The latest medical research on Musculoskeletal Radiology

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about musculoskeletal radiology gathered by our medical AI research bot.

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Multicenter survey clarifying phrases in emergency radiology reports.

Emergency Radiology

Interactions between radiologists and emergency physicians are often diminished as imaging volume increases and more radiologists read off site. We explore how several commonly used phrasings are perceived by radiologists and emergency physicians to decrease ambiguity in reporting.

An anonymous survey was distributed to attendings and residents at seven academic radiology and emergency departments across the USA via a digital platform as well as to an email group consisting of radiologists across the country with an interest in quality assurance. Physicians were asked to assign a percent score to probabilistic phrases such as, "suspicious of," or "concerned for." Additional questions including, "how often the report findings are reviewed," "what makes a good radiology report," and "when is it useful to use the phrase 'clinical correlation are recommended.'" Median scores and confidence intervals were compared using an independent Student's T-test.

Generally, there was agreement between radiologists and emergency room physicians in how they interpret probabilistic phrases except for the phrases, "compatible with," and "subcentimeter liver lesions too small to characterize." Radiologists consider a useful report to answer the clinical question, be concise, and well organized. Emergency physicians consider a useful report to be concise, definitive or include a differential diagnosis, answer the clinical question, and recommend a next step. Radiologists and emergency physicians did not agree on the usefulness of the phrase, "clinical correlation recommended," in which radiologists found the phrase more helpful under particular circumstances.

The survey demonstrated a wide range of answers for probabilistic phrases for both radiologists and emergency physicians. While the medians and means of the two groups were often different by statistical significance, the actual percent difference was minor. These wide range of answers suggest that use of probabilistic phrases may sometimes lead to misinterpretation between radiologist and emergency room physician and should be avoided or defined if possible.

Pediatric trauma and the role of the interventional radiologist.

Emergency Radiology

While interventional radiologists occupy a critical role in adult trauma management, the role of interventionalist in pediatric trauma continues to evolve. The indications for transarterial embolization (TAE) are significantly different in pediatric patients in whom non-operative management (NOM) has a much more prominent role than in adults. Contrast extravasation on imaging may not require acute surgical or interventional management as it would in an adult. There are also areas in which pediatric interventional radiology is increasingly useful such as pelvic TAE in failed management, or splenic embolization to treat bleeding without the loss of splenic function inherent to surgical splenectomy. The rapid evolution of techniques and devices in pediatric patients is also changing what interventions are possible in pediatric trauma management which necessitates frequent reassessment of the guidelines and interventional radiology's role in caring for these patients.

This review seeks to consolidate the recent literature to describe the evolving role of the interventional radiologist in pediatric trauma management.

Diagnosis and Clinical Features in Autoimmune-Mediated Movement Disorders.

Journal of Movement Disorders

Movement disorders are common manifestations in autoimmune-mediated encephalitis. This group of diseases is suspected to be triggered by infection ...

Development of Clinical Milestones in Parkinson's Disease After Bilateral Subthalamic Deep Brain Stimulation.

Journal of Movement Disorders

Deep brain stimulation of the subthalamic nucleus (STN-DBS) in Parkinson's disease (PD) patients does not halt disease progression, as these patients will progress and develop disabling non-levodopa responsive symptoms. These features may act as milestones that represent the overall functionality of patients after DBS. The objective of this study was to investigate the development of clinical milestones in advanced PD patients who underwent bilateral STN-DBS.

The study evaluated PD patients who underwent STN-DBS at baseline up to their last follow-up using the Unified Parkinson's Disease Rating Scale and Hoehn and Yahr scale. The symptoms of hallucinations, dysarthria, dysphagia, frequent falls, difficulty walking, cognitive impairment and the loss of autonomy were chosen as the clinical milestones.

A total of 106 patients with a mean age of 47.21 ± 10.52 years at disease onset, a mean age of 58.72 ± 8.74 years at surgery and a mean disease duration of 11.51 ± 4.4 years before surgery were included. Initial improvement of motor symptoms was seen after the surgery with the appearance of clinical milestones over time. Using the moderately disabling criteria, 81 patients (76.41%) developed at least one clinical milestone, while 48 patients (45.28%) developed a milestone when using the severely disabling criteria.

