Skeletal Radiology最新文献

Objectives: To identify clinical and radiographic findings of pediatric scaphoid fractures that predict the need for surgical treatment.

Methods: A retrospective review of pediatric patients (≤ 18 years) with scaphoid fractures, who underwent radiographic examination and treatment at our tertiary care pediatric hospital, between 2018 and 2024, identified all surgically treated patients. From the remaining conservatively treated patients, age matched comparisons were randomly selected. After randomization and blinded to outcome, skeletal age, fracture characteristics (location, displacement, comminution, articular involvement, perifracture radiodensity, lobulated perifracture resorption, fracture gap), and presence or absence of osteonecrosis were recorded. Findings were compared between surgically treated and conservatively treatd groups to identify predictors of surgery.

Results: Ninety-six children (81 males, 15 females, mean age: 15.0 ± 1.8 years, range: 11.0-17.8) included 48 in the surgery and 48 in the non-surgery groups. Proximal pole fractures (8.3%, 8/96), perifracture radiodensity (26.0%, 25/96), and presence of osteonecrosis (12.5%, 12/96) were uncommon, but were only found among patients in the surgery group. Presence of displacement (81.3% vs. 12.2%, p < 0.01) and more severe displacement (2.2 vs. 0.7 mm, p < 0.01), articular involvement (37.5% vs. 8.3%, p < 0.01), and lobulated perifracture resorption (64.6% vs. 10.4%, p < 0.01) were more common among patients in the surgery than patients in the non-surgery groups. Logistic regression analyses found proximal pole fractures (OR = 6.67, 95% CI: 1.48-16.78, p = 0.04), fracture displacement (OR = 6.30, 95% CI: 1.32-33.87, p < 0.01), and longer delay to initial radiographs (OR = 1.08, 95% CI: 1.04-1.18, p = 0.01) were independent predictors of surgery.

Conclusion: Children with scaphoid fractures are more likely to require surgery if radiographic evaluation is delayed, fracture is displaced, or involves the proximal pole.

Objective: To evaluate the cost-effectiveness of opportunistic CT for sarcopenia screening compared with standard-of-care clinical screening methods, using a decision-analytic model based on quality-adjusted life years (QALYs) and healthcare costs.

Materials and methods: We developed a decision-analytic model simulating a hypothetical cohort of 70-year-old male patients at risk for sarcopenia over a 3-year time horizon from a US healthcare system perspective. The model compared two screening strategies: standard-of-care clinical evaluation per EWGSOP2 guidelines (physical exam + DXA evaluation of lean mass) and opportunistic CT as measures of muscle mass and quality. Model inputs-including screening sensitivities/specificities, costs, utility values, and probabilities of cardiovascular complications-were derived from published literature. Incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) were calculated, and sensitivity analyses were performed to assess the robustness of findings across variable inputs.

Results: Opportunistic CT was the favored strategy, with lower costs ($845 vs. $1,295), comparable effectiveness (0.87 QALYs), and higher net monetary benefit ($86,037 vs. $85,588) relative to the standard-of-care strategy. The standard-of-care strategy's ICER was $47.7 million per QALY, exceeding our willingness-to-pay threshold of $100,000. Probabilistic sensitivity analysis across 100,000 simulations demonstrated that opportunistic CT was favored across all tested willingness-to-pay thresholds up to $200,000.

Conclusion: Opportunistic CT is a cost-effective strategy for sarcopenia screening, offering similar effectiveness at a lower cost compared to the standard-of-care approach. By leveraging existing imaging studies, opportunistic CT screening has the potential to enhance early detection and decrease the underdiagnosis of sarcopenia while also reducing the burden of additional DXA scans and clinical visits.

We describe the case of an 11-year-old boy with hemophilia B who presented with swelling and pain in the left index finger. The patient was referred to our hospital after first presenting to another hospital. The patient experienced slight difficulty making a fist because of limited flexion of the proximal interphalangeal joint. Radiography of the left index finger revealed an expansile remodeling osteolytic lesion with a well-defined sclerotic border and cortical thinning. The patient had prolonged activated partial thromboplastin times and decreased factor IX levels. We performed curettage of the tumor in the left proximal phalanx and artificial bone filling. A hemophilic pseudotumor was diagnosed. At 1 year postoperatively, the patient was able to mobilize the index finger without range of motion limitations. Radiography of the left index finger revealed no signs of recurrence. Hemophilic pseudotumor usually occurs in patients with severe hemophilia A; however, this is the first reported case of a hemophilic pseudotumor arising from the finger of a child with mild hemophilia B. When progressive expansile remodeling of bone in the hand of a patient with hemophilia is observed, the possibility of a hemophilic pseudotumor, regardless of the severity or type of hemophilia, should be considered.

Objectives: This study aimed to identify quantitative MRI features through radiomic analysis and to develop predictive models for determining the histological grade of myxoid liposarcoma (MLS).

