Background The diagnostic accuracy of magnetic resonance imaging (MRI) is low for detecting a subscapularis tendon tear. Purpose To identify MRI findings that may predict the presence of a clinically significant subscapularis tendon tear requiring surgical repair. Material and Methods We reviewed shoulder MR images of patients who had undergone arthroscopic rotator cuff repair at our institution between June 2018 and May 2019. Patients were divided into two groups: the study group (n = 51), with an intermediate- to high-grade partial thickness tear of the subscapularis tendon suspected on preoperative MRI and intermediate or higher grade of the tendon tear proven on arthroscopy; and the control group (n = 18), with an intermediate- to high-grade partial thickness tear of the subscapularis tendon suspected on preoperative MRI but no tear or low-grade partial thickness tear of the tendon shown on arthroscopy. Preoperative MR images were retrospectively evaluated by two readers for the size of the subscapularis tendon tear, bone reactions at the lesser tuberosity, and long head of the biceps tendon (LHBT) pathology. Results The subscapularis tendon tear measured by reader 2 was larger in the study group than in the control group. The prevalence of a tear ( P = 0.006 for reader 1; P = 0.011 for reader 2) and malposition ( P < 0.001 for both readers) of the LHBT were significantly greater in the study group. Conclusion A tear and malposition of the LHBT on MR images may predict the presence of a clinically significant subscapularis tendon tear.

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Background and purpose Spinal cord infarction (SCI) is difficult to diagnosis using MRI findings. We aimed to suggest the optimal timing of MRI studies for diagnosing SCI. Materials and methods This retrospective study was approved by our institutional review board. The requirement for informed consent was waived. MRI scans of SCI patients diagnosed between January 2015 and August 2019 were enrolled in the SCI group and subdivided according to the interval between symptom onset and time of MRI scan (A, within 6 h; B, 6–12 hours; C, 12–24 hours; D, 24–72 hours; E, 3–7 days). Three radiologists analyzed the T2WI scans and evaluated the confidence level of diagnosing SCI using a five-point Likert scale: 1, certainly not; 2, probably not; 3, equivocal; 4, probably yes; 5, certainly yes. Scores of 4 and 5 were defined as “T2WI-positive SCI” and scores of 1–3 were defined as “T2WI-negative SCI”. Results The SCI group included 58 MRI scans of 34 patients (mean age, 60.6 ± 14.0 years; 18 women). The T2WI positivity rate was 72.4% (42/58). In contrast to the other subgroups, subgroup A included fewer cases of T2WI-positive SCI (1/4, 25%) than T2WI-negative SCI. A confidence score of 5 was the most common in subgroup D (4/27, 14.8%). Among the 12 patients who underwent MRI studies more than twice, confidence scores increased with time. Conclusion In patients with suspected SCI showing equivocal initial MRI findings, follow-up MRI studies are helpful, especially when performed between 24 and 72 hours after symptom onset.

Gallbladder perforation is a complication of acute cholecystitis, occurring in 2-42% of patients with acute cholecystitis (1, 2). Since Niemeier (3) classified gallbladder perforation into three types, modified Niemeier classification of gallbladder perforation (4) has been used: type I, acute perforation into the free peritoneal cavity; type II, subacute perforation of the gallbladder surrounded by an abscess; and type III, chronic perforation with fistula formation between the gallbladder and other abdominal viscera. Purpose: Treatment of acute cholecystitis with gallbladder perforation remains controversial. We aimed to determine the feasibility of percutaneous cholecystostomy (PC) in these patients. Materials and Methods:We retrospectively reviewed patients who had acute cholecystitis with gallbladder perforation at a single institution. Group 1 (n = 27; M:F = 18:9; mean age, 69.9 years) consisted of patients who received PC followed by cholecystectomy, and group 2 (n = 16; M:F = 8:8; mean age 57.1 years) consisted of patients who were treated with cholecystectomy only. Preoperative details, including sex, age, underlying medical history, signs of systemic inflammatory response syndrome (SIRS), laboratory findings, body mass index, presence of gallstone, and type of perforation; treatment-related variables, including laparoscopic or open cholecystectomy, conversion to laparotomy, blood loss, surgical time and anesthesia time; and outcome, including postoperative complications and hospital stay were analyzed. Results: There was no significant difference in preoperative details, treatment-related variables, postoperative complications, and postoperative hospital stay. However, preoperative hospital stay (median, 14 days vs. 8 days; p < 0.05) and total hospital stay (median, 22 days vs. 14.5 days; p < 0.05) were significantly longer in group 1 than in group 2. Conclusion: The preferred treatment of acute cholecystitis with gallbladder perforation might be cholecystectomy without preoperative PC; however, preoperative PC can be a safe, optional treatment in elderly patients with signs of SIRS. Index terms