Skeletal Radiology最新文献

Objectives: To characterize ankle magnetic resonance imaging (MRI) features in pediatric and young adult patients with familial Mediterranean fever (FMF) and compare them with those in juvenile idiopathic arthritis (JIA) and chronic nonbacterial osteomyelitis (CNO) in order to identify distinguishing or overlapping imaging features among the three conditions.

Methods: Twelve ankle MRI examinations from 11 patients with FMF (mean age 12.4 years, 7 females) were retrospectively evaluated and compared with 22 examinations from 17 patients diagnosed with JIA (12 patients/14 ankles, mean age 14.3 years, 8 females) or CNO (5 patients/8 ankles, mean age 10.2 years, 3 females). Calcaneal enthesitis features were assessed at the insertion site of the Achilles tendon, plantar fascia, and the long plantar tendon. Also evaluated were the presence of diffuse calcaneal bone marrow edema (BME), midfoot arthritis, synovitis, and tenosynovitis.

Results: Insertional calcaneal BME, an enthesitis-related feature, was more prevalent in FMF patients compared to both JIA and CNO, while among the three evaluated entheses, long plantar tendon enthesitis was significantly more prevalent in FMF patients only compared to those with JIA (p < 0.001). CNO presented a predominantly osseous inflammation pattern with diffuse calcaneal BME (87.5%, p < 0.001) and additional hindfoot BME (75%, p < 0.002), clearly distinct from FMF. Synovitis and tenosynovitis were more commonly observed in JIA patients, although the differences compared to FMF and CNO were not statistically significant.

Conclusion: Although imaging features overlap among FMF, CNO, and JIA, distinct MRI patterns emerge: enthesitis predominates in FMF, osteitis in CNO, and synovitis in JIA.

Purpose: The aim of this study is to evaluate the treatment response of patients with osteoid osteoma (OO) following radiofrequency ablation (RFA) and identify factors influencing the time to complete pain relief post-treatment.

Materials and methods: This is a retrospective cohort study of patients who underwent RFA for OO between 2010 and 2023. Demographic, clinical data, and time between symptoms onset to diagnosis and RFA were recorded. CTs were reviewed for OO location (upper extremity, lower extremity, spine/pelvis), intra-articular versus extra-articular lesions, nidus size, degree of peripheral bone formation, and presence of vessel sign. Procedural related information included needle approach, RFA active tip length, and number of RFA cycles. Statistical analysis was made on factors and their correlation to complete pain relief.

Results: Out of 63 patients included in our study (mean age 19.3 ± 10.6), OO were located in the upper extremity (n = 7, 11%), lower extremity (n = 48, 76%), and pelvis/spine (n = 8, 13%). OO in the pelvis/spine achieved the quickest complete pain relief (14 days) compared to those in lower (25 days, 11 days longer) and upper extremity (54 days, 40 days longer) respectively (p = 0.04). Vessel sign had significant association with shorter time to complete pain relief (p = 0.03). Longer duration of symptoms until diagnosis or RFA, larger nidus, more bone formation, and extra-articular OO responded slower to RFA, though statistical significance was not reached.

Conclusions: Anatomical location and certain imaging characteristics of OO may have association with time to complete pain relief following RFA. The findings can potentially help optimizing patient counseling with more realistic expectations and symptom management strategies prior to and following RFA.

Older men suffer from hip FFx (fragility fracture) at femoral neck T-score approximately 0.6 higher than older women, thus we proposed a new category of low BMD status, osteofrailia, for older Caucasian men with femoral neck T-score ≤ -2.0 (T-score ≤ -2.1 for older East Asian men) who have an increased risk of hip FFx. Around the age of 78 years, mean LS (lumbar spine) QCT BMD is around 68 mg/mL and 100 mg/mL for East Asian men and Caucasian men, respectively. For East Asian men, LS QCT BMD <68 mg/mL offers a sensitivity of 77% for detecting vertebral FFx cases, which is consistent with LS QCT BMD <80 mg/mL and < 50 mg/mL offering a vertebral FFx detection sensitivity of around 77% for Caucasian women and East Asian women, respectively. For Chinese men, T-score ≤ -2.5 predicts hip FFx risk better than other T-score values, and LS DXA T-score - 2.5 corresponds to QCT BMD 68 mg/mL. Hip FFx occur at approximately 0.5 LS T-score higher in Caucasian men than in Caucasian women. Among older Caucasian populations, for the separation of patients with FFx and without FFx, QCT BMD <100 mg/mL in older men is approximately comparable to <80 mg/mL in older women. For FFx risk prediction, we propose osteofrailia threshold LS DXA T-score to be ≤ - 2.5 and ≤ -2.0, and QCT BMD to be <68 mg/mL and < 100 mg/mL, respectively, for East Asian men and Caucasian men. The relationship between LS QCT BMD and hip FFx risk should be better investigated in the future.

