A recent study was conducted to investigate the protocols of radiology practices throughout the United States regarding the performance and interpretation of breast MRI.

Methodology
Over a 6-month period, a Web-based survey was conducted with the members of the Society of Breast Imaging. Information regarding the type and characteristics of radiology practices, availability of breast MRI, and breast MRI techniques and protocols was obtained. A total of 754 surveys were completed.

Results
In regard to type and characteristics of the radiology practice, 334 hospital-based outpatient facilities, 323 private outpatient facilities, 300 facilities solely within a hospital, 144 facilities in academic settings, 25 county facilities, and 7 military or Veterans Administration facilities responded.

In these practices, the number of radiologists reading mammograms was 1 to 3 in 162 practices, 4 to 5 in 160 practices, 6 to 10 in 238 practices, 11 to 15 in 86 practices, 16 to 20 in 39 practices, and >20 in 34 practice.

Breast MRI was offered at 569 of the 754 facilities, corresponding to 75.5% of the practices.

Of those that did not offer breast MRI, 43.2% indicated anticipated programs to begin, and 5.6% were not interested in incorporating breast MRI into their practices.

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Of the facilities performing breast MRI, 37.4% did <5 per week, 167 did 5 to 10 per week, and 14.3% did 11 to 15 breast MRIs per week.

The most common indications were to evaluate the extent of disease and an equivocal diagnostic imaging workup.

Overall, academic practices were more likely to offer breast MRI than nonacademic practices, and a greater percentage of academic practices performed MRI-guided breast interventional procedures.

Reviewer’s Comments
Contrast-enhanced breast MRI is now widely used in the United States. As this relatively new technology expands further, it is most likely that academic practices will be leading the way in adopting the vast potential of this technology. The survey shows that breast MRI is widely available in the United States, but with standardization of practice still a long way off.

Author: Basil Hubbi, MD

Reference:
Bassett LW, Dhaliwal SG, et al. National Trends and Practices in Breast MRI. AJR; 2008; 191 (August): 332-339

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Interested in the latest news in the field of Obstetric Ultrasound?

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Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma

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Dear concerned radiology professional,

If you’re a practising radiologist, radiology resident or internist, you know how far Obstetric Ultrasound has advanced in recent years—even in the past few months, with newer and better imaging and more effective techniques emerging all the time.

So, what’s a busy radiologist to do?

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Radiology Daily was launched to help you stay on top of your CME requirements, bringing you the latest news on Obstetric Ultrasound. This is news you can use in your practice to stay on the cutting edge, or even ahead of the curve.

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Every professional caregiver has dedicated themselves to a lifetime of learning.

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• Why size matters when it comes to ovarian masses;
• How to approach ovarian masses in pre-menopausal women;
• How to approach ovarian masses in post-menopausal women;
• The main ovarian masses you will encounter on ultrasound;
• The main types of ovarian cysts;
• The characteristic appearance on a sonograph of the main types of ovarian cysts;
• How to approach ovarian masses if you locate them on ultrasound;
• Which types of ovarian cysts can be ruled benign upon ultrasound;
• Why practice is key when it comes to evaluating ovarian masses on ultrasound;
• Evaluating endometrial thickness with ultrasound;
• What is considered normal endometrial thickness in pre-menopausal women;
• Evaluating endometrial thickness in postmenopausal women;
• How your evaluation should differ if bleeding is present;
• Why it is important to identify atrophic endometrium with ultrasound;
• The appearance of endometrial carcinoma on ultrasound;
• Why focal thickenings of the endometrium are also important;
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• Further resources and suggested reading;
• And more…

Oakstone Medical Publishing is your reliable source for Obstetric Ultrasound CME.

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Your time is very valuable.

Keeping current on new medical technology and procedures is time-consuming, but essential to your professional career.

So we’ve distilled the most important facts about Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma into a fast-reading report of only about 2,500 words.

Why not invest the next 10 minutes in gaining a deeper understanding of the latest techniques for MRI imaging of the knee?

