Clinical Validation of a Deep Learning-Based Hybrid (Greulich-Pyle and Modified Tanner-Whitehouse) Method for Bone Age Assessment

Objective@#To evaluate the accuracy and clinical efficacy of a hybrid Greulich-Pyle (GP) and modified Tanner-Whitehouse (TW) artificial intelligence (AI) model for bone age assessment. @*Materials and Methods@#A deep learning-based model was trained on an open dataset of multiple ethnicities. A total of 102 hand radiographs (51 male and 51 female; mean age ± standard deviation = 10.95 ± 2.37 years) from a single institution were selected for external validation. Three human experts performed bone age assessments based on the GP atlas to develop a reference standard. Two study radiologists performed bone age assessments with and without AI model assistance in two separate sessions, for which the reading time was recorded. The performance of the AI software was assessed by comparing the mean absolute difference between the AI-calculated bone age and the reference standard. The reading time was compared between reading with and without AI using a paired t test. Furthermore, the reliability between the two study radiologists’ bone age assessments was assessed using intraclass correlation coefficients (ICCs), and the results were compared between reading with and without AI. @*Results@#The bone ages assessed by the experts and the AI model were not significantly different (11.39 ± 2.74 years and 11.35 ± 2.76 years, respectively, p = 0.31). The mean absolute difference was 0.39 years (95% confidence interval, 0.33– 0.45 years) between the automated AI assessment and the reference standard. The mean reading time of the two study radiologists was reduced from 54.29 to 35.37 seconds with AI model assistance (p < 0.001). The ICC of the two study radiologists slightly increased with AI model assistance (from 0.945 to 0.990). @*Conclusion@#The proposed AI model was accurate for assessing bone age. Furthermore, this model appeared to enhance the clinical efficacy by reducing the reading time and improving the inter-observer reliability.

Evaluation of reliability of radiologic images posted on hospital websites for medical advertisements

A medical advertisement can include media such as newspapers, magazines, and the Internet. Currently, the Internet is responsible for most medical advertising. Our purpose is to investigate the current status of radiologic images posted on hospitals' websites nationwide, and to evaluate the reliability of online medical advertisements using these images. I investigated the websites of all 1,450 hospitals and 290 oriental medicine clinics nationwide. Specific information on the radiologic images posted was recorded. In terms of body parts, musculoskeletal images account for 78% of the radiologic images on hospitals' websites and 98% of the images for oriental medicine clinics. The purposes for posting radiologic images are to explain the pathophysiology of diseases or the technique of surgical treatments, and to show the effects of hospital-specialized treatments. The most commonly used modalities of radiologic images are plain radiography and MR. More than 90% of the posted images have no source; 10% have no legends; and 5% to 7% have inappropriate legends. In terms of quality, only 60% of the radiologic images on hospitals' websites are rated as acceptable. Fifteen percent of the oriental medicine clinics posted the radiologic images without having a medical doctor on staff. Considering the results, I conclude that it is necessary to re-establish a system of pre-screening and post-evaluation for reviewing hospital websites, especially focusing on the radiologic images posted. Then we can prevent the inappropriate information from influencing or damaging public health, and set up healthy medical competition.

The Association between the Magnetic Resonance Imaging Findings of Adhesive Capsulitis and Shoulder Muscle Fat Quantification Using a Multi-Echo Dixon Method

