Seminars in Musculoskeletal Radiology最新文献

Spinal pain represents a significant clinical and socioeconomic burden, with conventional imaging often unable to identify the precise pain generator or distinguish active pathology from incidental degenerative findings. Hybrid nuclear medicine imaging techniques, such as bone single photon emission computed tomography/computed tomography and fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography, provide complementary functional and metabolic information that can enhance diagnostic accuracy in selected patients.This review summarizes current applications of hybrid imaging in prevalent spinal pathologies across preoperative and postoperative settings. In preoperative evaluation, bone single photon emission computed tomography/computed tomography localizes symptomatic degenerative changes, including facet joint and disk pathology. Postoperatively, bone single photon emission computed tomography/computed tomography demonstrates high sensitivity for hardware complications, pseudoarthrosis, and adjacent segment degeneration. In contrast, fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography is used to detect spinal infection. Understanding appropriate indications, optimal timing, and interpretive pitfalls is essential to integrate these techniques effectively into multidisciplinary management pathways and guide targeted therapeutic interventions in patients with persistent or recurrent spinal pain.

Spine magnetic resonance imaging is among the most frequently performed examinations in clinical radiology and places substantial demands on workflow efficiency and image quality. Over the past 20 years, acquisition times have been markedly reduced through a combination of optimized sequence parameters, advanced acceleration techniques, and modern image reconstruction methods.This article provides an overview of contemporary strategies for accelerating two-dimensional spine magnetic resonance imaging, with a focus on techniques that are robust and feasible in routine clinical practice. Classical parameter optimization, parallel imaging, compressed sensing, simultaneous multislice acquisition, and image reconstruction based on artificial intelligence are discussed with regard to their technical principles, advantages, and limitations.Particular emphasis is placed on practical protocol integration and a "how we do it" approach, illustrating how these methods can be combined to achieve substantial time savings while preserving diagnostic confidence. When applied judiciously, modern acceleration and reconstruction techniques enable efficient, high-quality spine magnetic resonance imaging and are particularly well suited for this high-volume clinical application.

This history page in the series "Leaders in Musculoskeletal Radiology" is dedicated to the memory and achievements of the Danish radiologist Christian Ingerslev Baastrup, whose name was given to the medical eponym Baastrup's disease of the spine.

Orthobiologics, a subset of regenerative medicine, involves autologous or allogeneic cells and bioactive molecules to promote musculoskeletal tissue repair and regeneration. This review examines the evolution, clinical applications, limitations, and future directions of orthobiologic therapies. Modalities such as mesenchymal stromal cells, platelet-rich plasma, extracellular vesicles, and growth factors have shown promise in managing tendinopathy, partial tears of ligaments and tendons, osteoarthritis, avascular necrosis, and other soft tissue injuries. These therapies can modulate inflammation, enhance healing, and potentially delay disease progression.However, clinical translation is hindered by donor variability, lack of preparation and procedural standardization, safety concerns with stem cell use, inconsistent evidence, and the absence of consensus guidelines. The unregulated market has also led to widespread use of unproven biologics. Future integration into core clinical practice requires standardized protocols, regulatory oversight, and robust clinical trials. Advances in gene therapy and endogenous stem cell mobilization may further enhance therapeutic outcomes and position orthobiologics as a key component of joint preservation and regenerative musculoskeletal care.

Image-guided percutaneous cryoablation plays an increasingly important role in managing bone and soft tissue tumors. Well-established indications include the treatment of osteoid osteoma, palliation of painful skeletal metastases, and local control of oligometastatic disease. Emerging indications are now a variety of painful benign bone tumors beyond osteoid osteoma, symptomatic soft tissue lesions (such as desmoid fibromatosis, vascular anomalies, abdominal wall endometriosis), as well as local recurrences of bone and soft tissue sarcoma. This state-of-the-art review describes the percutaneous cryoablation technique including current strategies to prevent complications. We also discuss the expanding range of clinical indications, as well as future directions of this promising technology in the musculoskeletal system.