STN-DBS has a limited effect on axial and nonmotor symptoms of the PD patients, in contrast to the effect on motor symptoms. These symptoms may serve as clinical milestones that can convey the status of PD patients and its impact on the patients and their caregivers. Therefore, advanced PD patients, even those treated with bilateral STN-DBS, will still require assistance and cannot live independently in the long run.

Accuracy of Machine Learning Using the Montreal Cognitive Assessment for the Diagnosis of Cognitive Impairment in Parkinson's Disease.

Journal of Movement Disorders

The Montreal Cognitive Assessment (MoCA) is recommended for assessing general cognition in Parkinson's disease (PD). Several cutoffs of MoCA scores for diagnosing PD with cognitive impairment (PD-CI) have been proposed, with varying sensitivity and specificity. This study investigated the utility of machine learning algorithms using MoCA cognitive domain scores for improving diagnostic performance for PD-CI.

In total, 2,069 MoCA results were obtained from 397 patients with PD enrolled in the Parkinson's Progression Markers Initiative database with a diagnosis of cognitive status based on comprehensive neuropsychological assessments. Using the same number of MoCA results randomly sampled from patients with PD with normal cognition or PD-CI, discriminant validity was compared between machine learning (logistic regression, support vector machine, or random forest) with domain scores and a cutoff method.

Based on cognitive status classification using a dataset that permitted sampling of MoCA results from the same individual (n = 221 per group), no difference was observed in accuracy between the cutoff value method (0.74 ± 0.03) and machine learning (0.78 ± 0.03). Using a more stringent dataset that excluded MoCA results (n = 101 per group) from the same patients, the accuracy of the cutoff method (0.66 ± 0.05), but not that of machine learning (0.74 ± 0.07), was significantly reduced. Inclusion of cognitive complaints as an additional variable improved the accuracy of classification using the machine learning method (0.87-0.89).

Machine learning analysis using MoCA domain scores is a valid method for screening cognitive impairment in PD.

Costal cartilage fractures in blunt polytrauma patients - a prospective clinical and radiological follow-up study.

Emergency Radiology

To assess the healing of costal cartilage fractures (CCFX) in patients with blunt polytrauma with follow-up imaging and clinical examination. Effect on physical performance and quality of life (QoL) was also evaluated.

The study group comprised twenty-one patients with diagnosed CCFX in trauma CT. All the patients underwent MRI, ultrasound, ultra-low-dose CT examinations, and clinical status control. The patients completed QoL questionnaires. Two radiologists evaluated the images regarding fracture union, dislocation, calcifications, and persistent edema at fracture site. An attending trauma surgeon clinically examined the patients, with emphasis on focal tenderness and ribcage mobility. Trauma registry data were accessed to evaluate injury severity and outcome.

The patients were imaged at an average of 34.1 months (median 36, range 15.8-57.7) after the initial trauma. In 15 patients (71.4%), CCFX were considered stable on imaging. Cartilage calcifications were seen on healed fracture sites in all the patients. The fracture dislocation had increased in 5 patients (23.8%), and 1 patient (4.8%) showed signs of a non-stable union. Four patients (19.0%) reported persistent symptoms from CCFX.

Non-union in CCFX is uncommon but may lead to decreased stability and discomfort. Both clinical and radiological examinations play an important part in the post-traumatic evaluation of CCFX. CT and MRI visualize the healing process, while dynamic ultrasound may reveal instability. No significant difference in QoL was detected between patients with radiologically healed and non-healed CCFX. Post-traumatic disability was mostly due to other non-thoracic injuries.

Diagnostic yield of CT angiography performed for suspected cervical artery dissection in the emergency department.

Emergency Radiology

Computed tomography angiographies are frequently performed in the emergency department (ED) for the assessment of cervical artery dissection (CeAD) due to the high risk of associated morbidity, but their diagnostic utility is not fully evaluated. We assessed the radiological outcomes and clinical correlates of CTAs performed for suspected CeAD.

CTAs for all indications (IndicationALL) over a 10-year period were evaluated to identify those with CeAD. A subgroup of CTAs performed for suspected CeAD (IndicationDISSECTION) was identified and further assessed for clinical findings predictive of CeAD. Magnetic resonance angiography/fat-saturated images (MRA/FSI) performed after CTA were also assessed.