OBJECTIVE: To investigate the association between the magnetic resonance imaging (MRI) findings of adhesive capsulitis and shoulder muscle fat percentages using a multi-echo Dixon method. MATERIALS AND METHODS: Twenty-four patients with clinical diagnoses of adhesive capsulitis and either intact rotator cuffs or Ellman grade 1 partial tears as indicated by MRI scans were included. Two radiologists independently evaluated MRI scans of adhesive capsulitis as follows: presence or absence of axillary recess capsular and extracapsular hyperintensities; thickness of the coracohumeral ligament; thickness of abnormal rotator interval soft tissue; and thickness of glenoidal/humeral axillary recess capsules. Fat quantifications of the supraspinatus, infraspinatus, teres minor, subscapularis, teres major and posterior deltoid muscles were performed using multi-echo Dixon imaging at three locations. Inter-rater agreement was assessed. Differences in fat percentages were assessed and correlations between fat percentages and quantitative measurements were evaluated. RESULTS: The fat percentage of the supraspinatus was significantly higher in patients with extracapsular hyperintensity (present, 3.00 ± 1.74%; absent, 1.81 ± 0.80%; p = 0.022). There were positive correlations between the fat percentage of the teres minor and the thicknesses of the abnormal rotator interval soft tissue (r = 0.494, p = 0.014) and the glenoidal axillary recess capsule (r = 0.475, p = 0.019). After controlling for the effects of age, sex and clinical stage, the relationship between the teres minor fat percentage and the thickness of the abnormal rotator interval soft tissue was statistically significant (r = 0.384, p = 0.048). Inter-rater agreement was almost perfect for fat quantification (intraclass correlation coefficients [ICC] > 0.9) and qualitative analyses (k = 0.824), but were variable for quantitative measurements (ICC, 0.170–0.606). CONCLUSION: Several MRI findings of adhesive capsulitis were significantly related to higher fat percentages of shoulder muscles.

Evaluation of reliability of radiologic images posted on hospital websites for medical advertisements

A medical advertisement can include media such as newspapers, magazines, and the Internet. Currently, the Internet is responsible for most medical advertising. Our purpose is to investigate the current status of radiologic images posted on hospitals' websites nationwide, and to evaluate the reliability of online medical advertisements using these images. I investigated the websites of all 1,450 hospitals and 290 oriental medicine clinics nationwide. Specific information on the radiologic images posted was recorded. In terms of body parts, musculoskeletal images account for 78% of the radiologic images on hospitals' websites and 98% of the images for oriental medicine clinics. The purposes for posting radiologic images are to explain the pathophysiology of diseases or the technique of surgical treatments, and to show the effects of hospital-specialized treatments. The most commonly used modalities of radiologic images are plain radiography and MR. More than 90% of the posted images have no source; 10% have no legends; and 5% to 7% have inappropriate legends. In terms of quality, only 60% of the radiologic images on hospitals' websites are rated as acceptable. Fifteen percent of the oriental medicine clinics posted the radiologic images without having a medical doctor on staff. Considering the results, I conclude that it is necessary to re-establish a system of pre-screening and post-evaluation for reviewing hospital websites, especially focusing on the radiologic images posted. Then we can prevent the inappropriate information from influencing or damaging public health, and set up healthy medical competition.

Current status of ultrasonography of the finger

The recent development of advanced high-resolution transducers has enabled the fast, easy, and dynamic ultrasonographic evaluation of small, superficial structures such as the finger. In order to best exploit these advances, it is important to understand the normal anatomy and the basic pathologies of the finger, as exemplified by the following conditions involving the dorsal, volar, and lateral sections of the finger: sagittal band injuries, mallet finger, and Boutonnière deformity (dorsal aspect); flexor tendon tears, trigger finger, and volar plate injuries (volar aspect); gamekeeper's thumb (Stener lesions) and other collateral ligament tears (lateral aspect); and other lesions. This review provides a basis for understanding the ultrasonography of the finger and will therefore be useful for radiologists.

Comparison of T1rho and T2 Mapping of Knee Articular Cartilage in an Asymptomatic Population

OBJECTIVE: To analyze subregional differences in T1rho (T1ρ) and T2 values and their correlation in asymptomatic knee cartilage, and to evaluate angular dependence with magic angles. MATERIALS AND METHODS: Six asymptomatic volunteers underwent knee MRI with T1ρ and T2 mapping. T1ρ and T2 values were measured by two radiologists independently, at nine subregions in the medial femoral condyle (MFC) cartilage, at angles of ± 0°, 15°, 35°, 55°, 75° respective to a vertical line (B0) bisecting the width of the distal femur, and at two locations in the patella. Subregional values of T1ρ and T2 were analyzed and significant differences in three divided portions of the MFC (anterior, central, and posterior) were statistically evaluated. Correlation between T1ρ and T2 and angular dependence with magic angles were also assessed for statistical significance. RESULTS: T1ρ values were lowest at +15° and highest at -55°. T2 values were lowest at +75° and highest at +35°. Both T1ρ and T2 were higher in superior patella than inferior patella. T1ρ showed significant differences in the three divided portions of the MFC, while T2 showed significant differences only between central and posterior portions. There was a weak correlation between T1ρ and T2 (r = 0.217, p = 0.127). T1ρ showed more angular dependence than T2. CONCLUSION: T1ρ and T2 showed different subregional values and angular dependence in asymptomatic knee cartilage with a weak correlation. Awareness of these differences will aid in assessment of cartilage in a specific subregion of the knee.

