Higher field strength does not confer higher accuracy in the diagnosis of ACL tears at MR imaging.

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Higher field strength does not confer higher accuracy in the diagnosis of multiple sclerosis with current-generation MR imagers.

We describe the endovascular exclusion and surgical resection of an intralobar pulmonary sequestration supplied by an aneurysmal feeding vessel from the aorta. Pulmonary sequestration is a rare congenital anomaly, and the presence of an aneurysmal feeding vessel is even rarer. The possibility of life-threatening hemorrhage resulting from failure to control these aberrant vessels has led many to pursue preoperative embolization. The anatomy in the patient described here was not deemed suitable for embolization, and we thus elected to pursue a novel approach. This case also demonstrates the diagnostic utility of magnetic resonance imaging for delineating the vasculature of pulmonary sequestrations when contrast-enhanced computed tomography is contraindicated.

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Purpose:Determining the effects of neoadjuvant chemotherapy (NAC) on benign breast lesions and to evaluate their response in comparison to breast cancers.Methods:A retrospective analysis performed on breast cancer patients between 2008 and 2014 to identify patients who had a pre- and post-NAC magnetic resonance imaging (MRI) and biopsy-proven benign lesions. Pre- and post-NAC size and intensity of enhancement of benign lesions and cancers were measured. Breast glandularity and background enhancement were graded. A 2 × 2 repeated measures ANOVAs and Sidak post hoc tests were conducted for multiple comparisons. Paired t-tests were conducted to examine changes over time, and two-tailed P values were reported.Results:The effects of NAC in 38 cancers were compared to the effects of NAC in 47 benign lesions in these patients. From pre- to post-NAC, the mean size (cm) of malignant lesions on MRI decreased from 4.09 (±standard deviation [SD] 2.51) to 1.54 (±SD 2.32), (P < 0.001); the mean size (cm) of benign lesions decreased from 0.83 (±SD 0.54 cm) to 0.28 (±SD 0.51), (P < 0.001). Both benign and malignant lesions decreased in size after NAC, the size reduction in malignant lesions was significantly greater than benign lesions. From pre- to post-NAC, the mean lesion enhancement of the malignant lesions (scale 1–4) decreased from 3.43 (±SD 0.80) to 1.02 (±SD 1.34); the mean lesion enhancement of benign lesions decreased from 2.96 (±SD 1.04) to 0.98 (±SD 1.51). For both benign and malignant lesions, there was a significant overall reduction in enhancement after NAC from moderate at pre-NAC to minimal at post-NAC, P < 0.001. There was no overall difference in the enhancement of cancers (mean = 2.22, SD = 0.79) versus benign lesions (mean = 1.97, SD = 1.08), (P = 0.23). There was no significant change in glandularity from pretherapy (mean = 3.11, SD = 0.84) to posttherapy (mean = 3.13, SD = 0.82), P < 0.001.Conclusion:Similar to cancers, benign breast lesions also show a significant decrease in size and enhancement after NAC; however, the decrease in size is less compared to cancers.

Background: The most common method to determine a traumatic knee arthrotomy is the saline load challenge. Recent literature has suggested high false-negative and false-positive rates using this method and also has shown that CT was effective in detecting these arthrotomies. The purpose of this study was to evaluate another method of diagnosing these injuries. We hypothesized that plain radiographs of the knee could be an effective alternative study in diagnosing a traumatic arthrotomy. Methods: After institutional review board approval, this retrospective cohort review identified 32 patients diagnosed with a traumatic arthrotomy by direct visualization in the operating room and another 32 patients with no evidence of traumatic arthopathy, according to the surgeon. The preoperative anteroposterior and lateral radiographs from both cohorts were blinded and randomized and then submitted to a radiologist to review for the presence of air in the joint space. Sensitivity and specificity were calculated based on radiographic review compared with the gold standard of direct visualization. Results: Plain film anteroposterior and lateral knee radiographs had a sensitivity of 78.1% and a specificity of 90.6% with a positive predictive value of 89.3% for diagnosis of traumatic arthrotomy in our cohort. Conclusions: Our study suggests that radiographs, which are obtained as standard of care during work-up of knee injuries, have a relatively high sensitivity and specificity and can be used as an adjunct to help diagnose a traumatic arthrotomy of the knee joint. Level of Evidence: Level III.

be achieved through policy action by making changes in legislation, by ensuring organisational culture and leadership, and by creating networks and champions for environmentally sustainable practices in health system settings. There is also an opportunity to integrate environmental sustainability in health systems teaching and research.Lessons from fighting the Covid-19 pandemic could be applied towards reducing food and health system impacts on climate, such as i) developing a clear understanding of the problem, of potentially effective solutions and identifying those interests are being prioritised, ii) start tackling the problem from areas making the largest contributions or being affected the most, and iii) knowing that shifting people's behaviour is at the core of any solution. Transformed food and health systems must be contextually relevant, resilient, regenerative, empowering, and with health at their centre. Bold government, community, and business actions that promote interdisciplinarity, collaboration and capacity building are key aspects to be considered.