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  • Surface adhesive and hand-aided needle-assisted biopsy technique (SAHNA).
    Skelet. Radiol. (IF 1.518) Pub Date : null
    R Rajakulasingam,A Iqbal,S L James,R Botchu

    OBJECTIVE We describe a novel and efficient CT biopsy technique that we have termed 'skin adhesive and hand-aided biopsy technique', shortened to the acronym SAHNA. This technique is ideal for biopsying surface osseous lesions where there is a lack of subcutaneous fat. This avoids the need for the radiologist's hand to be in close proximity to the CT scanner beam at the time of intervention. METHODS The SAHNA technique uses a plastic surgical forceps towel clamp to stabilise the biopsy needle just proximal to the lesion after piercing through the skin. The clamp itself is stabilised via a self-adhesive dressing which is stuck down to the skin at its shank. RESULTS In our institution, we have already used the SAHNA technique successfully in over 5 cases. CONCLUSION The SAHNA technique is a widely accessible and effective way of stabilising the CT biopsy needle in technically challenging superficial bony lesions.

    更新日期:2020-01-21
  • Underestimation of fluoroscopic exposure among orthopedic residents.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Kelly D Carmichael,Lattisha L Bilbrew

    OBJECTIVES Concerns about radiation exposure for health care workers have increased in the last decade, along with the increased use of fluoroscopic imaging for surgical procedures. Recent literature suggests that surgeons with the least experience have higher exposure during surgery, and their perception of exposure may be lower. The purpose of this study was to examine the accuracy of orthopedic resident trainees' estimates of their exposure during fluoroscopy cases. MATERIALS AND METHODS Orthopedic resident trainees were surveyed after participation in various fluoroscopic orthopedic surgeries and asked to estimate the number of fluoroscopy exposures used. Their answers were compared against the actual number of exposures retrieved from the fluoroscopy machine. The perceived number of exposures was then compared to the actual number taken for junior residents in training year 1, 2, or 3 versus senior residents in training year 4 or 5. RESULTS Nineteen residents were surveyed, 13 of which were junior residents and six of which were senior residents. Of the 13 junior-level residents, total estimation was 441 exposures, versus 1411 actual exposures, an underestimation of over 69%. The six senior residents totaled 457 estimated exposures, compared to 645 actual exposures, for an underestimation of just under 30%. CONCLUSIONS In this survey study at a single institution, junior-level residents greatly underestimated radiation exposure compared to senior-level residents. Trainees should be aware that they grossly underestimate their exposure levels during procedures, and residency programs should emphasize fluoroscopic training early.

    更新日期:2020-01-21
  • 3-T MRI mapping is a valid in vivo method of quantitatively evaluating the anterior cruciate ligament: rater reliability and comparison across age.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Adam W Anz,Jos Edison,Thomas S Denney,Eric A Branch,Christopher R Walz,Kenny V Brock,Michael D Goodlett

    OBJECTIVE As biologic augmentation methods emerge, objective measures of soft tissues are necessary for developmental study. The purpose of this study was to develop a quantitative MRI mapping protocol for the ACL. The objectives were (1) to provide age-based T2 relaxation, T2* relaxation, and volume values in healthy individuals, (2) to establish the intra-rater and inter-rater reliability of ACL mapping, and (3) to determine whether 3-T or 7-T MRI is more appropriate for future clinical trials. MATERIALS AND METHODS Thirty healthy participants, aged 18-62, asymptomatic for knee pathology and without history of knee injury underwent both a 3-T and 7-T MRI. Manual image mapping of the anterior cruciate ligament was performed by two observers and processed to obtain T2, T2*, and volume values. Analysis of variance and two-way random effects model were used to calculate statistical significance and intraclass correlation coefficients. RESULTS Across all participants, 3-T and 7-T mean T2, T2* and volume values were 37.1 ± 7.9 and 39.7 ± 6.2 ms (p = 0.124), 10.9 ± 1.3 and 10.9 ± 0.9 ms (p = 0.981), and 2380 ± 602 and 2484 ± 736 mm3 (p = 0.551), respectively. The T2, T2*, and volume did not vary between age cohorts (p > 0.05). Excellent inter-rater and intra-rater reliability regarding T2 and T2* values was found. While ACL volume exhibited good inter-rater reliability and excellent intra-rater reliability. CONCLUSIONS T2 relaxation values and ACL volume do not vary with age and therefore can be used as a quantifiable, non-invasive method to assess ACL graft maturation. 7-T MRI analysis was not superior to 3-T MRI analysis, suggesting that 3-T MRI is practical and capable for future comparative studies.

    更新日期:2020-01-21
  • External fixators: looking beyond the hardware maze.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Kimia Khalatbari Kani,Jack A Porrino,Felix S Chew

    External fixation has a wide variety of orthopedic applications. Although external fixator frames may have a complex appearance, these constructs are formed from several basic components and can be broadly categorized into unilateral, circular, or hybrid designs. The introduction of computer-aided circular external fixation devices (hexapod frames) has simplified the treatment of multiaxial and especially rotational deformities. Serial radiography plays a central role in the evaluation of callus formation (at the level of treated fracture or nonunion as well as the regenerate and docking site with distraction osteogenesis), tailoring the rate and rhythm of distraction during distraction osteogenesis, evaluation of frame complications, and determination of the timing of frame removal. The goals of this article are to review: the components, types, and relevant terminology of external fixator constructs with special emphasis on the Taylor spatial frame, the principles and techniques of distraction osteogenesis, and complications of external fixation.

    更新日期:2020-01-21
  • Do magnetic resonance imaging abnormalities of the non-dominant wrist correlate with ulnar-sided wrist pain in elite tennis players?
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-08-12
    Sidney M Levy,Machar Reid,Anne-Marie Montgomery,Elissa Botterill,Stephanie A Kovalchik,Melanie Omizzolo,Frank Malara,Timothy O Wood,Gregory A Hoy,Andrew H Rotstein

    OBJECTIVE Ulnar-sided injuries of the non-dominant wrist are common in elite tennis players that use the double-handed backhand technique. This study aimed to define the relationship between ulnar-sided wrist pain in symptomatic and asymptomatic elite tennis players, and the presence of abnormalities on magnetic resonance imaging (MRI). MATERIALS AND METHODS Fourteen symptomatic tennis players, 14 asymptomatic tennis players, and 12 healthy controls who did not play tennis, were analyzed prospectively, after undergoing MRI of their non-dominant wrist. Five anatomical regions were analyzed, thought to relate to ulnar-sided wrist pain. These consisted of the triangular fibrocartilage complex (TFCC), ulnar collateral ligament (UCL), extensor carpi ulnaris tendon (ECU), osseous-articular structures, and ganglia. Images were independently reviewed by two blinded musculoskeletal radiologists. RESULTS Non-dominant, ulnar-sided, wrist pain in elite tennis players was not statistically significantly associated with an increased number of MRI abnormalities when compared with asymptomatic tennis players (p > 0.05). However, some evidence of statistical association was seen with an increased prevalence of ECU tendon abnormalities (OR = 8.0, 95% CI = (0.74, 20.00), p = 0.07). A statistically significant increase in MRI abnormalities of osseous structures (OR = 15.1, 95% CI = (1.56, 656.05), p = 0.02) and the dorsal radioulnar ligament (DRUL) (OR = 12.5, 95% CI = (2.15, 111.11), p = 0.03), was observed in symptomatic players compared with controls. CONCLUSIONS Non-dominant, ulnar-sided, wrist pain in a subgroup of elite tennis players using a double-handed backhand technique is not associated with a statistically significant increased prevalence of MRI abnormalities when compared with asymptomatic tennis players, other than some evidence of statistical association with ECU tendon abnormalities. Therefore, significance of MRI abnormalities should be interpreted in the context of clinical findings.

    更新日期:2020-01-21
  • Unusual manifestations of diffuse-type tenosynovial giant cell tumor in two patients: importance of radiologic-pathologic correlation.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Ayca Dundar,Jason R Young,Doris E Wenger,Carrie Y Inwards,Stephen M Broski

    Diffuse-type tenosynovial giant cell tumor (TSGCT) is a rare, locally aggressive neoplasm. It most commonly occurs in the knee, followed by the hip, and has distinctive imaging features, including mass-like foci of low T2 signal intensity, "blooming" on gradient-echo MRI, and pronounced uptake on FDG PET/CT. Histologically, TSGCT demonstrates a neoplastic population of mononuclear cells admixed with hemosiderin-laden macrophages, foamy histiocytes, inflammatory cells, and osteoclast-like giant cells. In cases where diffuse-type TSGCT presents in an uncommon location or with atypical features, the imaging diagnosis may be challenging. Furthermore, because of its polymorphous appearance, it may be mistaken microscopically for other neoplastic and non-neoplastic histiocytic lesions. Herein, we present two cases of diffuse-type TSGCT presenting as large masses, and underscore the importance of radiologic-pathologic correlation for accurate diagnosis.