Detecting Peripheral Nerves in the Elbow using Three-Dimensional Diffusion-Weighted PSIF Sequences: a Feasibility Pilot Study

PURPOSE: To analyze the feasibility of three-dimensional (3D) diffusion-weighted (DW) PSIF (reversed FISP [fast imaging with steady-state free precession]) sequence in order to evaluate peripheral nerves in the elbow. MATERIALS AND METHODS: Ten normal, asymptomatic volunteers were enrolled (6 men, 4 women, mean age 27.9 years). The following sequences of magnetic resonance images (MRI) of the elbow were obtained using a 3.0-T machine: 3D DW PSIF, 3D T2 SPACE (sampling perfection with application optimized contrasts using different flip angle evolution) with SPAIR (spectral adiabatic inversion recovery) and 2D T2 TSE (turbo spin echo) with modified Dixon (m-Dixon) sequence. Two observers used a 5-point grading system to analyze the image quality of the ulnar, median, and radial nerves. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of each nerve were measured. We compared 3D DW PSIF images with other sequences using the Wilcoxon-signed rank test and Friedman test. Inter-observer agreement was measured using intraclass correlation coefficient (ICC) analysis. RESULTS: The mean 5-point scores of radial, median, and ulnar nerves in 3D DW PSIF (3.9/4.2/4.5, respectively) were higher than those in 3D T2 SPACE SPAIR (1.9/2.8/2.8) and 2D T2 TSE m-Dixon (1.7/2.8/2.9) sequences (P < 0.05). The mean SNR in 3D DW PSIF was lower than 3D T2 SPACE SPAIR, but there was no difference between 3D DW PSIF and 2D T2 TSE m-Dixon in all of the three nerves. The mean CNR in 3D DW PSIF was lower than 3D T2 SPACE SPAIR and 2D T2 TSE m-Dixon in the median and ulnar nerves, but no difference among the three sequences in the radial nerve. CONCLUSION: The three-dimensional DW PSIF sequence may be feasible to evaluate the peripheral nerves around the elbow in MR imaging. However, further optimization of the image quality (SNR, CNR) is required.

Usefulness of Digital Tomosynthesis for the Detection of Airway Obstruction: A Case Report of Bronchial Carcinosarcoma / Journal of the Korean Cancer Association, 대한암학회지

Bronchial carcinosarcoma is a very rare malignant tumor that is composed of carcinomatous and sarcomatous elements. We describe the first case in which digital tomosynthesis was useful for the evaluation of airway obstruction by bronchial carcinosarcoma that was overlooked on initial chest radiography.

Classification of Metastatic versus Non-Metastatic Axillary Nodes in Breast Cancer Patients: Value of Cortex-Hilum Area Ratio with Ultrasound / 한국유방암학회지

PURPOSE: To investigate the significance of the cortex-hilum (CH) area ratio and longitudinal-transverse (LT) axis ratio and the blood flow pattern for diagnosis of metastatic axillary lymph nodes by ultrasound in breast cancer patients. METHODS: From October 2005 to July 2006, we prospectively evaluated axillary nodes with ultrasound in 205 consecutive patients who had category 4B, 4C or 5 breast lesions according to the Breast Imaging Reporting and Data System-Ultrasound (BI-RADS-Ultrasound(R)). Among the 205, there were 24 patients who had pathologic verification of breast cancer and axillary lymph node status. For a total of 80 axillary nodes we measured the areas of the cortex and hilum of lymph nodes and calculated the area ratio. We also measured the length of the longitudinal and transverse axis of the lymph nodes and calculated the length ratio. We evaluated the blood flow pattern on power Doppler imaging and classified each lymph node into a central or peripheral pattern. Diagnostic performance was analyzed according to positive criteria for lymph node metastasis (CH area ratio >2, LT axis ratio <2, peripheral type on power Doppler imaging). RESULTS: The sensitivity of the CH area ratio was superior to that of the LT axis ratio (94.1% vs. 82.3%, p=0.031) and to that of the blood flow pattern (94.1% vs. 29.4%, p=0.009). For specificity, all three evaluating parameters had high values (89.1-95.6%) and no significant differences were found (p=0.121). The CH area ratio had a better positive predictive value than the LT axis ratio (94.1% vs. 80.0%, p=0.030) and power Doppler imaging (94.1% vs. 66.6%, p=0.028). For the negative predictive value, the CH area ratio was superior to the LT axis ratio (95.6% vs. 86.6%, p=0.035) and the blood flow pattern (95.6% vs. 63.0%, p=0.027). CONCLUSION: We recommend the CH area ratio of an axillary lymph node on ultrasound as a quantitative indicator for the classification of lymph nodes. The CH area ratio can improve diagnostic performance when compared with the LT axis ratio or blood flow pattern.

