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Despite more than 20 years of development, the MRI-based cartilage compositional biomarkers T2 and T1rho have not been routinely applied in clinical practice. This review examines these measures' historical development and frames the challenges in the application of these quantitative imaging tools to the care of patients with cartilage injury and osteoarthritis using the hierarchical model of efficacy proposed by Fryback and Thornbury. T2 and T1rho have been validated for the evaluation of early compositional and structural changes in cartilage extracellular matrix. Yet, these biomarkers lack direct correlation with pain or function loss, lack standardization of methods for acquisition and analysis, and have a limited role in guiding therapeutic management given the absence of effective disease-modifying osteoarthritis drugs. These issues present significant challenges in the path to the biomarkers' future implementation in clinical care. Nonetheless, these MRI-based cartilage compositional biomarkers provide an essential tool for musculoskeletal research and can provide important information on the biophysical properties of cartilage that will continue to contribute to our understanding of cartilage injury and osteoarthritis pathogenesis.
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OBJECTIVE. In this article, we review models for clinical integration across the full spectrum of radiologic services in merged health systems that include both academic and community practice components. We also discuss the issues involved in the integration of disparate practice models and reward systems for both the community radiology group and the academic faculty practice group. CONCLUSION. Although we see advantages to the current trends in mergers and acquisitions within academic radiology, it remains to be seen whether academic and community practice radiology groups can truly work and play well together.
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Centros Médicos Acadêmicos/organização & administração , Instituições Associadas de Saúde , Hospitais Comunitários/organização & administração , Administração da Prática Médica/organização & administração , Radiologia , Atenção à Saúde/organização & administração , Prática de Grupo , Humanos , Modelos Organizacionais , Objetivos OrganizacionaisRESUMO
Distal radioulnar dislocations typically occur in association with fractures of the distal radius and/or ulna. Rare isolated dislocations or subluxations are more difficult to diagnose and are initially missed in up to 50 % of cases. We present two cases of missed isolated volar rotatory dislocation of the distal radioulnar joint. Subtle, overlooked radiographic findings of abnormal radioulnar alignment and ulnar styloid projection are highlighted. The supplemental role of cross-sectional imaging is reviewed. Adequate clinical information, appropriate radiographic technique, and high index of suspicion are necessary for the accurate and timely diagnosis of this rare injury pattern.
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Luxações Articulares/diagnóstico por imagem , Traumatismos do Punho/diagnóstico por imagem , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ulna/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagemRESUMO
PURPOSE: To characterize the orientation of the normal supraspinatus central tendon and describe the displacement patterns of the central tendon in rotator cuff tears using a magnetic resonance imaging (MRI)-based method. METHODS: We performed a retrospective MRI and chart review of 183 patients with a rotator cuff tear (cuff tear group), 52 with a labral tear but no rotator cuff tear (labral tear group), and 74 with a normal shoulder (normal group). The orientation of the supraspinatus central tendon relative to the bicipital groove was evaluated based on axial MRI and was numerically represented by the shortest distance from the lateral extension line of the central tendon to the bicipital groove. Tear size, fatty degeneration, and involvement of the anterior supraspinatus were evaluated to identify the factors associated with orientation changes. RESULTS: The mean distance from the bicipital groove to the central tendon line was 0.7 mm and 1.3 mm in the normal group and labral tear group, respectively. Full-thickness cuff tears involving the anterior supraspinatus showed a significantly greater distance (17.7 mm) than those sparing the anterior supraspinatus (4.9 mm, P = .001). Fatty degeneration of the supraspinatus was significantly correlated with the distance (P = .006). Disruption of the anterior supraspinatus and fatty degeneration of the supraspinatus were independent predictors of posterior displacement. CONCLUSIONS: The supraspinatus central tendon has a constant orientation toward the bicipital groove in normal shoulders, and the central tendon is frequently displaced posteriorly in full-thickness rotator cuff tears involving the anterior leading edge of the supraspinatus. The degree of posterior displacement is proportional to tear size and severity of fatty degeneration of the supraspinatus muscle. A simple and quick assessment of the central tendon orientation on preoperative MRI can be a useful indicator of tear characteristics, potentially providing insight into the intraoperative repair strategy. LEVEL OF EVIDENCE: Level IV, diagnostic case-control study.
