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Bone marrow edema (BME) from dual-energy CT is useful to direct attention to radiographically occult fractures. The aim was to characterize utility of BME of lower extremity (LE) fractures with the hypothesis that stabilized and post-acute fractures exhibit decreased extent and frequency of BME than non-stabilized and acute fractures, respectively.An IRB-approved retrospective review of known LE fractures. A total of 141 cases met inclusion criteria, including 82 fractures without splint/cast stabilization, and 59 cases with stabilization. Two readers independently recorded BME, and its multiplicity and area (mmBME was significantly larger in non-stabilized (859.3 mmBME evaluation can assist in differentiation of acute versus post-acute fractures. Extent of BME is reduced with splint/cast stabilization, which may limit its accuracy in detection of lower extremity fractures.• Evaluation of bone marrow edema on dual-energy CT aids in differentiation of acute versus post-acute fracture. • Bone marrow edema evaluation is limited in the setting of post-acute or stabilized fractures. • There is decreased frequency and extent of bone marrow edema in post-acute, non-comminuted, and stabilized fractures.

Ankle sprain is the most common injury in athletic populations. Ligament and tendon pathologies of the ankle are common, ranging from traumatic injuries to degeneration leading to chronic pain and acquired foot deformities. MRI is the imaging modality of choice to evaluate tendon and ligament pathology of the ankle, specifically derangements of tendons and ligaments. 3-T MRI offers improved imaging characteristics relative to 1.5-T MRI, allowing for better delineation of anatomic detail and pathology. This article provides a review of the anatomy and common pathologies of the ankle ligaments and tendons using high-resolution 3-T MRI.

As quality and cost effectiveness become essential in clinical practice, an evidence-based evaluation of the utility of imaging orders becomes an important consideration for radiology’s value in patient care. We report an institutional quality improvement project including a retrospective review of utility of sacrum magnetic resonance (MR) imaging for low back pain at our institution over a four-year period and follow-up results after physician education intervention. Sacral MR imaging for low back pain and tailbone pain were only positive for major findings in 2/98 (2%) cases, and no major changes in patient management related to imaging findings occurred over this period, resulting in almost $500000 cost without significant patient benefit. We distributed these results to the Family Medicine department and clinics that frequently placed this order. An approximately 83% drop in ordering rate occurred over the ensuing 3 mo follow-up period. Sacrum MR imaging for low back pain and tail bone pain has not been a cost-effective diagnostic tool at our institution. Physician education was a useful tool in reducing overutilization of this study, with a remarkable drop in such studies after sharing these findings with primary care physicians at the institution. In conclusion, sacrum MR imaging rarely elucidates the cause of low back/tail pain diagnosed in a primary care setting and is even less likely to result in major changes in management. The practice can be adopted in other institutions for the benefit of their patients and improve cost efficiency.

OBJECTIVE To develop and validate an Osseous Tumor Reporting and Data System (OT-RADS) with the hypothesis that the proposed guideline is reliable and assists in separating benign from malignant osseous tumors with a good area under the curve, and that could assist further patient management. METHODS In this multireader cross-sectional validation study, an agreement was reached for OT-RADS categories based on previously described magnetic resonance imaging features and consensus of expert musculoskeletal radiologists. World Health Organization classification was used, and a wide spectrum of benign and malignant osseous tumors was evaluated. Magnetic resonance imaging categories were as follows: OT-RADS 0-incomplete imaging; OT-RADS I-negative; OT-RADS II-definitely benign; OT-RADS III-probably benign; OT-RADS IV-suspicious for malignancy or indeterminate; OT-RADS V-highly suggestive of malignancy; and OT-RADS VI-known biopsy-proven malignancy or recurrent malignancy in the tumor bed. Four blinded readers categorized each tumor according to OT-RADS classification. Intraclass correlation (ICC) and Conger κ were used. Diagnostic performance measures including area under the receiver operating curve were reported. Osseous Tumor Reporting and Data System was dichotomized as benign (I-III) and malignant (IV and V) for calculating sensitivity and specificity. RESULTS Interreader agreement for OT-RADS (ICC = 0.78) and binary distinction of benign versus malignant (κ = 0.67) were good to excellent, while agreement for individual tumor feature characteristics were poor to fair (ICC = 0.25-0.36; κ = 0.16-0.39). The sensitivities, specificities, and area under the receiver operating curve of the readers ranged from 0.93-1.0, 0.71-0.86, and 0.92-0.97, respectively. CONCLUSIONS Osseous Tumor Reporting and Data System lexicon is reliable and helps stratify tumors into benign and malignant categories. It can be practically used by radiologists to guide patient management, improve multidisciplinary communications, and potentially impact outcomes.

