Skeletal Radiology最新文献

Objectives: To systematically assess whether MRI-based measurements of glenoid bone loss (GBL) are comparable to CT in patients with shoulder instability.

Methods: We searched PubMed, Cochrane Library, Web of Science, and Embase for studies comparing GBL measurements between CT and MRI through May 16, 2024. We performed subgroup analyses based on 2D versus 3D imaging and linear versus area measurement methods. We conducted statistical analysis using Review Manager (RevMan) version 5.4.1, applying a random-effects model to calculate the mean difference.

Results: Eleven studies were included, totaling 492 shoulders. Of these, 119 shoulders were evaluated using 3D MRI versus 3D CT, 126 using 2D MRI versus 2D CT, 292 using the linear method, and 149 using the area method. The pooled analysis showed no significant difference in GBL measurements between MRI and CT (mean difference -0.05; 95% CI: -0.26 to 0.15; p = 0.61). Subgroup analyses also showed no significant differences (p = 0.94 for 3D, p = 0.14 for 2D, p = 0.67 for linear, p = 0.46 for area, and p = 0.51 comparing linear vs area methods).

Conclusions: MRI provides GBL measurements comparable to CT across various imaging protocols including 2D and 3D approaches and the linear and area methods. MRI may be sufficient as the sole imaging modality for comprehensive preoperative evaluation in patients with shoulder instability.

Objectives: To determine whether MRI can differentiate hips with nonspecific inflammatory conditions from controls based on measurements of the capsule and to identify the most significant measurements.

Methods: In this retrospective and case-control study, we reviewed hip MRIs containing the term "capsulitis" in the reports. Cases with other known diagnoses or confounding joint pathologies were excluded. Controls were asymptomatic hips with normal laboratory results. Three musculoskeletal radiologists independently reviewed the studies, assessing for qualitative (edema, enhancement, effusion, synovitis, and subjective thickening) and quantitative (capsular thickness in standardized planes) parameters. Interobserver agreement, group comparisons, and optimal cutoffs were analyzed.

Results: The final study group comprised 38 cases, and the control group included 51 matched subjects. Inter-reader agreement was moderate to excellent. For capsular thickness, ICC ranged from 0.49 (posterior sagittal) to 0.87 (anterior sagittal). For qualitative findings, kappa ranged from 0.59 (capsular enhancement) to 0.84 (joint effusion), the greatest being capsular thickening and effusion. All planes showed significantly larger capsular thickness in cases vs. controls (p < 0.05). Sensitivity reached 85.2% for anterior sagittal measurement (mean, 6.27 vs. 4.58 mm), and specificity reached 84% for lateral coronal (6.53 vs. 4.13 mm). Among cases, capsular signal abnormality was observed in 89.2% of cases, pericapsular edema in 91.9%, capsular enhancement in 97.3%, pericapsular enhancement in 94.6%, joint effusion in 81.1%, synovitis in 89.2%, and capsular thickening in 100% of cases.

Conclusions: Our study reveals increased hip capsular thickness in nonspecific inflammatory conditions of the hip (capsulitis), both for qualitative and quantitative assessments.

Objective: To develop a predictive model for estimating the histological response to preoperative chemotherapy based on imaging data in patients with Ewing sarcoma.

Materials and methods: We included 133 patients with Enneking stage IIB or IIIB Ewing sarcoma who underwent chemotherapy and definitive surgery between 2003 and 2020. We analyzed various radiological parameters before and after preoperative chemotherapy. The necrotic area was evaluated using gadolinium-contrasted magnetic resonance imaging (radiological necrotic grade). Patients were classified as good histological responders if > 95% of their resected specimens showed necrosis; otherwise, they were classified as poor responders. Radiological parameters were assessed using the least absolute shrinkage and selection operator (LASSO) with cross-validation. Optimal regularization parameters were identified as those minimizing cross-validation error. The area under the curve (AUC) was calculated based on the predictive model with the selected parameters for training and test data using receiver operating characteristic (ROC) curve.

