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Shrestha R, Haug LP, Kransdorf MJ, Fox MG. Ankle, knee, and elbow arthrography: 2022 survey of Society of Skeletal Radiology members. Skeletal Radiol 2024; 53:1119-1124. [PMID: 38062171 DOI: 10.1007/s00256-023-04523-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To determine the preferred ankle, knee, and elbow arthrography injection techniques for Society of Skeletal Radiology (SSR) members and whether more recently described techniques are gaining acceptance. We also sought to determine whether the concept of knowledge translation might explain differences between the preferred technique, year of fellowship graduation, and year the newer technique was described. MATERIALS AND METHODS A 29-question survey was created in Qualtrics and submitted to current SSR members to determine if they perform knee, elbow, and ankle arthrography, and if so, the year of fellowship completion and preferred approaches. Survey respondents indicated the starting and ending needle tip positions for three knee, two elbow, and three ankle arthrography approaches using grids placed over provided frontal and lateral radiographs. RESULTS Two hundred seventy-four SSR members (mean post-fellowship 13 years; range 0-38) completed the survey and performed fluoroscopic-guided knee (93%), elbow (95%), and ankle (75%) arthrography. Preferred approaches included the following: knee lateral subpatellar (43%), anterior (40%); elbow radiocapitellar (74%); ankle anterior/peritendon (70%), lateral mortise (24%). Preference of newer technique was related to fellowship graduation year and publication year for the ankle mortise (26% before, 42% after; p = 0.03) and posterior trans-triceps elbow articles (19% before, 33% after; p < 0.01). The anterior knee approach preference increased from 11% in 2008 to 40% (p ≤ 0.001). CONCLUSION Nearly twice as many SSR members who graduated after the posterior trans-triceps and ankle mortise techniques were published prefer them for performing arthrography, possibly due to knowledge translation. The preference of the anterior knee arthrography approach has increased nearly fourfold since 2008.
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Affiliation(s)
- Roman Shrestha
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Logan P Haug
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Michael G Fox
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA.
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2
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Weissman BN, Palestro CJ, Fox MG, Bell AM, Blankenbaker DG, Frick MA, Jawetz ST, Kuo PH, Said N, Stensby JD, Subhas N, Tynus KM, Walker EA, Kransdorf MJ. ACR Appropriateness Criteria® Imaging After Total Hip Arthroplasty. J Am Coll Radiol 2023; 20:S413-S432. [PMID: 38040462 DOI: 10.1016/j.jacr.2023.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
This article reviews evidence for performing various imaging studies in patients with total hip prostheses. Routine follow-up is generally performed with radiography. Radiographs are also usually the initial imaging modality for patients with symptoms related to the prosthesis. Following acute injury with pain, noncontrast CT may add information to radiographic examination regarding the presence and location of a fracture, component stability, and bone stock. Image-guided joint aspiration, noncontrast MRI, and white blood cell scan and sulfur colloid scan of the hip, are usually appropriate studies for patients suspected of having periprosthetic infection. For evaluation of component loosening, wear, and/or osteolysis, noncontrast CT or MRI are usually appropriate studies. Noncontrast MRI is usually appropriate for identifying adverse reaction to metal debris related to metal-on-metal articulations. For assessing patients after hip arthroplasty, who have trochanteric pain and nondiagnostic radiographs, ultrasound, or MRI are usually appropriate studies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | | | - Angela M Bell
- Rush University Medical Center, Chicago, Illinois; American College of Physicians
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | - Phillip H Kuo
- University of Arizona, Tucson, Arizona; Commission on Nuclear Medicine and Molecular Imaging
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Katherine M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland
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3
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Caracciolo JT, Ali S, Chang CY, Degnan AJ, Flemming DJ, Henderson ER, Kransdorf MJ, Letson GD, Madewell JE, Murphey MD. Bone Tumor Risk Stratification and Management System: A Consensus Guideline from the ACR Bone Reporting and Data System Committee. J Am Coll Radiol 2023; 20:1044-1058. [PMID: 37855758 DOI: 10.1016/j.jacr.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/21/2023] [Accepted: 07/05/2023] [Indexed: 10/20/2023]
Abstract
The assessment and subsequent management of a potentially neoplastic bone lesion seen at diagnostic radiography is often complicated by diagnostic uncertainty and inconsistent management recommendations. Appropriate clinical management should be directed by risk of malignancy. Herein, the ACR-sponsored Bone Reporting and Data System (Bone-RADS) Committee, consisting of academic leaders in the fields of musculoskeletal oncology imaging and orthopedic oncology, presents the novel Bone-RADS scoring system to aid in risk assignment and provide risk-aligned management suggestions. When viewed in the proper clinical context, a newly identified bone lesion can be risk stratified as having very low, low, intermediate, or high risk of malignancy. Radiographic features predictive of risk are reviewed include margination, pattern of periosteal reaction, depth of endosteal erosion, pathological fracture, and extra-osseous soft tissue mass. Other radiographic features predictive of histopathology are also briefly discussed. To apply the Bone-RADS scoring system to a potentially neoplastic bone lesion, radiographic features predictive of risk are each given a point value. Point values are summed to yield a point total, which can be translated to a Bone-RADS score (1-4) with corresponding risk assignment (very low, low, intermediate, high). For each score, evidence-based and best practice consensus management suggestions are outlined. Examples of each Bone-RADS scores are presented, and a standardized diagnostic radiography report template is provided.
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Affiliation(s)
- Jamie T Caracciolo
- Senior Member and Professor, Diagnostic Imaging, Section Head, Musculoskeletal Imaging, Moffitt Cancer Center, Tampa, Florida.
| | - Sayed Ali
- Professor of Radiology, Section Chief of Musculoskeletal Radiology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Connie Y Chang
- Associate Professor of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrew J Degnan
- Radiologist, Section Chief of Pediatric Radiology, Abington Hospital-Jefferson Health, UPMC Children's Hospital of Pittsburgh, Abington, Pennsylvania
| | - Donald J Flemming
- Professor of Radiology and Orthopaedics and Diagnostic Radiology Residency Program Director, Department of Radiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Eric R Henderson
- Associate Professor of Orthopaedic Surgery Adjunct Associate Professor of Engineering, Norris Cotton Cancer Center, Dartmouth-Hitchcock Health, Lebanon, New Hampshire
| | | | - George Douglas Letson
- Physician in Chief of the Moffitt Medical Group, Moffitt Cancer Center, Tampa, Florida
| | - John E Madewell
- Professor and Chair ad interim Musculoskeletal Imaging, MD Anderson Cancer Center, Houston, Texas
| | - Mark D Murphey
- Physician-in-Chief, American Institute for Radiologic Pathology, Silver Spring, Maryland
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4
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Kresse ME, Kransdorf MJ, Beauchamp CP, Larsen BT, Goulding KA. Periosteal chondrosarcoma: an unusual juxtacortical sarcoma. Skeletal Radiol 2023; 52:623-631. [PMID: 36318319 DOI: 10.1007/s00256-022-04216-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 01/18/2023]
Abstract
Periosteal chondrosarcoma is a rare tumor. It can be difficult to diagnose radiographically and pathologically and can be confused with periosteal osteosarcoma; however, the treatment of these two lesions is quite different. Increased awareness of imaging features of this lesion, particularly those that can help differentiate it from other surface-based tumors, can help one recognize this entity. We report the case of a periosteal chondrosarcoma in a young woman, highlighting the diagnostic imaging features of this disease, and her treatment with a joint-sparing geometric resection of the distal femur, using patient-specific 3D-printed cutting guides and matched allograft reconstruction.
