Seminars in Musculoskeletal Radiology最新文献

Metabolic bone diseases (MBDs), including osteoporosis, osteomalacia, and Paget's disease, represent a significant challenge in medical imaging and intervention. Interventional radiologists play a pivotal role in managing these conditions, due to the crucial role of detailed and precise imaging in diagnosing and treating MBDs. This article offers comprehensive recommendations aimed at optimizing interventional radiologic practices for patients with MBDs, highlighting the importance of using advanced imaging modalities, including dual-energy X-ray absorptiometry and magnetic resonance imaging, essential for accurate assessment of bone mineral density and architecture, guiding effective intervention strategies. We also discuss the use of minimally invasive procedures like vertebroplasty and biopsy, vital for both diagnostic and therapeutic purposes, to enhance diagnostic accuracy and therapeutic outcomes, ensuring high-quality patient management in the context of MBDs.

Dual-energy X-ray absorptiometry (DXA) and bone mineral density (BMD) pose several limitations in some patient categories, such as pregnant women and young people. This review article explores whether the innovative radiofrequency echographic multi-spectrometry (REMS) technology is beneficial for assessing the bone condition of various patient groups. Common consequences in patients with acromegalia, prostate cancer undergoing hormone therapy, osteogenesis imperfecta, anorexia nervosa, and in a peritoneal dialysis setting include decreased BMD and an increased risk of fragility fracture.DXA is currently regarded as the gold standard for BMD assessment. However, using the DXA technique has several drawbacks in a young patient who requires repeated BMD tests because it uses ionizing radiation. Because of its precision and consistency, the REMS technique may be a valuable tool to assess changes in bone condition in patients of all ages, particularly in female patients who are fertile or who are pregnant or nursing.

Metabolic bone diseases (MBDs) are a diverse group of diseases, affecting the mass or structure of bones and leading to reduced bone quality. Parameters representing different aspects of bone health can be obtained from various magnetic resonance imaging (MRI) methods such as proton MR spectroscopy, as well as chemical shift encoding-based water-fat imaging, that have been frequently applied to study bone marrow in particular. Furthermore, T2* mapping and high-resolution trabecular bone imaging have been implemented to study bone microstructure. In addition, quantitative susceptibility mapping and ultrashort echo time imaging are used for trabecular and cortical bone assessment. This review offers an overview of technical aspects, as well as major clinical applications and derived main findings, for MRI-based assessment of bone quality in MBDs. It focuses on osteoporosis as the most common MBD.

Alignment, longitudinal growth, and function of the musculoskeletal unit of the pediatric hand is complex due to the combination of open growth plates, ossification variations, and their relationship with finger tendinous and ligamentous attachments. This review presents the basics of normal development, acquired and congenital variations, and traumatic conditions of the pediatric hand from the perspective of the pediatric musculoskeletal radiologist and hand surgeon. This multimodality imaging article focuses on non-oncologic and non-rheumatologic conditions of the pediatric hand, inclusive of fingers, thumb, and metacarpal bones.

The pediatric hip undergoes significant changes from infancy through adolescence. Proper maturation is crucial for the development of a stable and functional hip joint. Imaging interpretation of the pediatric hip requires distinguishing normal variants and maturation patterns from pathology. We review femoral ossification centers, variants, and conditions that affect the proximal femur, such as Legg-Calvé-Perthes disease; the acetabulum, such as developmental hip dysplasia; the acetabular labrum, such as femoroacetabular impingement; and synovial pathology in children through adolescence. Understanding the spectrum of hip conditions and using advanced imaging techniques are essential for the accurate diagnosis and effective management of pediatric hip disorders.

The pediatric shoulder girdle is a complex anatomical structure uniting the upper extremity and trunk. The osseous structures, their articulations, and the surrounding soft tissue support structures (muscles, tendons, and ligaments) allow for a wide range of motion at the shoulder. Growth and maturation of the components at the shoulder girdle vary, particularly the osseous structures. This characteristic renders interpretation of imaging of the pediatric shoulder girdle more challenging because normal or variant anatomy can be confused for pathology. We review the physiologic growth and maturation of the shoulder girdle with special emphasis on the development of the bones and their articulations. The role of various imaging modalities and the common osseous and soft tissue variants in the pediatric shoulder are also discussed.

The pediatric ankle can present a broad range of normal variation and pathology unique to certain stages of development. Understanding the expected age ranges of ossification and fusion about the ankle is essential to provide accurate diagnoses regarding skeletal integrity. This conclusion has been well characterized radiographically and is supported by cadaveric research.The range of appearances on magnetic resonance imaging has also been well described. Knowledge about the structure of the periosteum and perichondrium aids in image interpretation as well as explaining typical injury patterns. The expected appearance of the physis and regional bone marrow signal is also of utmost importance.Ultrasonography is a valuable tool in pediatric musculoskeletal imaging but is limited when there is concern for intra-articular pathology. Computed tomography tends to be reserved for preoperative evaluation. We describe normal variation and maturation-dependent pathology of the pediatric ankle with an emphasis on imaging considerations.

Gaucher's disease (GD) is a lysosomal storage disorder characterized by the storage of glucosylceramide in macrophages ("Gaucher cells"), mainly in the reticuloendothelial system. GD type 1 (GD1) is the most common phenotype that usually manifests with hepatosplenomegaly, cytopenias, and bone involvement. Skeletal manifestations are the most debilitating characteristic and result in significant morbidities. We describe a case of GD1, first presented by a nontraumatic bone fracture. The case presentation highlights the importance of considering GD among the differential diagnosis of nontraumatic fractures, avascular necrosis, and infarcts of the bones. Early diagnosis and treatment improve the course of disease and avoid irreversible sequelae.