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Purpose: The impact of GH/IGF-1 levels on skeletal muscle in acromegaly is still controversial. Temporal (TMT) and masseter muscle (MMT) thickness has been recently demonstrated as a reliable measure of muscle mass. We aimed to investigate the relationship between TMT, MMT and clinical/biochemical characteristics in patients with acromegaly., Methods: Single center retrospective longitudinal study including 69 patients with at least one available brain/sella turcica MRI and matched clinical data. TMT, MMT, and muscle fatty infiltration (modified Goutallier score) were evaluated in all patients at baseline (first available MRI) and over time (182 MRIs analyzed)., Results: At baseline, both TMT and MMT were higher in males than females (p = 0.001 and p = 0.016, respectively). TMT and MMT were positively associated (β 0.508, p < 0.001), and they were positively correlated with IGF-1 xULN (TMT, p = 0.047; MMT, p = 0.001). MMT had a positive correlation with patients' weight (p = 0.015) and height (p = 0.006). No correlation was found between TMT, MMT and the presence of hypogonadism. Considering all available MRIs, sex and IGF-1 xULN were significant determinants of TMT and MMT at multivariable analysis (female sex: β -0.345/-0.426, p < 0.001; IGF-1 xULN: β 0.257/0.328, p < 0.001). At longitudinal evaluation, uncontrolled patients at baseline showed a significant reduction of MMT over time (p = 0.044). Remarkable fatty infiltration was observed in 34-37% of MRIs; age was the main determinant (temporal muscle: OR 1.665; p = 0.013; masseter muscle: OR 1.793; p = 0.009)., Conclusion: Male patients with higher IGF-1 values have thicker temporal and masseter muscles, suggesting that sex and IGF-1 have a significant impact on muscle mass in acromegaly., (© 2024. The Author(s).)

Context: Patients with acromegaly are characterized by chronic exposure to high growth hormone (GH) and insulin-like growth factor-1 levels, known for their anabolic effect on skeletal muscle. Therefore, an increased skeletal muscle mass could be hypothesized in these individuals. Herein, we have performed a systematic revision of published evidence regarding skeletal muscle mass, quality, and performance in patients with acromegaly., Evidence Acquisition: A systematic review of the literature in the PubMed database up to September 1, 2023, was conducted with the following query: acromegaly AND ("muscle mass" OR "skeletal muscle"). We excluded studies that did not compare different disease states or used nonradiological methods for the skeletal muscle analyses, except for bioelectrical impedance analysis., Evidence Synthesis: Fifteen studies met the inclusion criteria. A total of 360 patients were evaluated for skeletal muscle mass, 122 for muscle fatty atrophy, and 192 for muscle performance. No clear evidence of increased skeletal muscle mass in patients with active disease compared to control or healthy individuals emerged. As for skeletal muscle quality, we observed a trend toward higher fatty infiltration among patients with acromegaly compared to healthy participants. Likewise, patients with active disease showed consistently worse physical performance compared to control or healthy individuals., Conclusion: Skeletal muscle in acromegaly has lower quality and performance compared to that of healthy individuals. The small number of published studies and multiple confounding factors (eg, use of different radiological techniques) contributed to mixed results, especially regarding skeletal muscle mass. Well-designed prospective studies are needed to investigate skeletal muscle mass in patients with acromegaly., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Background: Hospitalized patients with coronavirus disease 2019 (COVID-19) can be classified into different clinical phenotypes based on their demographic, clinical, radiology, and laboratory features. We aimed to validate in an external cohort of hospitalized COVID-19 patients the prognostic value of a previously described phenotyping system (FEN-COVID-19) and to assess the reproducibility of phenotypes development as a secondary analysis., Methods: Patients were classified in phenotypes A, B or C according to the severity of oxygenation impairment, inflammatory response, hemodynamic and laboratory tests according to the FEN-COVID-19 method., Results: Overall, 992 patients were included in the study, and 181 (18%), 757 (76%) and 54 (6%) of them were assigned to the FEN-COVID-19 phenotypes A, B, and C, respectively. An association with mortality was observed for phenotype C vs. A (hazard ratio [HR] 3.10, 95% confidence interval [CI] 1.81-5.30, p  < 0.001) and for phenotype C vs. B (HR 2.20, 95% CI 1.50-3.23, p  < 0.001). A non-statistically significant trend towards higher mortality was also observed for phenotype B vs. A (HR 1.41; 95% CI 0.92-2.15, p  = 0.115). By means of cluster analysis, three different phenotypes were also identified in our cohort, with an overall similar gradient in terms of prognostic impact to that observed when patients were assigned to FEN-COVID-19 phenotypes., Conclusions: The prognostic impact of FEN-COVID-19 phenotypes was confirmed in our external cohort, although with less difference in mortality between phenotypes A and B than in the original study.

Objectives: Ankle sprains represent the second most common cause of emergency department access for musculoskeletal injury and lateral ankle ligament complex tears account for 850,000 cases annually in the United States with a relapse rate of 70%. Clinical examination is limited due to its subjectivity and the difficulty of identifying a specific involvement of the ligament; therefore, US and MRI are frequently requested. Therefore, the goal of this study is to analyze the available literature on the use of ultrasound (US) and magnetic resonance imaging (MRI) to diagnose injuries to the anterior talofibular ligament (ATFL) with a meta-analytic approach., Methods: According to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, all studies regarding the diagnostic accuracy of ultrasound and magnetic resonance imaging ATFL injuries were searched and assessed. The data were obtained from two independent reviewers with 12 and 3 years of experience in meta-analysis. A QUADAS-2 (Quality Assessment of Studies of Diagnostic Accuracy Studies) checklist was carried out to assess the risk of biases. From the selected studies, the sensitivity, specificity, and accuracy data were extracted., Results: Nine studies were included. The results of the meta-analysis demonstrate a greater sensitivity for ultrasound [96.88 (95% CI: 94-99) (fixed effects); 97 (95% CI: 94-99) (random effects)] compared to MRI [88.50 (95% CI: 85-91) (fixed effects); 86.98 (95% CI: 77-94) (random effects)], p < 0.05. The result of this meta-analysis shows that the less expensive diagnostic technique is also the most sensitive for the diagnosis of ATFL tears. Ultrasound articles resulted to have non-heterogeneity [( p = 0.2816; I° = 21.4607%)]., Conclusion: This meta-analysis demonstrates that US appears to be a highly sensitive diagnostic technique for diagnosing tears of the ATFL. Compared to MRI, the sensitivity of US result was higher.

Background: Chest CT on coronavirus disease (COVID-19) has been extensively investigated. Acute kidney injury (AKI) has been widely described among COVID patients, but the role of kidney imaging has been poorly explored. The aim of this study is to clarify the role of opportunistic kidney assessment on non-enhanced chest CT., Methods: We collected data on patients with COVID-19 consecutively admitted to our institution who underwent chest CT (including the upper parts of kidneys as per protocol). Three ROIs of 0.5-0.7 cm 2 were positioned in every kidney. The values of renal parenchyma attenuation (RPA) and the presence of perirenal fat stranding (PFS) were analyzed. The primary and secondary outcomes were the occurrence of AKI and death., Results: 86 patients with COVID-19 and unenhanced chest CT were analyzed. The cohort was split into CT RPA quartiles. Patients with a CT RPA <24 HU were more likely to develop AKI when compared with other patients (χ 2 = 2.77, p = 0.014): at multivariate logistic regression analysis, being in the first quartile of CT RPA was independently associated with a four times higher risk of AKI (HR 4.56 [95% CI 1.27-16.44, p = 0.020). Within a mean 22 ± 15 days from admission, 32 patients died (37.2%). Patients with PFS were more likely to die as compared to patients without it (HR 3.90 [95% CI 1.12-13.48], p = 0.031)., Conclusions: Detection of low RPA values and of PFS in COVID-19 patients independently predicts, respectively, the occurrence of AKI and an increased risk for mortality. Therefore, opportunistic kidney assessment during chest CT could help physicians in defining diagnostic and therapeutic strategies.