Characterization of Cystic Breast Masses on Ultrasound: Comparative Study among Conventional, Tissue Harmonic, Compound, and a Combination of Tissue Harmonic and Compound Imaging

PURPOSE: This prospective study was to compare the image quality and diagnostic performance of breast cystic masses by conventional and advanced ultrasound (US) techniques including tissue harmonic, compound, and the combination of these techniques. MATERIALS AND METHODS: All 91 patients, collectively having 109 breast cystic masses were scanned using four US techniques (complicated cysts in 36, septated cysts in 33, and complex cysts in 40). Two breast radiologists independently assessed the image quality and possibility of malignancy. Image quality was evaluated in terms of contrast and clarity of the wall and internal echo pattern and then graded on a scale of 1 (poor) to grade 3 (satisfactory). The possibility of malignancy was graded on a scale of 1 (suggestive of benignancy) to 5 (suggestive of malignancy) using US images. The histopathological results and follow-up images were used as the reference standard for the assessment of diagnostic performance. Results were evaluated by Friedman's test and receiver operating characteristic (ROC) analyses. RESULTS: In terms of image quality, a grade of 3 was significantly more frequent in the three advanced US techniques than conventional US (p < 0.05). For assessment of diagnostic performance, areas under the ROC curves in three advanced techniques were significantly higher than in conventional US (p < 0.05). CONCLUSION: Advanced US techniques including compound and tissue harmonic US techniques provide a better image quality in breast cystic masses and also improve the diagnostic performance compared with conventional US.

Sino-orbital Granulocytic Sarcoma Causing Bilateral Proptosis As an Initial Manifestation of Acute Myelogenous Leukemia (AML): A Case Report

Granulocytic sarcoma is a manifestation of myelogenous leukemia, which means a solid mass consisting of primitive precursors of the granulocytic series of white blood cells. We present CT and MR imaging findings of bilateral sino-orbital granulocytic sarcoma in a 22-month-old boy. The mass involved bilateral orbital fossa which resulted in bilateral proptosis. Moreover, the mass extended to the almost skull base including paranasal sinuses, maxilla, temporal bone, zygomatic bone, sphenoid bone, ethmoid, and palatine bone. The adjacent dura was continuously thickened and the lower half of cavernous sinus was also involved. The patient was diagnosed as AML (M5) with t(8,21) translocation through a chromosome study from the bone marrow.

Sino-orbital Granulocytic Sarcoma Causing Bilateral Proptosis As an Initial Manifestation of Acute Myelogenous Leukemia (AML): A Case Report

Granulocytic sarcoma is a manifestation of myelogenous leukemia, which means a solid mass consisting of primitive precursors of the granulocytic series of white blood cells. We present CT and MR imaging findings of bilateral sino-orbital granulocytic sarcoma in a 22-month-old boy. The mass involved bilateral orbital fossa which resulted in bilateral proptosis. Moreover, the mass extended to the almost skull base including paranasal sinuses, maxilla, temporal bone, zygomatic bone, sphenoid bone, ethmoid, and palatine bone. The adjacent dura was continuously thickened and the lower half of cavernous sinus was also involved. The patient was diagnosed as AML (M5) with t(8,21) translocation through a chromosome study from the bone marrow.

