Skeletal Radiology最新文献

An os subfibulare is an ossicle that is located distal to the lateral malleolus near the distal fibular tip and typically at the fibular attachment of the anterior talofibular ligament (ATFL). Although there is debate concerning whether these ossicles are unfused accessory ossification centers versus non-united ATFL avulsion fractures, they are seen frequently in the setting of ankle instability. We present a case of an active patient with an unstable os subfibulare contributing to painless "catching" of the ankle due to talar subluxation and locking. This report details the clinical presentation, radiological findings, including MRI and dynamic ultrasound in the "locked" position, and surgical treatment for this unusual presentation of this unstable ossicle. The case underscores the potential importance of the os subfibulare in a patient with ankle instability and highlights the role of advanced imaging in guiding effective treatment.

Objective: Ultrasound (US) is a more accessible alternative to MRI for rotator cuff tear (RCT) assessment. Rapid US can identify RCTs, but accurate US interpretation remains challenging, even for experts. We performed a retrospective cross-sectional study to evaluate intraobserver and interobserver agreement and accuracy in RCT detection with US between expert and non-expert readers.

Materials and methods: Long-axis cine sweeps of supraspinatus tendon from 138 patients with suspected RCTs were analyzed and compared to corresponding MRI results (reference standard). Three non-experts (graduate student, medical student, radiology resident) and three experts (fellowship-trained musculoskeletal (MSK) radiologist, MSK sonographer, and radiology fellow) independently classified tendons as normal, full-thickness tear, or partial-thickness tear by predefined criteria.

Results: For all-tear detection (ATD), expert accuracy (%) ranged from 68.8 (95% CI, 61.1-76.5) to 84.8% (78.8-90.9), and non-expert accuracy from 63.0 (54.9-71.1) to 79.7% (73.0-86.4). For full-thickness tear detection (FTTD), expert accuracy ranged from 75.4 (68.2-82.6) to 87.0% (81.4-92.6), and non-expert accuracy from 73.9 (66.6-81.2) to 79.0% (72.2-85.8). Interobserver agreement for ATD was moderate among experts (Light's kappa ( $\kappa$ ) = 0.42 (95% CI, 0.30-0.58)) and fair among non-experts ( $\kappa$ = 0.38 (0.32-0.50)). Intraobserver agreement was fair ( $\kappa$ = 0.35 (0.29-0.43)). Our experts achieved higher sensitivity, resulting in improved overall accuracy.

Conclusion: Ultrasound readers of all experience levels accurately identified over 80% of RCTs when compared with MRI. Expert readers achieved higher accuracy, sensitivity, and reliability than non-experts. Ultrasound reliably detects RCTs and remains the preferred imaging modality for its accessibility and patient comfort, underscoring the need for standardization, training, and technological improvements.

Objectives: To investigate the association between hormone replacement therapy (HRT) and change in body composition in post-menopausal women in the Baltimore Longitudinal Study of Aging (BLSA).

Materials and methods: We included postmenopausal women with repeated dual-energy X-ray absorptiometry measurements and documented HRT status. HRT users were propensity score-matched to non-users based on baseline characteristics including age, height, weight, race, smoking, alcohol use, physical activity, education, age at menopause, age at first pregnancy, oral contraceptive use, and oophorectomy. Linear mixed-effects models assessed associations between current HRT use and longitudinal changes in fat and lean mass. Age was modeled as a time-varying continuous variable using piecewise linear splines at 60, 70, and 80 years. Interaction terms between HRT use and age were included to evaluate differences in age-related trajectories.

Results: HRT users (n = 91) and matched non-users (n = 220) had similar baseline characteristics. No significant interactions were found between HRT use and age for lean mass (all p > 0.05), and the likelihood ratio test (LRT) showed no improvement in model fit with interaction terms (p = 0.20). In contrast, fat mass trajectories differed by HRT status. Before age 60, HRT users experienced significantly greater fat mass gain (β = 596 g/year; 95% CI 75, 1117). After age 60, this reversed, with HRT users gaining 869 g/year less fat than non-users (β = -869 g/year; 95% CI - 1583, - 155), indicating a protective association of HRT after age 60. No significant differences were observed at ages 70 or 80. The LRT supported including interaction terms (p = 0.04).

Conclusion: HRT use is associated with less fat accumulation beyond the age of 60, although this association attenuates with advancing age. No differential association with lean mass was observed.

Objective: To assess the ability of large language models (LLMs) to accurately simplify lumbar spine magnetic resonance imaging (MRI) reports.

Materials and methods: Patients who underwent lumbar decompression and/or fusion surgery in 2022 at one tertiary academic medical center were queried using appropriate CPT codes. We then identified all patients with a preoperative ICD diagnosis of lumbar spondylolisthesis and extracted the latest preoperative spine MRI radiology report text. The GPT-4 API was deployed on deidentified reports with a prompt to produce translations and evaluated for accuracy and readability. An enhanced GPT prompt was constructed using high-scoring reports and evaluated on low-scoring reports.

Results: Of 93 included reports, GPT effectively reduced the average reading level (11.47 versus 8.50, p < 0.001). While most reports had no accuracy issues, 34% of translations omitted at least one clinically relevant piece of information, while 6% produced a clinically significant inaccuracy in the translation. An enhanced prompt model using high scoring reports-maintained reading level while significantly improving omission rate (p < 0.0001). However, even in the enhanced prompt model, GPT made several errors regarding location of stenosis, description of prior spine surgery, and description of other spine pathologies.

Conclusion: GPT-4 effectively simplifies the reading level of lumbar spine MRI reports. The model tends to omit key information in its translations, which can be mitigated with enhanced prompting. Further validation in the domain of spine radiology needs to be performed to facilitate clinical integration.

