Skeletal Radiology最新文献

Objective: To report a single-center experience comparing the efficacy and safety of computed tomography (CT)-guided radiofrequency ablation (RFA) in the treatment of osteoid osteoma (OO) in pediatric and adult patients.

Materials and methods: The electronic medical records of 97 patients who underwent CT-guided RFA for OO between January 2019 and January 2025 were retrospectively reviewed. Patients were divided into pediatric and adult groups. Demographic data, anatomical location and size of the lesion, procedure duration, pre- and post-procedure visual analog scale (VAS) scores, complications, technical and clinical success rates, and recurrence rates were evaluated.

Results: Of the 97 patients, 51 (52.6%) were pediatric and 46 (47.4%) were adults. The mean lesion diameter was 7.98 ± 2.92 mm in the pediatric group and 7.14 ± 3.72 mm in the adult group. The overall technical success rate of CT-guided RFA for OO was 100%, with primary and secondary clinical success rates of 97.9% and 98.9%, respectively. The primary clinical success rate was 98.1% (50/51) in the pediatric group and 97.8% (45/46) in the adult group. No major complications related to the procedure were observed. Minor complications included transient skin burn in one pediatric patient (1.9%, 1/51) and localized muscle pain in one pediatric (1.9%, 1/51) and one adult (2.2%, 1/46) patient.

Conclusion: This study demonstrates that percutaneous CT-guided RFA is a highly effective and safe technique with high success and low complication rates for the treatment of OO in both pediatric and adult populations.

Objectives: To determine whether the peroneus brevis tendon shape, cross-sectional area, and patient age are associated with split tears on magnetic resonance imaging.

Methods: This retrospective cross-sectional study included 358 patients (179 with and 179 without split tears), with sample size based on an a priori power calculation (Cramér's V = 0.186, 80% power, α = 0.05). Musculoskeletal radiologists assigned patients to split tear or no-tear groups based on MRI findings 8 weeks before independent shape classification and area measurements. Tendon shape was visually assessed on transverse proton density images and categorized as oval, general flat, flattened with medial convexity, or flattened with lateral convexity. Associations with split tear were evaluated using multivariable logistic regression.

Results: Flat-shaped tendons were more common in the split tear group (91.6%) than in controls (82.1%), while oval tendons were less frequent (8.4% vs. 17.9%, p = 0.007). The flattened with lateral convexity shape was most strongly associated with split tear. In the multivariable analysis, flat shape (odds ratio [OR] = 2.26, p = 0.021), larger cross-sectional area (OR per mm² = 1.04, p = 0.059), and older age (OR per year = 1.03, p < 0.001) are independently associated with split tear. No significant differences were observed between right and left ankles. Inter-rater agreement was substantial for shape (κ = 0.71, AC1 = 0.74) and excellent for area (intraclass correlation coefficient = 0.95).

Conclusions: A flat-shaped peroneus brevis tendon, an increased cross-sectional area, and older age are associated with an increased likelihood of peroneus brevis split tears. These features may serve as anatomical imaging biomarkers for early risk identification.

An os subfibulare is an ossicle that is located distal to the lateral malleolus near the distal fibular tip and typically at the fibular attachment of the anterior talofibular ligament (ATFL). Although there is debate concerning whether these ossicles are unfused accessory ossification centers versus non-united ATFL avulsion fractures, they are seen frequently in the setting of ankle instability. We present a case of an active patient with an unstable os subfibulare contributing to painless "catching" of the ankle due to talar subluxation and locking. This report details the clinical presentation, radiological findings, including MRI and dynamic ultrasound in the "locked" position, and surgical treatment for this unusual presentation of this unstable ossicle. The case underscores the potential importance of the os subfibulare in a patient with ankle instability and highlights the role of advanced imaging in guiding effective treatment.

Objective: Ultrasound (US) is a more accessible alternative to MRI for rotator cuff tear (RCT) assessment. Rapid US can identify RCTs, but accurate US interpretation remains challenging, even for experts. We performed a retrospective cross-sectional study to evaluate intraobserver and interobserver agreement and accuracy in RCT detection with US between expert and non-expert readers.

Materials and methods: Long-axis cine sweeps of supraspinatus tendon from 138 patients with suspected RCTs were analyzed and compared to corresponding MRI results (reference standard). Three non-experts (graduate student, medical student, radiology resident) and three experts (fellowship-trained musculoskeletal (MSK) radiologist, MSK sonographer, and radiology fellow) independently classified tendons as normal, full-thickness tear, or partial-thickness tear by predefined criteria.

Results: For all-tear detection (ATD), expert accuracy (%) ranged from 68.8 (95% CI, 61.1-76.5) to 84.8% (78.8-90.9), and non-expert accuracy from 63.0 (54.9-71.1) to 79.7% (73.0-86.4). For full-thickness tear detection (FTTD), expert accuracy ranged from 75.4 (68.2-82.6) to 87.0% (81.4-92.6), and non-expert accuracy from 73.9 (66.6-81.2) to 79.0% (72.2-85.8). Interobserver agreement for ATD was moderate among experts (Light's kappa ( $\kappa$ ) = 0.42 (95% CI, 0.30-0.58)) and fair among non-experts ( $\kappa$ = 0.38 (0.32-0.50)). Intraobserver agreement was fair ( $\kappa$ = 0.35 (0.29-0.43)). Our experts achieved higher sensitivity, resulting in improved overall accuracy.

Conclusion: Ultrasound readers of all experience levels accurately identified over 80% of RCTs when compared with MRI. Expert readers achieved higher accuracy, sensitivity, and reliability than non-experts. Ultrasound reliably detects RCTs and remains the preferred imaging modality for its accessibility and patient comfort, underscoring the need for standardization, training, and technological improvements.

