Skeletal Radiology最新文献

Objectives: To assess if Lisfranc injury can be detected by US with and without abduction stress.

Methods: Eight cadaveric feet were obtained. The following measurements were obtained in the uninjured feet: C1M2 and C1C2 intervals and TMT1 and TMT2 dorsal step-off distances. Measurements were obtained both with and without abduction stress using ultrasound. The injury model was created by transecting the Lisfranc ligament complex, after which the observers performed the measurements again. Statistical analysis was used to identify differences between intact and injured models, to determine diagnostic cut-off values for identifying Lisfranc injuries, and to assess interobserver/intraobserver reliability.

Results: There was a significant difference in the mean C1M2 interval, both with and without abduction stress, between the intact and torn Lisfranc ligament (p < 0.001). A C1M2 interval with stress of > 2.03 mm yielded 81% sensitivity and 72% specificity for Lisfranc disruption. There was no significant difference in the mean C1C2 interval of the torn versus intact Lisfranc ligament without stress (p = 0.10); however, the distance was significantly different with the application of stress (p < 0.001). The C1C2 interval of > 1.78 mm yielded 72% sensitivity and 69% specificity for Lisfranc injury under stress. There were no significant differences in the mean TMT1 or TMT2 dorsal step-off measurements between the intact and torn Lisfranc ligaments. All observers showed good intraobserver ICCs. The interobserver ICCs for all measurements were good or excellent, except for TMT1, which was moderate.

Conclusion: Ultrasonography is a promising point-of-care imaging tool to detect Lisfranc ligamentous injuries when measuring C1M2 and C1C2 distances under abduction stress.

Objective: To analyze and quantify the change in United States of America Medicare reimbursement rates for the 30 most commonly performed spinal imaging procedures.

Materials and methods: The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was utilized to find and extract the 28 most billed spinal imaging procedures. All data was adjusted for inflation and listed in 2020 US dollars. Percent change in reimbursement and Relative Value Units between 2005 and 2020, both unadjusted and adjusted, were calculated and compared. Additionally, percent change per year and compound annual growth rate were calculated and compared.

Results: After adjusting for inflation, the average reimbursement for all analyzed spinal imaging procedures between the years 2005 and 2020 decreased by 45.9%. The adjusted reimbursement rate for all procedures decreased at an average 4.3% per year and experienced an average compound annual growth rate (CAGR) of - 4.4%. Magnetic resonance imaging (MRI) had the most substantial adjusted decline of all imaging modalities at - 72.6%, whereas x-ray imaging had the smallest decline at - 27.33%. The average total RVUs per procedure decreased by 50.1%, from 7.96 to 3.97.

Conclusion: From the years 2005 to 2020, Medicare reimbursement significantly decreased for all advanced imaging modalities involving the most common spinal imaging procedures. Among all practices, imaging procedures may be experiencing some of the largest decreases from Medicare reimbursement cutbacks.

Calcium pyrophosphate deposition (CPPD) disease is an arthropathy with increasing prevalence in the aging population that is associated with significant musculoskeletal morbidity. Although synovial fluid analysis (SFA) has been considered the gold standard for diagnosis, imaging is gaining an increasing role in the diagnosis and assessment of CPPD disease. Ultrasound (US) has proven to be useful in identifying calcium crystals while simultaneously assessing the surrounding inflammatory and structural damage consequent to calcific tissue deposition. Point-of-care ultrasound has the additional benefit of focusing the US evaluation to targeted symptomatic structures at the bedside, as well as allowing the sonographer to additionally scan joints frequently affected in CPPD disease to enhance the diagnostic utility of US. Furthermore, diagnostic and therapeutic procedures under US guidance can increase the yield of a diagnostic aspiration in CPPD disease and provide a therapeutic role in facilitating accurate delivery of medication in difficult to reach structures. Understanding the utility and limitations of US is essential to optimize the benefits of this imaging modality in the evaluation of CPPD disease.

Objective: Baker's cyst, or popliteal cyst, is a common knee condition associated with osteoarthritis and rheumatoid arthritis. While previous studies have explored the cyst's relationship with soft tissue abnormalities, the connection between popliteal cysts and medial knee bone morphology remains unclear. This study aims to assess the association between anatomical bone structures of the medial knee joint and popliteal cyst presence using magnetic resonance imaging (MRI).

Methods: A retrospective analysis was conducted on 100 patients who underwent MRI for knee pain between June and December 2021. Group 1 (n = 50) consisted of patients with Baker's cysts, and group 2 (n = 50) included those without cysts. MRI measurements included medial condyle width, condyle length, distal and posterior articular diameters, medial tibial plateau depth, and tibial slope. Cyst dimensions and volume were measured. Statistical analyses, including Pearson correlation and chi-square tests, were performed, with significance set at p < 0.05.