Objective: To develop and validate an artificial intelligence-based tool for the diagnosis of osteoporosis/osteopenia using hip radiographs. The tool aims to classify femurs into risk-based categories for osteoporosis/osteopenia, enabling patient prioritization, enhancing preventive medicine through incidental detection, and assisting clinicians' diagnosis in general.

Materials and methods: The AI tool was designed to perform three preprocessing tasks before the osteoporosis/osteopenia prediction: (1) splitting images into single femurs, (2) identifying and discarding femurs with prostheses, and (3) cropping images to isolate the proximal femur. A total of 2691 anteroposterior hip radiographs from 1654 patients were included in the study. The osteoporosis/osteopenia prediction model was trained on 3227 single femur images and tested on 826. Additionally, a final evaluation experiment was conducted on 313 new radiographs from 239 patients to assess the tool's applicability.

Results: The tool demonstrated high performance in the preprocessing tasks, achieving 99.0% accuracy in classifying single vs. double femur images, 99.3% accuracy in identifying prosthetic femurs, and 99.2% pixel accuracy in delineating the proximal femur before cropping. The final prediction model achieved an area under the curve of 86.6% for detecting osteoporosis/osteopenia in the test set and 81.0% in the final evaluation experiment.

Conclusions: The obtained results demonstrate the potential of the proposed AI-based pipeline for prediction of osteoporosis/osteopenia using hip radiographs. This study suggests that a tool based on the proposed methods could support DXA triage, incidental osteoporosis detection, and clinical decision-making in settings with limited access to bone densitometry.

Ossifying fibromyxoid tumors (OFMT) are rare tumors with an intermediate risk of malignancy that are usually found in the extremities. To date, only three cases of OFMTs involving the paraspinal musculature have been reported in the literature. Two of these previously reported cases demonstrated poorly circumscribed tumors with involvement of adjacent osseous and soft tissue structures. We report the first case of a well-circumscribed OFMT involving the paraspinal musculature with extrinsic erosion of bone but otherwise no significant soft tissue extension. Specifically, we review the CT and MRI findings, immunohistopathology, and genetics used to confirm the diagnosis of OFMT.

A distal posterior interosseous nerve (DPIN) neuroma related to prior surgery of the wrist can lead to disabling chronic pain. Ultrasound may represent a useful diagnostic tool due to its high resolution and ability to detect iatrogenic neuromas along small nerves of the limbs. However, the utility of ultrasound in the evaluation of both the normal sonographic appearance of the DPIN and traumatic neuromas is limited. We present a series of two patients who suffered from chronic dorsal wrist postoperative pain, where ultrasound detected histologically confirmed DPIN neuromas. After DPIN resection, the pain of our two patients completely disappeared without any functional deficit.

Objective: To introduce a tear location classification system for posterior cruciate ligament (PCL) injuries, aiming to unify diagnostic criteria and improve clinical decision-making based on tear location.

Materials and methods: A retrospective analysis was conducted using magnetic resonance imaging (MRI) examinations from a single institution, identifying all patients with acute or subacute PCL injuries from 2008 to 2024. Ligament sprains without significant fiber disruption and chronic injuries were excluded. Tears were classified by four independent observers according to the relative length (%) of the intact distal remnant compared to the total PCL length: Type I (> 90%), Type Ib (femoral bony avulsion), Type II (90-75%), Type III (75-25%), Type IV (distal tear 10-25%), Type V (< 10%), and Type Vb (tibial bony avulsion). For intra-observer reliability analysis, measurements were repeated once by two observers after 4 weeks.

Results: A subset of 45 MRIs with diagnosed PCL injuries that met the inclusion criteria (mean age 40.5 ± 19.2 years, 40% female) had 24% proximal tears, 33% midsubstance tears, 33% distal tears, and 11% single-bundle injuries. Inter-observer reliability (Fleiss' kappa, 0.88; 95% CI, 0.84-0.94; p < 0.01) and intra-observer reliability demonstrated to be almost perfect (Cohen's kappa, 0.95; 95% CI, 0.86-0.99 & 0.92; 95% CI, 0.84-0.99).

Conclusion: The proposed MRI-based classification system-which includes femoral avulsion, proximal quarter, midsubstance (50%), distal quarter, and tibial avulsion injuries-offers a reliable method for identifying the anatomical location of partial and complete PCL injuries. Standardizing tear localization has the potential to improve diagnostic consistency and inform more tailored, evidence-based treatment strategies.

Level of evidence: Diagnostic study; III.

An untreated scapholunate interosseous ligament injury or scaphoid nonunion leads to progressive post-traumatic periscaphoid osteoarthritis and carpal collapse. Symptomatic forms, known as scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC), are common and disabling, requiring surgical management. Numerous operative options exist depending on the stage of collapse and the extent of joint involvement. We apply a modified Watson radiological classification consisting of four stages of pancarpal collapse, integrating the etiological origin (SLAC or SNAC) and the arthritic progression pattern. This review summarizes current surgical principles for each stage of the disease and highlights the key role of imaging in postoperative assessment. Radiography remains the first-line tool to evaluate carpal alignment and implant positioning. CT and CBCT provide high-resolution analysis of bony structures and fixation devices, while ultrasound enables dynamic evaluation of superficial soft tissues and implant-tendon relationships without metallic artifacts. MRI, despite its sensitivity for soft tissues and bone marrow, remains limited by metal-induced distortion. A comprehensive understanding of surgical techniques, biomechanical principles, and implant types is essential to accurately interpret postoperative outcomes and detect complications early.