Skeletal Radiology最新文献

{"title":"Xanthogranulomatous epithelial tumour of the calcaneus in a 32-year-old female: a rare entity.","authors":"Darshana Sanghvi, Amrit Kaur Kaler, Manit Gundavda, Shalaka Satpute, Kunal Nadgouda, Nevitha Athikari","doi":"10.1007/s00256-026-05325-w","DOIUrl":"10.1007/s00256-026-05325-w","url":null,"abstract":"<p><p>Xanthogranulomatous epithelial tumour (XGET) is a recently described, rare mesenchymal neoplasm characterized by a HMGA2::NCOR2 gene fusion. We report a case of primary intraosseous XGET in the calcaneus of a 32-year-old female presenting with a 10-month history of heel pain. Initial differential diagnosis based on imaging features of the lytic calcaneal lesion included giant cell tumour of bone (GCTB) and solid aneurysmal bone cyst (sABC). Histopathology revealed a bland appearing lesion with xanthomatous histiocytes and giant cells, but immunohistochemistry showed diffuse cytokeratin positivity. Definitive diagnosis was established via molecular confirmation of the HMGA2::NCOR2 fusion and absence of H3F3A and USP6 alterations. This case documents the radiological features of a rare entity that mimics common bone tumours and emphasizes the role of molecular pathology in distinguishing XGET from other more frequent giant cell-rich lesions.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"3375-3380"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674257","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":"Arthroscopic Double-Bundle Posterior Cruciate Ligament (PCL) Reconstruction: characterization of imaging findings and temporal changes on postoperative MRI.","authors":"Thien Dang, Lawrence M White, Ali Naraghi, Dawn H Pearce, Daniel B Whelan","doi":"10.1007/s00256-026-05348-3","DOIUrl":"10.1007/s00256-026-05348-3","url":null,"abstract":"<p><strong>Objective: </strong>The study aims to characterize the postoperative MRI appearance of double-bundle PCL graft reconstructions (DB-PCL-R) with correlation to clinical PCL stability.</p><p><strong>Methods: </strong>A retrospective evaluation of 23 patients, 37 MRIs (12/37, 0-3 months; 8/37, 3-12 months; 17/37, > 12 months) following DB-PCL-R for MRI findings, integrity of the anterolateral (ALB) and posteromedial (PMB) bundles, position of tunnels, peritunnel marrow edema, graft fixation, graft signal, graft-bundle thickening, and synovitis or arthrofibrosis was performed. MRI findings were categorized by time interval postoperatively. PCL stability was assessed clinically (grade 0-III) in all patients. Chi-square or Fisher's exact analysis was performed to explore associations between MRI findings and PCL stability.</p><p><strong>Results: </strong>Graft bundles appeared intact in all cases. PMB graft femoral tunnel was inferiorly positioned in 2/23 patients. The tibial tunnel was inferiorly positioned in 5/23 and superiorly positioned in 2/23 patients. Displaced/fractured fixation hardware related to the PMB tunnel was observed in 3/23 patients, and in the tibial tunnel in 2/23 patients. The highest prevalence of peritunnel marrow edema (50-81.8%) was observed 0-3 months postoperatively, which decreased progressively with increasing timeframe postoperatively. The highest prevalence of increased graft signal (25-62.5%) and graft thickening (25-37.5%) was seen 3-12 months postoperatively, with subsequent decrease on exams > 12 months postoperatively. Synovitis or arthrofibrosis was observed in 87.5% of exams obtained 3-12 months postoperatively, with a decrease (58.8%) on MRI exams > 12 months post-surgery. No significant correlation was observed between MRI variables and PCL stability (p-values, 0.085-0.815).</p><p><strong>Conclusions: </strong>Although a high prevalence of peritunnel edema, increased graft signal and thickness and synovitis/arthrofibrosis may be encountered early postoperatively, particularly in the first 12 months; these findings are not correlated to PCL instability and seem to decrease over longer-term follow-up.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"3271-3285"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857615","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":"Preoperative CT-measured lateral widening is an independent associated factor with CT-detected cruciate ligament avulsion in tibial plateau fractures.","authors":"Wen-Kai Su, Chi-Hsiang Hsu, Leung-Chit Tsang, Kun-Hao Chen, Shan-Ling Hsu","doi":"10.1007/s00256-026-05314-z","DOIUrl":"10.1007/s00256-026-05314-z","url":null,"abstract":"<p><strong>Objective: </strong>To identify radiographic and computed tomography (CT) parameters predictive of cruciate ligament avulsion fractures in patients with tibial plateau fractures (TPFs).