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There are 13 Radiology Daily topics in all, news you can use to add to your knowledge of the rapidly changing world of radiology and stay on top of your CME requirements. You can easily unsubscribe from Radiology Daily at any time with a couple of mouse clicks. It couldn’t be easier.

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P.S. As any radiologist knows, when it comes to Obstetric Ultrasound, experience is key in detecting and treating disease. So is keeping up to date with the latest technologies, techniques, and procedures, in the hopes of gaining the best patient outcomes.

If you agree, I’m sure you’ll want to read Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma. Just enter your email address, download your free report, and start reading in minutes.

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3-T MRI Versus Arthroscopy to Diagnose Intrinsic Wrist Ligament and TFCC Tears

A recent study has compared 3-T MRI (3 Tesla magnetic resonance imaging) of the wrist and MR arthrography with arthroscopy in the diagnosis of intrinsic wrist ligament injury and triangular fibrocartilage complex (TFCC).

The study, published in AJR, has shown that the rate of sensitivity of ligamentous and cartilaginous wrist tears using 3-T MRI hovers above 82%, with a specificity of 100%.

The Study
Over a 7-year period, patients with conventional wrist MR examinations were identified, and results of these studies were reviewed by 2 radiologists. Patients who had also undergone MR arthrography after conventional MRI were identified.

Methodology
Radiologists were blinded to the arthroscopy results. Criteria used for diagnosis of a wrist ligament or TFCC tear on arthrography were visualization of the tear and abnormal communication of the joint spaces.

Microperforation was noted to be abnormal communication of the joint spaces without visualization of the tear. When available, results were compared with findings at arthroscopy if the arthroscopy was performed within 75 days of the MR exam.

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Results
300 MR examinations of the wrist were identified over the 7-year period. The radiologists reviewed all 300 cases in order not to introduce bias since they did not know which studies were read as positive for ligament or TFCC tears.

Thirty-five patients also underwent MR arthrography; 49 patients eventually underwent arthroscopy.

On arthroscopy, 22 patients had TFCC tears, 19 had scapholunate tears, and 11 had lunatotriquetral tears. There were no false-positive readings of ligament tears or TFCC tears on MRI when using arthroscopy as the standard.

MR sensitivity for TFCC tears was determined to be 86%, with a specificity of 100%.

For scapholunate ligament tears, the sensitivity was 89% and the specificity was 100%.

The sensitivity for lunatotriquetral tears was 82%, with a specificity of 100%.

For those who also underwent MR arthrography, there was increased sensitivity for ligament and TFCC tears, although there were an additional 3 false-positive results.

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Conclusions
“MRI at 3-T is sensitive and specific for detection of wrist ligament tears. MR Arthrography is more sensitive for ligament evaluation but can result in false-positive findings because of microperforations.”

Reviewer’s Comments
These findings are an improvement to previously published reports of ligamentous tears and TFCC injury for 1.5-T MRI of the wrist. For 1.5-T MRI compared with arthroscopy, the majority of calculated sensitivities on prior studies hovered in the 50% to 60% range, whereas the current study demonstrated sensitivity >82% for all evaluated wrist tears.

The findings with MR arthrography reveal marginal benefit for this modality, with an increased false-positive rate.

However, usage of MR arthrography in otherwise normal-appearing MR examinations in patients with a high clinical concern for ligamentous or cartilaginous tears may be warranted based on these data.

Author: Basil Hubbi, MD
Reference:

Magee T. Comparison of 3-T MRI and Arthroscopy of Intrinsic Wrist Ligament and TFCC Tears. AJR; 2009;192 (January): 80-85.

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Does BMI Affect Accuracy of MRI for Knee Dislocation?

A recent study in AJR examined the incidence and cause of knee dislocation in normal and obese patients with evaluation of MRI findings. It also sought to determine if specific injury patterns are associated with an increased body mass index (BMI).

The result have show that although diagnostic accuracy of MRI does not suffer as a result of a high BMI, there is an increased prevalence of popliteal tendon ruptures in obese patients with knee dislocation.