Magnetic resonance imaging (MRI) is commonly used to evaluate musculoskeletal pathologies due to its high spatial resolution and excellent tissue contrast. The diagnosis of rheumatic diseases can often be challenging. Investigation with conventional two-dimensional MRI is helpful for diagnosis and monitoring treatment. In the past few years, three-dimensional (3D) MRI has been more commonly used to assess joint pathologies including inflammatory and rheumatic diseases. This review discusses the techniques and protocols of 3D MRI and its diagnostic yield in the assessment of rheumatic diseases, along with different examples.

Magnetic resonance imaging (MRI) is frequently used in the imaging evaluation of wrist pain. The complex anatomy of the wrist can be demonstrated by MRI. Three tesla (3 T) MRI offers increased signal-to-noise ratio relative to 1.5 T MRI allowing for higher soft tissue contrast and better spatial resolution. The resulting increase in conspicuity of fine anatomic detail may improve the detection and characterization of wrist pathology. In this article, we will review the anatomy, normal variants, and common pathologies of the wrist tendons as evaluated on 3 T MRI.

Background: Diaphyseal tibial fractures are the most frequent bone fractures in the body and are usually treated with intramedullary nailing method. However, this approach is responsible for 41% of the rotational deviation. Objectives: This study aimed to provide a radiographic evaluation method to determine tibial malrotation in closed fixation of tibia bone fractures during or after the operation. Methods: This study was conducted in a university hospital from May 2015 to March 2016. All patients referring to the hospital with the complaints of minor trauma around the ankle and knee requiring radiographic evaluation of both joints were enrolled in the study. The inclusion criteria included being 20 and 50 years old; having normal axial, sagittal, and coronal lower limb alignment; lacking previous lower limb injury (such as fractures of the tibia or fibula), ankle or knee sprain; not having previous lower limb surgery, metabolic or congenital bone diseases, or malignancy. In all cases, a standard Anteroposterior (AP) radiograph of the knee was taken, and then, without changing the limb position or image setting, an AP radiograph of the ankle was obtained. The overlap between the distal tibia and fibula was measured in the PACS program environment. Results: Fifty cases were included in this study. The Mean±SD ages of males and females were 29.08±2.49 years and 31.46±2.04 years, respectively. The range of distal tibia-fibula overlap one centimeter above the tibiotalar joint line was 7.81 to 9.09 mm (confidence interval of 95%), and its percentage to the fibula shaft width at the same level was 49.43% to 54.35%. Conclusion: According to the results, distal tibia-fibula overlap when the knee is in the true AP position, regardless of the side and gender, is 7.81 to 9.09 mm or 49.43% to 54.35%.

Purpose Glenoid bone stock and morphology and rotator cuff muscle quality and tendon integrity affect the outcome of total shoulder arthroplasty. We hypothesized that glenoid bone loss correlates with rotator cuff muscle fatty infiltration (FI), tendinopathy, and atrophy. Design Forty-three 3-D CT scans and MRIs of 43 patients (mean age 62 years; SD 13 years; range 22–77 years) referred for primary shoulder pain were evaluated. Measurements of glenoid bone stock, version, and posterior humeral subluxation index (HSI) were assessed on an axial CT image reconstructed in the true scapular plane. Measurements utilized the Friedman line to approximate the pre-pathologic surface. Glenoid morphology was assigned by modified Walch classification. Rotator cuff FI, atrophy, and tendon integrity were assessed on corresponding MRIs. Results There was a very strong negative correlation between increasing glenoid version and HSI (r = − 0.908; p

Glenoid bone stock and morphology and rotator cuff muscle quality and tendon integrity affect the outcome of total shoulder arthroplasty. We hypothesized that glenoid bone loss correlates with rotator cuff muscle fatty infiltration (FI), tendinopathy, and atrophy.Forty-three 3D CT scans and MRIs of 43 patients (mean age 62 years; SD 13 years; range 22-77 years) referred for primary shoulder pain were evaluated. Measurements of glenoid bone stock, version, and posterior humeral subluxation index (HSI) were assessed on an axial CT image reconstructed in the true scapular plane. Measurements utilized the Friedman line to approximate the pre-pathologic surface. Glenoid morphology was assigned by modified Walch classification. Rotator cuff FI, atrophy, and tendon integrity were assessed on corresponding MRIs.There was a very strong negative correlation between increasing glenoid version and HSI (r = - 0.908; p 0.0001). There was a moderately negative correlation between anterior bone loss and HSI (r = - 0.562; p 0.0001) and a moderately positive correlation between posterior bone loss and HSI (r = 0.555; p 0.0001). Subscapularis muscle FI correlated moderately with increased anterior and central bone loss and increased humeral head medialization (r = 0.512, p = 0.0294; r = 0.479, p = 0.033; r = 0.494, p = 0.0294; respectively). Inter-observer reliability (intra-class correlation coefficient [ICC] and kappa) was good to excellent for all measurements and grading.Glenoid anteversion and anterior and posterior bone loss are associated with varying HSI. Subscapularis muscle FI, not tendon integrity, correlates to anterior and central glenoid erosion. The study adds evidence that neither rotator cuff tendinopathy nor muscle atrophy exhibits a significant relationship to HSI.

