Alternative Imaging Modality Research Articles

Rare delayed hypersensitivity reactions to contrast media: Severe cutaneous adverse reactions.

The risk of developing a severe delayed cutaneous reaction (SCAR) is very low following iodine-based contrast medium (ICM) administration and extremely low following gadolinium-based contrast agent (GBCA) administration. However, SCAR can be very severe and potentially life-threatening. It is crucial for the imaging physician to recognize danger signals: bullous skin eruption, skin erosion and detachment, mucosal involvement, systemic symptoms, and laboratory abnormalities. Patients suspected of having a SCAR should be urgently referred to a drug allergy specialist or dermatologist. To prevent recurrence, consider exploring alternative imaging modalities and avoid administering the same type of contrast medium involved: if the culprit is a ICM, avoid all ICM and if the culprit is a GBCA, avoid all GBCA. In an allergy centre with experience in SCAR evaluation a careful allergologic analysis may be performed safely several months after the patient has recovered from SCAR. However, allergologic analysis is challenging due to the lack of reliable in vitro diagnostic tests and the risks of in vivo diagnostic tests, particularly drug provocation tests.

Comparison of the diagnostic performance of non-contrast MR angiography and planar V/Q scintigraphy for pulmonary embolism: a systematic review and meta-analysis.

To conduct a meta-analysis of the diagnostic performance of non-contrast magnetic resonance pulmonary angiography (NC-MRPA) and ventilation-perfusion (V/Q) scintigraphy for the detection of acute pulmonary embolism (PE). Systematic searches of electronic databases were conducted from 2000 to 2024. Primary outcomes were per-patient sensitivity and specificity of NC-MRPA and V/Q scintigraphy. The pooled sensitivities, specificities, and 95% confidence intervals (95% CI) were calculated using a random-effect analysis. Summary receiver-operating characteristic (SROC) curves and the area under the curve (AUC) were obtained. A total of 3709 studies (1941 NC-MRPA studies) were identified through systematic searches, with eight published MRI and nine published V/Q investigations meeting inclusion criteria. The results showed that NC-MRPA had a pooled sensitivity of 0.88 (95% CI: 0.83-0.91) and specificity of 0.97 (95% CI: 0.93-0.98), yielding an AUC of 0.92 (95% CI: 0.85-0.96). V/Q scanning had a pooled sensitivity of 0.81 (95% CI: 0.76-0.85) and specificity of 0.84 (95% CI: 0.74-0.91), yielding an AUC of 0.87 (95% CI: 0.75-0.91). The pooled proportion of non-diagnostic tests for V/Q scans (34.7%, 95% CI: 30.8-38.7) was greater than that of NC-MRPA studies (3.31%, 95% CI: 1.65-4.97). This meta-analysis suggests that NC-MRPA is more specific than V/Q scintigraphy for the detection of PE, with comparable accuracy and sensitivity. NC-MRPA yielded fewer non-diagnostic scans than V/Q scintigraphy and is a feasible alternative imaging modality for diagnosing PE in patients for whom intravenous contrast administration poses a substantive risk. Question V/Q lung scintigraphy has been used as a reserve, alternative modality for patients who cannot undergo CT pulmonary angiography. Findings Non-contrast MR angiography (MRA) is a feasible alternative for diagnosing PE in patients for whom intravenous iodinated contrast administration poses a substantial risk. Clinical relevance Non-contrast MRA provides similar sensitivity and superior specificity to V/Q scintigraphy for diagnosing PE, without ionizing radiation exposure.

CT angiography of acute aortic syndrome in patients with chronic kidney disease.

