Pub Date : 2024-11-01Epub Date: 2024-04-01DOI: 10.1007/s00256-024-04670-y
M Alejandra Bedoya, Diego Jaramillo, Jade Iwasaka-Neder, Tal Laor
Objective: To identify MRI findings that can indicate chronic physeal stress injury and differentiate it from acute Salter-Harris (SH) fracture of the pediatric knee or wrist.
Methods: IRB-approved retrospective study of consecutively selected knee and wrist MRIs from 32 athletes with chronic physeal stress injury and 30 children with acute SH fracture. MRI characteristics (physeal patency, physeal thickening, physeal signal intensity (SI), continuity of the zone of provisional calcification (ZPC), integrity of the periosteum and/or perichondrium, pattern of periphyseal and soft tissue edema signal, and joint effusion) were compared.
Results: Forty-eight chronic physeal stress injuries (mean age 13.1 years [8.2-17.5 years]) and 35 SH fractures (mean age 13.3 years [5.1-16.0 years]) were included. Any physeal thickening was more common with chronic stress injury (98% vs 77%, p = 0.003). Abnormal physeal SI was more common with SH fractures (91% vs 67%, p = 0.008). ZPC discontinuity strongly suggested chronic stress injury (79% vs 49%, p < 0.004). Periosteal and/or perichondrial elevation or rupture and soft tissue edema characterized most of the acute SH fractures (p < 0.001) and were seen only in 1 chronic stress injury (< 2%). While periphyseal edema was not significantly different in the two groups (p = 0.890), a joint effusion was associated with acute SH fracture (p < 0.001).
Conclusion: Chronic physeal stress injury of the pediatric knee and wrist shows higher incidence of ZPC discontinuity and focal physeal thickening compared to SH fracture, reflecting disruption in normal endochondral ossification. However, these findings can overlap in the 2 groups. Periosteal and/or perichondrial injury, soft tissue edema signal, and joint effusion strongly suggest SH fracture and are rarely present with chronic stress injury.
目的:确定可提示慢性趾骨应力损伤的核磁共振成像结果,并将其与小儿膝关节或腕关节的急性 Salter-Harris 骨折区分开来:确定可提示慢性趾骨应力损伤的磁共振成像结果,并将其与小儿膝关节或腕关节的急性Salter-Harris(SH)骨折区分开来:经 IRB 批准,对 32 名患有慢性趾骨应力损伤的运动员和 30 名患有急性 Salter-Harris 骨折的儿童连续选择的膝关节和腕关节 MRI 进行回顾性研究。比较了核磁共振成像特征(趾骨通畅性、趾骨增厚、趾骨信号强度(SI)、临时钙化区(ZPC)的连续性、骨膜和/或软骨周围的完整性、骨膜周围和软组织水肿信号模式以及关节积液):共纳入了 48 例慢性趾骨应力损伤(平均年龄 13.1 岁 [8.2-17.5 岁])和 35 例 SH 型骨折(平均年龄 13.3 岁 [5.1-16.0 岁])。任何趾骨增厚在慢性应力损伤中都更为常见(98% vs 77%,P = 0.003)。趾骨SI异常在SH骨折中更为常见(91% vs 67%,P = 0.008)。ZPC 不连续强烈提示慢性应力损伤(79% 对 49%,P=0.003):与SH骨折相比,小儿膝关节和腕关节的慢性骺端应力损伤显示出更高的ZPC不连续性和局灶性骺端增厚,反映出正常软骨内骨化的破坏。不过,这两组患者的这些发现可能会重叠。骨膜和/或软骨周围损伤、软组织水肿信号和关节积液强烈提示 SH 型骨折,而慢性应力性损伤很少出现这种情况。
{"title":"Stressed or fractured: MRI differentiating indicators of physeal injury.","authors":"M Alejandra Bedoya, Diego Jaramillo, Jade Iwasaka-Neder, Tal Laor","doi":"10.1007/s00256-024-04670-y","DOIUrl":"10.1007/s00256-024-04670-y","url":null,"abstract":"<p><strong>Objective: </strong>To identify MRI findings that can indicate chronic physeal stress injury and differentiate it from acute Salter-Harris (SH) fracture of the pediatric knee or wrist.