Additional Breast Ultrasound Examinations in Clustered Calcifications: for Improving Diagnostic Performance / 한국유방암학회지

PURPOSE: We wanted to determine whether additional breast ultrasound examinations are needed for patients who have clustered calcifications found by mammography for the detection of breast carcinomas. METHODS: We performed targeted ultrasound examinations in 125 consecutive patients who had clustered calcifications found by mammography. Forty-eight pathologically proven patients with 61 breast lesions were included in this study (26 invasive carcinomas, 10 ductal carcinomas in situ and 25 benign diseases). Two breast radiologists evaluated the mammography and the ultrasound findings and they graded the probability of malignancy by consensus as follows: definitely benign 1, probably benign 2, probably malignant 3, and definitely malignant 4. The diagnostic performance values, including the sensitivity, specificity, accuracy, positive predictive value and negative predictive value, for mammography and additional ultrasound were compared using McNemar's test and receiver operating characteristic (ROC) analysis. On the ROC analysis, areas under the ROC curves (AUC) and 95% confidence intervals (CI) were obtained. RESULTS: The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for making the diagnosis of breast carcinoma by mammography were 88.9%, 12.0%, 57.4%, 59.3%, and 42.9% and those for additional ultrasound were 94.4%, 64.0%, 82.0%, 79.1%, and 88.9%, respectively. The differences of specificity and accuracy were statistically significant (p=0.0003). On the ROC analysis, ACU were significantly different between mammography (AUC=0.586, 95% CI=0.453-0.711) and ultrasound (AUC=0.823, 95% CI=0.704-0.909) (p=0.003). Clustered calcifications with associated masses or ductal changes on additional breast ultrasound had high frequency of malignancies, 79% or 73%. In addition, 87% of malignant masses were invasive carcinomas and 45% of malignant ductal changes were ductal carcinomas in situ. CONCLUSION: Additional breast ultrasound examinations for the lesions with clustered calcifications on mammography can improve the diagnostic performance and significantly contribute to the specificity and accuracy of a diagnosis of breast carcinoma. In addition, the ultrasound features may predict the pathologic findings such as benignity or malignancy and invasive carcinoma or ductal carcinoma in situ.

Sonographically Detected Architectural Distortion: linical Significance

PURPOSE: Architectural distortion is a suspicious abnormality for the diagnosis of breast cancer. The aim of this study was to investigate the clinical significance of sonographically detected architectural distortion. MATERIALS AND METHODS: From January 2006 to June 2008, 20 patients were identified who had sonographically detected architectural distortions without a history of trauma or surgery and abnormal mammographic findings related to an architectural distortion. All of the lesions were pathologically verified. We evaluated the clinical and pathological findings and then assessed the clinical significance of the sonographically detected architectural distortions. RESULTS: Based on the clinical findings, one (5%) of the 20 patients had a palpable lump and the remaining 19 patients had no symptoms. No patient had a family history of breast cancer. Based on the pathological findings, three (15%) patients had malignancies. The malignant lesions included invasive ductal carcinomas (n = 2) and ductal carcinoma in situ (n = 1). Four (20%) patients had high-risk lesions; atypical ductal hyperplasia (n = 3) and lobular carcinoma in situ (n = 1). The remaining 13 (65%) patients had benign lesions, however, seven (35%) out of 13 patients had mild-risk lesions (three intraductal papillomas, three moderate or florid epithelial hyperplasia and one sclerosing adenosis). CONCLUSION: Of the sonographically detected architectural distortions, 35% were breast cancers or high-risk lesions and 35% were mild-risk lesions. Thus, a biopsy might be needed for an architectural distortion without an associated mass as depicted on breast ultrasound, even though the mammographic findings are normal.

Non-Calcified Ductal Carcinoma in Situ: Ultrasound and Mammographic Findings Correlated with Histological Findings

