Present Status of Musculoskeletal Radiology in Europe: International Survey by the European Society of Musculoskeletal Radiology

How young radiologists use contrast media and manage adverse reactions: an international survey

OBJECTIVES

To collect real-world data about the knowledge and self-perception of young radiologists concerning the use of contrast media (CM) and the management of adverse drug reactions (ADR).

METHODS

A survey (29 questions) was distributed to residents and board-certified radiologists younger than 40 years to investigate the current international situation in young radiology community regarding CM and ADRs. Descriptive statistics analysis was performed.

RESULTS

Out of 454 respondents from 48 countries (mean age: 31.7 ± 4 years, range 25-39), 271 (59.7%) were radiology residents and 183 (40.3%) were board-certified radiologists. The majority (349, 76.5%) felt they were adequately informed regarding the use of CM. However, only 141 (31.1%) received specific training on the use of CM and 82 (18.1%) about management ADR during their residency. Although 266 (58.6%) knew safety protocols for handling ADR, 69.6% (316) lacked confidence in their ability to manage CM-induced ADRs and 95.8% (435) expressed a desire to enhance their understanding of CM use and handling of CM-induced ADRs. Nearly 300 respondents (297; 65.4%) were aware of the benefits of contrast-enhanced ultrasound, but 249 (54.8%) of participants did not perform it. The preferred CM injection strategy in CT parenchymal examination and CT angiography examination was based on patient's lean body weight in 318 (70.0%) and 160 (35.2%), a predeterminate fixed amount in 79 (17.4%) and 116 (25.6%), iodine delivery rate in 26 (5.7%) and 122 (26.9%), and scan time in 31 (6.8%) and 56 (12.3%), respectively.

CONCLUSION

Training in CM use and management ADR should be implemented in the training of radiology residents.

CRITICAL RELEVANCE STATEMENT

We highlight the need for improvement in the education of young radiologists regarding contrast media; more attention from residency programs and scientific societies should be focused on training about contrast media use and the management of adverse drug reactions.

KEY POINTS

• This survey investigated training of young radiologists about use of contrast media and management adverse reactions. • Most young radiologists claimed they did not receive dedicated training. • An extreme heterogeneity of responses was observed about contrast media indications/contraindications and injection strategy.

Imaging of Tendinous and Muscular Anatomical Variants Around the Ankle

Tendinous and muscular anatomical variants around the ankle are usually an unexpected finding on imaging. Magnetic resonance imaging offers the best visualization of the accessory muscles; however, they can also be detected on radiography, ultrasonography, and computed tomography. Their accurate identification facilitates appropriate management of the rare symptomatic cases, mostly caused by accessory muscles in the posteromedial compartment. Symptomatic patients present with chronic ankle pain, most commonly as tarsal tunnel syndrome. The most frequently observed accessory muscle around the ankle is the peroneus tertius muscle, an accessory muscle in the anterior compartment. The tibiocalcaneus internus and peroneocalcaneus internus are uncommon; anterior fibulocalcaneus is rarely mentioned. We describe the anatomy of the accessory muscles with their anatomical relations accompanied by schematic drawings and radiologic images from clinical practice.

Tendons and Tendon Sheaths of the Hand - An Update on MRI

BACKGROUND

 The tendons of the hand run in close proximity to each other and within retinacular tunnels adjacent to articular joints, while forming intersections in characteristic locations. The enclosing tendon sheaths are often sites of systemic or infectious inflammation.

METHOD

 This review article outlines the different entities of tendon and tendon sheath pathology and their manifestation in the hands. Diagnostic findings in tendon and tendon sheath disorders are illustrated using MRI imaging and discussed in context with the current literature.

RESULTS AND CONCLUSION

 Overuse may cause stenosis in the fibrous outer layer of the retinacula and the A1 annular ligaments as well as tendinosis. In contrast, proliferative tenosynovitis is a disease of the synovial inner layer of the tendon sheath with tendon infiltration and tendinitis. Pyogenic tenosynovitis favors the flexor compartments. Because of the narrow spaces in the hand, a high-resolution MRI technique must be used.

KEY POINTS

  · Diseases of the tendons and tendon sheaths may have a mechanical, degenerative, metabolic, systemic inflammatory, or infectious etiology.. · Fibrous tunnels and bony prominences in close proximity to crossing tendons predispose to mechanical tendon irritation at typical sites of the hand.. · Stenosing tenovaginitis occurs in the fibrous layer of the extensor retinaculum or the A1 annular pulleys. The most frequent manifestations are the "trigger finger" and de Quervain disease.. · Proliferative tenosynovitis affects the synovial layer of the tendon sheaths before infiltrating the tendons. The classic representative is rheumatoid arthritis..

