SKELETAL RADIOLOGY

Foreign body giant cell reaction due to Durolane (hyaluronic acid derivative) injection - A case report
Doddridge JR, Banner KA, Hunter NB and Beckmann NM
Osteoarthritis can be treated with hyaluronic acid derivatives, such as Durolane manufactured by Bioventus (Hill, 2017), particularly when conventional treatments prove ineffective. In osteoarthritic joints, the synovial fluid has a lower concentration of hyaluronic acid compared to healthy joints. Intra-articular therapy with exogenous hyaluronic acid can improve viscoelastic properties, enhance chondrocyte synthesis, reduce cartilage degradation, and alleviate pain associated with osteoarthritis (Migliore and Procopio in Clin Cases Miner Bone Metab. 12:31-3, 2015). This report describes a unique case where a patient, following Durolane administration, presented with an intraosseous foreign body giant cell reaction. A 2.5-cm lesion was identified on MRI, initially raising concerns for metastatic disease or multiple myeloma. Subsequent IR CT-guided biopsy confirmed a diagnosis of "foreign body giant cell reaction to gel," linked to the Durolane injection. This case presents a contribution to the literature due to the scarcity of documented instances where Durolane injection leads to an intraosseous foreign body giant cell reaction resembling metastatic disease. While a solitary intraosseous pseudotumor, reportedly due to viscosupplement injection, has been published, it differs in both location (hip vs. knee) and imaging characteristics from the presented case. The manifestation of a foreign body giant cell reaction after Durolane injection, mimicking malignant osseous lesions, merits attention among practitioners. This case underscores the necessity for further research into potential adverse reactions associated with hyaluronic acid derivatives.
Reducing Metal Artifacts in Clinical Photon Counting Detector Computed Tomography-A Phantom Study of an Exemplary Total Hip Arthroplasty
Marcus RP, Feuerriegel GC, Marth AA, Goller SS, Nanz D, Anhaus J and Sutter R
To examine how different photon-counting detector (PCD) CT scanning and reconstruction methods affect the volume of metal artifacts and image quality for a hip prosthesis phantom.
A young girl with a deformed little finger
Lam PL, Chan CH, Wong D and Wong KC
Right sided shoulder pain in an adolescent: Question
Howard K, Shirodkar K, Kanani A, Kurisunkal V, Vaiyapuri S and Botchu R
Sacroiliac joint dysfunction: anatomy, pathophysiology, differential diagnosis, and treatment approaches
Waldman LE, Maluli I, Moon CN, Skalski M and Matcuk GR
The sacroiliac joints (SIJ) play a pivotal role in pelvic stability and load transmission. SIJ-related disorders can pose a diagnostic challenge because of complex anatomy, non-specific imaging findings, and overlapping symptomatology with other lower back conditions. Broadly, SIJ pathology can be divided into the following categories: infectious, inflammatory, degenerative, mechanical, traumatic, and neoplastic. On the spectrum of mechanical disorders is the entity of SIJ dysfunction, defined as pain localized to the SIJ due to non-inflammatory causes. This paper aims to enhance the understanding of SIJ dysfunction by exploring SIJ anatomy, pathophysiology, and differential diagnosis for SIJ pain. Etiologies, associations, and diagnostic physical examination maneuvers for SIJ dysfunction are reviewed. We will discuss the role of diagnostic imaging in SIJ dysfunction and propose imaging findings which may indicate the diagnosis. Finally, we will discuss therapeutic strategies to treat SIJ dysfunction. By delving into the complexities of SIJ anatomy and pathophysiology, this paper provides valuable discernment for the diagnosis and management of SIJ-related disorders.
Evaluating tibial rotation in recurrent patellar dislocation with four-dimensional computed tomography
Kaneda K, Harato K, Oki S, Morishige Y, Kobayashi S, Nakamura M and Nagura T
This study is to investigate the three-dimensional (3D) kinematic changes in the knee joint in patients with recurrent patellar dislocation using four-dimensional computed tomography (4DCT) imaging and the 3D-3D surface registration technique.