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Affiliation(s)
- Maxine E Kresse
- Department of Radiology and Medical Imaging, University of Virginia, PO Box 800170, Charlottesville, VA, 22908, USA
| | - Mark J Kransdorf
- Department of Radiology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA.
| | - Christopher P Beauchamp
- Department of Orthopedic Surgery, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Brandon T Larsen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Krista A Goulding
- Department of Orthopedic Surgery, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
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5
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Roberts CC, Metter DF, Fox MG, Appel M, Jawetz ST, Morrison WB, Nacey N, Said N, Stensby JD, Subhas N, Tynus KM, Walker EA, Yu JS, Kransdorf MJ. ACR Appropriateness Criteria® Imaging After Shoulder Arthroplasty: 2021 Update. J Am Coll Radiol 2022; 19:S53-S66. [PMID: 35550805 DOI: 10.1016/j.jacr.2022.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 11/19/2022]
Abstract
Shoulder arthroplasty is a common orthopedic procedure with a complication rate reported to be as high as 39.8% and revision rates as high as 11%. Symptoms related to postoperative difficulties include activity-related pain, decreased range of motion, and apprehension. Some patients report immediate and persistent dissatisfaction, although others report a symptom-free postoperative period followed by increasing pain and decreasing shoulder function and mobility. Imaging plays an important role in diagnosing postoperative complications of shoulder arthroplasties. The imaging algorithm should always begin with radiographs. The selection of the next imaging modality depends on several factors, including findings on the initial imaging study, clinical suspicion of an osseous versus soft-tissue injury, and clinical suspicion of infection.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Michael G Fox
- Panel Chair, Musculoskeletal Division Chair and Diagnostic Radiology Program Director, Mayo Clinic Arizona, Phoenix, Arizona
| | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons; and liaison with AOOS
| | - Shari T Jawetz
- Director, Radiology Quality Assurance; Director, Radiology Resident and Medical Student Education; and Chief, Division of Body CT, Hospital for Special Surgery, New York, New York
| | - William B Morrison
- Director, Division of Musculoskeletal Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; ACR education center faculty; ACR AIRP faculty; ACR CPI author
| | - Nicholas Nacey
- Fellowship Director, Imaging Center Medical Director, University of Virginia Health System, Charlottesville, Virginia
| | - Nicholas Said
- Medical Director of MRI Duke University Health System, Access Champion Department of Radiology, Director of Musculoskeletal Intervention, Duke University Medical Center, Durham, North Carolina
| | - James D Stensby
- MSK Imaging Fellowship Director, University of Missouri Health Care, Columbia, Missouri
| | - Naveen Subhas
- Vice Chair of Clinical Effectiveness and Efficiency, Imaging Institute Program Director, Musculoskeletal Radiology; and Director, Bone Mineral Densitometry, Cleveland Clinic, Cleveland, Ohio
| | - Katherine M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania and Uniformed Services University of the Health Sciences, Bethesda, Maryland; Past President of the Penn State College of Medicine Faculty Organization, ACR local chapter PRS President Elect
| | - Joseph S Yu
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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6
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Renfree KJ, Dahiya N, Kransdorf MJ, Zhang N, Patel KA, Drace PA. Comparative Accuracy of 1.5T MRI, 3T MRI, and Static Ultrasound in Diagnosis of Small Gaps in Repaired Flexor Tendons: A Cadaveric Study. J Hand Surg Am 2021; 46:287-294. [PMID: 33451904 DOI: 10.1016/j.jhsa.2020.10.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/07/2020] [Accepted: 10/26/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE We hypothesized that magnetic resonance imaging (MRI) would more accurately diagnose small gaps (<6 mm) after flexor tendon repair than static ultrasound (US) and that suture artifact would negatively impair accuracy. METHODS A laceration of the flexor digitorum profundus was created in 160 fresh-frozen cadaveric digits and randomized to either an intact repair (0-mm gap) or repairs using a locked 4-strand suture repair with either 4-0 Prolene, Ethibond, or and gaps of 2, 4,or 6 mm; or no suture in which 2-, 4-, or 6-mm gaps were created without a suture crossing the repair site. We performed 1.5T and 3T MRI and static US studies; gap widths were estimated by radiologists blinded to suture presence and true gap widths. RESULTS The 1.5 and 3.0T MRI had a lower mean error than US for gap sizes 0 and 2 mm. All 3 modalities performed similarly for 4- and 6-mm gaps. Documentation of imaging artifact worsened error, and odds of seeing artifacts were 1.72 higher with MRI than with US. Suture did not worsen artifact nor impair accuracy for any of the 3 modalities. When no suture was used, all 3 modalities significantly overestimated the true gap. CONCLUSIONS MRI is most accurate for small gaps less than 4 mm. Although all modalities overestimated gap sizes in specimens with a 0-mm gap (intact tendon repair), mean overestimation (<2 mm) was not clinically relevant. Ultrasound overestimated 2-mm gaps (clinically intact repairs), whereas MRIs did not. We recommend MRI for evaluation of gaps after flexor tendon repair. The 1.5T has slightly better sensitivity and specificity for distinguishing clinically intact (gap < 3 mm) from clinically impaired (gap > 3 mm) repairs than the 3T. CLINICAL RELEVANCE Accurate diagnosis of intact repairs or small gaps (<3 mm) might prevent unnecessary exploration or allow modification of rehabilitation protocols. Diagnosis of clinically relevant gaps (3-6 mm) may allow for earlier revision surgery before significant tendon retraction and adhesions develop, possibly necessitating a staged reconstruction.
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Affiliation(s)
- Kevin J Renfree
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ.
| | | | | | - Nan Zhang
- Department of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ
| | - Karan A Patel
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Patricia A Drace
- Department of Orthopaedic Surgery, Phoenix Children's Hospital, Phoenix, AZ
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7
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Smith SE, Chang EY, Ha AS, Bartolotta RJ, Bucknor M, Chandra T, Chen KC, Gorbachova T, Khurana B, Klitzke AK, Lee KS, Mooar PA, Ross AB, Shih RD, Singer AD, Taljanovic MS, Thomas JM, Tynus KM, Kransdorf MJ. ACR Appropriateness Criteria® Acute Trauma to the Ankle. J Am Coll Radiol 2020; 17:S355-S366. [PMID: 33153549 DOI: 10.1016/j.jacr.2020.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023]
Abstract
Acute injuries to the ankle are frequently encountered in the setting of the emergency room, sport, and general practice. This ACR Appropriateness Criteria defines best practices for imaging evaluation for several variants of patients presenting with acute ankle trauma. The variants include scenarios when Ottawa Rules can be evaluated, when there are exclusionary criteria, when Ottawa Rules cannot be evaluated, as well as specific injuries. Clinical scenarios are followed by the imaging choices and their appropriateness with an accompanying narrative explanation to help physicians to order the most appropriate imaging test. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Stacy E Smith
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts.
