Skeletal Radiology最新文献

{"title":"Acute atraumatic compartment syndrome of the foot.","authors":"Marie Ugo, Aliyah Baksh, Joseph Dubois Inzinna, Leonardo Furtado Freitas, Ricardo Caldeira Cury, Atul Kumar Taneja","doi":"10.1007/s00256-026-05303-2","DOIUrl":"10.1007/s00256-026-05303-2","url":null,"abstract":"<p><p>Acute atraumatic compartment syndrome (AACS) of the foot is an uncommon, limb-threatening condition that is frequently underrecognized due to its atypical presentation and the absence of high-energy trauma. We report a case of a 32-year-old male presenting with abrupt, severe foot pain and swelling 24 h after playing in an indoor park barefoot, with no history of injury. While initial radiographs, CT, and inflammatory markers were unremarkable, physical examination demonstrated pain disproportionate to findings and increased compartmental tension. Magnetic resonance imaging (MRI) was pivotal in the diagnostic workflow, demonstrating severe diffuse enlargement, compartmental expansion, and marked edema of the abductor hallucis muscle. Laboratory evaluation post-MRI confirmed elevated creatine kinase levels consistent with rhabdomyolysis. These characteristic imaging findings prompted emergent decompressive fasciotomy, which revealed a tense medial compartment and pale musculature that successfully reperfused upon fascial release. Following surgery and aggressive hydration, the patient achieved a full recovery with preserved renal function and limb salvage. This case emphasizes that in the setting of atraumatic foot pain, MRI can provide decisive diagnostic evidence of AACS, assisting in timely surgical intervention and preventing irreversible myonecrosis or permanent neurological deficits.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"2995-2999"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423605","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":"Adhesive capsulitis embolization: a narrative review.","authors":"Ho Kit Kennis Leung, Ahmad Hussain, Ana Fernandez-Martinez, Bedros Taslakian, Yan Epelboym","doi":"10.1007/s00256-026-05308-x","DOIUrl":"10.1007/s00256-026-05308-x","url":null,"abstract":"<p><p>Adhesive capsulitis is a painful shoulder disorder characterized by progressive stiffness and loss of range of motion, affecting approximately 2%-5% of the general population. Adhesive capsulitis embolization (ACE) is a minimally invasive endovascular technique that targets abnormal neovascularization associated with capsular inflammation. This narrative review summarizes the current literature on ACE for adhesive capsulitis, focusing on procedural technique and reported clinical outcomes. Eleven published clinical studies comprising 422 patients were identified and summarized descriptively. Across these studies, embolization was associated with improvement in pain, functional outcomes, and shoulder range of motion, with no major complications reported. However, definitions of technical success, clinical success, minimal clinically important difference (MCID), outcome measures, and follow-up duration varied between studies, limiting direct comparison. Although early short- to mid-term results are promising, the available evidence remains limited. Larger prospective studies with longer follow-up duration, standardized outcome reporting, stage stratification, and appropriate control groups are needed to define the true value of ACE in the management of adhesive capsulitis.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"2733-2745"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563002","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":"Performance of multimodal large language models versus clinicians for radiographic knee osteoarthritis grading: A multiobserver study.","authors":"Asli Irmak Akdogan, Efe Kemal Akdogan, Mehmet Fatih Tumer, Sılanaz Kutlu, Mustafa Agah Tekindal, Ozgur Tosun","doi":"10.1007/s00256-026-05322-z","DOIUrl":"10.1007/s00256-026-05322-z","url":null,"abstract":"<p><strong>Objective: </strong>To compare the performance of clinicians and two generations of multimodal large language models (LLMs) in Kellgren-Lawrence (KL) grading of knee osteoarthritis (KOA), including feature-level assessment and intraobserver repeatability.</p><p><strong>Materials and methods: </strong>In this retrospective single-center study, 348 knee radiographs were graded by a senior musculoskeletal radiologist (reference standard), a radiologist, an orthopedic surgeon, a radiology resident, and LLMs (ChatGPT-4o and ChatGPT-5.0). Binary KOA detection (KL 0-1 vs ≥ 2), feature-level interpretation (joint space narrowing, osteophytes, subchondral sclerosis), and intraobserver repeatability were evaluated. Agreement metrics included weighted κ, accuracy, and standard diagnostic measures.