Objective: To assess the reliability of the myeloma spine and bone damage score (MSBDS) across multiple readers with different levels of expertise and from different institutions. Methods: A reliability exercise, including 104 data sets of static images and complete CT examinations of patients affected by multiple myeloma (MM), was performed. A complementary imaging atlas provided detailed examples of the MSBDS scores, including low-risk and high-risk lesions. A total of 15 readers testing the MSBDS were evaluated. ICC estimates and their 95% confidence intervals were calculated based on mean rating (k = 15), absolute agreement, a two-way random-effects model and Cronbach's alpha. Results : Overall, the ICC correlation coefficient was 0.87 (95% confidence interval: 0.79-0.92), and the Cronbach's alpha was 0.93 (95% confidence interval: 0.94-0.97). Global inter- and intra-observer agreement among the 15 readers with scores below or equal to 6 points and scores above 6 points were 0.81 (95% C.I.: 0.72-0.86) and 0.94 (95% C.I.:0.91-0.98), respectively. Conclusion: We present a consensus-based semiquantitative scoring systems for CT in MM with a complementary CT imaging atlas including detailed examples of relevant scoring techniques. We found substantial agreement among readers with different levels of experience, thereby supporting the role of the MSBDS for possible large-scale applications. Significance and Innovations • Based on previous work and definitions of the MSBDS, we present real-life reliability data for quantitative bone damage assessment in multiple myeloma (MM) patients on CT. • In this study, reliability for the MSBDS, which was tested on 15 readers with different levels of expertise and from different institutions, was shown to be moderate to excellent. • The complementary CT imaging atlas is expected to enhance unified interpretations of the MSBDS between different professionals dealing with MM patients in their routine clinical practice.

Blockchain usage in healthcare, in radiology, in particular, is at its very early infancy. Only a few research applications have been tested, however, blockchain technology is widely known outside healthcare and widely adopted, especially in Finance, since 2009 at least. Learning by history, radiology is a potential ideal scenario to apply this technology. Blockchain could have the potential to increase radiological data value in both clinical and research settings for the patient digital record, radiological reports, privacy control, quantitative image analysis, cybersecurity, radiomics and artificial intelligence.Up-to-date experiences using blockchain in radiology are still limited, but radiologists should be aware of the emergence of this technology and follow its next developments. We present here the potentials of some applications of blockchain in radiology., (© 2022. The Author(s).)

Objective: Sarcopenia or low muscle mass is related to worse prognosis in cancer patients. We investigated whether muscle mass is related to bone damage on CT in patients with multiple myeloma (MM)., Methods: Approval from the institutional review board was obtained. N = 74 consecutive patients (mean age, 60.8 years ± 9.24 [standard deviation]; range, 36-89 years) for MM who underwent transplant were included. Sarcopenia cut-off points defined as skeletal muscle index (SMI) used were<41 cm 2 /m 2 . To assess bone damage in MM the MSBDS (myeloma spine and bone damage score) was used. One-way analysis of variance and the X 2 test were used. Kaplan-Meier analysis was performed to generate progression and survival curves according to SMI and MSBDS. The testing level was set at 0.05., Results: The median SMI was 47.1 ± 14.2 and according to SMI 18/74 (24%) had sarcopenia which was more prevalent in females (p.001). A strong and significant association between patients with low muscle mass and elevated bone damage (24/74, 32.4%) and patients with normal/non-low muscle mass low bone damage (30/74, 40.5%) was present. Multiple Logistic regression did not show any significant relationship or confounding influence among SMI and MSBDS regarding sex (p.127), cytogenetic status (p.457), staging (p.756) and relapse (.126). Neither SMI nor MSBDS resulted significantly related to overall survival as shown in Kaplan-Meier analysis., Conclusion: Sarcopenia and bone damage affected MM patients undergoing stem cell transplantation and are significantly associated., Advances in Knowledge: Quantitative measurement of sarcopenia and bone damage on CT resulted present in MM patients undergoing stem cell transplantation and are significantly associated.

Sarcopenia indicates a loss of skeletal muscle mass, a condition that leads to a decline in physical performance. In 2018, the European Working Group on Sarcopenia in Older People met to update the original definition of sarcopenia: New scientific and clinical insights were introduced to emphasize the importance of muscle strength loss as a prime indicator of probable sarcopenia. In addition, the skeletal muscle is not only the organ related to mobility, but it is recognized as a secondary secretory organ too, with endocrine functions influencing several systems and preserving health. In this perspective, radiology could have a major role in early detection of sarcopenia and guarantee improvement in its treatment in clinical practice. We present here an update of clinical knowledge about sarcopenia and advantages and limitations of radiological evaluation of sarcopenia focusing on major body composition imaging modalities such as dual-energy X-ray absorptiometry, CT, and MRI. In addition, we discuss controversial such as the lack of consensus or standardization, different measurement methods, and diagnostic radiological cutoff points. Sarcopenia evaluation with radiological methods could enhance the role of radiologist in performing studies with relevant impact on medical and social outcome, placing radiology at the pinnacle of quality in evidence-based practice with high-level studies., (© 2022. The Author(s).)

Objectives: To report final results of the MUSTT trial, which has been designed to independently compare magnetic resonance imaging (MRI) and ultrasound (US) for local recurrences of non-metastatic patients operated for malignant soft tissue tumors (STT)., Methods: Magnetic resonance imaging or ultrasound in soft tissue tumors (MUSTT) is a prospective monocentric study recruiting asymptomatic, non-metastatic patients operated on for localized soft tissue sarcomas between 2015 and April. Eligible patients had MRI and physician-performed ultrasound (US) with an independent interpretation of imaging. Outcome measures were compared using ROC analysis and the X 2 test. An analysis of all patients was performed on a per-follow-up event basis., Results: A total of n = 51 patients who met the inclusion criteria agreed to participate. Among them, n = 8 were lost to follow-up, n = 6 had US and MRI acquired after a time frame > 7 days and were therefore excluded. Complete data available for 37 patients with 232 MRI and 232 US scan were finally considered (men/women: 18/20; age range, 18-84 years). Recurrences within 5 years occurred in 10/37 patients (27%). ROC analysis comparing US and MRI showed an AUC with 95% confidence intervals of 0.909 (0.832 to 0.981) for US and 0.966 (0.939 to 0.989) for MRI with Prob > X 2 = 0., Conclusions: Each of these tests detected local recurrences with suitable accuracy. MRI did not result clearly superior to US in terms of diagnostic accuracy, but US showed some false positive or negative results.

Multiple myeloma is a plasma cell dyscrasia characterized by focal and non-focal bone lesions. Radiomic techniques extract morphological information from computerized tomography images and exploit them for stratification and risk prediction purposes. However, few papers so far have applied radiomics to multiple myeloma. A retrospective study approved by the institutional review board: n = 51 transplanted patients and n = 33 (64%) with focal lesion analyzed via an open-source toolbox that extracted 109 radiomics features. We also applied a dedicated tool for computing 24 features describing the whole skeleton asset. The redundancy reduction was realized via correlation and principal component analysis. Fuzzy clustering (FC) and Hough transform filtering (HTF) allowed for patient stratification, with effectiveness assessed by four skill scores. The highest sensitivity and critical success index (CSI) were obtained representing each patient, with 17 focal features selected via correlation with the 24 features describing the overall skeletal asset. These scores were higher than the ones associated with a standard cytogenetic classification. The Mann-Whitney U-test showed that three among the 17 imaging descriptors passed the null hypothesis. This AI-based interpretation of radiomics features stratified relapsed and non-relapsed MM patients, showing some potentiality for the determination of the prognostic image-based biomarkers in disease follow-up.