Over the past decades, the growing pursuit of the "ideal body" has increased the demand for aesthetic procedures. There are four main types of procedures: autologous fat grafting, gluteal implants, dermal fillers, and local flaps. Fat grafting is the most commonly performed with the lowest complication rates, while implants are associated with higher risks. The use of dermal flaps is generally restricted to patients with massive weight loss, as in bariatric surgeries. Dermal fillers are not recommended by the Food and Drug Administration (FDA) for use on the buttocks; however, they have been increasingly used, especially by unqualified professionals. Complications include infections, seromas, hematomas, and suture dehiscence; however, the most feared complication is pulmonary embolism, more related to fat grafting and filling substances. Given the rising number of postoperative magnetic resonance imaging (MRI) exams, more and more radiologists have come across aesthetic gluteoplasty exams in daily practice and must understand the anatomy and the main anatomical variations of the gluteal region. Besides, it is important to have knowledge of the surgical techniques employed and actively look for potential postoperative complications related to each type of procedure. This article reviews surgical techniques, anatomical considerations, expected MRI findings, and common complications after gluteoplasty.

Objective: To characterize the clinical and imaging features of emphysematous osteomyelitis (EO) in a single-center cohort and to expand upon existing literature, which is largely limited to isolated case reports.

Materials and methods: This retrospective, IRB-approved study included patients identified through a PACS search for "intraosseous gas" or "intraosseous air" on CT or MRI from January 2014 to May 2025. Patients were excluded if intraosseous gas was attributable to trauma, open wounds, penetrating injury, or recent surgery. Clinical, laboratory, imaging, microbiologic, and histopathologic data were recorded.

Results: Of 382 patients with intraosseous gas, 20 were included in the study. The mean age was 63 years, and 80% were male. Diabetes mellitus was present in 75% of patients. The foot was the most commonly involved site (75%). The "pumice stone" sign was observed in 50% of cases. Osseous erosions, periostitis and soft tissue emphysema were seen in 60%, 15% and 85% of patients, respectively. Radiographs were less sensitive than CT or MRI. Erythrocyte sedimentation rate and C-reactive protein were markedly elevated (mean 114 mm/hr and 210 mg/L, respectively). Among 14 culture-positive cases, 64% were polymicrobial, most originating from the foot. Surgical intervention was required in 83% of patients, including amputation in 67%.

Conclusion: EO is a rare, aggressive infection that primarily affects older patients with diabetes. The foot was the most common site, frequently associated with polymicrobial infection. Characteristic imaging features of osteomyelitis, such as erosion and periostitis, may be absent. Early recognition is essential, as most patients require surgical intervention.

Objective: Determine the diagnostic characteristics of pre-reduction and post-reduction radiographs for bony lesions, identify associations between patient groups and bony lesions, and identify associations between the presence of certain bony lesions and others.

Materials and methods: A retrospective consecutive sample of anterior shoulder dislocation patients ≥ 12 years old presenting to the emergency department of the OLVG (Amsterdam) between January 2022 and July 2023 was included. The sensitivity and negative predictive value (NPV) for bony lesions on pre-reduction and post-reduction radiographs were compared. A reference standard was established by considering a lesion present when observed at least once. Associations with lesions were expressed as phi-values and R-values.

Results: Among 268 patients, the sensitivity and NPV of pre-reduction radiographs were lower compared to post-reduction radiographs for glenoid bone loss (sensitivity = 20-56% vs 61-92%; NPV = 91-94% vs 95-99%; n = 30) and bony Bankart lesions (sensitivity = 7-42% vs 91-94%; NPV = 68-94% vs 97-99%; n = 24). The 95% CI of pre-reduction radiographs were lower but had some overlap with post-reduction radiographs for Hill-Sachs lesions (sensitivity = 72-84% vs 80-90%; NPV = 60-72% vs 68-81%; n = 187), greater tubercle fractures (sensitivity = 76-96% vs 79-97%; NPV = 95-99% vs 96-99%; n = 45), and loose bodies (sensitivity = 13-65% vs 42-92%; NPV = 95-98% vs 97-99%; n = 14). Poor to very strong associations were identified between sex, age, and lesions with the presence of (other) lesions.

Conclusion: Post-reduction radiographs showed better diagnostic characteristics compared to pre-reduction radiographs for the identification of bony lesions. The age and sex of the patient and the presence of certain bony lesions were observed to be associated with the presence of (other) lesions.