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

If you are, we have good news!

A new free Special Report is now available:

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?

First and foremost, stay on top of the latest research, and your CME requirements, particularly those Obstetric Ultrasound courses that address the latest technology and how to use it correctly and safely, as well as how to interpret your findings to aid in treatment decisions in the hope of the best patient outcome.

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.

Radiology Daily, from Oakstone Medical Publishing, which produces the landmark Practical Reviews in Radiology, brings you the latest news in the world of radiology from over 40 journals around the globe.

Practical Reviews in Radiology brings you peer-reviewed article abstracts–essential reading for anyone in the field of radiology who wants to keep current with the latest research and findings, and meet their CME requirements at the same time.

Now you can get this invaluable free special report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma, completely free.

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Each time we publish a new article on Obstetric Ultrasound at the Radiology Daily website, it will be sent to your inbox, to help keep you up to date on the news you need to know in the world of obstetric ultrasound.

To get your free copy of Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma, simply enter your email address in the box, and click on the button below.

We will send you a confirmation email with your download link to get your PDF copy of this free report to read and use right away.

Then, each time we publish a new article at the site, about once every month, you will receive the new article via email–completely free!

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

You hunger for knowledge…for advanced skills…for tools that promote patient health…

Your goal is always the same:

You want to detect and diagnose disease more quickly and efficiently, in its earliest stages, when treatment is likely to be less difficult and cure is more probable.

This invaluable Special Report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma, brings you invaluable advice on how to detect and diagnose these three main women’s health concerns.

In this special report, you will learn:

• How to Identify Ectopic Pregnancy:
• Who is at risk;
• The main reasons for ectopic pregnancies;
• The 4 key observations to detect normal pregnancy on ultrasound and rule out ectopic pregnancy;
• Evaluating ovarian masses on ultrasound;
• 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;
• The difference in appearance on ultrasound between endometrial polyps and submucous myomas.
• Further resources and suggested reading;
• And more…

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

Claim your copy of our free special report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma now, and download in minutes.

Simply click on the button below. We will send you a download link to your copy of this free report, and notify you by email whenever we post new information about Obstetric Ultrasound and Obstetric Ultrasound CME courses to the Radiology Daily website.

[rclp_ofie title="Oakstone Medical Publishing is your reliable source for obstetric ultrasound CME" subtitle="Claim your copy of our free special report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma right now! " instructions="Simply click on the button below. We will send you a download link to your copy of this free report, and notify you by email whenever we post new information about obstetric ultrasound research and obstetric ultrasound courses to the Radiology Daily website. Save time, money, and potentially lives with this invaluable special report.
" button="http://radiologydaily.com/wp-content/themes/oakstone/images/buttons/click_to_get_your_special_report.gif" ]

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?

Best of all, you’ll also get a free subscription to Radiology Daily‘s email service, to keep you abreast of every new article we post at the site on the topics of the most interest to you.

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.

To get your copy of the free Special Report Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma right now, plus register for your free copy of the Radiology Daily newsletter, simply fill in your details below.

With kind regards,

Don Deye, M.D.
Medical Director

[rclp_ofie title="Oakstone Medical Publishing is your reliable source for obstetric ultrasound CME" subtitle="Claim your copy of our free special report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma right now! " instructions="Simply click on the button below. We will send you a download link to your copy of this free report, and notify you by email whenever we post new information about obstetric ultrasound research and obstetric ultrasound courses to the Radiology Daily website. Save time, money, and potentially lives with this invaluable special report.
" button="http://radiologydaily.com/wp-content/themes/oakstone/images/buttons/click_to_get_your_special_report.gif" ]

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.

[rclp_ofie title="Oakstone Medical Publishing is your reliable source for obstetric ultrasound CME" subtitle="Claim your copy of our free special report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma right now! " instructions="Simply click on the button below. We will send you a download link to your copy of this free report, and notify you by email whenever we post new information about obstetric ultrasound research and obstetric ultrasound courses to the Radiology Daily website. Save time, money, and potentially lives with this invaluable special report.
" button="http://radiologydaily.com/wp-content/themes/oakstone/images/buttons/click_to_get_your_special_report.gif" ]

Does Interpretation of Digital Mammograms Take Longer?

A recent study set out to investigate interpretation times of digital mammograms versus film-screen mammograms, also considering additional variables such as number of views and presence or absence of comparison studies.

The results, published in a recent issue of AJR, found that regardless of confounding variables, interpretation of a digital mammogram is consistently longer than that of film-screen mammography.