PURPOSE: To evaluate radiological findings of non-calcified ductal carcinoma in situ (DCIS) and to correlate those with histological features. MATERIALS AND METHODS: From July 2002 to March 2006, 22 patients with histologically-proven non-calcified DCIS were included. Mammography was obtained in 19 patients, ultrasound in 18 patients, and both examinations in 15 patients. Radiological findings were evaluated according to the Breast Imaging Reporting and Data System by American College of Radiology. Histological tumor subtype and Van Nuys classification of DCIS were assessed. RESULTS: Histological subtypes consisted of mixed type in 11 patients (50%), comedo in 4 (18%), cribriform in 4 (18%), papillary type in 2 (9%), and solid in one (5%). According to Van Nuys classification, group 3 DCIS was observed in 13 (59%) patients. In the 19 patients who underwent mammography, 13 patients presented with abnormal findings: focal asymmetry in 7 patients (37%), masses in 4 (21%), skin thickening in one (5%), and architectural distortion in one (5%). In the 18 patients who had received breast ultrasound, a mass was present in 15 (83%) patients and ductal changes in 3 patients (17%). Sixty percent of patients with masses on ultrasound had group 3 DCIS and 100% of patients with ductal change had group 1 DCIS (p=0.017). CONCLUSION: Diagnosis of non-calcified DCIS by mammography is not an easy task due to the lack of typical malignant calcifications or masses. High resolution ultrasound can be useful for detecting non-calcified DCIS, and ultrasound findings are correlated with histological features.

A Comparative Study of Palpable and Nonpalpable Breast Cancers determined by Ultrasonography / 한국유방암학회지

PURPOSE: The aim of this study was to investigate any difference of ultrasound findings for palpable and nonpalpable breast cancers. METHODS: Two hundred breast cancer patients that had undergone preoperative ultrasound and surgery were enrolled in the study. A total of 126 cancers were palpable, and the remaining 74 cancers were nonpalpable. We compared lesion characteristics using ultrasound images according to the BI-RADS(R)-Ultrasound guidelines of the American College of Radiology. A crude odds ratio (OR) and 95% confidence interval (CI) were calculated for a comparison of the palpable and nonpalpable breast cancers. RESULTS: Nonpalpable cancers displayed more often an oval shape (OR=0.35, 95% CI=0.17-0.70), no posterior acoustic features (OR=0.50, 95% CI=0.28-0.89), and a parallel orientation (OR=0.50, 95% CI=0.28-0.89). An irregular shape (OR=2.98, 95% CI=1.60-5.54), a spiculated margin (OR=2.66, 95% CI=1.23-5.74), and a combined pattern of posterior acoustic features (OR=7.20, 95% CI=1.64-31.66) were more commonly observed in the palpable cancers. CONCLUSION: Palpable and nonpalpable breast cancers were found to have different ultrasound characteristics.

Usefulness of High-Frequency Compound Spatial Sonography in the Assessment of Hepatitis B Virus Related Chronic Liver Disease

PURPOSE: To evaluate the liver parenchyma according to the echo patterns of CSS (compound spatial sonography), and to correlate them with the extent of hepatic fibrosis and the serum aminotransferase level. MATERIALS AND METHODS: The CSS images were classified into the following three echo patterns: type I, a normallooking echo; type II, hyperechoic or hypoechoic nodules scattered in a normal-looking echo; type III, a severely heterogeneous echogenic or hypoechoic honeycomb-like echo. The CSS findings were correlated with the histopathology findings in 63 patients with HBV. The serum aminotransferase levels and the occurrence of acute exacerbation in 168 patients with HBV, with and without a progressed parenchymal echo pattern, and who were followed up more than 1-year period, were compared. The interobserver agreement between the two radiologists for assessing the parenchymal echo pattern was scored. RESULTS: The correlation between the CSS pattern and hepatic fibrosis was statistically significant (correlation coefficient = 0.58, p < 0.05). The baseline serum aminotransferase level was not significantly different between the patients with and without a progressed parenchymal echo pattern. However, the rate of acute exacerbation was higher in patients with a progressed parenchymal echo pattern (p < 0.05). The interobserver agreement was good (k statistic = 0.63, 0.78). CONCLUSION: The liver parenchymal pattern based on the 5-12 MHz CSS is a useful and objective tool for diagnosing and monitoring HBV related chronic liver disease.