Objectives: To investigate the association between hormone replacement therapy (HRT) and change in body composition in post-menopausal women in the Baltimore Longitudinal Study of Aging (BLSA).

Materials and methods: We included postmenopausal women with repeated dual-energy X-ray absorptiometry measurements and documented HRT status. HRT users were propensity score-matched to non-users based on baseline characteristics including age, height, weight, race, smoking, alcohol use, physical activity, education, age at menopause, age at first pregnancy, oral contraceptive use, and oophorectomy. Linear mixed-effects models assessed associations between current HRT use and longitudinal changes in fat and lean mass. Age was modeled as a time-varying continuous variable using piecewise linear splines at 60, 70, and 80 years. Interaction terms between HRT use and age were included to evaluate differences in age-related trajectories.

Results: HRT users (n = 91) and matched non-users (n = 220) had similar baseline characteristics. No significant interactions were found between HRT use and age for lean mass (all p > 0.05), and the likelihood ratio test (LRT) showed no improvement in model fit with interaction terms (p = 0.20). In contrast, fat mass trajectories differed by HRT status. Before age 60, HRT users experienced significantly greater fat mass gain (β = 596 g/year; 95% CI 75, 1117). After age 60, this reversed, with HRT users gaining 869 g/year less fat than non-users (β = -869 g/year; 95% CI - 1583, - 155), indicating a protective association of HRT after age 60. No significant differences were observed at ages 70 or 80. The LRT supported including interaction terms (p = 0.04).

Conclusion: HRT use is associated with less fat accumulation beyond the age of 60, although this association attenuates with advancing age. No differential association with lean mass was observed.

Objective: To assess the ability of large language models (LLMs) to accurately simplify lumbar spine magnetic resonance imaging (MRI) reports.

Materials and methods: Patients who underwent lumbar decompression and/or fusion surgery in 2022 at one tertiary academic medical center were queried using appropriate CPT codes. We then identified all patients with a preoperative ICD diagnosis of lumbar spondylolisthesis and extracted the latest preoperative spine MRI radiology report text. The GPT-4 API was deployed on deidentified reports with a prompt to produce translations and evaluated for accuracy and readability. An enhanced GPT prompt was constructed using high-scoring reports and evaluated on low-scoring reports.

Results: Of 93 included reports, GPT effectively reduced the average reading level (11.47 versus 8.50, p < 0.001). While most reports had no accuracy issues, 34% of translations omitted at least one clinically relevant piece of information, while 6% produced a clinically significant inaccuracy in the translation. An enhanced prompt model using high scoring reports-maintained reading level while significantly improving omission rate (p < 0.0001). However, even in the enhanced prompt model, GPT made several errors regarding location of stenosis, description of prior spine surgery, and description of other spine pathologies.

Conclusion: GPT-4 effectively simplifies the reading level of lumbar spine MRI reports. The model tends to omit key information in its translations, which can be mitigated with enhanced prompting. Further validation in the domain of spine radiology needs to be performed to facilitate clinical integration.

Objective: To develop and validate an artificial intelligence-based tool for the diagnosis of osteoporosis/osteopenia using hip radiographs. The tool aims to classify femurs into risk-based categories for osteoporosis/osteopenia, enabling patient prioritization, enhancing preventive medicine through incidental detection, and assisting clinicians' diagnosis in general.

Materials and methods: The AI tool was designed to perform three preprocessing tasks before the osteoporosis/osteopenia prediction: (1) splitting images into single femurs, (2) identifying and discarding femurs with prostheses, and (3) cropping images to isolate the proximal femur. A total of 2691 anteroposterior hip radiographs from 1654 patients were included in the study. The osteoporosis/osteopenia prediction model was trained on 3227 single femur images and tested on 826. Additionally, a final evaluation experiment was conducted on 313 new radiographs from 239 patients to assess the tool's applicability.

Results: The tool demonstrated high performance in the preprocessing tasks, achieving 99.0% accuracy in classifying single vs. double femur images, 99.3% accuracy in identifying prosthetic femurs, and 99.2% pixel accuracy in delineating the proximal femur before cropping. The final prediction model achieved an area under the curve of 86.6% for detecting osteoporosis/osteopenia in the test set and 81.0% in the final evaluation experiment.

Conclusions: The obtained results demonstrate the potential of the proposed AI-based pipeline for prediction of osteoporosis/osteopenia using hip radiographs. This study suggests that a tool based on the proposed methods could support DXA triage, incidental osteoporosis detection, and clinical decision-making in settings with limited access to bone densitometry.

Ossifying fibromyxoid tumors (OFMT) are rare tumors with an intermediate risk of malignancy that are usually found in the extremities. To date, only three cases of OFMTs involving the paraspinal musculature have been reported in the literature. Two of these previously reported cases demonstrated poorly circumscribed tumors with involvement of adjacent osseous and soft tissue structures. We report the first case of a well-circumscribed OFMT involving the paraspinal musculature with extrinsic erosion of bone but otherwise no significant soft tissue extension. Specifically, we review the CT and MRI findings, immunohistopathology, and genetics used to confirm the diagnosis of OFMT.

A distal posterior interosseous nerve (DPIN) neuroma related to prior surgery of the wrist can lead to disabling chronic pain. Ultrasound may represent a useful diagnostic tool due to its high resolution and ability to detect iatrogenic neuromas along small nerves of the limbs. However, the utility of ultrasound in the evaluation of both the normal sonographic appearance of the DPIN and traumatic neuromas is limited. We present a series of two patients who suffered from chronic dorsal wrist postoperative pain, where ultrasound detected histologically confirmed DPIN neuromas. After DPIN resection, the pain of our two patients completely disappeared without any functional deficit.