The term acute aortic syndrome (AAS) refers to a range of different entities, including dissection, intramural haematoma and penetrating atherosclerotic ulcer. Patients with chronic renal disease and particularly those with dominant polycystic kidney disease are susceptible to this pathology, given the underlying renal arteriopathy and hypertension. Imaging plays a crucial role in diagnosing, grading and guiding management of these patients, with computed tomography angiography (CTA) being on the frontline. Albeit of overlapping of imaging findings between these conditions, specific imaging characteristics help discriminate and guide treatment. Given the nephrotoxic contrast agent involved, tailored CTA protocols or alternative imaging modalities such as MRI or US are necessary in this patient population. This review article discusses the main imaging findings of entities found in the spectrum of AAS, as well as the appropriate use and protocol of imaging modalities, focusing on the appropriate use of nephrotoxic contrast agents, the preservation of renal function and maintenance of optimal diagnostic accuracy.

CAR/CSAR Practice Statement on Pelvic MRI for Endometriosis.

The Canadian Association of Radiologists (CAR) Endometriosis Working Group was tasked with providing guidance and benchmarks to ensure the quality of technique and interpretation for advanced imaging modalities associated with diagnosing endometriosis. Advanced pelvic ultrasound is essential in diagnosing and mapping pelvic endometriosis, but pelvic MRI serves as an excellent imaging tool in instances where access to advanced ultrasound is limited, or an alternative imaging modality is required. Despite the known utility of MRI for endometriosis, there is no consensus on imaging protocol and patient preparation in Canada. To improve patient care and support excellence in imaging, the Working Group has developed recommendations for the use of pelvic MRI to assess for endometriosis with an aim to standardize MRI technique for use in both community and academic practices across Canada. The guidelines provide recommendations regarding imaging technique and patient preparation for pelvic MRI, along with suggestions for structured reporting of pelvic MRI for endometriosis.

Evaluation of Pediatric Radiation Dose for The Follow Up Chest Radiography Post Cardiac Surgery at Al Makassed Hospital with Risk Factors Assessment of Thyroid Gland

This study aimed to evaluate the radiation dose received by pediatric patients undergoing follow-up chest radiography after cardiac surgery, with a focus on assessing thyroid gland risk factors. A retrospective analysis was conducted on pediatric patients, categorizing the number of radiographic occurrences into three frequency ranges: 1-10, 11-20, and >21. Key variables analyzed included frequency, total radiation dose in mGy, and estimation risk, with descriptive statistics such as mean, standard deviation, minimum, and maximum calculated for each range. Results showed that the >21 frequency range had the highest mean frequency and total mGy, indicating significantly greater radiation exposure and average occurrences compared to lower ranges. Estimation risk also increased with frequency, suggesting a higher potential for risk assessment error. These findings underscore the need to optimize radiation dose protocols for follow-up chest radiography in pediatric patients post cardiac surgery. Recommendations include implementing dose monitoring and tracking systems, exploring alternative imaging modalities, and enhancing education among healthcare professionals. However, the study's retrospective nature highlights the necessity of prospective research to validate these findings.

A fully automated measurement of migration percentage on ultrasound images in children with cerebral palsy.

Migration percentage (MP) is the gold standard to assess the severity of hip displacement in children with cerebral palsy, which is measured on anteroposterior hip radiographs. Recently, the ultrasound (US) method has been developed as a safe alternative imaging modality to image and monitor children's hips. However, measuring MP on US images (MPUS) is time-consuming, challenging, and user-dependent. This study aimed to develop machine learning algorithms to automatically measure MPUS and validate the algorithms with MPXray. A combination of signal filtering, convolution neural networks (CNNs), and UNets was applied to segment the regions of interest (ROI), detect edges or feature points, and select the desired US frames. A total of 62 hips including both coronal and transverse scans per hip were acquired, out of which 36 with applying augmentation method were utilized for training, 8 for validation, and 18 for testing. The intraclass correlation coefficient (ICC2,1) and the mean absolute difference (MAD) between the automated MPUS versus manual MPXray were 0.86 and 6.5% ± 5.5%, respectively. To report the MPUS, it took an average of 104s/hip. This preliminary result demonstrated that MPUS was able to extract automatically within 2min with a clinical acceptance accuracy (10%).