Background and objectives : In order to increase the accuracy of lytic lesion detection in multiple myeloma, a dedicated second-opinion interpretation of medical images performed by subspecialty musculoskeletal radiologists could increase accuracy. Therefore, the purpose of this study is to evaluate the added value (increased accuracy) of subspecialty second-opinion (SSO) consultations for Computed Tomography (CT) examinations in Multiple Myeloma (MM) patients undergoing stem cell transplantation on standard computed tomography with a focus on focal lesion detection. Materials and Methods : Approval from the institutional review board was obtained. This retrospective study included 70 MM consecutive patients (mean age, 62 years ± 11.3 (standard deviation); range, 35-88 years) admitted in the last six years. Pre-transplant total-body CT (reported by general radiologists) was the only inclusion criteria. Each of these CT examinations had a second-opinion interpretation by two experienced subspecialty musculoskeletal (MSK) radiologists (13 years of experience and 6 years of experience, mean: 9.5 years), experts in musculoskeletal radiology and bone image interpretation with a focus on lytic lesions. Results : Per lesion intra- and inter-observer agreement between the two radiologists was calculated with K statistics and the results were good (K = 0.67: Confidence Inteval (CI) 95%: 0.61-0.78). When the initial CT reports were compared with the re-interpretation reports, 46 (65%) of the 70 cases (95% CI: 37-75%) had no discrepancy. There was a discrepancy in detecting a clinically unimportant abnormality in 10/70 (14%) patients (95% CI: 7-25%) unlikely to alter patient care or irrelevant to further clinical management. A discrepancy in interpreting a clinically important abnormality was registered in 14/70 (21%) patients for focal lesions. The mean diameter of focal lesions was: 23 mm (95% CI: 5-57 mm). The mean number of focal lesions per patient was 3.4 (95% CI). Conclusions : subspecialty second-opinion consultations in multiple myeloma CT is more accurate to identify lesions, especially lytic lesions, amenable to influence patients' care.

The peripheral nervous system is increasingly being investigated using medical imaging as a complement or in association with electrodiagnostics tests. The application of imaging techniques, such as ultrasound (US) and magnetic resonance imaging (MRI), allows detailed visualization of the peripheral nervous system. According to the European Society of Musculoskeletal Radiology, the use of US for nerve evaluation is strongly encouraged. In addition, the role of US is further enhanced by the wide application of US-guided techniques to diagnose or to treat peripheral nerve disorders.Standard evaluation of peripheral nerves on US usually relies on cross-sectional area evaluation with different cutoff values in the osteofibrous tunnels and outside them. In several anatomical areas, side-to-side comparison is highly recommended because it helps distinguish subtle variations by using the unaffected limb as an internal control.US is widely used to perform US-guided interventional procedures on peripheral nerves. The recent development of radiomics and machine and deep learning applied to peripheral nerves may reveal new insights beyond the capabilities of the human eye. Radiomics may have a role in expanding the diagnostic capabilities of US and MRI in the study of peripheral nerve pathology, especially when the cross-sectional area is not markedly increased., Competing Interests: None declared., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Background: Although image-guided interventional procedures of the elbow and wrist are routinely performed, there is poor evidence in the literature concerning such treatments. Our aim was to perform a Delphi-based consensus on published evidence on image-guided interventional procedures around the elbow and wrist and provide clinical indications on this topic., Methods: A board of 45 experts in image-guided interventional musculoskeletal procedures from the European Society of Musculoskeletal Radiology were involved in this Delphi-based consensus study. All panelists reviewed and scored published papers on image-guided interventional procedures around the elbow and wrist updated to September 2018 according to the Oxford Centre for Evidence-based Medicine levels of evidence. Consensus on statements drafted by the panelists about clinical indications was considered as "strong" when more than 95% of panelists agreed and as "broad" if more than 80% agreed., Results: Eighteen statements were drafted, 12 about tendon procedures and 6 about intra-articular procedures. Only statement #15 reached the highest level of evidence (ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement). Seventeen statements received strong consensus (94%), while one received broad consensus (6%)., Conclusions: There is still poor evidence in published papers on image-guided interventional procedures around the elbow and wrist. A strong consensus has been achieved in 17/18 (94%) statements provided by the panel on clinical indications. Large prospective randomized trials are needed to better define the role of these procedures in clinical practice., Key Points: • The panel provided 18 evidence-based statements on clinical indications of image-guided interventional procedures around the elbow and wrist. • Only statement #15 reached the highest level of evidence: ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement. • Seventeen statements received strong consensus (94%), while broad consensus was obtained by 1 statement (6%).

Background: Image-guided interventional procedures of the nerves are commonly performed by physicians from different medical specialties, although there is a lack of clinical indications for these types of procedures. This Delphi-based consensus provided a list of indications on image-guided interventional procedures for nerves of the upper limb based on updated published evidence., Methods: An expert panel of 45 members of the Ultrasound and Interventional Subcommittees of the ESSR participated in this Delphi-based consensus study. After revision of the published papers on image-guided interventional procedures for nerves of the upper limb updated to September 2018, the experts drafted a list of statements according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus on statements regarding clinical indications was considered as strong when more than 95% of experts agreed, and broad if more than 80% agreed., Results: Ten statements were drafted on procedures for nerves of the upper limb. Only two statements reached the highest level of evidence (ultrasound guidance is a safe and effective method for brachial plexus block; ultrasound-guided non-surgical approaches are safe and effective methods to treat carpal tunnel syndrome in the short term, but there is sparse evidence on the mid- and long-term effectiveness of these interventions). Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%)., Conclusions: This Delphi-based consensus study reported poor evidence on image-guided interventional procedures for nerves of the upper limb. Sixty percent of statements on clinical indications provided by the expert board reached a strong consensus., Key Points: • An expert panel of the ESSR provided 10 evidence-based statements on clinical indications for image-guided interventional procedures for nerves of the upper limb • Two statements reached the highest level of evidence • Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%).

Objective: To assess the discriminative power of radiomics of peripheral nerves at 1.5T MRI, using common entrapment neuropathies of the upper limb as a model system of focal nerve injury., Materials and Methods: Radiomics was retrospectively done on peripheral nerve fascicles on T1-weighted 1.5T MRI of 40 patients with diagnosis of mild carpal (n = 25) and cubital tunnel (n = 15) syndrome and of 200 controls. Z-score normalization and Mann-Whitney U test were used to compare features of normal and pathological peripheral nerves. Receiver operating characteristic analysis was performed., Results: A total of n = 104 radiomics features were computed for each patient and control. Significant differences between normal and pathological median and ulnar nerves were found in n = 23/104 features (p < 0.001). According to features classification, n = 5/23 features were shape-based, n = 7/23 were first-order features, n = 11/23 features were classified as gray level run length matrix. Nine of the selected features showed an AUC higher that 0.7: minimum AUC of 0.74 (95% CI 0.61-0.89) for sum variance and maximum AUC of 0.90 (95% CI 0.82-0.99) for zone entropy., Conclusion: Features analysis demonstrated statistically significant differences between normal and pathological nerve. The results suggested that radiomics analysis could assess the median and ulnar nerve inner structure changes due to the loss of the fascicular pattern, intraneural edema, fibrosis or fascicular alterations in mild carpal tunnel and mild cubital tunnel syndromes even when the nerve cross-sectional area does not change.

Background: Image-guided interventional procedures around the shoulder are commonly performed in clinical practice, although evidence regarding their effectiveness is scarce. We report the results of a Delphi method review of evidence on literature published on image-guided interventional procedures around the shoulder with a list of clinical indications., Methods: Forty-five experts in image-guided musculoskeletal procedures from the ESSR participated in a consensus study using the Delphic method. Peer-reviewed papers regarding interventional procedures around the shoulder up to September 2018 were scored according to the Oxford Centre for Evidence-based Medicine levels of evidence. Statements on clinical indications were constructed. Consensus was considered as strong if more than 95% of experts agreed and as broad if more than 80% agreed., Results: A total of 20 statements were drafted, and 5 reached the highest level of evidence. There were 10 statements about tendon procedures, 6 about intra-articular procedures, and 4 about intrabursal injections. Strong consensus was obtained in 16 of them (80%), while 4 received broad consensus (20%)., Conclusions: Literature evidence on image-guided interventional procedures around the shoulder is limited. A strong consensus has been reached for 80% of statements. The ESSR recommends further research to potentially influence treatment options, patient outcomes, and social impact., Key Points: • Expert consensus produced a list of 20 evidence-based statements on clinical indications of image-guided interventional procedures around the shoulder. • The highest level of evidence was reached for five statements. • Strong consensus was obtained for 16 statements (80%), while 4 received broad consensus (20%).

