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KEY POINTS A 49-year-old premenopausal woman underwent lumpectomy and sentinel lymph node biopsy for grade 1 invasive ductal carcinoma of the right breast. The tumour measured 1.6 cm and was positive for estrogen receptor and progesterone receptor, and negative for human epidermal receptor 2. The

To assess the radiographic appearance and interpretation of loosening in patients following first carpometacarpal joint pyrohemisphere arthroplasty. A retrospective review over a 6-year period was performed identifying patients with first carpometacarpal pyrohemisphere implants. All postoperative radiographs were reviewed and compared with clinical information. Loosening was defined as greater than 1 mm of periprosthetic lucency or increasing lucency on serial studies. Adverse clinical outcome was defined as infection, complex regional pain syndrome, subluxation or an inability to return to activities of daily living. Statistical analysis included Cohen’s Kappa coefficient to measure inter-reader agreement for radiographic interpretation and the agreement between radiographic loosening and an undesired or adverse clinical outcome. Thirty-one implants in 26 patients were reviewed. A total of 73 postoperative radiographs were reviewed. The mean age of the study subjects was 58 years. The mean radiographic follow-up was 13 months (range: 1–56). All arthroplasties were performed for osteoarthritis. Only one repeat surgery was performed. There was good agreement amongst readers with regard to radiographic interpretation, but the strength of agreement between radiographic loosening and adverse clinical outcome was poor. The sensitivity of radiography in predicting an adverse clinical outcome was 63%, specificity 65%, positive predictive value 39%, and negative predictive value 83%. Although radiography may be useful in the correct clinical context, it should not be utilized as the sole predictor of adverse clinical outcomes following carpometacarpal arthroplasty.

To determine whether 3D-MR osseous reformats of the shoulder are equivalent to 3D-CT osseous reformats in patients with glenohumeral instability. Patients with glenohumeral instability, who were to be imaged with both CT and MRI, were prospectively selected. CT and MR were performed within 24 h of one another on 12 shoulders. Each MR study included an axial 3D isotropic VIBE sequence. The image data from the isotropic VIBE sequence were post-processed using subtraction and 3D software. CT data were post-processed using 3D software. The following measurements were obtained for both 3D-CT and 3D-MR post-processed images: height and width of the humeral head and glenoid, Hill-Sachs size and percent humeral head loss (if present), size of glenoid bone loss and percent glenoid bone loss (if present). Paired t-tests and two one-sided tests for equivalence were used to assess the differences between imaging modalities and equivalence. The measurement differences from the 3D-CT and 3D-MR post-processed images were not statistically significant. The measurement differences for humeral height, glenoid height and glenoid width were borderline statistically significant; however, using any adjustment for multiple comparisons, this failed to be significant. Using an equivalence margin of 1 mm for measurements and 1.5% for percent bone loss, the 3D-MR and 3D-CT post-processed images were equivalent. Three-dimensional-MR osseous models of the shoulder using a 3D isotropic VIBE sequence were equivalent to 3D-CT osseous models, and the differences between modalities were not statistically significant.

The CT of the abdomen demonstrated gross hemoperitoneum, with a large subcapsular hematoma surrounding the right lobe of the liver (Figure 1). There was a stellate fracture of the right lobe of the liver that extended into the right hepatic venous and portal systems. Associated with the fracture was a 1.5-cm pseudoaneurysm within the right lobe