Shoulder MR arthrography: intraarticular anesthetic reduces periprocedural pain and major motion artifacts but does not decrease imaging time.

PURPOSE: To prospectively determine whether the addition of an intraarticular anesthetic to the magnetic resonance (MR) arthrography solution has an effect on periprocedural pain, motion artifacts, and imaging time. MATERIALS AND METHODS: This study was approved by the institutional review board, and written informed consent was obtained from all patients. From September 2009 to March 2010, 127 patients, most imaged for shoulder pain, were randomized into two groups. The first group (group A, 63 patients) received intraarticular injection of gadopentetate dimeglumine, ropivacaine 0.5%, and normal saline in a ratio of 1:100:100. The second group (group B, 64 patients) received intraarticular injection of gadopentetate dimeglumine and normal saline in a ratio of 1:200. Pain was assessed before and after injection and immediately after 1.5-T MR imaging and rated on a scale of 0 to 10. Motion artifact was assessed by two musculoskeletal radiologists and two fellows by using a scale of 0 to 3 (0=no artifact, 1=artifact present but not affecting diagnostic image quality, 2=artifact present and diminishing diagnostic image quality, and 3=artifact present and rendering image nondiagnostic). MR imaging time and examinations with repeated sequences were recorded. Wilcoxon rank sum, analysis of covariance, and permutation data analyses were performed. RESULTS: The mean pain levels before injection, after injection, and after MR imaging were 3.5, 2.3, and 2.5, respectively, for group A and 3.6, 3.1, and 3.2 for group B. After adjusting for age, sex, and preinjection pain level, the mean differences in pre- and postinjection pain and preinjection pain and post-MR imaging pain between the two groups were -0.9 (P=.017) and -0.8 (P=.056), respectively. No significant difference in mean total MR imaging time or number of patients with repeat sequences was noted. Radiologists 1 and 2 recorded grade 2 or 3 motion in six and five patients, respectively, in group A and 15 and 14 patients, respectively, in group B (P=.047 and .048, respectively). Radiologists 3 and 4 recorded grade 2 or 3 motion in 13 and 23 patients, respectively, in group A and 23 and 33 patients, respectively, in group B (P=.093 and .110, respectively). CONCLUSION: The use of an intraarticular anesthetic significantly reduces periprocedural pain and major motion artifacts associated with MR shoulder arthrography; however, total MR imaging time is not reduced.

Imaging characteristics of angiomatoid fibrous histiocytoma of bone.

We present the first report of a patient with angiomatoid fibrous histiocytoma of bone in the radiology literature. This tumor initially eluded diagnosis due to its similarities with chronic hematoma and aneurysmal bone cyst. Only two cases of angiomatoid fibrous histiocytoma have been reported in the radiology literature and both of these lesions were in the soft tissues. The fairly distinctive findings in our patient of multiple large cystic chambers with fluid-fluid levels are similar to the findings in the two soft tissue case reports, suggesting that imaging may be used to suggest this specific diagnosis regardless of location, especially in the clinical setting of unexplained hematoma or anemia. Mention of this diagnosis in the radiology report may aid in the final diagnosis at pathology, because special techniques, including fluorescent in situ hybridization, must be applied in order to fully evaluate for the diagnosis.

Radiology coding, reimbursement, and economics: a practical playbook for housestaff.

As radiologists-in-training, residents and fellows have little time to devote to understanding the complex and often confusing world of reimbursement and radiology economics. At best, housestaff are afforded only a modicum of exposure to the economics of medicine. Although most training programs try to provide some information on the subject, between learning radiology, taking call, and juggling life outside the hospital, the majority of residents and fellows have little time or energy to learn about the economics of radiology. Furthermore, information on medical economics and radiology has only occasionally been directed specifically to housestaff or widely distributed to residents across the country. This is unfortunate because the reimbursement and economic arena will significantly affect daily practice, relationships with other specialties, and compensation. In this article, the authors briefly describe the current reimbursement and economic climate: how we got here and where we may be headed, with specific attention to coding for radiologic services. In addition, and perhaps more important, the authors highlight aspects of residents' or fellows' daily practice that may have the potential to affect reimbursement in their years of practice ahead, such as proper dictation and coding techniques, the importance of adhering to new reporting guidelines, and the need for increased radiologist involvement in professional and community activities. The authors also emphasize measures that can be taken, specifically by housestaff, to promote and preserve the image of our specialty, which ultimately is intertwined with the reimbursement and economics of our field.