| | - Eric Y Chang
- Panel Chair, VA San Diego Healthcare System, San Diego, California
| | - Alice S Ha
- Panel Vice-Chair, University of Washington, Seattle, Washington
| | | | - Matthew Bucknor
- University of California San Francisco, San Francisco, California
| | | | - Karen C Chen
- VA San Diego Healthcare System, San Diego, California
| | | | | | - Alan K Klitzke
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kenneth S Lee
- University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Pekka A Mooar
- Temple University Hospital, Philadelphia, Pennsylvania; American Academy of Orthopaedic Surgeons
| | - Andrew B Ross
- University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - Richard D Shih
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, American College of Emergency Physicians
| | - Adam D Singer
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Jonelle M Thomas
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Katherine M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
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8
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Tafur M, Bencardino JT, Roberts CC, Appel M, Bell AM, Gyftopoulos S, Metter DF, Mintz DN, Morrison WB, Small KMS, Subhas N, Weissman BN, Yu JS, Kransdorf MJ. ACR Appropriateness Criteria® Chronic Foot Pain. J Am Coll Radiol 2020; 17:S391-S402. [PMID: 33153552 DOI: 10.1016/j.jacr.2020.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022]
Abstract
Chronic foot pain is a frequent clinical complaint, which can significantly impact the quality of live in some individuals. These guidelines define best practices with regards to requisition of imaging studies based on specific clinical scenarios, which have been grouped into different variants. Each variant is accompanied by a brief description of the usefulness, advantages, and limitations of different imaging modalities. The present narrative is the result of an exhaustive assessment of the available literature and a thorough review process by a panel of experts on Musculoskeletal Imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons
| | - Angela M Bell
- Rush University Medical Center, Chicago, Illinois; American College of Physicians
| | | | | | | | | | | | | | | | - Joseph S Yu
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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9
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Bestic JM, Wessell DE, Beaman FD, Cassidy RC, Czuczman GJ, Demertzis JL, Lenchik L, Motamedi K, Pierce JL, Sharma A, Sloan AE, Than K, Walker EA, Ying-Kou Yung E, Kransdorf MJ. ACR Appropriateness Criteria® Primary Bone Tumors. J Am Coll Radiol 2020; 17:S226-S238. [PMID: 32370967 DOI: 10.1016/j.jacr.2020.01.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 12/28/2022]
Abstract
Although primary bone tumors are relatively uncommon, appropriate imaging evaluation is essential when they are suspected or incidentally detected. In almost all cases, radiographs are the most appropriate initial imaging study for screening and characterization of primary bone tumors. Radiographs often provide sufficient information for diagnosis and to guide the treating clinician. However, when conventional radiographs alone are inadequate, they still often guide the selection of the most appropriate next step for advanced imaging. MRI and CT are typically the most appropriate next step. MRI provides excellent soft-tissue contrast allowing for evaluation of the tissue composition (such as fat, hemorrhage, fluid levels) and anatomic extent of bone tumors. CT provides complementary information, with its ability to detect subtle matrix mineralization or periosteal reaction that may not be seen on radiographs or MRI. This publication focuses on six common variants to guide diagnosis and management of primary bone tumors. In addition to conventional radiographs, appropriate use of MRI, CT, PET/CT, bone scan, and ultrasound are discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | | | | | - Leon Lenchik
- Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Kambiz Motamedi
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | | | - Andrew E Sloan
- University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio; Neurosurgery expert
| | - Khoi Than
- Oregon Health & Science University, Portland, Oregon; Neurosurgery expert
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania and Uniformed Services University of the Health Sciences, Bethesda, Maryland
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10
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Gorbachova T, Chang EY, Ha AS, Amini B, Dorfman SR, Fox MG, Khurana B, Klitzke A, Lee KS, Mooar PA, Shah KH, Shah NA, Singer AD, Smith SE, Taljanovic MS, Thomas JM, Kransdorf MJ. ACR Appropriateness Criteria® Acute Trauma to the Foot. J Am Coll Radiol 2020; 17:S2-S11. [PMID: 32370964 DOI: 10.1016/j.jacr.2020.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 12/26/2022]
Abstract
Acute injuries to the foot are frequently encountered in the emergency room and in general practice settings. This publication defines best practices for imaging evaluations for several variants of patients presenting with acute foot trauma. The variants include scenarios when the Ottawa rules can be evaluated, when there are exclusionary criteria, and when suspected pathology is in anatomic areas not addressed by the Ottawa rules. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Eric Y Chang
- Panel Chair, VA San Diego Healthcare System, San Diego, California
| | - Alice S Ha
- Panel Vice-Chair, University of Washington, Seattle, Washington
| | - Behrang Amini
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Alan Klitzke
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kenneth S Lee
- University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Pekka A Mooar
- Temple University Hospital, Philadelphia, Pennsylvania; American Academy of Orthopaedic Surgeons
| | - Kaushal H Shah
- Icahn School of Medicine at Mt Sinai, New York, New York; American College of Emergency Physicians
| | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
| | - Adam D Singer
- Emory University School of Medicine, Atlanta, Georgia
| | - Stacy E Smith
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | | | - Jonelle M Thomas
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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11
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Taljanovic MS, Chang EY, Ha AS, Bartolotta RJ, Bucknor M, Chen KC, Gorbachova T, Khurana B, Klitzke AK, Lee KS, Mooar PA, Nguyen JC, Ross AB, Shih RD, Singer AD, Smith SE, Thomas JM, Yost WJ, Kransdorf MJ. ACR Appropriateness Criteria® Acute Trauma to the Knee. J Am Coll Radiol 2020; 17:S12-S25. [PMID: 32370956 DOI: 10.1016/j.jacr.2020.01.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 11/20/2022]
Abstract
Acute trauma to the knee is a common presentation seen in the emergency department. After a routine clinical examination, imaging is frequently performed to facilitate the diagnosis and almost always starts with radiographs. If clinically indicated, advanced cross-sectional imaging may then be performed for further evaluation. CT is often performed for preoperative planning of the complex tibial plateau and distal femur fractures. Currently, MRI is the study of choice for evaluation of bone marrow, internal derangements, and other soft-tissue injuries about the knee joint. In patients with knee dislocations, MR angiography may be performed simultaneously with MRI for evaluation of internal derangements and vascular injuries with less morbidity compared to conventional angiography. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Eric Y Chang
- Panel Chair, VA San Diego Healthcare System, San Diego, California
| | - Alice S Ha
- Panel Vice-Chair, University of Washington, Seattle, Washington
| | | | - Matthew Bucknor
- University of California San Francisco, San Francisco, California
| | - Karen C Chen
- VA San Diego Healthcare System, San Diego, California
| | | | | | - Alan K Klitzke
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kenneth S Lee
- University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Pekka A Mooar
- Temple University Hospital, Philadelphia, Pennsylvania; American Academy of Orthopaedic Surgeons
| | - Jie C Nguyen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Andrew B Ross
- University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - Richard D Shih
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; American College of Emergency Physicians
| | - Adam D Singer
- Emory University School of Medicine, Atlanta, Georgia
| | - Stacy E Smith
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | - Jonelle M Thomas
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - William J Yost
- UnityPoint Health, Des Moines, Iowa; American College of Physicians
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Walker EA, Beaman FD, Wessell DE, Cassidy RC, Czuczman GJ, Demertzis JL, Lenchik L, Motamedi K, Pierce JL, Sharma A, Ying-Kou Yung E, Kransdorf MJ. ACR Appropriateness Criteria® Suspected Osteomyelitis of the Foot in Patients With Diabetes Mellitus. J Am Coll Radiol 2019; 16:S440-S450. [DOI: 10.1016/j.jacr.2019.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 12/16/2022]
