No abstract

Ultrasound is one of the most important imaging modalities in pediatric imaging because of its accessibility, portability, lack of ionizing radiation, and ability to generally perform examinations without need for sedation. Ultrasound elastography can measure the stiffness of various tissues. This review article aims to discuss how ultrasound elastography has performed in evaluating multiple pathologies in the pediatric population. The best studied pediatric applications are in liver diseases such as fibrosis, biliary atresia, and hepatic vascular congestion. Measuring muscle stiffness in cerebral palsy is the most promising pediatric musculoskeletal application, but many other applications are in the early stages of research. Other applications in pediatric small organ imaging have been explored and still need more study before gaining clinical relevance.

The purpose of this article is to describe the sonographic and radiographic findings in the diagnosis and treatment of posterior tibial tendon dysfunction. Ultrasound and radiographs play a crucial role in the diagnosis of posterior tibial tendon dysfunction and in imaging the postoperative changes related to posterior tibial tendon dysfunction. Early detection and diagnosis of posterior tibial tendon dysfunction is important in helping to prevent further progression of disease, obviating the need for more invasive and complex procedures.

Objectives To evaluate whether the ultrasound appearance of the deltoid muscle in diabetic patients differs from that in obese nondiabetic patients. Methods Ultrasound images of the deltoid muscle from 137 type 2 diabetic patients (including 13 prediabetic patients) and 49 obese nondiabetic patients were blindly reviewed by 2 musculoskeletal radiologists, and by a third when arbitration was needed, to determine whether the appearance was “normal,” “suspected diabetes,” or “definite diabetes.” Age, sex, race, body mass index (BMI), insulin use, and hemoglobin A1c were analyzed. This retrospective study included patients presenting between October 2005 and November 2017. Statistical analyses included a 2‐sided sample t test or Wilcoxon rank sum test and a χ2 or Fisher exact test. Statistical significance was defined as P < .05. Results The type 2 diabetic patients included 98 women and 39 men aged 29 to 92 years, and the nondiabetic patients included 19 women and 30 men aged 18 to 75 years. A consensus diagnosis of definite diabetes by the musculoskeletal radiologists based on a hyperechoic deltoid was a powerful predictor of diabetes, with a positive predictive value of 89%. A hyperechoic deltoid was also a powerful predictor of prediabetes. Of the 13 prediabetic patients, all had the same hyperechoic appearance of the diabetic deltoid, regardless of BMI. Although obese diabetic patients more often had a diagnosis of definite diabetes, the BMI alone could not explain the increased echogenicity, as obese nondiabetic patients’ deltoid muscles did not appear as hyperechoic and were correctly categorized as not having definite diabetes with 82% specificity. Conclusions The characteristic hyperechoic deltoid appearance is a strong predictor of both diabetes and prediabetes and differs from that of obese nondiabetic patients.

Wrist pain is common among competitive tennis players. Subluxation of the extensor carpi ulnaris (ECU) tendon has gained recognition as a cause of ulnar-side wrist pain in athletes. In tennis, the wrist is forcibly flexed, supinated, and ulnar deviated. These repetitive motions stress the ECU tendon stabilizers allowing tendon subluxation from the ulnar groove, especially in cases of anatomic variations such as a shallow groove. We present the presurgical and postsurgical imaging findings of recurrent ECU tendon subluxation in an elite tennis player.