Purpose: Focal pattern in multiple myeloma (MM) seems to be related to poorer survival and differentiation from diffuse to focal pattern on computed tomography (CT) has inter-reader variability. We postulated that a Radiomic approach could help radiologists in differentiating diffuse from focal patterns on CT., Methods: We retrospectively reviewed imaging data of 70 patients with MM with CT, PET-CT or MRI available before bone marrow transplant. Two general radiologist evaluated, in consensus, CT images to define a focal (at least one lytic lesion >5 mm in diameter) or a diffuse (lesions <5 mm, not osteoporosis) pattern. N = 104 Radiomics features were extracted and evaluated with an open source software., Results: The pathological group included: 22 diffuse and 39 focal patterns. After feature reduction, 9 features were different (p < 0.05) in the diffuse and focal patterns (n = 2/9 features were Shape-based: MajorAxisLength and Sphericity; n = 7/9 were Gray Level Run Length Matrix (Glrlm)). AUC of the Radiologists versus Reference Standard was 0.64 (95 % CI: (0.49-0.78) p = 0.20. AUC of the best 4 features (MajorAxisLength, Median, SizeZoneNonUniformity, ZoneEntropy) were: 0.73 (95 % CI: 0.58-0.88); 0.71 (95 % CI: 0.54-0.88); 0.79 (95 % CI: 0.66-0.92); 0.68 (95 % CI: 0.53-0.83) respectively., Conclusion: A Radiomics approach improves radiological evaluation of focal and diffuse pattern of MM on CT., (Copyright © 2019. Published by Elsevier B.V.)

Background To perform a radiomics analysis in local recurrence (LR) surveillance of limb soft tissue sarcoma (STS) Patients and methods This is a sub-study of a prospective multicenter study with Institutional Review Board approval supported by ESSR (European Society of Musculoskeletal Radiology). radiomics analysis was done on fast spin echo axial T1w, T2w fat saturated and post-contrast T1w (T1wGd) 1.5T MRI images of consecutively recruited patients between March 2016 and September 2018. Results N = 11 adult patients (6 men and 5 women; mean age 57.8 ± 17.8) underwent MRI to exclude STS LR: a total of 33 follow-up events were evaluated. A total of 198 data-sets per patients of both pathological and normal tissue were analyzed. Four radiomics features were significantly correlated to tumor size (p < 0.02) and four radiomics features were correlated with grading (p < 0.05). ROC analysis showed an AUC between 0.71 (95%CI: 0.55-0.87) for T1w and 0.96 (95%CI: 0.87-1.00) for post-contrast T1w. Conclusions radiomics features allow to differentiate normal tissue from pathological tissue in MRI surveillance of local recurrence of STS. radiomics in STS evaluation is useful not only for detection purposes but also for lesion characterization.

Background: To investigate whether quantitative radiomic features extracted from digital breast tomosynthesis (DBT) are associated with Ki-67 expression of breast cancer., Materials and Methods: This is a prospective ethically approved study of 70 women diagnosed with invasive breast cancer in 2018, including 40 low Ki-67 expression (Ki-67 proliferation index <14%) cases and 30 high Ki-67 expression (Ki-67 proliferation index ≥ 14%) cases. A set of 106 quantitative radiomic features, including morphological, grey/scale statistics, and texture features, were extracted from DBT images. After applying least absolute shrinkage and selection operator (LASSO) method to select the most predictive features set for the classifiers, low versus high Ki-67 expression was evaluated by the area under the curve (AUC) at receiver operating characteristic analysis. Correlation coefficient was calculated for the most significant features., Results: A combination of five features yielded AUC of up to 0.698. The five most predictive features (sphericity, autocorrelation, interquartile range, robust mean absolute deviation, and short-run high grey-level emphasis) showed a statistical significance (p ≤ 0.001) in the classification. Thirty-four features were significantly (p ≤ 0.001) correlated with Ki-67, and five of these had a correlation coefficient of > 0.5., Conclusion: The present study showed that quantitative radiomic imaging features of breast tumour extracted from DBT images are associated with breast cancer Ki-67 expression. Larger studies are needed in order to further evaluate these findings.

Objective: To evaluate inter- and intra-rater reliability of background parenchymal enhancement (BPE) assessment across breast MRI sequences., Materials and Methods: Institutional review board approval was obtained and the requirement for consent was waived. Three radiologists qualitatively categorized BPE on 150 breast MRI using a four-point scale (minimal, mild, moderate or marked) according to BI-RADS category system. According to MR-sequence used for the assessment of BPE, inter-rater and intra-rater reliability across a simulated reading strategy with four options was performed: (1) initial contrast-enhanced (CE) fat-suppressed T1-weighted images (2) initial CE subtracted images (3) maximum-intensity-projection (MIP) of the first CE subtracted images (4) combination of initial CE fat-suppressed T1-weighted, initial CE subtracted and MIP images. Raters repeated BPE assessment of 45 breast MRI four weeks after the initial assessment. Gwet's AC1 index with ordinal weights was used to assess reliabilities., Results: Gwet's index for the reliability among the three raters was 0.68 (0.63-0.74) using initial contrast-enhanced fat-suppressed T1 weighted images, 0.74 (0.69-0.80) using subtracted images, 0.80 (0.76-0.83) using MIP, 0.80 (0.77-0.84) using a combination of the initial contrast-enhanced fat-suppressed T1 weighted, initial contrast-enhanced subtracted and MIP images. Test-retest reliability was 0.81 (0.60-1.00) for rater 1, 0.77 (0.55-0.98) for rater 2, 0.79 (0.59-0.99) for rater 3 using the combination of initial contrast-enhanced fat-suppressed T1 weighted, initial contrast-enhanced subtracted and MIP images., Conclusions: Overall, the combination of all CE MRI images showed the highest reliability of BPE assessment. However, MIP showed a high reliability with lower reading time compared to the combination of all CE MRI images., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Nerve tumors are rare and heterogeneous soft tissue tumors arising from a peripheral nerve or showing nerve sheath differentiation. In a radiologic setting it is necessary to recognize soft tissue lesions that are of neural origin, their association with a peripheral nerve, and whether they are a true tumor or a so-called pseudotumor such as a neuroma, fibrolipoma, or peripheral nerve sheath ganglion. Ultrasound (US) and magnetic resonance imaging are the best modalities to characterize these lesions. US can be used to guide biopsy in difficult and uncertain cases when the lesion is either indeterminate or possibly malignant. At present, no single imaging feature or reproducible criteria, or a combination, can differentiate reliably between a neurofibroma and a schwannoma or discriminate with certainty between benign and malignant neurogenic tumors. Adequate imaging and consultation with a nerve tumors/sarcoma unit is advised., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Purpose: Sarcopenia has been considered a poor prognostic factor in various malignant diseases. However, the studies that evaluated the association between CT-determined sarcopenia and outcome in breast cancer patients reported different results. Therefore, the aim of the present study is to perform a systematic review of the current literature on the evaluation of body CT-determined sarcopenia in breast cancer patients, focusing on the correlation with outcome values., Methods: Two reviewers evaluated independently all studies dealing with CT-determined sarcopenia in breast cancer women from major medical libraries up to 24 April 2019. The keywords used for database searching were: "sarcopenia" or "muscles" or "muscle weight" or "body composition" and "breast neoplasms" or "breast cancer" and "computed tomography". Studies reporting clinical outcome values were finally compared., Results: Of the n = 191 studies identified, a total of n = 15 articles were included in the systematic review. In all studies, sarcopenia was assessed at the level of the third lumbar vertebra (L3) on CT; n = 14/15 studies were retrospective. N = 13/15 studies evaluated the impact of sarcopenia on clinical outcomes. Among these studies, n = 8/13 studies concluded that sarcopenia is an important risk factor for poor prognosis in breast cancer and n = 5/13 studies concluded that body composition changes are not associated with poor prognosis., Conclusions: Most studies concluded that sarcopenia assessed on CT is an important prognostic risk factor in breast cancer patients. High-quality prospective studies to strongly confirm and assess the impact of sarcopenia evaluated on CT and breast cancer outcome are needed., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: The purpose of this study was to evaluate the clinical contribution of wrist and hand sonography., Methods: This study was performed in a tertiary academic medical center. Institutional review board approval was obtained. Data collection was done retrospectively from January 2012 to December 2016 and prospectively from January 2017 to July 2017. The study included 112 consecutive patients (52 men and 60 women; mean age, 47 ± 16 years; range, 15-87 years). A total of 126 examinations were performed. All ultrasound examinations were done with high-resolution probes with up-to-date protocols. The clinical contribution of wrist and hand sonography was assessed (ultrasound examinations contributive/noncontributive). Descriptive statistic and nonparametric tests were used., Results: In 96 of 126 (76%) examinations, sonography proved to be contributive, and in 30 of 126 (24%) examinations, sonography proved to be noncontributive. The contributive/noncontributive ratio was 3.2 (96/30). A total of 51 of 126 (40%) examinations were performed in patients with a history of previous trauma. Sonography proved to be significantly more contributive in a posttraumatic setting (chi-square, 9.2; P = .0023)., Conclusion: Wrist and hand sonography significantly influences the diagnostic and therapeutic path, especially in a posttraumatic setting., (© 2018 by the American Institute of Ultrasound in Medicine.)

