Skeletal Radiology最新文献

{"title":"The immature sacroiliac joints on cross-sectional imaging: developmental anatomy and diagnostic pitfalls.","authors":"Bruno Beber Machado, Sergio Lopes Viana, Bruna Maria Stofela Sarolli","doi":"10.1007/s00256-026-05194-3","DOIUrl":"10.1007/s00256-026-05194-3","url":null,"abstract":"<p><p>The immature sacroiliac joint (SIJ) has developmental imaging appearances that frequently simulate sacroiliitis in children and adolescents evaluated for juvenile spondyloarthritis, and false-positive interpretation increases when adult MRI and structural criteria are applied. This review integrates developmental anatomy with MRI and CT findings and discusses CT-like MRI and MRI-based synthetic CT as structural adjuncts for cortical assessment in the immature SIJ. We emphasize the most relevant false-positive pathways in daily practice, including peri-physeal fluid-sensitive marrow hyperintensity, developmental cortical contour variants, transitional intersegmental fusion interfaces, well-corticated intra-articular developmental ossification centers, physiologic enhancement patterns, and intra-articular gas (vacuum phenomenon). The review also outlines modality-specific strengths and limitations and provides practical guidance on how to integrate fluid-sensitive and structural information across modalities. The figure set is organized as a teaching atlas focused on pattern recognition, multimodality correlation, and explicit interpretive safeguards to help radiologists distinguish physiologic maturation from true inflammatory disease in skeletally immature patients.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"1217-1226"},"PeriodicalIF":2.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481466","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":"Blastic plasmacytoid dendritic cell neoplasm: dermal thickening with T2-dark band as an early imaging clue.","authors":"Shingo Omata, Hiroki Kato, Takuya Seko, Masaya Kawaguchi, Yuto Kaneda, Nobuhiro Kanemura, Yusuke Kito, Masayuki Matsuo","doi":"10.1007/s00256-026-05140-3","DOIUrl":"10.1007/s00256-026-05140-3","url":null,"abstract":"<p><p>Blastic plasmacytoid dendritic cell neoplasm is a rare, aggressive hematologic malignancy that commonly involves the skin and can rapidly disseminate. We report the case of a 58-year-old man presenting with a rapidly enlarging reddish nodule over the right scapular region, which grew from 9 to 20 cm within 1 month. Chest magnetic resonance imaging revealed marked dermal thickening with a band-like low signal on T2-weighted images (\"T2-dark band\"). The T2-dark dermal layer was interposed between the tumor exhibiting restricted diffusion-superficial components bulging outward and invasive subcutaneous components (the \"Hamburger Sign\"). ¹⁸F-FDG PET/CT demonstrated intense uptake (SUVmax, 17) in the cutaneous lesion and revealed the involvement of multiple skeletal sites. Histopathology revealed diffuse infiltration of atypical cells extending from the dermis into the subcutis. Immunohistochemistry was positive for TCF4, CD123, and TCL1, confirming the diagnosis. Radiologic-pathologic correlation suggested that the T2-dark dermal band reflects interstitial tumor infiltration that splays and preserves dermal collagen bundles, providing a basis for the T2 shortening in a collagen-rich, low-free-water layer. We propose the \"Hamburger Sign\" to describe characteristic imaging findings of the blastic plasmacytoid dendritic cell neoplasm, that is, the dermal T2-dark \"patty\" is sandwiched by tumor \"buns\" and the superficial and deep tumor components. Early recognition of this sign may prompt appropriate immunohistochemical work-up (plasmacytoid dendritic markers of TCF4, CD123, and TCL1) and expedite diagnosis, particularly when initial biopsy suggests undifferentiated carcinoma.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"1409-1413"},"PeriodicalIF":2.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030756","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":"Test yourself question: 38-year-old female with left hip pain.","authors":"Ruhaid Khurram, Amar Nitin Kanani, Mohammed Saif Sait, Khamaeel Khaleel Al Lami, Ramanan Rajakulasingam","doi":"10.1007/s00256-026-05144-z","DOIUrl":"10.1007/s00256-026-05144-z","url":null,"abstract":"","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"1397-1399"},"PeriodicalIF":2.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107187","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":"Metal-artefact-reduction MRI for diagnosing periprosthetic joint infection: a systematic review and meta-analysis.","authors":"Ben Thompson, Jonathan Gibson, Tanwen Bird, Jamie Arbuthnot, Rajesh Botchu","doi":"10.1007/s00256-026-05184-5","DOIUrl":"10.1007/s00256-026-05184-5","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) remains one of the most serious. Advances in metal-artefact-reduction sequences (MARS) now allow for improved diagnostic quality imaging in the periprosthetic region. Early studies suggest the diagnostic efficacy of MARS, including subfeatures, yet no formal synthesis of available data exists.