</p><p><strong>Methods: </strong>IRB-approved retrospective study of consecutively selected knee and wrist MRIs from 32 athletes with chronic physeal stress injury and 30 children with acute SH fracture. MRI characteristics (physeal patency, physeal thickening, physeal signal intensity (SI), continuity of the zone of provisional calcification (ZPC), integrity of the periosteum and/or perichondrium, pattern of periphyseal and soft tissue edema signal, and joint effusion) were compared.</p><p><strong>Results: </strong>Forty-eight chronic physeal stress injuries (mean age 13.1 years [8.2-17.5 years]) and 35 SH fractures (mean age 13.3 years [5.1-16.0 years]) were included. Any physeal thickening was more common with chronic stress injury (98% vs 77%, p = 0.003). Abnormal physeal SI was more common with SH fractures (91% vs 67%, p = 0.008). ZPC discontinuity strongly suggested chronic stress injury (79% vs 49%, p < 0.004). Periosteal and/or perichondrial elevation or rupture and soft tissue edema characterized most of the acute SH fractures (p < 0.001) and were seen only in 1 chronic stress injury (< 2%). While periphyseal edema was not significantly different in the two groups (p = 0.890), a joint effusion was associated with acute SH fracture (p < 0.001).</p><p><strong>Conclusion: </strong>Chronic physeal stress injury of the pediatric knee and wrist shows higher incidence of ZPC discontinuity and focal physeal thickening compared to SH fracture, reflecting disruption in normal endochondral ossification. However, these findings can overlap in the 2 groups. Periosteal and/or perichondrial injury, soft tissue edema signal, and joint effusion strongly suggest SH fracture and are rarely present with chronic stress injury.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140336828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-01-18DOI: 10.1007/s00256-024-04575-w
Feyikemi O Ogunfuwa, Steven Needell, Ryan W Simovitch
Metallosis is an unusual but consequential complication arising from orthopedic hardware implantation, characterized by the deposition of metallic particles in the periprosthetic soft tissues. The incidence of metallosis associated with shoulder arthroplasties is exceptionally rare since the shoulder is not a weight-bearing joint, making it less susceptible to mechanical wear and, consequently, to conditions like particle disease and metallosis. Nevertheless, anomalous metal-on-metal interactions can develop in total shoulder arthroplasties if the polyethylene component fails due to wear, fracture, or dissociation. If left unaddressed, metallosis can incite an adverse immune-mediated local tissue response, culminating in joint destruction and adjacent soft tissues and muscle necrosis. In this case report, the diagnosis of metallosis was made in a patient with an anatomic total shoulder arthroplasty using a state-of-the-art photon counting detector CT supplemented by post-processing metal artifact reduction algorithms. This advanced imaging approach was effective in discerning the source of implant failure and in identifying manifestations of severe metallosis including osteolysis and pseudotumor formation. Advanced imaging methods can accurately characterize the severity and extent of metallosis, thereby helping guide surgical planning to mitigate serious complications associated with this condition.