BackgroundTo our knowledge, no current guideline exists in outlining follow-up or interventional strategies in musculoskeletal soft tissue tumor management. To develop and validate soft-tissue tumor reporting and data system (ST-RADS) with the hypothesis that the proposed guideline reliably and accurately assists in separating benign from malignant musculoskeletal soft tissue tumors.Methods This is a multi-institutional cross-sectional study of soft-tissue masses. An expert consensus agreement was reached for ST-RADS categories using the terminology from WHO classification. Adipocytic tumors, T2-hyperintense and T2-hypointense masses of extremities with a wide spectrum of histologies were assessed. MRI categories were: STRADS 0 - incomplete imaging, I – no lesion identified, II - definitely benign, III - probably benign, IV - indeterminate or suspicious for malignancy, V- highly suggestive of malignancy, and VI - known biopsy-proven malignancy or recurrence. Eight readers evaluated cases and ICC and AUC were calculated. Results 200 soft tissue masses were tested. There was good inter-reader agreement with ICC= 0.72 [95% CI=0.64-0.79] and 0.69 [95% CI=0.59-0.70] for adipocytic and T2-hyperintense, and fair, 0.48 [95% CI=0.35-0.62] for T2- hypointense masses. The sensitivity and specificity for detection of malignancy were 96% and 63%, 93% and 71%, 64% and 84% for adipocytic, T2-hyperintense, and T2-hypointense masses, respectively. The AUC was 0.79-0.89.Conclusion ST-RADS guideline using standardized terminology stratifies musculoskeletal tumors into benign and malignant categories and provides management strategy. This MRI-based guideline is meant to be a "dynamic" document that can be further refined and updated in response to future user feedback and as new scientific data becomes available.

To develop and validate an Osseous Tumor Reporting and Data System (OT-RADS) with the hypothesis that the proposed guideline is reliable and assists in separating benign from malignant osseous tumors with a good area under the curve, and that could assist further patient management.In this multireader cross-sectional validation study, an agreement was reached for OT-RADS categories based on previously described magnetic resonance imaging features and consensus of expert musculoskeletal radiologists. World Health Organization classification was used, and a wide spectrum of benign and malignant osseous tumors was evaluated. Magnetic resonance imaging categories were as follows: OT-RADS 0-incomplete imaging; OT-RADS I-negative; OT-RADS II-definitely benign; OT-RADS III-probably benign; OT-RADS IV-suspicious for malignancy or indeterminate; OT-RADS V-highly suggestive of malignancy; and OT-RADS VI-known biopsy-proven malignancy or recurrent malignancy in the tumor bed. Four blinded readers categorized each tumor according to OT-RADS classification. Intraclass correlation (ICC) and Conger κ were used. Diagnostic performance measures including area under the receiver operating curve were reported. Osseous Tumor Reporting and Data System was dichotomized as benign (I-III) and malignant (IV and V) for calculating sensitivity and specificity.Interreader agreement for OT-RADS (ICC = 0.78) and binary distinction of benign versus malignant (κ = 0.67) were good to excellent, while agreement for individual tumor feature characteristics were poor to fair (ICC = 0.25-0.36; κ = 0.16-0.39). The sensitivities, specificities, and area under the receiver operating curve of the readers ranged from 0.93-1.0, 0.71-0.86, and 0.92-0.97, respectively.Osseous Tumor Reporting and Data System lexicon is reliable and helps stratify tumors into benign and malignant categories. It can be practically used by radiologists to guide patient management, improve multidisciplinary communications, and potentially impact outcomes.