Materials and methods: This retrospective single-center study included 57 patients with histologically confirmed MLS (30 low-grade, 27 high-grade). Tumors were segmented and 107 radiomic features were extracted from T1-weighted imaging (WI), T2-WI, short tau inversion recovery (STIR), apparent diffusion coefficient (ADC) maps, and contrast-enhanced (CE) images with and without fat saturation (FS). Features showing statistical significance (p < 0.05) were selected and used to develop predictive models, whose performance was assessed using cross-validation and reported as area under the curve (AUC).

Results: Mean age was 51.6 ± 14.7 years (32 men, 25 women). Radiomic analysis identified three significant features for T1-WI and STIR and 19 for T2-WI. For CE-T1-WI, CE-T1-FS-WI, and CE-3D, four, six, and three features were significant, respectively. Models based on T2-WI and CE-3D achieved the highest performance (AUC up to 0.88). Additional models trained exclusively on institutional T1-WI and T2-WI showed reduced performance on external validation, although AUCs improved when applied to patients scanned with the same vendor.

Conclusion: Radiomic analysis of pre-treatment MRI shows promising results in predicting histological grade of MLS. This study is novel in addressing grading rather than diagnosis alone, a distinction with clear clinical relevance for treatment planning and prognostic assessment. In particular, models based on T2-WI may complement conventional imaging and histopathology by providing whole-tumor quantitative grading, while multicentric validation is required for clinical application.

Objectives: To evaluate the diagnostic success of image-guided core needle biopsy (ICNB) of bone and soft tissue lesions in the pediatric population and what factors influence diagnostic success.

Methods: For 370 biopsies performed on 350 patients 18 years of age and younger, the diagnostic yield (proportion of biopsies histopathologically sufficient for diagnosis) and accuracy (proportion of biopsies in which ICNB specimen concordant with the reference standard histopathology from surgical excision) of the biopsies, as well as a series of patient, lesion-related, and technical factors, were retrospectively analyzed. Multivariate statistical analysis was performed to evaluate what factors predicted diagnostic yield and accuracy.

Results: Diagnostic yield was 95.1% (213/224) for bone biopsies and 97.1% (132/136) for soft tissue biopsies. Diagnostic accuracy was 93.1% (27/29) for bone biopsies and 88.4% (38/43) for soft tissue biopsies. Lesions of suspected benign etiology were found to be associated with lower diagnostic yield (OR = 15.2, p = 0.002) for bone biopsies, and increased total core length (OR = 3.3, p = 0.047) was found to be associated with higher yield for soft tissue biopsies. Increased needle gauge (OR = 2.9, p = 0.03) was found to be associated with higher accuracy for bone biopsies, and using a manual drill (compared to a battery-powered drill) was associated with lower accuracy (OR = 0.03, p = 0.03). Overall, 88.9% (32/36) of samples from the biopsy were sufficient for additional cytogenetic analysis. Complications occurred in 0.3% (1/370) of biopsies.

Conclusions: ICNB has a high rate of diagnostic success and a low complication rate and should be considered an alternative to open biopsy.

Gore-Tex or expandable polytetrafluorethylene (ePTFE) was commonly used for synthetic ACL and PCL graft reconstruction in the late 1980s, but was discontinued owing to high failure rates and osteolytic complications. While this is an uncommon complication within the initial 20 years of post-graft implantation, the effects of these ligaments at much longer follow-up have little documentation due to increasing rarity. We present a case of a 64-year-old male with massive osteolysis first suspected to be extensive subchondral cystic changes secondary to advanced osteoarthritis. Two years after the initial presentation of knee pain, the patient represented with a tibial plateau fracture through the massive osteolytic lesion. CT imaging and pathology favored particle wear osteolysis secondary to the implanted grafts. The patient was treated with partial graft removal and TKA with a revision-style tibial stem. This case highlights the rare, long-term complications of synthetic ligament grafts, including progressive osteolysis and pathologic fracture decades after implantation. Synthetic graft-related osteolysis should be considered in patients with a remote history of graft reconstruction presenting with late-onset joint instability or fractures. CT imaging is crucial in evaluating the degree of osteolysis as a staged surgical approach with bone grafting may be necessary for severe cases.

Objective: To evaluate differences in apparent diffusion coefficient (ADC) values between benign and malignant primary pediatric bone tumors and to assess their diagnostic accuracy in differentiating these tumors.

Materials and methods: We retrospectively analyzed MRI scans of 96 pediatric patients (54 males, 42 females; mean age 12.97 ± 3.9 years) with primary bone tumors who underwent diffusion-weighted imaging, including 48 benign and 48 malignant tumors. We measured ADCmean, ADCmin, and ADCmax of the solid tumor part, carefully avoiding cystic, necrotic, or sclerosed tumor areas. The Wilcoxon rank-sum test was used to test the distributional difference of benign vs malignant tumors. ROC curve analysis was performed to assess the diagnostic accuracy. The optimal cutoff of ADC values to differentiate benign and malignant bone tumors was defined as the point at which the Youden index, the sum of sensitivity and specificity, was maximized.