{"title":"Severe metallosis following catastrophic failure of total shoulder arthroplasty - a case report.","authors":"Feyikemi O Ogunfuwa, Steven Needell, Ryan W Simovitch","doi":"10.1007/s00256-024-04575-w","DOIUrl":"10.1007/s00256-024-04575-w","url":null,"abstract":"<p><p>Metallosis is an unusual but consequential complication arising from orthopedic hardware implantation, characterized by the deposition of metallic particles in the periprosthetic soft tissues. The incidence of metallosis associated with shoulder arthroplasties is exceptionally rare since the shoulder is not a weight-bearing joint, making it less susceptible to mechanical wear and, consequently, to conditions like particle disease and metallosis. Nevertheless, anomalous metal-on-metal interactions can develop in total shoulder arthroplasties if the polyethylene component fails due to wear, fracture, or dissociation. If left unaddressed, metallosis can incite an adverse immune-mediated local tissue response, culminating in joint destruction and adjacent soft tissues and muscle necrosis. In this case report, the diagnosis of metallosis was made in a patient with an anatomic total shoulder arthroplasty using a state-of-the-art photon counting detector CT supplemented by post-processing metal artifact reduction algorithms. This advanced imaging approach was effective in discerning the source of implant failure and in identifying manifestations of severe metallosis including osteolysis and pseudotumor formation. Advanced imaging methods can accurately characterize the severity and extent of metallosis, thereby helping guide surgical planning to mitigate serious complications associated with this condition.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139486359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-02-21DOI: 10.1007/s00256-024-04616-4
Manit K Gundavda, Darshana Sanghvi, Nevitha Athikari, Raghuram Sekhar
{"title":"A painful mass infiltrating the quadriceps compartment of a young female.","authors":"Manit K Gundavda, Darshana Sanghvi, Nevitha Athikari, Raghuram Sekhar","doi":"10.1007/s00256-024-04616-4","DOIUrl":"10.1007/s00256-024-04616-4","url":null,"abstract":"","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-03-27DOI: 10.1007/s00256-024-04665-9
Riccardo Cristiani, Fabian van de Bunt, Joanna Kvist, Anders Stålman
Objectives: To evaluate the type and prevalence of associated injuries by using magnetic resonance imaging (MRI) in patients with anterior cruciate ligament (ACL) tears.
Methods: Data from the Natural Corollaries and Recovery after ACL injury multicenter longitudinal cohort study were analyzed. Between May 2016 and October 2018, patients aged between 15 and 40 years, who had experienced an ACL tear within the last 6 weeks and sought medical attention at one of seven healthcare clinics in Sweden, were invited to participate. The mean time from injury to MRI was 19.6 ± 15.2 days. An orthopedic knee surgeon and a musculoskeletal radiologist reviewed all the MRI scans. The following structures were assessed: posterior cruciate ligament (PCL), medial collateral ligament (MCL) complex, lateral collateral ligament (LCL), popliteus tendon, medial meniscus (MM), lateral meniscus (LM), and cartilage. In addition, the presence of bone bruising, impaction fractures in the lateral femoral condyle (LFC) or posterolateral tibia (PLT), and Segond fractures were also assessed. RESULTS: A total of 254 patients (48.4% males) with a mean age of 25.4 ± 7.1 years were included. The prevalence of associated injuries was as follows: PCL (0.4%), MCL {41.3% [superficial MCL and deep MCL (dMCL) 16.5%; isolated dMCL 24.8%]}, LCL (2.4%), MM (57.4%), LM (25.2%), cartilage (15.0%), bone bruising (92.9%), impaction fracture in the LFC (45.7%) and PLT (4.7%), and Segond fracture (7.5%).
Conclusions: The prevalence of associated injuries in patients with ACL tears was high. The findings reported in this study may serve as a reference tool for orthopedic surgeons and radiologists in the diagnosis of associated injuries using MRI in patients with ACL tears.
