Skeletal Radiology最新文献

{"title":"Arthrocentesis of suspected septic sternoclavicular arthritis: microbial yield and predictors of culture positivity.","authors":"John S Symanski, Joshua Arnold, Mary E Buchanan, Ritika Punathil, Michael J Tuite, Andrew B Ross","doi":"10.1007/s00256-024-04596-5","DOIUrl":"10.1007/s00256-024-04596-5","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the microbial yield and factors predicting culture positivity for image-guided arthrocentesis of suspected septic sternoclavicular (SC) arthritis.</p><p><strong>Materials and methods: </strong>An electronic health record search identified image-guided SC joint aspirations for suspected septic arthritis. Data was extracted by retrospective chart review including patient demographics, procedure characteristics, pre-procedure lab testing, joint culture results, final SC joint diagnoses and any effect of positive synovial cultures on subsequent antibiotic therapy. Factors associated with positive joint fluid cultures were assessed using a Chi-squared test for categorical predictors and logistic regression for continuous predictors.</p><p><strong>Results: </strong>A total of 31 SC arthrocenteses met inclusion criteria with most (81%) performed using ultrasound guidance. Synovial fluid was successfully aspirated in 19/31 (61%) of cases, and in all other cases lavage fluid was successfully obtained. Synovial cultures were positive in 9/31 (29%) of cases. A final diagnosis of septic arthritis was assigned to 20/31 cases (65%) in which 9/20 (45%) had positive synovial cultures. There was no statistically significant association between synovial culture positivity and risk factors for septic arthritis, positive blood cultures, pre-aspiration antibiotics and whether synovial fluid or lavage fluid was cultured. Serum white blood cell count (WBC) and erythrocyte sedimentation rate (ESR) demonstrated statistically significant positive correlation with positive synovial cultures.</p><p><strong>Conclusion: </strong>Arthrocentesis is effective for microbial speciation in SC septic arthritis, and diagnostic yield may be increased with lavage when encountering a dry tap. Normal serum WBC and ESR values indicate an extremely low likelihood of positive synovial cultures.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139492003","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":"Disseminated Cryptococcus infection presenting as lytic skeletal lesions suggesting bony metastatic disease.","authors":"Caleb M Yeung, Nicola Fabbri","doi":"10.1007/s00256-023-04442-0","DOIUrl":"10.1007/s00256-023-04442-0","url":null,"abstract":"<p><p>A 76-year-old male diagnosed with sarcoidosis presented with atraumatic left anterior knee pain. Initial imaging of the left lower extremity revealed an eccentrically-based lytic lesion in the mid-distal femur with cortical erosion and an additional lytic lesion in the proximal tibia. Magnetic resonance imaging (MRI) demonstrated an aggressive lesion in the proximal tibia with surrounding marrow edema, cortical breach, and erosion into the distal patellar tendon. Given concern for metastatic bone lesions, a18-fluorodeoxyglucose positron emission tomography/computed tomography scan (FDG PET/CT) was performed which demonstrated concordant hypermetabolic lytic lesions at the left mid-distal femur and the left proximal tibia, as well as hypermetabolic diffuse lymphadenopathy. The patient was presumed to have metastatic lung cancer based on the presence of lung nodules. Due to concern for impending pathologic fracture, the patient underwent open biopsy with a plan for prophylactic fixation of both lesions. Intra-operatively, however, both lesions were found to contain pus, from which cultures ultimately grew Cryptococcus neoformans. This is a case of disseminated skeletal cryptococcosis masquerading as metastatic cancer in a patient without classic risk factors for disseminated cryptococcosis (defined as extrapulmonary evidence of infection). Classically, disseminated cryptococcosis is thought to occur in severely immunocompromised patients, such as those with human immunodeficiency virus (HIV) or organ transplant recipients. This case highlights the need to maintain a high index of suspicion in patients with underlying immunocompromising conditions, including less common conditions such as sarcoid, who present with bony lesions. This case report then discusses the diagnostic evaluation and treatment of disseminated skeletal cryptococcosis.