Objectives: To update the 2012 European Society of Musculoskeletal Radiology (ESSR) clinical consensus guidelines for musculoskeletal ultrasound referral in Europe., Methods: Twenty-one musculoskeletal imaging experts from the ESSR participated in a consensus study based on a Delphic process. Two independent (non-voting) authors facilitated the procedure and resolved doubtful issues. Updated musculoskeletal ultrasound literature up to July 2017 was scored for shoulder, elbow, wrist/hand, hip, knee, and ankle/foot. Scoring of ultrasound elastography was included. The strength of the recommendation and level of evidence was scored by consensus greater than 67% or considered uncertain when the consensus was consensus less than 67%., Results: A total of 123 new papers were reviewed. No evidence change was found regarding the shoulder. There were no new relevant articles for the shoulder, 10 new articles for the elbow, 28 for the hand/wrist, 3 for the hip, 7 for the knee, and 4 for the ankle/foot. Four new evidence levels of A were determined, one for the hip (gluteal tendons tears), one for the knee (meniscal cysts), one for the ankle (ankle joint instability), and one for the foot (plantar plate tear). There was no level A evidence for elastography, although for Achilles tendinopathy and lateral epicondylitis evidence level was B with grade 3 indication., Conclusions: Four new areas of level A evidence were included in the guidelines. Elastography did not reach level A evidence. Whilst ultrasound is of increasing importance in musculoskeletal medical practice, the evidence for elastography remains moderate., Key Points: • Evidence and expert consensus shows an increase of musculoskeletal ultrasound indications. • Four new A evidence levels were found for the hip, knee, ankle, and foot. • There was no level A evidence for elastography.

Introduction: In this study we evaluated the frequency and further assessment of extraneural findings encountered during peripheral nerve ultrasound (US)., Methods: Our retrospective review identified 278 peripheral nerve US examinations of 229 patients performed between December 2014 and December 2015. Reports were reviewed to assess the number of studies without peripheral nerve abnormalities and the frequency and further assessment of extraneural findings., Results: A total of 107 peripheral nerve US examinations of 90 patients (49 men and 41 women, mean age 55 ± 16 years) did not report peripheral nerve abnormalities. Extraneural findings were observed in 24 of 107 (22.4%) studies. Fifteen of the 278 [5.4% (95% confidence interval 2.7%-8.1%)] studies led to a recommendation for additional imaging or clinical evaluation of an extraneural finding., Discussion: At least 5.4% (15 of 278) of peripheral nerve US studies led to additional clinical or imaging assessment. Muscle Nerve 57: 65-69, 2018., (© 2017 Wiley Periodicals, Inc.)

Objective: To compare six strategies using digital breast tomosynthesis in women with mammographically negative dense breasts., Materials and Methods: This is a substudy of the 'ASTOUND' trial. 163 women who underwent tomosynthesis with synthetically reconstructed projection images (S-2D) inclusive of 13 (7.9%) cases diagnosed with breast cancer at histopathology after surgery were evaluated. Accuracy measures and screen-reading time of six reading strategies were assessed: (A) Single reading of S-2D alone, (B) single reading of tomosynthesis alone, (C) single reading of joint interpretation of tomosynthesis + S-2D, (D) double-reading of S-2D alone, (E) double reading of tomosynthesis alone, (F) double reading of joint interpretation of tomosynthesis + S-2D., Results: The median age of the patients was 53 years (range, 36-88 years). The highest global accuracy was obtained with double reading of tomosynthesis + S2D (F) with an AUC of 0.979 (p<0.001) and a mean reading time of 154 s versus 34 s for the fastest strategy (single reading of S-2D alone). The AUCs for the other five strategies did not differ from each other., Conclusion: Double reading of tomosynthesis+ S2D had the best accuracy of six screen-reading strategies although it had the longest reading time., Key Points: • Tomosynthesis acquisitions are progressively implemented with reconstructed synthesized 2D images • Double reading using S-2D plus tomosynthesis had the highest global accuracy (p<0.001). • Double reading of S-2D plus tomosynthesis increased reading time.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objectives: Our aim was to evaluate the quality of published guidelines on musculoskeletal ultrasound (MSK-US) for adults., Methods: Between June and July 2016, we conducted an online search for MSK-US guidelines, which were evaluated by four independent readers blinded to each other using the AGREE II tool. A fifth independent reviewer calculated scores per each domain and agreement between reviewers' scores using the intraclass correlation coefficient (ICC)., Results: Five guidelines were included in this appraisal. They were published between 2001 and 2014. Our appraisal showed intermediate results, with four out of five guidelines scoring "average" as overall quality. Domain 1 (scope and purpose) achieved the highest result (total score = 71.1% ± 18.7%). Domain 6 (editorial independence) had the lowest score (total score = 26.3% ± 19.3%). Interobserver agreement was very good for all the evaluated guidelines (ICC ranged between 0.932 and 0.956)., Conclusions: Overall, quality of MSK-US guidelines ranges from low to average when evaluated using the AGREE II tool. The editorial independence domain was the most critical, thus deserving more attention when developing future guidelines., Main Messages: • Four of five guidelines on MSK-US had an average quality level. • Scope/purpose had the highest score (71.1% ± 18.7%). • Editorial independence had the lowest score (26.3% ± 19.3%). • Interobserver agreement was very good (ranges: 0.932-0.956).

