Skeletal Radiology最新文献

Objectives: This study aimed to compare diagnostic performance and reporting efficiency for evaluating degenerative musculoskeletal conditions of the lumbar spine of a structured template against the free-narrative approach.

Methods: We developed a structured reporting template through interdisciplinary consensus assessing the key categories spinal canal stenosis, disc herniation, neuroforaminal stenosis, recess stenosis, alignment, and activated arthrosis. A 2nd-year radiology resident and a senior radiologist read the lumbar spine MRI of seventy-eight patients using the structured and free-narrative report reading approach in a blinded manner. The reports of a third, subspecialized senior radiologist in consensus with the initial clinical reports constituted the gold standard. We statistically compared the primary outcomes reporting time, diagnostic accuracy in the key categories, and diagnostic confidence between structured and free-narrative report reading.

Results: Structured reporting significantly reduced reporting time (8 vs. 21 min) and diagnostic confidence of the resident. In reporting of the resident, the structured approach yielded higher accuracy in neuroforaminal stenosis (p = 0.0002), higher sensitivity in spinal canal stenosis (p = 0.0156) and disc herniation (p = 0.0010), but lower specifity and accuracy in disc herniations (p = 0.0001, and p = 0.0011). The senior radiologist performed overall better with free-narrative report reading, mainly due to better specifity.

Conclusions: Structured reporting may enhance diagnostic confidence and reduce reporting time for residents, making it particularly valuable in early training stages. However, experienced radiologists may not benefit in terms of efficiency. Free-narrative reports retain advantages in identifying subtle findings, highlighting the importance of a balanced integration of both methods in clinical practice.

Objective: To evaluate the relationship of depth of the bicipital groove at the shoulder and chronicity of long head biceps tendon tear. To assess the effect of long head biceps tendon (LHBT) tears on the depth of the bicipital groove over time on shoulder MRI.

Materials and methods: A retrospective study was conducted in two cohorts. The first cohort included age, gender, and BMI-matched patients with either a complete LHBT tear or an intact tendon on a single shoulder MRI. Bicipital groove depth was compared between these two groups. The second cohort consisted of patients with a complete LHBT tear and one or more follow-up shoulder MRIs, used to evaluate longitudinal changes in groove depth.

Results and conclusion: In the first cohort (n = 80; 40 complete LHBT tears, 40 intact tendons), the average bicipital groove depth was significantly shallower in the tear group (3.38 ± 1.23 mm) compared to the intact group (5.33 ± 0.87 mm) (p < 0.0001). In the second cohort (n = 31), initial groove depth averaged 4.94 ± 1.37 mm, decreasing to 2.47 ± 1.44 mm on follow-up MRI at an average of 40 months. The findings suggest that the morphology of the bicipital groove is maintained by the presence of an intact LHBT. Complete tears result in a gradual, measurable decrease in groove depth. Recognition of groove shallowing on MRI may serve as a secondary sign of chronic long head biceps tendon tear, aiding in diagnosis and assessment of chronicity.

Objectives: To determine the diagnostic accuracy of a wrist MR-arthrography (MR-A) protocol using iodinated contrast agent only compared to wrist diagnostic arthroscopy in the detection of tears of intrinsic ligaments and triangular fibrocartilage complex (TFCC).

Materials and methods: This study retrospectively enrolled 39 patients who underwent MR-A using iodinated contrast agent only before arthroscopic examination between May 2019 and December 2021. For each patient, a resident (R1) and an experienced musculoskeletal radiologist (R2) independently reviewed the MR-A dataset. The performance in detecting and characterizing tears of intrinsic ligaments and TFCC was calculated against arthroscopic reports. Intra- and interrater agreements for MR-A were calculated too.

