Skeletal Radiology最新文献

{"title":"Declining Medicare reimbursement in spinal imaging: a 15-year review.","authors":"Evan H Richman, Parker J Brown, Ian D Minzer, Joseph C Brinkman, Michael S Chang","doi":"10.1007/s00256-024-04792-3","DOIUrl":"10.1007/s00256-024-04792-3","url":null,"abstract":"<p><strong>Objective: </strong>To analyze and quantify the change in United States of America Medicare reimbursement rates for the 30 most commonly performed spinal imaging procedures.</p><p><strong>Materials and methods: </strong>The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was utilized to find and extract the 28 most billed spinal imaging procedures. All data was adjusted for inflation and listed in 2020 US dollars. Percent change in reimbursement and Relative Value Units between 2005 and 2020, both unadjusted and adjusted, were calculated and compared. Additionally, percent change per year and compound annual growth rate were calculated and compared.</p><p><strong>Results: </strong>After adjusting for inflation, the average reimbursement for all analyzed spinal imaging procedures between the years 2005 and 2020 decreased by 45.9%. The adjusted reimbursement rate for all procedures decreased at an average 4.3% per year and experienced an average compound annual growth rate (CAGR) of - 4.4%. Magnetic resonance imaging (MRI) had the most substantial adjusted decline of all imaging modalities at - 72.6%, whereas x-ray imaging had the smallest decline at - 27.33%. The average total RVUs per procedure decreased by 50.1%, from 7.96 to 3.97.</p><p><strong>Conclusion: </strong>From the years 2005 to 2020, Medicare reimbursement significantly decreased for all advanced imaging modalities involving the most common spinal imaging procedures. Among all practices, imaging procedures may be experiencing some of the largest decreases from Medicare reimbursement cutbacks.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"585-592"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing tin-prefiltration in routine clinical CT scans of the lower extremity: impact on radiation dose.","authors":"Thomas Marth, Georg Wilhelm Kajdi, Christoph Stern, Reto Sutter","doi":"10.1007/s00256-025-04897-3","DOIUrl":"https://doi.org/10.1007/s00256-025-04897-3","url":null,"abstract":"<p><strong>Objectives: </strong>Several studies have demonstrated the potential of tin-prefiltration to reduce radiation dose while maintaining diagnostic image quality for musculoskeletal imaging. Still, no study has reported data on the impact of tin-prefiltration on radiation dose reduction for clinical routine scanning.</p><p><strong>Materials and methods: </strong>Retrospective inclusion of 300 clinically indicated CT scans of the pelvis, knee, and ankle before January 2020 (without tin filter) and after December 2020 (with tin filter). For each joint, 50 examinations with tin-prefiltration and 50 examinations without tin-prefiltration were selected. Dose parameters were extracted, calculated, and compared. Subjective and quantitative parameters for image quality were assessed.</p><p><strong>Results: </strong>The CTDI_vol, DLP, and effective dose were reduced significantly in all tin-prefiltered examinations compared to the non-tin-prefiltered examinations (p < 0.001): CTDI_vol was 65% lower in the pelvis, 73% lower in the knee, and 54% lower in the ankle. This reduced the effective dose of 61%, 71%, and 60%, respectively. In absolute numbers, the reduction of the median effective dose delivered in a single CT scan of the pelvis was - 2.29 mSv, - 0.15 mSv for the knee, and - 0.03 mSv for the ankle. No difference in diagnostic image quality, depiction of bone anatomy and soft tissues, and image artifacts was observed (p > 0.05). Subjective and objective image noise was higher in tin-prefiltered pelvis CT (p < 0.001).</p><p><strong>Conclusion: </strong>The implementation of tin-prefiltration in clinical routine scan protocols significantly reduced the effective radiation dose for unenhanced CT scans of the lower extremities between 60 and 70%.