Skeletal Radiology最新文献

Objectives: Metacarpal fractures are common injuries that are frequently managed with repeated radiological follow-up, although the clinical value of routine imaging is uncertain. The aim of this study was to evaluate the frequency and clinical impact of follow-up imaging in patients with metacarpal fractures treated operatively or non-operatively, and to quantify the associated financial and environmental impact.

Materials and methods: This retrospective study evaluated adult patients with metacarpal fractures treated non-operatively or operatively at a Dutch level 2 trauma center between 2017 and 2022. Radiology reports and medical records were reviewed to assess whether follow-up imaging led to treatment modification. Additionally, the corresponding financial and environmental impact was calculated.

Results: A total of 2342 patients were included (median age 32 years; 28% female). Among initially non-operatively treated patients (n = 1978), 1.1% (n = 22) required conversion to surgery. The overall cost associated with this 1% conversion amounted to €230,000, with an estimated environmental impact of 2711 kg CO₂-eq. Among operatively treated patients (n = 386), postoperative imaging rarely prompted re-operation (0.3%, n = 1). The total costs associated with 0.3% re-operation were €171,000 and an associated environmental impact of 1801 kg CO₂-eq. Together, the impact equals almost one trip around the world by car.

Conclusions: Routine radiological follow-up after the initial decision for operative or non-operative treatment in metacarpal fractures provided minimal clinical benefit. A symptom-driven approach may optimize care while reducing unnecessary financial and environmental burden.

Level of evidence: Level IV.

Multicentric carpotarsal osteolysis (MCTO) is a very rare skeletal disorder marked by progressive bone resorption, predominantly affecting carpal and tarsal bones. It results from a MAFB gene mutation, leading to increased osteoclastic activity and bone loss. The condition may also involve renal impairment and subtle craniofacial anomalies. Due to overlapping features, MCTO is often misdiagnosed as juvenile idiopathic arthritis (JIA). We report the case of a 10-year-old patient, who initially avoided using the hands while crawling. By age three, the patient developed a limping gait and joint pain. Imaging showed carpal and tarsal bone resorption suggestive of MCTO, later confirmed by a disease-causing MAFB variant. Treatment with methotrexate, naproxen, and intra-articular triamcinolone improved symptoms and resolved inflammation-related anemia and thrombocytosis, but radiographic progression persisted despite clinical improvement. This case highlights the challenge of distinguishing MCTO from JIA and underscores the importance of integrating clinical, lab, and imaging data for accurate diagnosis. Immunosuppressive therapy may be associated with symptomatic relief, although not halting disease progression. Further research is needed to identify more effective treatment.

Gossypiboma, although rare, is a serious surgical complication with potential medicolegal implications. We report a case of a 70-year-old female presenting with a progressively enlarging painless mass in the left iliac region, initially suspected to be a pelvic sarcoma. The patient had a history of femoral intramedullary nailing performed 16 years ago for a femoral shaft fracture, followed 2 years later by exchange nailing and iliac bone grafting due to non-union. Ultrasonography revealed a lobulated, avascular mass with acoustic shadowing. Computed tomography (CT) demonstrated a hypodense lesion causing erosion of the left anterior superior iliac spine (ASIS), while magnetic resonance imaging (MRI) revealed a well-defined mass with a whorled pattern. Histopathology confirmed the diagnosis of gossypiboma with foreign body material. Uniquely, to our knowledge, this is the first reported case of gossypiboma located at the ASIS mimicking neoplastic bone erosion, presenting radiologically as a pelvic bone defect. This distinctive imaging appearance carries important diagnostic implications, particularly for musculoskeletal radiologists, and broadens the known spectrum of gossypiboma-related complications following orthopedic surgery.

Objective: Compare the ultrasound findings in primary adhesive capsulitis and a control group to determine the sonographic diagnostic performance.

Materials and methods: This retrospective single-center study compared US findings in patients with a clinical and MRI diagnosis of adhesive capsulitis and a control group of consecutive patients. The US findings were as follows: coracohumeral ligament thickening, increased tissue and vascularity of the rotator interval, axillary recess thickening and hypervascularity, and subacromial gliding. Ultrasound findings were evaluated by Student's t-test and Fisher's exact test (p < 0.05).

Results: The mean (± SD) thickness of the coracohumeral ligament (2.3 ± 0.6 vs 1.6 ± 0.3; p < 0.001) was significantly greater in the adhesive capsulitis group (n = 61) than in the control group (n = 69). A cut-off value of 1.6 mm (AUC 0.963, 95% CI 0.934-0.992), yielded 90.2% sensitivity and 90.9% specificity. In the rotator interval, the presence of tissue (72.1% vs 11.6%; p < 0.001) and hypervascularity (8.2% vs 0%, p < 0.02) were significantly higher in the adhesive capsulitis group. In the axillary recess, the mean thickness in the axial (4.7 ± 1.3 vs 1.4 ± 0.4; p < 0.001) and longitudinal plane (4.4 ± 1.2 vs 1.4 ± 0.5; p < 0.001) was significantly higher in the adhesive capsulitis group. A cut-off value of 3 mm (AUC 1) obtained 100% sensitivity and specificity. Increased Doppler flow in the axillary recess (9.8% vs 0%, p < 0.009) and limited subacromial gliding (93.4% vs 2.9%; p < 0.001) were also associated with adhesive capsulitis.