</p><p><strong>Methods: </strong>We retrospectively analyzed 127 patients with TPFs, categorized by the presence (n = 39) or absence (n = 88) of cruciate ligament avulsion fractures. Demographic variables, fracture classification, and radiographic parameters measured on plain radiographs and CT images were compared using univariate analysis. Multivariate logistic regression and Receiver Operating Characteristic (ROC) analysis were performed to identify independent associated factors and diagnostic thresholds.</p><p><strong>Results: </strong>Cruciate ligament avulsion fractures occurred in 30.7% of patients and were most frequently associated with high-energy Schatzker type V and VI fractures. On univariate analysis, both CT-measured lateral plateau widening (10.6 ± 5.6 mm vs 7.5 ± 4.6 mm, P = 0.003) and radiographic lateral widening (10.8 ± 6.1 mm vs 9.0 ± 11.0 mm, P = 0.011) were significantly greater in the avulsion group. Multivariate logistic regression identified CT lateral widening as the only independent -associated factor for cruciate ligament avulsion. ROC analysis demonstrated moderate discriminative ability for CT lateral widening (area under the curve = 0.655), with an optimal cutoff value of 6.8 mm yielding a sensitivity of 79.5%.</p><p><strong>Conclusions: </strong>CT-measured lateral plateau widening is an independent preoperative indicator of cruciate ligament avulsion in tibial plateau fractures. A lateral widening threshold of approximately 6.8 mm on CT should be regarded as a quantitative imaging \"secondary sign\" prompting heightened suspicion for associated ligamentous avulsion injury and consideration of comprehensive preoperative planning.</p><p><strong>Level of evidence: </strong>Retrospective comparative study, Level III.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"3339-3346"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907201","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":"Challenging bone biopsies: what radiologists needs to know.","authors":"Leonor Garbin Savarese, Nicolas Papalexis, Mateus de Andrade Hernandes, Paolo Spinnato, Giancarlo Facchini, Marco Miceli, Nelson Fabricio Gava, Edgard Eduard Engel, Marcello Henrique Nogueira-Barbosa","doi":"10.1007/s00256-026-05336-7","DOIUrl":"10.1007/s00256-026-05336-7","url":null,"abstract":"<p><p>Bone biopsies play a pivotal role in the diagnostic workup of a wide range of bone pathologies. In many cases, image-guided percutaneous biopsy is favored over surgical approaches because it is minimally invasive, highly accurate, cost-efficient, and associated with lower morbidity. Among the available imaging modalities, CT guidance offers superior spatial resolution and enables precise needle placement, but certain skeletal locations remain technically demanding even under CT guidance. This review focuses on challenging CT-guided bone biopsy scenarios, including lesions adjacent to critical neurovascular or spinal structures, densely sclerotic lesions, and lesions occult on CT, and illustrates practical decision-making through representative clinical cases.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"3061-3072"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A skeletally immature patient with Diamond-Blackfan anemia with Deferoxamine induced bone dysplasia: An analysis on diffusion tensor imaging.","authors":"Sarah L Lu, Camilo Perdomo-Luna, Samuel A Beber, Ariana I Matarangas, Daniel W Green, Diego Jaramillo","doi":"10.1007/s00256-026-05339-4","DOIUrl":"10.1007/s00256-026-05339-4","url":null,"abstract":"<p><p>Deferoxamine-induced bone dysplasia is a rare but clinically significant complication of chronic iron chelation therapy, characterized by metaphyseal abnormalities and growth disturbances. While conventional imaging demonstrates abnormal endochondral ossification, the extent of physeal involvement remains poorly understood. Diffusion tensor imaging (DTI) enables microstructural evaluation of physeal architecture and may provide additional