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant transformation of osteochondroma to chondrosarcoma: a challenging case.","authors":"Seyyed Mohammad Ata Sharifi Dalooei, Behzad Aminzadeh, Naime Ataei, Farzaneh Khoroushi, Mohsen Saberifar","doi":"10.1007/s00256-025-04898-2","DOIUrl":"https://doi.org/10.1007/s00256-025-04898-2","url":null,"abstract":"<p><p>A 50-year-old female presented with a large palpable mass in the right buttock and proximal thigh, accompanied by sciatic paresthesia. She reported intermittent thigh and knee pain for 5 years, worsening over the previous 6 months. Plain radiography images revealed a pedunculated osteochondroma on the posterolateral aspect of the femur with extensive soft tissue involvement and soft tissue calcifications. A computed tomography (CT) scan showed an osteochondroma with a large adjacent bursa containing multiple foci of calcifications with a \"snowstorm\" appearance. A diagnostic dilemma arose regarding whether the condition represented reactive bursitis secondary to osteochondroma or a malignant transformation to chondrosarcoma with intra-bursal invasion. Magnetic resonance imaging (MRI) indicated a thick cartilage cap of osteochondroma measuring 53 mm and multiple cartilage nodules in the bursa along with heterogeneous enhancement in cartilage islands. Moreover, evidence of adjacent muscle invasion and sciatic nerve encasement was noted. These findings suggested an unusual diagnosis of malignant transformation of the osteochondroma to chondrosarcoma with intra-bursal invasion. The patient underwent wide-margin resection of the proximal femur and tumoral soft tissue, reconstructed with a proximal femoral mega prosthesis. Histologic evaluation confirmed a well-differentiated chondrosarcoma with intra-bursal invasion. This case highlights the critical role of diagnostic imaging in differentiating between benign and malignant complications associated with osteochondroma.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-like image based on 3D fast low-angle shot: superior diagnostic performance of ossification of the posterior longitudinal ligament.","authors":"Sujin Kim, Guen Young Lee, Bo Mi Chung","doi":"10.1007/s00256-025-04891-9","DOIUrl":"https://doi.org/10.1007/s00256-025-04891-9","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic performance of 3D fast low-angle shot (FLASH) compared with conventional MRI sequences for detecting OPLL.</p><p><strong>Materials and methods: </strong>This retrospective study included 106 patients who underwent cervical spine MRI and CT. Thirty-nine and 67 patients were enrolled in the OPLL and control groups, respectively. Diagnostic performance and reader confidence for detecting OPLL were compared between conventional MRI using turbo spin echo (TSE) and conventional MRI plus 3D FLASH. Interobserver agreement was also calculated. Three subgroups were defined within the OPLL group according to the sequences required for detecting OPLL (TSE group: cases that were diagnosed as OPLL by reviewing only TSE; 3D FLASH group: cases that were diagnosed by reviewing both TSE and 3D FLASH; none group: cases that were not diagnosed on MRI). The thickness of the OPLL was compared between the subgroups.</p><p><strong>Results: </strong>The diagnostic performance of both readers improved when 3D FLASH was added to conventional MRI, and the difference was statistically significant for reader 2 (p = 0.006). After adding 3D FLASH, reader confidence significantly increased (p < 0.001), and interobserver agreement improved from good to excellent. The three subgroups exhibited significantly different OPLL thicknesses (p = 0.008), with the thickest in the TSE group (4.5 mm), followed by the 3D FLASH (3.4 mm) and None groups (2.4 mm).</p><p><strong>Conclusion: </strong>3D FLASH can be helpful for detecting OPLL when combined with conventional T1- and T2-weighted imaging.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Musculoskeletal manifestations of systemic lupus erythematosus.","authors":"Erica M Lanser, Iwona Sudol-Szopinska, Jennifer S Weaver, Matthew Vickery, Mihra S Taljanovic","doi":"10.1007/s00256-025-04896-4","DOIUrl":"https://doi.org/10.1007/s00256-025-04896-4","url":null,"abstract":"<p><p>Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease affecting nearly every organ system in the body. The musculoskeletal (MSK) system is frequently affected and often the earliest site of disease presentation. Tendon, tendon sheath, bone, muscle, and soft tissue involvement is assessed through a multimodality approach. Radiology has an evolving role in the diagnosis and management of SLE. In this article, the authors discuss the epidemiology, pathophysiology, and typical imaging findings, as well as review the role of imaging in the management of SLE.