X-Ray Utilization Patterns in Pediatric Musculoskeletal Trauma: Assessing Potential Overprescription

Background: Traumatic injuries are among the leading causes of visits to the pediatric emergency department (PED). Objectives: This study aims to evaluate the pediatric approach to musculoskeletal trauma in children to determine whether the routine use of X-rays can be reduced by encouraging the use of ultrasound. Methods: This retrospective observational study included children aged 0 - 18 years admitted to the PED of the Policlinico A. Gemelli with a diagnosis of musculoskeletal trauma from January 2017 to December 2021. Patients were divided into two groups based on the presence of fractures identified through radiological examinations: "Fracture Yes" and "Fracture No." Data on X-rays performed were categorized according to the site of trauma. Results: A total of 5,972 children were enrolled. The most notable findings concern the regions of trauma. Among 1,273 patients who underwent X-rays of the hand region, 617 (48%) showed fractures, and 656 (51%) did not. Of the 744 X-rays performed for the foot region, 235 (31%) revealed fractures, while 509 (68%) were negative for fractures. In the upper limbs region, 1,334 X-rays were performed, with 1,079 (80%) identifying fractures and 255 (20%) showing no fractures. For the lower limbs region, 479 X-rays were conducted, 204 (42%) of which revealed fractures, while 275 (58%) were negative for fractures. All these results demonstrated statistically significant differences (P < 0.05). Conclusions: Despite the limitations of the study's retrospective design and its single-center setting, the findings highlight a high prevalence of X-rays in the hand and upper limb regions, often with positive results. In contrast, radiography of the lower limbs and feet frequently yielded negative findings, suggesting potential overuse. Future research should investigate the clinical utility of musculoskeletal ultrasound as an alternative imaging modality to minimize unnecessary radiation exposure in pediatric patients.

Correlation of Prostate High-Resolution Micro-Ultrasound with Multiparametric Magnetic Resonance Imaging

To assess the correlation between high-resolution microultrasound (microUS) and multiparametric magnetic resonance imaging (MP-MRI) in clinically significant prostate cancer (csPCa) lesion identification. We reviewed our prospectively maintained database of 267 consecutive patients who underwent MP-MRI and transperineal microUS-guided biopsy between February 2021 and April 2023. The Prostate Risk Identification using MicroUS (PRI-MUS) protocol was utilized to risk stratify prostate lesions, with PRI-MUS 3-5 defined as positive. MRI lesions were classified according to the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1. Clinicopathologic outcomes were analyzed. Spearman correlation testing was computed to assess the relationship between PRI-MUS and PI-RADS. A total of 161 patients met inclusion criteria. Mean±standard deviation age was 65.6±1.5years and prostate-specific antigen was 7.6±0.6ng/mL. Ninety-two patients were found to have PIRADS 3-5 lesions. Spearman correlation analysis revealed a moderate positive correlation between PRI-MUS and PI-RADS (r=0.40, P<.001). MicroUS-targeted cores detected higher grade disease than systematic and MRI-targeted cores in 8/161 (5.0%) patients. CsPCa would have been missed in 4/161 (2.5%) patients without microUS-targeted sampling. MicroUS/PRI-MUS demonstrates moderate positive correlation with MP-MRI/PI-RADS and offers improved csPCa detection compared to MRI-targeted biopsy alone. MicroUS may be useful in conjunction with MP-MRI or as an alternative imaging modality in MRI-ineligible patients.

Diagnostic performance of dual-energy CT with electron-density reconstruction for lumbar disc herniation.