    更新日期:2020-01-21
  • Tibial bone stress injury: diagnostic performance and inter-reader agreement of an abbreviated 5-min magnetic resonance protocol.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Jessica R Mann,Ged G Wieschhoff,Ryan Tai,William C Wrobel,Nehal Shah,Jacob C Mandell

    OBJECTIVE To compare the diagnostic performance and inter-reader agreement of an abbreviated (5 min) MR protocol compared to a complete (25 min) protocol, for evaluation of suspected tibial bone stress injury. MATERIALS AND METHODS This IRB-approved retrospective study consisted of 95 consecutive MR examinations in 88 patients with suspected tibial bone stress injury. Three musculoskeletal radiologists independently classified all examinations utilizing both an abbreviated protocol consisting only of axial T2-weighted images with fat suppression, and after a washout period again classified the complete examinations. Accuracy was calculated as proportion of cases classified exactly, within 1 grade, within 2 grades, and also utilizing a simplified "clinically relevant" classification combining grades 2, 3, and 4A into a single group. Significance testing was performed with the chi-test, and a post-hoc power analysis was performed. Inter-reader agreement was calculated with Kendall's coefficient of concordance, with significance testing performed utilizing the z-test after bootstrapping to obtain the standard error. RESULTS AND CONCLUSIONS There was no significant difference in accuracy of grading tibial bone stress injuries between complete and abbreviated examinations. For complete exams, pooled exact accuracy was 47.8%; accuracy within 1 grade was 82.8%; and accuracy within 2 grades was 96.1%. For the abbreviated protocol, corresponding accuracies were 50.2, 82.0, and 93.9%. With the "clinically relevant" simplified classification, accuracy was 58.6% for complete exams and 64.2% for abbreviated exams. There was no significant difference in inter-reader agreement, with substantial agreement demonstrated for both complete (Kendall coefficient of concordance 0.805) and abbreviated examinations (coefficient of 0.767).

    更新日期:2020-01-21
  • Skeletal fluorosis: don't miss the diagnosis!
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Meriem Sellami,Hend Riahi,Kaouther Maatallah,Hanen Ferjani,Mouna Chelli Bouaziz,Mohamed Fethi Ladeb

    Skeletal fluorosis is a rare toxic osteopathy characterized by massive bone fixation of fluoride. The disease occurs as an endemic problem in some parts of the world and is the result of prolonged ingestion or rarely by inhalation of high amounts of fluoride. Radiographic presentation is mainly characterized by bone changes with osteocondensation and later ossification of many ligaments and interosseous membranes. Skeletal fluorosis is not clinically obvious and can be confused with other rheumatologic disorders. Its severity lies in the development of skeletal deformities and neurological complications. Management of fluorosis generally focuses on symptom treatment.

    更新日期:2020-01-21
  • Percutaneous reinforced osteoplasty for long bone metastases: a feasibility study.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-08-05
    Nischal Koirala,Gordon McLennan

    OBJECTIVE While percutaneous osteoplasty is common for the treatment of vertebral fractures, low strength of fixation remains a major challenge for use in metastatic weight-bearing bones. With stent, wire, and cement augmentation, this study explores the feasibility of percutaneous reinforced osteoplasty for use in correcting long bone fractures. MATERIALS AND METHODS Fifteen explanted swine femora were randomly assigned into three groups. Group 1 (n = 5) was native (intact) bones without any intervention (control), group 2 (n = 5) received cementoplasty, and group 3 (n = 5) received stent and wire scaffolding ("rebar") in addition to cementoplasty. All treatment procedures were performed under fluoroscopic guidance. Mechanical strength of fracture fixation was quantified by peak load to failure, stiffness, work done to fracture, and fatigue testing with four-point bend test. RESULTS Percutaneous osteoplasty with or without reinforcement was successfully achieved in all specimens. The respective peak load at failure, flexural stiffness, and work done to fracture (mean ± SEM) for group 1 was 2245 ± 168 N, 14.77 ± 1.3 Nm/degree, and 4854 ± 541 Nmm; group 2 was 468 ± 81 N, 3.9 ± 0.5 Nm/degree, and 401 ± 56 Nmm; and group 3 was 594 ± 90 N, 4.42 ± 0.4 Nm/degree, and 522 ± 54 Nmm. The mean cyclic displacement for groups 1, 2, and 3 were 0.15, 0.58, and 0.48 mm, respectively, at 220-240 N loading. CONCLUSIONS While percutaneous reinforced osteoplasty with stent, wire, and cement augmentation resulted in improved mechanical strength in restored bones, it did not differ significantly from specimens that underwent exclusive cementoplasty. With the improvement of fracture strength, the concept may be applicable for prevention or treatment of pathological fractures.

    更新日期:2020-01-21
  • Enthesopathy of the anterior chest wall joints in patients with diffuse idiopathic skeletal hyperostosis (DISH): a retrospective analysis of computed tomography scans.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Shani Broitman,Amir Herman,Myriam Stern,Merav Lidar,Iris Eshed

    PURPOSE To evaluate and characterize anterior chest wall (ACW) joint's enthesopathy on CT scans in patients with DISH compared with age- and gender-matched control group. MATERIAL AND METHODS Retrospective evaluation for enthesopathy features of ACW joints-sterno-clavicular (SCJ), manubrio-sternal (MSJ), costo-sternal 1-7 (CSJ)-on chest CT scans of subjects with DISH (Resnick criteria) and of age- and gender-matched control subjects was performed. 183 subjects (DISH: 92, control: 91); male:female: 126:57, average age: 71.7 years (range 50-94) were evaluated. Total enthesopathy scores per subjects and per each joint were compared. RESULTS Total enthesopathy score of ACW joints was significantly higher among DISH compared to controls (64.03 ± 15.1, 50.47 ± 12.4, p < 0.001). At joint level, SCJ and CSJ enthesopathy, but not MSJ was significantly more prevalent in DISH compared to controls. CONCLUSION ACW joints' enthesopathy as seen on CT scans, an entity not included in the Resnick classification criteria, is common among DISH subjects. The difference between SCJ and CSJ prevalence compared to MSJ may result from different joint type. ACW joints' enthesopathy may be considered to be included in future modified radiographic criteria for DISH.

    更新日期:2020-01-21
  • Accessory anterolateral talar facet associated with tarsal coalition: prevalence and cross-sectional characterization.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Eman Alqahtani,Evelyne Fliszar,Donald L Resnick,Brady K Huang

    OBJECTIVE The accessory anterolateral talar facet (AALTF) is a developmental entity described as a potential cause for rigid, painful flat foot. This study evaluates the possible association between the AALTF and other flat foot etiologies, specifically different types of tarsal coalitions. MATERIALS AND METHODS We evaluated patients with tarsal coalition or sinus tarsi syndrome for an AALTF on CT and MRI. Exclusion criteria included acute ankle trauma, recent surgery, motion or metal artifacts. We evaluated the AALTF length and height, and the lateral talocalcaneal structures for associated findings. The presence of calcaneonavicular (CNC), intra-articular middle facet talocalcaneal (MFTCC), posterior facet talocalcaneal (PFTCC), extra-articular posteromedial talocalcaneal (EATCC) and other rare coalitions were also evaluated. RESULTS One hundred eighty-seven patients were included (age range 14-91 years; mean ± SD; 50 ± 17 years). The AALTF prevalence in the study population was 31.55% (59/187), 40.91% in men, and 23.23% in women. The AALTF average length was 4.5 ± 1.1 mm, and average height was 8.9 ± 3.4 mm. The AALTF was found to be significantly associated with lateral talocalcaneal osseous changes such as cortical thickening and cystic changes (34/59 and 24/59 respectively, P < 0.01). The AALTF was also found to be significantly associated with sinus tarsi edema on MRI (45/52, P < 0.05). The AALTF was also significantly associated with EATCC (19/59, P < 0.01) and MFTCC (7/59, P < 0.05). No significant association was found with CNC, PFTCC or other rare coalitions. CONCLUSION The AALTF is common and significantly associated with some tarsal coalitions, specifically EATCC and MFTCC. When an AALTF or coalition is identified, special attention should be made to evaluate for other associated pathologies, as this could potentially affect management.

    更新日期:2020-01-21
  • The effect of music on pain and subjective experience in image-guided musculoskeletal corticosteroid injections: a randomized controlled trial.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Weier Li,Roy G Bryan,Arvin Kheterpal,Frank J Simeone,Connie Y Chang,Martin Torriani,Ambrose J Huang

    PURPOSE To investigate the role of music on subjects undergoing routine image-guided musculoskeletal corticosteroid injections and its effect on post-procedure pain and subjective overall experience. MATERIALS AND METHODS This prospective study was IRB-approved and HIPAA-compliant. A total of 126 subjects referred for outpatient image-guided musculoskeletal corticosteroid injections were enrolled in the study and randomized into a music offered group ((+)MO) and a no music offered group ((-)MO). (+)MO subjects were given the opportunity to listen to music during their corticosteroid injection. All subjects were then given an anonymous survey on which they recorded their pre-procedural and post-procedural pain on a scale from 0 to 9 and rated their overall experience and how likely they were to recommend our department for musculoskeletal procedures on scales from 1 to 5. RESULTS (+)MO subjects had significantly lower post-procedural pain (p = 0.013) and significantly greater decrease in pain (p = 0.031) compared to (-)MO subjects. Among the (+)MO subjects, there was no statistically significant difference in post-procedure pain (p = 0.34) or change in pain (p = 0.62) if music was accepted or declined. However, subjects who listened to music did have lower post-procedural pain compared to those who did not listen to music (p = 0.012), although the differences in the decrease of pain between the two groups did not quite reach statistical significance (p = 0.062). CONCLUSIONS Playing music during image-guided musculoskeletal corticosteroid injections may reduce patients' post-procedure pain. Offering patients some measure of control over their procedure may be a factor that contributes to decreased post-procedure pain as well.