To quantify and compare signal intensity (SI) changes on T1-weighted (W) and T2W Dixon imaging in yellow marrow, red marrow, and bone marrow lesions. A total of 141 patients (77 controls, 64 lesions—33 benign, 31 malignant) between January 2016 and December 2017 were retrospectively identified. For the control group, fixed 2-cm2 region of interests (ROI) were drawn at L5, bilateral ilium and femurs on in-phase and opposed-phase T1W and T2W Dixon images. For the lesion group, ROIs of best fit were drawn around each lesion on in-phase and opposed-phase T2W Dixon images. SI changes between in-phase and opposed phase maps for each group were compared. Inter-reader analysis was performed. Yellow marrow exhibited smaller SI changes as compared to red marrow on both T1W and T2W Dixon imaging at all locations (p

Purpose The accuracy of magnetic resonance neurography (MRN) for quantitative assessment of nerve injury gap is unknown. We tested the hypothesis that presurgical MRN predicts the final surgical gap size after neuroma resection at the time of surgery. Materials and Methods This was a retrospective, single-blinded, nonrandomized cohort study on 43 patients with Sunderland Class IV and V injuries of the inferior alveolar (IAN) or the lingual nerve (LN). The MRN maxillofacial protocol was performed on a 3T scanner and was read by 2 musculoskeletal radiologists to determine the maximum size of neuroma and the abnormal nerve segment. Two independent variables were recorded during surgery: 1) the length of neuroma from histologic specimens since only 9 of the 43 neuroma size measurements were accurately measureable at the time of surgery; and 2) the length of nerve gap size after the neuroma was removed and normal fascicles were identified. Results There were 7 IAN and 36 LN cases analyzed. The mean time in months from injury to MRN was 6.97 ± 9.18 and MRN to surgery was 1.21 ± 1.4. The mean length of the neuroma at surgery was 7.22 ± 2.78 mm and mean nerve gap size was 12.02 ± 4.41 mm. Intraclass coefficient (ICC) agreement was fair for abnormal nerve thickness and neuroma length (ICC = 0.28, 0.39) while it was moderate for neuroma thickness and abnormal nerve length (0.50, 0.59). There was no significant correlation between MRN based measurements and surgical gap size for both readers (P > .05). Conclusions Abnormal nerve and neuromas of the peripheral trigeminal nerve as identified on MRN imaging demonstrates no correlation of the assessed MRN findings with the final surgical gap after neuroma removal.

Introduction To conduct a morphometric analysis of intact and torn menisci using isotropic meniscus plane three-dimensional (3D) reconstructions on 3-Tesla MRI and compare 2D versus 3D MRI for meniscus tear characterization. Materials and methods One hundred thirty three normal menisci from 92 patients (39 male, 53 female), and 38 arthroscopy-proven torn menisci from 36 patients (23 male, 13 female) were evaluated using 3D isotropic multi-planar MRI reconstructions and 2D MRI. Two observers measured the tibial plateau height and area, meniscal height, axial plane cross-sectional areas, and extrusion of intact menisci. Two observers also measured the meniscal tear length, tear area, and residual area of pathological menisci on 2D and 3D MRI. Intraclass correlation coefficients (ICC) were obtained. Institutional Review Board approval was obtained, and the informed consent was waived. Results Medial meniscus (MM) and lateral meniscus (LM) areas were 503.6 ± 85.1 mm2 and 396.6 ± 72.0 mm2 for Observer 1, and 515.8 ± 82.1 mm2 and 408.0 ± 68.3 mm2 for Observer 2 (ICC:0.86, 0.87). In torn menisci, average tear length, area, and residual area were 36.3 ± 13.6 mm, 182.6 ± 139.3 mm2 , and 235.4 ± 140.3 mm2 , respectively for Observer 1, and 38.9 ± 14.7 mm, 181.2 ± 135.6 mm2 , 238.2 ± 140.5 mm2 for Observer 2. In the MM and LM, bucket-handle and complex tears were largest in areas, respectively. ICCs were excellent (0.91-1.0) on 3D MRI and moderate-good (0.57-0.81) on 2D MRI. Conclusion Meniscus morphometry on 3D MRI shows moderate to excellent inter-observer reliability and meniscus tear extent is more reliably defined on 3D MRI than 2D MRI. Residual meniscus-area calculation can be performed on 3D MRI.