Methodology
Over a 7-year period, patients who were given the diagnosis of knee dislocation at a level 1 trauma center were identified. Two radiologists independently reviewed the MRI results.

Findings were noted, including injury to the anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament, lateral collateral ligament, popliteus tendon, quadriceps tendon, patellar ligament, and medial retinaculum.

Injuries to the bone, cartilage, menisci, nerves, and arteries were also recorded.

Equivocal cases were resolved by consensus.

Images were classified subjectively as diagnostic or nondiagnostic.

BMI and mechanism of injury were obtained from the patients’ files. MRI findings of those with a BMI >25 were compared with those with a BMI <25, and statistical analysis was performed.

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Results
24 patients were identified as having knee dislocation over the 7-year period. The incidence based on the local population was determined to be 2.3 knee dislocations per million.

Of the 24 patients, 19 had an MRI of diagnostic quality. The mechanism of injury was determined as follows:

• 7 cases secondary to high-energy trauma
• 7 cases secondary to athletic injury
• 10 cases secondary to a simple fall.

When comparing those with a BMI >25 to those with a BMI <25, no statistical significance was found in image quality and subjective diagnostic quality of the MRI study.

The only statistically significant injury pattern identified between both groups was complete rupture of the popliteal tendon, a finding seen only in the overweight group.

In total, 46% of patients in this study with knee dislocation were overweight and underwent low-incidence trauma.

Conclusions
Although diagnostic accuracy of MRI does not suffer due to a high body mass index, there is an increased prevalence of popliteal tendon ruptures in obese patients with knee dislocation.

The annual incidence of low-energy trauma-induced knee dislocations in overweight patients is not insignificant at a level 1 trauma center.

Reviewer’s Comments
These findings can be practically utilized to determine whether knee dislocation occurred in patients with a BMI >25 after spontaneous reduction.

The presence of popliteal tendon rupture in the setting of low-energy trauma in this patient population subset can be reliably used to diagnose those who may have had a recent knee dislocation.

Author: Basil Hubbi, MD

Reference:
Peltola EK, Lindahl J, et al. Knee Dislocation in Overweight Patients. AJR; 2009;192 (January): 101-106

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Welcome to the Musculoskeletal Radiology Section of Radiology Daily.

In the Musculoskeletal Radiology section, we will be keeping you up to date on the latest information in the field of Musculoskeletal Radiology, including x-ray, ultrasound, Bone Scintigraphy, CT, MRI, and Arthrography.

We will also include news on the current clinical challenges in Musculoskeletal Radiology, up-to-date imaging protocols, as well as imaging pitfalls.
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Welcome to the Neuroradiology Section of Radiology Daily.

In the Neuroradiology section, we will be keeping you up to date on the latest information in the field of Neuroradiology, including x-ray, MRI, Bone Scintigraphy, PET, PET/CT, and SPECT/CT.

We will also include news on the current clinical challenges in Neuroradiology, interpreting imaging studies, and how to use the various imaging technologies in the hope of better patient outcomes.
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Welcome to the Emergency Radiology Section of Radiology Daily.

In the Emergency Radiology section, we will be keeping you up to date on the latest information in the field of Emergency Radiology, including x-ray, EKG, CT, MRI and more.

We will also include news on the current clinical challenges in Emergency Radiology, and best practices.

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Welcome to the Diagnostic Imaging Section of Radiology Daily.

In the Diagnostic Imaging section, we will be keeping you up to date on the latest technology  in the field of Diagnostic Imaging, including x-ray, ultrasound, mammography, CT, CT/MR angiography, MRI, PET and more.

We will also include information on current clinical challenges, as well as case studies and how to interpret them, for better diagnosis in the hope of better patient outcomes.

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Welcome to the Chest Radiology Section of Radiology Daily.

In the Chest Radiology section, we will be keeping you up to date on the latest information in the field of Chest Radiology, including cardiac imaging, multidetector CT, CT/MR angiography, MRI and more.

We will also include news on the current clinical challenges in Chest Radiology, interpreting imaging studies, and how to use the various imaging technologies in the hope of better patient outcomes.
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