The Role of an Axial MR Scan on the Diagnosis of a Meniscal Tear of the Knee Joint

PURPOSE: To evaluate the role of standard axial MR images for the diagnosis of meniscal tears of the knee. MATERIALS AND METHODS: Forty-five patients with a prior MRI examination that underwent arthroscopic surgery of the knee due to clinical impression of a meniscal tear were included in the study group. The sequence for meniscal evaluation was an axial fat-saturated proton density-weighted image with a 4 mm slice thickness. Axial MR images were independently reviewed by two radiologists and were compared with findings of arthroscopy. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the axial MR scan for the diagnosis of the meniscal tear were calculated. RESULTS: A total 90 menisci of 45 patients were evaluated in the axial MR scans. Forty-two patients had meniscal tears, and two of the patients had tears in both menisci; thus, a total of44 meniscal tears were found by arthroscopy. For meniscal tears, the sensitivity of the axial plane was 76.2%, the specificity was 89.1% and the accuracy was 81.1%. False negative meniscal tears were seen in 12 cases and false positive meniscal tears were seen in 5 cases on the axial MR images. CONCLUSION: In standard knee MRI examinations, axial images may be valuable for the detection and localization of meniscal tears.

Nodular Fasciitis on the Nasolabial Fold in a 5-month-old Infant: A Case Report

We report the case of a 5-month-old infant with a rapidly growing mass on the right nasolabial fold; to our knowledge, this is the youngest infant diagnosed with nodular fasciitis in the literature. Based on the anatomic location, this was a subcutaneous type of nodular fasciitis and it had a mixed cellular and fibrous histologic composition, which is rare in infancy. Here we present periodic ultrasonographic images and MR images, as well as a detailed comparison of the pathologic and radiologic findings.

Femoral Arterial Puncture: Comparison of Using the Inguinal Crease and Bony Landmarks

PURPOSE: We tried to compare the accuracy of using bony landmarks and inguinal crease landmarks for performing femoral artery puncture and to determine an ideal puncture site. MATERIALS AND METHODS: We studied ninety consecutive patients who underwent femoral arterial puncture for performing angiogram. For the evaluation of bony landmarks, the pelvis and inguinal areas were divided into 8 zones according to 7 lines that were drawn parallel to the line drawn between the anterior superior iliac spine and the pubic tubercle. For evaluation of the inguinal crease as a landmark, the 8 zones above and 4 zones below the inguinal crease were determined. The zones were divided by 11 lines drawn parallel to the inguinal crease, and the interval between each line was 1cm. Locations of the inguinal ligament and femoral bifurcation were recorded for every patient according to the above zones, and an ideal zone for the femoral arterial puncture was decided upon. The ideal zone was considered if the locations of all of inguinal ligaments were above the zone and the least possibility to puncture was below the femoral bifurcation. RESULTS: On the bony landmark, the femoral bifurcations were located at zone 3 in 1 patient (1.1%), at zone 4 in 2 patients (2.2%), at zone 5 in 3 patients (3.3%), at zone 6 in 24 patients (26.7%), and at zone7 in 44 patients (48.9%). Inguinal ligaments were at zone 1 in 2 patients (3.0%), at zone 2 in 34 patients (50.7%), at zone 3 in 25 patients (37.3%), and at zone 4 in 6 patients (8.9%). When the inguinal creases were used as a landmark, the femoral bifurcations were located at zone 4 in 4 patients (4.4%), at zone 3 in 19 patients (21.1%), at zone 2 in 30 patients (33.3%), at zone 1 in 19 patients (21.1%), at zone -1 in 13 patients (14.4%), at zone -2 in 3 patients (3.3%) and at zone-4 in 2 patients (2.2%). Inguinal ligaments were at zone 8 in 7 patients (10.4%), at zone 7 in 11 patients (16.4%), at zone 6 in 19 patients (28.4%), at zone 5 in 20 patients (29.9%), at zone 4 in 7 patients (10.4%), and at zone 3 in 3 patients (4.5%). Therefore, the best zone for femoral arterial puncture was zone 5 with using bony landmarks and zone 2 with using inguinal crease landmarks. In terms of zone 5 on the bony landmark, every locations of inguinal ligaments was above it and 84 patients (93.4%) had their femoral bifurcation below it, excluding the 6 patients who had their femoral bifurcations at zones 3, 4, and 5. Therefore, zone 5 with using the bony landmarks was a good indicator for femoral arterial puncture. In case of zone 2 on the inguinal crease landmark, although every location of the inguinal ligament was above it, 53 patients (58.8%) had their femoral bifurcation above it at zones 4, 3, and 2. So, it was not a good indicator for femoral arterial puncture. CONCLUSION: Bony landmarks are more accurate indicators for performing femoral arterial puncture than the inguinal crease landmark. Zone 5 on the bony landmark is an ideal location for femoral arterial puncture.