Background The 3D short tau inversion recovery (STIR) sequence is routinely used in clinical MRI to achieve robust fat suppression. However, the performance of the commonly used adiabatic inversion pulse, hyperbolic secant (HS), is compromised in challenging areas with increased B0 and B1 inhomogeneities, such as brachial plexus at 3T. Purpose To demonstrate the frequency offset corrected inversion (FOCI) pulse as an efficient fat suppression STIR pulse with increased robustness to B0 and B1 inhomogeneities at 3T, compared to the HS pulse. Study type Prospective. Subjects/phantom Initial evaluation was performed in phantoms and one healthy volunteer by varying the B1 field, while subsequent comparison was performed in three healthy volunteers and five patients without varying the B1 . Field strength/sequence 3T; 3D TSE-STIR with HS and FOCI pulses. Assessment Brachial plexus images were qualitatively evaluated by two musculoskeletal radiologists independently using a four-point grading scale for fat suppression, shading artifacts, and nerve visualization. Statistical test The Wilcoxon signed-rank test with P Results Simulations and phantom experiments demonstrated broader bandwidth (2.5 kHz vs. 0.83 kHz, increased B0 robustness) at the same adiabatic threshold and lower adiabatic threshold (5 μT vs. 7 μT at 3.5 ppm, increased B1 robustness) at the same bandwidth with the FOCI pulse compared to the HS pulse With increased bandwidth, the FOCI pulse achieved robust fat suppression even at 50% of maximum B1 strength, while the HS pulse required >75% of maximum B1 strength. Compared to the standard 3D TSE-STIR with HS pulse, the FOCI pulse achieved uniform fat suppression (P Data conclusion The FOCI pulse has increased robustness to B0 and B1 inhomogeneities, compared to the HS pulse, and enables uniform fat suppression in brachial plexus at 3T. Level of evidence 1 Techinical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;48:1104-1111.

Fat suppression technique is a valuable resource in musculoskeletal magnetic resonance (MR) imaging that is helpful in the diagnosis and differentiation of various pathologies. Multiple different techniques are available for fat suppression, including frequency selective pulse sequence, inversion recovery, hybrid technique, chemical shift imaging (CSI) and the related Dixon based approach. The utility of CSI and Dixon approach is not well recognized in the domain of musculoskeletal MR imaging. The aim of this article is to review the various options for fat suppression and present focused discussion of the role of CSI and Dixon techniques for musculoskeletal MR imaging.

Purpose Axial spondyloarthritis (SpA) is a group of diseases with temporally disseminated symptoms and clinical signs, which render the diagnosis challenging. Laboratory and MRI findings are used in addition for confirming the diagnosis and evaluation of disease activity. The purpose of this study was to evaluate clinically suspected axial SpA to determine the technical success of a multiparametric and 3D rheumatology lumbosacral MR imaging (MRLI) protocol and to assess the disease distribution, inter-reader reliability, and impact on patient management. Methods A consecutive series of patients with clinical suspicion of axial SpA were included. Two rheumatologists recorded the clinical findings and disease activity on a confidence scale before and after MRLI. Two musculoskeletal (MSK) radiologists read the imaging data including enthesitis, arthritis, osseous lesions, ADC values, and enhancement. Prevalence-adjusted and bias-adjusted kappa (PABAK), ICC and Fisher exact test were calculated. Results There were 41 patients including 31 females and 10 males with ages of 41 ± 10 and 41 ± 12 (mean ± SD), respectively. The spine T2W imaging received the highest quality scores followed by whole abdomen-pelvis 3D-T2W imaging, 3D-CEMR (contrast-enhanced MRI), and DWI. On spine imaging, acute and chronic lesions of lumbar spine and sacroiliac joints were seen in 4/41, 18/41 and 6/41, and 27/41 of the patients, respectively. Several additional enthesopathy lesions were seen on the whole abdomen-pelvis 3D sequence. ADC value of bone lesions was different 0.95 ± 0.23 (mean ± SD) than normal bone (0.20 ± 0.1). PABAK for acute and chronic findings ranged 0.70–1.0 and 0.41-0.51, respectively. Imaging changed the diagnosis in 17 of 41 patients. No association was noted with respect to treatment change (p = 1) or clinical response (p = 0.2). Conclusion Multiparametric lumbosacral MR imaging is a technically successful modality to identify multiple spinal and additional extraspinal sites of involvement in SpA, which are helpful in establishing the diagnosis of axial SpA. Larger patient population study is warranted to evaluate further impact on the treatment efficacy.

