Background: Diagnosis of residual or recurrent tumor in soft‐tissue sarcomas (STS) is a differential diagnostic challenge since post‐therapeutic changes impede diagnosis.Purpose: To evaluate the diagnostic accuracy of quantitative dynamic contrast enhanced (DCE)‐MRI and diffusion‐weighted imaging (DWI) to detect local recurrence of STS of the limb.Study Type: Prospective.Population: A totalof 64 consecutive patients with primary STS of the limbs were prospectively included 3–6 months after surgery between January 2016 and July 2021.Field Strength/Sequence: A 1.5 T; axial DWI echo‐planar imaging sequences and DCE‐MRI using a 3D T1‐weighted spoiled gradient‐echo sequence.Assessment: The quantitative DCE‐MRI parameters relative plasma flow (rPF) and relative mean transit time (rMTT) were calculated and ADC mapping was used to quantify diffusion restriction. Regions of interest of tumor growth and postoperative changes were drawn in consensus by two experts for diffusion and perfusion analysis. An additional morphological assessment was done by three independent and blinded radiologists.Statistical Test: Unpaired t‐test, ROC‐analysis, and a logistic regression model were applied. Interobserver reliability was calculated using Fleiss kappa statistics. A P value of 0.05 was considered statistically significant.Results: A total of 11 patients turned out to have local recurrence. rPF was significantly higher in cases of local recurrence when compared to cases without local recurrence (61.1–4.5) while rMTT was slightly and significantly lower in local recurrence. ROC‐analysis showed an area under the curve (AUC) of 0.95 (SEM ± 0.05) for rPF while a three‐factor multivariate logistic regression model showed a high diagnostic accuracy of rPF (R² = 0.71). Compared with morphological assessment, rPF had a distinct higher specificity and true positive value in detection of LR.Data Conclusion: DCE‐MRI is a promising additional method to differentiate local recurrence from benign postoperative changes in STS of the limb. Especially specificity in detection of LR is increased compared to morphological assessment.Evidence Level: 1Technical Efficacy: Stage 2

(1) Background: Chest radiography (CXR) is still a key diagnostic component in the emergency department (ED). Correct interpretation is essential since some pathologies require urgent treatment. This study quantifies potential discrepancies in CXR analysis between radiologists and non-radiology physicians in training with ED experience. (2) Methods: Nine differently qualified physicians (three board-certified radiologists [BCR], three radiology residents [RR], and three non-radiology residents involved in ED [NRR]) evaluated a series of 563 posterior-anterior CXR images by quantifying suspicion for four relevant pathologies: pleural effusion, pneumothorax, pneumonia, and pulmonary nodules. Reading results were noted separately for each hemithorax on a Likert scale (0–4; 0: no suspicion of pathology, 4: safe existence of pathology) adding up to a total of 40,536 reported pathology suspicions. Interrater reliability/correlation and Kruskal–Wallis tests were performed for statistical analysis. (3) Results: While interrater reliability was good among radiologists, major discrepancies between radiologists’ and non-radiologists’ reading results could be observed in all pathologies. Highest overall interrater agreement was found for pneumothorax detection and lowest agreement in raising suspicion for malignancy suspicious nodules. Pleural effusion and pneumonia were often suspected with indifferent choices (1–3). In terms of pneumothorax detection, all readers mainly decided for a clear option (0 or 4). Interrater reliability was usually higher when evaluating the right hemithorax (all pathologies except pneumothorax). (4) Conclusions: Quantified CXR interrater reliability analysis displays a general uncertainty and strongly depends on medical training. NRR can benefit from radiology reporting in terms of time efficiency and diagnostic accuracy. CXR evaluation of long-time trained ED specialists has not been tested.

Objective: Correct identification of adhesive capsulitis of the shoulder (ACS) has an important impact on adequate therapy. The aim of our study was to investigate the influence of intravenous contrast administration and of reader’s experience on sensitivity and specificity of MRI in diagnosing ACS. Materials and methods: A total of 180 patients were included in a retrospective study: 60 subjects with at least 4 of 5 clinical signs of adhesive capsulitis of the shoulder and 120 patients with other shoulder diseases who underwent contrast-enhanced MRI. In a first session, only non-enhanced images and in a second session also contrast-enhanced (CE) series were independently evaluated by three radiologists with various levels of professional experience. Readers were blinded to all clinical information and had to rate the shoulder MRIs for absence or presence of adhesive capsulitis. Data analysis included McNemar’s test, t test, and U test (p < .05). Results: Using non-enhanced MRI, readers achieved a mean sensitivity of 63.9% and a mean specificity of 86.4%. By additional use of CE sequences, the mean sensitivity (85.5%) and the sensitivity for each reader increased significantly (p = .046, p < .01, p < .001, p = .045) while the improvement in mean specificity was not significant. Reader’s experience had a positive effect on sensitivity and specificity, which was in part but not consistently significant. Conclusion: The addition of CE sequences can significantly increase the sensitivity of MRI in the diagnosis of ACS. Reader’s experience has shown to be another important factor for the diagnostic outcome.

Objective: The aims of our study were to analyze agreement among readers with different levels of expertise and diagnostic performance of individual and combined imaging signs for the diagnosis of adhesive capsulitis of the shoulder. Methods: In a retrospective study, contrast-enhanced shoulder MRIs of 60 patients with and 120 without clinically diagnosed adhesive capsulitis were evaluated by three readers independently. As non-enhanced imaging signs, readers evaluated signal intensity and thickness of the axillary recess capsule, thickness of the rotator interval capsule and the coracohumeral ligament as well as obliteration of subcoracoid fat. Furthermore, contrast enhancement of axillary recess and rotator interval capsule were evaluated. Data analysis included interreader reliability, ROC analysis, and logistic regression (p < 0.05). Results: Contrast-enhanced parameters showed substantially higher agreement among readers (ICC 0.79–0.80) than non-enhanced parameters (0.37–0.45). AUCs of contrast-enhanced signs (95.1–96.6%) were significantly higher (p < 0.01) than of non-enhanced imaging signs (61.5–85.9%) when considered individually. Combined evaluation of axillary recess signal intensity and thicknesses of axillary recess or rotator interval—when at least one of two signs was rated positive—increased accuracy compared to individual imaging signs, however not statistically significant. Conclusion: Contrast-enhanced imaging signs show both distinctly higher agreement among readers and distinctly higher diagnostic performance compared to non-enhanced imaging signs based on the imaging protocol used in this study. Combined evaluation of parameters showed a tendency to increase discrimination; however, the effect on diagnosis of ACS was not statistically significant.