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scanogram leg length measurement after total hip arthroplasty: not all landmarks are created equal.","authors":"Brian T N Le, Yoan Bourgeault-Gagnon, Matthew C Lyons, Samuel L McCaffrey, Lucy J Salmon, Michael D O'Sullivan","doi":"10.1007/s00256-025-04895-5","DOIUrl":"https://doi.org/10.1007/s00256-025-04895-5","url":null,"abstract":"<p><strong>Objective: </strong>To compare the magnitude of post-arthroplasty leg length discrepancy (LLD) and incidence of clinically significant LLD measured on CT scanogram using a commonly used measurement method (from the acetabular apex to tibial plafond) to an alternative technique avoiding the use of the acetabular prosthesis as a landmark and to assess inter-observer and intra-rater reliability of the new technique.</p><p><strong>Materials and methods: </strong>In this retrospective study, post-arthroplasty LLD measurements were conducted in 100 hips by two interpreters on CT scanogram scout views from the acetabular apex to the tibial plafond (AA-TP) and the inter-teardrop line to the tibial plafond (IT-TP). Aggregate means and proportions of clinically relevant LLD (≥ 10 mm) were compared between methods. Inter-rater reliability was calculated, and both interpreters repeated measurements on ten randomly selected patients to calculate intra-rater reliability.</p><p><strong>Results: </strong>The commonly used AA-TP technique overestimated LLD by 3.7 mm compared to the IT-TP technique. The odds of LLD measurement exceeding the clinically significant threshold of 10 mm were 3.8 times higher when using the AA-TP technique. Excellent inter-rater (ICC 0.984, 0.958) and intra-rater reliability (ICC > 0.9) were found for both techniques.</p><p><strong>Conclusion: </strong>CT scanogram measurements from the acetabular apex to the tibial plafond often overestimate operative limb length due to reference landmarks in different axial planes. Measurements from the inter-teardrop line to the tibial plafond yield significantly lower LLD values, possibly reflecting actual limb length better. The authors recommend using the inter-teardrop line and tibial plafond as reference landmarks to improve LLD assessment accuracy post-arthroplasty.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis: Phosphaturic mesenchymal tumor.","authors":"Hila Yashar, Ashley Flaman, Adam Frost, Mara Caragea, Bashiar Thejeel","doi":"10.1007/s00256-025-04894-6","DOIUrl":"https://doi.org/10.1007/s00256-025-04894-6","url":null,"abstract":"","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calvarial melorheostosis: an extremely rare case and diagnostic challenge.","authors":"Gregory Wenokor, David Suster, Ada Baisre de Leon, James K Liu, Cornelia Wenokor, Esther A Nimchinsky","doi":"10.1007/s00256-025-04882-w","DOIUrl":"https://doi.org/10.1007/s00256-025-04882-w","url":null,"abstract":"<p><p>Melorheostosis is a rare bone disease that presents as sclerotic lesions growing on existing bone surfaces. This disease is of unknown etiology and affects both genders equally. The disease is unique in appearance, described in the literature as having a radiologic appearance of flowing candle wax, and usually occurs in the appendicular skeleton. We present an extremely rare case of melorheostosis of the calvarium in a 55-year-old male patient, initially thought to represent a large osteoma, and discuss the CT and MRI features, pathology, and surgical management. Recently, new insights have been gained by molecular biologic studies into the potential pathogenesis of this disease indicating genetic mutations, which will be discussed. This case report will help radiologists arriving at the correct diagnosis for an unusual manifestation of a rare disease.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunistic screening for osteoporosis: validation study for L1 bone density measurements using contrast-enhanced chest and abdominal CTs.","authors":"Arnau Hanly, Soterios Gyftopoulos, Casey E Pelzl, Wei He, Connie Y Chang","doi":"10.1007/s00256-025-04892-8","DOIUrl":"https://doi.org/10.1007/s00256-025-04892-8","url":null,"abstract":"<p><strong>Objective: </strong>To retrospectively validate the diagnostic power of attenuation values on chest and abdomen/pelvis CECTs, together and separately, compared with dual-energy X-ray absorptiometry (DEXA)-determined osteoporosis diagnoses, and to determine thresholds for accurate osteoporosis diagnosis.