Results: Prevalence of ligament tear was 74% for scapholunate (SL) ligament, 51% for lunotriquetral (LT) ligament and 64% for TFCC. Wrist arthroscopy revealed cartilage lesions in 25.6%. Concerning SL tears, sensitivity, specificity, and accuracy of MR-A were 1.00, 0.70, and 0.92 (R1) and 0.90, 0.90, and 0.90 (R2). For LT tears, sensitivity, specificity, and accuracy were 0.90, 0.74, and 0.82 (R1) and 0.90, 0.84, and 0.87 (R2). Regarding TFCC tears, sensitivity, specificity, and accuracy were 0.80, 0.79, and 0.79 (R1) and 0.96, 0.86, and 0.92 (R2). Concerning SL tear characterization (partial versus complete tear), agreement between MR-A and arthroscopy was good (0.62 [0.42-0.83] for R1; 0.76 [0.60-0.91] for R2). Interobserver and intraobserver agreements for MR-A assessment were respectively good (0.68 [0.56-0.79]) and very good (0.92 [0.86-0.98]).

Conclusions: MR-arthrography with iodinated contrast agent only displays high sensitivity and specificity for ligamentous injuries, making this technique an interesting option for exploring wrist pain.

Objectives: Radiological appearance of benign and malignant rib lesions is often similar, making biopsy essential for accurate diagnosis. However, factors influencing rib biopsy success have not been thoroughly explored. This study aims to evaluate factors affecting the success of CT-guided rib biopsies in patients with suspected malignancy.

Methods: Retrospective analysis was conducted on CT-guided rib biopsies performed in our hospital between 2016 and 2023. The outcome reference was based on tissue examination and/or clinical and radiological follow-up to 6 months post-procedure. Biopsies were categorized as "diagnostic," "adequate," or "non-diagnostic" based on the outcome reference. The total success rate was calculated based on the sum of diagnostic and adequate biopsies.

Results: Of a total of 38 rib biopsies, 20 were classified as diagnostic, six as adequate, and 12 as non-diagnostic based on the outcome reference. There were 20 voluminous lesions (volume > 500 mm³): 13 diagnostic, two adequate, and five non-diagnostic. Of the 18 non-voluminous biopsied lesions (volume < 500 mm³), seven were classified as diagnostic, four as adequate, and seven as non-diagnostic. Out of 24 osteolytic lesions, 16 were successfully diagnosed, while 8 were non-diagnostic. Among 14 sclerotic lesions, 10 were successfully diagnosed, and 4 were non-diagnostic. No statistically significant correlations were found between biopsy success and either the lesion volume or the needle insertion angle. Complications were encountered in 4 cases (11%).

Conclusions: CT-guided rib biopsy is an effective diagnostic method. However, given the relatively high complication rate, the procedure should be used judiciously and preferably performed by radiologists experienced in musculoskeletal biopsies.

Objectives: The purpose of this study is to compare three commonly used classification systems for MRI grading of acute muscle injury concerning their inter-reader reliability.

Methods: Ethical committee approval was obtained. Inclusion criteria comprised patients with acute muscle injury, age ≥ 18 years, and signed informed consent. MR examinations were evaluated by four independent musculoskeletal radiologists. Muscle injuries were graded according to the British Athletics Muscle Injury Classification (BAMIC), the Munich Consensus Injury Classification (MCIC), and the Chan et al. Injury Classification (CIC). Inter-reader reliability was quantified with Fleiss' Kappa (κ) and associated 95% confidence interval (CI).

Results: One hundred eleven acute muscle injuries in 110 patients (84% males) were assessed. Injured muscle groups included 85 thigh injuries (44 hamstrings, 41 non-hamstrings), 19 lower leg injuries, and 7 injuries in other locations. κ values (CI) were 0.506 (0.499, 0.514) for BAMIC, 0.566 (0.549, 0.584) for MCIC, and 0.306 (0.302, 0.311) for CIC. The highest reproducibility was seen for non-hamstring injuries in the thigh using MCIC 0.749 (0.720, 0.777), the lowest for lower leg injuries using CIC 0.199 (0.185, 0.213). Injury severity showed greater reproducibility (κ = 0.594-0.696) than the location of the injury within the muscle (κ = 0.349-0.576).