Objective: To assess the correlation between magnetic resonance and ultrasound findings and clinical outcome after intratendinous injection of leucocyte-rich platelet-rich plasma or adipose-derived stromal vascular fraction in patients with non-insertional Achilles tendinopathy., Materials and Methods: Forty-three patients (age: 47.8±5.1, range 29-55) with unilateral or bilateral non-insertional Achilles tendinopathy (58 tendons overall) were randomly assigned to platelet-rich plasma (22 patients, 28 tendons) or adipose-derived stromal vascular fraction (21 patients, 30 tendons) injection group. All patients underwent magnetic resonance (tendon cross-sectional area, signal intensity, maximum anteroposterior thickness were measured), ultrasound (maximum anteroposterior thickness, power Doppler signal, ultrasound gray scale echotexture were measured), and visual analogue scale (VAS) pain evaluation at baseline and at six months from treatment. Wilcoxon, intraclass correlation coefficient, repeated measure ANOVA tests were used., Results: There was a significant (P<0.001) decrease of mean VAS from pre-treatment (6.4±1.4) to six-month evaluation (1.8±1.7). Significant increase of tendon thickness measured using magnetic resonance (P=0.013) and ultrasound (P=0.012) and power Doppler signal (P=0.027) was seen. There was no significant difference between pre- and post-treatment cross sectional area, signal intensity, and echotexture (P>0.217). None of the pre-treatment parameters was a predictor of treatment outcome (P>0.104). There was an excellent agreement between tendon thickness measurement between magnetic resonance and ultrasound (intraclass correlation coefficient=0.986) CONCLUSIONS: Both treatments seem to allow for clinical benefit, associated to early slight increase of tendon size and power Doppler signal. Imaging cannot be used as a predictor of clinical outcome., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objectives: Dual energy X-ray absorptiometry (DXA) is the most widely used technique to measure bone mineral density (BMD). Appropriate and accurate use of DXA is of great importance, and several guidelines have been developed in the last years. Our aim was to evaluate the quality of published guidelines on DXA for adults., Methods: Between June and July 2016 we conducted an online search for DXA guidelines, which were evaluated by four independent readers blinded to each other using the AGREE II instrument. A fifth independent reviewer calculated scores per each domain and agreement between reviewers' scores., Results: Four out of 59 guidelines met inclusion criteria and were included. They were published between 2005 and 2014. Three out of four guidelines reached a high level of quality, having at least five domain scores higher than 60%. Domain 1 (Scope and Purpose) achieved the highest result (total score = 86.8 ± 3.7%). Domain 6 (Editorial Independence) had the lowest score (total score = 54.7 ± 12.5%). Interobserver agreement ranged from fair (0.230) to good (0.702)., Conclusions: Overall, the quality of DXA guidelines is satisfactory when evaluated using the AGREE II instrument. The Editorial Independence domain was the most critical, thus deserving more attention when developing future guidelines., Main Messages: • Three of four guidelines on DXA had a high quality level (>60%). • Scope/purpose had the highest score (86.8 ± 3.7%). • Editorial Independence had the lowest score (54.7 ± 12.5%). • Interobserver agreement ranged from fair (0.230) to good (0.702).

Introduction: We prospectively compared ultrasound (US) and MRI in patients with common fibular neuropathy., Methods: Forty adult patients with clinical suspicion of common fibular neuropathy and 40 healthy controls underwent both US and MRI. US and MRI datasets were randomized for prospective reading., Results: The overall sensitivity of US and MRI for diagnosing fibular neuropathy was 90% (95% confidence interval [CI], 79.7%-97.3%) and 87.5% (95% CI, 71.55%-93.1%), respectively. The overall specificity of US and MRI was 92% (95% CI, 77.45%-96.1%) and 85% (95% CI, 73.3%-94.4%), respectively. The overall sensitivity and specificity of US combined with MRI were 94% (95% CI, 0.80%-0.99%) and 84% (95% CI, 0.70%-0.91%), respectively. Overall intra- and inter-observer agreements among 3 readers were 0.76% (95% CI, 0.62%-0.85%) and 0.74% (95% CI, 0.65%-0.81%)., Conclusions: US diagnostic accuracy for common fibular neuropathy was slightly higher than that of MRI. Muscle Nerve 55: 849-857, 2017., (© 2016 Wiley Periodicals, Inc.)

Objective: To perform a systematic review of the methods used for background parenchymal enhancement (BPE) evaluation on breast MRI., Methods: Studies dealing with BPE assessment on breast MRI were retrieved from major medical libraries independently by four reviewers up to 6 October 2015. The keywords used for database searching are "background parenchymal enhancement", "parenchymal enhancement", "MRI" and "breast". The studies were included if qualitative and/or quantitative methods for BPE assessment were described., Results: Of the 420 studies identified, a total of 52 articles were included in the systematic review. 28 studies performed only a qualitative assessment of BPE, 13 studies performed only a quantitative assessment and 11 studies performed both qualitative and quantitative assessments. A wide heterogeneity was found in the MRI sequences and in the quantitative methods used for BPE assessment., Conclusion: A wide variability exists in the quantitative evaluation of BPE on breast MRI. More studies focused on a reliable and comparable method for quantitative BPE assessment are needed. Advances in knowledge: More studies focused on a quantitative BPE assessment are needed.

Aim: To develop a survey to help define the main problems in radiological clinical trials., Methods: Since 2006, we have managed seven different radiological clinical trials recruiting patients in academic and non-academic centres. We developed a preliminary questionnaire using a four-round Delphi approach to identify problems occurring in radiological clinical trials run at our centre. We investigated the recruitment experience, involvement of all multi-disciplinary team members and main obstacles to completing the projects. A final round of Delphi processes elucidated solutions to the identified problems., Results: Among 19/20 (95%) respondents, 10 (53%) were young physicians (under 35 years old), and the respondents included non-faculty members, fellows, residents, and undergraduate students. Ninety-four percent (18/19) of respondents showed interest in conducting clinical trials. On a scale of 1 to 10, the problems with higher/worse scores (8-9) were related to technical or communication problems. The most frequent problems across all studies were technical problems related to clinical trial equipment, insufficient willingness to participate, obstacles to understanding the design of electronic-case report form and extra work., Conclusion: The developed questionnaire identified the main recurring problems in radiological clinical trials as perceived by end-users and helped define possible solutions that are mostly related to having dedicated clinical trial research staff., Competing Interests: Conflict-of-interest statement: None declared.

This article is a practical review update on ultrasound (US)-guided interventional procedures on peripheral nerves. Technical considerations, biopsy techniques, and some examples of injections are described. US is considered a safe imaging guidance for interventional procedures, due to its high spatial resolution and the possibility to image the needle and inject drugs in real time. US-guided injections could be considered a diagnostic and therapeutic option in the most common neuropathy, before or as an alternative to surgery. US-guided injection techniques in patients with carpal tunnel syndrome, cubital tunnel syndrome, meralgia paresthetica, and Morton neuroma are reviewed. US-guided injections of the iliohypogastric, ilioinguinal, genitofemoral, and pudendal nerve are also illustrated. Knowledge of anatomy is crucial; therefore a brief description of the courses of anatomical nerves and clinical notes are also reported. Treatment of stump neuromas treatment was excluded., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Purpose: To estimate sensitivity and specificity of CESM for breast cancer diagnosis., Methods: Systematic review and meta-analysis of the accuracy of CESM in finding breast cancer in highly selected women. We estimated summary receiver operating characteristic curves, sensitivity and specificity according to quality criteria with QUADAS-2., Results: Six hundred four studies were retrieved, 8 of these reporting on 920 patients with 994 lesions, were eligible for inclusion. Estimated sensitivity from all studies was: 0.98 (95% CI: 0.96-1.00). Specificity was estimated from six studies reporting raw data: 0.58 (95% CI: 0.38-0.77). The majority of studies were scored as at high risk of bias due to the very selected populations., Conclusion: CESM has a high sensitivity but very low specificity. The source studies were based on highly selected case series and prone to selection bias. High-quality studies are required to assess the accuracy of CESM in unselected cases., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objectives: To evaluate breast findings incidentally detected on body MRI., Methods: A retrospective review of the institutional database identified 1752 body MRI performed between January 2015 and September 2015. MRI of women with breast tissue visible in the field-of-view were reviewed for breast findings. Breast findings were classified with the breast imaging reporting and data system (BI-RADS) lexicon. The standard statistic, costs of additional work-up, and the clinical relevance were used to describe breast findings, and we calculated 95 % exact confidence intervals (CIs)., Results: 440 body MRI of 440 women (mean age: 57 ± 20 years) included breast tissue in the field-of-view. A total of 41 breast findings were identified in 41 patients. Breast findings were classified BI-RADS 2 N = 25, BI-RADS 3 N = 13, BI-RADS 4 N = 3. A total of 3.6 % [95 % CI 1.6 %, 5.6 %] women with breast tissue visible on MRI had a recommendation for further imaging work-up for a breast finding. The 18.7 % (3 of 16) of these patients had a clinically important finding (breast cancer). Further imaging evaluation increased costs of €108.3 per patient with a breast finding., Conclusions: Clinically important breast findings could be detected on body MRI in up to 0.7 % (3 of 440) of women.

