically active young adults. When considering injuries that were missed by plain radiographs but detected by magnetic resonance imaging, the bones most often affected were the tarsal bones, of which the talus and calcaneus were the most prominent single bones and most common locations for higher grade (IV-V) bone stress injuries. With use of magnetic resonance imaging, early detection and grading of bone stress injuries are available, which enable early and appropriate injury management.

Stress injuries of the calcaneus detected with magnetic resonance imaging in military recruits.

BACKGROUND: Calcaneal stress injuries are fairly common overuse injuries in military recruits and athletes. We assessed the anatomic distribution, nature, and healing of calcaneal stress injuries in a group of military recruits. METHODS: Military recruits who underwent magnetic resonance imaging for the evaluation of exercise-induced ankle and/or heel pain were identified from the medical archives. The magnetic resonance images, plain radiographs, and medical records of these patients were evaluated with regard to fracture type and the natural history of the injury. RESULTS: Over ninety-six months, magnetic resonance imaging revealed calcaneal stress injuries in thirty recruits in a population with a total exposure time of 117,149 person-years, yielding an incidence of 2.6 (95% confidence interval, 1.6 to 3.4) per 10,000 person-years. Four patients exhibited a bilateral injury. Of the thirty-four injuries, nineteen occurred in the posterior part of the calcaneus, six occurred in the middle part of the calcaneus, and nine occurred in the anterior part of the calcaneus, with 79% occurring in the upper region and 21% occurring in the lower region. The calcaneus alone was affected in twelve cases. In twenty-two cases, stress injury was also present in one or several other tarsal bones. A distinct association emerged between injuries of the different parts of the calcaneus and stress injuries in the surrounding bones. In only 15% of the patients was the stress injury visible on plain radiographs. With the numbers available, there were no significant differences between the patients with calcaneal stress injuries and unaffected recruits with regard to age, height, weight, body mass index, or physical fitness. CONCLUSIONS: The majority of stress injuries of the calcaneus occur in the posterior part of the bone, but a considerable proportion can also be found in the middle and anterior parts. To obtain a diagnosis, magnetic resonance imaging is warranted if plain radiography does not show abnormalities in a physically active patient with exercise-induced pain in the ankle or heel.

Outcomes of stress fractures of the talus.

BACKGROUND: Stress fractures of the talus are rare, and only a few small studies have been published. In the absence of follow-up studies, the outcomes of these injuries are unknown. HYPOTHESIS: Traumatic fractures of the talus frequently heal poorly, and stress fracture healing might remain inadequate. The purpose of this study was to determine the outcome of stress fractures of the talus treated in the authors' institution with reduced exercise and nonweightbearing. STUDY DESIGN: Case series (prognosis); Level of evidence, 4. METHODS: Patients with a diagnosed stress fracture in the talus by magnetic resonance imaging between April 1997 and March 2005 were recalled for a follow-up inspection by an orthopaedic surgeon, magnetic resonance imaging, and plain radiographs to determine the outcome of the injury. RESULTS: One of the 9 patients in our sample declined the invitation, leaving 8 patients with 9 stress fractures in the talus who participated in the follow-up examination. Five patients displayed subchondral degeneration and edema near the original injury area in the follow-up magnetic resonance imaging. In 2 patients, the degeneration was also visible on the plain radiographs. Three patients had mild and 2 moderate symptoms after the mean follow-up time of 45 months (range, 12-74 months). No serious complications in the healing process were seen. CONCLUSION: Stress fractures of the talus do not seem to seriously damage the foot. In a middle-term follow-up, however, minor to moderate symptoms and radiological degeneration of the injured area prevailed in roughly half of the patients.

Bone stress injuries of the talus in military recruits.

The purpose of the present study was to assess the incidence, anatomic distribution, and nature of fatigue bone stress injuries of the talus in military recruits based on magnetic resonance imaging (MRI). Military recruits referred to MRI examination due to exercise-induced ankle and/or foot pain were identified from the MRI archives. MR images of cases with bone stress injury findings in the talus were retrospectively re-evaluated concerning the anatomic location and type of the bone stress injury. During 96 months, fifty-one consecutive recruits displayed bone stress injuries of the talus in the population base of 117,149 person-years, yielding an incidence of 4.4 (3.2-5.5)/10,000 person-years. Bilateral injuries were seen in five of the patients. Of the 56 bone stress injuries, 40 occurred in the head, 15 in the body, and 5 in the posterior part of the talus. In four cases, both the head and the body were affected. Solitary, the talus was affected in 12 cases. In 44 cases, a stress injury was also present in other tarsal bones. Assessing the severity of the bone stress injury, a grade I-III injury was found in 46 and a grade IV injury with a fracture line in 10 of the cases. Injuries of the upper part of the body were associated with calcaneal stress injuries in 78% of the cases (P=0.03), and injuries of the head of the talus were associated with stress injuries in the naviculare in 60% of the cases (P=0.04). Age, sex, height, weight, body mass index, or physical fitness failed to reach statistical significance as risk factors for fatigue bone stress injuries of the talus. On MRI, the majority of the bone stress injuries of the talus were revealed in the head. A grade IV injury was discovered in 18% of the cases; in the remaining 82%, only grade I-III injuries were ascertained. In all locations, the lower grade bone stress injuries dominated. This study established the incidence of fatigue bone stress injury of the talus and indicated that these injuries are rare but not unseen in military recruits.