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following PRISMA-DTA and PRISMA 2020 guidelines. Eligible studies include diagnostic accuracy studies reporting MARS-MRI compared with established reference standards, such as Musculoskeletal Infection Society (MSIS) or International Consensus Meeting (ICM) criteria, or intraoperative microbiology and histology. Adults (≥18 years) with hip, knee, or shoulder arthroplasty undergoing MRI for suspected infection or aseptic loosening were included. Comprehensive searches were conducted in PubMed, Embase, Scopus, and Web of Science, from 2005 onwards, without language restriction.</p><p><strong>Results: </strong>A total of 11 studies were included in this meta-analysis evaluating MARS-MRI for diagnosing periprosthetic joint infection (PJI). Pooled performance demonstrated high diagnostic accuracy with sensitivity 0.88 (95% CI 0.72-0.95), specificity 0.95 (95% CI 0.80-0.99), and AUC 0.94. Subgroup analysis showed soft tissue changes had the best diagnostic performance (sensitivity 0.82, specificity 0.91), followed by synovitis and effusion, whilst bone changes were less accurate. Overall, MARS-MRI demonstrates excellent utility in diagnosing PJI.</p><p><strong>Conclusion: </strong>MARS-MRI demonstrates high diagnostic accuracy for periprosthetic joint infection (sensitivity 0.88, specificity 0.95, AUC 0.94), particularly with soft tissue changes. It aids antimicrobial stewardship by reducing unnecessary interventions. Further large, multi-centre prospective studies are needed to strengthen evidence and validate clinical utility.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"1181-1195"},"PeriodicalIF":2.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147370377","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":"MRI findings for differentiating benign and malignant soft tissue tumors: a systematic review-part 2: key imaging findings.","authors":"Muaz Wahid, Aayush Sharma, Mahad Rehman, Shyam Ramachandran, Majid Chalian, Gitanjali Bajaj, Jim S Wu, Hillary Garner, Jonathan Samet, Shivani Ahlawat, Kambiz Motamedi, Ty Subhawong, Mark Murphey, Avneesh Chhabra","doi":"10.1007/s00256-026-05155-w","DOIUrl":"10.1007/s00256-026-05155-w","url":null,"abstract":"<p><strong>Objective: </strong>To synthesize magnetic resonance imaging (MRI) features and their reported diagnostic performance that differentiate benign from malignant soft-tissue tumors in alignment with the 2020 World Health Organization classification.</p><p><strong>Materials and methods: </strong>A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials were searched through July 2024. Eligible studies reported MRI feature frequencies or diagnostic accuracy for common soft-tissue tumor subtypes. Reviews, case reports, duplicates, non-English publications, and studies outside the scope were excluded. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).</p><p><strong>Results: </strong>Seventy-six studies met inclusion criteria. In lipomatous tumors, homogeneous fat signal and thin septa supported lipoma, whereas thick or nodular septa and enhancement favored atypical or well-differentiated liposarcoma. Myxofibrosarcoma often demonstrated an infiltrative fascial \"tail.\" Vascular lesions included angioleiomyoma with a reticular T2 pattern and glomus tumor with marked T2 hyperintensity and avid enhancement. In peripheral nerve sheath tumors, lower apparent diffusion coefficient values and peritumoral edema favored malignancy. Heterogeneity in imaging protocols precluded meta-analysis; results were summarized descriptively by subtype.</p><p><strong>Conclusion: </strong>Consolidated MRI patterns-such as septal morphology in lipomatous tumors, the fascial tail in myxofibrosarcoma, characteristic T2 patterns in vascular lesions, and diffusion and edema cues in nerve sheath tumors-support differentiation of benign and malignant entities, enhance reader confidence, and inform biopsy and management. Standardized prospective studies are needed to validate these thresholds and improve generalizability.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"1279-1295"},"PeriodicalIF":2.