Ultrasound-guided intervention of peripheral nerves is a new and promising branch of sonography. It offers minimally invasive therapeutic solutions with relatively little effort and has thus become an alternative to surgical procedures for managing entrapment neuropathies. It has shown considerable success in treating carpal tunnel syndrome, as well as other neuropathies caused by compression or focal strangulations. Sonosurgery, in particular, has become established as a validated reliable alternative to both open and endoscopic surgery. This review article critically examines the historical development of peripheral nerve ultrasound-guided intervention, leading ultimately to sonosurgery, and describes potential future uses.

In interventional radiology, percutaneous osteosynthesis has experienced major growth, pushing boundaries that were unimaginable 20 years ago. Driven by advanced imaging (computed tomography, cone-beam computed tomography, electromagnetic navigation, computed tomography-fluoroscopy fusion, and emerging robotics), by a refined understanding of bone biomechanics, and by improved knowledge of implant behavior (fully or partially threaded screws, washers, cement augmentation), its indications now extend from trauma to osteoporosis/insufficiency fractures and oncology.This article provides a practical framework for safely going "further": rational selection of devices according to cortical or cancellous bone, planning of long or oblique trajectories (iliosacral, trans-sacro-bi-iliac, acetabular roof, odontoid, sternum), use of adjunct techniques (hydrodissection, thermal ablation, embolization), and, when necessary, external reduction maneuvers under image guidance. We highlight decision-making principles, indications, anatomical limitations, and pitfalls to avoid (sacral foramina, shear forces, narrow corridors), as well as adapted pain management and anesthesia strategies.By mastering indications, guidance systems, and a detailed understanding of underlying pathologies, interventional radiology offers minimally invasive, stable, and durable solutions. This approach accelerates patient remobilization and transforms situations once deemed inoperable into safe, personalized, and reproducible trajectories. These advances firmly establish interventional radiology as a central multidisciplinary actor in musculoskeletal care.

To highlight the expanding role of interventional radiology in managing high-level athletes by presenting advanced minimally invasive procedures that extend beyond traditional infiltration techniques, aiming to accelerate recovery and preserve athletic performance.This review explores three main interventional procedures currently implemented in elite sports medicine: (1) percutaneous computed tomography-guided screw fixation for isthmic spondylolysis, (2) vertebroplasty for posttraumatic vertebral fractures, and (3) percutaneous lumbar diskectomy under computed tomography and fluoroscopic guidance. Each technique is detailed from patient selection and procedural setup to postoperative outcomes, with emphasis on imaging guidance, anatomical precision, and rapid rehabilitation.In high-level athletes, computed tomography-guided percutaneous screw fixation for isthmic spondylolysis provides immediate biomechanical stabilization, pain relief, and early return to sport, with the option of hardware removal. Vertebroplasty in selected A1-type fractures enables full weight-bearing within 48 hours and eliminates the need for bracing. Percutaneous lumbar diskectomy offers precise decompression with minimal disruption, yielding symptom resolution within days and preserving spinal integrity. Across all procedures, interventional radiology techniques have shown low complication rates, excellent tolerance under local anesthesia, and consistent return to preinjury performance levels.Interventional radiology now plays a central role in elite sports medicine, offering targeted, image-guided, and minimally invasive alternatives to traditional surgery. These techniques align with the demands of high-performance athletes, ensuring fast recovery, sustained functionality, and long-term musculoskeletal health. As interventional radiology continues to evolve, will become an essential pillar in the multidisciplinary care of professional athletes.

Bone marrow edema, a typical and exclusive finding of magnetic resonance imaging, is a characteristic of multiple pathologies. There is still no consensus about its origin and histologic characteristics. In this article, we describe six causes of bone edema based on pathophysiologic characteristics: traumatic, infectious, inflammatory, degenerative, tumoral, and neuromediated. For each of them, we explain both the diagnostic and therapeutic role of interventional radiology. The fundamental importance of bone biopsy in characterizing the lesions associated with bone edema is also reviewed.