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  • Journal Highlights

    The following are highlights from the current issues of RSNA’s two peer-reviewed journals.


    October 1, 2018

    Radiology

    MRI Predictors of Posterolateral Corner Instability: A Decision Tree Analysis of Patients with Acute Anterior Cruciate Ligament Tear

    Posterolateral corner (PLC) injuries of the knee most often result from high-energy trauma and are commonly associated with cruciate ligament tears. Clinical examination is the standard for the detection of posterolateral instability, but may be difficult in the acute trauma setting due to knee pain, joint effusion and diffuse tissue swelling. However, early diagnosis and treatment is crucial because untreated posterolateral instability is associated with poor clinical outcome, increases the risk for anterior cruciate ligament (ACL) graft failure and may lead to chronic instability.

    In an article published online in Radiology (RSNA.org/Radiology), Lukas Filli, MD, Balgrist University Hospital, Zurich, and colleagues investigated the diagnostic performance of various MRI findings for helping to predict posterolateral instability in patients with acute complete ACL tears. Researchers performed a decision tree analysis to identify the most significant MRI predictors of posterolateral instability.

    The retrospective cohort study was performed in a consecutive series of 162 patients (mean age, 32.8 years) who underwent ACL reconstruction with or without concomitant PLC reconstruction between 2014 and 2017. MR images were evaluated by two radiologists.

    Complete tear or avulsion of the lateral collateral ligament was the most significant predictor at MRI of posterolateral instability, according to results. Assessment of the smaller posterolateral corner structures did not improve diagnostic performance. Instability was correctly predicted in 147 of 162 patients (90.7 percent) by reader 1 and in 151 of 162 patients (93.2 percent) by reader 2.

    “It is possible that some MRI findings may be indicative of higher subsequent ACL graft failure rates despite clinical testing negative for posterolateral instability at the time of surgery. Prospective longitudinal studies with long-term follow-up of graft failure rates will be necessary to test this hypothesis,” the authors write.

     This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only.

    Impact Factors Stay Strong for RSNA Journals

    The highly regarded RSNA journals Radiology and RadioGraphics scored strong impact factors in 2017, according to the 2018 edition of Journal Citation Reports. An impact factor is a measure of the yearly average number of citations to articles published in a journal.

    The latest impact factor for Radiology, edited by David A. Bluemke, MD, PhD, is 7.469 up from 7.296 in 2016, with 54,109 total citations up from 50,983. The impact factor for RadioGraphics, edited by Jeffrey S. Klein, MD, is 3.249, with citations increasing from 10,286 to 11,207.

    Radiology is ranked fourth among radiology, nuclear medicine and medical imaging journals. RadioGraphics is ranked 29th.

    Published regularly since 1923 by RSNA, Radiology has long been recognized as the authoritative reference for the most current, clinically relevant and highest quality research in the field of radiology.

    Launched by RSNA in 1981, RadioGraphics is one of the premier education journals in diagnostic radiology.

    The highly regarded RSNA journals Radiology and RadioGraphics scored strong impact factors in 2017, according to the 2018 edition of Journal Citation Reports. An impact factor is a measure of the yearly average number of citations to articles published in a journal.

    The latest impact factor for Radiology, edited by David A. Bluemke, MD, PhD, is 7.469 up from 7.296 in 2016, with 54,109 total citations up from 50,983. The impact factor for RadioGraphics, edited by Jeffrey S. Klein, MD, is 3.249, with citations increasing from 10,286 to 11,207.

    Published regularly since 1923 by RSNA, Radiology is ranked fourth among radiology, nuclear medicine and medical imaging journals.

    Launched by RSNA in 1981, RadioGraphics is ranked 29th.

     Radiographics 

    Fundamentals of Diagnostic Error in Imaging

    With estimates of average diagnostic error rates ranging from 3 to 5 percent, there are approximately 40 million diagnostic errors involving imaging annually worldwide. Developing a comprehensive process to identify diagnostic errors, analyze errors to discover contributing factors and biases and develop interventions based on these contributing factors, is fundamental to reducing such errors.

