Skeletal Radiology最新文献

Osteoarthritis (OA) is a leading cause of pain, functional impairment, and disability in older adults. However, there are no effective treatments to delay and reverse OA. Magnetic resonance imaging (MRI) can assess structural abnormalities of OA by directly visualizing damage and inflammatory reactions within the tissues and detecting abnormal signals in the subchondral bone marrow region. While some studies have shown that bone marrow lesions (BMLs) are one of the early signs of the development of OA and predict structural and symptomatic progression of OA, others claimed that BMLs are prevalent in the general population and have no role in the progression of OA. In this narrative review, we screened and summarized studies with different designs that evaluated the association of BMLs with joint symptoms and structural abnormalities of OA. We also discussed whether BMLs may serve as an imaging biomarker and a treatment target for OA based on existing clinical trials.

Objective: Although some patients may experience collapse progression while others may not in post-collapse osteonecrosis of the femoral head (ONFH) with a necrotic lesion located within the weight-bearing part of the acetabulum (Type B/C1), few studies have focused on the natural course after collapse. This study aimed to clarify the correlation between necrotic volume (NV) and necrotic depth (ND) in predicting collapse progression in patients with post-collapse ONFH Type B/C1.

Materials and methods: We retrospectively reviewed 54 hips with post-collapse ONFH Type B/C1 from 52 consecutive patients who were conservatively followed up for more than 1 year. We measured the amount of femoral head collapse using biplane radiographs at each follow-up period, and produced Kaplan-Meier survival curves with collapse progression (≥ 1 mm) as the endpoint. We compared NV and ND, which were calculated as the ratio of the distance from the articular surface of the femoral head to the deepest point of a necrotic lesion to the femoral head diameter in the mid-coronal slice of T1-weighted magnetic resonance imaging (MRI).

Results: We observed collapse progression in 31 hips (57.4%). The NV and ND were significantly greater in hips with collapse progression than in those without collapse progression (p = 0.0127 and 0.0047, respectively). Necrotic volume was significantly correlated with ND　(rs = 0.56, p < 0.0001).

Conclusion: This study suggests that necrotic depth on the mid-coronal slice of T1-weighted MRI can be a substitute for necrotic volume to predict collapse progression in ONFH Type B/C1.

Objective: Fatty infiltration of skeletal muscle (Myosteatosis) is associated with increased frailty, decreased muscle and mobility function, which seems fairly prevalent in multiple myeloma (MM) patients. This study aimed to determine the prognostic value of myosteatosis assessed by CT for progression-free survival (PFS) and overall survival (OS).

Materials and methods: This IRB-approved cohort study included patients with newly diagnosed MM who were treated at a single university hospital and received CT at baseline. Geriatric assessment was performed via International Myeloma Working Group frailty score and Revised Myeloma Comorbidity Index. Myosteatosis was determined through measurement of paravertebral muscle radiodensity. Statistical analyses included uni- and multivariable Cox proportional hazard models and the Kaplan-Meier-method.

Results: A total of 226 newly diagnosed MM patients (median age: 65 years [range: 29-89], 63% males, mean BMI: 25 [14-42]) were analyzed. The prevalence of myosteatosis was 51%. Muscle radiodensity was significantly decreased in individuals with International Staging System stage III vs. I (p < 0.001), indicating higher fatty muscle infiltration in patients with advanced disease. Both PFS and OS were significantly decreased in patients with myosteatosis (PFS: median 32.0 months (95% CI 20.5.5-42.2) vs. 66.4 months without myosteatosis (95% CI 42.5-not reached), p < .001); OS: median 58.6 (95% CI 51.3-90.2) vs. not reached, p < .001). Myosteatosis remained an independent predictor of OS in multivariable analyses (HR: 1.98; 95%-CI: 1.20-3.27).

Conclusion: Myosteatosis seems fairly prevalent in patients with newly diagnosed MM and associated with impaired overall survival. Prospective clinical trials are required to better understand the role of myosteatosis in MM patients.

There are numerous cases reported of the accessory muscles of the hand and wrist in surgical, cadaveric, and imaging-based studies. Anatomical muscle variations in the flexor compartment of the wrist and forearm can present as a pseudo mass or space-occupying lesion causing external compression on the traversing nerves. Guyon's canal is a compact space with a high potential for nerve entrapment. Common etiologies include ganglion cysts, osteophytes, or soft tissue masses. This rare case illustrates the combined existence of two accessory muscles, an accessory flexor carpi ulnaris, and an accessory abductor digiti minimi, causing ulnar nerve compression in Guyon's canal with imaging correlation. One can raise the suspicion of an anomalous muscle when symptoms concern a patient of a younger age group in the absence of common etiologies. Furthermore, detailed anatomical knowledge of muscles around Guyon's canal is essential in making a diagnosis and aiding treatment.

Objective: To examine the association between medial meniscal extrusion and structural progression in adults with symptomatic knee osteoarthritis (OA).

Methods: This prospective cohort study examined 176 participants with symptomatic knee OA recruited into a randomised controlled trial. The participants underwent magnetic resonance imaging (MRI) of the study knee at baseline and approximately 2 years later. Meniscal extrusion, tibial cartilage volume, and tibiofemoral bone marrow lesions (BMLs) were measured from MRI using validated methods.

Results: Participants with medial meniscal extrusion ≥ 3 mm had a higher prevalence of lateral tibiofemoral BMLs at baseline (OR = 2.21, 95% CI 1.06-4.61, p = 0.035), and those with medial meniscal extrusion 2-3 mm had a higher likelihood of lateral BML worsening over 2 years (OR = 3.76, 95% CI 1.35-10.52, p = 0.011), compared with those with medial meniscal extrusion < 2 mm. Participants with stable medial meniscal extrusion had a lower likelihood of lateral BML worsening compared with those with regression of medial meniscal extrusion over 2 years (OR = 0.20, 95% CI 0.07-0.56, p = 0.002). There were no associations between medial meniscal extrusion and tibial cartilage volume or medial tibiofemoral BMLs.

