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With its standardized MRI datasets of the entire spine, the German National Cohort (GNC) has the potential to deliver standardized biometric reference values for intervertebral discs (VD), vertebral bodies (VB) and spinal canal (SC). To handle such large-scale big data, artificial intelligence (AI) tools are needed. In this manuscript, we will present an AI software tool to analyze spine MRI and generate normative standard values. 330 representative GNC MRI datasets were randomly selected in equal distribution regarding parameters of age, sex and height. By using a 3D U-Net, an AI algorithm was trained, validated and tested. Finally, the machine learning algorithm explored the full dataset (n = 10,215). VB, VD and SC were successfully segmented and analyzed by using an AI-based algorithm. A software tool was developed to analyze spine-MRI and provide age, sex, and height-matched comparative biometric data. Using an AI algorithm, the reliable segmentation of MRI datasets of the entire spine from the GNC was possible and achieved an excellent agreement with manually segmented datasets. With the analysis of the total GNC MRI dataset with almost 30,000 subjects, it will be possible to generate real normative standard values in the future. [ABSTRACT FROM AUTHOR]

Background: Muscle degeneration as a consequence of rotator cuff tears is mainly assessed by magnetic resonance imaging. Contrast-enhanced ultrasound (CEUS) is a new functional imaging method to assess microvascular perfusion as a fundamental parameter of muscle tissue vitality. In this cross-sectional study, the authors evaluated supraspinatus muscle perfusion after cuff repair and analyzed its association with functional shoulder outcome and the grade of echogenicity in B-mode ultrasound indicating fatty infiltration. Hypothesis: The authors expected reduced microperfusion of the operated versus the contralateral supraspinatus muscle and a correlation of the muscular microperfusion with functional shoulder outcome. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients who received unilateral repair of the supraspinatus tendon between 2009 and 2014 were invited for a single follow-up examination. Functional scores were assessed, including the Constant-Murley score and American Shoulder and Elbow Surgeons score. CEUS examination was performed bilaterally in an oblique sagittal plane of the supraspinatus fossa. Perfusion was quantified by the parameters wash-in perfusion index (WiPI) and peak enhancement via VueBox quantification software. The results of the Constant-Murley score, American Shoulder and Elbow Surgeons score, and perfusion parameters were referenced to the contralateral shoulder. Echogenicity of the supraspinatus muscle was classified with a 3-point scale as compared with the trapezius muscle. Results: Sixty-seven patients were available, with a mean follow-up of 38.0 ± 18.5 months. Functional assessment showed impaired shoulder function on the operated shoulder as compared with the contralateral side (relative Constant Score [CS], 80% ± 19%). CEUS revealed diminished perfusion on the operated shoulder (WiPI, 55.1% ± 40.2%, P < .001). A strong correlation could be demonstrated between the perfusion deficit and functional impairment (relative WiPI and CS: rs = .644, P < .001). Higher grade of echogenicity in B-mode ultrasound was associated with reduced perfusion. Conclusion: CEUS could visualize impaired supraspinatus muscle perfusion after rotator cuff repair as compared with the contralateral, healthy shoulder. With its ability to quantify microvascular perfusion as a surrogate parameter for muscle vitality and function, CEUS may serve as a quantitative method to evaluate rotator cuff muscles. [ABSTRACT FROM AUTHOR]

The pre-operative determination of infection plays a decisive role in non-union treatment. This study investigated in a large cohort the diagnostic potential of contrast-enhanced ultrasound (CEUS) as stand-alone method for the differentiation between aseptic and infected non-unions. Of 109 patients with lower extremity non-unions (tibia n = 78, femur n = 31) osseous perfusion with CEUS was prospectively assessed before revision surgery. The perfusion was quantified via time-intensity curves and peak enhancement (PE) (arbitrary unit [au]). Significant perfusion differences between aseptic and infected non-unions were evident (PE, p < 0.001). The sensitivity and specificity for the detection of infected tibial and femoral non-unions could be determined with 85.1% and 88.7% (cutoff PE: 81.2 au). CEUS illustrates tibial and femoral non-union perfusion in real time and discriminates reliably between aseptic and infected non-unions. Consequently, when CEUS is integrated into the diagnostic routine algorithm, non-union revision surgery can be planned more accurately as a single or multistep procedure. [ABSTRACT FROM AUTHOR]

