Seminars in Musculoskeletal Radiology最新文献

Groin pain is a common cause of disability in athletes. Imaging is crucial in a clinical diagnosis, given the multiple associated etiologies. The main sites of groin pain are the adductors, iliopsoas muscles, inguinal ring, hip joint, and pubic symphysis. Although magnetic resonance imaging is the gold standard to image groin pain, ultrasound (US) offers excellent accuracy in pinpointing muscle injuries, inguinal disruption, and hernias. US requires a detailed knowledge of anatomical landmarks; imaging pitfalls, and pathologic patterns. We review the complex anatomy of the groin region, the sonographic appearance of the involved structures, and the strengths and weaknesses of US.

Peripheral nerve disorders refer to any condition that damages the peripheral nervous system with variable presentations and numerous causes. The diagnosis is usually suspected clinically and then confirmed using electrophysiology. Yet electrodiagnostic studies lack precise anatomical delineation and often cannot determine the underlying cause of the peripheral neuropathy. However, thanks to recent technological advances, high-resolution ultrasound (HRUS) and magnetic resonance (MR) imaging have emerged as exceptional modalities to identify the exact site of pathology and demonstrate the underlying etiology. These developments have led to a multimodality approach to peripheral nerve disorders. Imaging provides anatomical and morphological information while functional evaluation remains derived from electrodiagnostic study. This article reviews the HRUS features of common as well as less frequent peripheral nerve disorders: entrapment neuropathies, traumatic injuries, neuralgic amyotrophy, polyneuropathies, and nerve tumors.

Carpal tunnel syndrome (CTS), the most common mononeuropathy, results from compression of the median nerve within the fibro-osseous carpal tunnel. Diagnosis is typically based on clinical evaluation and confirmed by nerve conduction studies. However, ultrasound (US) has emerged as a valuable noninvasive adjunct for CTS confirmation, offering potential advantages over electrodiagnostic testing in terms of patient comfort and diagnostic accuracy. This review begins with a concise summary of carpal tunnel anatomy and CTS pathophysiology as a foundation for exploring the diverse applications of US in CTS evaluation. B-mode US assessment is presented with a focus on cross-sectional imaging and dynamic evaluations, including the transverse translocation and longitudinal gliding of the median nerve. We also review current methods for assessing vascularization in CTS and explore the usefulness of elastography in CTS evaluation. The advantages and limitations of each US method are elucidated, highlighting their practical utility in clinical practice.

The joints of the fingers play an important role in prehension. They must accomplish both great mobility in the sagittal plane to allow the fingers to roll up and great stability to ensure the grip is both precise and firm. The collateral ligaments and palmar plates are the main passive stabilizing structures between the interphalangeal (IP) and metacarpophalangeal (MCP) joints. Sprains with or without dislocation of the proximal IP joints of the fingers are common injuries in sports pathology and may involve not only the ligaments but also their bony insertion on the phalanges or extensor tendons. Certain entities are specific to the MCP joints: ligament ruptures with Stener-like effect under the sagittal bands and MCP flexion locking (locked finger). Radiographs and ultrasound usually enable a precise diagnosis, so appropriate treatment can be provided.

Iatrogenic nerve injuries are common and require an immediate accurate diagnosis to allow surgical treatment within a short window of opportunity. Targeted investigation using high-resolution ultrasound (US) allows an accurate diagnosis in the acute phase when electrophysiology has a limited role. By identifying the exact site of injury, mechanism, and type of nerve damage, US can help determine the prognosis of the lesion and the need for surgical management. This pictorial review discusses the role of high-resolution US in the work-up of iatrogenic nerve injuries, with an emphasis on US appearances and the clinical knowledge needed by the radiologist to provide solutions to clinical challenges.

A radiographic gold standard to distinguish osteoporotic vertebral fractures (VFs) from nonosteoporotic VFs does not exist. Radiographic fracture-shaped vertebral deformity (FSVD) is common among young populations with normal bone strength. FSVD in an older population is called osteoporotic-like vertebral fracture (OLVF) when the FSVD is likely associated with compromised bone strength. For more severe grade deformities or when a vertebra is collapsed, experienced readers can make an osteoporotic VF diagnosis with a high degree of certainty. In milder cases, radiographic osteoporotic VF is often diagnosed based on a high probability rather than an absolute diagnosis. For older women, three nonadjacent minimal grade OLVFs (< 20% height loss), one minimal grade OLVF and one mild OLVF (≥ 20∼25% height loss), or one OLVF with ≥ 25% height loss meets the diagnosis of osteoporosis. For older men, a single OLVF with ≥ 33 to 40% height loss is insufficient to suggest the patient has osteoporosis.

Quantitative computed tomography (QCT) has important technical advantages for the measurement of bone mineral density, and the technique is well suited for both the diagnosis of osteoporosis and the monitoring of treatment. Its use deserves a wider application than at present. The use of QCT in both research and in the clinic has recently garnered increasing attention. In this review, we update the advances and application of QCT in the study of osteoporosis.

The Trabecular Bone Score (TBS), a gray-level textural assessment derived from dual-energy X-ray absorptiometry images, serves as a validated index of trabecular bone microarchitecture. Over the past decade, significant evidence has highlighted the usefulness of TBS in primary and secondary osteoporosis, leading to its integration with the Fracture Risk Assessment Tool (FRAX) and bone mineral density (BMD) T-score adjustments. This review explores the role of TBS in fracture prediction, treatment initiation, and monitoring. Studies confirm that TBS enhances fracture risk prediction in both primary and secondary osteoporosis when combined with BMD and clinical risk factors. Evidence also suggests that including TBS alongside BMD and FRAX offers significant potential for treatment stratification, considering the overall skeletal profile, such as bone mass, bone quality, and clinical risk factors. Consequently, TBS has become a standard part of clinical care worldwide. Future enhancements hope to adjust for soft tissue thickness, broadening the applicability of TBS across diverse body types and pediatric populations.

This history page is dedicated to the memory and achievements of the pediatric radiologist Hooshang Taybi whose name is associated with the Rubinstein-Taybi syndrome, Taybi syndrome, and Taybi-Linder syndrome.