CITATION FORMAT

· Schmitt R, Hesse N, Grunz JP. Tendons and Tendon Sheaths of the Hand - An Update on MRI. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1826-1007.

Current status of MSK radiology training: an international survey by the European Society of Musculoskeletal Radiology (ESSR) Young Club

Objectives

There is wide variation between Countries in the structures of residency programmes, need for subspecialisation, and health care system organisation. This survey was aimed at gathering information regarding current musculoskeletal (MSK) educational programmes offered both in European and non-European Countries.

Methods

We administered an online survey to European Society of Radiology (ESR) residents and radiologists aged up to 35 years. The questionnaire was further disseminated by delegates of the ESR Radiology Trainees Forum. Survey consisted of 20 questions about the structure and organisation of MSK training programmes.

Results

Overall, 972 participants from 86 Countries completed the survey, with a wide heterogeneity of answers. Of them, 636 were residents (65.9%), 329 were certified radiologists (34.1%), with a mean age of 30.8 ± 3 years. Almost half of the participants had a dedicated MSK rotation/block during residency, with a duration of 3–6 months in 62.5% of cases. A dedicated period in MSK Ultrasound was present in only one-third of residency programmes; 38% of participants were expected to learn interventional MSK procedures, but only 28.2% have been actively involved in interventions during their residency. Overall, 62.7% of participants rated the quality of their MSK training as poor to average. Almost all (93.1%) thought that MSK training could be improved in their residency, especially ultrasound practice (80.7%) and MRI reporting (71.1%).

Conclusions

There are significant inconsistencies in the structure of MSK training offered by different Countries. Radiology trainees are showing substantial interest in MSK training, which necessitates strategic investments to standardise and enhance its quality.

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part IV, hip

Objectives

Image-guided musculoskeletal interventional procedures around the hip are widely used in daily clinical practice. The need for clarity concerning the actual added value of imaging guidance and types of medications to be offered led the Ultrasound and the Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) to promote, with the support of its Research Committee, a collaborative project to review the published literature on image-guided musculoskeletal interventional procedures in the lower limb in order to derive a list of clinical indications.

Methods

In this article, we report the results of a Delphi-based consensus of 53 experts who reviewed the published literature for evidence on image-guided interventional procedures offered in the joint and soft tissues around the hip in order of their clinical indications.

Results

Ten statements concerning image-guided treatment procedures around the hip have been collected by the panel of ESSR experts.

Conclusions

This work highlighted that there is still low evidence in the existing literature on some of these interventional procedures. Further large prospective randomized trials are essential to better confirm the benefits and objectively clarify the role of imaging to guide musculoskeletal interventional procedures around the hip.

Key Points

• Expert consensus produced a list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the hip.

• The highest level of evidence was only reached for one statement.

• Strong consensus was obtained for all statements.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00330-021-07997-5.

Quantitative Imaging and Radiomics in Multiple Myeloma: A Potential Opportunity?

Multiple Myeloma (MM) is the second most common type of hematological disease and, although it is rare among patients under 40 years of age, its incidence rises in elderly subjects. MM manifestations are usually identified through hyperCalcemia, Renal failure, Anaemia, and lytic Bone lesions (CRAB). In particular, the extent of the bone disease is negatively related to a decreased quality of life in patients and, in general, bone disease in MM increases both morbidity and mortality. The detection of lytic bone lesions on imaging, especially computerized tomography (CT) and Magnetic Resonance Imaging (MRI), is becoming crucial from the clinical viewpoint to separate asymptomatic from symptomatic MM patients and the detection of focal lytic lesions in these imaging data is becoming relevant even when no clinical symptoms are present. Therefore, radiology is pivotal in the staging and accurate management of patients with MM even in early phases of the disease. In this review, we describe the opportunities offered by quantitative imaging and radiomics in multiple myeloma. At the present time there is still high variability in the choice between various imaging methods to study MM patients and high variability in image interpretation with suboptimal agreement among readers even in tertiary centers. Therefore, the potential of medical imaging for patients affected by MM is still to be completely unveiled. In the coming years, new insights to study MM with medical imaging will derive from artificial intelligence (AI) and radiomics usage in different bone lesions and from the wide implementations of quantitative methods to report CT and MRI. Eventually, medical imaging data can be integrated with the patient’s outcomes with the purpose of finding radiological biomarkers for predicting the prognostic flow and therapeutic response of the disease.