Reporting of paediatric osteoporotic vertebral fractures in Duchenne muscular dystrophy and potential impact on clinical management: the need for standardised and structured reporting.

BACKGROUND: In boys with Duchenne muscular dystrophy (DMD), initiation of bisphosphonate is recommended upon identification of moderate or severe vertebral fractures, even if asymptomatic. Clear radiological reporting is important for consistency of clinical interpretation and management. OBJECTIVES: To audit radiology reports of spine imaging for vertebral fracture assessment in DMD, and assess potential impact on diagnosis and management. MATERIALS AND METHODS: Lateral thoracolumbar spine imaging (71 lateral spine radiographs and 13 lateral dual energy absorptiometry spine image) in 84 boys with DMD performed across two centres. Anonymised radiology reports by paediatric radiologists were circulated to two neuromuscular clinicians and two endocrinologists. Clinicians determined if there was vertebral fracture, no vertebral fracture, or unclear interpretation. Endocrinologists also determined if bisphosphonate was indicated. A single observer (a clinician with expertise in vertebral fracture assessment) performed vertebral fracture assessment in 37 images and re-reported using a structured format. Structured reports were re-circulated to the four clinicians to re-evaluate the degree of concordance in clinical diagnosis of vertebral fracture and treatment decisions with bisphosphonate. RESULTS: The term "fracture" was used in 25/84 (30%) radiology reports and only in 8/43 (19%) with description of vertebral body abnormalities. Fracture grading was included in 7/43 (16%) radiology reports. Diagnostic concordance by the clinicians was noted in 36/84 (43%). Unclear interpretation was noted in 22% to 51% based on radiology reports. No unclear interpretation was noted with structured reports. Complete diagnostic (37/37, 100%) and treatment (37/37, 100%) concordance was noted with the structured reports, whereas complete diagnostic and treatment concordance was noted in only 16/37 (43%) and 17/37 (46%) of the radiology reports, respectively. CONCLUSION: Only a third of radiology reports of spine imaging in DMD explicitly used the terminology "fracture". Grading was only noted in a small percentage. Variability in diagnostic interpretation by clinicians may lead to differing management plans. As identification of vertebral fracture is a trigger for treatment, developing reporting guidelines for paediatric vertebral fracture assessment will improve care. A structured template should be introduced for radiological reporting of paediatric vertebral fracture assessment.

Signet ring cell adenocarcinoma of the bladder: linitis plastica variant.

An unusual case of the signet ring cell variant of adenocarcinoma of the bladder occurred in which the tumor extensively infiltrated the bladder wall and perivesical fascia. The pattern of infiltration was analogous to that seen in the linitis plastica variant of gastric carcinoma. Cystoscopic and roentgenographic studies failed to reveal a grossly evident lesion.

Undifferentiated sarcoma arising in an augmented ileocystoplasty patch.

We report an unusual case of a sarcoma at the patch site of an ileocystoplasty. The tumor proved to be an aggressive neoplasm that metastasized widely. The literature is reviewed concerning neoplasms occurring in urinary diversion procedures.

The natural history of symptomatic recurrent bacteriuria in women.

In 23 adult women having uncomplicated recurrent urinary tract infections treated with 10 days of appropriate antibiotic for each infection, the following findings were noted. 1. The attack rate was 0.17 infections per month. 2. 94% of infections has associated symptoms. 3. 73% of symptomatic episodes had an associated infection. 4. 21% of infections had less than 10(5) bacteria per ml. 5. 34% of all infections were followed by an infection-free interval of at least six months and averaged 12.8 months. All but one patient had at least one infection-free interval. 6. Long infection-free intervals were followed by further infections; a remission is not a cure. 7. Between infection-free intervals the infections tended to occur in clusters with an attack rate of 0.47 infections per month. 8. Prophylaxis is less costly if begun at the second infection within a six-month period.