Musculoskeletal steroid injections in pregnancy: a review.

Pregnant women experience a wide range of musculoskeletal pain disorders, which include general ailments occurring during pregnancy, exacerbation of pre-existing conditions, or pregnancy-specific pain/inflammatory conditions. There are significant concerns and knowledge gaps surrounding the safety, dosage, and potential long-term effects of several drugs used during pregnancy. Our article reviews the use of focal steroid injections during pregnancy. A mixture of case studies, meta-analyses, and randomised controlled trials have shown at least there is no adverse side effect to the mother or baby from maternal use of non-systemic injection during pregnancy and a significant improvement in symptoms of pain or paraesthesia can be achieved in patients that do not respond to more conservative measures. As with all patients, the use of steroid injection should be judged on a case-by-case basis to ensure that it is the most appropriate treatment choice. However, being pregnant should not be considered a contraindication to a single dose of non-systemic steroid administration, as these women can achieve significant symptomatic relief that reduces reliance on systemic medication and can significantly improve their quality of life.

Artificial Intelligence Tool for Assessment of Indeterminate Pulmonary Nodules Detected with CT.

Background Limited data are available regarding whether computer-aided diagnosis (CAD) improves assessment of malignancy risk in indeterminate pulmonary nodules (IPNs). Purpose To evaluate the effect of an artificial intelligence-based CAD tool on clinician IPN diagnostic performance and agreement for both malignancy risk categories and management recommendations. Materials and Methods This was a retrospective multireader multicase study performed in June and July 2020 on chest CT studies of IPNs. Readers used only CT imaging data and provided an estimate of malignancy risk and a management recommendation for each case without and with CAD. The effect of CAD on average reader diagnostic performance was assessed using the Obuchowski-Rockette and Dorfman-Berbaum-Metz method to calculate estimates of area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Multirater Fleiss κ statistics were used to measure interobserver agreement for malignancy risk and management recommendations. Results A total of 300 chest CT scans of IPNs with maximal diameters of 5-30 mm (50.0% malignant) were reviewed by 12 readers (six radiologists, six pulmonologists) (patient median age, 65 years; IQR, 59-71 years; 164 [55%] men). Readers' average AUC improved from 0.82 to 0.89 with CAD (P < .001). At malignancy risk thresholds of 5% and 65%, use of CAD improved average sensitivity from 94.1% to 97.9% (P = .01) and from 52.6% to 63.1% (P < .001), respectively. Average reader specificity improved from 37.4% to 42.3% (P = .03) and from 87.3% to 89.9% (P = .05), respectively. Reader interobserver agreement improved with CAD for both the less than 5% (Fleiss κ, 0.50 vs 0.71; P < .001) and more than 65% (Fleiss κ, 0.54 vs 0.71; P < .001) malignancy risk categories. Overall reader interobserver agreement for management recommendation categories (no action, CT surveillance, diagnostic procedure) also improved with CAD (Fleiss κ, 0.44 vs 0.52; P = .001). Conclusion Use of computer-aided diagnosis improved estimation of indeterminate pulmonary nodule malignancy risk on chest CT scans and improved interobserver agreement for both risk stratification and management recommendations. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Yanagawa in this issue.

Primary peritoneal mucinous cystadenocarcinoma mimicking possible recurrent ovarian mucinous cystadenoma: coincidental pathology or a spectrum of disease?

We present the case of a 32-year-old woman with a previous surgical history of benign mucinous cystadenoma resected in 2012 who underwent magnetic resonance cholangiopancreatography following her second pregnancy in 2020. This demonstrated a large cystic mass in the left subdiaphragmatic space. Histopathology confirmed a well-differentiated primary peritoneal mucinous cystadenocarcinoma displaying cells of a Mullerian origin. We subsequently discuss the aetiology of these conditions separately and explore the possibility of a connection between the two regarding origin or potential malignant transformation that may otherwise have occurred coincidentally in this young patient. We also acknowledge a paucity of evidence regarding subsequent management strategies.

Ultrasound features of sole of foot pathology: a review.

Foot pain is a common problem among adults, with approximately 19% of men and 25% of women describing significant daily foot pain that limits their ability to function. Older adults, the obese, and active adults participating in sports involving running and jumping are at increased risk of developing pathology. Problems affecting the sole of the foot are often the cause of pain. Ultrasound is an extremely useful method of quickly and accurately localizing and characterizing pathology of the foot. The wide availability of ultrasound combined with its low cost, lack of ionizing radiation, high spatial resolution, multiplanar capability and excellent patient tolerance makes it an ideal technique for assessing the superficial structures in the sole of the foot. Ultrasound has the advantage of dynamic assessment over other imaging modalities. Furthermore, Doppler interrogation allows a real-time assessment of vascularity, not possible using other techniques. The ability to perform extended field of view images allows improved image presentation, which has increased clinicians' acceptance of the technique. Finally, ultrasound can be used to guide interventional procedures. This review article will consider the ultrasound features of pathology commonly affecting the sole of the foot, and will describe MRI correlates that can be expected.Foot pain is a common problem among adults, with approximately 19% of men and 25% of women describing significant daily foot pain that limits their ability to function. Older adults, the obese, and active adults participating in sports involving running and jumping are at increased risk of developing pathology. Problems affecting the sole of the foot are often the cause of pain. Ultrasound is an extremely useful method of quickly and accurately localizing and characterizing pathology of the foot. The wide availability of ultrasound combined with its low cost, lack of ionizing radiation, high spatial resolution, multiplanar capability and excellent patient tolerance makes it an ideal technique for assessing the superficial structures in the sole of the foot. Ultrasound has the advantage of dynamic assessment over other imaging modalities. Furthermore, Doppler interrogation allows a real-time assessment of vascularity, not possible using other techniques. The ability to perform extended field of view images allows improved image presentation, which has increased clinicians' acceptance of the technique. Finally, ultrasound can be used to guide interventional procedures. This review article will consider the ultrasound features of pathology commonly affecting the sole of the foot, and will describe MRI correlates that can be expected.