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Imageamento por Ressonância Magnética , Lesões do Manguito Rotador , Manguito Rotador/patologia , Traumatismos dos Tendões/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Retrospectivos , Manguito Rotador/cirurgia , Adulto JovemRESUMO
PURPOSE: The purpose of this study was to evaluate the clinical outcomes and playing status of professional hockey players 4 years after they underwent bilateral magnetic resonance imaging (MRI) of asymptomatic hips. METHODS: Twenty-one professional hockey players with no previous hip/groin pain underwent hip/pelvis MRI. Each MRI study was evaluated by 3 subspecialty-trained musculoskeletal radiologists for alpha-angle measurement and the presence of adductor-abdominal rectus abnormalities, acetabular labral tears, osteochondral lesions of the femoral head or acetabulum, hip effusion, adjacent muscle contusions or strain injury, and stress fractures. The MRI findings of the players were previously published. In the present study, each athlete was followed up by (1) completion of a questionnaire assessing hip/groin dysfunction at 1 and 2 years' follow-up and (2) number of games played over the course of the next 4 years. A significant difference in the number of games played was considered when a player missed more than 5 games compared with the index year. RESULTS: We enrolled 21 players in the study. Of these players, 4 had no abnormality bilaterally, 10 had muscle strain and/or tendinosis in 1 or both hips, and 15 had labral tears identified in 1 or both hips. Eight players had a combination of labral tears and muscle strain/tendinosis. Of 21 professional hockey players, 16 (76%) and 14 (67%) were available at 1 and 2 years' follow-up, respectively. Nineteen of 21 players (90%) continued to play professional hockey at 4 years' follow-up. The development of any hip and/or pelvis symptoms occurred in only 3 players (14%) within 4 years. Only 1 of the 3 players missed any games because of hip and/or pelvis symptoms. The affected player missed several games because of proximal iliotibial band symptoms that occurred in the third year after MRI. CONCLUSIONS: Hip/pelvis pathology is commonly uncovered on MRI of asymptomatic hockey players; however, this pathology does not produce symptoms or result in missed games within 4 years in most players. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
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Traumatismos em Atletas/diagnóstico , Hóquei/lesões , Acetábulo/lesões , Seguimentos , Virilha/lesões , Lesões do Quadril/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Estudos Prospectivos , Entorses e Distensões/diagnóstico , Inquéritos e Questionários , Tendinopatia/diagnósticoRESUMO
PURPOSE: T2 mapping techniques use the relaxation constant as an indirect marker of cartilage structure, and the relaxation constant has also been shown to be a sensitive parameter for cartilage evaluation. As a possible additional robust biomarker, T2* relaxation time is a potential, clinically feasible parameter for the biochemical evaluation of articular cartilage. MATERIALS AND METHODS: The knees of 15 healthy volunteers and 15 patients after microfracture therapy (MFX) were evaluated with a multi-echo spin-echo T2 mapping technique and a multi-echo gradient-echo T2* mapping sequence at 3.0 Tesla MRI. Inline maps, using a log-linear least squares fitting method, were assessed with respect to the zonal dependency of T2 and T2* relaxation for the deep and superficial regions of healthy articular cartilage and cartilage repair tissue. RESULTS: There was a statistically significant correlation between T2 and T2* values. Both parameters demonstrated similar spatial dependency, with longer values measured toward the articular surface for healthy articular cartilage. No spatial variation was observed for cartilage repair tissue after MFX. CONCLUSIONS: Within this feasibility study, both T2 and T2* relaxation parameters demonstrated a similar response in the assessment of articular cartilage and cartilage repair tissue. The potential advantages of T2*-mapping of cartilage include faster imaging times and the opportunity for 3D acquisitions, thereby providing greater spatial resolution and complete coverage of the articular surface.