Professional organizations recommend against repeat radiographs for routine follow-up of osteoarthrosis. However, clinics frequently obtain radiographs during or before the clinical visit. The purpose of our project was to determine the baseline frequency of unnecessary knee radiographs and whether educational interventions can reduce this frequency. This QI project was exempt from IRB review. Radiology reports of knee radiographs were searched in our database filtered by presence of the words “severe”, “degenerative”, “osteoarthritis”, and similar variants. We reviewed 500 consecutive corresponding medical records to confirm the presence of severe osteoarthritis, and presence of a repeat radiograph within 6 months. Indications for repeat radiographs were determined. Repeat radiographs were counted as “non-indicated” when medical records revealed no new symptoms. A focused educational intervention was provided to the orthopedic and family practice departments. An additional 500 radiology reports were evaluated 9 months after intervention in the same manner and the rate of non-indicated radiographs was calculated. Follow-up review of additional 500 radiology reports at 1-year time point was performed. Our initial search returned 1517 reports. Upon evaluation of 500 studies, there were 112/500 repeat radiographs (22%); 77/500 (15%) of knee radiographs were not indicated. Upon initial follow-up evaluation of 500 studies, there were 52/500 repeat radiographs (10%) and 40/500 (8%) radiographs were not indicated. The reduction of unnecessary repeat knee radiographs rate was sustained at 1 year. Focused educational intervention results in a substantial (50%) reduction of the number of unnecessary repeat knee radiographs in patients with known severe OA.

A single ADC value is used in clinical practice on multi b-value acquisitions. Low b-value acquisitions are affected by intravoxel incoherent motion, which is dependent on perfusion. Giant cell tumors (GCTs) are known to exhibit early arterial enhancement and low ADC values. Mean, minimum and fractional ADC characteristics of osseous and tenosynovial GCTs are systematically evaluated. Tenosynovial and osseous GCTs were included. Each lesion was evaluated on conventional MRI and DWI by two musculoskeletal radiologists. ADC was measured by placing an ROI on the most confluent enhancing portion of the lesion. Fractional and best fit ADC calculations were performed using MATLAB software. No statistically significant difference was found between tenosynovial and osseous lesions’ ADC values. Mean ADC for all lesions was 1.0 × 10−3 mm2/s (SD = 0.2 × 10−3 mm2/s) and minimum ADC was 0.5 × 10−3 mm2/s (SD = 0.3 × 10−3 mm2/s). Average mean ADC value obtained from B50–B400 slope was 1.1 × 10−3 mm2/s (SD = 0.2 × 10−3 mm2/s), and the average mean ADC value obtained from B400–B800 slope was 0.8 × 10−3 mm2/s (SD = 0.1 × 10−3 mm2/s) [p-value

To evaluate the relationships between acromial anatomy and developmental alterations with rotator cuff tears in female patients and compare these parameters on radiographs and corresponding MRIs along with inter-reader performance. Patient demographics, symptoms, and acromial characteristics on radiograph (acromial index, lateral acromion angle, subacromial space on AP and Y- views, acromial anterior and lateral downsloping) and MRI (shape, slope, spur, osteoarthrosis, os acromiale) were recorded. Radiographic and MRI findings were compared and correlated with rotator cuff pathology on MRI. Inter-reader analysis was performed. A total of 140 MRIs from 137 female patients were included. No significant correlation (p > 0.05) existed between acromial parameters and rotator cuff tears, except for a smaller subacromial space on the Y view and spurs correlated with subscapularis tendon tear (p = 0.02, p = 0.04). The presence of lateral downsloping on MRI correlated with a smaller lateral acromion angle (p = 0.0002) and the presence of lateral downsloping on radiography (p = 0.0015). Inter-reader agreements were good to excellent (ICC: 0.65–0.89). Subacromial impingement anatomy characteristics have no significant associations with supraspinatus or infraspinatus tears in symptomatic women. Among different measures, supine MRI can be reliably used to identify lateral downsloping of the acromion.

The 3D short tau inversion recovery (STIR) sequence is routinely used in clinical MRI to achieve robust fat suppression. However, the performance of the commonly used adiabatic inversion pulse, hyperbolic secant (HS), is compromised in challenging areas with increased BTo demonstrate the frequency offset corrected inversion (FOCI) pulse as an efficient fat suppression STIR pulse with increased robustness to BProspective.Initial evaluation was performed in phantoms and one healthy volunteer by varying the B3T; 3D TSE-STIR with HS and FOCI pulses.Brachial plexus images were qualitatively evaluated by two musculoskeletal radiologists independently using a four-point grading scale for fat suppression, shading artifacts, and nerve visualization.The Wilcoxon signed-rank test with P 0.05 was considered statistically significant.Simulations and phantom experiments demonstrated broader bandwidth (2.5 kHz vs. 0.83 kHz, increased BThe FOCI pulse has increased robustness to B1 Techinical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;48:1104-1111.