Results: No significant differences in medial knee bone morphology were found between groups (p > 0.05). However, popliteal cyst size was positively correlated with age (p = 0.016, r = 0.339 and p = 0.020, r = 0.328, respectively). Higher Kellgren-Lawrence grades were also associated with cyst presence (p = 0.001). Gender correlated with knee measurements, showing smaller knee dimensions in women (p < 0.001).

Conclusion: This study found no direct association between medial knee bone morphology and the presence of popliteal cysts. However, cyst size increased with age and degenerative changes, suggesting that inflammation and joint degeneration may play a significant role in cyst development. Further studies with larger cohorts are required to validate these findings.

Psoriatic arthritis (PsA) is a chronic inflammatory condition principally affecting the skin and musculoskeletal system, associated with comorbidities and decreased quality of life. Imaging is crucial for diagnosis, monitoring progression, and evaluating treatment efficacy; therefore, it plays an important role in PsA clinical trials. In this review, we aimed to characterize how imaging modalities and advances in imaging techniques are being used specifically in the PsA clinical trial literature. Following the Arksey and O'Malley framework for scoping reviews, we conducted a comprehensive search of multiple literature databases, from January 1, 2000, to June 27, 2024. We captured 1961 articles and after deduplication, title and abstract screening, and full-text review, 53 studies were included. Radiographs were the most used imaging modality (n = 32/53, 60%), and radiographic progression was frequently measured using the PsA-modified Sharp/van der Heijde score. MRI (n = 16/53, 30%) was used in evaluating peripheral and axial disease, with more recent adoption of validated scoring systems (PsAMRIS and SPARCC). Ultrasound (n = 11/53, 21%), including power Doppler, was used to assess soft tissue inflammation. Standardized scoring systems (e.g. GLOESS) were used in a minority of ultrasound-based studies. Multimodality imaging (n = 7/53, 13%) and CT (n = 2/53, 4%) was uncommon. The development of PsA-specific scoring systems for radiographs and MRI has been instrumental in advancing imaging assessment in PsA. However, their application remains limited, particularly in ultrasound, where further standardization is needed. Future clinical trials should focus on increasing the adoption of PsA-specific scoring systems, exploring advanced techniques (e.g. DCE-MRI), and multi-modal imaging to improve PsA disease monitoring.

Objective: The scaphotrapeziotrapezoid (STT) joint transmits load between the wrist and thumb. Despite its clinical importance, it has received less diagnostic attention than adjacent wrist and thumb joints. CT-derived three-dimensional models offer the ability to improve measurement of articular space by evaluating subchondral articular surfaces, which can be quantified using articular morphometrics. The objectives of this study were to investigate whether articular surface areas, interosseous proximities, and carpal bone positions differ between sexes.

Materials and methods: Thirty participants (50% female, median age 27.0 years) were prospectively recruited to a cohort study of normative wrist imaging and biomechanics. Carpal bones were meshed from CT-based segmentations using a marching cubes algorithm. Rigid body kinematic parameters of individual bones were calculated. Carpal bone postures were defined using projection angles between bone centroids. Articular surface areas and interosseous proximity distributions between adjacent bones were calculated. Morphometrics were compared between sexes using Wilcoxon rank sum or two-tailed Kolmogorov-Smirnov tests as appropriate.

Results: Median articular surface area was significantly smaller in females than in males at the trapeziotrapezoid but not scaphotrapezium or scaphotrapezoid joints. Interosseous proximity distributions were closer in females at all joints (scaphotrapezium, 1.19 versus 1.42 mm; scaphotrapezoid, 1.15 versus 1.43 mm; trapeziotrapezoid, 0.45 versus 0.65 mm). Distal bones were more dorsally translated in females.

Conclusion: This study quantifies sex-stratified morphological variations at the STT joint. Interosseous proximity distributions may guide interpretation of imaging-derived STT joint space and can serve as reference ranges for studies of STT arthrokinematics.

Objective: To validate the performance of the American College of Radiology (ACR) Bone-RADS™ in identifying malignant osteolytic bone tumors and to evaluate the inter-observer agreement between musculoskeletal radiologists performing ACR Bone-RADS™ assessments.