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Algoritmos , Cartilagem Articular/lesões , Cartilagem Articular/patologia , Interpretação de Imagem Assistida por Computador/métodos , Traumatismos do Joelho/patologia , Imageamento por Ressonância Magnética/métodos , Adulto , Artroplastia Subcondral , Estudos de Viabilidade , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: To evaluate the perceived utility and associated charges of the anteroposterior (AP) radiograph during rotational ankle fracture postoperative follow-up. DESIGN: Survey study with charge analysis using published data at 50 orthopaedic hospitals in the United States. SETTING: Not Applicable. PARTICIPANTS: Orthopaedic Trauma Association Members with an active email address who were invited and interested in answering a survey. RESULTS: Ninety-four percent of respondents stated that they did routinely obtain an AP radiograph during rotational ankle fracture follow-up. However, 57% thought that the AP view should be eliminated from standard follow-up and only 51% found this view useful after initial treatment. CHARGE ANALYSIS: The mean difference between a 2-view and 3-view ankle radiograph series was $102.00. Using this value and the assumption that each patient with a rotational ankle fracture gets 3 follow-up radiographs, there is the potential for a charge reduction of $306 per patient. Assuming over 134,000 rotational ankle fractures, a charge reduction of 41 million US dollars (USD) per year is possible if the AP image is routinely removed. Actual savings are likely to be less based on agreed on payer rates. Although less easy to quantify, there is also a potential reduction of radiation exposure, radiologists' interpretation time, and data storage. CONCLUSIONS: Routine AP radiographs should potentially be eliminated from routine postoperative ankle x-ray protocols based on this survey of experienced orthopaedic surgeons. If this specific radiograph is ordered on a case-by-case basis, then significant savings may occur.
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Fraturas do Tornozelo , Ortopedia , Tornozelo , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo , Humanos , Inquéritos e QuestionáriosRESUMO
PURPOSE: To prospectively determine the reproducibility of quantitative magnetic resonance (MR) imaging biomarkers of the morphology and composition (spin lattice relaxation time in rotating frame [T1-ρ], T2) of knee cartilage in a multicenter multivendor trial involving patients with osteoarthritis (OA) and asymptomatic control subjects. MATERIALS AND METHODS: This study was HIPAA compliant and approved by the institutional review committees of the participating sites, with written informed consent obtained from all participants. Fifty subjects from five sites who were deemed to have normal knee joints (n = 18), mild OA (n = 16), or moderate OA (n = 16) on the basis of Kellgren-Lawrence scores were enrolled. Each participant underwent four sequential 3-T knee MR imaging examinations with use of the same imager and with 2-63 days (median, 18 days) separating the first and last examinations. Water-excited three-dimensional T1-weighted gradient-echo imaging, T1-ρ imaging, and T2 mapping of cartilage in the axial and coronal planes were performed. Biomarker reproducibility was determined by using intraclass correlation coefficients (ICCs) and root-mean-square coefficients of variation (RMS CVs, expressed as percentages). RESULTS: Morphometric biomarkers had high reproducibility, with ICCs of 0.989 or greater and RMS CVs lower than 4%. The largest differences between the healthy subjects and the patients with radiographically detected knee OA were those in T1-ρ values, but precision errors were relatively large. Reproducibility of T1-ρ values was higher in the thicker patellar cartilage (ICC range, 0.86-0.93; RMS CV range, 14%-18%) than in the femorotibial joints (ICC range, 0.20-0.84; RMS CV range, 7%-19%). Good to high reproducibility of T2 was observed, with ICCs ranging from 0.61 to 0.98 and RMS CVs ranging from 4% to 14%. CONCLUSION: MR imaging measurements of cartilage morphology, T2, and patellar T1-ρ demonstrated moderate to excellent reproducibility in a clinical trial network.
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Cartilagem Articular/patologia , Imageamento por Ressonância Magnética/métodos , Osteoartrite do Joelho/patologia , Adolescente , Adulto , Biomarcadores/análise , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Análise dos Mínimos Quadrados , Masculino , Imagens de Fantasmas , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
Magnetic resonance (MR) imaging is the most important imaging modality for the evaluation of traumatic or degenerative cartilaginous lesions in the knee. It is a powerful noninvasive tool for detecting such lesions and monitoring the effects of pharmacologic and surgical therapy. The specific MR imaging techniques used for these purposes can be divided into two broad categories according to their usefulness for morphologic or compositional evaluation. To assess the structure of knee cartilage, standard spin-echo (SE) and gradient-recalled echo (GRE) sequences, fast SE sequences, and three-dimensional SE and GRE sequences are available. These techniques allow the detection of morphologic defects in the articular cartilage of the knee and are commonly used in research for semiquantitative and quantitative assessments of cartilage. To evaluate the collagen network and proteoglycan content in the knee cartilage matrix, compositional assessment techniques such as T2 mapping, delayed gadolinium-enhanced MR imaging of cartilage (or dGEMRIC), T1ρ imaging, sodium imaging, and diffusion-weighted imaging are available. These techniques may be used in various combinations and at various magnetic field strengths in clinical and research settings to improve the characterization of changes in cartilage.