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13
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Torabi M, Lenchik L, Beaman FD, Wessell DE, Bussell JK, Cassidy RC, Czuczman GJ, Demertzis JL, Khurana B, Klitzke A, Motamedi K, Pierce JL, Sharma A, Walker EA, Kransdorf MJ. ACR Appropriateness Criteria® Acute Hand and Wrist Trauma. J Am Coll Radiol 2019; 16:S7-S17. [DOI: 10.1016/j.jacr.2019.02.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/09/2019] [Indexed: 12/28/2022]
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14
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Beckmann NM, West OC, Nunez D, Kirsch CF, Aulino JM, Broder JS, Cassidy RC, Czuczman GJ, Demertzis JL, Johnson MM, Motamedi K, Reitman C, Shah LM, Than K, Ying-Kou Yung E, Beaman FD, Kransdorf MJ, Bykowski J. ACR Appropriateness Criteria® Suspected Spine Trauma. J Am Coll Radiol 2019; 16:S264-S285. [DOI: 10.1016/j.jacr.2019.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 02/05/2023]
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Small KM, Adler RS, Shah SH, Roberts CC, Bencardino JT, Appel M, Gyftopoulos S, Metter DF, Mintz DN, Morrison WB, Subhas N, Thiele R, Towers JD, Tynus KM, Weissman BN, Yu JS, Kransdorf MJ. ACR Appropriateness Criteria ® Shoulder Pain-Atraumatic. J Am Coll Radiol 2019; 15:S388-S402. [PMID: 30392607 DOI: 10.1016/j.jacr.2018.09.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 01/25/2023]
Abstract
Shoulder pain is one of the most common reasons for musculoskeletal-related physician visits. Imaging plays an important role in identifying the specific cause of atraumatic shoulder pain. This review is divided into two parts. The first part provides a general discussion of various imaging modalities (radiographs, arthrography, nuclear medicine, ultrasound, CT, and MRI) and their usefulness in evaluating atraumatic shoulder pain. The second part focuses on the most appropriate imaging algorithms for specific shoulder conditions including: rotator cuff disorders, labral tear/instability, bursitis, adhesive capsulitis, biceps tendon abnormalities, postoperative rotator cuff tears, and neurogenic pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Shaan H Shah
- Research Author, Brigham & Women's Hospital, Boston, Massachusetts
| | | | - Jenny T Bencardino
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons
| | | | - Darlene F Metter
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | | | | | - Ralf Thiele
- University of Rochester School of Medicine and Dentistry, Rochester, New York; American College of Rheumatology
| | - Jeffrey D Towers
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Katherine M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
| | | | - Joseph S Yu
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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16
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Amini B, Beckmann NM, Beaman FD, Wessell DE, Bernard SA, Cassidy RC, Czuczman GJ, Demertzis JL, Greenspan BS, Khurana B, Lee KS, Lenchik L, Motamedi K, Sharma A, Walker EA, Kransdorf MJ. ACR Appropriateness Criteria ® Shoulder Pain-Traumatic. J Am Coll Radiol 2019; 15:S171-S188. [PMID: 29724420 DOI: 10.1016/j.jacr.2018.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 02/08/2023]
Abstract
Traumatic shoulder pain is pain directly attributed to a traumatic event, either acute or chronic. This pain may be the result of either fracture (the clavicle, scapula, or proximal humerus) or soft-tissue injury (most commonly of the rotator cuff, acromioclavicular ligaments, or labroligamentous complex). Imaging assessment of traumatic shoulder pain begins with conventional radiography and, depending on physical examination findings, will require MRI or MR arthrography for assessment of soft-tissue injuries and CT for delineation of fracture planes. Ultrasound excels in assessment of rotator cuff injuries but has limited usefulness for assessment of the deep soft-tissues. CT angiography and conventional arteriography are helpful for assessment of vascular injury, and bone scintigraphy can be used in assessment of complex regional pain syndrome after traumatic shoulder injury. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Behrang Amini
- Principal Author, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | | | | | | | | | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | | | | | | | | | - Kenneth S Lee
- University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Leon Lenchik
- Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Kambiz Motamedi
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; and Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Fox MG, Chang EY, Amini B, Bernard SA, Gorbachova T, Ha AS, Iyer RS, Lee KS, Metter DF, Mooar PA, Shah NA, Singer AD, Smith SE, Taljanovic MS, Thiele R, Tynus KM, Kransdorf MJ. ACR Appropriateness Criteria® Chronic Knee Pain. J Am Coll Radiol 2018; 15:S302-S312. [DOI: 10.1016/j.jacr.2018.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
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18
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Kransdorf MJ, Murphey MD, Wessell DE, Cassidy RC, Czuczman GJ, Demertzis JL, Lenchik L, Motamedi K, Pierce JL, Sharma A, Walker EA, Ying-Kou Yung E, Beaman FD. ACR Appropriateness Criteria ® Soft-Tissue Masses. J Am Coll Radiol 2018; 15:S189-S197. [DOI: 10.1016/j.jacr.2018.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 02/07/2023]
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19
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Hochman MG, Melenevsky YV, Metter DF, Roberts CC, Bencardino JT, Cassidy RC, Fox MG, Kransdorf MJ, Mintz DN, Shah NA, Small KM, Smith SE, Tynus KM, Weissman BN. ACR Appropriateness Criteria ® Imaging After Total Knee Arthroplasty. J Am Coll Radiol 2018; 14:S421-S448. [PMID: 29101982 DOI: 10.1016/j.jacr.2017.08.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/29/2023]
Abstract
Total knee arthroplasty (TKA) is the most commonly performed joint replacement procedure in the United States and annual demand for primary TKA is expected to grow by 673% by 2030. The first part provides an overview of imaging modalities (radiographs, CT, MRI, ultrasound, and various nuclear medicine studies) and discusses their usefulness in the imaging evaluation of TKA. The second part focuses on evidence-based imaging and imaging-guided intervention algorithms for the workup of TKA and its complications, including routine follow-up, component wear, periprosthetic infection, aseptic loosening, granulomas/osteolysis, conventional and rotational instability, periprosthetic fracture, patellar complications, and a variety of periprosthetic soft tissue abnormalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Mary G Hochman
- Principal Author, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Yulia V Melenevsky
- Research Author, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Darlene F Metter
- Co-author, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Jenny T Bencardino
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | | | | | | | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
| | | | | | - Kathy M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
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20
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Rosenthal DI, Kransdorf MJ, Link TM, Astrom G. Skeletal Radiology: The Year in Review 2017. Skeletal Radiol 2018; 47:303-305. [PMID: 29273828 DOI: 10.1007/s00256-017-2844-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
| | | | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Abstract
Radiologic evaluation of musculoskeletal soft-tissue masses has changed dramatically with the continued improvements in imaging technology. The integration of advanced imaging has provided the radiologist with a wide range of assessment tools, but as with all powerful arsenals, selection and application of the appropriate imaging method can be problematic. Although the choices available for imaging evaluation of musculoskeletal masses have changed dramatically, the basic objectives of this assessment have remained constant: diagnosis and staging. The basic principles for evaluating musculoskeletal soft-tissue masses and achieving these objectives have not changed. This article addresses application of the current imaging methods to assessment of soft-tissue musculoskeletal masses, emphasizing fundamental concepts. We do not intend to provide a comprehensive review of imaging techniques, but rather to provide a useful review of the concepts needed to select the appropriate initial imaging method, magnetic resonance (MR) imaging field of view, MR imaging sequences, contrast material requirements, and rapid image acquisition techniques. We also address use of the new quantitative techniques of chemical shift and diffusion-weighted imaging. Finally, we review the current uses of computed tomography and ultrasonography. Although the choices available for imaging evaluation of musculoskeletal masses have changed dramatically within the past decade, appropriate application of the fundamental concepts of imaging will maximize the diagnostic utility of imaging examinations. ©RSNA, 2016.
