Seminars in Musculoskeletal Radiology最新文献

Rheumatoid arthritis is a common chronic inflammatory arthritis, primarily characterized by proliferative synovitis of the small joints of the appendicular skeleton. Rapidly evolving treatment regimens for rheumatoid arthritis patients, including conventional and biologic disease-modifying antirheumatic drugs, promise improved quality of life and prognosis. These treatments necessitate earlier clinical detection of rheumatoid arthritis, a goal that has forever changed the role of imaging in this pursuit. This review discusses the dominant imaging modalities in state-of-the-art rheumatoid arthritis management: radiography, magnetic resonance imaging, and ultrasound. It focuses on hand and wrist evaluation, with key relevant findings detected by each modality and recent evidence supporting them. Emerging techniques are also described in this discussion to understand likely future radiologic contributions to rheumatoid arthritis diagnosis and management.

Ultrasound (US) is a valuable tool in the evaluation of arthritis both for diagnosis and treatment response. Pertinent findings such as joint effusions, synovitis, bursitis, bone erosions, tenosynovitis, and enthesitis can all be readily evaluated sonographically. In this article, we describe specific considerations in the US evaluation of rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, crystalline arthritis (gout, calcium pyrophosphate deposition disease, and hydroxyapatite deposition disease), septic arthritis, and osteoarthritis with attention to certain differentiating features. The potential role of US in the diagnosis of specific arthritides is discussed, together with an overview of newer technologies and future directions.

Gout is a common inflammatory arthritis with well-described imaging characteristics. Radiography depicts erosive change and in advanced cases, tophus deposition near joints and in association with tendons or bursae. Computed tomography demonstrates the same features but may also use dual-energy or photon-counting techniques that allow for tissue composition analysis and the specific identification of monosodium urate deposition. Magnetic resonance imaging (MRI) is useful in identifying tophi and the damage associated with gout, such as bone erosion and cartilage loss in advanced cases. MRI also helps differentiate gout from other types of inflammatory arthritis, infection, or tumor that may have a similar clinical presentation. Ultrasound is widely used in the diagnosis of gout and also useful in procedural guidance of joint aspiration or soft tissue biopsy.

This case report concerns a 16-year-old boy who developed pain in his right thigh after a soccer game. Imaging studies revealed a pathologic transtrochanteric fracture of the right femur, accompanied by a large expansive intramuscular lesion centered in the deep planes of the adductor musculature. Main imaging findings included intense enhancement and vascularization of the lesion, along with peripheral and central flow voids, the latter described as characteristic of this subtype of soft tissue sarcoma. Alveolar soft part sarcoma is a rare and distinctive sarcoma with an indolent clinical course that typically occurs in young patients and predominantly affects the deep tissues of the lower limbs. · Soft tissue sarcomas are a rare group of malignancies, often found in the extremities. Suspicious features include larger size, deeper location, heterogeneous enhancement, and progressive growth.. · Alveolar soft part sarcoma (ASPS), a rare subtype primarily seen in children, is characterized by high T1 signal intensity, intense contrast enhancement, and more than five central and peripheral flow voids that are highly indicative of this condition.. · Magnetic resonance imaging (MRI) is the preferred modality for evaluating these lesions. Advanced MRI techniques, such as diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC), enhance diagnostic confidence, particularly in postoperative evaluations..

Sacroiliac joint pathology presents a complex diagnostic challenge due to the diverse range of conditions, both mechanical and inflammatory, that can affect the joint. Although axial spondyloarthritis-related sacroiliitis is often the most recognized pathology, numerous other conditions closely mimic axial spondyloarthritis in both clinical presentation and imaging features. This review describes key anatomical aspects of the sacroiliac joint, including its distinct morphology, ligamentous support, and histologic characteristics, essential for understanding and differentiating various pathologies. It also examines detailed imaging findings from magnetic resonance imaging, computed tomography, and radiography in relation to each pathologic condition. By providing a framework for distinguishing between common and rare sacroiliac joint disorders and axial spondyloarthritis, this article will enhance diagnostic accuracy and offer insights into the anatomical nuances that impact clinical and imaging assessments.

Whole-body magnetic resonance imaging (WB-MRI) can effectively diagnose rheumatologic diseases with systemic and multifocal characteristics, such as spondyloarthritis, chronic recurrent multifocal osteomyelitis, and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, among others. Advances in rheumatic disease treatments have emphasized the importance of early diagnosis for effective management, function preservation, and improved quality of life. WB-MRI offers comprehensive imaging of the musculoskeletal system, detecting early and subtle disease changes that traditional methods might overlook. Initially used for spondyloarthritis, the technique has recently expanded to other rheumatic diseases and is becoming the gold standard for diagnosing and monitoring chronic nonbacterial osteomyelitis in pediatric patients. This review article presents the current status of WB-MRI in rheumatologic conditions.

Thoracic involvement is common in patients with rheumatic diseases, contributing to significant morbidity and mortality. Early detection and prompt treatment may prevent the establishment of irreversible changes, thus improving patients' outcomes. Imaging studies play a vital role in the early detection of chest and chest wall manifestations, especially in patients with subclinical disease. Familiarity with the frequently affected thoracic regions and their presentation on imaging is therefore essential for practicing radiologists to provide an accurate assessment of the disease burden and treatment response. This review summarizes the common and less well-known chest and chest wall imaging features of rheumatic diseases.

Juvenile idiopathic arthritis (JIA) is a heterogeneous disorder affecting children < 16 years of age. The clinical heterogeneity translates to imaging, where no specific joint is affected. This article highlights a general imaging approach to JIA, using specific examples of the knee, hand, and wrist as the typical joints affected. We then focus on unique joints that are commonly affected by JIA: the temporomandibular joint, the joints of the upper cervical spine, and the sacroiliac joint. For these latter anatomical sites, regional anatomy and development, location-specific imaging considerations, and arthritis, treatment decision making, and potential differential considerations are reviewed. We highlight, where applicable, a multimodal approach to imaging using developed or developing standardized scoring systems.

Arthritis is an important cause of disability globally, with high prevalence in low- and middle-income countries. Although osteoarthritis is the most common type of arthritis, various types of nondegenerative arthritis are prevalent in low- and middle-income countries. Multiple imaging modalities, such as radiography, ultrasound, computed tomography, and magnetic resonance imaging, are helpful in diagnosing and prognosticating arthritis. Although imaging appearances can overlap between types of arthritis, specific imaging findings have been described for the different etiologies. Knowing these imaging findings, especially on radiographs and ultrasound in resource-constrained areas, can be helpful in managing arthritis effectively.

This article focuses on updates in calcium pyrophosphate deposition disease (CPPD) and basic calcium phosphate deposition (BCPD), highlighting recent advances in imaging and the understanding of these conditions. It explores their clinical presentations, crystal formation mechanisms, and diagnostic challenges. CPPD and BCPD are often underrecognized causes of arthritis, and recent imaging diagnostic criteria are presented.