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41151375","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":"The role of advanced metal artifact reduction MRI in the diagnosis of periprosthetic joint infection.","authors":"Sara E Sacher, Matthew F Koff, Ek T Tan, Alissa Burge, Hollis G Potter","doi":"10.1007/s00256-023-04483-5","DOIUrl":"10.1007/s00256-023-04483-5","url":null,"abstract":"<p><p>Identification and diagnosis of periprosthetic joint infection (PJI) are challenging, requiring a multi-disciplinary approach involving clinical evaluation, laboratory tests, and imaging studies. MRI is advantageous to alternative imaging techniques due to superior soft tissue contrast and absence of ionizing radiation. However, the presence of metallic implants can cause signal loss and artifacts. Metal artifact suppression (MARS) MRI techniques have been developed that mitigate metal artifacts and improve periprosthetic soft tissue visualization. This paper provides a review of the various MARS MRI techniques, their clinical applicability and accuracy in PJI diagnosis and evaluation, and current challenges and future perspectives.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11039568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50158735","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":"Musculoskeletal manifestations of COVID-19.","authors":"Lucas N M da Silva, Alípio Gomes Ormond Filho, Júlio Brandão Guimarães","doi":"10.1007/s00256-023-04549-4","DOIUrl":"10.1007/s00256-023-04549-4","url":null,"abstract":"<p><p>During the COVID-19 pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected millions of people worldwide, with acute respiratory distress syndrome (ARDS) being the most common severe condition of pulmonary involvement. Despite its involvement in the lungs, SARS-CoV-2 causes multiple extrapulmonary manifestations, including manifestations in the musculoskeletal system. Several cases involving bone, joint, muscle, neurovascular and soft tissues were reported shortly after pandemic onset. Even after the acute infection has resolved, many patients experience persistent symptoms and a decrease in quality of life, a condition known as post-COVID syndrome or long COVID. COVID-19 vaccines have been widely available since December 2020, preventing millions of deaths during the pandemic. However, adverse reactions, including those involving the musculoskeletal system, have been reported in the literature. Therefore, the primary goal of this article is to review the main imaging findings of SARS-CoV-2 involvement in the musculoskeletal system, including acute, subacute, chronic and postvaccination manifestations.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138809321","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":"Bacterial osteomyelitis in pediatric patients: a comprehensive review.","authors":"Ricardo Restrepo, Halley J Park, S Pinar Karakas, Luisa F Cervantes, Felipe G Rodriguez-Ruiz, Anna Maria Zahrah, Emilio J Inarejos-Clemente, Marcelo Laufer, Verena M Shreiber","doi":"10.1007/s00256-024-04639-x","DOIUrl":"10.1007/s00256-024-04639-x","url":null,"abstract":"<p><p>Bacterial osteomyelitis, an inflammatory response in the bone caused by microorganisms, typically affects the metaphysis in the skeletally immature. Bacterial osteomyelitis possesses a significant diagnostic challenge in pediatric patients due to its nonspecific clinical presentation. Because the metaphysis is the primary focus of infection in skeletally immature patients, understanding the normal physiologic, maturation process of bones throughout childhood allows to understand the pathophysiology of osteomyelitis. Timely and accurate diagnosis is crucial to initiate appropriate treatment, and prevent long-term sequelae and efforts must be made to isolate the causative organism. The potential causative organism changes according to the age of the patient and underlying medical conditions. Staphylococcus Aureus is the most common isolated bacteria in pediatric pyogenic osteomyelitis whereas Kingella Kingae is the most common causative agent in children aged 6 months to 4 years. Imaging plays a pivotal role in the diagnosis, characterization, evaluation of complications, and follow up of bacterial osteomyelitis. Imaging also plays a pivotal role in the evaluation of potential neoplastic and non-neoplastic mimickers of osteomyelitis. In children, MRI is currently the gold standard imaging modality when suspecting bacterial osteomyelitis, whereas surgical intervention may be required in order to isolate the microorganism, treat complications, and exclude mimickers.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140176348","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":"Imaging features for the evaluation of skin and nail infections.","authors":"Carolina Ávila de Almeida, Robertha Nakamura, Andreia Leverone, Flávia Costa, Bruna Duque Estrada, Priscilla Haui, Flavio Luz, Andre Fukunishi Yamada, Heron Werner, Clarissa Canella","doi":"10.1007/s00256-023-04557-4","DOIUrl":"10.1007/s00256-023-04557-4","url":null,"abstract":"<p><p>Clinical manifestations of dermatological and musculoskeletal conditions can sometimes overlap, leading to confusion in diagnosis. Patients with nail and skin infections may undergo imaging examinations with suspicions of muscle, tendon, or joint injuries. Dermatological infections often involve soft tissues and musculoskeletal structures, and their etiology can range from fungi, bacteria, viruses, to protozoa. Relying solely on physical examination may not be sufficient for accurate diagnosis and treatment planning, necessitating the use of complementary imaging exams. The objective of this paper is to present and discuss imaging findings of the main infectious conditions affecting the nail apparatus and skin. The paper also highlights the importance of imaging in clarifying diagnostic uncertainties and guiding appropriate treatment for dermatological conditions.