Seminars in Musculoskeletal Radiology最新文献

Plain radiography continues to be a crucial imaging modality in the field of rheumatology. It provides a comprehensive view of bone-related changes and highlights soft tissue abnormalities. The significance of radiography extends to early disease detection, aiding in differentiating various conditions and monitoring the effectiveness of treatment. It remains the preferred imaging technique for evaluating disease progression, offering insights into cumulative damage over time.In the early stages of arthritis, magnetic resonance imaging and ultrasound are the preferred methods because they can identify subtle disease activity, such as synovitis, tenosynovitis, and dactylitis, osteitis or bone edema, and enthesitis. But they have a lower specificity in distinguishing among various rheumatic conditions.We evaluate the use of radiography in inflammatory arthropathies, highlighting its role in differential diagnoses. Advances in automated radiographic assessment for arthritis are addressed. The discussion encompasses rheumatoid arthritis, juvenile idiopathic arthritis, other connective tissue diseases, and spondyloarthritis.

Peripheral spondyloarthritis (pSpA) encompasses multiple entities affecting the musculoskeletal system with classic findings of synovitis, enthesitis, and tenosynovitis. It remains poorly defined when compared with the axial spondyloarthritides due to nonspecific symptoms, ill-defined imaging findings, and lack of specific testable biomarkers. Previous research has tried to distinguish between the two disease entities using clinical presentations, scoring systems, and radiographic findings; however, overlap remains. We summarize the current classification of pSpA, imaging findings, and the distinction between these entities and axial spondyloarthritis.

Spondyloarthritis (SpA) encompasses inflammatory disorders affecting the axial skeleton, with sacroiliitis as a hallmark feature of axial SpA (axSpA). Imaging plays a vital role in early diagnosis and disease monitoring. Magnetic resonance imaging (MRI) is the preferred modality for detecting early inflammatory changes in axSpA, whereas structural lesions are better visualized using computed tomography (CT). However, synthetic computed tomography (sCT), a technique that generates CT-like images from MRI data, including deep learning methods, zero echo time, ultrashort echo time, and gradient-recalled echo sequences, has emerged as an innovative tool. It offers detailed anatomical resolution without ionizing radiation and combines the advantages of both, MRI and CT, by enabling the simultaneous evaluation of inflammatory and structural lesions. This review explores the potential role of MRI-based sCT in assessing structural changes in the sacroiliac joints, particularly in the context of axSpA, discussing conventional imaging and highlighting the potential of sCT to enhance early detection and monitoring of sacroiliitis.

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the axial skeleton, historically termed "human leukocyte antigen B27 positive spondyloarthropathy" or ankylosing spondylitis. Improved understanding of the underlying pathologic mechanisms has led to an ongoing redefinition of this disease state, a recognition of the substantial phenotypic and biological variation, and an emphasis on earlier detection. Magnetic resonance imaging has become central to identifying and confirming early axSpA, critical to fulfilling the promise of slowing disease progression and preventing irreversible structural abnormalities. We review the clinical background and current role of medical imaging in axSpA, with a focus on Assessment of SpondyloArthritis International Society consensus definitions, to improve radiology reporting and facilitate discussion between radiologists and other clinical experts in spondyloarthritis.

Septic arthritis is a major cause of morbidity and mortality worldwide, with survivors often facing long-term functional impairments. Prompt diagnosis is crucial to decrease complications such as cartilage loss, osteomyelitis, and reduced mobility. Imaging plays a central role in the diagnosis, as well as offering guidance for diagnostic aspiration. Because septic arthritis may involve any joint in the body, both native and prosthetic, different imaging modalities may be more applicable in various scenarios. We describe the hallmark imaging findings of septic arthritis in radiography, ultrasound, computed tomography, magnetic resonance imaging, and nuclear medicine scintigraphy, as well as the associated complications.

This history page is dedicated to the history of the International Skeletal Society that just celebrated its 50th anniversary. As a society focused on the science and art of radiology of the skeleton, it is unique in its inclusion of both musculoskeletal radiologists and allied physicians with an interest in skeletal disease and disorders.

Tophaceous gout of the patella and extensor apparatus of the knee can mimic a musculoskeletal neoplasm. Considering gout, correlation with clinical history and presentation, and meticulous analysis of imaging semiology are key to a correct diagnosis. The most useful signs are periarticular erosion with overhanging edges, increased soft tissue on radiography and computed tomography, the "snowstorm sign" on ultrasound, variable signal and enhancement, bandlike infiltration of tendons, and osseous erosions with no or little bone marrow edema on magnetic resonance imaging. Dual-energy computed tomography is both a sensitive and specific tool for noninvasive characterization of gout and for differentiating other crystal arthropathies.

Patellofemoral instability is common, often affecting young female patients. It contributes to significant morbidity, such as pain and premature osteoarthritis. Patient presentation varies, from acute instability events to chronic/recurrent instability. This article provides a detailed description of the anatomy and biomechanics of the patellofemoral joint and relates it to the pathology of patellofemoral instability. There are well-recognized predisposing anatomical factors, such as trochlear morphology, patella height, excessive lateralization of the tibial tubercle, excessive valgus alignment, and femoral or tibial torsion.Diagnosis of patellofemoral instability requires a thorough clinical history and physical examination, combined with a multimodality imaging approach. Imaging is useful in surgical planning to define the severity of predisposing anatomical factors and to detect postoperative complications. The operative management of patellofemoral instability targets predisposing anatomical factors, such as medial stabilizing ligament reconstruction or repair, tibial tubercle osteotomy, femoral trochleoplasty, coronal plane realignment osteotomy, and torsional osteotomy.

This review offers a comprehensive discussion of magnetic resonance imaging (MRI) for the assessment of rotator cuff tendon repair and joint-preserving surgical options for patients with irreparable rotator cuff tears. Deciding to proceed with arthroscopic repair of a rotator cuff tendon tear is impacted both by clinical factors and morphological imaging features. Preoperative clinical and imaging features also predict the likelihood of success of a rotator cuff tendon repair and are important to recognize. In patients with irreparable rotator cuff tears and relatively preserved glenohumeral cartilage, various joint-preserving surgical options are available and seen increasingly in clinical practice.The acceptable range of postoperative imaging findings correlating with a functionally intact rotator cuff repaired tendon, and MRI findings that are either suggestive of or definitive for rotator cuff tendon repair failure are discussed in detail, with attention to the Sugaya classification. Ancillary features, such as progressive retraction of the myotendinous junction and the degree of muscle fatty atrophy, can be used as problem-solving tools in cases equivocal for rotator cuff retear. Finally, this review discusses in detail the most common joint-preserving treatment options for patients with irreparable rotator cuff tears, including an in-depth focus on superior capsular reconstruction.