    更新日期:2020-01-21
  • CT-guided transarticular biopsy of the sacroiliac joint: Technique and histomorphological results. A preliminary study.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Niels Egund,Flemming Brandt Sørensen,René Østgård,Anne Gitte Loft,Lene Warner Thorup Boel,Anne Grethe Jurik

    OBJECTIVE To introduce and evaluate computed tomography (CT)-guided transarticular needle biopsy of the cartilaginous sacroiliac joint (SIJ) and to assess the biopsy results microscopically. MATERIALS AND METHODS The new CT-guided transarticular biopsy of the SIJ was performed in a young corpse and ten patients, two males and eight females aged 18-81 years. All patients had abnormal findings by magnetic resonance imaging (MRI) of the SIJs, including bone marrow edema, related to different types of joint disorders. The biopsies were focused on areas with bone marrow edema. The quality of the specimens obtained, using two different types of biopsy needles, was assessed microscopically. RESULTS Biopsies containing cartilage, subchondral plate, and bone marrow from the iliac and sacral sides were obtained from the corpse and three patients and from the iliac bone only in two patients. In three patients, the biopsy needles could not penetrate the bone marrow to the joint facet due to pronounced subchondral sclerosis, but adequate marrow biopsies were obtained. Two biopsies were inadequate, one due to technical problems and one was crushed during preparation. Histological assessment of eight adequate specimens revealed inflammatory bone marrow changes, except in two specimens from females with pronounced sclerosis conforming to osteitis condensans ilii. CONCLUSIONS Transarticular SIJ biopsies are obtainable and can be directed towards areas with MRI abnormalities. They can be used to confirm inflammatory changes histologically. With the biopsy needles used, severe bone marrow sclerosis may hinder penetration to the cartilage, but bone marrow specimens can be obtained.

    更新日期:2020-01-21
  • MRI criteria for diagnosis and predicting severity of carpal tunnel syndrome.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Alex W H Ng,James F Griffith,Cina S L Tong,Eric K C Law,W L Tse,Clara W Y Wong,P C Ho

    OBJECTIVE To study MRI criteria for diagnosing and predicting severity of carpal tunnel syndrome (CTS). METHODS Sixty-nine wrists in 41 symptomatic CTS patients and 32 wrists in 28 asymptomatic subjects were evaluated by MRI. Circumferential surface area (CSA), flattening ratio, relative median nerve signal intensity, and retinacular bowing were measured. CTS severity was classified as mild, moderate, or severe. Parameters for patients with and without CTS and for the three severity groups were compared. ROC curves were plotted to assess accuracy for CTS diagnosis and severity prediction. RESULTS Significant differences were found between CTS and control wrists for median nerve CSA, flattening ratio at inlet, relative median nerve signal intensity, and retinacular bowing. ROC curve analysis revealed a sensitivity, specificity, and accuracy of median nerve CSA > 15 mm2 proximal to the tunnel (CSAp) of 85.5, 100, and 90.1%. Using either CSAp or CSAd > 15 mm2 as a diagnostic criterion, MRI could achieve a sensitivity of 100% and specificity of 94% for diagnosis of CTS while overall accuracy was 98%. Significant differences were found among the three severity groups. Sensitivity, specificity, and accuracy of prediction of severe CTS using for CSAp > 19 mm2 were 75.0, 65.9, and 69.6%, respectively. CONCLUSIONS MRI is highly accurate at diagnosing CTS and moderately accurate at determining CTS severity. We recommend using CSA > 15 mm2 either proximal to or distal to the tunnel as a diagnostic criterion for CTS and CSA > 19 mm2 proximal to the tunnel as a marker for severe CTS.

    更新日期:2020-01-21
  • Talus Partitus: a review of five cases diagnosed by MRI.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-11-11
    Corbin L Pomeranz,William B Morrison,Vishal Desai,Adam C Zoga,Jeffrey A Belair

    Talus partitus is a rare skeletal developmental abnormality characterized by a split of the posterior talar bone in the coronal plane. Patients with talus partitus typically present with posterior ankle pain and instability, often displaying varying degrees of chondrosis and secondary degenerative change on imaging. To date, only few case reports describing the imaging appearance of talus partitus have been published. The majority of these publications are limited to radiographic and computed tomography (CT) imaging findings, despite the ubiquity of magnetic resonance imaging (MRI). To the authors' knowledge, there is little description of typical MRI findings of the symptomatic talus partitus in the radiologic literature. We present a series of five cases of talus partitus identified on MRI and examine pitfalls in diagnosis, differential considerations, pathophysiology, and treatment options.

    更新日期:2020-01-21
  • Correction to: Skeletal Radiology Volume 49, issue 1, January 2020
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-12-27

    Unfortunately in Volume 49, Issue 1 had been published online with an incorrect date (2001 instead of 2020).

    更新日期:2020-01-04
  • Highlights of the special scientific sessions of the 46th Annual Scientific Meeting of the International Skeletal Society (ISS) 2019, Vancouver, Canada
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-11-21
    Miriam A. Bredella

    Abstract This paper summarizes the highlights of the Scientific Sessions of the 46th Annual Scientific Meeting of the International Skeletal Society (ISS) which was hosted in Vancouver, Canada, in September 2019.

    更新日期:2020-01-04
  • Subsynovial epidermal inclusion cyst of the knee
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-16
    Anne-Sophie Vanhoenacker, Patrick Seynaeve, Frederik Vanrietvelde, Herwig Alaerts, Koenraad Verstraete

    We report a case of a subsynovial epidermal inclusion cyst in a 47-year-old woman with a painful spontaneous swelling of the right knee and a 2-year history of puncture and arthroscopy. Epidermal inclusion cysts are one of the most common benign subcutaneous tumours. Very rarely, they are located in an articulation and can cause an inflammatory reaction when rupture occurs. Simple surgical excision is the preferred therapy. The main goal of this case report is to include the possibility of an intra-articular epidermal inclusion cyst into the differential when imaging shows an intra-articular structure, and more so if there is a history of trauma, intra-articular puncture or arthroscopy.

    更新日期:2020-01-04
  • Nodal metastases of soft tissue sarcomas: risk factors, imaging findings, and implications
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-08-23
    Jeffrey Rosenthal, Kenneth Cardona, Samia K. Sayyid, Adam J. Perricone, Nickolas Reimer, David Monson, Adam Daniel Singer

    Abstract Soft tissue sarcomas (STS) are malignancies derived from connective tissue, and regional lymph node metastasis (RLNM), while not common, is an important aspect of prognosis and treatment. Various risk factors, in particular the histological subtype, affect the likelihood of nodal involvement, which can be characterized by imaging features such as nodal dimension and morphology. Currently, surveillance and management vary by institution, as concrete societal guidelines have not been established. Common nodal status assessment strategies include physical exam, US CT, MRI, sentinel lymph node biopsy (SLNB) and radical lymphadenectomy. This article summarizes data regarding relevant risk factors of RLNM, imaging features, and any available data regarding surveillance recommendations.

    更新日期:2020-01-04
  • Changes in the morphology of the triangular fibrocartilage complex (TFCC) on magnetic resonance arthrography related to disruption of ulnar foveal attachment
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-18
    Ji Hun Park, Kyung-Sik Ahn, Anseong Chang, Young Woo Kwon, In Cheul Choi, Jong Woong Park

    Abstract Objective To assess whether a proximal ligamentous component (PLC) of the triangular fibrocartilage complex (TFCC) with a distally prolapsing morphology is associated with the presence of a TFCC foveal tear on arthroscopy. Methods One-hundred thirty-two patients (134 wrists) who underwent MR arthrography and subsequent wrist arthroscopy between September 2014 and March 2018 were retrospectively evaluated. The degree of distal PLC prolapse was measured on coronal MR arthrography using the height-to-length ratio (HLR). Subjects’ demographics, ulnar variance, presence of a degenerative TFCC tear, and ulnar styloid nonunion were assessed. The association between specific variables and the presence of a foveal tear was investigated. Results A TFCC foveal tear was identified in a total of 101 of 134 wrists examined by arthroscopy. Univariable analysis showed that the HLR of the PLC was significantly greater in the foveal tear group compared with the intact fovea group (44.6 vs. 38.9%, respectively, p < 0.001). Multivariable analysis showed that HLR was positively associated with a foveal tear (odds ratio [OR], 1.211; p < 0.001). The estimated cut-off value of the HLR was 41% (area under the curve [AUC] 0.77). Conclusions PLCs with a distal prolapse pattern and large HLR are associated with TFCC foveal tears. The HLR of the PLC measured on coronal MR images can therefore be used as an additional predictor of tears of the foveal attachment of the TFCC.

    更新日期:2020-01-04
  • Bone mineral density measurement combined with vertebral fracture assessment increases diagnosis of osteoporosis in postmenopausal women
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-27
    Siqing Cai, Haiming Yu, Yizhong Li, Xiaobo He, Lisheng Yan, Xueqing Huang, Peiwen Wang

    Abstract Objective Osteoporosis is diagnosed based on the results of BMD assessment and/or fragility fractures. Vertebral fracture is the most common fragility fracture. Many vertebral fractures are asymptomatic and are not clinically recognized. Early detection of vertebral fracture may increase diagnosis of osteoporosis. In this study, we performed BMD measurement combined with vertebral fracture assessment (VFA) by DXA for the postmenopausal women receiving the first bone densitometry and studied the impact of VFA on the diagnosis of osteoporosis. Methods A total of 502 postmenopausal women were enrolled in our study. Patients’ age was 66.7 ± 9.5 years. All patients had BMD assessment and VFA by dual-energy X-ray absorptiometry. Genant’s semiquantitative assessment was used. The impact of VFA on the diagnosis of osteoporosis was studied. All parameters of groups were compared using the Chi-squared test. Results There were 257 patients with T-score ≤−2.5, 202 patients with a T-score between −1 and − 2.5, and 43 patients with BMD within the normal range. There were 162 patients with 345 fractured vertebrae identified by VFA, among which 84% of patients were previously unknown. Osteoporosis or severe osteoporosis was presented in 51.2% patients diagnosed by BMD alone, in 55.2% patients diagnosed by BMD plus fracture history, and in 62.4% of patients diagnosed by BMD plus fracture history and VFA. Severe osteoporosis significantly increased by 17.2% in patients receiving VFA. Conclusions VFA combined with BMD can detect previously unknown vertebral fractures and increase clinical diagnosis of osteoporosis. It is plausible to speculate that this method should be considered in postmenopausal women for the first BMD assessment.