Conclusions: The MCIC and BAMIC demonstrate moderate inter-reader reliability, whereas the CIC demonstrates fair inter-reader reliability. The challenge with the classifications is the reproducibility of localizing the injury anatomically within the muscle, rather than classifying injury severity. Non-hamstring thigh injuries were most reproducible with MCIC, while lower leg injuries were least reproducible with CIC.

Objective: To investigate the longitudinal association between diabetes and changes in vertebral bone mineral density (BMD) derived from conventional chest CT and to evaluate whether kidney function (estimated glomerular filtration rate (eGFR)) modifies this relationship.

Materials and methods: This longitudinal study included 1046 participants from the Multi-Ethnic Study of Atherosclerosis Lung Study with vertebral BMD measurements from chest CTs at Exam 5 (2010-2012) and Exam 6 (2016-2018). Diabetes was classified based on the American Diabetes Association criteria, and those with impaired fasting glucose (i.e., prediabetes) were excluded. Volumetric BMD was derived using a validated deep learning model to segment trabecular bone of thoracic vertebrae. Linear mixed-effects models estimated the association between diabetes and BMD changes over time. Following a significant interaction between diabetes status and eGFR, additional stratified analyses examined the impact of kidney function (i.e., diabetic nephropathy), categorized by eGFR (≥ 60 vs. < 60 mL/min/body surface area).

Results: Participants with diabetes had a higher baseline vertebral BMD than those without (202 vs. 190 mg/cm³) and experienced a significant increase over a median followpup of 6.2 years (β = 0.62 mg/cm³/year; 95% CI 0.26, 0.98). This increase was more pronounced among individuals with diabetes and reduced kidney function (β = 1.52 mg/cm³/year; 95% CI 0.66, 2.39) compared to the diabetic individuals with preserved kidney function (β = 0.48 mg/cm³/year; 95% CI 0.10, 0.85).

Conclusion: Individuals with diabetes exhibited an increase in vertebral BMD over time in comparison to the non-diabetes group which is more pronounced in those with diabetic nephropathy. These findings suggest that conventional BMD measurements may not fully capture the well-known fracture risk in diabetes. Further studies incorporating bone microarchitecture using advanced imaging and fracture outcomes are needed to refine skeletal health assessments in the diabetic population.

Objective: Identifying periosteal entrapment in pediatric physeal fractures is crucial for making treatment decisions. The purpose of this study is to evaluate the diagnostic value of radiographic indices in predicting periosteal entrapment in pediatric proximal phalangeal base physeal fractures of the toes.

Materials and methods: This retrospective study included 35 pediatric patients with proximal phalangeal base physeal fractures, 15 of whom exhibited periosteal entrapment confirmed via MRI. Physeal fracture distance, diaphyseal axis-metatarsal head deviation angle, and the presence of a rim fragment sign were assessed on anteroposterior radiographs. Diagnostic performance was evaluated using ROC analysis, and optimal cut-off values were determined using Youden's index. Logistic regression models were developed to examine the added value of combining multiple radiographic indices for predicting periosteal entrapment.

Results: Physeal fracture distance and diaphyseal axis-metatarsal head deviation angle measured on radiographs showed excellent diagnostic performance, with AUC values of 0.94 and 0.93, respectively. Optimal cut-off values were 1.97 mm for physeal fracture distance (sensitivity 93%, specificity 85%) and 9.5° for diaphyseal axis-metatarsal head deviation angle (sensitivity 80%, specificity 95%). Combined models incorporating the rim fragment sign with either physeal fracture distance or diaphyseal axis-metatarsal head deviation angle yielded higher AUCs of 0.97 and sensitivities of 100%.

Conclusions: Physeal fracture distance and diaphyseal axis-metatarsal head deviation angle are valuable radiologic markers for predicting periosteal entrapment in pediatric proximal phalangeal base fractures of toes. When used in conjunction with these radiologic measurements, the rim fragment sign may further improve diagnostic accuracy.

Objective: To develop and validate a deep learning model for automated 3D segmentation of rotator cuff muscles on longitudinal CT scans to quantify muscle volume and fat fraction in patients undergoing total shoulder arthroplasty (TSA).

