Abstract:
Ultrasound (US) has gained importance in musculoskeletal imaging. One of the reasons is that it is the best technique to guide interventional procedures. These procedures have grown unstoppably. A recent review found more than 80 different procedures, the vast majority with US guidance. Shoulder pain treatments were the first introduced. They include treatment of calcific tendinitis, infiltrations of bursa and rotator cuff, joint injections, and nerve blocks. Tendons and fasciae are also targets of these procedures, including infiltrations, several treatments for tendinosis and fasciitis, trigger finger and palmar fibromatosis treatment. Musculoskeletal cysts (ganglions and Baker´s) and fluid collections can also be treated with ultrasound-guided techniques, as well as conditions at joints and nerves. Finally, foreign bodies can be removed also using US. This article reviews these applications. The list of procedures cannot be exhaustive, given the large number of procedures and their complexity, but it will serve to give a glimpse of how these techniques can solve specific musculoskeletal problems.

Key words:
Musculoskeletal diseases. Interventional ultrasonography. Tendon injuries. Arthrocentesis. Nerve block. Foreign bodies.

Introduction:
A standardized lexicon of morphology descriptors is essential for interpreting and reporting contrast enhanced mammography (CEM). This pictorial essay describes representative clinical cases using the first version of the BI-RADS® lexicon for CEM.

Material and methods:
Clinical cases, BI-RADS categories 1 to 6 with CEM examination, were eligible. CEM included low-energy (LE) and high-energy recombined (RC) images. Breast ultrasound (US) findings are also described. Biopsy histopathology of BI-RADS categories 4, 5, and 6 are reported. The first version of the BI-RADS® lexicon was used for CEM reading, interpretation, and structured reporting.

Results:
We performed a detailed imaging morphologic analysis of all breast characteristics in clinical cases BI-RADS 1 to 6 using the first version of the BI-RADS® lexicon for CEM. We describe normal, benign, or suspected malignant findings on US, LE and RC images of 8 clinical cases. Dense breasts were detected in 6 (75.0%) of the 8 cases. The presence of mass(es), radial scar, asymmetry, non-mass lesion, and microcalcifications are described. The histopathologic diagnosis in BI-RADS categories 4, 5, and 6 are shown.

Conclusion:
CEM increased the diagnostic accuracy in cases with nonconclusive results, suspicious malignant findings, or newly diagnosed breast cancer with the added value of using the first version of the BI-RADS® lexicon for CEM.

Key words:
Contrast enhanced mammography. CEM. BI-RADS categories. Recombined images. Low-energy CEM. High-energy CEM.