Magnetic resonance imaging (MRI) is used for the evaluation of degenerative spinal disease. However, its utility is restricted in routine practice because of contraindications and a lack of widespread availability. Dual-energy computed tomography (DECT) is a newer technique for the evaluation of degenerative spinal disease. This study aimed to evaluate the diagnostic performance of DECT with electron-density (ED) image reconstruction compared to standard CT for the detection of lumbar disc herniation, with MRI as the gold standard. The retrospective study included 84 patients between 01 July 2023 to 31 December 2023 who underwent DECT and 1.5-T MRI within 1 week. Four radiologists, blinded to the clinical and MRI information, independently evaluated the standard CT series and DECT series with ED reconstructions for lumbar disc herniation and spinal nerve root impingement. The gold standard for comparison was lumbar spine MRI, and diagnostic accuracy was measured with sensitivity and specificity. MRI revealed 417 lumbar disc herniations. Dual-energy computed tomography with ED reconstruction showed higher sensitivity (86.36% [532/616] vs. 57.79% [356/616]) and specificity (96.86% [1019/1052] vs. 95.82% [1008/1052]) for the detection of lumbar disc herniation compared to standard CT. Dual-energy computed tomography with ED reconstruction shows better diagnostic performance for the detection of lumbar disc herniation compared to standard CT and can be a useful alternative imaging modality when MRI is contraindicated or unavailable. This study shows the usefulness of DECT as an alternative imaging technique for screening of degenerative spinal disease whenever MRI is contraindicated or unavailable.

Clinical utility of echocardiography in internal medicine: a narrative review

Echocardiography has emerged as an invaluable tool in internal medicine, providing real-time, non-invasive evaluation of cardiac structure and function. Its clinical utility spans a wide range of applications, including the diagnosis and management of heart failure, valvular heart diseases, and cardiomyopathies, as well as systemic conditions like sepsis and chronic kidney disease. The ability to perform bedside echocardiography has made it particularly useful in critical care settings, allowing for rapid assessment of cardiac function in hemodynamically unstable patients. Echocardiography also plays a key role in guiding therapeutic interventions, from fluid management to valvular repair and replacement procedures. Despite its many advantages, echocardiography is not without limitations. Image quality may be compromised in patients with obesity, lung disease, or prior thoracic surgery, necessitating alternative imaging modalities like cardiac magnetic resonance imaging or computed tomography. Operator expertise is another critical factor influencing diagnostic accuracy, underscoring the importance of proper training. Recent advancements, including artificial intelligence integration and portable devices, are expected to further expand the role of echocardiography, making it more accessible in diverse clinical settings. This narrative review highlights the broad clinical utility of echocardiography in internal medicine, its challenges, and the future directions that promise to enhance its role in patient care.

Imaging for upper tract urothelial carcinoma: update of the evidence and a glimpse into the future.

Upper tract urothelial carcinoma (UTUC) is a rare malignancy posing significant diagnostic and management challenges. This review provides an overview of the evidence supporting various imaging modalities and offers insights into future innovations in UTUC imaging. With the growing use of advancements in computed tomography (CT) technologies for both staging and follow-up of UTUC patients, continuous innovations aim to enhance performance and minimize the risk of excessive exposure to ionizing radiation and iodinated contrast medium. In patients unable to undergo CT, magnetic resonance imaging serves as an alternative imaging modality, though its sensitivity is lower than CT. Positron emission tomography, particularly with innovative radiotracers and theranostics, has the potential to significantly advance precision medicine in UTUC. Endoscopic imaging techniques including advanced modalities seem to be promising in improved visualization and diagnostic accuracy, however, evidence remains scarce. Radiomics and radiogenomics present emerging tools for noninvasive tumor characterization and prognosis. The landscape of imaging for UTUC is rapidly evolving, with significant advancements across various modalities promising improved diagnostic accuracy, patient outcomes, and safety.

Diffuse correlation tomography: a technique to characterize tissue blood flow abnormalities in benign and malignant breast lesions.