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146132892","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":"Brachial plexopathy in juvenile-onset Krabbe disease: A rare case.","authors":"Vaishali Upadhyaya, Konika Bansal","doi":"10.1007/s00256-026-05159-6","DOIUrl":"10.1007/s00256-026-05159-6","url":null,"abstract":"<p><p>Krabbe disease is an autosomal recessive leukodystrophy where a deficiency of the galactosylceramide beta-hydrolase enzyme leads to accumulation of toxic substances which cause demyelination in both central and peripheral nervous systems. It is classified into early infantile, late infantile, juvenile and adult types based on the age of presentation. MRI of the brain in patients with Krabbe disease shows bilaterally symmetrical T2 hyperintense signal in the periventricular and deep white matter and in the corticospinal tracts. Patients can have peripheral neuropathy, which, on imaging, is commonly seen in the form of thickening and enhancement of cranial nerves and nerve roots of cauda equina. Our patient, a child aged eleven years, had intracranial lesions along with brachial plexopathy. This is the first described case of juvenile-onset Krabbe disease with brachial plexus involvement.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"1421-1424"},"PeriodicalIF":2.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143460","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":"Ultrasound gap measurement after acute Achilles rupture is reliable overall but uncertain near a 5-mm decision threshold.","authors":"Dan Mocanu, Katarzyna Bokwa-Dąbrowska, Elin Larsson, Katarina Nilsson Helander, Pawel Szaro","doi":"10.1007/s00256-026-05243-x","DOIUrl":"https://doi.org/10.1007/s00256-026-05243-x","url":null,"abstract":"<p><strong>Objective: </strong>Ultrasound gap distance has been proposed as a supportive triage input within protocol-based pathways after acute Achilles tendon rupture. We assessed intra-/inter-rater reliability of gap measurement and the extent of classification uncertainty around a 5-mm threshold. Retrospective observer-agreement study without a definitive reference standard, using protocol-acquired stored ultrasound cine loops from 30 clinically diagnosed complete acute ruptures in a prospectively collected cohort.</p><p><strong>Methods: </strong>Retrospective observer-agreement study without a definitive reference standard, using protocol-acquired stored ultrasound cine loops from 30 clinically diagnosed complete acute ruptures in a prospectively collected cohort. Two blinded musculoskeletal radiologists re-reviewed stored cine loops and measured tendon-gap distance in two sessions each (≥ 4 weeks apart). We calculated intraclass correlation coefficients (ICC), Bland-Altman mean difference and 95% limits of agreement (LoA), and standard error of measurement (SEM). Agreement at the 5-mm protocol cut-point was assessed using Cohen's κ and Gwet's AC1. Using SEM, we derived 90% confidence zones indicating firm classification versus a grey zone where repeat measurement or second read may be considered.</p><p><strong>Results: </strong>Intra-rater ICC(2,1) was 0.88 (95% CI 0.83-0.91) and 0.94 (0.82-0.97); SEMs were 1.57 and 1.19 mm. Inter-rater bias was + 1.12 mm with LoA - 3.85 to 6.10 mm. Agreement for study experimental pathway classification at the 5-mm cut-point (operative vs non-operative) was moderate (κ = 0.60; AC1 = 0.61), with 6/30 examinations classified differently. SEM-based 90% zones were ≤ 2.42 and ≥ 7.58 mm (rater 1) and ≤ 3.04 and ≥ 6.96 mm (rater 2); a conservative cross-rater rule suggested ≤ 2.05 or ≥ 7.95 mm.</p><p><strong>Conclusion: </strong>Gap measurement shows good relative reliability, but uncertainty near 5 mm can alter classification. Reporting LoA/SEM alongside ICC and flagging a grey zone may reduce misclassification in borderline cases.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857014","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":"A comprehensive review of ultrasonographic imaging in athletic elbow injuries: a compartment-based approach.","authors":"Dong Rak Kwon, EunKuk Kim","doi":"10.1007/s00256-026-05241-z","DOIUrl":"https://doi.org/10.1007/s00256-026-05241-z","url":null,"abstract":"<p><p>Elbow injury rates are markedly higher among collegiate athletes than in the general population; however, this elevated incidence is largely driven by overhead throwing sports and does not represent a uniform risk across all athletes. Elbow disorders represent a significant diagnostic challenge in sports medicine due to the intricate anatomy of the joint. High-resolution ultrasonography has become an indispensable first-line imaging modality, offering superior spatial resolution for superficial structures and the unique capability for real-time dynamic assessment. This review illustrates the ultrasonographic spectrum of common elbow injuries in athletes, including epicondylopathy, ulnar collateral ligament insufficiency, and nerve entrapment syndromes. By employing a systematic, compartment-based approach categorizing findings into anterior, medial, lateral, and posterior zones, radiologists can ensure a comprehensive evaluation. Particular emphasis is placed on dynamic maneuvers such as valgus stress for ulnar collateral ligament stability and flexion-extension for ulnar nerve subluxation, which provide functional insights that are often unavailable on static magnetic resonance imaging. Furthermore, emerging adjunctive techniques, such as sonoelastography, may provide complementary information on tissue stiffness and integrity, potentially improving lesion characterization in specific athletic elbow conditions. Understanding these imaging patterns is crucial for accurate diagnosis and optimized management in athletes.