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Affiliation(s)
- Mark J Kransdorf
- From the Department of Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.J.K.); American Institute for Radiologic Pathology, Silver Spring, Md (M.D.M.); and Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.M.)
| | - Mark D Murphey
- From the Department of Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.J.K.); American Institute for Radiologic Pathology, Silver Spring, Md (M.D.M.); and Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.M.)
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Abstract
BACKGROUND No single imaging approach is ideal for every tumor. While radiography can be effective for diagnosis of specific tumors, additional imaging is often required. Soft tissue sarcomas require a multimodality approach. METHODS The authors discuss the general imaging approaches for patients who present with soft tissue masses, the fundamental principles inherent to tumor imaging, and the specific applications of newer imaging modalities. RESULTS Magnetic resonance imaging has emerged as the preferred technique for evaluating soft tissue tumors but is limited in demonstrating the pattern of soft tissue calcification. Computed tomography is the best modality for evaluating osseous architecture and for patients who cannot be evaluated with MRI. PET is helpful in metabolic imaging, and ultrasonography is useful in differentiating cystic from solid masses. Magnetic resonance angiography accurately reveals the arterial and venous supply of vascular tumors. CONCLUSIONS Current imaging techniques provide numerous noninvasive methods to diagnose and stage suspected soft tissue sarcomas.
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Affiliation(s)
- Edson L Knapp
- East Pasco Medical Center, Department of Radiology, Zephyrhills, FL 33541, USA.
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Beaman FD, von Herrmann PF, Kransdorf MJ, Adler RS, Amini B, Appel M, Arnold E, Bernard SA, Greenspan BS, Lee KS, Tuite MJ, Walker EA, Ward RJ, Wessell DE, Weissman BN. ACR Appropriateness Criteria ® Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot). J Am Coll Radiol 2017; 14:S326-S337. [DOI: 10.1016/j.jacr.2017.02.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 11/28/2022]
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Mintz DN, Roberts CC, Bencardino JT, Baccei SJ, Caird MS, Cassidy RC, Chang EY, Fox MG, Gyftopoulos S, Kransdorf MJ, Metter DF, Morrison WB, Rosenberg ZS, Shah NA, Small KM, Subhas N, Tambar S, Towers JD, Yu JS, Weissman BN. ACR Appropriateness Criteria ® Chronic Hip Pain. J Am Coll Radiol 2017; 14:S90-S102. [DOI: 10.1016/j.jacr.2017.01.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 11/27/2022]
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Mosher TJ, Kransdorf MJ, Adler R, Appel M, Beaman FD, Bernard SA, Bruno MA, Dempsey ME, Fries IB, Khoury V, Khurana B, Roberts CC, Tuite MJ, Ward RJ, Zoga AC, Weissman BN. ACR Appropriateness Criteria acute trauma to the ankle. J Am Coll Radiol 2016; 12:221-7. [PMID: 25743919 DOI: 10.1016/j.jacr.2014.11.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 12/26/2022]
Abstract
Acute ankle injuries are frequently diagnosed and treated in emergency departments and outpatient clinics. Recent evidence-based clinical treatment guidelines and systematic review of economic analyses support the use of 3-view (anteroposterior, lateral, and mortise) radiographic evaluation of patients meeting the criteria of the Ottawa ankle rules. Cross-sectional imaging has a limited secondary role primarily as a tool for preoperative planning and as a problem-solving technique in patients with persistent symptoms and suspected of having occult fractures. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
- Timothy J Mosher
- Penn State University, Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | | | - Ronald Adler
- New York University Center for Musculoskeletal Care, New York, New York
| | - Marc Appel
- Warwick Valley Orthopedic Surgery, Warwick, New York; American Academy of Orthopaedic Surgeons, Rosemont, Illinois
| | | | - Stephanie A Bernard
- Penn State University, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Michael A Bruno
- Penn State University, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Ian Blair Fries
- American Academy of Orthopaedic Surgeons, Rosemont, Illinois; Bone, Spine and Hand Surgery, Chartered, Brick, NJ
| | - Viviane Khoury
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | - Adam C Zoga
- Thomas Jefferson University, Philadelphia, Pennsylvania
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27
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Roberts CC, Kransdorf MJ, Beaman FD, Adler RS, Amini B, Appel M, Bernard SA, Fries IB, Germano IM, Greenspan BS, Holly LT, Kubicky CD, Lo SSM, Mosher TJ, Sloan AE, Tuite MJ, Walker EA, Ward RJ, Wessell DE, Weissman BN. ACR Appropriateness Criteria Follow-Up of Malignant or Aggressive Musculoskeletal Tumors. J Am Coll Radiol 2016; 13:389-400. [PMID: 26922595 DOI: 10.1016/j.jacr.2015.12.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/16/2015] [Indexed: 02/07/2023]
Abstract
Appropriate imaging modalities for the follow-up of malignant or aggressive musculoskeletal tumors include radiography, MRI, CT, (18)F-2-fluoro-2-deoxy-D-glucose PET/CT, (99m)Tc bone scan, and ultrasound. Clinical scenarios reviewed include evaluation for metastatic disease to the lung in low- and high-risk patients, for osseous metastatic disease in asymptomatic and symptomatic patients, for local recurrence of osseous tumors with and without significant hardware present, and for local recurrence of soft tissue tumors. The timing for follow-up of pulmonary metastasis surveillance is also reviewed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Ronald S Adler
- New York University Center for Musculoskeletal Care, New York, New York
| | - Behrang Amini
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marc Appel
- Warwick Valley Orthopedic Surgery, Warwick, New York, American Academy of Orthopaedic Surgeons
| | - Stephanie A Bernard
- Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Ian Blair Fries
- Bone, Spine and Hand Surgery, Chartered, Brick, New Jersey, American Academy of Orthopaedic Surgeons
| | | | | | - Langston T Holly
- University of California Los Angeles Medical Center, Los Angeles, California
| | | | - Simon Shek-Man Lo
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Timothy J Mosher
- Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Andrew E Sloan
- University Hospital Case Medical Center, Cleveland, Ohio
| | | | - Eric A Walker
- Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Garner HW, Kransdorf MJ. Musculoskeletal Sarcoma: Update on Imaging of the Post-treatment Patient. Can Assoc Radiol J 2016; 67:12-20. [DOI: 10.1016/j.carj.2014.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 12/30/2022] Open
Abstract
Post-treatment imaging of musculoskeletal sarcoma remains challenging, but newer imaging techniques are improving our ability to recognize both local and distant recurrence and accurately distinguish local recurrence from post-treatment change. We review recent advances in dynamic contrast-enhanced magnetic resonance imaging, diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient mapping and positron emission tomography/computed tomography in the post-treatment follow-up of musculoskeletal sarcoma. We also describe our multidisciplinary sarcoma team approach to patient care and the essential role of the radiologist in the clinical follow-up scheme.