Conclusions: Our study showed associations between medial meniscal extrusion and baseline prevalence and worsening over 2 years of lateral tibiofemoral BMLs in people with symptomatic knee OA. Although the reasons for the lack of associations in the medial compartment are not clear, our results suggest a role of medial meniscal extrusion in predicting structural progression in lateral knee OA and that meniscal extrusion might be a potential target in the management of knee OA.

Objective: To assess the accuracy of an artificial intelligence (AI) software (BoneMetrics, Gleamer) in performing automated measurements on weight-bearing forefoot and lateral foot radiographs.

Methods: Consecutive forefoot and lateral foot radiographs were retrospectively collected from three imaging institutions. Two senior musculoskeletal radiologists independently annotated key points to measure the hallux valgus, first-second metatarsal, and first-fifth metatarsal angles on forefoot radiographs and the talus-first metatarsal, medial arch, and calcaneus inclination angles on lateral foot radiographs. The ground truth was defined as the mean of their measurements. Statistical analysis included mean absolute error (MAE), bias assessed with Bland-Altman analysis between the ground truth and AI prediction, and intraclass coefficient (ICC) between the manual ratings.

Results: Eighty forefoot radiographs were included (53 ± 17 years, 50 women), and 26 were excluded. Ninety-seven lateral foot radiographs were included (51 ± 20 years, 46 women), and 21 were excluded. MAE for the hallux valgus, first-second metatarsal, and first-fifth metatarsal angles on forefoot radiographs were respectively 1.2° (95% CI [1; 1.4], bias =  - 0.04°, ICC = 0.98), 0.7° (95% CI [0.6; 0.9], bias =  - 0.19°, ICC = 0.91) and 0.9° (95% CI [0.7; 1.1], bias = 0.44°, ICC = 0.96). MAE for the talus-first, medial arch, and calcaneal inclination angles on the lateral foot radiographs were respectively 3.9° (95% CI [3.4; 4.5], bias = 0.61° ICC = 0.88), 1.5° (95% CI [1.2; 1.8], bias =  - 0.18°, ICC = 0.95) and 1° (95% CI [0.8; 1.2], bias = 0.74°, ICC = 0.99). Bias and MAE between the ground truth and the AI prediction were low across all measurements. ICC between the two manual ratings was excellent, except for the talus-first metatarsal angle.

Conclusion: AI demonstrated potential for accurate and automated measurements on weight-bearing forefoot and lateral foot radiographs.

Nodular fasciitis is a benign soft tissue pseudotumour typically occurring in the upper extremities, head and neck, thigh and trunk. It is most commonly seen in subcutaneous locations but also can be present in intramuscular and intermuscular (fascial) locations. Its occurrence in the hand is rare, and while it can occur in close proximity to tendons, its presentation as an intra-tendinous mass has not been previously described. We present a unique and rare case of nodular fasciitis arising within the flexor digitorum profundus (FDP) tendon of the hand in a 16-year-old female. The patient presented with a painful swelling in the volar aspect of the base of her left middle finger, with progressive flexion deformity of the finger. Ultrasound and magnetic resonance imaging revealed a mass within the FDP tendon of the middle finger. An ultrasound-guided biopsy revealed a diagnosis of nodular fasciitis. Given the self-limiting nature of the condition, she was managed conservatively with close clinical and imaging follow-up. This case highlights the importance of considering nodular fasciitis in the differential diagnosis of an intra-tendinous lesion in the hand, even though it is a rare occurrence in this location. The clinical presentation, diagnostic workup, and management of this unique case are discussed, emphasising the potential for its misdiagnosis as a malignancy which can have important implications in management.

Objective: A new axial loading device was used to investigate the effects of axial loading and positions on lumbar structure and lumbar spinal stenosis.

Methods: A total of 40 patients sequentially underwent 4 examinations: (1) the psoas-relaxed position MRI, (2) the extended position MRI, (3) the psoas-relaxed position axial loading MRI, (4) the extended position axial loading MRI. The dural sac cross-sectional area, sagittal vertebral canal diameter, disc height and ligamentum flavum thickness of L3-4, L4-5, L5-S1 and lumbar lordosis angle were measured and compared. A new device with pneumatic shoulder-hip compression mode was used for axial loading.

Results: In the absence of axial loading, there was a significant reduction in dural sac cross-sectional area with extension only seen at the L3-4 (p = 0.033) relative to the dural sac area in the psoas-relaxed position. However, with axial loading, there was a significant reduction in dural sac cross-sectional area at all levels in both psoas-relaxed (L3-4, p = 0.041; L5-S1, p = 0.005; L4-5, p = 0.002) and extension (p < 0.001) positions. The sagittal vertebral canal diameter and disc height were significantly reduced at all lumbar levels with axial loading and extension (p < 0.001); however, in psoas-relaxed position, the sagittal vertebral canal diameter was only reduced with axial loading at L3-4 (p = 0.018) and L4-5 (p = 0.011), and the disc height was reduced with axial-loading at all levels (L3-4, p = 0.027; L5-S1, p = 0.001; L4-5, p < 0.001). The ligamentum flavum thickness and lumbar lordosis in extension position had a statistically significant increase compared to psoas-relaxed position with or without axial loading (p < 0.001).

Conclusion: Both axial loading and extension of lumbar may exacerbate lumbar spinal stenosis. Axial loading in extension position could maximally aggravate lumbar spinal stenosis, but may cause some patients intolerable. For those patients, axial loading MRI in psoas-relaxed position may be a good choice.