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404286","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":"Correlation between post-chemotherapy MRI and histopathology of malignant bone tumors treated with extra-articular resection.","authors":"Corentin Petitpas, Aurélie Grandmougin, Béatrice Marie, Philippe Petit, Sébastien Pesenti, Pierre Journeau","doi":"10.1007/s00256-024-04806-0","DOIUrl":"https://doi.org/10.1007/s00256-024-04806-0","url":null,"abstract":"<p><strong>Objective: </strong>Magnetic resonance imaging (MRI) remains the gold standard for diagnosing tumoral joint involvement; however, its interpretation remains uncertain due to the presence of perilesional edema that can lead to unjustified arthrectomy. The aim of the study is to identify precise MRI signs that are predictive of joint involvement.</p><p><strong>Materials and methods: </strong>This retrospective multicenter study included 25 patients who underwent extra-articular resection for malignant bone tumor with suspected joint involvement at the shoulder, hip, or knee, between January 2004 and July 2023. Joint resection was indicated based on preoperative MRI examination. MRI signs of joint involvement were joint effusion, capsuloligamentous invasion, disruption of articular cartilage, and intra-articular tumor mass. We then compared histopathological \"true\" joint involvement of the resected specimen with its preoperative MRI diagnosis.</p><p><strong>Results: </strong>Extra-articular resection was performed in 9 shoulders, 4 hips, and 12 knees. Histological analysis confirmed wide resections for all patients. Based on histopathological analysis, extra-articular resection was unjustified in 40% (44%, 0%, and 50%, respectively). The most specific iconographic criteria were intra-capsular cortical breach and the presence of a tumor mass inside the joint. Articular cartilage disruption is often the most accurate sign.</p><p><strong>Conclusion: </strong>Our results suggest that MRI has a poor ability to accurately diagnose joint involvement. To date, however, this is the best tool available. In addition to obvious signs of joint involvement, MRI analysis must be performed with a thorough understanding of capsular anatomy and its particularities for each joint so as not to miss other signs, such as intra-capsular cortical effraction.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353394","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":"Phenotypic variations in knee osteoarthritis: insights from MRI and radiographic comparisons.","authors":"Ozgur Tosun, Kazim Ayberk Sinci, Caner Baysan, Yasemin Kucukciloglu, Mehmet Aksit, Cemal Kazimoglu, Gokay Karaca, Atilla Hikmet Cilengir","doi":"10.1007/s00256-024-04807-z","DOIUrl":"https://doi.org/10.1007/s00256-024-04807-z","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the correlation between MRI-based phenotypes (cartilage-meniscus, subchondral bone, and inflammatory) and radiography-based atrophic and hypertrophic phenotypes, aiming to demonstrate MRI's diagnostic capability in identifying complex osteoarthritis phenotypes that radiography cannot fully capture.</p><p><strong>Materials and methods: </strong>This single-center retrospective study examined knee radiographs and MRIs of patients from November 2021 to April 2023 to identify osteoarthritis phenotypes. Radiographs were staged by the Kellgren-Lawrence system, and both modalities were classified into atrophic or hypertrophic phenotypes. MRIs were further classified into three phenotypes: cartilage-meniscus, subchondral bone, and inflammatory. Associations between phenotypes, Kellgren-Lawrence stage, age, and gender were analyzed with Pearson chi-square test and student T-test. Reliability measurements were evaluated using kappa statistic.</p><p><strong>Results: </strong>A total of 214 knees from 187 individuals (73.3% women, 26.7% men; mean age 57.1 ± 9.1 years) were included. The hypertrophic MRI phenotype was significantly associated with cartilage-meniscus and subchondral bone phenotypes (p < 0.001). Cartilage-meniscus and subchondral bone phenotypes were less prevalent in Kellgren-Lawrence stage 2 than in stages 3 and 4 (p < 0.001 and p = 0.004, respectively). The subchondral bone phenotype was more common in men (p = 0.022), and the cartilage-meniscus phenotype in the elderly (p < 0.001). Radiography and MRI had substantial agreement (Kappa = 0.637, p < 0.001) in diagnosing hypertrophic and atrophic phenotypes.