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Murphey MD, Foreman KL, Klassen-Fischer MK, Fox MG, Chung EM, Kransdorf MJ. From the radiologic pathology archives imaging of osteonecrosis: radiologic-pathologic correlation. Radiographics 2015; 34:1003-28. [PMID: 25019438 DOI: 10.1148/rg.344140019] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Osteonecrosis is common and represents loss of blood supply to a region of bone. Common sites affected include the femoral head, humeral head, knee, femoral/tibial metadiaphysis, scaphoid, lunate, and talus. Symptomatic femoral head osteonecrosis accounts for 10,000-20,000 new cases annually in the United States. In contradistinction, metadiaphyseal osteonecrosis is often occult and asymptomatic. There are numerous causes of osteonecrosis most commonly related to trauma, corticosteroids, and idiopathic. Imaging of osteonecrosis is frequently diagnostic with a serpentine rim of sclerosis on radiographs, photopenia in early disease at bone scintigraphy, and maintained yellow marrow at MR imaging with a serpentine rim of high signal intensity (double-line sign) on images obtained with long repetition time sequences. These radiologic features correspond to the underlying pathology of osseous response to wall off the osteonecrotic process and attempts at repair with vascularized granulation tissue at the reactive interface. The long-term clinical importance of epiphyseal osteonecrosis is almost exclusively based on the likelihood of overlying articular collapse. MR imaging is generally considered the most sensitive and specific imaging modality both for early diagnosis and identifying features that increase the possibility of this complication. Treatment subsequent to articular collapse and development of secondary osteoarthritis typically requires reconstructive surgery. Malignant transformation of osteonecrosis is rare and almost exclusively associated with metadiaphyseal lesions. Imaging features of this dire sequela include aggressive bone destruction about the lesion margin, cortical involvement, and an associated soft-tissue mass. Recognizing the appearance of osteonecrosis, which reflects the underlying pathology, improves radiologic assessment and is important to guide optimal patient management.
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Affiliation(s)
- Mark D Murphey
- From the Departments of Musculoskeletal Imaging (M.D.M., K.L.F., E.M.C.) and Pediatric Imaging (E.M.C.), American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910; Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.M., E.M.C.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.D.M., K.L.F., E.M.C.); Joint Pathology Center, Silver Spring, Md (M.K.K.F.); Department of Radiology, University of Virginia, Charlottesville, Va (M.G.F.); and Mayo Clinic Hospital, Phoenix, Ariz (M.J.K.)
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Tuite MJ, Kransdorf MJ, Beaman FD, Adler RS, Amini B, Appel M, Bernard SA, Dempsey ME, Fries IB, Greenspan BS, Khurana B, Mosher TJ, Walker EA, Ward RJ, Wessell DE, Weissman BN. ACR Appropriateness Criteria Acute Trauma to the Knee. J Am Coll Radiol 2015; 12:1164-72. [DOI: 10.1016/j.jacr.2015.08.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/16/2015] [Indexed: 01/03/2023]
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31
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Bancroft LW, Kransdorf MJ, Adler R, Appel M, Beaman FD, Bernard SA, Bruno MA, Dempsey ME, Fries IB, Khoury V, Khurana B, Mosher TJ, Roberts CC, Tuite MJ, Ward RJ, Zoga AC, Weissman BN. ACR Appropriateness Criteria Acute Trauma to the Foot. J Am Coll Radiol 2015; 12:575-81. [DOI: 10.1016/j.jacr.2015.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 02/18/2015] [Indexed: 12/23/2022]
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Kohl CA, Chivers FS, Lorans R, Roberts CC, Kransdorf MJ. Accuracy of chemical shift MR imaging in diagnosing indeterminate bone marrow lesions in the pelvis: review of a single institution's experience. Skeletal Radiol 2014; 43:1079-84. [PMID: 24781818 DOI: 10.1007/s00256-014-1886-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/28/2014] [Accepted: 03/30/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To re-assess the accuracy of chemical shift imaging in diagnosing indeterminate bone marrow lesions as benign or malignant. MATERIALS AND METHODS We retrospectively reviewed our experience with MR imaging of the pelvis to assess the accuracy of chemical shift imaging in distinguishing benign from malignant bone lesions. Two musculoskeletal radiologists retrospectively reviewed all osseous lesions biopsied since 2006, when chemical shift imaging was added to our routine pelvic imaging protocol. Study inclusion criteria required (1) MR imaging of an indeterminate bone marrow lesion about the pelvis and (2) subsequent histologic confirmation. The study group included 50 patients (29 male, 21 female) with an average age of 67 years (range, 41-89 years). MR imaging results were evaluated using biopsy results as the "gold standard." RESULTS There were 27 malignant and 23 benign lesions. Chemical shift imaging using an opposed-phase signal loss criteria of less than 20 % to indicate a malignant lesion, correctly diagnosed 27/27 malignant lesions and 14/23 benign lesions, yielding a 100 % sensitivity, 61 % specificity, 75 % PPV, 100 % NPV, and 82 % accuracy. The area under the receiver operator characteristic (ROC) curve was 0.88. The inter-rater and intra-rater agreement K values were both 1.0. CONCLUSIONS Chemical shift imaging is a useful adjunct MR technique to characterize focal and diffuse marrow abnormalities on routine non-contrast pelvic imaging. It is highly sensitive in identifying malignant disease. Despite its lower specificity, the need for biopsy could be eliminated in more than 60 % of patients with benign disease.
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Affiliation(s)
- Chad A Kohl
- Department of Radiology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
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Ward RJ, Weissman BN, Kransdorf MJ, Adler R, Appel M, Bancroft LW, Bernard SA, Bruno MA, Fries IB, Morrison WB, Mosher TJ, Roberts CC, Scharf SC, Tuite MJ, Zoga AC. ACR Appropriateness Criteria Acute Hip Pain—Suspected Fracture. J Am Coll Radiol 2014; 11:114-20. [DOI: 10.1016/j.jacr.2013.10.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 10/25/2013] [Indexed: 10/25/2022]
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Affiliation(s)
- Kristopher L Foreman
- Departments of Diagnostic Radiology, Orthopedic Surgery, and Pathology, Mayo Clinic Florida, Jacksonville, FL 32224, USA.