{"title":"High prevalence of associated injuries in anterior cruciate ligament tears: A detailed magnetic resonance imaging analysis of 254 patients.","authors":"Riccardo Cristiani, Fabian van de Bunt, Joanna Kvist, Anders Stålman","doi":"10.1007/s00256-024-04665-9","DOIUrl":"10.1007/s00256-024-04665-9","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the type and prevalence of associated injuries by using magnetic resonance imaging (MRI) in patients with anterior cruciate ligament (ACL) tears.</p><p><strong>Methods: </strong>Data from the Natural Corollaries and Recovery after ACL injury multicenter longitudinal cohort study were analyzed. Between May 2016 and October 2018, patients aged between 15 and 40 years, who had experienced an ACL tear within the last 6 weeks and sought medical attention at one of seven healthcare clinics in Sweden, were invited to participate. The mean time from injury to MRI was 19.6 ± 15.2 days. An orthopedic knee surgeon and a musculoskeletal radiologist reviewed all the MRI scans. The following structures were assessed: posterior cruciate ligament (PCL), medial collateral ligament (MCL) complex, lateral collateral ligament (LCL), popliteus tendon, medial meniscus (MM), lateral meniscus (LM), and cartilage. In addition, the presence of bone bruising, impaction fractures in the lateral femoral condyle (LFC) or posterolateral tibia (PLT), and Segond fractures were also assessed. RESULTS: A total of 254 patients (48.4% males) with a mean age of 25.4 ± 7.1 years were included. The prevalence of associated injuries was as follows: PCL (0.4%), MCL {41.3% [superficial MCL and deep MCL (dMCL) 16.5%; isolated dMCL 24.8%]}, LCL (2.4%), MM (57.4%), LM (25.2%), cartilage (15.0%), bone bruising (92.9%), impaction fracture in the LFC (45.7%) and PLT (4.7%), and Segond fracture (7.5%).</p><p><strong>Conclusions: </strong>The prevalence of associated injuries in patients with ACL tears was high. The findings reported in this study may serve as a reference tool for orthopedic surgeons and radiologists in the diagnosis of associated injuries using MRI in patients with ACL tears.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11410909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140294394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-01-20DOI: 10.1007/s00256-024-04581-y
Jasmine Zacharias, Uday Mandalia, Jason Palman, Fatima Kagalwala, Cecil Bernard Colaco, Janani K Pillai
We present the clinical and radiological characteristics of phalangeal microgeodic syndrome in a cluster of five children during the second peak of COVID-19 pandemic in the UK. Each child presented with phalangeal swelling and erythema, prompting a comprehensive multi-disciplinary team review to analyse the clinical presentation, blood test results and imaging. The cohort's average age was 14.1 years, ranging from 10.4 to 16.6 years, with two girls and three boys. Four children experienced phalangeal involvement in the hands, whilst one was affected solely in the feet. A rheumatological work-up was performed for all. Hand X-rays performed on three children revealed distinct radiographic features like microgeodes, subperiosteal bone resorption and rarefaction in two cases. However, further MRI showed extensive changes closely correlated with the clinical signs of cutaneous vasculopathic rashes. The MRI abnormalities were notable, encompassing marrow oedema primarily affecting metaphyses and epiphyses, displaying broad transition zones. Soft tissue swelling and cortical erosions were also observed. These MRI features proved more pathognomonic in the acute clinical context. The study concluded that phalangeal microgeodic syndrome, characterised by digital swelling and erythema, might not be adequately assessed by plain X-rays. The more comprehensive MRI features, including marrow oedema and soft tissue abnormalities, appeared to be more indicative in diagnosing the condition. Considering the rarity of this syndrome and its temporal association with the COVID-19 pandemic, the study hypothesised that COVID-related thrombophilia and immune-mediated vasculopathy might act as crucial triggers for the active bony manifestations seen in this syndrome. KEY POINTS: • PMS is a rare, predominantly paediatric condition, of unknown aetiology which affects the digits. • Laboratory investigations are generally negative; however, in the appropriate clinical context, the X-ray findings of microgeodes and pattern of bone marrow oedema seen on MRI are pathognomonic. • Considering the rarity of PMS and temporal association with the COVID-19 pandemic, COVID vasculopathy may represent a previously unrecognised aetiology for PMS.