Purpose: Debate on adjunct screening in women with dense breasts has followed legislation requiring that women be informed about their mammographic density and related adjunct imaging. Ultrasound or tomosynthesis can detect breast cancer (BC) in mammography-negative dense breasts, but these modalities have not been directly compared in prospective trials. We conducted a trial of adjunct screening to compare, within the same participants, incremental BC detection by tomosynthesis and ultrasound in mammography-negative dense breasts., Patients and Methods: Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts is a prospective multicenter study recruiting asymptomatic women with mammography-negative screens and dense breasts. Eligible women had tomosynthesis and physician-performed ultrasound with independent interpretation of adjunct imaging. Outcome measures included cancer detection rate (CDR), number of false-positive (FP) recalls, and incremental CDR for each modality; these were compared using McNemar's test for paired binary data in a preplanned interim analysis., Results: Among 3,231 mammography-negative screening participants (median age, 51 years; interquartile range, 44 to 78 years) with dense breasts, 24 additional BCs were detected (23 invasive): 13 tomosynthesis-detected BCs (incremental CDR, 4.0 per 1,000 screens; 95% CI, 1.8 to 6.2) versus 23 ultrasound-detected BCs (incremental CDR, 7.1 per 1,000 screens; 95% CI, 4.2 to 10.0), P = .006. Incremental FP recall occurred in 107 participants (3.33%; 95% CI, 2.72% to 3.96%). FP recall (any testing) did not differ between tomosynthesis (FP = 53) and ultrasound (FP = 65), P = .26; FP recall (biopsy) also did not differ between tomosynthesis (FP = 22) and ultrasound (FP = 24), P = .86., Conclusion: The Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts' interim analysis shows that ultrasound has better incremental BC detection than tomosynthesis in mammography-negative dense breasts at a similar FP-recall rate. However, future application of adjunct screening should consider that tomosynthesis detected more than 50% of the additional BCs in these women and could potentially be the primary screening modality., (© 2016 by American Society of Clinical Oncology.)

Introduction: The aim of this study was to demonstrate single fascicular involvement in common fibular (CF) neuropathy using high-resolution ultrasound (US)., Methods: We prospectively enrolled 40 adult patients with clinical and electrodiagnostic suspected CF neuropathy between April 2012 and December 2014. Two musculoskeletal radiologists used high-resolution US probes to prospectively and independently evaluate the CF nerve bilaterally in these patients. The presence of single fascicular involvement (increased cross-sectional area and loss of fascicular echotexture) was recorded., Results: US revealed involvement of only 1 fascicular component of the CF nerve in 7 patients. In all these patients, US revealed involvement of the anterior fascicles corresponding to fibers for the deep fibular nerve., Conclusions: High-resolution US allowed identification of single fascicular involvement in CF neuropathy. Anterior fascicular involvement was present in up to 17% of patients with suspected CF neuropathy., (© 2016 Wiley Periodicals, Inc.)

Purpose: To quantitatively and qualitatively compare fat-suppressed MR imaging quality using iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) with that using frequency-selective fat-suppressed (FSFS) T2 images of the brachial plexus at 3.0 T., Materials and Methods: Prospective MR image analysis was performed in 40 volunteers and 40 patients at a single centre. Oblique-sagittal and coronal IDEAL fat-suppressed T2 images and FSFS T2 images were compared. Visual assessment was performed by two independent musculoskeletal radiologists with respect to: (1) susceptibility artefacts around the neck, (2) homogeneity of fat suppression, (3) image sharpness and (4) tissue resolution contrast of pathologies. The signal-to-noise ratios (SNR) for each image sequence were assessed., Results: Compared to FSFS sequences, IDEAL fat-suppressed T2 images significantly reduced artefacts around the brachial plexus and significantly improved homogeneous fat suppression (p < 0.05). IDEAL significantly improved sharpness and lesion-to-tissue contrast (p < 0.05). The mean SNRs were significantly improved on T2-weighted IDEAL images (p < 0.05)., Conclusion: IDEAL technique improved image quality by reducing artefacts around the brachial plexus while maintaining a high SNR and provided superior homogeneous fat suppression than FSFS sequences.

Objectives: To quantitatively evaluate and compare nerve density in patients with limited cutaneous systemic sclerosis (lcSSc) and control subjects using high-resolution ultrasound (US) with a computer-aided assessment., Methods: Forty patients and 40 age- and sex-matched control subjects were prospectively enrolled. Ultrasound (US) examination (17-5 MHz probe) of the median nerve at the elbow was performed bilaterally by one radiologist. A software quantified the ratio between the hypoechoic and hyperechoic areas of peripheral nerves on ultrasound. Two observers set the threshold in the images acquired, and three observers performed the digital analysis of nerve density. Statistical analysis included Mann-Whitney U-test of patients versus control subjects and subgroup analysis of symptomatic and non-symptomatic patients. Intra and inter-observer agreement of the three observers were assessed with the kappa statistic., Results: In all, 160 median nerves were evaluated. According to the US, nerve density was significantly reduced in lcSSc patients compared to control subjects (mean and standard deviation: 41 ± 3 vs 56 ± 4, p < 0.01). Subgroup analysis showed that symptomatic patients (n = 15) had reduced nerve density compared to non-symptomatic (n = 25) patients (39 ± 5 vs 43 ± 4, p < 0.01). Intra-observer agreement was very good (K = 0.82). Inter-observer agreements were good: reader 1 vs reader 2: k = 0.78 (95% confidence interval 0.65 to 0.91); reader 2 vs reader 3: k = 0.72 (95% confidence interval 0.65 to 0.82); reader 3 vs reader 1: k = 0.71 (95% confidence interval 0.64-0.81)., Conclusions: In lcSSc patients, nerve density was reduced, especially in the symptomatic group, compared to control subjects.

Objectives: To evaluate diagnostic performance of ultrasound in the detection of local recurrences in patients with localized soft tissue sarcomas of the limb., Methods: An analysis of patients treated for soft tissue sarcomas between 2005 and April 2014 was performed. Sixty-eight patients (men/women, 36:32; age range, 18-84 years) were evaluated. Sensitivity, specificity with 95% confidence intervals (CIs), positive predictive value (PPV), pre-test probability (the prevalence), negative predictive value (NPV), likelihood ratio for positive results (LH+), accuracy and post-test probability (post-P) of ultrasound were reported on a per patient basis using surgical findings and clinical follow-up as reference standard. Effects of independent variables (US equipment, age and sex, body mass index, radiologist) were considered. Comparison with MR was also performed., Results: The overall sensitivity and specificity were 0.88 (0.60-0.94) and 0.94 (0.86-0.98). PPV, pre-test probability, NPV, LH+, accuracy and post-P: 0.83/0.25/0.96/14.9/0.92/0.83. There were two false negative cases both graded as G3 and deeply located and three false positive US cases. Diagnostic accuracy was not dependent by US machine (p = 0.08), age and sex (p = 0.16), body mass index (p = 0.07) and radiologists (p = 0.07)., Conclusions: Diagnostic accuracy of ultrasound was relatively high. Negative US results excluded the presence of a local recurrence with acceptable accuracy., Key Points: • US accuracy is relatively high in sarcoma follow-up. • Negative US results exclude the presence of local recurrence with acceptable accuracy. • US may miss a small proportion of lesions. • False positive US cases are rare.