Results: LASSO models identified key parameters including volume change, radiological necrotic grade, complete regression of the extraskeletal component, and the disappearance of peritumoral gadolinium-enhancement after preoperative chemotherapy. ROC curve analysis showed that the predictive model achieved measurable discrimination ability on both training and test datasets (AUC = 0.89 [95% confidence interval (95%CI); 0.83-0.95] on training data, 0.77 [95%CI; 0.58-0.95] on test data).

Conclusion: The developed model may facilitate accurate monitoring of the efficacy of preoperative chemotherapy in patients with Ewing sarcoma. Identifying patients with a poor histological response to preoperative chemotherapy can aid in the planning of secure surgical margins and effective treatment strategies.

Paget's disease of bone (PDB) is a skeletal remodeling disorder diagnosed primarily via radiographs. In long bones, the early lytic stage of the disease is characterized by flame-shaped or blade of grass radiolucent bone resorption beginning in subchondral bone with variable length of extension into the metadiaphysis, and the later stages show bone expansion, cortical thickening, and coarsening of the trabeculae [1, 2]. Despite the usually diagnostic features, other considerations with overlapping appearance include aggressive benign and malignant bone tumors [3]. Malignancy such as lymphoma can present shared clinical features to PDB. When there is doubt as to the diagnosis, biopsy should be performed. A 60-year-old male presented with chronic left lower extremity pain. Radiographs showed a flame-shaped lytic lesion in the left femur with corresponding uptake on the bone scintigraphy. Radiographic features were suggestive of PDB, but due to some atypical findings, a biopsy was performed and showed small lymphocytic lymphoma (SLL) in the setting of chronic lymphocytic leukemia (CLL). This diagnosis led to the patient being promptly treated with targeted therapy and radiation. Pathologic verification is critical in an aberrant presentation of PDB to mitigate misdiagnosis and establish an appropriate therapeutic course.

Objectives: EOS bi-planar imaging enables three-dimensional (3D) reconstructions of the spine and pelvis with segmental vertebral measurements in three planes from a neutral pelvis. This study evaluates the repeatability of these measurements and the accuracy in detecting true changes.

Methods: Twenty patients from four clinical backgrounds (surgical threshold, bracing threshold, micro-dose, and in-brace) were included. EOS bi-planar "full spine" images were modelled and then subsequently re-modelled at least 4 weeks later by the same researcher. All 3D measurements were recorded and compared.

Results: The average modelling interval was 6.7 weeks. Paired measures indicated high agreement, except for planes of maximal curvature (PMC): thoracic (Spearman's = 0.67; p < 0.05) and lumbar (Spearman's = 0.40; p > 0.05). Intraclass correlation coefficients (ICCs) showed excellent agreement, with thoracic and lumbar Cobb angles averaging 0.99. Sagittal measurements ranged from 0.93 (L1/S1 lordosis) to 0.96 (T1/T12 kyphosis). Pelvic parameters ranged from 0.88 (obliquity) to 0.99 (tilt). The transverse profile ranged from 0.82 (apical thoracic rotation) to 0.98 (average lumbar rotation). Repeatability (2.77 × technical error of measurement [TEM]) was ± 4.4° for Cobb angles, ± 7.7° for sagittal profile, ± 5.0° for pelvic parameters, ± 4.8° for transverse profile, and ± 100.4° for automated thoracic and lumbar PMC. With strong outliers excluded, thoracic PMC was ± 16.2° and lumbar PMC was ± 15.5°.

Conclusion: 3D EOS measurements demonstrate excellent intra-rater ICC repeatability despite notable true measurement error that should define future success criteria. Semi-automated modelling provides quick 3D spinal alignment measurements from a neutral pelvis, with this study being the first to report TEM for 3D EOS reconstructions. PMC disagreement indicates the need for further investigation.

Objectives: To evaluate whether dual-layer spectral computed tomography, compared with conventional CT, improves diagnostic accuracy for osteolytic vertebral metastases. Furthermore, to investigate the influence of dual-layer CT on the subjective visibility of metastases.

Materials and methods: In this single-center retrospective study, consecutive patients with an untreated primary tumor who underwent dual-layer CT and either MRI or PET-CT as reference standard within 14 days were included. Two independent observers, blinded to the reference, performed two scorings. First, the conventional CT was scored and the results were recorded. Subsequently, Calcium suppression, monoenergetic (monoE40 and monoE200), and Z-effective reconstructions were added. Subjective visibility was compared to conventional CT using a 5-point Likert scale. Diagnostic accuracy measures were calculated with 95% confidence intervals. Sensitivity and specificity were compared using the McNemar's test.