    更新日期:2020-01-04
  • A novel technique for retrieval of a broken biopsy needle
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-09-02
    Walker Asprey, Grace Knuttinen, Jeremiah R. Long, Michael Fox, Jonathan Flug, Jeffrey P. Mayer, Adam J. Schwartz

    Abstract A broken needle is a rare complication of bone biopsy. We describe an easily applied technique of retrieval of a retained biopsy needle fragment using a cannulated drill typically used for internal fixation of femoral neck fractures. This approach allows for removal under moderate conscious sedation and can be performed by a radiologist using fluoroscopic or CT-fluoroscopic guidance in the radiology suite.

    更新日期:2020-01-04
  • Current status and recommendations for imaging in neurofibromatosis type 1, neurofibromatosis type 2, and schwannomatosis
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-08-08
    Shivani Ahlawat, Jaishri O. Blakeley, Shannon Langmead, Allan J. Belzberg, Laura M. Fayad

    Neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), and schwannomatosis (SWN) are three clinically distinct tumor predisposition syndromes with a shared tendency to develop peripheral and central nervous system neoplasms. Disease expression and complications of NF1, NF2, and SWN are highly variable, necessitating a multidisciplinary approach to care in order to optimize outcomes. This review will discuss the imaging appearance of NF1, NF2, and SWN and highlight the important role that imaging plays in informing management decisions in people with tumors associated with these syndromes. Recent technological advances, including the role of both whole-body and localized imaging strategies, routine anatomic and advanced magnetic resonance (MR) imaging sequences such as diffusion-weighted imaging (DWI) with quantitative apparent diffusion coefficient (ADC) mapping, and metabolic imaging techniques (MR spectroscopy and positron emission testing) are discussed in the context of the diagnosis and management of people with NF1, NF2, and SWN based on the most up-to-date clinical imaging studies.

    更新日期:2020-01-04
  • Cartilage degeneration post-meniscectomy performed for degenerative disease versus trauma: data from the Osteoarthritis Initiative
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-09
    Jan Neumann, Kai Kern, Dong Sun, Sarah C. Foreman, Gabby B. Joseph, Alexandra S. Gersing, Michael C. Nevitt, Charles E. McCulloch, Azien Quitzke, Thomas M. Link

    To compare the extent of cartilage deterioration in knees with prior meniscal resection related to trauma versus knees with resection related to degenerative disease, and to compare cartilage deterioration in knees with meniscal surgery to knees without meniscal surgery, controlling for prior knee trauma.

    更新日期:2020-01-04
  • Clinical utility of a postprocedural CT scan in CT-guided musculoskeletal biopsies
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-20
    Lisa Ratanaprasatporn, Jacob C. Mandell

    Abstract Objective The purpose of this study is first to determine the clinical utility of the postprocedure scan in detecting postinterventional complications after CT-guided musculoskeletal biopsies, and second to evaluate the contribution to the radiation dose of the postprocedural CT scan. Materials and methods Retrospective analysis of 500 consecutive CT-guided musculoskeletal biopsies over an 18-month period from 29 March 2017 to 28 September 2018, where spiral postprocedure scans were obtained in every case. To assess the clinical utility of postinterventional CT scans, it was determined whether immediate post-procedural complications were detected on the postprocedural scans only or were also seen on the procedural images. To evaluate the relative radiation exposure of postprocedural scans, a ratio was obtained of the dose–length product (DLP) of the postprocedural scan compared with the total DLP of each case. Results A total of 397 bone biopsies and 103 soft-tissue biopsies were performed in 471 patients. The immediate postprocedural complication rate was 0.4% (2 out of 500) in all procedures. Both complications were minor (small hematomas) and detected only on postinterventional CT scans. The average total DLP for the procedures was 383.5 mGy*cm. The average DLP of the postprocedural scan was 64.0 mGy*cm. The average radiation dose contribution of the postprocedural CT scans toward the total DLP was 17.4%. Conclusion Immediate postprocedural complications in CT-guided musculoskeletal interventions are rare. When complications do occur, they are usually minor. To substantially reduce radiation dose, postinterventional CT scans should not be performed routinely.

    更新日期:2020-01-04
  • Lumbosacral plexiform neurofibroma: a rare case in an adult without neurofibromatosis type I
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-24
    Naomi K. Atkins, J. Derek Stensby, Ayman H. Gaballah

    Plexiform neurofibromas are an uncommon variant of neurofibromas that are described as being essentially pathognomonic of neurofibromatosis type 1 (NF1). Plexiform neurofibromas in the absence of NF1 are extremely rare. We present the case of a 38-year-old woman with a large multilobulated lumbosacral mass extending into the pelvis and proximal thigh. Histopathology of a CT-guided biopsy of the mass revealed it to be a neurofibroma. The imaging findings were consistent with a plexiform subtype. Further imaging and clinical workup showed that the patient had no other identifiable neurofibromas and did not meet criteria for the diagnosis of NF1.

    更新日期:2020-01-04
  • The added value of SPECT-CT in the detection of heterotopic ossification on bone scintigraphy
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-30
    Mohammad A. Ghanem, Shurouq Dannoon, Abdelhamid H. Elgazzar

    Abstract Purpose Heterotopic ossification (HO) is the abnormal osteogenesis in non-skeletal tissue. It can be difficult to detect, as it can mimic other conditions clinically and on imaging studies. The purpose of this study was to find the added value of SPECT-CT in accurate detection of HO. Materials and methods A total of 1780 reports on the PACS system of patients underwent bone scintigraphy at the Department of Nuclear Medicine and were filtered for the term “HO” or “heterotopic bone formation” and “SPECT-CT”. Thirty-four patients fulfilled this criterion. All patients had bone scintigraphy and SPECT/CT in the same occasion. Images were reviewed by two nuclear medicine physicians blindly. The certainty of the presence of extra-skeletal soft tissue ossification on the planar with SPECT was graded as “definitely present”, “maybe present”, or “not present”, and the same was determined on planar with SPECT-CT images. Results Based on SPECT/CT, 23 (67.6%) patients were found to have HO, and 11 (32.4%) did not have confirming findings. Of the 23 positive patients on SPECT/CT, eight (34.8%) showed “definitely present” and 12 (52.2%) patients were under “maybe present” on SPECT only. Three (13%) patients were negative on the SPECT and showed evidence of HO on CT. Of the 11 patients that did not demonstrate definite evidence of HO on SPECT/CT, seven (63.6%) were negative on SPECT alone and, four (36.4%) were under “maybe present” on SPECT. The definite detection of HO was statistically significant higher when CT is added to SPECT. Conclusions Our findings suggest that adding the CT component to SPECT is valuable in the detection of HO.

    更新日期:2020-01-04
  • The ring-shaped meniscus: a case series demonstrating the variation of imaging appearances on MRI
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-30
    A. Iqbal, E. McLoughlin, Rajesh Botchu, S. L. James

    The ring-shaped meniscus (RSM) is a rare meniscal variant in which there is an intermeniscal bridge between the anterior and posterior horns of the meniscus, thus forming a complete ring. The lateral meniscus is more commonly involved than the medial meniscus. Distinguishing an RSM from a bucket handle tear (BHT) with a displaced fragment in the intercondylar notch is challenging and there are reports of negative arthroscopies for suspected BHTs. There are many reports of symptomatic and asymptomatic lateral RSMs diagnosed on MRI in the literature. We report a series of RSMs in six patients, which includes MRI descriptions of two cases of medial RSM and a case of bilateral lateral RSM, which were diagnosed on MRI and have never previously been reported. This study will also describe the various imaging features of a RSM that distinguish it from a displaced BHT. We will also discuss associated rare malformations encountered in our study, such as hypoplastic anterior cruciate ligament and the anomalous insertion of the popliteus tendon onto the posterior horn of a lateral RSM.

    更新日期:2020-01-04
  • Current applications and future directions of deep learning in musculoskeletal radiology
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-08-04
    Pauley Chea, Jacob C. Mandell

    Abstract Deep learning with convolutional neural networks (CNN) is a rapidly advancing subset of artificial intelligence that is ideally suited to solving image-based problems. There are an increasing number of musculoskeletal applications of deep learning, which can be conceptually divided into the categories of lesion detection, classification, segmentation, and non-interpretive tasks. Numerous examples of deep learning achieving expert-level performance in specific tasks in all four categories have been demonstrated in the past few years, although comprehensive interpretation of imaging examinations has not yet been achieved. It is important for the practicing musculoskeletal radiologist to understand the current scope of deep learning as it relates to musculoskeletal radiology. Interest in deep learning from researchers, radiology leadership, and industry continues to increase, and it is likely that these developments will impact the daily practice of musculoskeletal radiology in the near future.

    更新日期:2020-01-04
  • The influence of knee bolster on lumbar spinal stenosis parameters on MR images
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-30
    Azaria Simonovich, Anna Nagar Osherov, Lina Linov, Leonid Kalichman

    Abstract Objective To estimate the effect of the knee bolster use during an MRI on lumbar spinal stenosis parameters and low back pain-related disability. Methods A repeated-measurement study of 27 males and 19 females with mean age 55.78 ± 14.36, referred for an MRI of the lumbar spine due to low back pain, performed with and without standard knee bolster. A radiologist evaluated the lumbar lordosis Cobb’s angle, the cross-sectional area of the right and left intervertebral foramina and spinal canal at L1-L2, L2-L3, L3-L4 spinal levels. Spinal symptoms were evaluated by the Oswestry Disability Questionnaire. Results The Cobb angle of lumbar lordosis was found significantly greater on an MRI performed without knee bolster than with bolster (47.30 ± 9.90 vs. 42.57 ± 10.62, p < 0.001). The cross-sectional area of the intervertebral foramina and spinal canal at all evaluated levels was smaller when performed without knee bolster than with bolster. However, differences were significant only at the L1-L2 level and in the spinal canal at all evaluated levels. The Cobb angle, measured with and without knee bolster, showed significant positive correlations with back pain while standing and walking. The spinal canal area without knee bolster showed greater correlations with the Oswestry score parameters than with knee bolster. Conclusions MR images at evaluated spinal levels taken without knee bolster showed greater correlations of the spinal canal cross-sectional area with the Oswestry score than ones with knee bolster. Thus, one may prefer MR images acquired without a bolster below the knee compared to an MRI with a knee bolster.

