Journal Club: From Inguinal Hernias to Spermatic Cord Lipomas: Pearls, Pitfalls, and Mimics of Abdominal and Pelvic Hernias

Citation: Miguel C. Cabarrus, MD, Benjamin M. Yeh, MD, Andrew S. Phelps, MD, Jao J. Ou, MD, PhD, Spencer C. Behr, MD. RadioGraphics 2017; 37:2063–2082.

Abdominal and pelvic hernias may be indolent and detected incidentally, manifest acutely with pain and distress, or cause chronic discomfort. Physical examination findings are often ambiguous and insufficient for optimal triage. Therefore, accurate anatomic delineation and identification of complications are critical for effective treatment planning. Imaging, particularly computed tomography, provides a vital understanding of the hernia’s location and size, involved viscera, and severity of associated complications. Reader familiarity with the imaging appearances and anatomic landmarks of hernias is important for correct diagnosis, which may impact preoperative planning and reduce morbidity. This article reviews the appearance of anatomic structures in the abdominal wall and pelvis that are important for diagnosing common and uncommon abdominal and pelvic hernias, and it highlights key imaging features that are helpful for differentiating hernias, mimics, and their complications.

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Online Course Resource: Writing a Healthcare Research Paper

Sharing a learning resource focused on writing a healthcare research paper. This is a modular resource that is self paced and meant for self improvement. We will share one module each week.

The material is developed and shared as an open access resource by the Research Action Group (RAG) of AMMA Education and Research Foundation (,  a unit of Annie Mathew Memorial Associated (AMMA) Center for Diagnostic and Preventive Medicine, Kochi, Kerala, India.


Writing a Healthcare Research Paper-Course Introduction

Ultrasound Elastography: The New Frontier in Direct Measurement of Muscle Stiffness

Authors: Joline E. Brandenburg, MD, Sarah F. Eby, Pengfei Song, Heng Zhao, PhD, Jeffrey S. Brault, DO, Shigao Chen, PhD, and Kai-Nan An, PhD

Published in: Arch Phys Med Rehabil. 2014 November ; 95(11): 2207–2219. doi:10.1016/j.apmr.2014.07.007.

The use of brightness-mode ultrasound and Doppler ultrasound in physical medicine and rehabilitation has increased dramatically. The continuing evolution of ultrasound technology has also produced ultrasound elastography, a cutting-edge technology that can directly measure the mechanical properties of tissue, including muscle stiffness. Its real-time and direct measurements of muscle stiffness can aid the diagnosis and rehabilitation of acute musculoskeletal injuries and chronic myofascial pain. It can also help monitor outcomes of interventions affecting muscle in neuromuscular and musculoskeletal diseases, and it can better inform the functional prognosis. This technology has implications for even broader use of ultrasound in physical medicine and rehabilitation practice, but more knowledge about its uses and limitations is essential to its appropriate clinical implementation. In this review, we describe different ultrasound elastography techniques for studying muscle stiffness, including strain elastography, acoustic radiation force impulse imaging, and shear-wave elastography. We discuss the basic principles of these techniques, including the strengths and limitations of their measurement capabilities. We review the current muscle research, discuss physiatric clinical applications of these techniques, and note directions for future research.

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Power and Color Doppler Ultrasound Settings for Inflammatory Flow: Impact on Scoring of Disease Activity in Patients With Rheumatoid Arthritis

Authors: Søren Torp-Pedersen, Robin Christensen, Marcin Szkudlarek, Karen Ellegaard, Maria Antonietta D’Agostino, Annamaria Iagnocco, Esperanza Naredo, Peter Balint, Richard J. Wakefield, Arendse Torp-Pedersen, and Lene Terslev

Published in: ARTHRITIS & RHEUMATOLOGY, Vol. 67, No. 2, February 2015, pp 386–395
DOI 10.1002/art.38940

Objective. To determine how settings for power and color Doppler ultrasound sensitivity vary on different high- and intermediate-range ultrasound machines and to evaluate the impact of these changes on Doppler scoring of inflamed joints.