Introduction: Non-union perfusion can be visualized with dynamic contrast-enhanced (DCE) MRI. This study evaluated DCE-MRI to predict non-union consolidation after surgery and detect factors that affect bone healing.Materials and Methods: Between 2010 and 2015 non-union perfusion was prospectively quantified in 205 patients (mean age, 51.5 years, 129 men, 76 women) before intervention and at 6, 12, 26, 52 and more weeks follow-up. DCE-MRI results were related to the osseous consolidation, the ability to predict successful outcome was estimated by ROC analysis. The relevance of the body mass index (BMI) and the non-union severity score (NUSS) to the healing process was assessed.Results: Tibial (n=99) and femoral (n=76) non-unions were most common. Consolidation could be assessed in 169 patients, of these 103 (61%) showed eventual healing and demonstrated higher perfusion than in failed consolidation at 6 (p=0.0226), 12 (p=0.0252) and 26 (p=0.0088) weeks follow-up. DCE-MRI at 26 weeks follow-up predicted non-union consolidation with a sensitivity of 75% and a specificity of 87% (false classification rate 19%). Higher BMI (p=0.041) and NUSS (p<0.0001) were associated with treatment failure.Conclusions: DCE-MRI perfusion analysis after non-union surgery predicts successful outcome and could facilitate the decision of early intervention. NUSS and BMI are important prognostic factors concerning consolidation. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance (MRI) imaging of the skeletal muscles (muscle MRI for short) is increasingly being used in clinical routine for diagnosis and longitudinal assessment of muscle disorders. However, cross-centre standards for measurement protocol and radiological assessment are still lacking., Objectives: The aim of this expert recommendation is to present standards for the application and interpretation of muscle MRI in hereditary and inflammatory muscle disorders., Methods: This work was developed in collaboration between neurologists, neuroradiologists, radiologists, neuropaediatricians, neuroscientists and MR physicists from different university hospitals in Germany. The recommendations are based on expert knowledge and a focused literature search., Results: The indications for muscle MRI are explained, including the detection and monitoring of structural tissue changes and oedema in the muscle, as well as the identification of a suitable biopsy site. Recommendations for the examination procedure and selection of appropriate MRI sequences are given. Finally, steps for a structured radiological assessment are presented., Conclusions: The present work provides concrete recommendations for the indication, implementation and interpretation of muscle MRI in muscle disorders. Furthermore, it provides a possible basis for the standardisation of the measurement protocols at all clinical centres in Germany., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Competing Interests: Fabian Rengier is an employee of Bayer Vital GmbH and holds stocks of Bayer AG. The other authors declare that they have no conflict of interest.

Background: Ultrasound (US) is widely used as a fast and cost-efficient first-choice imaging technique without relevant side effects for a variety of diagnostic tasks. Due to technical advances, more complex and sophisticated methods such as color-coded duplex ultrasound, image fusion, contrast-enhanced ultrasound (CEUS), and ultrasound-guided interventions have become increasingly important in diagnostic algorithms., Method: This study presents an overview of all aspects regarding the establishing of an interdisciplinary US center based on five representative examples in Germany. These aspects include topics of ultrasound education, research, economics, and administration., Results: The goal of an interdisciplinary US center is to bundle the use of equipment, staff, rooms, and infrastructure resources (optimization of equipment availability and use of new techniques) to expand the range of examinations, to promote resident training, and to boost continuing medical education of residents. This should result in better patient care and has additionally improved patient care while considering the added value for the participating institutions involved. Interdisciplinary US centers allow a reduction of the number of US devices needed in a hospital and more efficient use of available equipment through bedside time optimization by central organization within interdisciplinary management. The focused application of special US techniques such as CEUS or image fusion for complex, difficult interventions as well as the training and education of younger colleagues in using these techniques is centrally organized by experts and can be improved through the multidisciplinary experience available., Conclusion: Organizational structures, sharing of materials, and standardization of diagnostic reports facilitate and accelerate cooperation with the referring specialty., Key Points: · Interdisciplinary US centers foster clinical collaboration, research, and jointly organized, standardized training.. · Economic aspects include optimization of available equipment, use of the latest US techniques, and centralization of organizational structures.. · Common terminology and standardized reporting increase the satisfaction of referring doctors., Citation Format: · Clevert DA, Jung EM, Weber M et al. Concepts in the Establishment of Interdisciplinary Ultrasound Centers: The Role of Radiology. Fortschr Röntgenstr 2022; 194: 1322 - 1332., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: Use of the arm above shoulder level has been described as a risk factor for developing rotator cuff tears (RCT). There is a lack of information regarding the frequency and distribution of RCT in a population using their arms above shoulder level during daily work. The aim of this study was to analyze clinical and radiographic findings in a population of painters working more than 10 years and to compare the results with a control group (CG)., Materials and Methods: 100 individuals working more than 10 years as a painter were compared to 100 matched controls without using their arms above shoulder level. MRI scans were performed in all participants. Clinically, the Constant score, DASH score and range of motion (ROM) of the shoulders were analyzed., Results: In the painter group (PG) a tear of the supraspinatus tendon was detected in 45% (10%full-thickness; 35% partial) compared to 8% in the (CG) (3% full-thickness; 5%partial; p<0.001). Impingement test was painful in 52% of PG and 7% of CG (p<0.001). The Constant score in the PG was significantly lower compared to the CG (62 vs. 93 points; p<0.001). PG had significantly worse DASH scores and inferior active and passive ROM of the dominant shoulders. In the multivariable logistic regression analysis, three risk factors (smoking, sports activity, and handedness) showed no effect. However, group membership (PG/CG) and age revealed a significant effect., Conclusion: Long-term occupational load on the shoulders in painters seems to be associated with an increased risk for developing RCT. Our findings may provide support for developing preventive strategies for this unique cohort. Level of evidence: III., Competing Interests: The authors have declared that no competing interests exist.