    更新日期:2020-01-04
  • Browser's Notes.
    Skelet. Radiol. (IF 1.518) Pub Date : null

    更新日期:2019-11-01
  • Pediatric ankle injuries: utilizing the Dias-Tachdjian classification.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Christy B Pomeranz,Roger J Bartolotta

    Pediatric ankle injuries require timely diagnosis due to their involvement of the distal tibial physis and subsequent impact on long bone growth. These injuries occur in a predictable pattern based on ankle position, direction of force, and degree of closure of the distal tibial physis. The Dias-Tachdjian classification describes possible ankle injury patterns for the completely open physis, and we present a simplified algorithm for applying this system in routine radiographic interpretation. Similar to the Lauge-Hansen classification in adults, the Dias-Tachdjian system is based on the position of the foot and direction of force at the time of injury with four major patterns: supination-inversion, pronation-eversion external rotation, supination-plantar flexion, and supination-external rotation. In addition, we examine the effect that the closing distal tibial physis has on adolescent fracture patterns (specifically, Tillaux and triplane fractures). Awareness of these injury patterns helps the radiologist to identify nondisplaced fractures and subtle physeal injuries with implications for surgical and/or conservative management.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Response to: letter to the editor re: Osteoma-like melorheostosis: a rare type of skeletal dysplasia depicted on FDG PET/CT.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-10-28
    Alain S Abi-Ghanem,Karl Asmar,Samar Muwakkit,Fouad Boulos

    更新日期:2019-11-01
  • Highlights of the annual scientific meeting of the Society of Skeletal Radiology (SSR) 2019, Scottsdale, Arizona, USA.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-10-24
    Michael G Fox,Laura W Bancroft

    Peer-reviewed abstracts presented at the 2019 Society of Skeletal Radiology (SSR) Annual Meeting were reviewed following oral presentation. Topics felt to be of potential interest to musculoskeletal (MSK) investigators and practicing clinicians are highlighted in this compilation and analysis of the meeting. New concepts regarding MSK imaging and intervention, MSK protocols and techniques, and quality improvement are included. ePoster highlights are also presented.

    更新日期:2019-11-01
  • Imaging in Lisfranc injury: a systematic literature review.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-08-02
    Yantarat Sripanich,Maxwell W Weinberg,Nicola Krähenbühl,Chamnanni Rungprai,Megan K Mills,Charles L Saltzman,Alexej Barg

    OBJECTIVES To systematically review current diagnostic imaging options for assessment of the Lisfranc joint. MATERIALS AND METHODS PubMed and ScienceDirect were systematically searched. Thirty articles were subdivided by imaging modality: conventional radiography (17 articles), ultrasonography (six articles), computed tomography (CT) (four articles), and magnetic resonance imaging (MRI) (11 articles). Some articles discussed multiple modalities. The following data were extracted: imaging modality, measurement methods, participant number, sensitivity, specificity, and measurement technique accuracy. Methodological quality was assessed by the QUADAS-2 tool. RESULTS Conventional radiography commonly assesses Lisfranc injuries by evaluating the distance between either the first and second metatarsal base (M1-M2) or the medial cuneiform and second metatarsal base (C1-M2) and the congruence between each metatarsal base and its connecting tarsal bone. For ultrasonography, C1-M2 distance and dorsal Lisfranc ligament (DLL) length and thickness are evaluated. CT clarifies tarsometatarsal (TMT) joint alignment and occult fractures obscured on radiographs. Most MRI studies assessed Lisfranc ligament integrity. Overall, included studies show low bias for all domains except patient selection and are applicable to daily practice. CONCLUSIONS While conventional radiography can demonstrate frank diastasis at the TMT joints; applying weightbearing can improve the viewer's capacity to detect subtle Lisfranc injury by radiography. Although ultrasonography can evaluate the DLL, its accuracy for diagnosing Lisfranc instability remains unproven. CT is more beneficial than radiography for detecting non-displaced fractures and minimal osseous subluxation. MRI is clearly the best for detecting ligament abnormalities; however, its utility for detecting subtle Lisfranc instability needs further investigation. Overall, the available studies' methodological quality was satisfactory.

    更新日期:2019-11-01
  • Reverse total shoulder arthroplasty: an imaging overview.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-20
    Dong Hyun Lee,Yun Sun Choi,Hollis G Potter,Yoshimi Endo,Thiru Sivakumaran,Tae Kang Lim,Tong Jin Chun

    Although not as common as hip or knee arthroplasty, shoulder arthroplasty is becoming a more common procedure. Reverse total shoulder arthroplasty (RTSA) is known to be an effective surgical procedure for massive irreparable rotator cuff tears, comminuted proximal humerus fractures, and revision shoulder arthroplasty. The utilization of RTSA has been increasing, and although complications following reverse arthroplasty have been reported, there are few reports in the literature that focus on the imaging features of RTSA. Herein, we demonstrate the biomechanics of RTSA, prosthesis components, indications, and imaging features of the normal postoperative appearance and various complications after RTSA. Familiarization with the normal and abnormal imaging appearances after RTSA can be helpful for appropriate management of patients.

    更新日期:2019-11-01
  • MRI of the distal tibiofibular joint.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-11
    Ban Sharif,Matthew Welck,Asif Saifuddin

    The distal tibiofibular joint is a fibrous joint that plays a crucial role in the stability of the ankle joint. It is stabilized by three main ligaments: the anterior inferior tibiofibular ligament, the posterior inferior tibiofibular ligament, and the interosseous tibiofibular ligament, which are well delineated on magnetic resonance imaging. Pathology of the distal tibiofibular joint is mostly related to trauma and the longer-term complications of trauma, such as soft tissue impingement, heterotopic ossification, and synostosis. This review article outlines the MRI anatomy and pathology of this joint.

    更新日期:2019-11-01
  • CT and MR imaging findings of solitary nevus lipomatosus cutaneous superficialis: radiological-pathological correlation.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-08
    Masaya Kawaguchi,Hiroki Kato,Hiroyuki Tomita,Akira Hara,Masayuki Matsuo

    OBJECTIVE This study assessed the CT and MRI findings of solitary nevus lipomatosus cutaneous superficialis (NLCS). MATERIALS AND METHODS Eleven patients with histopathologically and clinically confirmed solitary NLCS who underwent CT and/or MRI were enrolled. Radiological and histopathological findings of elevated lesions located above the level of the surrounding normal skin surface and coexisting subcutaneous lipoma-like lesions were assessed retrospectively. RESULTS Elevated skin lesions were observed in all 11 patients; these lesions were pedunculated in 4 patients (36%) and broad-based in 7 (64%). The CT attenuation of elevated lesions was fat attenuation in 2 out of 7 patients (29%), slightly increased fat attenuation in 4 out of 7 (57%), and combined fat and soft-tissue attenuation in 1 out of 7 (14%). The MR signal intensity of elevated lesions on T1-weighted images was fat signal intensity in 2 out of 6 patients (33%), slightly decreased fat signal intensity in 3 out of 6 (50%), and combined fat signal intensity and hypointensity in 1 out of 6 (17%). Subcutaneous lipoma-like lesions with fat attenuation and/or fat signal intensity were observed in 6 out of 11 patients (55%). Histopathologically, various amounts of fatty tissue and collagenous fiber were observed within the elevated lesions in all 11 patients. CONCLUSION The CT and MRI features of solitary NLCS were the broad-based or pedunculated elevated lesions, including fatty components. Additionally, subcutaneous lipoma-like lesions were frequently observed.

    更新日期:2019-11-01
  • Core curriculum online lecture series in musculoskeletal imaging: initial results.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-07
    Lawrence M White,David A Rubin,Mini N Pathria,Michael J Tuite,Michael P Recht

    OBJECTIVE To augment the educational resources available to training programs and trainees in musculoskeletal (MSK) radiology by creating a comprehensive series of Web-based open-access core curriculum lectures. MATERIALS AND METHODS Speakers with recognized content and lecturing expertise in MSK radiology were invited to create digitally recorded lecture presentations across a series of 42 core curriculum topics in MSK imaging. Resultant presentation recordings, organized under curriculum subject headings, were archived as open-access video file recordings for online viewing on a dedicated Web page (http://radiologycorelectures.org/msk/). Information regarding the online core curriculum lecture series was distributed to members of the International Skeletal Society, Society of Skeletal Radiology, Society of Chairs of Academic Radiology Departments, and the Association of Program Directors in Radiology. Web page and online lecture utilization data were collected using Google Analytics (Alphabet, Mountain View, CA, USA). RESULTS Forty-two lectures, by 38 speakers, were recorded, edited and hosted online. Lectures spanned ACGME curriculum categories of musculoskeletal trauma, arthritis, metabolic diseases, marrow, infection, tumors, imaging of internal derangement of joints, congenital disorders, and orthopedic imaging. Online access to the core curriculum lectures was opened on March 4, 2018. As of January 20, 2019, the core curriculum lectures have had 77,573 page views from 34,977 sessions. CONCLUSIONS To date, the MSK core curriculum lecture series lectures have been widely accessed and viewed. It is envisioned that the initial success of the project will serve to promote ongoing content renewal and expansion to the lecture materials over time.