{"title":"Phalangeal microgeodic syndrome: a paediatric case series.","authors":"Jasmine Zacharias, Uday Mandalia, Jason Palman, Fatima Kagalwala, Cecil Bernard Colaco, Janani K Pillai","doi":"10.1007/s00256-024-04581-y","DOIUrl":"10.1007/s00256-024-04581-y","url":null,"abstract":"<p><p>We present the clinical and radiological characteristics of phalangeal microgeodic syndrome in a cluster of five children during the second peak of COVID-19 pandemic in the UK. Each child presented with phalangeal swelling and erythema, prompting a comprehensive multi-disciplinary team review to analyse the clinical presentation, blood test results and imaging. The cohort's average age was 14.1 years, ranging from 10.4 to 16.6 years, with two girls and three boys. Four children experienced phalangeal involvement in the hands, whilst one was affected solely in the feet. A rheumatological work-up was performed for all. Hand X-rays performed on three children revealed distinct radiographic features like microgeodes, subperiosteal bone resorption and rarefaction in two cases. However, further MRI showed extensive changes closely correlated with the clinical signs of cutaneous vasculopathic rashes. The MRI abnormalities were notable, encompassing marrow oedema primarily affecting metaphyses and epiphyses, displaying broad transition zones. Soft tissue swelling and cortical erosions were also observed. These MRI features proved more pathognomonic in the acute clinical context. The study concluded that phalangeal microgeodic syndrome, characterised by digital swelling and erythema, might not be adequately assessed by plain X-rays. The more comprehensive MRI features, including marrow oedema and soft tissue abnormalities, appeared to be more indicative in diagnosing the condition. Considering the rarity of this syndrome and its temporal association with the COVID-19 pandemic, the study hypothesised that COVID-related thrombophilia and immune-mediated vasculopathy might act as crucial triggers for the active bony manifestations seen in this syndrome. KEY POINTS: • PMS is a rare, predominantly paediatric condition, of unknown aetiology which affects the digits. • Laboratory investigations are generally negative; however, in the appropriate clinical context, the X-ray findings of microgeodes and pattern of bone marrow oedema seen on MRI are pathognomonic. • Considering the rarity of PMS and temporal association with the COVID-19 pandemic, COVID vasculopathy may represent a previously unrecognised aetiology for PMS.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139512977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-02-03DOI: 10.1007/s00256-024-04600-y
Andrew M Hernandez, Christopher O Bayne, Cyrus Bateni, Ramit Lamba, John M Boone
Objective: To demonstrate the potential of low-dose ultra-high-resolution CT (UHRCT) images to generate high-quality radiographic images on extremity phantoms and to estimate the radiation dose required for this.
Materials and methods: A hand and knee phantom containing real human bones was imaged on an UHRCT scanner at full-dose, half-dose, and quarter-dose levels using a high-resolution extremity protocol. The raw data was reconstructed using both filtered back projection (FBP) and an iterative reconstruction algorithm (AIDR3D). Using custom designed software, each CT volume data set was converted to attenuation coefficients, and then a synthesized radiograph (synDX) was generated by forward projecting the volume data sets from a point source onto a 2D synthetic detector. The signal-to-noise ratio (SNR) was measured in the synDXs across all dose levels and the root-mean-squared error (RMSE) was computed with the FD synDXs as the reference.
Results: The proposed workflow generates high-quality synDXs at any arbitrary angle. For FBP, the SNR largely tracked with the radiation dose levels for both the knee and hand phantoms. For the knee phantom, iterative reconstruction provided a 6.1% higher SNR when compared to FBP. The RMSE was overall higher for the lowest dose levels and monotonically decreased with increasing dose. No substantial differences were observed qualitatively in the visualization of skeletal detail of the phantoms.
Conclusion: The fine detail provided by UHRCT acquisitions of extremities facilitates the ability to generate quality radiographs, potentially eliminating the need for additional scanning on a conventional digital radiography system.
{"title":"Extremity radiographs derived from low-dose ultra-high-resolution CT: a phantom study.","authors":"Andrew M Hernandez, Christopher O Bayne, Cyrus Bateni, Ramit Lamba, John M Boone","doi":"10.1007/s00256-024-04600-y","DOIUrl":"10.1007/s00256-024-04600-y","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate the potential of low-dose ultra-high-resolution CT (UHRCT) images to generate high-quality radiographic images on extremity phantoms and to estimate the radiation dose required for this.</p><p><strong>Materials and methods: </strong>A hand and knee phantom containing real human bones was imaged on an UHRCT scanner at full-dose, half-dose, and quarter-dose levels using a high-resolution extremity protocol. The raw data was reconstructed using both filtered back projection (FBP) and an iterative reconstruction algorithm (AIDR3D). Using custom designed software, each CT volume data set was converted to attenuation coefficients, and then a synthesized radiograph (synDX) was generated by forward projecting the volume data sets from a point source onto a 2D synthetic detector. The signal-to-noise ratio (SNR) was measured in the synDXs across all dose levels and the root-mean-squared error (RMSE) was computed with the FD synDXs as the reference.</p><p><strong>Results: </strong>The proposed workflow generates high-quality synDXs at any arbitrary angle. For FBP, the SNR largely tracked with the radiation dose levels for both the knee and hand phantoms. For the knee phantom, iterative reconstruction provided a 6.1% higher SNR when compared to FBP. The RMSE was overall higher for the lowest dose levels and monotonically decreased with increasing dose. No substantial differences were observed qualitatively in the visualization of skeletal detail of the phantoms.</p><p><strong>Conclusion: </strong>The fine detail provided by UHRCT acquisitions of extremities facilitates the ability to generate quality radiographs, potentially eliminating the need for additional scanning on a conventional digital radiography system.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Benign fibrous histiocytoma of the bone (BFHB) is a rare mesenchymal tumor, representing less than 1% of all benign bone tumors. This controversial entity is characterized by a mixture of fibroblasts arranged in a storiform pattern, varying amounts of osteoclast-type giant cells and foamy macrophages. Curettage or simple resection is usually curative. However, it was reported that up to 11% of the patients suffer from relapse. Here, we report a case of malignant transformation of BFHB after long-lasting disease stabilization under denosumab therapy.