</p><p><strong>Conclusion: </strong>The hypertrophic phenotype was associated with cartilage-meniscus and subchondral bone phenotypes, with lower prevalences in Kellgren-Lawrence stage 2 knees. MRI offers enhanced phenotypic characterization, which facilitates more precise and individualized management in osteoarthritis care. Despite limitations compared to MRI, radiography remains valuable for the evaluation of hypertrophic and atrophic phenotypes.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353396","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":"Magnetic resonance imaging of the shoulder in symptomatic professional rugby players: a retrospective analysis.","authors":"Phey Ming Yeap, Philip Robinson, Andrew J Grainger","doi":"10.1007/s00256-024-04803-3","DOIUrl":"https://doi.org/10.1007/s00256-024-04803-3","url":null,"abstract":"<p><strong>Objective: </strong>Shoulder injuries in rugby players are common due to frequent high-impact collisions and tackles. This study aimed to describe the spectrum and pattern of shoulder MRI findings in professional rugby players.</p><p><strong>Methods: </strong>Single-center retrospective study of shoulder MRI was carried out between 2012 and 2016 in symptomatic professional male rugby league and rugby union players. One hundred ten shoulder MRIs were scored for rotator cuff and long head of biceps tendons, labral, bursal, joint, and osseous abnormalities. MRI features were compared using the chi-square or Fisher's exact tests for categorical variables.</p><p><strong>Results: </strong>There were a total of one hundred ten professional male rugby players (80 rugby league and 30 rugby union), with a mean age of 24.6 (range 17-38) and 23.7 (range 17-33) years old, respectively. Rotator cuff or long head biceps abnormality was found in 36 (33%) players, of which 22 (20%) were either partial or full-thickness tears. Glenoid labral tears were present in 63 (57%) players. There was no significant difference (p > 0.05) in the frequency of tears of the superior (24%), anterior inferior (25%), posterior superior (25%), and posterior inferior (32%) labrum. Forty-seven percent of players presented with two or more abnormalities of the rotator cuff tendons and glenoid labrum. There were significantly more osseous abnormalities in backs compared to forwards (48% vs. 21%; p = 0.01).</p><p><strong>Conclusions: </strong>There is a wide spectrum of shoulder abnormalities on MRI in professional rugby players, and many have two or more abnormalities. In common with other contact sports, posterior labral injury was a common finding and may relate to sub-clinical trauma, without an association with instability.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353395","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 analysis of the physiological patellofemoral joint morphology of adult knees.","authors":"Marc-Pascal Meier, Yara Hochrein, Mark-Tilmann Seitz, Paul Jonathan Roch, Katharina Jäckle, Ali Seif Amir Hosseini, Wolfgang Lehmann, Thelonius Hawellek","doi":"10.1007/s00256-024-04794-1","DOIUrl":"https://doi.org/10.1007/s00256-024-04794-1","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the present study was to determine physiological reference values for the morphology of the patella and to analyse these parameters according to patella position in healthy knee joints.</p><p><strong>Material and methods: </strong>Healthy knee joints of 409 patients (mean age, 52.3 years [± 16.8]) were analysed retrospectively on MRI images for Insall-Salvati index (ISI), sagittal patella thickness (PTS) and patella length (PLS) as well as axial patella thickness (PTA) and patella width (PWA). Differences between patellar diameters were analysed depending on ISI, side, age and gender.</p><p><strong>Results: </strong>Mean PTS was 20.1 mm (± 2.4), PLS 44.0 mm (± 4.4), PTA 21.8 mm (± 2.4) and PWA 44.5 mm (± 4.7). Depending on the vertical patellar position (ISI), all patellar parameters (p < 0.01) showed significant differences between patients with a patella alta, norma and baja. In general, a smaller ISI showed higher measured values for the patellar parameters. There were no significant differences for the laterality. Only PTS showed a significant age difference (p = 0.031). All parameters were significantly larger in male compared to female knees (p < 0.001).</p><p><strong>Conclusion: </strong>Reference parameters for the patella morphology are reported. Concluding from the results, a relationship between vertical patellar position and patellar morphology seems to exist. This finding should be taken into account in diagnostics and therapy of patella disorders.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308526","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}