Conclusion: Several ultrasound findings are typical in primary adhesive capsulitis. Therefore, ultrasound can be considered the first diagnostic tool.

Objective: Sacral chordoma is a rare bone tumor frequently treated with pre-surgical radiation; however, treatment response is difficult to determine based on imaging features of conventional MRI. We hypothesized that MRI texture analysis may be capable of demonstrating the effects of radiation therapy.

Materials and methods: We retrospectively examined pre- and post-radiation therapy MRI of patients with sacral chordomas. Firstly, the regions of interest delimiting the largest cross-sectional area of the tumors on coronal T1-weighted images were compared between pre- and post-radiation therapy MRI. Texture analysis features were extracted, analyzed, and classified. Secondly, all the coronal T1-weighted images were compared using large language models (LLM) to extract texture features.

Results: A total of 22 patients received pre-surgical radiation therapy (RT) and obtained pre- and post-radiation therapy MRI. A linear discriminant analysis model of the top 10 texture analysis features classified correctly 79.5% of chordomas pre- vs. post-treatment. The top 4 textural features had 81.8% sensitivity and 77.2% specificity in differentiating pre- vs. post-radiation chordomas, with a receiver operator area under the curve (AUC) of 84.5% (P = 0.003). Three texture features were related to pixel relationships and one to variations in pixel gray level (wavelet). The second approach using all the coronal-T1 images analyzing gray-level co-occurrence matrix (GLCM) features revealed a significant increase in correlation after RT (mean pre, 0.92; mean post, 0.95; P = 0.016).

Conclusion: Texture analysis is a quantitative tool capable of differentiating pre- and post-radiotherapy chordomas and may provide biomarkers of treatment response.

Fatigue fractures occur due to repetitive submaximal mechanical stress on bone and are most common in the lower extremities of endurance athletes and military recruits. This report details a rare case of bilateral anterior acetabular-superior pubic ramus junction fatigue fractures in a marathon runner presenting with low back and hip pain. MR imaging of the pelvis was initially interpreted as normal. Further review by a sports medicine physician and a musculoskeletal radiologist prompted an addendum identifying bilateral mild marrow edema of the anterior acetabula with incomplete fracture line on the left and near complete fracture line on the right. Multiple factors may have contributed to the initial missed diagnosis, including the rarity of the stress fracture location and symmetry, the subtlety of the imaging findings, and the atypical clinical presentation often associated with pelvic stress fracture development. Additionally, the patient's infection with SARS-CoV-2 prior to fatigue fracture formation may have played a pathologic role due to muscular deconditioning as well as disrupted bone metabolism. The subacute fracture pattern described in this report should be recognized by radiologists on MR imaging to avoid the potentially debilitating consequences of progression and exacerbation of fatigue fractures in endurance athletes.

Objective: To evaluate the impact of combining a second-generation super-resolution deep learning-based reconstruction (DLR2) with a metal artifact reduction (MAR) algorithm in CT images of patients with metal hip implants by assessing both quantitative metrics and qualitative reader ratings.

Materials and methods: This retrospective study included 40 patients (30 females; age range, 54-93 years) with metal hip implants. Images were reconstructed using DLR2, a first-generation DLR (DLR1), and a conventional hybrid iterative reconstruction (HIR), each combined with MAR. Images without MAR were also reconstructed using DLR2 (DLR2-only). Standard deviations (SDs) of attenuation in the regions of interest (ROI) over the bladder, gluteus maximus muscle, and gluteal fat were recorded. Artifact indices for muscle (AI_muscle) and fat (AI_fat) were also calculated. Three radiologists independently assessed the depiction of pelvic structures (femoral artery, bladder, rectum, uterus/prostate), artifact reduction, and diagnostic usability with 5-point scores. For statistical analysis, the Wilcoxon signed-rank test was used with the Holm correction for multiple comparisons.

Results: DLR2 + MAR showed significantly lower SDs than DLR1 + MAR, HIR + MAR, and DLR2-only across all three ROIs (p < 0.01-0.02). For both AI_muscle and AI_fat, DLR2 + MAR had the lowest values, though differences with DLR1 + MAR were not significant (p = 0.80, 0.11). DLR2 + MAR showed significantly higher scores for the depiction of the femoral artery and rectum compared with other + MAR reconstruction methods (p < 0.01-0.04), with no significant differences in the remaining categories (p = 0.08-0.91). Inter-rater agreement ranged from 0.67 to 0.77, indicating substantial agreement.

Conclusion: Combining DLR2 and MAR improves image quality and visualization of pelvic structures.