Seminars in Musculoskeletal Radiology最新文献

Cystic soft tissue lesions of the hand often pose a diagnostic challenge due to their broad range of differential diagnoses that include benign ganglion cysts as well as inflammatory and malignant conditions. Although most lesions are benign, atypical clinical or imaging features may suggest rare but significant pathologies that require timely recognition. This article provides a structured case-based overview of cystic and cystic-appearing soft tissue lesions of the hand, integrating each case with a brief review of relevant pathophysiology, imaging characteristics, and therapeutic considerations. The cases illustrate the spectrum of cystic lesions categorized as true cysts, tumors or tumor-like lesions with cystic features, and infectious and inflammatory entities. Special emphasis is placed on identifying imaging red flags in lesions that may mimic benign cysts, such as synovial sarcoma, and on the role of magnetic resonance imaging as the key imaging modality in ambiguous cases.

Intravascular lipomas are rare benign tumors composed of adipose tissue that originate from the walls of blood vessels. They most commonly arise from veins, are typically asymptomatic, and rarely occur in the lower extremities. When large, these tumors can cause symptoms related to venous obstruction, such as swelling and pain. We report a case of a 75-year-old man with an intravascular lipoma in the right common femoral vein, identified during evaluation of lower extremity swelling and poorly healing ulcers. Surgical resection was ultimately required. This case contributes to the few published reports of pathologically proven symptomatic intravascular lipomas involving the lower extremity veins. Comprehensive preoperative imaging played a critical role in characterizing the lesion. The case facilitates a discussion of key differential diagnoses, such as atypical lipomatous tumors/well-differentiated liposarcoma and leiomyosarcoma. · Intravascular lipomas are rare and generally asymptomatic masses that most often arise in the veins of the upper extremity and thorax.. · The differential diagnosis for a fatty intravascular mass includes benign lipoma, atypical lipomatous tumor (ALT)/well-differentiated liposarcoma, and leiomyosarcoma.. · Benign lipomas usually demonstrate homogeneous fat signal with thin fibrous septa and minimal nonadipose components.. · Imaging features suggestive of ALT/well-differentiated liposarcoma are reduced and/or heterogeneous fat composition, thickened septa, and nodular nonadipose tissue..

Cystic bone lesions of the hand encompass a heterogeneous group of entities presenting as mostly well-defined lytic areas on imaging. The most common entities are ganglion cysts and degenerative geodes, typically arising adjacent to joints in adults. Primary masses include simple (unicameral) and aneurysmatic bone cysts. Also, other benign tumors like enchondroma, epidermoid inclusion cyst, giant cell tumor, fibrous dysplasia, tenosynovial giant cell tumor, and brown tumor can appear as expansile lucent lesions. Inflammatory processes such as rheumatoid arthritis or gout often produce focal osteolytic defects resembling cystic cavities. Multimodal imaging is often necessary. Magnetic resonance imaging is useful to detect cystic defects and assess adjacent soft tissues; computed tomography can depict cortical integrity. Radiography is especially helpful to assess aggressiveness of growth and for follow-up. Management depends on symptoms and etiology. Most true cystic lesions are usually treated conservatively. Other symptomatic or aggressive lesions may require curettage, bone grafting, or targeted therapy.

A swollen finger may be caused by a variety of lesions of different etiologies, such as infection, inflammation, degenerative disorders, crystal diseases, congenital diseases, trauma, and tumors or tumorlike disorders of bone and soft tissues. Following a case presentation of a rare case presenting with a swollen finger, this article reviews the imaging features of the most common etiologies of swelling of the digits.

Solid soft tissue masses of the hand represent a diverse group of lesions, most of which are benign. Accurate diagnosis is essential to guide management and avoid unnecessary or inappropriate surgical intervention. This review discusses solid soft tissue tumors of the hand in accordance with the 2020 World Health Organization Classification of Soft Tissue Tumors, emphasizing imaging features and clinical presentation, as well as the current European Society of Musculoskeletal Radiology guidelines from 2023 for primary imaging of soft tissue lesions. Characteristic imaging features help diagnose common entities such as lipomas, tenosynovial giant cell tumors, glomus tumors, and nerve sheath tumors. Various pseudolesions (e.g., traumatic neuromas) are also discussed. The importance of referral to specialized sarcoma centers for indeterminant or aggressive lesions is highlighted.