Accurate assessment and quantification of neoangiogenesis associated with breast cancer could be potentially used to improve the sensitivity and specificity of non-invasive diagnosis, as well as predict outcomes and monitor treatment effects. In this study, we adapted an emerging technology, namely diffuse correlation tomography (DCT), to image microvascular blood flow in breast tissues and evaluate the potential for discriminating between benign and malignant lesions. A custom-made DCT system was designed for breast blood flow imaging, with both the source-detector array and reconstruction algorithm optimized to ensure precise imaging of breast blood flow. The global features and local features of three-dimensional blood flow images were extracted from the relative blood flow index (rBFI), which was obtained from most of the breasts targeted to the lesion. A total of 37 women with 19 benign and 18 malignant lesions were included in the study. Significant differences between malignant and benign groups were found in 12 image features. Moreover, when selecting the lesion mean relative blood flow index (MrBFI) as a single indicator, the malignant and benign tumors were discriminated with an accuracy of 89.2%. The blood flow features were found to successfully identify malignant and benign tumors, suggesting that DCT, as an alternate functional imaging modality, has the potential to be translated into clinical practice for diagnosis and assessment of breast cancers. There is potential to reduce the need for biopsy of benign lesions by improving the specificity of diagnostic imaging, as well as monitoring response to breast cancer treatment.

Environmental and patient safety: Advances in radiological techniques to reduce radiation exposure

The growing concern for environmental and patient safety in medical imaging has driven significant advancements in radiological techniques aimed at reducing radiation exposure. This review explores these developments, emphasizing the dual focus on minimizing harm to patients and addressing the broader environmental impact of radiological practices. Recent innovations include the optimization of imaging protocols, the introduction of low-dose imaging technologies, and the integration of advanced software algorithms that enhance image quality while reducing the need for higher radiation doses. The implementation of iterative reconstruction techniques, for instance, has allowed for significant dose reductions in computed tomography (CT) scans without compromising diagnostic accuracy. Additionally, the use of alternative imaging modalities such as magnetic resonance imaging (MRI) and ultrasound, which do not involve ionizing radiation, is increasingly recommended where clinically appropriate, further mitigating radiation risks. Furthermore, the shift towards personalized imaging protocols, where radiation doses are adjusted based on individual patient characteristics, marks a critical advance in patient safety. This approach not only reduces unnecessary exposure but also enhances the overall effectiveness of diagnostic procedures. Environmental safety considerations have also led to the development of more sustainable radiological practices, including the safe disposal of radioactive materials and the reduction of energy consumption in imaging facilities. These efforts are aligned with broader healthcare initiatives to lower the carbon footprint of medical practices. The advancements in radiological techniques to reduce radiation exposure reflect a growing commitment to patient-centered care and environmental stewardship in healthcare. As technology continues to evolve, ongoing research and collaboration between medical professionals, physicists, and environmental scientists will be crucial in furthering these goals. By continuing to innovate and implement safer radiological practices, the medical community can significantly mitigate the risks associated with radiation exposure, ensuring better health outcomes for patients and reducing the environmental impact of radiological services.

Ultrasound Imaging of Various Ingested Foreign Bodies in an Ex Vivo Intestinal Model.

Foreign body ingestion is an increasingly prevalent issue for children who are in the preverbal to early verbal stages of life. Foreign bodies lodged in the gastrointestinal tract can cause issues such as obstruction, perforation, and fistulae. Radiographic imaging can often locate most foreign bodies; however, radiolucent objects may be missed. Ultrasound is an alternative imaging modality that can be used to locate and track foreign objects as they pass through the bowel. The objective of this study was to characterize the sonographic appearance of various ingested foreign bodies of varying characteristics in an ex vivo gastrointestinal tract segment. A GE Logiq 9 ultrasound machine with a linear transducer at a frequency of 15 MHz was used to examine various ingested foreign bodies placed in a segment of pig intestinal tract. Imaged objects varied in visual appearance from echogenicity, texture, size, and shape; acoustic shadows and reverberation artifacts cast were particularly distinguishing characteristics. Ultrasound evaluation to assess foreign body ingestion in the pediatric population may provide a useful alternative or supportive imaging modality in confirming the location and real-time tracking of the ingested item. This may be especially useful for objects of varying radiodensities that cannot always be reliably seen in traditional radiographs.

