Skeletal Radiology最新文献

Paget's disease of bone (PDB) is a skeletal remodeling disorder diagnosed primarily via radiographs. In long bones, the early lytic stage of the disease is characterized by flame-shaped or blade of grass radiolucent bone resorption beginning in subchondral bone with variable length of extension into the metadiaphysis, and the later stages show bone expansion, cortical thickening, and coarsening of the trabeculae [1, 2]. Despite the usually diagnostic features, other considerations with overlapping appearance include aggressive benign and malignant bone tumors [3]. Malignancy such as lymphoma can present shared clinical features to PDB. When there is doubt as to the diagnosis, biopsy should be performed. A 60-year-old male presented with chronic left lower extremity pain. Radiographs showed a flame-shaped lytic lesion in the left femur with corresponding uptake on the bone scintigraphy. Radiographic features were suggestive of PDB, but due to some atypical findings, a biopsy was performed and showed small lymphocytic lymphoma (SLL) in the setting of chronic lymphocytic leukemia (CLL). This diagnosis led to the patient being promptly treated with targeted therapy and radiation. Pathologic verification is critical in an aberrant presentation of PDB to mitigate misdiagnosis and establish an appropriate therapeutic course.

Objectives: EOS bi-planar imaging enables three-dimensional (3D) reconstructions of the spine and pelvis with segmental vertebral measurements in three planes from a neutral pelvis. This study evaluates the repeatability of these measurements and the accuracy in detecting true changes.

Methods: Twenty patients from four clinical backgrounds (surgical threshold, bracing threshold, micro-dose, and in-brace) were included. EOS bi-planar "full spine" images were modelled and then subsequently re-modelled at least 4 weeks later by the same researcher. All 3D measurements were recorded and compared.

Results: The average modelling interval was 6.7 weeks. Paired measures indicated high agreement, except for planes of maximal curvature (PMC): thoracic (Spearman's = 0.67; p < 0.05) and lumbar (Spearman's = 0.40; p > 0.05). Intraclass correlation coefficients (ICCs) showed excellent agreement, with thoracic and lumbar Cobb angles averaging 0.99. Sagittal measurements ranged from 0.93 (L1/S1 lordosis) to 0.96 (T1/T12 kyphosis). Pelvic parameters ranged from 0.88 (obliquity) to 0.99 (tilt). The transverse profile ranged from 0.82 (apical thoracic rotation) to 0.98 (average lumbar rotation). Repeatability (2.77 × technical error of measurement [TEM]) was ± 4.4° for Cobb angles, ± 7.7° for sagittal profile, ± 5.0° for pelvic parameters, ± 4.8° for transverse profile, and ± 100.4° for automated thoracic and lumbar PMC. With strong outliers excluded, thoracic PMC was ± 16.2° and lumbar PMC was ± 15.5°.

Conclusion: 3D EOS measurements demonstrate excellent intra-rater ICC repeatability despite notable true measurement error that should define future success criteria. Semi-automated modelling provides quick 3D spinal alignment measurements from a neutral pelvis, with this study being the first to report TEM for 3D EOS reconstructions. PMC disagreement indicates the need for further investigation.

Objectives: To evaluate whether dual-layer spectral computed tomography, compared with conventional CT, improves diagnostic accuracy for osteolytic vertebral metastases. Furthermore, to investigate the influence of dual-layer CT on the subjective visibility of metastases.

Materials and methods: In this single-center retrospective study, consecutive patients with an untreated primary tumor who underwent dual-layer CT and either MRI or PET-CT as reference standard within 14 days were included. Two independent observers, blinded to the reference, performed two scorings. First, the conventional CT was scored and the results were recorded. Subsequently, Calcium suppression, monoenergetic (monoE40 and monoE200), and Z-effective reconstructions were added. Subjective visibility was compared to conventional CT using a 5-point Likert scale. Diagnostic accuracy measures were calculated with 95% confidence intervals. Sensitivity and specificity were compared using the McNemar's test.

Results: Fourteen patients (63 ± 8 years; 64.3% female) and 189 vertebrae were included, with 46 vertebrae showing 58 metastases with a mean diameter of 18 mm (range 5-53 mm). For conventional CT, the sensitivity, specificity, and diagnostic accuracy for observer A and B were, respectively, 57% and 57%, 96% and 90%, 85% and 81%. The diagnostic performance did not improve when using the dual-layer CT reconstructions in addition to conventional CT (p ≥ 0.13). MonoE40 improved the subjective visibility of metastases. Interobserver agreement was moderate for conventional CT (ĸ:0.48), and dual-layer CT reconstructions (ĸ:0.41-0.51).

Conclusion: Dual-layer CT reconstructions did not improve diagnostic accuracy for osteolytic vertebral metastases compared with conventional CT, although subjective visibility was improved on low monoenergetic reconstructions.

We report a very rare case of an intraossesous extra-axial chordoma (EAC) involving the distal femur. We describe the clinical presentation, radiologic and pathological findings, and the treatment. In addition, a systematic literature search was performed to further expand the knowledge regarding EAC in the lower extremities, including 13 papers describing a total of 21 adult patients.