</p><p><strong>Results: </strong>Agreement with the reference standard was highest for the radiologist (κ = 0.87), followed by the orthopedic surgeon and radiology resident. Both LLMs demonstrated moderate agreement, with ChatGPT-5.0 outperforming ChatGPT-4o. For binary KOA detection, ChatGPT-5.0 showed very high sensitivity (0.96) but reduced specificity. Per-grade classification was most accurate for KL 0 and KL 4, but remained limited for KL 1-2. Feature-level concordance was modest across all radiographic findings. Intraobserver repeatability was highest for the reference reader (κ = 0.881), followed by the orthopedic surgeon (κ = 0.634) and radiologist (κ = 0.626), while lower agreement was observed for the resident (κ = 0.478) and LLMs, with ChatGPT-5.0 showing higher consistency than ChatGPT-4o (κ = 0.591 vs. 0.485).</p><p><strong>Conclusion: </strong>Although ChatGPT-5.0 outperformed ChatGPT-4o, both models remained inferior to clinicians in detailed KL grading, feature-level interpretation, and reproducibility. Current multimodal LLMs show high sensitivity but limited specificity and are not suitable for standalone radiographic KOA assessment.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"2801-2811"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585163","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":"Zero echo time MRI for detecting osseous anomalies in neurogenic thoracic outlet syndrome.","authors":"Yenpo Lin, Allison S Lowe, Falko Ensle, Zenas Igbinoba, Shu-Han Wang, Daniel Alschuler, Ek T Tan, Darryl B Sneag","doi":"10.1007/s00256-026-05315-y","DOIUrl":"10.1007/s00256-026-05315-y","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the additive value of a zero echo time (ZTE) sequence to standard brachial plexus MR neurography (MRN) for detecting and characterizing osseous anomalies in patients with suspected neurogenic thoracic outlet syndrome (nTOS).</p><p><strong>Materials and methods: </strong>In this retrospective, case-control study (January 2022-March 2025), unilateral brachial plexus MRN examinations with ZTE and reference imaging (radiographs and/or CT) were included. Two board-certified radiologists determined case status and osseous anomaly subtype (cervical rib, rib synostosis, or elongated C7 transverse process) on the reference imaging. Age- and sex-matched controls were randomly selected. Three musculoskeletal radiologists independently reviewed each examination in 3 rounds (MRN-only, ZTE-only, MRN + ZTE). Inter-reader agreement was assessed, and diagnostic performance was compared with reference standard.</p><p><strong>Results: </strong>Thirty examinations from 27 subjects (20 female; median age 31 years) were analyzed, including 15 case examinations (elongated C7 transverse process n = 7, cervical rib n = 4, rib synostosis n = 4) and 15 control examinations. Accuracy for osseous anomaly detection was highest in ZTE-only (0.90; sensitivity 0.80; specificity 1.00), followed by MRN + ZTE (0.87; 0.73; 1.00) and MRN-only (0.73; 0.53; 0.93). MRN + ZTE identified anomaly-related nerve impingement more frequently than MRN-only. MRN + ZTE showed the highest agreement for osseous anomaly detection and subtype (κ = 0.68 and 0.61), compared with MRN-only (κ = 0.53 and 0.56) and ZTE-only (κ = 0.59 and 0.54). Agreement for nerve impingement improved from fair with MRN-only (κ = 0.40) to substantial with MRN + ZTE (κ = 0.62).</p><p><strong>Conclusion: </strong>ZTE improves detection of osseous anomalies in brachial plexus MRN and increases inter-reader agreement and diagnostic confidence, supporting its incorporation into MR protocols for nTOS evaluation.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"2813-2821"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585218","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 accelerated MRI protocol approaches for clinical assessment of the knee.","authors":"Ananya Goyal, James MacKay, Matthew Petterson, Rianne van der Heijden, Kathryn Stevens, Min Yoon, Tie Liang, Jason Wong, Akshay Chaudhari, Feliks Kogan","doi":"10.1007/s00256-026-05309-w","DOIUrl":"10.1007/s00256-026-05309-w","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic performance and image quality of four accelerated knee MRI protocols (~ 6 minutes) compared with a conventional 2D fast spin echo (FSE) protocol (12-15 minutes).