Methods: The proposed segmentation models adopted DeepLabV3 + with ResNet50 as the backbone. The models were trained, validated, and tested on preoperative or minimum 2-year follow-up CT scans from 53 TSA subjects. 3D Dice similarity scores, average symmetric surface distance (ASSD), 95th percentile Hausdorff distance (HD95), and relative absolute volume difference (RAVD) were used to evaluate the model performance on hold-out test sets. The trained models were applied to a cohort of 172 patients to quantify rotator cuff muscle volumes and fat fractions across preoperative and minimum 2- and 5-year follow-ups.

Results: Compared to the ground truth, the models achieved mean Dice of 0.928 and 0.916, mean ASSD of 0.844 mm and 1.028 mm, mean HD95 of 3.071 mm and 4.173 mm, and mean RAVD of 0.025 and 0.068 on the hold-out test sets for the pre-operative and the minimum 2-year follow-up CT scans, respectively.

Conclusion: This study developed accurate and reliable deep learning models for automated 3D segmentation of rotator cuff muscles on clinical CT scans in TSA patients. These models substantially reduce the time required for muscle volume and fat fraction analysis and provide a practical tool for investigating how rotator cuff muscle health relates to surgical outcomes. This has the potential to inform patient selection, rehabilitation planning, and surgical decision-making in TSA and RCR.

Gout is an inflammatory arthritis caused by monosodium urate crystal deposition, often resulting in joint pain and impaired function. While pharmacologic treatments are usually effective, some patients with persistent inflammation and hypervascular tophi may experience suboptimal responses, necessitating alternative approaches. We present the case of a 63-year-old male with chronic right knee pain due to tophaceous gout that was unresponsive to standard medical therapy. Imaging demonstrated calcified tophi with associated hypervascularity in the knee joint. Transarterial microembolization (TAME) using imipenem/cilastatin (IPM/CS) was performed, targeting abnormal vascular blushes identified on angiography. The patient reported significant pain relief shortly after the procedure. Subsequently, febuxostat with prophylactic colchicine was initiated as urate-lowering therapy. This case illustrates the feasibility of TAME as a potential adjunctive treatment in selected patients with refractory tophaceous gout. Additionally, pre-procedural imaging, such as contrast-enhanced magnetic resonance imaging (MRI), may help identify patients who are more likely to benefit from TAME.

Objective: High-resolution CT (HR-CT) cannot image trabecular bone due to insufficient spatial resolution. Ultra-high-resolution CT may be a valuable alternative. We aimed to describe the accuracy of Canon Medical HR, super-high-resolution (SHR), and ultra-high-resolution (UHR)-CT in measuring trabecular bone microarchitectural parameters using micro-CT as a reference.

Material and methods: Sixteen cadaveric distal tibial epiphyses were enrolled in this pre-clinical study. Images were acquired with HR-CT (i.e., 0.5 mm slice thickness/512² matrix) and SHR-CT (i.e., 0.25 mm slice thickness and 1024² matrix) with and without deep learning reconstruction (DLR) and UHR-CT (i.e., 0.25 mm slice thickness/2048² matrix) without DLR. Trabecular bone parameters were compared.

Results: Trabecular thickness was closest with UHR-CT but remained 1.37 times that of micro-CT (P < 0.001). With SHR-CT without and with DLR, it was 1.75 and 1.79 times that of micro-CT, respectively (P < 0.001), and 3.58 and 3.68 times that of micro-CT with HR-CT without and with DLR, respectively (P < 0.001). Trabecular separation was 0.7 times that of micro-CT with UHR-CT (P < 0.001), 0.93 and 0.94 times that of micro-CT with SHR-CT without and with DLR (P = 0.36 and 0.79, respectively), and 1.52 and 1.36 times that of micro-CT with HR-CT without and with DLR (P < 0.001). Bone volume/total volume was overestimated (i.e., 1.66 to 1.92 times that of micro-CT) by all techniques (P < 0.001). However, HR-CT values were superior to UHR-CT values (P = 0.03 and 0.01, without and with DLR, respectively).

Conclusion: UHR and SHR-CT were the closest techniques to micro-CT and surpassed HR-CT.