insight beyond routine MRI. We report a 9-year-old skeletally immature male with Diamond-Blackfan anemia treated with chronic deferoxamine iron chelation therapy who presented with bilateral genu valgum confirmed on alignment radiographs. MRI revealed multiple metaphyseal cartilage tongues with areas of abnormal ossification in both distal femurs. DTI of both knees was performed to assess physeal integrity prior to guided growth surgery. Tractography demonstrated preserved bilateral physeal tracts with femoral physeal volumes of 15.9 mL (left) and 13.0 mL (right), and mean tract lengths of 6.9 ± 4.0 mm and 6.4 ± 3.3 mm, respectively. Despite metaphyseal abnormalities, tract volume and fractional anisotropy values suggested ongoing physeal activity. The patient subsequently underwent bilateral hemiepiphysiodesis with early postoperative improvement in alignment. In this case of deferoxamine-associated bone dysplasia, DTI demonstrated preserved physeal microarchitecture despite marked metaphyseal abnormalities on conventional MRI. Thus, DTI tractography may serve as a useful adjunct in evaluating physeal function and surgical candidacy in pediatric patients with growth disturbances. To the best of our knowledge, this is the first reported use of DTI in this condition and suggests a potential role for assessing physeal function and surgical candidacy in pediatric growth disturbances.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"3381-3387"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712448","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":"Superb microvascular imaging enhances detection of microvascularity in plantar fasciosis: a clinical correlation study.","authors":"Çiğdem Samur Salbaş, Ender Salbaş, Nilay Şahin","doi":"10.1007/s00256-026-05298-w","DOIUrl":"10.1007/s00256-026-05298-w","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate superb microvascular imaging (SMI) for detecting microvascularity in chronic plantar heel pain and to assess its clinical correlation in comparison with grayscale ultrasound and conventional Doppler, using a standardized clinical diagnosis as the reference standard.</p><p><strong>Materials and methods: </strong>In this prospective study, 29 patients (58 fasciae) with bilateral plantar fasciosis and 30 matched asymptomatic controls (60 fasciae) underwent ultrasound examinations. Assessments included grayscale parameters (thickness > 4 mm, swelling hypoechogenicity), color/power Doppler, and SMI. Pain and function were evaluated using the VAS and FAOS-derived impairment scores. Discriminative ability was assessed via receiver operating characteristic (ROC) curves.</p><p><strong>Results: </strong>Symptomatic fasciae had significantly greater fascial thickness (5.02 ± 1.29 mm vs. 3.27 ± 0.56 mm, p < 0.001) and exceeded 4 mm in 82.8%/9.3% (right/left) versus 6.7%/10.0% of controls. Color Doppler detected no signals; power Doppler identified flow in 10.3% of symptomatic fasciae. SMI detected microvascular flow in 41.4%/44.8% (right/left) of symptomatic fasciae versus none (0%) of asymptomatic control fasciae (p < 0.001). SMI-detected vascularity showed a moderate association with clinical disease status (right r = 0.494; left r = 0.510; p < 0.001). ROC analysis demonstrated good discriminative ability for fascial thickness (AUC = 0.886) and fair performance for SMI (AUC = 0.707), both outperforming power Doppler (AUC = 0.603).</p><p><strong>Conclusion: </strong>SMI is substantially more sensitive than conventional Doppler for detecting microvascularity in plantar fasciopathy. However, grayscale fascial thickness retained the highest single-test discriminative ability, and many symptomatic fasciae remained SMI-negative. Therefore, SMI should be considered a complementary vascular assessment rather than a stand-alone diagnostic test. Larger multicenter studies are required to define its routine clinical role.