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Murphey MD, Senchak LT, Mambalam PK, Logie CI, Klassen-Fischer MK, Kransdorf MJ. From the Radiologic Pathology Archives: Ewing Sarcoma Family of Tumors: Radiologic-Pathologic Correlation. Radiographics 2013; 33:803-31. [DOI: 10.1148/rg.333135005] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Ginzel AW, Kransdorf MJ, Peterson JJ, Garner HW, Murphey MD. Mass-like extramedullary hematopoiesis: imaging features. Skeletal Radiol 2012; 41:911-6. [PMID: 22101909 DOI: 10.1007/s00256-011-1323-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/27/2011] [Accepted: 10/30/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the imaging appearances of mass-like extramedullary hematopoiesis (EMH), to identify those features that are sufficiently characteristic to allow a confident diagnosis, and to recognize the clinical conditions associated with EMH and the relative incidence of mass-like disease. MATERIALS AND METHODS We retrospectively identified 44 patients with EMH; 12 of which (27%) had focal mass-like lesions and formed the study group. The study group consisted of 6 male and 6 female subjects with a mean age of 58 years (range 13-80 years). All 12 patients underwent CT imaging and 3 of the 12 patients had undergone additional MR imaging. The imaging characteristics of the extramedullary hematopoiesis lesions in the study group were analyzed and recorded. The patient's clinical presentation, including any condition associated with extramedullary hematopoiesis, was also recorded. RESULTS Ten of the 12 (83%) patients had one or more masses located along the axial skeleton. Of the 10 patients with axial masses, 9 (90%) had multiple masses and 7 (70%) demonstrated internal fat. Eight patients (80%) had paraspinal masses and 4 patients (40%) had presacral masses. Seven patients (70%) had splenomegaly. Eleven of the 12 patients had a clinical history available for review. A predisposing condition for extramedullary hematopoiesis was present in 10 patients and included various anemias (5 cases; 45%), myelofibrosis/myelodysplastic syndrome (4 cases; 36%), and marrow proliferative disorder (1 case; 9%). One patient had no known predisposing condition. CONCLUSION Mass-like extramedullary hematopoiesis most commonly presents as multiple, fat-containing lesions localized to the axial skeleton. When these imaging features are identified, extramedullary hematopoiesis should be strongly considered, particularly when occurring in the setting of a predisposing medical condition.
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Affiliation(s)
- Andrew W Ginzel
- Synergy Radiology Associates, P.A., 7026 Old Katy Road #276, Houston, TX 77024, USA
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Tuite MJ, Daffner RH, Weissman BN, Bancroft L, Bennett DL, Blebea JS, Bruno MA, Fries IB, Hayes CW, Kransdorf MJ, Luchs JS, Morrison WB, Roberts CC, Scharf SC, Stoller DW, Taljanovic MS, Ward RJ, Wise JN, Zoga AC. ACR appropriateness criteria(®) acute trauma to the knee. J Am Coll Radiol 2012; 9:96-103. [PMID: 22305695 DOI: 10.1016/j.jacr.2011.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 10/24/2011] [Indexed: 01/03/2023]
Abstract
There are more than 1 million visits to the ER annually in the United States for acute knee trauma. Many of these are twisting injuries in young patients who can walk and bear weight, and emergent radiography is not required. Several clinical decision rules have been devised that can considerably reduce the number of radiographic studies ordered without missing a clinically significant fracture. Although fractures are seen on only 5% of emergency department knee radiographs, 86% of knee fractures result from blunt trauma. In patients with falls or twisting injuries who have focal tenderness, effusion, or inability to bear weight, radiography should be the first imaging study performed. If radiography shows no fracture, MRI is best for evaluating for a suspected meniscal or ligament tear or patellar dislocation. Patients with knee dislocation should undergo radiography and MRI, as well as fluoroscopic angiography, CT angiography, or MR angiography. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Desai MA, Peterson JJ, Garner HW, Kransdorf MJ. Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics 2012; 31:1365-75; discussion 1376-7. [PMID: 21918049 DOI: 10.1148/rg.315115510] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although diagnosing gout generally is straightforward, atypical disease may present a challenge if it is associated with unusual symptoms or sites, discordant serum urate level, or mimics of gout. Dual-energy computed tomography (CT) may be used to differentiate urate crystals from calcium by using specific attenuation characteristics, which may help diagnose gout. In patients with known tophaceous gout, dual-energy CT may be used for serial volumetric quantification of subclinical tophi to evaluate response to treatment. Given the utility of dual-energy CT in challenging cases and its ability to provide an objective outcomes measure in patients with tophaceous gout, dual-energy CT promises to be a unique and clinically relevant modality in the diagnosis and management of gout.
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Affiliation(s)
- Madhura A Desai
- Department of Radiology, Mayo Clinic, Jacksonville, FL 32224, USA.
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Desai MA, Peterson JJ, Garner HW, Kransdorf MJ. Authors’ Response. Radiographics 2011. [DOI: 10.1148/radiographics.31.5.3151377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Khanna M, Naraghi AM, Salonen D, Bhumbra R, Dickson BC, Kransdorf MJ, White LM. Massive localised lymphoedema: clinical presentation and MR imaging characteristics. Skeletal Radiol 2011; 40:647-52. [PMID: 21249496 DOI: 10.1007/s00256-010-1080-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/02/2010] [Accepted: 12/05/2010] [Indexed: 02/02/2023]
Abstract
Three morbidly obese women were referred to us with suspected soft-tissue sarcomas. All lesions arose from the medial subcutaneous tissues of the thigh, and were shown to represent massive localised lymphoedema (MLL), a rare condition occurring in morbidly obese adults. MR imaging typically demonstrates a sharply demarcated, pedunculated mass consisting of fat partitioned by fibrous septae surrounded by a thickened dermis. There is oedema both within the mass and tracking along the subcutaneous septae in a "lace-like" fashion outwards from the pedicle, outlining large lobules of fat. Minimal enhancement is observed within the dermis of the lesion following intravenous gadolinium administration. Obesity is a growing problem that is likely to result in an increase in the prevalence of this condition; therefore, familiarity with the radiological appearance is important in establishing a correct diagnosis in this condition that may mimic a soft-tissue sarcoma.
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Affiliation(s)
- Monica Khanna
- Department of Clinical Imaging, Imperial College Healthcare NHS Trust, London, UK.
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Bernard SA, Murphey MD, Flemming DJ, Kransdorf MJ. Improved differentiation of benign osteochondromas from secondary chondrosarcomas with standardized measurement of cartilage cap at CT and MR imaging. Radiology 2010; 255:857-65. [PMID: 20392983 DOI: 10.1148/radiol.10082120] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To validate a technique for reproducible measurement of the osteochondroma cartilage cap with computed tomography (CT) and magnetic resonance (MR) imaging and to reevaluate the correlation of the thickness of the cartilage cap with pathologic findings to improve noninvasive differentiation of benign osteochondromas from secondary chondrosarcomas. MATERIALS AND METHODS The institutional review board approved the study and waived the need for informed consent. HIPAA compliance was maintained. After validation of the measurement technique, 101 pathologically confirmed osteochondromas were retrospectively reviewed. Patient demographic data, histologic diagnosis, and chondrosarcoma grade were recorded. Two musculoskeletal radiologists used a standardized technique to independently measure the thicknesses of the cartilage caps on CT and MR images; these measurements were compared for interobserver agreement. Agreement between measurements with CT and MR imaging was also evaluated, as were the sensitivity and specificity of both modalities for differentiation of osteochondromas from chondrosarcomas. RESULTS Evaluated were 67 benign osteochondromas (from 49 male patients and 18 female patients; mean age, 23.4 years) and 34 secondary chondrosarcomas (from 27 male patients and seven female patients; mean age, 33.2 years). On the basis of the proposed measuring technique, there was 88% interobserver measurement agreement with MR imaging (95% confidence interval [CI]: 80%, 94%) and 93% with CT (95% CI: 84%, 98%). The median difference between measurements of cap thickness at CT and MR imaging was 0 cm (25th and 75th percentiles, -3 mm and 1 mm, respectively). With 2 cm used as a cutoff for distinguishing benign osteochondromas from chondrosarcomas, the sensitivities and specificities were 100% and 98% for MR imaging and 100% and 95% for CT, respectively. CONCLUSION The proposed measuring technique allows accurate and reproducible measurement of cartilage cap thickness with both CT and MR imaging. Cap thickness of 2 cm or greater strongly indicated secondary chondrosarcomas.