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Cartilagem Articular/patologia , Articulação do Joelho/patologia , Imageamento por Ressonância Magnética/métodos , HumanosRESUMO
UNLABELLED: Pro-inflammatory cytokines like TNF-α activate sphingosine kinase (SK). Therefore, inhibition of SK is a potential molecular target for the treatment of rheumatoid arthritis. AIMS: The primary goal of this study was to assess the efficacy of ABC249640 (a selective SK-2 inhibitor) in two models of rodent arthritis. A secondary goal was to evaluate the pharmacological profile of ABC294640, when given in combination with methotrexate. METHODS: The efficacy of ABC294640 was determined by paw diameter/volume measurements, histological evaluations, and micro-CT analyses. RESULTS: ABC294640 attenuated both collagen-induced arthritis in mice, as well as adjuvant-induced arthritis in rats. With the adjuvant arthritis model, the prophylactic efficacy profile of ABC294640 was similar to indomethacin. Of note, ABC294640 reduced the bone and cartilage degradation, associated with adjuvant-induced arthritis. Rats treated with a suboptimal dose of MTX (50 µg/kg/day) in combination with ABC249640 (100 mg/kg/day) had better anti-arthritis effects in the adjuvant model, than treatment with either agent alone. CONCLUSION: Our results suggest that ABC249640 is an orally available drug candidate with a good pre-clinical efficacy profile for the prevention and/or treatment of RA.
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Adamantano/análogos & derivados , Artrite Experimental/tratamento farmacológico , Artrite Experimental/prevenção & controle , Inibidores Enzimáticos/administração & dosagem , Inibidores Enzimáticos/uso terapêutico , Fosfotransferases (Aceptor do Grupo Álcool)/antagonistas & inibidores , Piridinas/administração & dosagem , Piridinas/uso terapêutico , Adamantano/administração & dosagem , Adamantano/farmacologia , Adamantano/uso terapêutico , Administração Oral , Animais , Tornozelo/patologia , Articulação do Tornozelo/efeitos dos fármacos , Articulação do Tornozelo/patologia , Artrite Experimental/patologia , Peso Corporal/efeitos dos fármacos , Quimioterapia Combinada , Edema/patologia , Inibidores Enzimáticos/farmacologia , Feminino , Pé/patologia , Indometacina/administração & dosagem , Indometacina/farmacologia , Indometacina/uso terapêutico , Inflamação/patologia , Metotrexato/administração & dosagem , Metotrexato/farmacologia , Metotrexato/uso terapêutico , Camundongos , Camundongos Endogâmicos DBA , Piridinas/farmacologia , Ratos , Ratos Endogâmicos Lew , Esplenomegalia/induzido quimicamente , Esplenomegalia/tratamento farmacológico , Esplenomegalia/patologia , Esplenomegalia/prevenção & controle , Microtomografia por Raio-XRESUMO
MRI provides diagnostic three-dimensional imaging and remains extremely important in the diagnosis and management of spinal trauma as well as other acute traumatic injuries, including those of the extremities. The American Society for Testing and Materials has created standards against which all implantable medical devices are tested to ensure safety in an MR environment. Most implantable passive orthopaedic devices can undergo MRI without consequence to the patient. However, the American Society for Testing and Materials has recently updated its terminology resulting in confusion among providers and institutions. Primary safety concerns are radiofrequency-induced heating and magnetically induced torque or displacement. These safety concerns have emerged as a recent source of debate, particularly regarding the imaging of patients with external fixation and cervical immobilization devices in place. Surveys have shown a lack of consensus among radiologists regarding this issue. Having an institutional protocol in place for the imaging of these patients streamlines the diagnosis and early stabilization of certain polytraumatized patients. The purpose of this review is to summarize the pertinent literature as well as the current industry recommendations regarding the safety of commonly used external fixation, cervical immobilization, and traction devices in the MR environment.