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842541","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":"Primary Kaposiform hemangioendothelioma of the tibia: report of a case with a previously undescribed GNAQ mutation.","authors":"Giorgia Arcovito, Raffaele Gaeta, Giacomo Aringhieri, Lorenzo Andreani, Francesca Lessi, Mariangela Morelli, Chiara Maria Mazzanti, Alessandro Franchi","doi":"10.1007/s00256-026-05245-9","DOIUrl":"https://doi.org/10.1007/s00256-026-05245-9","url":null,"abstract":"<p><p>Primary occurrence of Kaposiform hemangioendothelioma (KHE) in bone is extremely rare. We report the radiologic, histopathologic and molecular features of a case of KHE affecting the tibia of an adult male, who presented with pain in the left knee initially associated with previous trauma. Radiographs showed an eccentric well-defined lytic lesion of the tibial epiphysis. On MRI, the lesion showed hypo to isointensity on T1-weighted images and hyperintensity on STIR sequences. A CT-guided biopsy was pathologically inconclusive. MRI performed 11 months later showed lesion progression with cortical erosion and soft tissue extension. Extended curettage was performed and histologically the lesion consisted of irregular nodules permeating bone trabeculae, composed of glomeruloid structures with densely packed capillary-sized vessels lined by flat endothelial cells without nuclear atypia. A second component of bland spindle cells arranged in fascicles with slit-like spaces resembling Kaposi sarcoma was present, together with intermixed dilated lymphatic channels and multiple nodular lymphoid aggregates. Neoplastic cells were positive for CD31 and CD34, whereas podoplanin was positive in the lymphatic component. Using digital droplet PCR, we identified a previously unreported GNAQ T96S mutation, whereas other GNAQ mutations were not detected. Despite its rarity, recognition of intraosseous KHE is crucial because it allows for prompt curative surgical treatment and avoids potential complications.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857068","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":"Comparison of radiomics-based models for detection of Modic type 1 changes in photon-counting detector CT images of the lumbar spine.","authors":"Adrian A Marth, Benjamin Fritz, Reto Sutter","doi":"10.1007/s00256-026-05247-7","DOIUrl":"https://doi.org/10.1007/s00256-026-05247-7","url":null,"abstract":"<p><strong>Objective: </strong>To compare diagnostic performance of four radiomics-based machine learning models for detecting Modic type 1-changes of the lumbar spine in photon-counting detector (PCD)-CT images, using MRI as the reference standard.</p><p><strong>Materials and methods: </strong>In this retrospective single-center study, 60 patients who underwent lumbar spine PCD-CT and MRI within a one-week interval showing Modic type 1-changes were analyzed. A total of 105 radiomic features were extracted from 360 segmented vertebrae, of which 348 were included in the final analysis after quality control. Least Absolute Shrinkage and Selection Operator (LASSO), Random Forest, Extreme Gradient Boosting (XGBoost), and support vector machines (SVM) were trained and evaluated using nested cross-validation. Discriminatory performance of the models was evaluated by area under the receiver operating characteristic curve (AUC). AUC values were compared using the DeLong Test with Benjamini-Hochberg correction to adjust for multiple testing. Diagnostic accuracy was assessed by calculating sensitivity, specificity and F1-score for each model.</p><p><strong>Results: </strong>LASSO achieved the highest AUC (0.842, 95% CI 0.793-0.891), pairwise comparisons did not show significant differences across the models (p ≥ 0.337). Sensitivity was highest for LASSO (0.756, 95% CI 0.662-0.846), whereas specificity was highest for SVM (0.929, 95% CI 0.896-0.958). The highest F1-score was observed for LASSO (0.605, 95% CI 0.521-0.679).</p><p><strong>Conclusion: </strong>Four radiomics-based machine learning models demonstrated similar high discriminatory performance but differing diagnostic accuracy for detecting Modic type 1-changes on PCD-CT images. These results support the feasibility of radiomics for evaluation of pathologies beyond visual inspection, although further validation is required to determine clinical applicability.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842490","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}