    In the October special issue of RadioGraphics (RSNA.org/RadioGraphics), Jason N. Itri, MD, PhD, of Wake Forest Baptist Medical Center, Winston-Salem, NC, and colleagues looked at ways to learn from diagnostic errors, including effective peer learning practices, supportive leadership and a culture of quality. Such methods have been shown to reduce diagnostic errors, improve patient outcomes and increase satisfaction for all stakeholders.

    Understanding the types of interventions that drive quality improvement can help prevent diagnostic errors. Interventions relying solely on remediation and increased effort or vigilance are less effective because they assume that errors are due to individual failures, whereas modern approaches view errors as the result of organizational and environmental factors. Successful interventions are those designed to either help people do the right thing (e.g., follow standard workflow and avoid workarounds) or prevent them from doing the wrong thing (e.g., forcing functions and hard stops).

    “It is critical to understand that diagnostic errors are predictable events with readily identifiable contributing factors, which lead to both perceptual and interpretive errors. Identifying contributing factors is key to developing interventions that reduce or mitigate diagnostic errors,” the authors conclude.

     This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only.

     Radiology Podcasts 

     Bluemke

    Listen to Radiology Editor David A. Bluemke, MD, PhD, discuss this month’s research you need to know. Podcasts summarize the importance and context of selected recent articles. Subscribe today at  RSNA.org/Radiology-Podcasts  and never miss a single episode.

     Highlights include: 

    “Gadolinium Distribution in Cerebrospinal Fluid after Administration of a Gadolinium-based MR Contrast Agent in Humans,” Berger F., et al.

    “Immediate Mild Reactions to CT with Iodinated Contrast Media: Strategy of Contrast Media Readministration without Corticosteroids,” Park S.J., et al.

    “Contrast-enhanced CT for Colonic Diverticular Bleeding before Colonoscopy: A Prospective Multicenter Study,” Umezawa S., et al.

     


    Radiology Podcasts 

     Klein


    Listen to RadioGraphics Editor Jeffrey S. Klein, MD, and authors discuss the following articles from recent issues of RadioGraphics at RSNA.org/RG-Podcasts. 

    “Updated Fleischner Society Guidelines for Managing Incidental Pulmonary Nodules: Common Questions and Challenging Scenarios,” Bueno J., et al.

    Audio summary podcasts (also available on iTunes and Google Play) include these studies: “Imaging Evaluation of Pediatric Parotid Gland Abnormalities,” Inarejos Clemente, E.J., et al.; “CT Findings of Acute Small-Bowel Entities,” Sugi M.D., et al.; “MR Neurographic Evaluation of Facial and Neck Pain: Normal and Abnormal Craniospinal Nerves below the Skull Base,” Chhabra A., et al.; and “Retroperitoneal Leiomyosarcoma,” Marko J and Wolfman DJ.




    RADFilli
    Posterolateral corner injuries at the sagittal plane. Sagittal fat-saturated proton density-weighted image in a 50-year-old female patient from the anterior cruciate ligament (ACL)–only group (ie, ACL rupture without clinical evidence of posterolateral instability) one day after trauma. No popliteomeniscal fascicles are visible (dashed circle shows the popliteal hiatus). The partially displayed popliteus tendon (PT ) shows a normal course. The lateral inferior genicular artery (*) is accompanied by small veins (hyperintense round structures proximal) and surrounded by fluid. Bone marrow edema (arrows) is manifest in the anterior aspect of the lateral femoral condyle and in the posterolateral tibial plateau. Filli, L., et al., Radiology 2018:InPress © RSNA 2018.

    RG Fig
    Missed pulmonary embolus in a 44-year-old man with Crohn disease who underwent contrast-enhanced CT in the emergency department for abdominal pain and concern for obstruction. Axial images of 5-mm (a) and 1.25-mm (b) section thickness show an incidental pulmonary embolus in the right lower lobe (arrow), which is more apparent on the 1.25-mm-thick section. Itri , J., et al, RadioGraphics 2018:38;6 © RSNA 2018.




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