</p><p><strong>Subjects and methods: </strong>In this prospective single-center study, 32 adults with knee pain and/or self-reported osteoarthritis underwent 3T MRI using five protocols: conventional 2D FSE, 2D FSE with deep learning (DL) reconstruction, 3D Cube, 3D quantitative double-echo steady-state (qDESS), and thin-slice 2D FSE. Five radiologists independently evaluated joint pathologies. Interreader and intermethod agreement (Gwet's AC1), positive and negative percent agreement (PPA and NPA), and diagnostic image quality (Likert scale; Friedman test, p < 0.05) were assessed.</p><p><strong>Results: </strong>Overall, 12/160 protocol scans were excluded due to motion artifacts. Interreader agreement was similar across protocols but varied by tissues. Intermethod agreement between accelerated protocols and the conventional protocol approached the repeatability of the conventional protocol. NPA remained consistently high across tissues and protocols. PPA was more variable, particularly for synovitis and effusion, whereas for bone marrow, cartilage, and meniscus, PPA for the DL, Cube, and qDESS protocols approached the repeatability of the reference protocol. For all accelerated protocols except the thin-slice approach, diagnostic image quality was diagnostically acceptable or better in > 94% of examinations.</p><p><strong>Conclusion: </strong>Accelerated 2D DL, 3D Cube, and 3D qDESS protocols demonstrated diagnostic agreement and diagnostic image quality comparable to the conventional knee MRI protocol while reducing scan time to ~ 6 min. These approaches may serve as practical alternatives to conventional protocols, with potential benefits for clinical workflow and patient experience.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"2857-2871"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621300","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":"Can CT-guided cervical nerve root injections delay or prevent the need for surgical intervention in cervical radiculopathy?","authors":"Adnan R Alnaser, Terngu Moti, Haneen Khalifeh, Moath Khalifah, Muhammad Dherijha, Christopher Hilditch, Robert McCreary, Saeed Mohammad, Rukhtam Saqib","doi":"10.1007/s00256-026-05338-5","DOIUrl":"10.1007/s00256-026-05338-5","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of computed tomography (CT)-guided cervical nerve root injections (CNRI) for cervical radiculopathy, identify predictors of favourable pain response, and assess their impact on subsequent surgical intervention rates.</p><p><strong>Methods: </strong>Retrospective observational study included 148 patients undergoing CT-guided CNRI for cervical radiculopathy between October 2021 and April 2024 at a regional neuroscience centre in the Northwest of England providing a tertiary-level specialist care. Data on demographics, clinical presentation, radiological findings, procedural details, patient-reported outcomes, and subsequent surgery were collected. Univariate and multivariate logistic regression analyses were performed to identify predictors of pain improvement.</p><p><strong>Results: </strong>Overall, 66.2% (98/148) of patients reported improvement in radicular pain following CT-guided CNRI (55.1% substantial, 44.9% partial), with a mean symptom relief duration of 20.2 weeks (SD 22.8). Multivariate analysis identified unilateral symptoms as a significant positive predictor of improvement (OR = 7.0, 95% CI 2.01-24.08, p = 0.002), while multilevel disease (OR = 0.40, 95% CI 0.15-0.98, p = 0.047) and prior cervical surgery (0.31, 95% CI 0.11-0.82, p = 0.018) were significant negative predictors. During the study period, 24.3% (36/148) of patients proceeded to or were listed for cervical spinal surgery. No major neurovascular complications were reported.</p><p><strong>Conclusion: </strong>CT-guided CNRI provides effective short- to medium-term pain relief for a majority of patients with cervical radiculopathy and can reduce the need for subsequent surgery in approximately three-quarters of cases. Treatment success is more likely in patients with unilateral symptoms and without multilevel disease or prior cervical surgery. These findings can aid in patient selection and counselling.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"2919-2930"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685718","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":"Apparent diffusion coefficient metrics for treatment response assessment in soft tissue sarcoma: Reproducibility and prognostic value of whole-tumor and sub-regional analysis.","authors":"Iris van der Loo, Valentina Valentini, Kalina Chupetlovska, Stephan Ursprung, Petra J van Houdt, Annemarie Bruining, Regina G H Beets-Tan, Alex L T Imholz, Andrea Delli Pizzi, Stefano Trebeschi","doi":"10.1007/s00256-026-05318-9","DOIUrl":"10.1007/s00256-026-05318-9","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the inter-observer reproducibility and predictive value of apparent diffusion coefficient (ADC) metrics derived from diffusion-weighted MRI for assessing histopathologic response to neoadjuvant radiotherapy in soft tissue sarcoma (STS).