Methods. Six different types of ultrasound machines were used. On each machine, the factory setting for superficial musculoskeletal scanning was used unchanged for both color and power Doppler modalities. The settings were then adjusted for increased Doppler sensitivity, and these settings were designated study settings. Eleven patients with rheumatoid arthritis (RA) with wrist involvement were scanned on the 6 machines, each with 4 settings, generating 264 Doppler images for scoring and color quantification. Doppler sensitivity was measured with a quantitative assessment of Doppler activity: color fraction. Higher color fraction indicated higher sensitivity.

Results. Power Doppler was more sensitive on half of the machines, whereas color Doppler was more sensitive on the other half, using both factory settings and study settings. There was an average increase in Doppler sensitivity, despite modality, of 78% when study settings were applied. Over the 6 machines, 2 Doppler modalities, and 2 settings, the grades for each of 7 of the patients varied between 0 and 3, while the grades for each of the other 4 patients varied between 0 and 2.

Conclusion. The effect of using different machines, Doppler modalities, and settings has a considerable influence on the quantification of inflammation.

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Shear-Wave Elastography: Basic Physics and Musculoskeletal Applications

Authors: Mihra S. Taljanovic, MD, PhD, Lana H. Gimber, MD, MPH, Giles W. Becker, MD, L. Daniel Latt, MD, PhD, Andrea S. Klauser, MD, David M. Melville, MD, Liang Gao, PhD, Russell S. Witte, PhD

In the past 2 decades, sonoelastography has been progressively used as a tool to help evaluate soft-tissue elasticity and add to information obtained with conventional gray-scale and Doppler ultrasonographic techniques. Recently introduced on clinical scanners, shearwave elastography (SWE) is considered to be more objective, quantitative,
and reproducible than compression sonoelastography with increasing applications to the musculoskeletal system. SWE uses an acoustic radiation force pulse sequence to generate shear waves, which propagate perpendicular to the ultrasound beam, causing transient displacements. The distribution of shear-wave velocities at each pixel is directly related to the shear modulus, an absolute measure of the tissue’s elastic properties. Shear-wave images are automatically coregistered with standard B-mode images to provide quantitative color elastograms with anatomic specificity. Shear waves propagate faster through stiffer contracted tissue, as well as along the long axis of tendon and muscle. SWE has a promising role in determining the severity of disease and treatment followup of various musculoskeletal tissues including tendons, muscles, nerves, and ligaments. This article describes the basic ultrasound physics of SWE and its applications in the evaluation of various traumatic and pathologic conditions of the musculoskeletal system.

RadioGraphics 2017; 37:855–870
Published online 10.1148/rg.2017160116

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X-ray phase contrast imaging of the breast-advances towards clinical implementation

Citation: Auweter SD, Herzen J, Willner M, Grandl S, Scherer K, Bamberg F, et al. X-ray phase-contrast imaging of the breast—advances towards clinical implementation. Br J Radiol 2014;87:20130606.

Breast cancer constitutes about one-quarter of all cancers and is the leading cause of cancer death in women. To reduce breast cancer mortality, mammographic screening programmes have been implemented in many Western countries. However, these programmes remain controversial because of the associated radiation exposure and the need for improvement in terms of diagnostic accuracy. Phase-contrast imaging is a new X-ray-based technology that has been shown to provide enhanced soft-tissue contrast and improved visualization of cancerous structures. Furthermore, there is some indication that these improvements of image quality can be maintained at reduced radiation doses. Thus, X-ray phase-contrast mammography may significantly contribute to advancements in early breast cancer diagnosis. Feasibility studies of X-ray phase-contrast breast CT have provided images that allow resolution of the fine structure of tissue that can otherwise only be obtained by histology. This implies that X-ray phase-contrast imaging may also lead to the development of entirely new (micro-) radiological applications. This review provides a brief overview of the physical characteristics of this new technology and describes recent developments towards clinical implementation of X-ray phase-contrast imaging of the breast.

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