Results: Fourteen patients (63 ± 8 years; 64.3% female) and 189 vertebrae were included, with 46 vertebrae showing 58 metastases with a mean diameter of 18 mm (range 5-53 mm). For conventional CT, the sensitivity, specificity, and diagnostic accuracy for observer A and B were, respectively, 57% and 57%, 96% and 90%, 85% and 81%. The diagnostic performance did not improve when using the dual-layer CT reconstructions in addition to conventional CT (p ≥ 0.13). MonoE40 improved the subjective visibility of metastases. Interobserver agreement was moderate for conventional CT (ĸ:0.48), and dual-layer CT reconstructions (ĸ:0.41-0.51).

Conclusion: Dual-layer CT reconstructions did not improve diagnostic accuracy for osteolytic vertebral metastases compared with conventional CT, although subjective visibility was improved on low monoenergetic reconstructions.

We report a very rare case of an intraossesous extra-axial chordoma (EAC) involving the distal femur. We describe the clinical presentation, radiologic and pathological findings, and the treatment. In addition, a systematic literature search was performed to further expand the knowledge regarding EAC in the lower extremities, including 13 papers describing a total of 21 adult patients.

Atypical proximal tibial fractures in adolescents are rare, particularly when linked to hormonal therapy for short stature. This case series reports the clinical and imaging features of atypical proximal tibial and distal femoral physeal fractures in male adolescents undergoing combined growth hormone (GH) and aromatase inhibitor (AI) therapy for idiopathic short stature. We report three cases of skeletally immature male adolescents (ages 12-16) treated with GH and anastrozole who presented with acute leg pain following low-energy trauma during soccer. Computed tomography (CT) imaging identified fractures through the physis and metaphysis with characteristic anterior displacement-resembling an "opened-bottle" configuration. Fractures occurred during periods of rapid growth with delayed physeal closure and reduced bone mineral density. Two cases were managed surgically, and one conservatively. Salter-Harris and Ogden classification systems were used. These cases highlight the potential impact of growth-modulating therapies on bone integrity, particularly their influence on the growth plate and overall bone strength, which may increase fracture risk. Imaging and clinical findings emphasize the role of hormone-related delayed physeal closure and altered biomechanics in fracture development. This report aims to raise awareness of this complication and explores possible mechanisms connecting therapy to these atypical injuries.

Objective: A plantar fibroma (PF) is a painful benign lesion in which fibrous tissues infiltrate the plantar aponeurosis. The largest study published to date on MRI characteristics of PF includes only 16 patients. The aim was to systematically evaluate MRI characteristics of PFs from the database of our tertiary care center imaged over a decade with patient symptom analysis.

Materials and methods: This cross-sectional study included 196 cases of MRI-confirmed PFs. Four readers assessed the lesions with respect to cords of plantar fascia, number of lesions, MRI features, largest size, and enhancement characteristics. Regional findings of local fracture deformity, muscle denervation, and plantar fasciitis were recorded. Patient symptoms were correlated using Fisher's exact test, Wilcoxon rank sum test, and Chi-squared test.

Results: The most common location of PF was the central cord (83%), followed by medial cord (15%) and lateral cord (1.5%) with 14% involving multiple cords. 32% of cases showed multiple lesions with 5% showing 4-5 lesions. The majority (68%) of PFs were isointense on T1W images and 43-45% lesions were hypointense on fsT2W and T2W images, respectively, with 66% of lesions being heterogeneous, 8.7% showing cystic-necrotic areas, and 64% with solid contrast enhancement. 52% had pain with 54% with diabetes mellitus. T2W and fsT2W signal alterations, enhancement characteristics, and plantar muscle denervation were significant for pain symptoms (p < 0.05).

Conclusion: This large systematic study adds to the body of literature on PFs, which can affect different fascial cords, can be multiple in up to 1/3 cases, and have contributory MRI features that correlate with foot pain symptoms.