Abstract:Objective: The exquisite bone detail offered by computed tomography makes it the ideal modality for evaluation of bone healing. However, few studies have investigated the normal computed tomographic appearance of the sternum after median sternotomy and, to the best of our knowledge, no computed tomographic classification of sternal healing has been proposed. Given the potential benefit of objective criteria, we propose a validated scoring classification of sternal healing using computed tomography for both clinical and investigational purposes.Methods: Computed tomography scans from 20 patients who underwent a median sternotomy were evaluated for sternal healing at either 3 or 6 months postoperatively. Five anatomic locations along the sternum were selected using defined criteria, and a 6-point quantitative scale was developed to evaluate sternal healing. Independent radiologists read and scored each of the 5 locations on the sternum. Inter-and intra-observer variability was assessed by calculating the kappa statistics to measure the reliability of the scoring algorithm.Results: Calculation of the kappa statistics indicated substantial agreement for intra-observer variability and substantial to almost perfect agreement for inter-observer variability. For intra-observer variability, the kappa statistics ranged from 0.591 to 0.802, and for inter-observer variability, the kappa statistics ranged from 0.590 to 0.969. When the two radiologists differed, the magnitude of the difference was no more than 1 or 2 points. Conclusion:This simple system of evaluating sternal healing had high inter-and intra-observer reliability. Therefore, it may be considered a valid method for assessing sternal osteosynthesis for both clinical and investigative purposes.Ultramini abstract: (49 words): Few studies have investigated the normal computed tomography appearance of the sternum after median sternotomy, and we knew of no computed tomography-based classification of sternal healing. Given the potential benefit of objective criteria, we designed and validated a scoring classification of sternal osteosynthesis for both clinical and investigational purposes.

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Vascular claudication is a symptom complex characterized by reproducible pain and weakness in an active muscle group due to peripheral arterial disease. Noninvasive hemodynamic tests such as the ankle brachial index, toe brachial index, segmental pressures, and pulse volume recordings are considered the first imaging modalities necessary to reliably establish the presence and severity of arterial obstructions. Vascular imaging is consequently used for diagnosing individual lesions and triaging patients for medical, percutaneous, or surgical intervention. Catheter angiography remains the reference standard for imaging the peripheral arteries, providing a dynamic and accurate depiction of the peripheral arteries. It is particularly useful when endovascular intervention is anticipated. When combined with noninvasive hemodynamic tests, however, noninvasive imaging, including ultrasound, CT angiography, and MR angiography, can also reliably confirm or exclude the presence of peripheral arterial disease. All modalities, however, have their own technical limitations when classifying the location, extent, and severity of disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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