Magnetic resonance imaging technology allows for in vivo visualization of fiber tracts of the central nervous system using diffusion-weighted imaging sequences and data processing referred to as "diffusion tensor imaging" and "diffusion tensor tractography." While protocols for high-fidelity diffusion tensor imaging of the brain are well established, the spinal cord has proven a more difficult target for diffusion tensor methods. Here, we review the current literature on spinal diffusion tensor imaging and tractography with special emphasis on neuroanatomical correlations and clinical applications.

This article highlights the key aspects and current perspectives of the role of cross-sectional imaging in adult crystal and inflammatory arthropathies in adults, briefly discussing CT, and particularly focusing on MRI and US imaging as it supplements the conventional radiography. The role of conventional and advanced MR imaging techniques and imaging findings in this domain is discussed and illustrated with case examples. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article contains images and data, which were collected from patients as a part of a retrospective IRB from the institutional teaching files and informed consent was waived.

Muscle edema or edema-like signal alterations are commonly encountered findings in musculoskeletal magnetic resonance (MR) imaging. Although such signal alterations are very sensitive for detection of the underlying muscle pathology, these are often non-specific findings. Encompassing knowledge of their typical clinical presentations, characteristic appearances and patterns of muscle signal alterations and following a systematic approach towards their assessment, a reader can effectively narrow down the differential diagnosis. This article outlines the role of conventional imaging and advanced anatomic and functional musculoskeletal MR imaging techniques in the evaluation of various muscle disorders and presents a systematic approach towards their diagnosis and management.

Radiology report signature time (ST) can be a substantial component of total report turnaround time. Poor turnaround time resulting from lengthy ST can adversely affect patient care. The combination of technology adoption with financial incentive was evaluated to determine if ST improvement can be augmented and sustained.This prospective study was performed at a 751-bed, urban, tertiary care adult teaching hospital. Test-site imaging volume approximated 48,000 examinations per month. The radiology department has 100 trainees and 124 attending radiologists serving multiple institutions. Over a study period of 4 years and 4 months, three interventions focused on radiologist signature performance were implemented: 1) a notification paging application that alerted radiologists when reports were ready for signature, 2) a picture archiving and communications systems (PACS)-integrated speech recognition report generation system, and 3) a departmental financial incentive to reward radiologists semiannually for ST performance. Signature time was compared before and after the interventions. Wilcoxon and linear regression statistical analyses were used to assess the significance of trends.Technology adoption (paging plus speech recognition) reduced median ST from5 to1 hour (P.001) and 80th-percentile ST from24 to 15 to 18 hours (P.001). Subsequent addition of a financial incentive further improved 80th-percentile ST to 4 to 8 hours (P.001). The gains in median and 80th-percentile ST were sustained over the final 31 months of the study period.Technology interventions coupled with financial incentive can result in synergistic and sustainable improvement in radiologist report-signing behavior. The addition of a financial incentive leads to better performance than that achievable through technology alone.

Gadoxetate disodium is a gadolinium-based contrast agent (GBCA) typically used for body imaging, as about 50% of its excretion is via the liver. Its use for craniospinal MRI has not been reported.Over a 3 years period, 31 adults underwent postcontrast MRI using gadoxetate disodium, each of whom had a relative contraindication to a GBCA, but a GBCA was deemed necessary by the clinical service to direct therapy. Postcontrast T1WI included either gradient-echo (GET1WI, n=12) or spin-echo (SET1WI, n=13) imaging. The contraindication in 29 patients was stage 3-5 chronic kidney disease (CKD) or acute kidney injury (AKI); the other two had normal kidney function, but a history of a reaction to another GBCA (vomiting in one and hypersensitivity in the other). Over a 3 years period, in those patients in whom a GBCA was both deemed necessary and had an estimated GFR (eGFR) of40 ml/min/1.73 m(2) (i.e., stage 3-5 CKD), both informed consent and nephrology consultation was obtained. A 10 ml dose was given for cranial (n=23), spinal (n=9), and neck/face MRI (n=3), as well as craniocervical MRA (n=6). Three neuroradiologists separately evaluated for normal enhancement in 11 structures. The contrast enhancing percentage (CE%) was measured in 3 structures, and in enhancing lesions, if present.The pre-MRI eGFR was not significantly different from that at 30-90 days (p=0.522) in the 23 patients with an available eGFR at90 days post-MRI; no patients developed acute kidney injury post-MRI, nor nephrogenic systemic fibrosis. Of the 11 intracranial structures scored, the superior sagittal sinus, pituitary stalk, and atrial choroid plexus enhanced in all 23 patients who underwent brain MRI, with CE%'s of 171.0%, 73.0%, and 69.8%, respectively. The number of patients with enhancing lesions were 3/23 brain MRI's, 8/9 spinal MRI's, 3/3 neck MRI's, and 2/6 craniocervical MRA/MRV's. In 9 spinal MRI's, the basivertebral plexus CE% was 213.7%; in the 7 with spondylodiscitis, the CE% measured 125.8% in enhancing epidural tissue, with a contrast-to-noise ratio (CNR) of 98.0%.This preliminary report describes the use of gadoxetate disodium as an alternative GBCA for craniospinal MRI and MRA in the renally impaired, but its efficacy in this regard must be further evaluated prospectively.