Methods: This single-center, retrospective study included patients who visited our orthopedic oncology department on January 2019-December 2020 for bone tumors. Three radiologists evaluated the initial radiographs and assessed whether the tumor was eligible for ACR Bone-RADS™ assessment considering its transverse location and radiodensity. For eligible tumors, the radiologists rated the descriptors of ACR Bone-RADS™ and calculated the Bone-RADS™ categories. Using multi-reader, multi-case analysis, the performance in identifying malignant bone tumors was assessed in terms of sensitivity and area under the receiver-operating-characteristic curve (AUC), while dichotomizing the Bone-RADS™ categories into potentially benign (categories 1-2) and potentially malignant (categories 3-4). Gwet's AC1 was calculated to evaluate inter-observer agreement on the categories. The proportion of malignancy in each Bone-RADS™ category was calculated.

Results: In total, 278 patients (mean age ± standard deviation, 40 ± 22 years; 161 men; and 93 with malignant tumors) were eligible for assessment. The sensitivity and AUC for discriminating malignancy using ACR Bone-RADS™ were 95.0% and 0.915, respectively. There was moderate inter-observer agreement on the ACR Bone-RADS™ category, with a Gwet's AC1 of 0.594 (95% confidence interval, 0.536-0.652). The proportions of malignancy were 0.0-1.2% in Bone-RADS™ category 1; 4.0-9.0% in category 2; 18.2-30.3% in category 3; and 77.7-83.3% in category 4.

Conclusion: The ACR Bone-RADS™ showed high diagnostic performance in detecting malignant osteolytic bone tumors, with moderate inter-observer agreement.

Objective: To evaluate the diagnostic performance and inter-reader reliability of the Bone Reporting and Data System (Bone-RADS) for solitary bone lesions on CT.

Materials and methods: This retrospective analysis included 179 patients (mean age, 56 ± 18 years; 94 men) who underwent bone biopsies between March 2005 and September 2021. Patients with solitary bone lesions on CT and sufficient histopathology results were included. Two radiologists categorized the bone lesions using the Bone-RADS (1, benign; 4, malignant). The diagnostic performance of the Bone-RADS was calculated using histopathology results as a standard reference. Inter-reader reliability was calculated.

Results: Bone lesions were categorized into two groups: 103 lucent (pathology: 34 benign, 12 intermediate, 54 malignant, and 3 osteomyelitis) and 76 sclerotic/mixed (pathology: 46 benign, 2 intermediate, 26 malignant, and 2 osteomyelitis) lesions. The Bone-RADS for lucent lesions had sensitivities of 95% and 82%, specificities of 11% and 11%, and accuracies of 57% and 50% for readers 1 and 2, respectively. The Bone-RADS for sclerotic/mixed lesions had sensitivities of 75% and 68%, specificities of 27% and 27%, and accuracies of 45% and 42% for readers 1 and 2, respectively. Inter-reader reliability was moderate to very good (κ = 0.744, overall; 0.565, lucent lesions; and 0.851, sclerotic/mixed lesions).

Conclusion: Bone-RADS has a high sensitivity for evaluating malignancy in lucent bone lesions and good inter-reader reliability. However, it has poor specificity and accuracy for both lucent and sclerotic/mixed lesions. A possible explanation is that proposed algorithms heavily depend on clinical features such as pain and history of malignancy.

Objectives: To explore the feasibility of simultaneous multi-slice (SMS) technique for reducing acquisition times in readout-segmented echo planar imaging (RESOLVE) for diffusion tensor imaging (DTI) of the knee.

Materials and methods: A total of 30 healthy volunteers and 23 patients with knee acute injury (12 cases with anterior ligament (ACL) tears and 16 cases with patellar cartilage (PC) injury) were enrolled in this prospective study. Three DTI protocols were used: conventional RESOLVE-DTI with 12 directions (protocol 1), SMS-RESOLVE-DTI with 12 directions (protocol 2) and 20 directions (protocol 3). DTI parameters of gastrocnemius, ACL and posterior cruciate ligament (PCL), and PC from three protocols were quantitatively assessed.

Results: For volunteers, protocol 2 significantly reduced acquisition time by 38.6% and 34.2% compared to protocols 1 and 3 while maintaining similar high-quality images and similar diffusive parameters, except for the fractional anisotropy (FA) and axial diffusivity (AD) of the PC between protocols 2 and 1 (P < 0.05). For injured ACL and PC, protocols 1 and 2 showed similar accurate diffusive parameters (except for AD, P = 0.025) and similar diagnostic efficacy, which demonstrated significantly lower FA and higher radial diffusivity (RD) in protocols 1 and 2 compared to volunteers (P < 0.05).

Conclusions: The 12-direction SMS-RESOLVE-DTI demonstrated a favorable balance between acquisition time and image quality, making it a promising alternative to conventional DTI for evaluating ligament and cartilage injuries.

Advances in knowledge: The SMS technique greatly reduces acquisition time while maintaining image quality, which signified the possibility of DTI's clinical application.