Talar Fractures and Dislocations: A Radiologist's Guide to Timely Diagnosis and Classification.

The talus, the second largest tarsal bone, has distinctive imaging characteristics and injury patterns. The predominantly extraosseous vascular supply of the talus predisposes it to significant injury in the setting of trauma. In addition, the lack of muscular attachments and absence of a secondary blood supply can lead to subsequent osteonecrosis. Although talar fractures account for less than 1% of all fractures, they commonly result from high-energy trauma and may lead to complications and long-term morbidity if not recognized and managed appropriately. While initial evaluation is with foot and ankle radiographs, computed tomography (CT) is often performed to evaluate the extent of the fracture, displacement, comminution, intra-articular extension, and associated injuries. Talar fractures are divided by anatomic region: head, neck, and body. Talar head fractures can be treated conservatively if nondisplaced, warranting careful radiographic and CT evaluation to assess rotation, displacement, and extension into the neck. The modified Hawkins-Canale classification of talar neck fractures is most commonly used due to its simplicity, usefulness in guiding treatment, and prognostic value, as it correlates associated malalignment with risk of subsequent osteonecrosis. Isolated talar body fractures may be more common than previously thought. The Sneppen classification further divides talar body fractures into osteochondral talar dome, lateral and posterior process, and shear and crush comminuted central body fractures. Crush comminuted central body fractures carry a poor prognosis due to nonanatomic reduction, bone loss, and subsequent osteonecrosis. Lateral process fractures can be radiographically occult and require a higher index of suspicion for successful diagnosis. Subtalar dislocations are often accompanied by fractures, necessitating postreduction CT. Familiarity with the unique talar anatomy and injury patterns is essential for radiologists to facilitate appropriate and timely management.

Ambulatory ECG-based T-wave alternans predicts sudden cardiac death in high-risk post-MI patients with left ventricular dysfunction in the EPHESUS study.

BACKGROUND: Exercise microvolt T-wave alternans (TWA) identifies sudden cardiac death (SCD) risk. TWA can be measured from ambulatory ECGs (AECGs) using modified moving average (MMA) method. Whether MMA TWA from AECGs predicts SCD in post-MI patients with left ventricular dysfunction (LVD) is unknown. METHODS: EPHESUS enrolled hospitalized post-MI patients with heart failure and/or diabetes with LVD. Before randomization to drug treatment, AECGs were obtained in 493 patients. Of them, 46 died of cardiovascular causes, including 18 of SCD. Patients alive at end of follow-up (N = 92) were matched with 46 nonsurvivors based on age, gender, and diabetes. MMA TWA was analyzed using MARSPC system (GE Healthcare, Milwaukee, WI, USA). The three highest TWA values from artifact-free periods were averaged for AECG channels corresponding to leads V(1) and V(3). SCD prediction was tested with a prespecified 47 microV cutpoint and at a cutpoint maximizing the separation between SCD patients versus survivors or non-SCD. RESULTS: TWA in either lead was higher for patients with SCD (P < or = 0.05) versus survivors or non-SCD. TWA > or = 47 microV was associated with RR = 5.2 (95%CI = 1.8-13.6, P = 0.002) in V(1) and RR = 5.5 (95% CI = 2.2-13.8, P < 0.001) in V(3) for SCD. The optimal cutpoint for TWA in V(1) was > or = 43 microV (RR = 5.9 [95%CI = 2.2-15.8, P < 0.001]). The optimal cutpoint in V(3) was > or = 47 microV. TWA greater than the optimal cutpoint in either lead was associated with RR = 7.1 (95%CI = 2.7-18.3, P < 0.001) for SCD, with 11 out of 18 patients dying of SCD. CONCLUSIONS: AECG-based TWA measured with MMA is a powerful predictor of SCD in high-risk post-MI patients with LV dysfunction.

Characteristics of Federal Political Contributions of Self-Identified Radiologists Across the United States.

PURPOSE: As federal legislation increasingly influences health care delivery, the impact of election funding has grown. We aimed to characterize US radiologist federal political contributions over recent years. METHODS: After obtaining 2003 to 2016 finance data from the Federal Election Commission (FEC), we extracted contribution data for all self-identified radiologists. Contributions were classified by recipient group and FEC-designated political party and then analyzed temporally and geographically, in aggregate, and by individual radiologist. RESULTS: Between 2003 and 2016, the FEC reported 35,408,584 political contributions. Of these, 36,474 (totaling $16,255,099) were from 7,515 unique self-identified radiologists. Total annual radiologist contributions ranged from $480,565 in 2005 to $1,867,120 in 2012. On average, 1,697 radiologists made political contributions each year (range 903 in 2005 to 2,496 in 2016). On average, contributing radiologists gave $2,163 ± $4,053 (range $10-$121,836) over this time, but amounts varied considerably by state (range $865 in Utah to $4,325 in Arkansas). Of all radiologist dollars, 76.3% were nonpartisan, with only 14.8% to Republicans, 8.5% to Democrats, and 0.4% to others. Most radiologist dollars went to political action committees (PACs) rather than candidates (74.6% versus 25.4%). Those PAC dollars were overwhelmingly (92.5%) directed to the Radiology Political Action Committee (RADPAC), which saw self-identified radiologist contributions grow from $351,251 in 2003 to $1,113,966 in 2016. CONCLUSION: Radiologist federal political contributions have increased over 3-fold in recent years. That growth overwhelmingly represents contributions to RADPAC. Despite national political polarization, the overwhelming majority of radiologist political contributions are specialty-focused and nonpartisan.