Injury Surveillance and Reporting for Trainees with Bone Stress Injury: Current Practices and Recommendations.

Background: Musculoskeletal injuries, including lower extremity bone stress injuries (BSI) significantly impact initial entry training (IET) in the U.S. Army due to limited duty days, trainee attrition, early medical discharge, and related financial costs. Factors complicating trainee BSI surveillance include inconsistent BSI coding practices, attrition documentation as both administrative separations and medical discharges and the inability to code for BSI grade or severity when using International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10) codes. Methods: A multidisciplinary expert panel developed policy guidance to enhance clinical and administrative management of BSI, following extensive analysis of current, peer-reviewed literature. Policy guidance incorporates leading practices concerning clinical BSI management, including imaging procedures, recommended notifications, early intervention, and ICD-10 diagnostic coding procedures. Policy guidance also standardizes BSI grading criteria for magnetic resonance imaging and skeletal scintigraphy (bone scan). Findings: Multidisciplinary expert opinion indicates inconsistent BSI diagnosis and management across IET due to variability in trainee BSI grading, documentation, and coding practices. Injury surveillance conducted by the United States Army Medical Command (USAMEDCOM) will benefit from routine, standardized musculoskeletal injury data base searches by BSI severity/grade and anatomical location upon implementation of BSI policy guidance. Discussion: Effective injury surveillance is critical for determining trainee BSI incidence and attrition, developing anticipated return to duty (RTD) timelines, and assessing long-term outcomes. BSI RTD timelines should account for gender, BSI grade/severity, anatomical location, and type of intervention. Well-defined RTD timelines would benefit administrative decision-making purposes, including whether to grant convalescent leave or enroll in the Warrior Training and Rehabilitation Program during BSI recovery. Enhanced management procedures may improve initial enlistment completion rates for trainees sustaining at least one BSI who eventually complete IET.

Femoral Neck Stress Injuries: Analysis of 156 Cases in a U.S. Military Population and Proposal of a New MRI Classification System.

OBJECTIVE: The objective of this study is to formulate a new MRI classification system for fatigue-type femoral neck stress injuries (FNSIs) that is based on patient management and return-to-duty (RTD) time. MATERIALS AND METHODS: A retrospective review of 156 consecutive FNSIs in 127 U.S. Army soldiers over a 24-month period was performed. The width of marrow edema for low-grade FNSIs and the measurement of macroscopic fracture as a percentage of femoral neck width for high-grade FNSIs were recorded. RTD time was available for 90 soldiers. Nonparametric testing, univariate linear regression, and survival analysis on RTD time were used in conjunction with patient management criteria to develop a new FNSI MRI classification system. RESULTS: The FNSI incidence was 0.09%, and all FNSIs were compressive-sided injuries. RTD time was significantly longer for high-grade FNSIs versus low-grade FNSIs (p < 0.001). Our FNSI MRI classification system showed a significant difference in RTD time between grades 1 and 2 (p = 0.001-0.029), 1 and 3 (p < 0.001), and 1 and 4 (p = 0.001-0.01). There was no significant RTD time difference between the remaining grades. The rates of completing basic training (BT) and requiring medical discharge were significantly associated with the FNSI MRI grades (p = 0.038 and p = 0.001, respectively). CONCLUSION: The proposed FNSI MRI classification system provides a robust framework for patient management optimization by permitting differentiation between operative and nonoperative candidates, by allowing accurate prediction of RTD time, and by estimating the risk of not completing BT and requiring medical discharge from the military.

Imaging of Extranodal Genitourinary Lymphoma.

The genitourinary (GU) system is commonly affected by disseminated lymphoma. Rarely, lymphoma can originate from and remain localized to one of the GU organs and thus presents as primary extranodal disease. Up to 40% of lymphomas present as extranodal disease, with only 3% having the GU system as the primary site of involvement. This article describes and correlates the radiologic and pathologic features of extranodal lymphomatous disease affecting the GU system with specific focus on the kidneys, adrenal glands, testicles, and ovaries. Lymphoma of the uterine body and cervix, external female genitalia, urinary bladder, and prostate gland is briefly discussed.

From the radiologic pathology archives: pediatric polycystic kidney disease and other ciliopathies: radiologic-pathologic correlation.

Genetic defects of cilia cause a wide range of diseases, collectively known as ciliopathies. Primary, or nonmotile, cilia function as sensory organelles involved in the regulation of cell growth, differentiation, and homeostasis. Cilia are present in nearly every cell in the body and mutations of genes encoding ciliary proteins affect multiple organs, including the kidneys, liver, pancreas, retina, central nervous system (CNS), and skeletal system. Genetic mutations causing ciliary dysfunction result in a large number of heterogeneous phenotypes that can manifest with a variety of overlapping abnormalities in multiple organ systems. Renal manifestations of ciliopathies are the most common abnormalities and include collecting duct dilatation and cyst formation in autosomal recessive polycystic kidney disease (ARPKD), cyst formation anywhere in the nephron in autosomal dominant polycystic kidney disease (ADPKD), and tubulointerstitial fibrosis in nephronophthisis, as well as in several CNS and skeletal malformation syndromes. Hepatic disease is another common manifestation of ciliopathies, ranging from duct dilatation and cyst formation in ARPKD and ADPKD to periportal fibrosis in ARPKD and several malformation syndromes. The unifying molecular pathogenesis of this emerging class of disorders explains the overlap of abnormalities in disparate organ systems and links diseases of widely varied clinical features. It is important for radiologists to be able to recognize the multisystem manifestations of these syndromes, as imaging plays an important role in diagnosis and follow-up of affected patients.

MR findings in the arthropathy of relapsing polychondritis.

We report a case of relapsing polychondritis involving three synovial joints in a child. Initial presentation was at 5 years of age with periorbital edema and chemosis of the conjunctiva with a definite diagnosis established at 9 years of age following an acute monoarticular arthropathy of the knee. The role of MRI in suggesting the diagnosis of relapsing polychondritis is emphasized by demonstrating a unique pattern of inflammation and enhancement that preferentially involves the perichondrium and chondroepiphysis.