The Study
Over the course of 9 months, interpretation times of 4 separate readers were recorded while the readers read actual clinical cases and mammograms.

Methodology
Readers were either assigned to digital or film-screen mammograms at any given session, with no mixing of the modalities at a single interpretation session.

Reports regarding the mammograms were dictated via the same automated report-entering program for both modalities.

Post-residency experience for the 4 readers ranged from 1 to 16 years.

A trained observer recorded the beginning and end times required by each reviewer for each case. Interpretations of the mammograms did not include the input of a resident or fellow.

Variables that were also recorded included number of images per case, whether the study was unilateral or bilateral, the presence or absence of breast implants, and whether the radiologist was involved in hanging the films.
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Results
Timed interpretations were performed for 17 batches of film-screen mammograms and 26 batches of digital mammograms, with an average of 11 cases per batch.

A total of 457 studies were included in the analysis, 268 of which were digital.

The average interpretation time for all readers was 240 seconds for digital mammograms and 127 seconds for film-screen mammograms.

There was a difference of 129 seconds between average time of the fastest reader versus the slowest reader for digital mammograms, and a difference of 76 seconds for film-screen mammograms.

The differences were statistically significant for all variables, except when it was recorded that the radiologist hung the films. The difference in the number of digital mammograms having ≥4 studies compared to film-screen mammography was statistically significant, causing the authors to suggest a possible reason for the apparent increased time for digital mammography.

Reviewer’s Comments
Regardless of confounding variables, interpretation of a digital mammogram is consistently longer than that of film-screen mammography.

Here is another study that demonstrates increased time in interpreting digital mammograms compared with film-screen mammograms.

The significance of this study is that it showed no difference when accounting for BI-RADs category, the presence or absence of comparison films, or whether the reader personally hung additional films.

Author: Basil Hubbi, MD

Reference:
Haygood TM, Wang J, et al. Timed Efficiency of Interpretation of Digital and Film-Screen Screening Mammograms. AJR; 2009;192 (January): 216-220

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Minkowski Functionals: Quantitative Classification of Breast Parenchymal Density

A recent study was conducted to test the hypothesis that spatial distribution of x-ray attenuation values in digital mammograms can be analyzed quantitatively by using topologic techniques based on Minkowski functionals.

Minkowski functionals are described as a set of topographic descriptors used in an algorithm for quantitative imaging processors.

The study concluded that Minkowski functionals are a novel reproducible approach to quantitatively classify breast parenchymal density.

The Study

Digital mammograms of 100 women performed over a 1-year period at a single institution were randomly chosen. Those that had prior breast surgery, known malignant disease, or breast implants were excluded.

Methodology
A 512- x 512-pixel region of interest was drawn on each of the mammograms in an area of the breast where the density pattern was homogeneous.

Subsequently, 2 experienced radiologists classified the parenchymal pattern within these regions of interest as normal, involution atrophy, or fibrosis based on predetermined qualitative definitions for each category.

Subsequently, quantitative density measurements were performed by first using mean, median, and 20th percentile values of gray-level intensity.

Subsequently, mathematic topology using Minkowski functional spectra analysis as described in a prior publication by Michielsen et al was used. Both quantitative methods were compared with the predetermined radiologist classifications as the standard.

Results
Minkowski functionals are a novel reproducible approach to quantitatively classify breast parenchymal density.

Mean, median, and 20th percentile gray-level intensity for normal breast tissue was 90 ± 9, 91 ± 8, and 68 ± 18, respectively. The mean, median, and 20th percentile gray-level intensity for involution was 84±7, 83 ± 7, and 75 ± 6, respectively, and for fibrosis, the mean, median, and 20th percentile gray-level intensity was 90 ± 8, 89 ± 9, and 73 ± 10, respectively.

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Using the qualitative classification as a standard, with the parameters obtained from gray-level histograms, only 37% to 66% of cases were classified correctly.

Comparatively, discriminant models of the spectral information of the Minkowski functionals exhibited a rate of correct classification of 76% to 83%.

Reviewer’s Comments
The heavy use of statistical analysis and technical descriptors in this study belie the potential this may have on the future of breast imaging by way of computer-aided detection.

We may see this kind of information resurface at a later date, when this approach to categorizing the density of breast tissue trickles down the industry path.

Author: Basil Hubbi, MD

Reference:

Boehm HF, Schneider T, et al. Automated Classification of Breast Parenchymal Density: Topologic Analysis of X-Ray Attenuation Patterns Depicted With Digital Mammography. AJR; 2008;191 (December): W275-W282

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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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In a recent study reported in Pediatric Radiology, the safety and results of MR cholangiopancreatography (MRCP) on pediatric patients were examined, including the effects of secretin and a negative oral contrast agent. Additionally, the findings on MRCP were compared with those of endoscopic retrograde CP (ERCP) in patients who underwent both studies.