{"title":"Recurrent benign fibrous histiocytoma of the bone benefits from denosumab followed by malignant transformation: a case report.","authors":"Wetterwald Laureline, Omoumi Patrick, Nguyen Tu, Cherix Stephane, Dolcan Ana, Ferraro Daniela, Saglietti Chiara, Letovanec Igor, Digklia Antonia","doi":"10.1007/s00256-024-04610-w","DOIUrl":"10.1007/s00256-024-04610-w","url":null,"abstract":"<p><p>Benign fibrous histiocytoma of the bone (BFHB) is a rare mesenchymal tumor, representing less than 1% of all benign bone tumors. This controversial entity is characterized by a mixture of fibroblasts arranged in a storiform pattern, varying amounts of osteoclast-type giant cells and foamy macrophages. Curettage or simple resection is usually curative. However, it was reported that up to 11% of the patients suffer from relapse. Here, we report a case of malignant transformation of BFHB after long-lasting disease stabilization under denosumab therapy.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11410898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-03-19DOI: 10.1007/s00256-024-04658-8
Evangelia E Vassalou, Iraklis Perysinakis, Michail E Klontzas, Eelco de Bree, Apostolos H Karantanas
Objective: Although there is growing evidence that ultrasonography is superior to X-ray for rib fractures' detection, X-ray is still indicated as the most appropriate method. This has partially been attributed to a lack of studies using an appropriate reference modality. We aimed to compare the diagnostic accuracy of ultrasonography and X-ray in the detection of rib fractures, considering CT as the reference standard.
Materials and methods: Within a 2.5-year period, all consecutive patients with clinically suspected rib fracture(s) following blunt chest trauma and available posteroanterior/anteroposterior X-ray and thoracic CT were prospectively studied and planned to undergo thoracic ultrasonography, by a single operator. All imaging examinations were evaluated for cortical rib fracture(s), and their location was recorded. The cartilaginous rib portions were not assessed. CTs and X-rays were evaluated retrospectively. Concomitant thoracic/extra-thoracic injuries were assessed on CT. Comparisons were performed with the Mann-Whitney U test and Fisher's exact test.
Results: Fifty-nine patients (32 males, 27 females; mean age, 53.1 ± 16.6 years) were included. CT, ultrasonography, and X-ray (40 posteroanterior/19 anteroposterior views) diagnosed 136/122/42 rib fractures in 56/54/27 patients, respectively. Ultrasonography and X-ray had sensitivity of 100%/40% and specificity of 89.7%/30.9% for rib fractures' detection. Ultrasound accuracy was 94.9% compared to 35.4% for X-rays (P < .001) in detecting individual rib fractures. Most fractures involved the 4th-9th ribs. Upper rib fractures were most commonly overlooked on ultrasonography. Thoracic cage/spine fractures and haemothorax represented the most common concomitant injuries.
Conclusion: Ultrasonography appeared to be superior to X-ray for the detection of rib fractures with regard to a reference CT.