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Segurança de Equipamentos/normas , Imageamento por Ressonância Magnética/normas , Próteses e Implantes , Humanos , MetaisRESUMO
A principal challenge in creating accurate models of in situ scapulae is delineating bone from surrounding soft tissues. Computed tomography scans were obtained of both shoulders of 20 embalmed cadavers. Each shoulder was rescanned after repositioning of the cadavers to test for rescan reliability. After scans were complete, all scapulae were excised and stripped of all soft tissue. Thresholding, region growing, and manual processing were used to create computer-generated 3-dimensional (3D) models. Seven anatomic measurements were performed on each scapula and 3D model. Mean differences between corresponding measurements of specimen and model were small (<3 mm). Intraobserver and interobserver reliability for cadaveric measurements and rescan and interobserver reliability for model measurements were all excellent (R(2) = 0.99). Patient positioning was not a significant source of error in obtaining measurements from 3D models. Results from this work verify that accurate and reproducible 3D models can be created from in situ scapulae by use of effective segmentation.
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Imageamento Tridimensional , Modelos Biológicos , Escápula/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Ombro/diagnóstico por imagemRESUMO
MSK MR imaging applications are making the transition rapidly from 1.5T to 3T. Initial experience in the knee suggests that the higher SNR provides technical improvement in routine clinical imaging with the potential for greater accuracy in the diagnosis of articular cartilage injury. Similarly, initial experience with 3T MR imaging in the evaluation of the hip and small joints of the hand and wrist has been positive. In other joints, clinical development has been limited by the lack of availability of dedicated surface coils, and sensitivity of 3TMR imaging to artifact. The clinical impact of this technology remains uncertain because no published controlled clinical trial has evaluated the impact of 3T MR imaging on diagnostic outcomes. In addition to clinical application, 3T MR imaging has an important role for furthering translational research in MSK diseases through the development of new molecular and functional MR imaging techniques.
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Imageamento por Ressonância Magnética/tendências , Doenças Musculoesqueléticas/diagnóstico , Artefatos , Previsões , Humanos , Aumento da Imagem/métodos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética/métodos , Próteses e ImplantesRESUMO
Appropriate imaging modalities for the follow-up of malignant or aggressive musculoskeletal tumors include radiography, MRI, CT, (18)F-2-fluoro-2-deoxy-D-glucose PET/CT, (99m)Tc bone scan, and ultrasound. Clinical scenarios reviewed include evaluation for metastatic disease to the lung in low- and high-risk patients, for osseous metastatic disease in asymptomatic and symptomatic patients, for local recurrence of osseous tumors with and without significant hardware present, and for local recurrence of soft tissue tumors. The timing for follow-up of pulmonary metastasis surveillance is also reviewed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Assistência ao Convalescente/normas , Diagnóstico por Imagem/normas , Oncologia/normas , Doenças Musculoesqueléticas/diagnóstico por imagem , Neoplasias/diagnóstico por imagem , Radiologia/normas , Seguimentos , Humanos , Doenças Musculoesqueléticas/terapia , Neoplasias/terapia , Avaliação de Resultados em Cuidados de Saúde/normas , Prognóstico , Sociedades Médicas/normas , Resultado do Tratamento , Estados UnidosRESUMO
Acute ankle injuries are frequently diagnosed and treated in emergency departments and outpatient clinics. Recent evidence-based clinical treatment guidelines and systematic review of economic analyses support the use of 3-view (anteroposterior, lateral, and mortise) radiographic evaluation of patients meeting the criteria of the Ottawa ankle rules. Cross-sectional imaging has a limited secondary role primarily as a tool for preoperative planning and as a problem-solving technique in patients with persistent symptoms and suspected of having occult fractures. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Fraturas do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/diagnóstico por imagem , Guias de Prática Clínica como Assunto , Radiografia/normas , Radiologia/normas , Medicina Baseada em Evidências , Humanos , Estados UnidosRESUMO