    更新日期:2019-11-01
  • Whole-body MRI in assessing malignant transformation in multiple hereditary exostoses and enchondromatosis: audit results and literature review.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-06
    Anne Grethe Jurik,Peter Holmberg Jørgensen,Mikkel Meng Mortensen

    OBJECTIVE To analyze the results of annual screening using whole-body magnetic resonance imaging (WBMRI) in patients with multiple hereditary exostoses (MHE) and enchondromatosis (EC), and estimate the risk for transformation to chondrosarcoma (CS) in these disorders. MATERIALS AND METHODS A total of 62 patients (57 with MHE and five with EC) screened during a mean follow-up period of 4.6 years (range, 1-10 years) using 253 WBMRIs (median four WBMRIs per patient, range, 1-10) were analyzed retrospectively. The time of WBMRIs was compared with dates for diagnosed CSs. A supplementary literature review was performed focusing on the risk of malignant transformation. RESULTS Ten patients had CS before being enrolled in the screening program, nine with MHE and one with EC. Three asymptomatic CSs were detected by screening; one in a patient with EC and two in patients with MHE, one of whom had CS previously. During the screening period, there was no occurrence of CS not detected by WBMRI in the study group. Histopathologically, the CSs were predominantly grade 1 and were, except for in two patients, located at the truncus, proximal femur, and shoulder girdle. Based on the current material and literature review, the risk of CS seems to be in the range of 2-3.7% for MHE and up to 50% for EC patients. CONCLUSIONS MRI may be used as a screening method detecting malignant transformation in MHE and EC patients, but the efficacy has to be confirmed in long-term follow-up studies including cost analysis.

    更新日期:2019-11-01
  • T2 distribution profiles are a good way to show cartilage regional variabilities and cartilage insufficiency.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-05
    Ž Snoj,J Vidmar,M Gergar,D Plut,V Salapura

    OBJECTIVE To use T2 relaxation time distribution profiles to assess inter-group regional differences along articular surfaces and to evaluate the feasibility of this analysis for comparison of cartilage insufficiency. MATERIALS AND METHODS Twelve pairs matched according to age and gender (12 healthy volunteers and 12 patients after anterior cruciate ligament reconstruction (ACLR)) underwent 3-T MRI. T2 maps were calculated from six time echo images of the mid-sagittal slice in the lateral and medial compartment. The femoral and tibial cartilage was analyzed by measuring T2 distribution profiles along the articular surfaces. RESULTS T2 distribution profiles were generated along the length of the articular surface in the femorotibial compartments. Differences in the T2 distribution profiles between the tibial and femoral cartilage as well as between the cartilage of the femoral condyles were identified in healthy individuals. T2 distribution profiles clearly demonstrated cartilage insufficiency in the weight-bearing areas for subjects in the ACLR group. CONCLUSIONS T2 distribution profiles can identify regional differences in femoral and tibial cartilage. The T2 distribution profile pattern is preserved with cartilage insufficiency, however, with important differences in T2 values for the ACLR group in weight-bearing areas.

    更新日期:2019-11-01
  • Extraneural perineurioma: CT and MRI imaging characteristics.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-07-04
    Stephen M Broski,Laurel A Littrell,Benjamin M Howe,Andrew L Folpe,Doris E Wenger

    OBJECTIVE To examine the CT and MRI characteristics of extraneural perineuriomas. MATERIALS AND METHODS With IRB approval, our institutional imaging database was retrospectively reviewed for cases of pathologically proven extraneural perineuriomas. CT and MRI features were recorded, correlative imaging analyzed, and the electronic medical record cross-referenced. RESULTS We identified ten patients [(seven males, three females, mean age 49.4 ± 18.3 years (range, 16-70 years)]. All cases were pathologically confirmed. Nine cases were conventional soft tissue extraneural perineuriomas, including one with "reticular" features and one with histologic features of malignancy; the tenth case contained admixed Schwann cells (hybrid perineurioma/schwannoma). Six out of ten patients underwent CT and ten of ten MRI evaluation. Nine out of ten MRIs were performed with IV contrast. Five lesions were subcutaneous, four intermuscular, and one intramuscular. Mean lesion diameter was 4.3 ± 2.7 cm (range, 0.9-10.2 cm). Nine out of ten lesions were well circumscribed; one had irregular margins. On CT, five of six were hypodense and one isodense compared to skeletal muscle. Most lesions were T1 isointense (5/10) or hypointense (4/10) and T2 hyperintense (7/10) relative to skeletal muscle, and demonstrated solid enhancement (6/9). There was no evidence of muscular denervation on any MRI exam, and a nerve of origin was identified in two out of ten cases. CONCLUSIONS Extraneural perineuriomas have a distinctly different imaging appearance from intraneural perineuriomas, manifesting as rounded or ovoid soft tissue masses, without evidence of muscular denervation, and usually without an apparent nerve of origin. Because these features mimic other benign and malignant soft tissue lesions, including sarcomas, biopsy or excision is needed for definitive diagnosis.

    更新日期:2019-11-01
  • Regional muscle changes in adult dysfunctional hip conditions of femoroacetabular impingement and hip dysplasia.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-06-30
    Majid Chalian,Natalie Schauwecker,Anthony Cai,Riham Dessouky,Nicholas Fey,Yin Xi,Avneesh Chhabra,Joel Wells

    OBJECTIVE To analyze regional muscle CT density and bulk in femoroacetabular impingement (FAI) and hip dysplasia (HD) versus controls. MATERIALS AND METHODS Patients who obtained perioperative CT imaging for FAI and HD before surgery were retrospectively studied. Asymptomatic controls included for comparison. Two readers independently evaluated regional hip muscle [iliopsoas (IP), rectus femoris (RF), gluteus minimus (Gm), and medius (GM)] density, muscle area, and muscle circumference. Inter-observer reliability calculated using intra-class correlation coefficient (ICC). RESULTS A consecutive series of 25 FAI patients, 16 HD patients, and 38 controls were recruited in the study. FAI patients had significantly greater Gm and GM circumferences as well as greater RF and IP areas on the normal side compared to the asymptomatic control group (p values 0.004, 0.032, 0.033, and 0.028, respectively). In addition, Gm and RF circumferences and RF area were significantly larger (p values 0.029, 0.036, and 0.014, respectively) in FAI patients on the affected side compared to the control group. HD patients had significantly smaller Gm and GM circumferences on the affected side than normal side measurements in FAI group (p values 0.043 and 0.003, respectively). Normal side GM circumference was also smaller in HD patients than normal side FAI hips (p value 0.02). There was no significant difference between the measurements on normal and abnormal sides in each disease group. No significant difference was found between measurements of HD compared to controls (p > 0.05). No muscle density differences were seen among different groups. There was moderate to excellent inter-reader reliability for all measurements except Gm muscle density. CONCLUSIONS Muscle analysis was able to quantify differences among patients with FAI, HD, and asymptomatic controls. These changes could indicate either a muscle imbalance contributing to the pathology or disuse atrophy, which may have implications for specific muscle-strengthening therapies and rehabilitation procedures in such patients.

    更新日期:2019-11-01
  • The lipid-poor hemangioma: an investigation into the behavior of the "atypical" hemangioma.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-06-30
    J M Hoyle,L J Layfield,J Crim

    OBJECTIVE Most vertebral hemangiomas contain high signal intensity on T1-weighted MRI images. Atypical vertebral hemangiomas, which are defined as showing low-signal intensity on T1-weighted images, have been described as lesions which are prone to aggressive behavior. This study was performed to assess behavior of atypical hemangiomas. MATERIALS AND METHODS Thoracic and lumbar spine MRI reports for the year 2012 were reviewed for diagnosis of atypical hemangioma. Images were reviewed by two independent observers, and cases which showed atypical vertebral hemangioma, and had imaging or clinical follow-up, were included in our study. RESULTS Thirty atypical hemangiomas which had follow-up data were identified out of 2784 thoracic and lumbar MR examinations performed during 2012 at a single institution. Imaging follow-up was available for 23 lesions (mean follow-up 32 months), while there was clinical follow-up for the remaining seven lesions (mean 43.6 months). Twenty-two lesions were stable on imaging, while one demonstrated significant growth over approximately 6 years, developing MRI signal characteristics of a typical hemangioma. Eleven lesions had CT scans showing typical features of hemangioma. Two of the index lesions could not be identified on follow-up CT examinations, which showed normal-appearing spines. The remaining seven lesions were followed clinically; none of the patients reported symptoms in the region of the index lesions. CONCLUSIONS Atypical hemangiomas are uncommon lesions. The cases in our population did not show aggressive behavior. A more appropriate designation for these lesions may be lipid-poor hemangioma, to distinguish them from aggressive hemangiomas.

    更新日期:2019-11-01
  • Rachitic change and vitamin D status in young children with fractures.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-06-28
    Sabah Servaes,Lisa States,Joanne Wood,Samantha Schilling,Cindy W Christian

    OBJECTIVE To examine the association between rachitic changes and vitamin D levels in children less than 2 years old with fractures. METHODS Children less than 2 years old who were admitted to a large children's hospital for a fracture and underwent a skeletal survey were included. Two pediatric radiologists blinded to the children's vitamin D levels independently reviewed the skeletal surveys for the following rachitic findings: demineralization, widened sutures, rachitic rosary, Looser zones, and metaphyseal changes. Kappa coefficients were calculated to assess inter-rater agreement. Logistic regression was used to test the association between vitamin D level and rachitic findings. RESULTS There were 79 subjects (40 female and 39 male) with a median age of 4 months. Vitamin D levels ranged from 11.6 to 88.9 ng/ml and were low in 27. Questionable demineralization was noted in seven subjects; mild to moderate demineralization was observed in four subjects. Widened sutures were noted in seven subjects, many also with concurrent intracranial hemorrhage. Lower vitamin D levels were associated with increased odds of demineralization after adjusting for age, gender, and prematurity (P < 0.015). An association was not found between the vitamin D level and suture widening (P = 0.07). None of the cases demonstrated Looser zones, rachitic rosary, or metaphyseal changes of rickets. CONCLUSIONS Infants and toddlers with fractures frequently have suboptimal vitamin D levels, but radiographic evidence of rickets is uncommon in these children.