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"3241-3249"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797922","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":"Decoding imaging in ankle impingement: a comprehensive review.","authors":"Rajnandini Dasgupta, Muhammed Munavvir Vannante Valappil, Stuti Chandola, Ankur Goyal, Shivanand Gamanagatti, Vijay Kumar Digge, Stanzin Spalkit","doi":"10.1007/s00256-026-05350-9","DOIUrl":"10.1007/s00256-026-05350-9","url":null,"abstract":"<p><p>Ankle impingement syndromes comprise a heterogeneous group of osseous and soft tissue pathologies caused by abnormal contact between articular or peri-articular structures, resulting in chronic pain and restricted motion. They are anatomically classified into posterior compartment (posterior proper and posteromedial), anterior compartment (including anterior proper, anterolateral and anteromedial), and extra-articular lateral hindfoot impingement (ELHFI). Posterior impingement is most commonly related to os trigonum or a prominent Stieda process, with MRI demonstrating marrow edema and posterior soft tissue hypertrophy, while ultrasound enables dynamic assessment and image-guided intervention. Anterior impingement results from repetitive microtrauma leading to osteophyte formation and capsular fibrosis; radiography and CT depict osseous abnormalities, whereas MRI and ultrasound characterize associated soft tissue changes. Anterolateral impingement and anteromedial impingement are typically post-traumatic, with fibrosis and ligamentous injury within the joint recesses, best evaluated on MRI, and ultrasound providing dynamic assessment. ELHFI is an under-recognized entity associated with posterior tibial tendon dysfunction and medial arch collapse, resulting in talocalcaneal or subfibular impingement. Weight-bearing radiographs and CT assess hindfoot alignment, while MRI delineates tendon, ligamentous, and marrow abnormalities. Ultrasound plays an adjunctive role in evaluating tendon pathology and guiding interventions. This review summarizes current evidence on the imaging features, pathomechanisms, and management of ankle impingement syndromes, with particular emphasis on extra-articular lateral hindfoot impingement. It emphasizes the value of a multimodality imaging approach and underscores the evolving role of ultrasound in both diagnosis and management, supporting its integration as a frontline modality in appropriately selected clinical and interventional settings.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"3083-3107"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866760","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":"High-resolution visualization of cervical spine anatomy using 3D DESS at 7-T MRI: a cohort study in asymptomatic volunteers.","authors":"Christoph Germann, Veronika Zubler, Florian Wanivenhaus, Daniel Nanz, Reto Sutter","doi":"10.1007/s00256-026-05356-3","DOIUrl":"10.1007/s00256-026-05356-3","url":null,"abstract":"<p><strong>Objective: </strong>To validate the feasibility of a three-dimensional dual-echo-steady-state (3D-DESS) sequence at 7-T MRI to reliably depict the detailed anatomy in the cervical spine.</p><p><strong>Materials and methods: </strong>Seventy-eight asymptomatic volunteers (age 36.4 ± 11.6 years) were imaged, using a 3D-DESS sequence at 7-T MRI. The course of the vertebral artery (VA) and the visualization of dorsal root ganglia (DRG) were analyzed by two fellowship-trained musculoskeletal radiologists. Additionally, degenerative changes were graded.</p><p><strong>Results: </strong>Uncovertebral arthrosis was present in 47.4% of participants; spinal canal stenosis was present in 16.1% (grade 1) and 2.6% (grade 2). Facet joint osteoarthritis at the most affected level was found in up to 12.8% (grade 1) and 3.8% (grade 2). Foraminal stenosis at the most affected level was seen in 10.3% (grade 1) and 3.8% (grade 2). Agreement was \"almost perfect\" for uncovertebral arthrosis (κ = 0.94) and spinal canal stenosis (κ = 0.82), \"moderate\" for facet joint osteoarthritis (κ = 0.56) and \"substantial\" for foraminal stenosis (κ = 0.68). Agreement was \"perfect\" regarding location of the VA (κ = 1.0), and almost perfect (κ = 0.93) for VA kinking. The agreement was \"excellent\" for distance between spinal cord and DRG (ICC = 0.94) and \"good\" for both width and height of DRG (ICC = 0.90 and 0.87, respectively). Contact between VA and DRG was present in almost all participants in levels C2/3 through C5/6 (94.9-100%).</p><p><strong>Conclusion: </strong>This study demonstrates the capability of a 3D-DESS sequence at 7-T MRI to reliably visualize the detailed anatomy of the cervical spine. Contact between VA and DRG is a relatively consistent finding in levels C2/3 through C5/6.