Nine-thousand-two-hundred-four CTAs were performed by our ED for IndicationALL of which 850 (9.2%) were for IndicationDISSECTION. CeAD was noted in 1.5% (142/9204) among IndicationALL and in 6.1% (53/850) of IndicationDISSECTION CTAs. The most common radiological findings were mural thrombus and eccentric lumen. In the IndicationDISSECTION group, new headache (OR: 2.5, 95%CI: 1.2-5.7) and partial Horner syndrome (OR: 14.4, 95%CI: 4.2-49.9) predicted carotid dissection and cervical fracture (OR: 5.5, 95%CI: 2.1-14.6) predicted vertebral artery dissections. MRA/FSI confirmed CeAD in all positive cases, but in 2 CTAs read as negative, MRA/FSI was positive for vertebral artery dissection.

Although the yield of CTAs for clinically suspected CeAD is low, the paucity of reliable clinical predictors, high risk of morbidity, availability in ED, and comparable performance to MRA/FSI justifies its widespread utilization for initial diagnosis of CeAD.

Association of CT findings in patients with hemoperitoneum due to ruptured ovarian cysts with subsequent intervention.

Emergency Radiology

Hemoperitoneum caused by ovarian cyst rupture may necessitate intervention. The literature is lacking in descriptions of CT findings that help guide patient management. The purpose of this study is to consider CT findings associated with a need for intervention (surgical or interventional radiology management) versus conservative treatment (observation, pain management, and blood transfusions).

Two radiologists retrospectively and independently reviewed 103 CTs of pre-menopausal women who presented with acute hemoperitoneum related to ruptured ovarian cysts between January 2010 and January 2019. The following imaging features were assessed: ovarian cyst characteristics, sentinel clot, contrast extravasation, and hemoperitoneum size. Findings were correlated with patient demographics, clinical parameters, and management with surgery/interventional radiology procedure (intervention group) versus conservative management (conservative group).

Of the 103 patients with hemoperitoneum from cyst rupture, 16% (n = 16) required intervention, and 84% underwent conservative treatment (n = 87). Length of stay (p = .008) was higher in the intervention group. Statistically significant CT findings in the intervention versus conservative group included (p-value reader 1/p-value reader 2) greatest AP dimension of hemoperitoneum (p = .001/p = 0.02), posterior cul-de-sac AP dimension (p = 0.03/p = .006), total cul-de-sac AP dimension (p = .002/p = .007), and number of spaces with hemoperitoneum (p = .01/p = .02). There was good to excellent inter-reader agreement for these findings (ICC 0.68-0.91). Active contrast extravasation was significant for one reader (p = .02) with poor inter-reader agreement (ICC 0.36). In utilizing ROC curves, thresholds of 107 mm (greatest axial AP dimension of hemoperitoneum) yielded a sensitivity and specificity of 0.81 and 0.62 for reader 1 and 0.69 and 0.55 for reader 2; 45 mm (posterior cul-de-sac AP dimension) yielded a sensitivity and specificity of 0.75 and 0.63 for reader 1 and 0.94 and 0.49 for reader 2; 70 mm (total cul-de-sac AP dimension) yielded a sensitivity and specificity of 0.75 and 0.64 for reader 1 and 0.75 and 0.50 for reader 2; and greater than 5 spaces yielded a sensitivity and specificity of 0.75 and 0.58 for reader 1 and 0.69 and 0.70 for reader 2.

CT findings associated with intervention in hemoperitoneum due to ovarian cyst rupture include size of hemoperitoneum, number of abdominopelvic spaces with hemoperitoneum, and contrast extravasation.

Diagnostic dilemma in an infant with stridor: ultrasound to the rescue!

Emergency Radiology

Stridor is one of the most important signs of partial or complete upper airway obstruction. Subglottic hemangioma (SGH) is a well-recognized howeve...

Movement Disorders Resulting From Bilateral Basal Ganglia Lesions in End-Stage Kidney Disease: A Systematic Review.

Journal of Movement Disorders

The basal ganglia (BG) are susceptible to fluctuations in blood urea levels, sometimes resulting in movement disorders. We described patients with end-stage kidney disease (ESKD) presenting with movement disorders associated with bilateral BG lesions on imaging.