Microbial contamination of ultrasound probes for percutaneous or endoscopic use is common. However, infectious diseases caused by transmission of microorganisms by US procedures have rarely been reported. In Germany, legal regulations address hygiene in ultrasound procedures. Based on these regulations and the available literature, an expert panel of the German Society of Ultrasound in Medicine (DEGUM) has formulated sophisticated recommendations on hygienic measures in percutaneous and endoscopic US, including US-guided interventions., Competing Interests: Heiko Dudwiesus is a former employee of GE Healthcare. The other authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Issue: Ultrasound is an integral part of imaging diagnostics but, unlike CT or MRI, requires the physician to have advanced technical skills for the implementation and documentation of studies., Current Situation: Owing to poor remuneration and the large effort required, ultrasound is not a priority at many institutions, and compared to CT, MRI or interventions, little reward is given to those committed to ultrasound. Intense practical teaching is rarely given. As a result, residents have to teach themselves or gain experience during rotations outside radiology. In some cases, they are not educated at all. Only rarely do residents in radiology participate in certified ultrasound courses, compared to other clinical disciplines. ONGOING DEVELOPMENTS: (1) Standardized ultrasound curricula accompanying resident training, training focused on contrast-enhanced ultrasound, ultrasound-guided interventions, vascular ultrasound, and typical radiological applications of ultrasound like image fusion for biopsies or therapeutic interventions; (2) interdisciplinary ultrasound centers; (3) fostering of ultrasound education by the German Radiological Society (DRG) through intensive courses during the annual meeting., Achievements: The above measures will help to increase skill and dexterity of radiologists in ultrasound, to introduce typical radiological applications of ultrasound into a broader field of applications and increase the awareness of these methods, and to strengthen the role of ultrasound in resident training. FUTURE REQUIREMENTS: (1) One senior radiologist in charge of ultrasound in each department; (2) communication of and adherence to examination and documentation standards; (3) demonstration of ultrasound studies during rounds and boards; (4) interdisciplinary centers for ultrasound education.

Purpose: To detail the rationale, design, and future perspective of implementing whole-body magnetic resonance (MR) imaging in the German National Cohort, a large multicentric population-based study., Materials and Methods: All institutional review boards approved the study, and informed consent is obtained before study enrollment. Participants are enrolled from a random sample of the general population at five dedicated imaging sites among 18 recruitment centers. MR imaging facilities are equipped with identical 3.0-T imager technology and use uniform MR protocols. Imager-specific hardware and software settings remained constant over the study period. On-site and centralized measures of image quality enable monitoring of completeness of the acquisitions and quality of each of the MR sequences. Certified radiologists read all MR imaging studies for presence of incidental findings according to predefined algorithms., Results: Over a 4-year period, six participants per day are examined at each center, totaling a final imaging cohort of approximately 30 000 participants. The MR imaging protocol is identical for each site and comprises a set of 12 native series to cover neurologic, cardiovascular, thoracoabdominal, and musculoskeletal imaging phenotypes totaling approximately 1 hour of imaging time. A dedicated analysis platform as part of a central imaging core incorporates a thin client-based integrative and modular data handling platform to enable multicentric off-site image reading for incidental findings. Scientific analysis will be pursued on a per-project hypothesis-driven basis., Conclusion: Population-based whole-body MR imaging as part of the German National Cohort will serve to compile a comprehensive image repository, will provide insight into physiologic variants and subclinical disease burden, and has the potential to enable identification of novel imaging biomarkers of risk., ((©) RSNA, 2015 Online supplemental material is available for this article.)