Ex vivo human teeth imaging with various photoacoustic imaging systems.

Dental caries cause pain and if not diagnosed, it may lead to the loss of teeth in extreme cases. Dental X-ray imaging is the gold standard for caries detection; however, it cannot detect hidden caries. In addition, the ionizing nature of X-ray radiation is another concern. Hence, other alternate imaging modalities like photoacoustic (PA) imaging are being explored for dental imaging. Here, we demonstrate the feasibility of acoustic resolution photoacoustic microscopy (ARPAM) to image a tooth with metal filling, circular photoacoustic computed tomography (cPACT) to acquire images of teeth with caries and pigmentation, and linear array-based photoacoustic imaging (lPACT) of teeth with caries and pigmentation. The cavity measured with lPACT imaging is compared with the X-ray computed tomography image. The metal filling and its boundaries are clearly seen in the ARPAM image. cPACT images at 1064 nm were a better representative of the tooth surface compared to the images acquired at 532 nm. It was possible to detect the cavities present in the dentine when lPACT imaging was used. The PA signal from the pigmented caries on the lateral surface (occlusion view) of the tooth was high when imaged using the lPACT system.

Challenges were faced during radiography of pregnant women

Radiography of pregnant patients poses significant challenges to radiographers due to the need to balance diagnostic requirements with the safety of the developing foetus. This article explores the challenges faced by radiographers when conducting radiographic procedures on pregnant women and their foetus and discusses strategies employed to minimize radiation exposure. Key challenges include the risk of foetal radiation exposure, timing of examination, proper positioning of the patient and patient anxiety. Strategies such as radiation shielding, collimation, low-dose techniques and alternative imaging modalities are crucial for minimizing radiation exposure while obtaining diagnostic information. Clear communication between radiographers and patient is essential to ensure the safety and well-being of both the mother and the foetus during radiographic procedure. Radiographers knows the dangers of radiation exposure to fetal health. Now days, diagnostic imaging of pregnant women is increasing. X-ray risks depending on the gestational age of the pregnancy, and other potential health effects. In addition, ethical issues have been considered by improving overall communication to minimize unnecessary radiation exposure to pregnant women and fetuses.

Present and future of whole-body MRI in metastatic disease and myeloma: how and why you will do it.

Metastatic disease and myeloma present unique diagnostic challenges due to their multifocal nature. Accurate detection and staging are critical for determining appropriate treatment. Bone scintigraphy, skeletal radiographs and CT have long been the mainstay for the assessment of these diseases, but have limitations, including reduced sensitivity and radiation exposure. Whole-body MRI has emerged as a highly sensitive and radiation-free alternative imaging modality. Initially developed for skeletal screening, it has extended tumor screening to all organs, providing morphological and physiological information on tumor tissue. Along with PET/CT, whole-body MRI is now accepted for staging and response assessment in many malignancies. It is the first choice in an ever increasing number of cancers (such as myeloma, lobular breast cancer, advanced prostate cancer, myxoid liposarcoma, bone sarcoma, …). It has also been validated as the method of choice for cancer screening in patients with a predisposition to cancer and for staging cancers observed during pregnancy. The current and future challenges for WB-MRI are its availability facing this number of indications, and its acceptance by patients, radiologists and health authorities. Guidelines have been developed to optimize image acquisition and reading, assessment of lesion response to treatment, and to adapt examination designs to specific cancers. The implementation of 3D acquisition, Dixon method, and deep learning-based image optimization further improve the diagnostic performance of the technique and reduce examination durations. Whole-body MRI screening is feasible in less than 30min. This article reviews validated indications, recent developments, growing acceptance, and future perspectives of whole-body MRI.

