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Objective We sometimes encounter unintentional flow of contrast into the facet joints during cervical interlaminar epidural injection, which leads to false-positive epidural injection. The purposes of this study were to evaluate the rate of facet flow of contrast and to investigate various factors associated with injection into the space of Okada during fluoroscopy-guided cervical interlaminar epidural injection. Setting and Subjects Images from consecutive cases of fluoroscopy-guided cervical interlaminar epidural injection performed at a single institution between July 2015 and July 2018 were obtained and reviewed. Methods Cases of epidural injection were classified as either facet flow or no facet flow. Multivariate logistic regression was used to identify the predictive factors of unintended injection into the Okada space. Results A total of 2,006 cases were included. Intra-articular flow was identified in 6.0% of cases (121/2,006). All cases of flow of contrast into the facet joints were recognized, and appropriate epidurograms were obtained during the procedures. The highest rate of unintended facet flow of the contrast (10.1%, 44/436) occurred at C5–6. Cervical interlaminar epidural injection at C5–6 and above (adjusted odds ratio [aOR] = 1.929, P  =   0.001) and the paramidline approach for epidural injection (aOR = 2.427, P  <   0.001) were associated with injection into the space of Okada. Conclusions We detected injection into the space of Okada during fluoroscopy-guided cervical interlaminar epidural injection in 6.0% of procedures. Cervical interlaminar epidural injection at C5–6 and above and the paramidline approach for epidural injection were positive predictors of unintentional facet flow of the contrast. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the diagnostic value of tumor homogeneity on contrast‐enhanced (CE) computed tomography (CT) to differentiate multiple myeloma (MM) from osteolytic bone metastases (Mets). Methods: This retrospective study included patients who were diagnosed with MM or Mets and had multiple (≥2) osteolytic bone tumors on pre‐treatment CE‐CT. Intratumoral homogeneity was assessed by coefficient of variation (CV, ratio of standard deviation to mean) of the density of a single lesion (CV‐lesion). Intertumoral homogeneity was assessed as the CV of the densities of multiple lesions in one patient (CV‐patient). A classification model was built from CT parameters using classification and regression tree (CART) analysis. Diagnostic performance of the model was evaluated using C‐statistics. Results: A total of 272 lesions (81 MM and 191 Mets) of 105 patients were analyzed. The mean CV‐lesion and CV‐patient of MM were significantly lower than those of Mets: 0.17 vs 0.26 for CV‐lesion (p = 0.005) and 0.16 vs 0.23 for CV‐patient (p = 0.013). Thickened struts were more common in MM than in Mets (49.1% vs 12.8%, p ≤ 0.001). In CART analysis, CV‐lesion was the first partitioning predictor, followed by thickened struts and by CV patient. The CART model could distinguish MM from Mets in both the model development cohort (C‐statistic: 0.843) and the temporal validation cohort (0.721, 0.686, and 0.686 for three reviewers, respectively). Conclusions: MM showed intratumoral and intertumoral homogeneity compared with Mets on CE‐CT. The combination of CV‐lesion and CV‐patient can be helpful to radiologists in differentiation of MM from Mets. Advances in knowledge: Our study showed that MM had intratumoral and intertumoral homogeneity compared with Mets on contrast‐enhanced CT. [ABSTRACT FROM AUTHOR]

To correlate the deterioration of preserved long head of biceps tendon (LHB) after rotator cuff repair with preoperative and postoperative MRI factors. Total of 209 shoulder joints (F:M = 145:64; mean age 57.4 years) which underwent rotator cuff repair and at least two postoperative MRI scans over 10 months after surgery were included. LHB integrity was graded with a five point severity scale. LHB deterioration was defined by increased composite score of integrity and extent score between the preoperative and second postoperative MRI. For preoperative and postoperative MRI factors, size and location of superior cuff -supraspinatus and infraspinatus- and subscapularis tears, fatty degeneration of rotator cuff, preoperative LHB status, subluxation of LHB, superior labral tear, acromion type, repaired rotator cuff status, postoperative capsulitis and acromioplasty state were assessed. Logistic regression was used to evaluate the association between LHB deterioration and aforementioned factors. Same analysis was conducted for 62 shoulder joints with a long-term follow-up MRI. Of the 209 shoulders, 49.3% (n = 103) showed LHB deterioration on short-term follow-up MRI. In long-term follow-up subgroup, 32 LHBs were further deteriorated. In multivariate analysis, fatty degeneration of superior cuff showed significant association with LHB deterioration in both short-term (p =.04, p =.007) and long-term subgroups (p =.004, p =.005) among preoperative and postoperative factors, respectively. Degree of fatty degeneration in superior cuff is associated with LHB deterioration on postoperative MRI. Our results support that tenotomy or tenodesis of LHB should be considered during rotator cuff repair, especially in patients with advanced fatty degeneration of rotator cuff. [ABSTRACT FROM AUTHOR]

