Background:Repetitive pitching produces significant stress on the elbow that may result in structural abnormalities discernable on magnetic resonance imaging (MRI) without causing symptoms.Purpose:To determine whether there exists an association between subclinical MRI findings in asymptomatic elbows of Major League Baseball (MLB) players and future placement on the disabled list (DL) or future operative procedure.Study Design:Cohort study; Level of evidence, 3.Methods:MRI scans of the elbows of professional-level baseball pitchers, taken during routine presigning imaging at a single organization from 2005 to 2017, were retrospectively reviewed. Publicly available databases were queried to exclude pitchers with an injury before the earliest session of elbow MRI. Three blinded reviewers reviewed all MRI scans independently to evaluate for the presence of chondral damage to the joint, loose bodies, ulnar collateral ligament (UCL) heterogeneity or tears, flexor pronator mass defects, and signs of posteromedial (PM) impingement. Binary imaging findings were related to future placement on the DL for elbow complaints and future elbow surgery.Results:A total of 41 pitchers had asymptomatic MRI findings with no prior DL placement. For players who eventually went on the DL, there were a statistically greater number of players with UCL heterogeneity (P = .021), humeral-sided partial UCL tears (P = .031), and PM impingement (P = .004) on preinjury MRI compared with players who remained healthy. PM impingement was related to future elbow-related surgery (P = .003). Pitchers with UCL heterogeneity were associated with reduced career strike zone percentage, innings pitched, and fastball percentage (P < .05 for all).Conclusion:UCL heterogeneity, PM impingement, and humeral-sided partial tears were correlated with future DL placement for elbow-related reasons in MLB pitchers. Asymptomatic PM impingement may be a precursor to future surgery.

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Background: To develop a deep learning (DL) method based on multiphase, contrast-enhanced (CE) magnetic resonance imaging (MRI) to distinguish Liver Imaging Reporting and Data System (LI-RADS) grade 3 (LR-3) liver tumors from combined higher-grades 4 and 5 (LR-4/LR-5) tumors for hepatocellular carcinoma (HCC) diagnosis.Methods: A total of 89 untreated LI-RADS-graded liver tumors (35 LR-3, 14 LR-4, and 40 LR-5) were identified based on the radiology MRI interpretation reports. Multiphase 3D T1-weighted gradient echo imaging was acquired at six time points: pre-contrast, four phases immediately post-contrast, and one hepatobiliary phase after intravenous injection of gadoxetate disodium. Image co-registration was performed across all phases on the center tumor slice to correct motion. A rectangular tumor box centered on the tumor area was drawn to extract subset tumor images for each imaging phase, which were used as the inputs to a convolutional neural network (CNN). The pre-trained AlexNet CNN model underwent transfer learning using liver MRI data for LI-RADS tumor grade classification. The output probability number closer to 1 or 0 indicated a higher possibility of being combined LR-4/LR-5 tumor or LR-3 tumor, respectively. Five-fold cross validation was used for training (60% dataset), validation (20%) and testing processes (20%).Results: The DL CNN model for LI-RADS grading using inputs of multiphase liver MRI data acquired at three time points (pre-contrast, arterial, and washout phase) achieved a high accuracy of 0.90, sensitivity of 1.0, precision of 0.835, and AUC of 0.95 with reference to the expert human radiologist report. The CNN output of probability provided radiologists a confidence level of the model's grading for each liver lesion.Conclusions: An AlexNet CNN model for LI-RADS grading of liver lesions provided diagnostic performance comparable to radiologists and offered valuable clinical guidance for differentiating intermediate LR-3 liver lesions from more-likely malignant LR-4/LR-5 lesions in HCC diagnosis.

Among patients with acute obstructive ureterolithiasis, moderate-severe PFS was associated with elevated serum creatinine from baseline. This elevated creatinine was not explained by the obstructed kidney alone, as there was no association between the severity of hydronephrosis and increased creatinine. Pyelovenous/pyelolymphatic backflow resulting in PFS may be a contributing factor to elevated serum creatinine in this setting.

Background: Although initial studies have demonstrated that concentrated bone marrow aspirate (cBMA) injections promote rotator cuff repair (RCR) healing, there are no randomized prospective studies investigating clinical efficacy. Hypothesis/Purpose: To compare outcomes after arthroscopic RCR (aRCR) with and without cBMA augmentation. It was hypothesized that cBMA augmentation would result in statistically significant improvements in clinical outcomes and rotator cuff structural integrity. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients indicated for aRCR of isolated 1- to 3-cm supraspinatus tendon tears were randomized to receive adjunctive cBMA injection or sham incision. Bone marrow was aspirated from the iliac crest, concentrated using a commercially available system, and injected at the aRCR site after repair. Patients were assessed preoperatively and serially until 2 years postoperatively via the following functional indices: American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Simple Shoulder Test, 12-Item Short Form Health Survey, and Veterans RAND 12-Item Health Survey. Magnetic resonance imaging (MRI) was performed at 1 year to assess rotator cuff structural integrity according to Sugaya classification. Treatment failure was defined as decreased 1- or 2-year ASES or SANE scores as compared with preoperative baseline, the need for revision RCR, or conversion to total shoulder arthroplasty. Results: An overall 91 patients were enrolled (control, n = 45; cBMA, n = 46): 82 (90%) completed 2-year clinical follow-up and 75 (82%) completed 1-year MRI. Functional indices significantly improved in both groups by 6 months and were sustained at 1 and 2 years (all P < .05). The control group showed significantly greater evidence of rotator cuff retear according to Sugaya classification on 1-year MRI (57% vs 18%; P < .001). Treatment failed for 7 patients in each group (control, 16%; cBMA, 15%). Conclusion: cBMA-augmented aRCR of isolated supraspinatus tendon tears may result in a structurally superior repair but largely fails to significantly improve treatment failure rates and patient-reported clinical outcomes when compared with aRCR alone. Additional study is warranted to investigate the long-term benefits of improved repair quality on clinical outcomes and repair failure rates. Registration: NCT02484950 (ClinicalTrials.gov identifier).

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