Results: The median values of the ADCmean, ADCmin, and ADCmax for benign bone tumors [1.34 (1.13-1.83), 0.98 (0.73-1.34), and 1.80 (1.57-2.46) × 10^-3mm²/s, respectively] were significantly higher compared to malignant bone tumors [0.93 (0.78-1.03), 0.59 (0.43-0.72), and 1.35 (1.22-1.66) × 10^-3mm²/s, respectively; all p < 0.05]. ADCmean yielded the highest diagnostic accuracy, with an optimal cutoff of 1.04 (0.94-1.15) × 10^-3mm²/s (sensitivity 77%, specificity 93%, AUC = 0.91). An ADCmin cutoff of 0.82 (0.65-0.98) × 10^-3mm²/s resulted in a sensitivity of 87.5%, specificity of 70.0%, and AUC of 0.85. An ADCmax cutoff of 1.48 (1.18-1.78) × 10^-3mm²/s achieved a sensitivity of 68%, specificity of 81%, and AUC of 0.80.

Conclusion: ADCmean, ADCmin, and ADCmax differ significantly between benign and malignant pediatric bone tumors, and the ADCmean provides the highest diagnostic accuracy.

Objective: Sciatic nerve injury is a rare, devastating complication of acetabular fracture.

Purpose: assess CT predictive value (bony features and perineural hematoma) for sciatic nerve injury following acetabular fracture.

Materials and methods: IRB-approved retrospective study (n = 471) from 2011 to 2022. Single rater evaluated each case for Judet-Letournel subtype, joint congruence loss, and posterior displacement. Three raters assessed perineural hematoma in zones 1-3: obturator internus, piriformis, and posterior thigh. EMG/NCS confirmed sciatic injury in 20 cases. Sensitivity, specificity, PPV, NPV, OR, and accuracy (AUC) were computed for each marker. Intra- and inter-rater reliability was calculated.

Results: Sciatic injury was most frequent in associated both column (8.0%) and transverse family (5.9%) fractures. Sensitivity and specificity of fracture features on sciatic injury were both column involvement (0.85 [17/20], 0.31 [140/451]), congruence loss (0.90 [18/20], 0.36 [163/451]), and posterior displacement (0.70 [14/20], 0.54 [244/451]). Joint congruence loss (OR 5.08, p = 0.016) and posteriorly displaced fragment (OR = 2.74, p = 0.04) were statistically significant (p < 0.05). For hematoma, sensitivity and specificity were zone 1, 0.65-0.80 [13/20-16/20] and 0.30-0.36 [136/451-161/451]; zone 2, 0.60-0.80 [12/20-16/20] and 0.39-0.57 [176/451-255/451]; and zone 3, 0.15-0.25 [3/20-5/20] and 0.69-0.86 [312/451-388/451]. AUC values were zone 1, 0.65-0.71 (satisfactory-to-good); zone 2, 0.69-0.71; and zone 3, 0.48-0.61 (poor-to-satisfactory). Values were significant in zones 1 and 2. Intra-rater reliability (Gwet's AC2) was almost perfect in zone 1 (0.86-0.87), moderate to almost perfect in zones 2-3 (0.47-0.90). Inter-rater agreement (Gwet's AC2) in zones 1-3 was 0.73 (substantial), 0.49 (moderate), and 0.50.

Conclusion: We found three statistically significant predictors of sciatic nerve injury following acetabular fracture: joint congruence loss, posteriorly displaced bone fragment, and perineural hematoma at the level of (a) obturator internus and (b) piriformis. Rater agreement for perineural hematoma was excellent for zone 1.

Objective: Percutaneous ultrasound-guided fenestration of ganglia (PUGG) in children has been a first line treatment option at our institution in lieu of surgical resection. The purpose of our study is to report our efficacy and safety of PUGG in symptomatic pediatric wrist ganglia, and to determine if any pre-procedural ultrasound findings help predict ganglia recurrence.

Materials and methods: A retrospective study of children who underwent PUGG of the wrist from May 2023 through November 2024 at an academic children's hospital was performed. Patients were excluded if the ganglion was ruptured on pre-PUGG imaging and were $\ge$ 19 years old. Patient demographics, pre-procedure ultrasound characteristics, procedure details, and recurrence/complications were collected by utilizing the electronic medical record and PACS. Continuous and categorical data were assessed with a significance level set to 0.05.

Results: There were 105 children (mean age (years):14.1 + / - 3.0 (4-18)) who underwent successful PUGG with 97.1% performed without sedation. Of these, 70 patients had optional clinical follow-up. Recurrence for the total population was 26.7% (28/105), and subset analysis for those patients with optional clinical follow-up was 40.0% (28/70). Ganglion symptom duration, ganglion size, presence of septations, internal debris, PUGG needle size, and steroid dosage did not statistically predict recurrence. Temporary numbness (2.9%) and site pain (7.6%) were the most common complications, and no children reported cosmetic scarring of the wrist.

Conclusion: PUGG is a safe, minimally invasive procedure to treat symptomatic pediatric wrist ganglia. With appropriate patient selection, PUGG can serve as a valuable first-line elective therapeutic treatment for wrist ganglia.