To determine whether the apparent diffusion coefficient (ADC) on 3T MR imaging including diffusion-weighted MR imaging (DWI) correlate with the standardized uptake value (SUV) on 18F-FDG PET/CT in musculoskeletal tumours. This retrospective cohort study included 57 patients (36 males, 21 females, mean age 54 years, range 12–90 years) with pathologically confirmed soft tissue (n = 32) and bone (n = 25) tumours who underwent 3T MR imaging including DWI and whole-body 18F-FDG PET/CT before treatment. 14 patients had follow-up MR imaging and 18F-FDG PET/CT after treatment. The minimum (ADCmin) and mean (ADCmean) ADCs of musculoskeletal tumour, ADC of normal skeletal muscle (ADCmus), SUVmax and SUVmean of musculoskeletal tumour were obtained. Correlation between ADCs and SUVs was assessed using Pearson correlation coefficients (r). ADCmin and SUVmax were compared between pretreatment and posttreatment by t-test. There was inverse correlation between SUVmax and the ratio ADCmin/ADCmus (r = - 0.505 to - 0.495, p ≤ 0.001) and between SUVmean and the ratio ADCmean/ADCmus (r = - 0.501 to - 0.493, p = 0.001). After treatment ADC was significantly increased whereas SUV was significantly decreased (p = 0.001). There was significant correlation in percent change between the initial and follow-up values of ADCmin and SUVmax (r = 0.750 to 0.773, p ≤ 0.005). The ADCmin was increased by 163% and SUVmax was decreased by 61% in 11 patients with treatment response. ADC at 3T MR DWI and SUV at 18F-FDG PET/CT have an inverse correlation in musculoskeletal tumours. Our study showed that ADC at 3T DWI and SUV at 18F-FDG PET/CT had an inverse correlation in musculoskeletal tumours. [ABSTRACT FROM AUTHOR]

To evaluate the intravoxel incoherent motion (IVIM) diffusion-weighted (DW) MRI for differentiating between benign and malignant musculoskeletal tumours at 3 T. 65 patients with treatment-naïve musculoskeletal tumours (47 malignant and 23 benign lesions) who underwent 3 T MRI including IVIM DW imaging were included. IVIM-derived parameters included pure diffusion coefficient (D), perfusion related incoherent microcirculation (D*, pseudodiffusion coefficient), and perfusion fraction (f). IVIM parameters and mono-exponential apparent diffusion coefficient (ADC) were retrospectively measured by two independent musculoskeletal radiologists. D and ADC values of malignant tumours (923 ± 360, 965 ± 353 µm2 s–1, respectively) were significantly lower than those of benign tumours (1668 ± 546, 1689 ± 526 µm2 s–1) (p < 0.001). F values of malignant tumours (9.6%) were significantly higher than those of benign tumours (7.2%) (p = 0.021), whereas D* values showed no significant difference (p > 0.05). The area under the receiver operating characteristic (ROC) curve of D, ADC and f were 0.874, 0.880 and 0.671, respectively. Using cut-off values of D and ADC of 1200 µm2 s–1, the sensitivity, specificity and accuracy were 92, 83, 89%, 92, 87 and 90%, respectively. D and ADC may be more accurate and reliable for differentiation of malignant from benign musculoskeletal tumours than f and D* at 3 T IVIM DW imaging. Among IVIM-derived parameters, D is more accurate and reliable in differentiating malignant from benign musculoskeletal tumours than f and D* at 3.0T IVIM DW imaging. There was no significant difference in the diagnostic performance of D and ADC. [ABSTRACT FROM AUTHOR]