This case-based review explores the biomechanical foundations of the wrist by integrating advanced imaging findings with core anatomical and functional principles. We analyze six representative scenarios: distal radioulnar joint instability, ulnocarpal impaction, unstable triangular fibrocartilage complex tear, scapholunate ligament injury, posttraumatic ulnar translocation of the carpus, and scaphotrapeziotrapezoid osteoarthritis. The cases reviewed here illustrate how static and dynamic stabilizers preserve carpal congruence and load transmission. We highlight the roles of the triangular fibrocartilage complex, the distal interosseous membrane, and the intrinsic and extrinsic ligament systems, along with the kinematic interplay between carpal rows and sensorimotor control mechanisms. We emphasize the value of magnetic resonance imaging, magnetic resonance arthrography, and wrist arthroscopy as essential tools for detecting instability and planning treatment. By applying biomechanical principles to imaging interpretation, we can enhance lesion pattern recognition, support informed surgical decision making, and foster a more effective multidisciplinary approach to wrist pathology.

The distal radioulnar joint is essential for forearm rotation and wrist stability. Instability of the distal radioulnar joint, often resulting from trauma, ligamentous injury, or degeneration, can lead to pain, functional impairment, and progressive joint damage. Accurate diagnosis relies on a thorough imaging assessment due to the complex joint anatomy, especially the triangular fibrocartilage complex.Standard radiographs are useful to evaluate bone alignment but have limited soft tissue sensitivity. Ultrasound provides dynamic real-time assessment of superficial structures, although it is operator dependent. Computed tomography offers excellent spatial resolution for bony abnormalities and joint congruity, with a static and pseudo-dynamic approach, considered the gold standard.Magnetic resonance imaging is the reference standard for soft tissue evaluation, particularly the triangular fibrocartilage complex and surrounding ligaments. Emerging dynamic imaging techniques, including real-time magnetic resonance imaging and four-dimensional computed tomography, allow visualization of joint kinematics and detection of subtle instabilities not seen on static images. This review outlines the role of each modality in assessing distal radioulnar joint instability.

The general term collagenosis covers a group of connective tissue diseases triggered by systemic autoimmune processes and as yet unknown trigger mechanisms. Systemic sclerosis is one of the five types of collagenosis. Of the systemic rheumatic diseases, it has the highest mortality rate, partly due to the historical lack of disease-modifying therapies. Early diagnosis of systemic sclerosis can be challenging if the typical symptoms and diagnostic or classification criteria are not yet evident. However, given the disease's often heterogeneous course, early diagnosis and treatment are crucial for prognosis and to protect against progression involving the internal organs. Because reliable and prognostically valid biomarkers are generally lacking, deciding whether or not to pursue aggressive treatment in the early stages of the disease remains problematic. This article discusses the potential benefits of imaging techniques such as magnetic resonance imaging and pharmacoangiography for the early diagnosis of systemic sclerosis.

Crystal arthropathies of the hand encompass a wide spectrum of disorders characterized by the deposition of various crystals within joints and soft tissues, often leading to inflammatory and degenerative changes. Due to their ability to mimic other rheumatic diseases, accurate diagnosis is challenging and relies heavily on imaging. This review highlights the pathophysiologic features and typical manifestations of key crystal arthropathies-calcium pyrophosphate crystal deposition, gout, hydroxyapatite deposition disease, oxalosis, amyloidosis, and rare mimickers such as ochronosis-focusing on their radiologic appearances. Emphasis is placed on the strengths and limitations of different imaging modalities, particularly radiography, ultrasound, computed tomography, magnetic resonance imaging, and dual-energy computed tomography, in detecting both crystal deposits and associated inflammatory activity. Understanding these imaging patterns is essential for an appropriate differential diagnosis and clinical management.