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"3287-3296"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Greater occipital nerve iatrogenic neuroma after cervical arthrodesis: high-frequency ultrasound findings and ultrasound-guided management.","authors":"Cláudia Fontan, Carolina Ávila de Almeida, Danielle Martiniano da Silva Rodrigues, Victor Alfredo de Santana Silva, Clarissa Canella","doi":"10.1007/s00256-026-05362-5","DOIUrl":"10.1007/s00256-026-05362-5","url":null,"abstract":"<p><p>Persistent occipital headache after cervical arthrodesis is a disabling complication, often due to iatrogenic injury to the greater or lesser occipital nerves. Clinical overlap with primary headaches may delay diagnosis. High-resolution ultrasound (HRUS) has emerged as a reliable tool for evaluating superficial peripheral nerves and postoperative changes. We report a case illustrating its diagnostic value in occipital nerve injury, with a focused review of sonoanatomy. A 45-year-old woman developed refractory bilateral occipital pain consistent with occipital neuralgia after cervical arthrodesis for disc herniation. HRUS (24 MHz) using a standardized protocol revealed postsurgical changes and focal fusiform thickening with loss of fascicular architecture of the right greater occipital nerve at its muscular perforation site, consistent with iatrogenic neuroma. These findings guided targeted management. This case underscores the diagnostic challenge of postsurgical occipital neuralgia and the utility of HRUS. Knowledge of occipital nerve sonoanatomy and its relationship to adjacent cervical muscles is essential. HRUS enables real-time evaluation of nerve morphology and continuity, detecting focal thickening often missed by other imaging methods. HRUS allowed diagnosis and percutaneous treatment of greater occipital nerve neuroma in this patient.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"3397-3401"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging-based prevalence of the peroneus quartus muscle and its association with peroneal tendon pathology: a systematic review and meta-analysis.","authors":"Luiza Borba de Almeida Madruga, Pandora Eloa Oliveira Fonseca, Giovanna Macanhã Scremin, Marco Aurelio Soato Ratti, João Paulo Costa Coelho, Mariana Jungles Polato, Edgar Leonardo Martinez Salazar","doi":"10.1007/s00256-026-05343-8","DOIUrl":"10.1007/s00256-026-05343-8","url":null,"abstract":"<p><strong>Objective: </strong>To determine the imaging-based prevalence of the peroneus quartus muscle and to quantify concurrent peroneal tendon pathology among individuals with this anatomical variant.</p><p><strong>Materials and methods: </strong>A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. PubMed, EMBASE and Cochrane were searched from inception to 2025 for imaging-based studies reporting peroneus quartus prevalence. Overall prevalence was estimated using generalized linear mixed models with random effects. Heterogeneity was assessed using the I² statistic. Risk of bias was evaluated using design-specific Joanna Briggs Institute critical appraisal checklists. Subgroup analyses examined sex and laterality distribution among positive cases.</p><p><strong>Results: </strong>Seventeen studies comprising 3,725 ankle imaging examinations were included. The overall prevalence of the peroneus quartus was 11% (95% CI: 8-15%), with substantial heterogeneity (I² = 80.5%). Among six studies (315 positive ankles), peroneal tendon pathology was present in 51.4% (95% CI: 41.9-60.8%). In three studies reporting tears in ankles with and without the peroneus quartus, its presence was associated with higher odds of peroneal tendon tears (pooled odds ratio 3.40, 95% CI: 2.03-5.68; I² = 0%; p < 0.001). The majority of studies (58.8%) were classified as low risk of bias.</p><p><strong>Conclusion: </strong>The peroneus quartus muscle is identified in approximately one of nine ankle imaging examinations, and in studies with a comparison group its presence was associated with higher odds of peroneal tendon tears. This supports the proposed crowding-effect hypothesis, although a causal relationship remains to be established.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"3229-3239"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797857","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}