    更新日期:2019-11-01
  • A novel morphological classification for the femoral notch based on MRI: a simple and effective assessment method for the femoral notch.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-06-27
    Chengyuan Zhang,Guoming Xie,Shikui Dong,Chang'an Chen,Xiaochun Peng,Feng Yuan,Jinzhong Zhao

    OBJECTIVE To propose a novel morphological classification method for notches, which may provide new evidence for notchplasty based on the three-dimensional (3D) features of notches and the risk of anterior cruciate ligament (ACL) injury. MATERIALS AND METHODS Three hundred individuals in total were included in our study, including 150 patients with ACL ruptures (75 males and 75 females) and 150 age- and gender-matched individuals without ACL ruptures. The notches were divided into four types according to the notch widths at the notch inlet, outlet, and ACL attachment based on the preoperative MRI, the notch volume was calculated, and the risk of ACL injury was compared. The surgical records were reviewed and whether these cases performed notchplasty were collected. RESULTS The inlet-and-outlet stenosis notch type was associated with smaller notch volume (P = 0.007) and a higher risk of ACL injury (P < 0.001). There were no significant differences in morphological distribution between males and females. The rate of notchplasty in inlet-and-outlet stenosis type was higher than the others. CONCLUSIONS The new morphological classification method efficiently reflected the association of the notch shape with the 3D notch volume and the risk of ACL injury. The knees with the inlet-and-outlet stenosis notch type and smaller notch volume tended to have a higher risk of ACL injury. Level of evidence Level III, case-control study.

    更新日期:2019-11-01
  • Chondroid lipoma: multimodality imaging in a 9-year-old female.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-06-24
    Melissa Tannenbaum,Philip G Colucci,Michael Baad,Alain C Borczuk,Shaun A Steigman,Arzu Kovanlikaya

    Chondroid lipomas are rare, benign lipomatous tumors that occur most frequently in adults during the fourth decade of life. While a female predominance was observed in the initial series of 20 cases described in 1993, the subsequent 49 reported cases do not support a strong gender predilection. We report a case of a chondroid lipoma presenting in a 9-year-old female as a painless, enlarging, left gluteal mass. This is the second case to be reported in the first decade of life and the fourth pediatric case reported in the literature (age < 21). We review the imaging and pathology findings as well as present a comprehensive review of the current literature.

    更新日期:2019-11-01
  • Magnetic resonance evaluation of the pediatric knee after arthroscopic fixation of osteochondral lesions with biodegradable nails.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-06-20
    Jie C Nguyen,Daniel W Green,Bin F Lin,Yoshimi Endo

    PURPOSE To use magnetic resonance imaging (MRI) to investigate the knee joint of children following arthroscopic fixation of osteochondral lesions using bioabsorbable nails and to correlate these imaging findings with time from arthroscopic treatment and with risk factors at the time of imaging. MATERIALS AND METHODS Our study included postarthroscopic MRI studies from 58 children (mean age at arthroscopy, 13.8 + 2.1 years) who have undergone bioabsorbable nail fixation of unstable osteochondral lesions between February 1, 2011 and September 30, 2017. All studies were retrospectively reviewed for broken nails, intra-articular debris, and internal knee derangement. Demographic information and information pertaining to active symptoms was obtained from both MRI questionnaire that was completed at the time of the study and clinical note that preceded the study. Marginal logistic regression models estimated using generalized estimating equations (GEE) were used to identify factors associated with a broken nail and joint effusion. RESULTS A total of 104 postoperative studies were reviewed, which included 60 with symptoms and 44 without symptoms. Nail breakage was present in 38 (36.6%) studies and associated with presence of symptoms (OR 2.43, p = 0.036) and effusion (OR 2.76, p = 0.025). An effusion was present in 40 (38.5%) studies which decreased with increasing time from treatment (OR 0.89, p = 0.007) and increased with symptoms (OR 10.87, p < 0.001). Meniscal tear was present on 8 (7.7%) and chondral irregularity on 14 (13.5%) studies. CONCLUSION Broken nail, effusion, and less commonly, meniscal tears and chondral irregularity, are all complications that can arise following fixation of osteochondral lesions with bioabsorbable nails. MRI can serve as a valuable tool in assessing these complications.

    更新日期:2019-11-01
  • The value of radiographic markers in the diagnostic work-up of rotator cuff tears, an arthroscopic correlated study.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-06-16
    Jeroen J van der Reijden,Syert L Nienhuis,Matthijs P Somford,Michel P J van den Bekerom,Job N Doornberg,Esther van 't Riet,Maaike P J van den Borne

    OBJECTIVE To evaluate the value of radiographs during the diagnostic work-up of rotator cuff tears, using arthroscopy as reference standard. MATERIALS AND METHODS This retrospective study included 236 shoulders of 236 patients. All radiographs were evaluated for inferior cortical acromial sclerosis, lateral acromial spur, superior migration of the humeral head, greater tubercle cysts, and subacromial space calcifications. Predictive value of these radiographic signs in predicting rotator cuff tears was determined with arthroscopy as reference standard. RESULTS According to arthroscopy, 131 shoulders were diagnosed with rotator cuff tears. Seventy-two out of 131 shoulders (55%) had inferior cortical acromial sclerosis, 37 (28%) lateral acromial spur, 21 (16%) superior migration of the humeral head, 7 (5%) greater tubercle cysts and 15 subacromial space calcifications (11%). Inferior cortical acromial sclerosis (P = 0.001), lateral spur (P = 0.001), superior migration (P = 0.002), and cysts (P = 0.03) were significantly and independently associated with rotator cuff tears, whereas subacromial calcifications (p = 0.21) was not. Inferior cortical acromial sclerosis, superior migration, lateral acromial spur, and cysts combined have a positive predictive value of 78%. CONCLUSIONS The combination of inferior cortical acromial sclerosis, lateral acromial spur, superior migration of the humeral head, and greater tubercle cysts has a high positive predictive value for the presence of full-thickness rotator cuff tears. In patients with a high suspicion for having a rotator cuff tear based on radiographic findings, MRI can be performed directly without the delay and costs caused by an additional ultrasound exam.

    更新日期:2019-11-01
  • IgG4-related disease: rare presentation as a soft-tissue mass in the thigh of an adolescent.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-06-06
    Maud Creze,Sofia Boussebaa,Thierry Lazure,Sylvain Briand,Charles Court

    We report a case of a 16-year-old boy who presented a soft-tissue mass in the anterior compartment of the right thigh discovered by positron emission tomography/computed tomography within the work-up of unexplained prolonged inflammatory syndrome. The mass has no calcification. Subsequently, magnetic resonance imaging of the femoral triangle was carried out. Axial short tau inversion recovery images showed a 3.5-cm ill-defined mass in the femoral triangle with focal areas of hypointensity, which suggests that there might be fibrosis or hemosiderin within the tumor. Axial T1-weighted images showed a slight hyperintense mass involving the iliopsoas muscle. Contrast-enhanced fat-suppressed T1-weighted imaging showed a heterogeneous solid enhancement. Adjacent thick fascia enhancement of the vastus intermedius and the vastus lateralis muscles extending from the mass as a tail-like margin suggested the infiltrative spread of the tumor along the fascial plane. The mass and the lymphadenopathy were excised. Immunohistochemically, tumor cells were staining for muscle actin and desmin. Many plasma cells were IgG4+ (175per high-power field) with a ratio IgG4+/IgG+ of 50%. The diagnosis of IgG4-related disease (IgG4-RD) was made. Although a diffuse array of musculoskeletal symptoms has been observed in IgG4-related disease, reports of biopsy-proven musculoskeletal involvement of the limb are rare. We showed the radiological features of IgG4-RD presenting as a soft-tissue mass of the thigh. Musculoskeletal involvement, clinical significance, and treatment of IgG4-RD are also discussed.

    更新日期:2019-11-01
  • Acetabular avascular necrosis following high-dose steroid treatment and chemotherapy for leukemia : Computer tomography analysis of treatment with impaction bone grafting.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-05-30
    Daud Tai Shan Chou,Mark Taylor,Markus Baker,Patrick Studer,Lucian Bogdan Solomon

    Avascular necrosis (AVN) of the bone is thought to be a serious complication of treatment for acute lymphoblastic leukemia (ALL). The acetabulum is an unusual area to be affected by AVN, and there are currently no reports of successful joint salvage procedures found in the literature. We present a case of a 20-year-old man with ALL who was diagnosed with debilitating AVN of both acetabula 2 years following initial diagnosis of ALL and treatment with a multi-agent chemotherapy regimen including high-dose corticosteroids. After unsuccessful treatment with bisphosphonate therapy, the acetabular AVN underwent bilateral curettage and impaction bone grafting to prevent collapse of subchondral fractures with the hope of salvaging both hip joints. Computer tomography (CT) of the AVN affected areas, pre- and post-bone impaction grafting, demonstrated healing of the subchondral fractures and a doubling of bone density that was maintained at 2 years after surgery. The patient resumed full weight-bearing at 3 months after first surgery, continues to ambulate unrestricted, and remains pain free 3 years post-surgery.