More than 500,000 visits to the emergency room occur annually in the United States, for acute knee trauma. Many of these are twisting injuries in young patients who can walk and bear weight, and emergent radiographs are not required. Several clinical decision rules have been devised that can considerably reduce the number of radiographs ordered without missing a clinically significant fracture. Although a fracture is seen on only 5% of emergency department knee radiographs, 86% of knee fractures result from blunt trauma. In patients with a fall or twisting injury who have focal tenderness, effusion, or inability to bear weight, radiographs should be the first imaging study obtained. If the radiograph shows no fracture, MRI is best for evaluating for a suspected meniscus or ligament tear, or the injuries from a reduced patellar dislocation. Patients with a knee dislocation should undergo radiographs and an MRI, as well as an angiographic study such as a fluoroscopic, CT, or MR angiogram. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures, by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Diagnóstico por Imagem/estatística & dados numéricos , Diagnóstico por Imagem/normas , Traumatismos do Joelho/diagnóstico , Guias de Prática Clínica como Assunto/normas , Doença Aguda , Adolescente , Adulto , Fatores Etários , Criança , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Traumatismos do Joelho/terapia , Imageamento por Ressonância Magnética/normas , Imageamento por Ressonância Magnética/estatística & dados numéricos , Masculino , Doses de Radiação , Proteção Radiológica , Medição de Risco , Sociedades Médicas/normas , Tomografia Computadorizada por Raios X/normas , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ultrassonografia Doppler/estatística & dados numéricos , Estados UnidosRESUMO
This ACR Appropriateness Criteria article offers imaging triage guidance for several variants of patients presenting with acute foot trauma. Patients meeting inclusion criteria for the Ottawa Rules should undergo a 3-view radiographic series. Diabetic patients with peripheral neuropathy should undergo radiography, even though they do not meet the Ottawa Rules inclusion criteria. Patients with suspected midfoot and/or Lisfranc injury should undergo 3-view radiographs with weight bearing on at least the anterior-posterior view. Patients with suspected Lisfranc injury and normal radiographs should be considered for MRI and CT on a case-by-case basis. MRI or ultrasound could confirm cases of suspected acute tendon rupture. Radiography is the initial imaging modality for suspected plantar plate injury after metatarsal-phalangeal joint injury. Weight-bearing anterior-posterior, lateral, and sesamoid axial views may detect proximal migration of the hallux sesamoids. Ultrasound or MRI can directly evaluate the capsuloligamentous complex, specifically the plantar plate. Radiography can detect radiopaque penetrating foreign bodies, and ultrasound can be helpful in detecting those that are nonradiopaque. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures, by the panel. In instances in which evidence is lacking or is not definitive, expert opinion may be used to recommend imaging and treatment.
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Diagnóstico por Imagem/normas , Traumatismos do Pé/diagnóstico , Radiologia/normas , Doença Aguda , Humanos , Guias de Prática Clínica como Assunto , Estados UnidosRESUMO
Current undergraduate medical school curricular trends focus on both vertical integration of clinical knowledge into the traditionally basic science-dedicated curricula and increasing basic science education in the clinical years. This latter type of integration is more difficult and less reported on than the former. Here, we present an outline of a course wherein the primary learning and teaching objective is to integrate basic science anatomy knowledge with clinical education. The course was developed through collaboration by a multi-specialist course development team (composed of both basic scientists and physicians) and was founded in current adult learning theories. The course was designed to be widely applicable to multiple future specialties, using current published reports regarding the topics and clinical care areas relying heavily on anatomical knowledge regardless of specialist focus. To this end, the course focuses on the role of anatomy in the diagnosis and treatment of frequently encountered musculoskeletal conditions. Our iterative implementation and action research approach to this course development has yielded a curricular template for anatomy integration into clinical years. Key components for successful implementation of these types of courses, including content topic sequence, the faculty development team, learning approaches, and hidden curricula, were developed. We also report preliminary feedback from course stakeholders and lessons learned through the process. The purpose of this report is to enhance the current literature regarding basic science integration in the clinical years of medical school.
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Anatomia/educação , Educação de Graduação em Medicina/métodos , Sistema Musculoesquelético/anatomia & histologia , Competência Clínica , Currículo , Dissecação , Humanos , Exame FísicoRESUMO
Substantial cost, morbidity, and mortality are associated with acute proximal femoral fracture and may be reduced through an optimized diagnostic imaging workup. Radiography represents the primary diagnostic test of choice for the evaluation of acute hip pain. In middle aged and elderly patients with negative radiographs, the evidence indicates MRI to be the next diagnostic imaging study to exclude a proximal femoral fracture. CT, because of its relative decreased sensitivity, is only indicated in patients with MRI contraindications. Bone densitometry (DXA) should be obtained in patients with fragility fractures. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.