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Affiliation(s)
- Stephanie A Bernard
- Department of Radiology, Penn State-Milton S. Hershey Medical Center, 500 University Dr, Room H066, Hershey, PA 17033, USA.
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Affiliation(s)
- Tonya L. Dixon
- Meharry Medical College School of Medicine, Nashville, TN USA
| | | | - Murli Krishna
- Department of Pathology, Mayo Clinic, Jacksonville, FL USA
| | - Mary I. O’Connor
- Department of Orthopedic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
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Affiliation(s)
- Benjamin K. Potter
- Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL USA ,Integrated Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Building 2A, Room 205, Washington, DC 20307 USA ,Department of Surgery, Uniformed Service University of Health Sciences, Bethesda, MD USA
| | - Sheila C. Adams
- Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL USA
| | | | - H. Thomas Temple
- Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL USA
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Moore LF, Kransdorf MJ, Buskirk SJ, O'Connor MI, Menke DM. Radiation-induced pseudotumor following therapy for soft tissue sarcoma. Skeletal Radiol 2009; 38:579-84. [PMID: 19221738 DOI: 10.1007/s00256-009-0653-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 01/10/2009] [Accepted: 01/12/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to describe the prevalence and imaging appearance of radiation induced pseudotumors in patients following radiation therapy for extremity soft tissue sarcomas. MATERIALS AND METHODS We retrospectively reviewed the serial magnetic resonance (MR) images of 24 patients following radiation therapy for extremity soft tissue sarcomas. A total of 208 exams were reviewed (mean, 8.7 exams per patient) and included all available studies following the start of radiation therapy. Exams were analyzed for the identification of focal signal abnormalities within the surgical bed suggesting local tumor recurrence. Histopathologic correlation was available in nine patients suspected of having local tumor recurrence. Additional information recorded included patient demographics, tumor type and location, radiation type, and dose. RESULTS The study group consisted of 12 men and 12 women, having an average age of 63 years (range, 39-88 years). Primary tumors were malignant fibrous histiocytoma (n = 13), leiomyosarcoma (n = 6), liposarcoma (n = 3), synovial sarcoma (n = 1), and extraskeletal chondrosarcoma (n = 1). All lesions were high-grade sarcomas, except for two myxoid liposarcomas. Average patient radiation dose was 5,658 cGy (range, 4,500-8,040 cGy). Average follow-up time was 63 months (range, 3-204 months). Focal signal abnormalities suggesting local recurrence were seen in nine (38%) patients. Three of the nine patients with these signal abnormalities were surgically proven to have radiation-induced pseudotumor. The pseudotumors developed between 11 and 61 months following the initiation of radiation therapy (mean, 38 months), with an average radiation dose of 5,527 cGy (range, 5,040-6,500 cGy). MR imaging demonstrated a relatively ill-defined ovoid focus of abnormal signal and intense heterogeneous enhancement with little or no associated mass effect. CONCLUSION MR imaging of radiation-induced pseudotumor typically demonstrates a relatively ill-defined ovoid mass-like focus of intense heterogeneous enhancement with little or no associated mass effect. Imaging follow-up or biopsy may be an alternative course of action to surgical re-exploration if this diagnosis is considered. The study revealed radiation-induced pseudotumor in 12.5% of patients in our extremity study group, suggesting that radiation-induced pseudotumor may be more prevalent than previously reported.
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Affiliation(s)
- Lacey F Moore
- Department of Radiology, Mayo Clinic, Jacksonville, FL 32224-3899, USA
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Abstract
Differential diagnosis of soft tissue lesions of the foot can be narrowed with imaging. The cystic nature of ganglia, synovial cysts, and bursitis can be confirmed with MR imaging or sonography. Location and signal characteristics of noncystic lesions can suggest Morton's neuroma, giant cell tumor of tendon sheath, and plantar fibromatosis. Synovial-based lesions of the foot and ankle can be differentiated based on presence or absence of mineralization, lesion density, signal intensity, and enhancement pattern. Knowledge of the incidence of specific neoplasms of the foot and ankle based on patient age aids in providing a limited differential diagnosis.
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Affiliation(s)
- Laura W Bancroft
- Department of Radiology, University of Central Florida, Florida Hospital, 601 East Rollins Street, Orlando, FL 32803, USA.
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Garner HW, Kransdorf MJ, Bancroft LW, Peterson JJ, Berquist TH, Murphey MD. Benign and Malignant Soft-Tissue Tumors: Posttreatment MR Imaging. Radiographics 2009; 29:119-34. [DOI: 10.1148/rg.291085131] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kransdorf MJ. Society of skeletal radiology 2008 annual meeting. Skeletal Radiol 2009; 38:97-100. [PMID: 18594810 DOI: 10.1007/s00256-008-0531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 05/22/2008] [Indexed: 02/02/2023]
Abstract
Peer-reviewed abstracts presented at the 2008 Society of Skeletal Radiology (SSR) Annual Meeting were reviewed again following oral presentation. Topics representing new concepts, new or novel imaging techniques and instructive case series involving the musculoskeletal system, felt to be of potential interest to investigators and practicing clinicians, have been highlighted in this compilation and analysis.
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Affiliation(s)
- Mark J Kransdorf
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Russell JM, Kransdorf MJ, Bancroft LW, Peterson JJ, Berquist TH, Bridges MD. Magnetic resonance imaging of the sacral plexus and piriformis muscles. Skeletal Radiol 2008; 37:709-13. [PMID: 18521595 DOI: 10.1007/s00256-008-0486-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2008] [Revised: 02/24/2008] [Accepted: 03/03/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective was to evaluate the piriformis muscles and their relationship to the sacral nerve roots on T1-weighted MRI in patients with no history or clinical suspicion of piriformis syndrome. PATIENTS AND METHODS Axial oblique and sagittal T1-weighted images of the sacrum were obtained in 100 sequential patients (200 pairs of sacral roots) undergoing routine MRI examinations. The relationship of the sacral nerve roots to the piriformis muscles and piriformis muscle size were evaluated, as were clinical symptoms via a questionnaire. RESULTS The S1 nerve roots were located above the piriformis muscle in 99.5% of cases (n=199). The S2 nerve roots were located above the piriformis muscle in 25% of cases (n=50), and traversed the muscle in 75% (n=150). The S3 nerve roots were located above the piriformis muscle in 0.5% of cases (n=1), below the muscle in 2.5% (n=5), and traversed the muscle in 97% (n=194). The S4 nerve roots were located below the muscle in 95% (n=190). The piriformis muscles ranged in size from 0.8-3.2 cm, with an average size of 1.9 cm. Nineteen percent of patients had greater than 3 mm of asymmetry in the size of the piriformis muscle, with a maximum asymmetry of 8 mm noted. CONCLUSION The S1 nerve roots course above the piriformis muscle in more than 99% of patients. The S2 roots traverse the piriformis muscle in 75% of patients. The S3 nerve roots traverse the piriformis muscle in 97% of patients. Piriformis muscle size asymmetry is common, with muscle asymmetry of up to 8 mm identified.
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Affiliation(s)
- J Matthew Russell
- Department of Radiology, St. Vincent's Medical Center, 1800 Barrs Street, Jacksonville, FL, 32204, USA
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