</p><p><strong>Materials and methods: </strong>This retrospective, single-institution cohort study included 23 patients with histologically proven STS treated with neoadjuvant radiotherapy. Patients underwent 1.5 T or 3.0 T MRI, including diffusion-weighted sequences (b = 200, 800 s/mm²). Three independent radiologists measured mean tumor ADC, high-ADC, and low-ADC regions at baseline and post-radiotherapy. Reproducibility was assessed using the Intraclass Correlation Coefficient (ICC). Response prediction and clinicopathological associations were evaluated using Mann-Whitney U tests, logistic regression, and Spearman rank correlations.</p><p><strong>Results: </strong>Single-timepoint ADC measurements demonstrated high inter-observer reproducibility, particularly for mean tumor ADC (ICC = 0.91-0.95). Reproducibility for ADC changes over time was lower; agreement for mean tumor ADC (ICC = 0.79) outperformed subregional values (ICC = 0.06-0.63). Post-treatment mean tumor ADC was significantly elevated in responders (median 2.39 × 10⁻³ mm²/s) versus non-responders (1.50 × 10⁻³ mm²/s, p = 0.02). High follow-up ADC values (mean and high-ADC subregions) were the strongest predictors of pathological response (OR = 20.3-33.1, all p < 0.05). Follow-up ADC values inversely correlated with the percentage of viable tumor cells (p < 0.05).</p><p><strong>Conclusion: </strong>Post-treatment ADC measurements were highly reproducible and best predicted pathological response in our cohort. Longitudinal changes were less robust and require further research into the effect of standardized DWI protocols and more reliable techniques for sub-regional analysis.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"2845-2855"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621358","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":"Intramuscular granular cell tumor of the forearm: a rare case and diagnostic challenge.","authors":"Jiro Ichikawa, Tomonori Kawasaki, Masanori Wako, Tetsuhiro Hagino, Kouhei Mitsui, Kojiro Onohara","doi":"10.1007/s00256-026-05320-1","DOIUrl":"10.1007/s00256-026-05320-1","url":null,"abstract":"<p><p>Granular cell tumors (GCT) are rare neoplasms of neuroectodermal origin that can arise at various anatomical sites. Intramuscular GCTs in the extremities, particularly the upper limbs, are uncommon. MRI may suggest a GCT; however, variable signal intensity patterns complicate the diagnosis, necessitating histopathological confirmation. A 55-year-old woman presented with a gradually enlarging painless mass on the ulnar side of the left forearm. MRI revealed a poorly defined intramuscular lesion within the flexor carpi ulnaris, showing peripheral high signal intensity on T2-weighted and fat-suppressed images, with rim-like enhancement. Gadolinium-enhanced images revealed internal linear structures, interpreted as the stripe sign, within the tumor. Differential diagnoses included undifferentiated pleomorphic sarcoma, myxofibrosarcoma, inflammatory myositis, and granular cell tumors. Needle biopsy suggested the presence of a GCT or inflammatory lesion. Surgical resection revealed large epithelioid-to-polygonal cells with eosinophilic granular cytoplasm, perineural invasion, and lymphocytic infiltration. Immunohistochemical analysis showed positivity for S-100, SOX10, Inhibin, NSE, CD68, and TFE3. The Ki-67 index was 3%, supporting the diagnosis of benign GCT. Although the surgical margins were positive, no recurrence was observed at the two-year follow-up. Peripheral T2 hyperintensity and the stripe sign have been proposed as MRI findings of GCT. However, peripheral T2 hyperintensity is considered to have low specificity, whereas the stripe sign may be more specific to GCT. Although histopathological examination remains essential for the definitive diagnosis, further radiologic evaluation of the utility of the stripe sign is warranted.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"3015-3019"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593125","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":"Detection of metastasis in myxoid liposarcoma: WB-MRI versus CT-CAP.","authors":"Ruhaid Khurram, Elise Chua, Mohammed Saif Sait, Ramanan Rajakulasingam","doi":"10.1007/s00256-026-05307-y","DOIUrl":"10.1007/s00256-026-05307-y","url":null,"abstract":"<p><strong>Objective: </strong>To describe the incidence and distribution of skeletal and extraskeletal metastases in myxoid liposarcoma (MLS) on staging whole-body MRI (WB-MRI) and CT chest, abdomen, and pelvis (CT-CAP), to inform initial staging protocols.