目的:尽管越来越多的证据表明,超声波检查在肋骨骨折的检测中优于 X 光检查,但 X 光检查仍被认为是最合适的方法。部分原因是缺乏使用适当参考模式的研究。我们将 CT 作为参考标准,旨在比较超声波和 X 光在检测肋骨骨折方面的诊断准确性:在 2.5 年的时间里,我们对所有在胸部钝性创伤后临床疑似肋骨骨折的连续患者进行了前瞻性研究,并计划由一名操作员进行胸部超声波检查。所有造影检查都对肋骨皮质骨折进行了评估,并记录了骨折位置。软骨肋骨部分未作评估。对 CT 和 X 光片进行回顾性评估。同时进行的胸廓/胸廓外损伤通过 CT 进行评估。比较采用 Mann-Whitney U 检验和 Fisher's 精确检验:共纳入 59 名患者(32 名男性,27 名女性;平均年龄为 53.1 ± 16.6 岁)。CT、超声波和 X 光(40 个后正位切面/19 个前正位切面)分别诊断出 56/54/27 例患者的 136/122/42 根肋骨骨折。超声波和 X 光检查对肋骨骨折检测的敏感性分别为 100%/40%,特异性分别为 89.7%/30.9%。超声检查的准确率为 94.9%,而 X 光检查的准确率为 35.4%(P 结论:超声检查似乎比 X 光检查更准确:与参考 CT 相比,超声波检查在检测肋骨骨折方面似乎优于 X 光检查。
{"title":"Performance of thoracic ultrasonography compared with chest radiography for the detection of rib fractures using computed tomography as a reference standard.","authors":"Evangelia E Vassalou, Iraklis Perysinakis, Michail E Klontzas, Eelco de Bree, Apostolos H Karantanas","doi":"10.1007/s00256-024-04658-8","DOIUrl":"10.1007/s00256-024-04658-8","url":null,"abstract":"<p><strong>Objective: </strong>Although there is growing evidence that ultrasonography is superior to X-ray for rib fractures' detection, X-ray is still indicated as the most appropriate method. This has partially been attributed to a lack of studies using an appropriate reference modality. We aimed to compare the diagnostic accuracy of ultrasonography and X-ray in the detection of rib fractures, considering CT as the reference standard.</p><p><strong>Materials and methods: </strong>Within a 2.5-year period, all consecutive patients with clinically suspected rib fracture(s) following blunt chest trauma and available posteroanterior/anteroposterior X-ray and thoracic CT were prospectively studied and planned to undergo thoracic ultrasonography, by a single operator. All imaging examinations were evaluated for cortical rib fracture(s), and their location was recorded. The cartilaginous rib portions were not assessed. CTs and X-rays were evaluated retrospectively. Concomitant thoracic/extra-thoracic injuries were assessed on CT. Comparisons were performed with the Mann-Whitney U test and Fisher's exact test.</p><p><strong>Results: </strong>Fifty-nine patients (32 males, 27 females; mean age, 53.1 ± 16.6 years) were included. CT, ultrasonography, and X-ray (40 posteroanterior/19 anteroposterior views) diagnosed 136/122/42 rib fractures in 56/54/27 patients, respectively. Ultrasonography and X-ray had sensitivity of 100%/40% and specificity of 89.7%/30.9% for rib fractures' detection. Ultrasound accuracy was 94.9% compared to 35.4% for X-rays (P < .001) in detecting individual rib fractures. Most fractures involved the 4th-9th ribs. Upper rib fractures were most commonly overlooked on ultrasonography. Thoracic cage/spine fractures and haemothorax represented the most common concomitant injuries.</p><p><strong>Conclusion: </strong>Ultrasonography appeared to be superior to X-ray for the detection of rib fractures with regard to a reference CT.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: We developed the deep neural network (DNN) model to automatically measure hallux valgus angle (HVA) and intermetatarsal angle (IMA) on foot radiographs. The objective is to assess the accuracy of the model by comparing to the manual measurement of foot and ankle surgeons.