Objectives: To compare ultrasound (US) and magnetic resonance imaging (MRI) in the diagnosis of Morton's neuroma., Methods: Studies that assessed the diagnostic accuracy of US and MRI for Morton's neuroma were retrieved from major medical libraries independently by two reviewers up to 1 April 2014. Predefined inclusion and exclusion criteria were adopted., Results: 277 studies were initially found, and the meta-analysis was conducted on 14 studies. US sensitivity was studied in five studies, MRI sensitivity in three studies, and bothin six studies. All studies used surgery as the reference standard. A high sensitivity (SE) of diagnostic testing was observed for both US (SE (95 % CI) = 0.91 (0.83-0.96)) and MRI (SE (95 % CI) = 0.90 (0.82-0.96)) with no significant differences between the two modalities in diagnosis (Q test p = 0.88). For MRI, specificity of test was 1.00 with a pooled estimation of 1.00 (0.73-1.00), while the pooled specificity was 0.854 (95 % CI: 0.41-1.00) for US. No differences were observed between US and MRI in study design (p = 0.76)., Conclusion: This meta-analysis shows that the SE of US (0.91) is equal to (p = 0.88) that of MRI (0.90) for identification of Morton's neuroma., Key Points: • For Morton's neuroma, US sensitivity is equal to MRI. • US is as accurate as MRI in diagnosing Morton's neuroma. • US may be the most cost-effective imaging method for Morton's neuroma.

As with other musculoskeletal joints, elbow ultrasonography (US) depends on the examination technique. Deep knowledge of the relevant anatomy, such as the bone surface anatomy, tendon orientation, nerves, and vessels, is crucial for diagnosis. It is important to be aware of the primary imaging pitfalls related to US technique (anisotropy) in the evaluation of deep tendons such as the distal biceps and peripheral nerves. In this article, US scanning technique for the elbow as well as the related anatomy, primary variants, and scanning pitfalls are described. In addition, an online video tutorial of elbow US describes a possible approach to elbow evaluation. Online supplemental material is available for this article., (RSNA, 2015)

Objective: To prospectively evaluate the precision and reproducibility of T2*-derived measurements of the peripheral nerves., Materials and Methods: The study was approved by the local ethics committee and written informed consent was obtained. Bilateral upper and lower limb MRI examination was performed in 40 healthy subjects on a 3.0-T scanner. MRI protocol included T1-turbo spin-echo, T2-turbo spin-echo with fat suppression, and multiecho gradient recalled echo. Measurements of T2* times on T2* maps at different anatomical levels were performed. Three authors measured independently and in different sessions at baseline and after 4 weeks. Non-parametric tests and Bland-Altman statistics were used., Results: Minimum and maximum percentage variability were 10 % and 19 % for T2* (84-91 % of reproducibility). Maximum values of minimum detectable differences between limbs was 16 % (with 95 % CI: 2-37). Intra- and inter-observer agreement of the three radiologists for T2* was considered good. Evaluating the combined influence of the observer and of the repeated measurements the reproducibility was 87-98 %., Conclusions: T2* measurement of the peripheral nerves is precise and reproducible. The healthy contralateral side can be used as an internal control. Variations in T2* values up to 16 % have to be considered.

Objectives: To compare DBT and FFDM in the classification of microcalcification clusters (MCs) using BI-RADS., Methods: This Institutional Review Board-approved study was undertaken in three centres. A total of 107 MCs evaluated with both DBT and FFDM were randomised for prospective reading by six experienced breast radiologists and classified using BI-RADS., Results: The benign/malignant ratio of MC was 66/41. Of 11/107 discordant results, DBT classified MCs as R2 whereas FFDM classified them as R3 in 9 and R4 in 2. Three of these (3/107 = 2.8%) were malignant; 8 (7.5%) were nonmalignant and were correctly classified as R2 on DBT but incorrectly classified as R3 on FFDM. Estimated sensitivity and specificity, respectively, were 100% (95% CI: 91% to 100%) and 94.6% (95% CI: 86.7% to 98.5%) for FFDM and 91.1% (95% CI: 78.8% to 97.5%) and 100% (95% CI: 94.8% to 100%) for DBT. Overall intra- and interobserver agreements were 0.75 (95% CI: 0.61-0.84) and 0.73 (95% CI: 0.62-0.78)., Conclusions: Most MCs are scored similarly on FFDM and DBT. Although a minority (11/107) of MCs are classified differently on FFDM (benign MC classified as R3) and DBT (malignant MC classified as R2), this may have clinical relevance., Key Points: • The BI-RADS classification of MC differs for FFDM and DBT in 11/107 cases • DBT assigned lower BI-RADS classes compared to FFDM in 11 clusters • In 4/107 DBT may have missed some malignant and high-risk lesions • In 7/107 the 'underclassification' on DBT was correct, potentially avoiding unnecessary biopsies • DBT may miss a small proportion of malignant lesions.

Objective: To evaluate quantitative measurements of background parenchymal enhancement (BPE) on breast MRI and compare them with observer-based scores., Methods: BPE of 48 patients (mean age: 48 years; age range: 36-66 years) referred to 3.0-T breast MRI between 2012 and 2014 was evaluated independently and blindly to each other by two radiologists. BPE was estimated qualitatively with the standard Breast Imaging Reporting and Data System (BI-RADS) scale and quantitatively with a semi-automatic and an automatic software interface. To assess intrareader agreement, MRIs were re-read after a 4-month interval by the same two readers. The Pearson correlation coefficient (r) and the Bland-Altman method were used to compare the methods used to estimate BPE. p-value <0.05 was considered significant., Results: The mean value of BPE with the semi-automatic software evaluated by each reader was 14% (range: 2-79%) for Reader 1 and 16% (range: 1-61%) for Reader 2 (p > 0.05). Mean values of BPE percentages for the automatic software were 17.5 ± 13.1 (p > 0.05 vs semi-automatic). The automatic software was unable to produce BPE values for 2 of 48 (4%) patients. With BI-RADS, interreader and intrareader values were κ = 0.70 [95% confidence interval (CI) 0.49-0.91] and κ = 0.69 (95% CI 0.46-0.93), respectively. With semi-automated software, interreader and intrareader values were κ = 0.81 (95% CI 0.59-0.99) and κ = 0.85 (95% CI 0.43-0.99), respectively. BI-RADS scores correlated with the automatic (r = 0.55, p < 0.001) and semi-automatic scores (r = 0.60, p < 0.001). Automatic scores correlated with the semi-automatic scores (r = 0.77, p < 0.001). The mean percentage difference between automatic and semi-automatic scores was 3.5% (95% CI 1.5-5.2)., Conclusion: BPE quantitative evaluation is feasible with both semi-automatic and automatic software and correlates with radiologists' estimation., Advances in Knowledge: Computerized BPE quantitative evaluation is feasible with both semi-automatic and automatic software. Computerized BPE quantitative scores correlate with radiologists' estimation.

Introduction: In this study we aimed to determine whether high-resolution ultrasound (US) can identify the iliohypogastric (IH), ilioinguinal (II), and genitofemoral (GF) nerves and their relations., Methods: This investigation, initially undertaken in cadavers, was followed by a high-resolution US study in 30 healthy adult volunteers (180 nerves) by 2 musculoskeletal radiologists on separate occasions, using 2 different approaches (proximal to distal and distal to proximal). A 0-3 scale was used to assess nerve visibility. Location and course of the IH, II, and GF nerves and their relations to adjacent anatomical structures were analyzed., Results: Nerves and their terminal branches were better visualized with the distal-to-proximal approach (P < 0.05). Visualization of the terminal branches was possible in up to 60% of volunteers., Conclusions: High-resolution ultrasound (US) can identify the IH, II, and GF nerves at the level of the abdominal wall and the terminal branches in the majority of volunteers., (© 2014 Wiley Periodicals, Inc.)