The peripheral nerves can be affected by different diseases, and these diseases can be broadly categorized, according to etiology, as either entrapment or nonentrapment neuropathies. Entrapment syndrome is a neuropathy due to a structural abnormality that results in compression, displacement, or traction of the nerve ( Miller & Reinus, 2010 ). The main diagnostic work-up includes clinical history, physical examination, and electrodiagnostic testing. Magnetic resonance imaging (MRI) can also play a crucial role by providing further information about the exact anatomic location of the pathology, as well as the alternative findings. MRI can show both the nerve involvement (e.g., change in caliber, increased signal, and enhancement) and the abnormalities of the associated innervated muscles (e.g., increased signal and denervation edema in early stages and atrophy with fatty replacement in more severe and chronic cases). The purpose of the chapter is to briefly review the imaging of the common entrapment syndromes in the upper and lower extremities.

The variations of renal arteries are considered critical issues that surgeons should have thorough envision and appreciation of the condition. Variations of these vessels may influences urological, renal transplantation and laparoscopic surgeries. We present a case of bilateral accessory renal artery with a striking pre-hilar branching pattern encountered upon digital subtraction angiography (DSA) for imaging of the renal arteries of a healthy 30-year-old man, renal transplant donor. The right kidney received two renal arteries from the aorta including a main hilar and one lower polar. However, the left accessory artery while originated from the aorta, simultaneously, supplied both upper and lower renal poles following its pre-hilar division that replaced upper/apical and lower segmental arteries of the single main renal artery, respectively. The left main renal artery divided into two anterior and posterior segmental arteries. Whether this should be categorized either as an accessory hilar artery or a unique variant of renal arterial supply, the so-called bipolar supernumerary renal artery, is a matter of debate. We discuss possible embryologic origin and clinical aspects of accessory renal artery.

Magnetic resonance imaging technology allows for in vivo visualization of fiber tracts of the central nervous system using diffusion-weighted imaging sequences and data processing referred to as "diffusion tensor imaging" and "diffusion tensor tractography." While protocols for high-fidelity diffusion tensor imaging of the brain are well established, the spinal cord has proven a more difficult target for diffusion tensor methods. Here, we review the current literature on spinal diffusion tensor imaging and tractography with special emphasis on neuroanatomical correlations and clinical applications.

Rationale and Objectives Technium-99m methylene diphosphonate (99mTc-MDP) bone scintigraphy and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) are useful imaging modalities to detect skeletal metastases. Several other conditions such as infection, fractures, and arthritis can cause false-positive results with either modality. However, PET is felt to be more specific than bone scintigraphy for malignancy. Our objective was to investigate the value of PET scan compared with bone scintigraphy for directing biopsies in patients with suspected metastatic bone lesions. Materials and Methods Retrospective case series of subjects with undergoing skeletal biopsy of suspected metastases detected by 99mTc-MDP scintigraphy or 18F-FDG PET scan. Reference standards were pathologic reports and follow-up for 6 months. The diagnostic test performance measures of true positive (TP), false positive (FP), and positive predictive value (PPV) were calculated for each group. The PPV with 95% confidence intervals (CI) was compared using the Fisher exact test. Results There were a total of 68 subjects. PET-directed skeletal biopsies (n = 39) showed 35 TP, 4 FP, and an 89.7% PPV (95% CI: 75.7–97.1%). Bone scintigraphy directed biopsies (n = 29) had 21 TP, 8 FP, and 72.4 % PPV (95% CI: 52.7–82.7%). The PPV was not significantly different between the groups (P = .10). Conclusion This study supports that PET can be used to effectively direct bone biopsies to confirm metastatic neoplasm and suggests that PET may provide incremental improvement to diagnostic yield over bone scintigraphy. The role of PET compared with bone scintigraphy for directing skeletal biopsies warrants further verification.