</p><p><strong>Materials and methods: </strong>Retrospective review of staging WB-MRI and CT-CAP performed within 60 days in 57 histologically proven MLS cases at a quaternary sarcoma center (October 2018 to August 2022). Findings were classified by consensus as normal, indeterminate, or metastasis (bone, lung, and soft tissue). Primary tumor characteristics were compared between metastatic and nonmetastatic cases.</p><p><strong>Results: </strong>Fifty-seven patients (25 female, 32 male; mean age 46 years) comprised 55 new diagnoses and two recurrences. Median WB-MRI to CT-CAP interval was 0 days (IQR 0 to 8). Among new diagnoses, WB-MRI classified 76% as normal, 13% indeterminate, and 11% metastatic; CT-CAP proportions were 82%, 11%, and 7%. All bone metastases and indeterminate osseous lesions on WB-MRI were occult on CT-CAP or outside the CT field of view (FOV). All extrapulmonary soft tissue lesions within the CT FOV were seen on both. Small pulmonary nodules (< 5 mm) were seen only on CT. All metastases occurred in deep tumors; mean maximum dimension and volume were significantly larger with metastases (19.3 vs. 10.6 cm, p = 0.035; 1566 vs. 399 cm³, p = 0.007).</p><p><strong>Conclusion: </strong>Osseous metastases and indeterminate lesions were more frequent on WB-MRI than CT-CAP, whereas extrapulmonary soft tissue metastases were seen on both within the CT FOV. CT chest retained value for small pulmonary nodules. These findings support prospective evaluation of WB-MRI plus CT chest for initial staging in MLS.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"2791-2800"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585217","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 bone lymphoma: a radiologic-pathologic series of 72 cases uncovering the diagnostic complexity of a rare and heterogeneous entity.","authors":"Eva Manuela Pena-Burgos, Adrián Ibáñez Navarro, Mar Tapia-Viñe, Juan Diego De la Morena Molina, Gabriel Olmedilla-Arregui, María Eugenia García Fernández, Jose Manuel Cordero-García, Eduardo José Ortiz-Cruz, Jose Juan Pozo-Kreilinger","doi":"10.1007/s00256-026-05317-w","DOIUrl":"10.1007/s00256-026-05317-w","url":null,"abstract":"<p><strong>Introduction: </strong>Primary bone lymphoma (PBL) is a rare extranodal lymphoma accounting for approximately 7% of malignant primary bone tumors. It typically presents with nonspecific features, frequently resulting in diagnostic delay and inappropriate initial management.</p><p><strong>Material and methods: </strong>We retrospectively analyzed the characteristics of 72 patients diagnosed with PBL between 1966 and 2025 at a tertiary referral center in Spain.</p><p><strong>Results: </strong>Diffuse large B-cell lymphoma (DLBCL) was the predominant histological subtype. The most frequent presentations included persistent bone pain, pathological fractures, and palpable masses, often associated with elevated LDH levels or underlying immunosuppressive conditions. Imaging findings were heterogeneous, ranging from permeative lytic patterns to sclerotic lesions, occasionally resembling osteomyelitis or other aggressive neoplasms. MRI proved essential for early detection, accurate assessment of bone marrow infiltration, and soft tissue extension, while CT played a key role in biopsy guidance. FDG PET/CT was critical for staging, restaging, and treatment response evaluation. Diagnostic precision depended heavily on close clinico-radiological-pathological correlation, particularly in cases with atypical or misleading imaging patterns. Most patients were treated with combined chemotherapy and radiotherapy, which was associated with high response rates and favorable survival outcomes.</p><p><strong>Conclusion: </strong>PBL is an uncommon but potentially curable malignancy. Early diagnosis requires a high index of suspicion and systematic integration of clinical data, laboratory findings, and multimodal imaging. PBL should be systematically considered in patients presenting with aggressive-appearing bone lesions, pathological fractures, or unexplained marrow replacement, especially in the presence of elevated LDH levels or immunosuppression, in order to prevent diagnostic delay and optimize outcomes.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":" ","pages":"2883-2896"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654305","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}