Atypical proximal tibial fractures in adolescents are rare, particularly when linked to hormonal therapy for short stature. This case series reports the clinical and imaging features of atypical proximal tibial and distal femoral physeal fractures in male adolescents undergoing combined growth hormone (GH) and aromatase inhibitor (AI) therapy for idiopathic short stature. We report three cases of skeletally immature male adolescents (ages 12-16) treated with GH and anastrozole who presented with acute leg pain following low-energy trauma during soccer. Computed tomography (CT) imaging identified fractures through the physis and metaphysis with characteristic anterior displacement-resembling an "opened-bottle" configuration. Fractures occurred during periods of rapid growth with delayed physeal closure and reduced bone mineral density. Two cases were managed surgically, and one conservatively. Salter-Harris and Ogden classification systems were used. These cases highlight the potential impact of growth-modulating therapies on bone integrity, particularly their influence on the growth plate and overall bone strength, which may increase fracture risk. Imaging and clinical findings emphasize the role of hormone-related delayed physeal closure and altered biomechanics in fracture development. This report aims to raise awareness of this complication and explores possible mechanisms connecting therapy to these atypical injuries.

Objective: A plantar fibroma (PF) is a painful benign lesion in which fibrous tissues infiltrate the plantar aponeurosis. The largest study published to date on MRI characteristics of PF includes only 16 patients. The aim was to systematically evaluate MRI characteristics of PFs from the database of our tertiary care center imaged over a decade with patient symptom analysis.

Materials and methods: This cross-sectional study included 196 cases of MRI-confirmed PFs. Four readers assessed the lesions with respect to cords of plantar fascia, number of lesions, MRI features, largest size, and enhancement characteristics. Regional findings of local fracture deformity, muscle denervation, and plantar fasciitis were recorded. Patient symptoms were correlated using Fisher's exact test, Wilcoxon rank sum test, and Chi-squared test.

Results: The most common location of PF was the central cord (83%), followed by medial cord (15%) and lateral cord (1.5%) with 14% involving multiple cords. 32% of cases showed multiple lesions with 5% showing 4-5 lesions. The majority (68%) of PFs were isointense on T1W images and 43-45% lesions were hypointense on fsT2W and T2W images, respectively, with 66% of lesions being heterogeneous, 8.7% showing cystic-necrotic areas, and 64% with solid contrast enhancement. 52% had pain with 54% with diabetes mellitus. T2W and fsT2W signal alterations, enhancement characteristics, and plantar muscle denervation were significant for pain symptoms (p < 0.05).

Conclusion: This large systematic study adds to the body of literature on PFs, which can affect different fascial cords, can be multiple in up to 1/3 cases, and have contributory MRI features that correlate with foot pain symptoms.

Objective: To report a single-center experience comparing the efficacy and safety of computed tomography (CT)-guided radiofrequency ablation (RFA) in the treatment of osteoid osteoma (OO) in pediatric and adult patients.

Materials and methods: The electronic medical records of 97 patients who underwent CT-guided RFA for OO between January 2019 and January 2025 were retrospectively reviewed. Patients were divided into pediatric and adult groups. Demographic data, anatomical location and size of the lesion, procedure duration, pre- and post-procedure visual analog scale (VAS) scores, complications, technical and clinical success rates, and recurrence rates were evaluated.

Results: Of the 97 patients, 51 (52.6%) were pediatric and 46 (47.4%) were adults. The mean lesion diameter was 7.98 ± 2.92 mm in the pediatric group and 7.14 ± 3.72 mm in the adult group. The overall technical success rate of CT-guided RFA for OO was 100%, with primary and secondary clinical success rates of 97.9% and 98.9%, respectively. The primary clinical success rate was 98.1% (50/51) in the pediatric group and 97.8% (45/46) in the adult group. No major complications related to the procedure were observed. Minor complications included transient skin burn in one pediatric patient (1.9%, 1/51) and localized muscle pain in one pediatric (1.9%, 1/51) and one adult (2.2%, 1/46) patient.

Conclusion: This study demonstrates that percutaneous CT-guided RFA is a highly effective and safe technique with high success and low complication rates for the treatment of OO in both pediatric and adult populations.

Objectives: To determine whether the peroneus brevis tendon shape, cross-sectional area, and patient age are associated with split tears on magnetic resonance imaging.

Methods: This retrospective cross-sectional study included 358 patients (179 with and 179 without split tears), with sample size based on an a priori power calculation (Cramér's V = 0.186, 80% power, α = 0.05). Musculoskeletal radiologists assigned patients to split tear or no-tear groups based on MRI findings 8 weeks before independent shape classification and area measurements. Tendon shape was visually assessed on transverse proton density images and categorized as oval, general flat, flattened with medial convexity, or flattened with lateral convexity. Associations with split tear were evaluated using multivariable logistic regression.

Results: Flat-shaped tendons were more common in the split tear group (91.6%) than in controls (82.1%), while oval tendons were less frequent (8.4% vs. 17.9%, p = 0.007). The flattened with lateral convexity shape was most strongly associated with split tear. In the multivariable analysis, flat shape (odds ratio [OR] = 2.26, p = 0.021), larger cross-sectional area (OR per mm² = 1.04, p = 0.059), and older age (OR per year = 1.03, p < 0.001) are independently associated with split tear. No significant differences were observed between right and left ankles. Inter-rater agreement was substantial for shape (κ = 0.71, AC1 = 0.74) and excellent for area (intraclass correlation coefficient = 0.95).

Conclusions: A flat-shaped peroneus brevis tendon, an increased cross-sectional area, and older age are associated with an increased likelihood of peroneus brevis split tears. These features may serve as anatomical imaging biomarkers for early risk identification.

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.