</p><p><strong>Materials and methods: </strong>Subjects were identified using the electronic health record. Included patients received DEXA and CECT scans within 60 days of each other. Patients were excluded if taking osteoporosis medication, undergoing dialysis, receiving hormone or cancer therapy, had a history of cancer, osseous metastases, fractures, or compressions. Minimum, mean, and maximum CECT attenuation values of L1 trabecular bone axial cross-sections were measured by a non-physician in Hounsfield units (HUs) using an elliptical region of interest (ROI) tool. DEXA diagnoses were dichotomized as positive (osteoporosis) or negative (osteopenia/normal). The area under the receiver-operator characteristic curves (AUCs) were compared to identify ideal CECT attenuation thresholds.</p><p><strong>Results: </strong>Two hundred nineteen subjects (mean age 66 ± 0.6 [range 35-92]; 196 (89%) females and 23 (11%) males) were included for analysis. Thirty-one (14%) subjects were positive and 188 (86%) were negative for osteoporosis. Minimum, mean, and maximum combined chest and abdomen/pelvis attenuation values demonstrated AUCs of 0.75 (95% CI 0.67-0.84), 0.931 (95% CI 0.88-0.99), and 0.82 (95% CI 0.73-0.90). The optimal mean attenuation threshold for osteoporosis diagnosis was 120 HU (84% sensitive, 90% specific). There was no statistical difference in diagnostic power between mean attenuation values of chest and abdomen/pelvis CECTs.</p><p><strong>Conclusion: </strong>CECT mean attenuation values of either chest or abdomen/pelvis CECTs could be used as appropriate thresholds in screening for osteoporosis.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cauda equina movements during the Valsalva maneuver in patients with lumbar spinal stenosis: introducing a novel method for redundant nerve evaluations.","authors":"Ryo Yamakuni, Shiro Ishii, Koji Otani, Shinya Seino, Takuya Nikaido, Kazuyuki Watanabe, Kinshi Kato, Hiroshi Kobayashi, Masataka Nakamura, Takeyasu Kakamu, Hironobu Ishikawa, Hirofumi Sekino, Kenji Fukushima, Yoshihiro Matsumoto, Hiroshi Ito","doi":"10.1007/s00256-025-04888-4","DOIUrl":"https://doi.org/10.1007/s00256-025-04888-4","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether inchworm-like cauda equina movements can be observed in patients with lumbar spinal stenosis using a novel Valsalva maneuver cine MRI (cMRI) protocol.</p><p><strong>Materials and methods: </strong>Fifteen lumbar spinal stenosis patients (11 males; mean age, 73.9 years) underwent lumbar static MRI (sMRI) and sagittal 60-s cMRI. The cMRI protocol, called the Kinematic Assessment of Redundant Nerves (KAoRN), included three resting and Valsalva maneuver sets. Two radiologists independently evaluated cauda equina movement and lumbar spinal stenosis severity from L1/2 to L5/S1 using an MRI lumbar spinal stenosis score. Scores from both analysts were averaged; the most severe averaged score from all levels was extracted and defined as the worst score. Moreover, the level at which severe stenosis (averaged score ≥ 3.5) was observed was counted.</p><p><strong>Results: </strong>KAoRN-positive cauda equina movement was observed in 11 participants (73.3%). KAoRN-negative participants tended to have non-significantly higher worst lumbar spinal stenosis scores (4.0, interquartile range 3.9-4.0) than those of KAoRN-positive participants (3.5, interquartile range 3.0-4.0) (p = 0.310, χ² test). KAoRN-negative participants tended to have more severe stenosis than that of KAoRN-positive participants, though the difference was not significant (p = 0.182, Wilcoxon rank sum test).</p><p><strong>Conclusion: </strong>KAoRN-positive cauda equina movement is frequently observed in participants with lumbar spinal stenosis; however, it is not observed in all such cases. Further exploration of the differences in the presence or absence of KAoRN-positive findings may provide new insights into the diagnosis of clinically relevant LSS requiring surgical intervention.</p><p><strong>Trail registration: </strong>The UMIN clinical trial number: UMIN000052276.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}