Materials and methods: A DNN was developed to predict the bone axes of the first proximal phalanx and all metatarsals from the first to the fifth in foot radiographs. The dataset used for model development consisted of 1798 radiographs collected from a population-based cohort and patients at our foot and ankle clinic. The retrospective validation cohort comprised of 92 radiographs obtained from 92 consecutive patients visiting our foot and ankle clinic. The mean absolute error (MAE) between automatic measurements by the model and the median of manual measurements by three foot and ankle surgeons was compared to 3° using one-tailed t-test and was also compared to the inter-rater difference in manual measurements among the three surgeons using two-tailed paired t-test.
Results: The MAE for HVA was 1.3° (upper limit of 95% CI 1.6°), and this was significantly smaller than the inter-rater difference of 2.0 ± 0.2° among the surgeons, demonstrating the superior accuracy of the model. In contrast, the MAE for IMA was 0.8° (upper limit of 95% CI 1.0°) that showed no significant difference from the inter-rater difference of 1.0 ± 0.1° among the surgeons.
Conclusion: Our model demonstrated the ability to measure the HVA and IMA with an accuracy comparable to that of specialists.
目的:我们开发了深度神经网络(DNN)模型,用于自动测量足部X光片上的外翻角(HVA)和跖间角(IMA)。目的是通过与足踝外科医生的人工测量进行比较,评估该模型的准确性:开发了 DNN 来预测足部 X 光片中第一近节指骨和第一至第五节所有跖骨的骨轴。用于模型开发的数据集包括从人群队列和足踝诊所患者处收集的 1798 张射线照片。回顾性验证队列包括从 92 名连续到我们足踝诊所就诊的患者处获得的 92 张射线照片。使用单尾 t 检验比较了模型自动测量值与三位足踝外科医生手工测量值中位数之间的平均绝对误差(MAE)与 3°之间的差异,并使用双尾配对 t 检验比较了三位外科医生手工测量值之间的差异:结果:HVA 的 MAE 为 1.3°(95% CI 上限为 1.6°),明显小于外科医生之间 2.0 ± 0.2°的评分者间差异,这表明该模型具有更高的准确性。相比之下,IMA的MAE为0.8°(95% CI上限为1.0°),与外科医生之间1.0 ± 0.1°的评分差异无明显差异:我们的模型证明了测量 HVA 和 IMA 的能力,其准确性可与专科医生媲美。
{"title":"Automatic estimation of hallux valgus angle using deep neural network with axis-based annotation.","authors":"Ryutaro Takeda, Hiroyasu Mizuhara, Akihiro Uchio, Toshiko Iidaka, Kenta Makabe, Taro Kasai, Yasunori Omata, Noriko Yoshimura, Sakae Tanaka, Takumi Matsumoto","doi":"10.1007/s00256-024-04618-2","DOIUrl":"10.1007/s00256-024-04618-2","url":null,"abstract":"<p><strong>Objectives: </strong>We developed the deep neural network (DNN) model to automatically measure hallux valgus angle (HVA) and intermetatarsal angle (IMA) on foot radiographs. The objective is to assess the accuracy of the model by comparing to the manual measurement of foot and ankle surgeons.</p><p><strong>Materials and methods: </strong>A DNN was developed to predict the bone axes of the first proximal phalanx and all metatarsals from the first to the fifth in foot radiographs. The dataset used for model development consisted of 1798 radiographs collected from a population-based cohort and patients at our foot and ankle clinic. The retrospective validation cohort comprised of 92 radiographs obtained from 92 consecutive patients visiting our foot and ankle clinic. The mean absolute error (MAE) between automatic measurements by the model and the median of manual measurements by three foot and ankle surgeons was compared to 3° using one-tailed t-test and was also compared to the inter-rater difference in manual measurements among the three surgeons using two-tailed paired t-test.</p><p><strong>Results: </strong>The MAE for HVA was 1.3° (upper limit of 95% CI 1.6°), and this was significantly smaller than the inter-rater difference of 2.0 ± 0.2° among the surgeons, demonstrating the superior accuracy of the model. In contrast, the MAE for IMA was 0.8° (upper limit of 95% CI 1.0°) that showed no significant difference from the inter-rater difference of 1.0 ± 0.1° among the surgeons.</p><p><strong>Conclusion: </strong>Our model demonstrated the ability to measure the HVA and IMA with an accuracy comparable to that of specialists.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11410836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}