The Study

Over a 3-year period, any patient age 18 years younger who underwent an MRCP at the author’s institution were identified in this retrospective study.

The most frequent clinical indications for MRCP were pancreatitis and elevated liver function tests. They found that secretin allowed better delineation of the pancreatic duct as well as qualitative evaluation of the exocrine function of the pancreas. The MRCP and ERCP diagnoses were concordant in 13 of 16 patients evaluated as abnormal on MRCP.

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As they discussed, MRCP is technically feasible and safe in children, and the use of both secretin enhancement and a negative oral contrast agent appears to improve both image quality and the diagnostic confidence of the radiologist.

MRCP gives additional information, compared to ERCP alone, on a variety of pathologies in the pancreaticobiliary systems. This comprehensive article summarizes the main usages of MRCP in general, and particularly in children. Besides addressing the feasibility and safety, the article comments on the use of secreting and negative oral contrast as useful adjuncts in those patients who are amenable.

Author: Basil Hubbi, MD

Reference:

Delaney L, Applegate KE,et al. MR Cholangiopancreatography in Children: Feasibility, Safety, and Initial Experience. Pediatr Radiol 2007;38 (December):64-75.

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A recent study was conducted to evaluate intraobserver and interobserver agreement when using a 10-point scale of abnormal findings designed to standardize reporting of abdominal radiographs in neonates or infants with suspected necrotizing enterocolitis (NEC).

The study, published in AJR, demonstrates that substantial inter- and intraobserver agreement can be found when radiologists use a 10-point scale to report abnormal findings in children with suspected NEC.

The Study
All patients who underwent anteroposterior and cross-table lateral abdominal radiography for suspected necrotizing enterocolitis over a 1-year period were identified.

Inclusion criteria consisted of age <=2 months at the time of study, frontal and cross-table lateral views obtained, and clinically suspected NEC.

Subjects were selected as sample cases to exemplify the separate classifications of findings as determined on a 10-point scale (the Duke Abdominal Assessment Scale).

The scale was designed so that increasing numbers reflected increasing certainty that a patient had NEC and increasing concern regarding the severity of the patient’s disease, with 0 indicating a normal exam and 10 indicating pneumoperitoneum.

Eighty-eight cases from 49 patients were included in the study for review.

Methodology
The radiographs were reviewed as well as the most recent prior abdominal radiograph by 4 pediatric radiologists who were recruited as study participants. Each participant recorded a single score using the 10-point scale.

Each participant reviewed the cases in the same sequence. The studies were interpreted twice by all participants at least 4 weeks apart to evaluate for intraobserver agreement. Data analysis was performed by a statistician.

Results
The patient mean age in the total study population was 24.9 days. Overall, 47.3% were girls and 52.7% were boys. The 4-weighted kappa values for intraobserver agreement ranged from 0.635 to 0.946 corresponding to substantial intraobserver agreement.

The 24-weighted kappa values for interobserver agreement ranged from 0.574 to 0.898, also corresponding to substantial interobserver agreement. Reader agreement was greatest for a score of 9 and 10, indicating portal venous gas and pneumoperitoneum, respectively.

Agreement was poorest for scores of 4 and 6, indicating separation or focal thickening of bowel loops and possible pneumatosis with other abnormal findings, respectively.

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Conclusions
The investigation served to initiate validation of the Duke Abdominal Assessment Scale by demonstrating consistent substantial intraobserver and interobserver agreement when evaluating radiographs for suspected necrotizing enterocolitis.

Reviewer’s Comments
Although the authors allude to this also, this reviewer feels that this article lacks the correlation with the scoring system to clinical outcomes or change in management that may result depending on the scoring assigned.

They refer to the greatest inter- and intraobserver agreement with portal venous gas and pneumoperitoneum, both signs that often indicate impending surgical treatment.

However, this reviewer wonders how the scale can be helpful when the scoring falls somewhere between 2 and 6.

Thankfully for us, the authors recognize that this is only early data, and follow-up studies will be conducted

Author: Basil Hubbi, MD
Reference:
Coursey CA, Hollingsworth CL, et al. Radiologists’ Agreement When Using a 10-Point Scale to Report Abdominal Radiographic Findings of Necrotizing Enterocolitis in Neonates and Infants. AJR; 2008; 191 (July): 190-197

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