Diagnostic accuracy of chest x-ray in covid -19, taking high resolution computed tomography as gold standard

ABSTRACT Objective: To determine sensitivity &amp; specificity of chest X-ray in COVID-19, taking High-Resolution Computed Tomography as gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Radiology Deptt, Margalla Hospital, Taxila and Islamabad Diagnostic Centre, Wah. Two years (February 2020 to February 2022). Patients and Methods: The sample comprised 100 COVID-19 patients (Positive Polymerase chain reaction (PCR) test). Their HighResolution Computed Tomography (HRCT) was done which was considered a gold standard for diagnosing COVID-19. Their Chest X-rays (CXR) were performed, and findings of both modalities were compared. Patients having respiratory tract symptoms but PCR negative for COVID-19 were excluded. Results: The research had 49 males &amp; 51 females having a median (IQR) age of 46.50(35-55.75) years. The minimum &amp; maximum ages were 6 years and 83 years respectively. Among 100 PCR-positive patients, 29 were found normal on HRCT and 30 on CXR. For moderate cases, the chest X-rays were 72% sensitive &amp; 90.67% specific, with Positive Predictive Value (PPV), Negative Predictive Value (NPV) &amp; diagnostic efficacy of 72%,90.67% &amp; 86% respectively. Similarly, other severity levels were assessed. Conclusion: CXR has acceptable diagnostic accuracy for COVID-19 patients, especially with good sensitivity for moderate cases and better specificity for severe cases. A portable chest radiograph might be regarded as an initial alternative imaging modality for patients with COVID-19 signs and symptoms in remote areas. Key words: COVID-19, CXR , HRCT

Retroperitoneal soft tissue sarcoma, a rare mimic and important differential of iliopsoas abscess

This case report highlights the diagnostic challenges posed by retroperitoneal soft tissue sarcoma (STS) presenting as an iliopsoas abscess, mimicking common symptoms and radiological findings. This patients’ symptoms recurred despite multiple percutaneous drains and revisions over a period of months. Further investigation revealed a partly solid, partly cystic mass consistent with sarcoma. Surgical excision confirmed the diagnosis, but recurrence necessitated palliation. This case emphasizes the importance of differential diagnoses of iliopsoas collection and the need for research into alternative imaging modalities to aid clinicians and radiologists in differentiating benign retroperitoneal collections from malignancy.

Utilizing Diagnostic Musculoskeletal Ultrasound for Assessment of the Infraspinatus Muscle and Tendon: Implications for Rehabilitation Professionals

The rotator cuff, comprising the subscapularis, supraspinatus, infraspinatus, and teres minor muscles, plays a crucial role in stabilizing the glenohumeral joint by securing the head of the humerus within the glenoid cavity of the scapula. The tendinous insertions of these muscles generate tension within the capsule, enhancing joint stability during muscular activity. The rotator cuff is susceptible to damage from disease, injury, or trauma, which can result in tears or ruptures of one or more tendons. The evaluation of the infraspinatus muscle and tendon is vital for diagnosing and managing various shoulder pathologies. Accurate imaging to determine the specific muscle involvement and injury severity significantly impacts treatment decisions. Diagnostic musculoskeletal ultrasound (MSK-US) has emerged as a valuable tool for assessing the infraspinatus muscle and tendon, offering real-time, dynamic assessment capabilities essential for precise diagnosis and effective rehabilitation planning. This article reviews the utility and advantages of MSK-US in evaluating the infraspinatus muscle and tendon, emphasizing technique specifics, diagnostic accuracy, and comparative efficacy against other imaging modalities. It details a systematic approach to the ultrasound examination technique for the infraspinatus, including patient positioning and identification of common pathologies such as tears, tendinopathy, and calcifications. With recent advancements in transducer strength, image resolution, and operator training, ultrasound serves as an excellent alternative imaging modality for diagnosing rotator cuff tears. This article aims to equip rehabilitation professionals with a comprehensive understanding of MSK-US as a diagnostic tool for the infraspinatus, promoting more precise diagnosis, treatment planning and improved patient outcomes.