    更新日期:2019-11-01
  • Correlation between the accessory anterolateral talar facet, bone marrow edema, and tarsal coalitions.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Josephina A Vossen,Mashya Abbassi,Yanjun Qian,Curtis W Hayes,Peter J Haar,Kevin B Hoover

    OBJECTIVE The purposes of this study was to determine the prevalence of the accessory anterolateral talar facet (AALTF); to evaluate the relationship between AALTF, focal abutting bone marrow edema (FABME), and sinus tarsi edema; and to study the prevalence of tarsal coalitions in patients with the AALTF utilizing ankle MR images. MATERIALS AND METHODS 5-T ankle MR images were reviewed for the presence of AALTF, FABME, sinus tarsi edema, tarsal coalition, and location and type of coalition (cartilaginous, fibrous, and osseous). Multivariate analysis was performed to examine the correlation between AALTF and the other variables. RESULTS Three hundred ninety-one consecutive patients were included (age range 5-86 years; mean age 45 years). An AALTF was present in 3.6% (14/391) of patients. The AALTF prevalence was 2% in women and 6.6% in men. There was a significantly association between AALTF and FABME (9/14, p < 0.05), sinus tarsi edema (13/14, p < 0.05), and tarsal coalition (4/14, p < 0.05). CONCLUSION AALTF is relatively often detected on MRI of the ankle and significantly associated with BME, sinus tarsi edema, and subtalar coalition. Patients with a tarsal coalition should be evaluated for the concurrent presence of an AALTF.

    更新日期:2019-11-01
  • Bipartite medial cuneiform: magnetic resonance imaging findings and prevalence of this rare anatomical variant.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Aline Serfaty,Aline Pessoa,Erika Antunes,Erick Malheiro,Clarissa Canella,Edson Marchiori

    OBJECTIVE To describe the imaging features of bipartite medial cuneiform and to determine the prevalence of this rare anatomical variant in a large group of patients that were evaluated by magnetic resonance imaging (MRI) of the foot. MATERIALS AND METHOD Seven hundred and fifty-one patients that underwent MRI of the foot from May 2016 to December 2018 were included in the study (mean age 49 years; 540 females; 211 males). All MRIs were retrospectively analyzed to identify bipartite medial cuneiform. For patients with bipartite medial cuneiform, we analyzed partial and complete bipartition, the type of articulation (synchondrosis, syndesmosis, or a combination of these two), and stress changes related to abnormal motion (i.e., subchondral cysts and sclerosis). Bone marrow edema-like signal, diastasis in the cleavage plane, concomitant fractures, and the presence of the E-sign were also evaluated. RESULTS Nine feet from six patients presented bipartite medial cuneiform on the MRI. Six and three feet exhibited complete and partial bipartition. All patients were referred for MRI because of midfoot pain, of which two had history of trauma prior to imaging. Stress changes related to abnormal motion were observed in three feet (34%), all with complete bipartition. Bone marrow edema-like signal was recorded in five feet (55%) and diastasis in one foot (11%). No fractures were present in the bipartite medial cuneiform. All patients had E-signs. CONCLUSION Bipartite medial cuneiform is a rare anatomical variant occurring in 0.79% of patients who underwent foot MRI in this study. It is important to be aware of this variant as it is a cause of midfoot pain. Being familiar with the E-sign helps identify and differentiate it from a fracture.

    更新日期:2019-11-01
  • Test yourself: cutaneous mass on the thigh.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Lucas Savaris Linhares,André Vaz,Cesar Rodrigo Trippia,Camila Pietroski Reifegerste

    更新日期:2019-11-01
  • A comparison of saline and gadolinium shoulder MR arthrography to arthroscopy.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Adam D Singer,Jeffrey Rosenthal,Monica Umpierrez,Yi Guo,Felix Gonzalez,Eric Wagner

    PURPOSE Compare the diagnostic performance of saline and gadolinium shoulder magnetic resonance arthrograms (MRA) in the detection of labral and rotator cuff injury compared to arthroscopy. MATERIALS AND METHODS Consecutive patients who underwent a gadolinium or saline MRA followed by arthroscopy were retrospectively reviewed. The reports were reviewed for injuries. A chi square or Fisher's exact test was performed to compare the MRA and surgery. Kappa values were calculated to correlate diagnosis of tear between MRA and arthroscopy. RESULTS There were a total of 58 patients included, including 34 gadolinium arthrograms and 24 saline arthrograms. The accuracy of saline MRA was similar compared to gadolinium MRA in the diagnosis of tears of the supraspinatus (accuracy 0.88 vs 0.74, respectively) and infraspinatus (accuracy 0.88 vs 0.65, respectively) tendons and tears of the anterior/anterior inferior, posterior, and superior labrum, (accuracy 0.79 vs 0.76, 0.71 vs 0.62, and 0.58 vs 0.56), and saline vs gadolinium, respectively. Although there was a trend toward overall better saline MRA performance, a statistically significant difference in the accuracy to detect tears was only noted for the infraspinatus tendon. Interobserver agreement for rotator cuff tears was higher for saline than gadolinium MRA. CONCLUSION Saline MRA was accurate, with no significant differences compared gadolinium arthrograms in the diagnosis of labral and rotator cuff pathology. Given expense, and the potential additional information provided by fluid sensitive sequences over T1 fat-suppressed sequences, consideration should be given to using saline for shoulder MRAs. LEVEL OF EVIDENCE Level III, Retrospective Cohort Study.

    更新日期:2019-11-01
  • Bone oxaloma-a localized manifestation of bone oxalosis.
    Skelet. Radiol. (IF 1.518) Pub Date : null
    Eun Ji Choi,Choong Guen Chee,Wanlim Kim,Joon Seon Song,Hye Won Chung

    Oxalosis is a metabolic disorder characterized by the accumulation of calcium oxalate deposits in various organ systems. Bone oxalosis is a systemic manifestation of oxalosis, in which calcium oxalate deposits accumulate in the skeletal system. This report describes a 69-year-old female patient who presented with right hip pain and was later found to have an osseous mass-like lesion in the right proximal femur, with radiographic findings resembling those of a benign bone tumor. CT-guided biopsy and surgical biopsy showed that the mass had pathologic findings typical of bone oxalosis. Because the patient had no predisposing factors for systemic oxalosis and had no hyperoxalemia or hyperoxaluria, she could be diagnosed with localized bone oxalate deposition disease or bone oxaloma rather than bone oxalosis. This is the first report of this clinical entity to present as a benign-appearing bone mass and without any predisposing systemic causes.

    更新日期:2019-11-01
  • Intraligamentous synovial chondromatosis of the anterior cruciate ligament.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-11-25
    Aria Ashir,Wei-Xian Li,Hoda Shirazian,Douglas G Chang,Eric Y Chang

    Synovial chondromatosis is a rare disease that causes disability and dysfunction of the involved synovial joint. We describe the second case in the literature of intraligamentous synovial chondromatosis involving the anterior cruciate ligament, confirmed by pathology after arthroscopic removal of the chondral bodies. We also describe associated magnetic resonance imaging findings which may be helpful for diagnosis of this very rare entity.

    更新日期:2019-11-01
  • The exploration of feature extraction and machine learning for predicting bone density from simple spine X-ray images in a Korean population.
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-11-25
    Sangwoo Lee,Eun Kyung Choe,Hae Yeon Kang,Ji Won Yoon,Hua Sun Kim

    OBJECTIVE Osteoporosis is hard to detect before it manifests symptoms and complications. In this study, we evaluated machine learning models for identifying individuals with abnormal bone mineral density (BMD) through an analysis of spine X-ray features extracted by deep learning to alert high-risk osteoporosis populations. MATERIALS AND METHODS We retrospectively used data obtained from health check-ups including spine X-ray and dual-energy X-ray absorptiometry (DXA). Consecutively, we selected people with normal and abnormal bone mineral density. From the regions of interest of X-ray images, deep convolutional networks were used to generate image features. We designed prediction models for abnormal BMD using the image features trained by machine learning classification algorithms. The performances of each model were evaluated. RESULTS From 334 participants, 170 images of abnormal (T scores < - 1.0 standard deviations (SD)) and 164 of normal BMD (T scores > = - 1.0 SD) were used for analysis. We found that a combination of feature extraction by VGGnet and classification by random forest based on the maximum balanced classification rate (BCR) yielded the best performance in terms of the area under the curve (AUC) (0.74), accuracy (0.71), sensitivity (0.81), specificity (0.60), BCR (0.70), and F1-score (0.73). CONCLUSION In this study, we explored various machine learning algorithms for the prediction of BMD using simple spine X-ray image features extracted by three deep learning algorithms. We identified the combination for the best performance in predicting high-risk populations with abnormal BMD.

    更新日期:2019-11-01
  • CT-guided discitis-osteomyelitis biopsies with negative microbiology: how many days should we wait before repeating the biopsy?
    Skelet. Radiol. (IF 1.518) Pub Date : 2019-11-25
    Kaitlyn J Yeh,Jad S Husseini,Robert Hemke,Sandra B Nelson,Connie Y Chang

    PURPOSE To determine the number of days to positive CT-guided biopsy sample culture in patients with discitis-osteomyelitis. METHODS Our study was IRB approved and HIPAA compliant. All CT-guided biopsies performed for acute discitis-osteomyelitis with positive microbiology between 2002 and 2018 were reviewed. Microbiological organism and days to positive biopsy were documented. Mean, median, skew, and standard deviation were calculated. The proportion of positive cultures that become positive after each day has elapsed was also calculated. RESULTS There were 96 true positive cultures, with 64 (67%) male and 32 (33%) female, ages 57 ± 18 (range 19-87) years. Overall, including all culture results, the mean number of days to positive culture was 2.9 ± 3.5 days. The median number of days was 2, with a positive skew of 2.9. At days 1, 2, 3, 4, and 5, 48%, 68%, 78%, 85%, and 89%, respectively, of biopsy samples had a positive microbiology culture. CONCLUSION Approximately three-quarters of discitis-osteomyelitis pathogens will be identified by biopsy sample culture by 3 days after CT-guided biopsy. This finding should be considered if planning for a repeat biopsy in the setting of a negative microbiology culture.

    更新日期:2019-11-01
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