We report four patients and systematically reviewed all published cases of ESKD presenting with movement disorders and bilateral BG lesions (EBSCOhost and Ovid).

Of the 72 patients identified, 55 (76.4%) were on regular dialysis. Parkinsonism was the most common movement disorder (n = 39; 54.2%), followed by chorea (n = 24; 33.3%). Diabetes mellitus (n = 51; 70.8%) and hypertension (n = 16; 22.2%) were the most common risk factors. Forty-three (59.7%) were of Asian ethnicity. Complete clinical resolution was reported in 17 (30.9%) patients, while 38 (69.1%) had incomplete clinical resolution with relapse. Complete radiological resolution occurred in 14 (34.1%) patients.

Movement disorders associated with BG lesions should be recognized as a rare and potentially reversible metabolic movement disorder in patients with ESKD.

Efficacy of the scatter correction algorithm in portable chest radiography.

Emergency Radiology

Portable chest radiographs (CXRs) continue to be a vital diagnostic tool for emergency and critical care medicine. The scatter correction algorithm (SCA) is a post-processing algorithm aiming to reduce scatter within portable images. This study aimed to assess whether the SCA improved image quality (IQ) in portable CXRs.

Objective and subjective IQ assessments were undertaken on both phantom and clinical images, respectively. For objective analysis, attenuators were placed on the anterior surface of the patient's thorax to simulate pathologies present within uniform regions of the phantom's lung and heart. Phantom CXRs were acquired with three different tube-current-times (mAs). Phantom images were processed with different SCA strengths. Contrast to noise ratios (CNR) within the attenuator were determined for each algorithm strength and compared to non-SCA images. For subjective analysis, two independent radiologists graded 30 clinical images with and without the SCA activated. The images were graded for IQ in different anatomical structures and overall diagnostic confidence.

Objectively, most strengths of the SCA improved the CNR in both regions. However, a detrimental effect was recorded for some algorithm strengths in regions of high contrast. Subjectively, both observers recorded the SCA significantly improved IQ in clinical CXRs in all anatomical regions. Observers indicated the greatest improvement in the lung and hilar regions, and least improvement in the chest wall and bone. All images with and without the SCA were deemed diagnostic.

This study shows the potential radiation dose neutral IQ improvement when using an SCA in clinical patient CXRs.

Cut-off point of CT-assessed epicardial adipose tissue volume for predicting worse clinical burden of SARS-CoV-2 pneumonia.

Emergency Radiology

To identify a cut-off value of epicardial adipose tissue (EAT) volume quantified by CT associated with a worse clinical outcome in patients with SARS-CoV-2 pneumonia.

In this retrospective study, sixty patients with a diagnosis of laboratory-confirmed COVID-19 pneumonia and a chest CT exam on admission were enrolled. Based on a total severity score (range 0-20), patients were divided into two groups: ordinary group (total severity score < 7) and severe/critical group (total severity score > 7). Clinical results and EAT volume were compared between the two groups.

The severe/critical patients, compared to the ordinary ones, were older (66.83 ± 11.72 vs 58.57 ± 16.86 years; p = 0.031), had higher body mass index (27.77 ± 2.11 vs 25.07 ± 2.80 kg/m2; p < 0.001) and higher prevalence of comorbidities. EAT volume was higher in severe/critical group, compared with the ordinary group (151.40 ± 66.22 cm3 vs 92.35 ± 44.46 cm3, p < 0.001). In severe/critical group, 19 (73%) patients were admitted in intensive care unit (ICU), compared with 6 (20%) patients in the ordinary group (p < 0.001). The area under the ROC curve (AUC) is equal to 0.781 (p < 0.001) (95% CI: 0.662-0.900). The cut-off found, in correspondence with the highest value of the Youden Index, is 97 cm3: the sensitivity is equal to 83.3%, while the specificity is equal to 70% for predicting a worse outcome. The risk (odds ratio) of belonging to the severe/critical group in this population due to EAT ≥ 97 cm3 is 11.667 (95% CI: 3.384-40.220; p < 0.001).

An EAT volume of 97 cm3 has good sensitivity and specificity to predict a greater extent of pulmonary involvement and therefore a worse clinical outcome in patients with SARS-CoV-2 pneumonia.