Regions of interest in opportunistic computed tomography-based screening for osteoporosis: impact on short-term in vivo precision
Park J, Kim Y, Hong S, Chee CG, Lee E and Lee JW
To determine an optimal region of interest (ROI) for opportunistic screening of osteoporosis in terms of short-term in vivo diagnostic precision.
Imaging of primary periphyseal finger stress injuries in climbers
Miro P, Crawford A, Mills MK and Schöffl V
Periphyseal stress injuries (PPSIs) in young rock climbers are gaining recognition due to the surge in popularity of the sport. These injuries, occurring near the growth plates of fingers, pose diagnostic challenges due to their subtle presentation and potential long-term complications if left untreated. This review emphasizes the importance of radiologists' awareness of PPSIs, covering their anatomy, biomechanics, and imaging findings. Techniques like the "crimp-grip" in climbing exacerbate the vulnerability of the physis, leading to repetitive stress injuries. Imaging modalities such as radiography, MRI, CT, and ultrasound play crucial roles in diagnosis, each with its advantages and limitations. While radiographs remain a cost-effective initial choice, MRI offers detailed soft tissue evaluation and can detect occult injuries. Understanding the pathophysiology and imaging characteristics of PPSIs is essential for early detection and appropriate management to prevent long-term skeletal deformities and growth disturbances in young climbers.
High-resolution volumetric dynamic magnetic resonance imaging of the wrist using an 8-channel flexible receive coil
Zi R, Abbas B, Wang B, Walczyk J, Brown R, Petchprapa C, Fishbaugh J, Gerig G, Block KT and Lattanzi R
Real-time imaging is useful for the evaluation of wrist instability. However, currently available real-time magnetic resonance imaging (MRI) methods are limited due to their 2D nature or provide insufficient temporal resolution and image quality for quantitative kinematic analysis. This work introduces a novel approach for volumetric dynamic MRI of the wrist joint during active motion and demonstrates the feasibility of tracking carpal bone motion.
Ultrasound-guided interventions in elite soccer players
Allen GM
In the world of elite soccer, or football as we call it in the UK, a player who cannot play for any length of time costs the team money and team performance. The time to return to play (RTP) is crucial in any player's career, and the use of ultrasound-guided ultrasound injections has become important in the management of injury. In this article, I will explain the importance of good practice when performing these procedures and the use of steroids, sodium hyaluronic acid, platelet-rich plasma (PRP), and other therapies in achieving the goal of decreasing the time of RTP for the footballer. KEY POINTS: •Injection therapies are routine practice in maintaining and treating soccer injuries. •Injection therapies can be safely performed under ultrasound guidance.
MRI-guided neurolysis for the treatment of chronic refractory knee pain: a case report
Marka AW, Strenzke M, Weiss K, Karampinos DC, Woertler K, Herbort M, Befrui N and Finck T
Chronic refractory pain poses a significant challenge in knee joint pathologies, especially after exhaustion of conservative, arthroscopic, and endoprosthetic therapy options. This case report illustrates an innovative approach using MRI-assisted chemical neurolysis of a genicular nerve to manage persistent knee pain after arthroscopy. A 62-year-old male patient with chronic refractory knee pain, primarily localized at the inferomedial part of the knee, underwent high-resolution MRI to visualize the genicular nerves. This allowed for targeted ethanol-based neurolysis of the inferomedial genicular nerve. Following the procedure, the patient experienced substantial pain reduction for the follow-up duration of 4 months. The successful use of MRI-assisted chemical neurolysis offers a promising alternative treatment for patients with refractory knee pain, providing long-lasting pain relief without major side effects. This technique has the potential to improve the quality of life for patients suffering from chronic knee pain While these initial results are encouraging, it is important to note that further research, including both short-term and long-term studies, as well as randomized controlled trials, is warranted to establish the efficacy and safety of this treatment method in broader populations before it can be considered for routine incorporation into pain management practices.
A young girl with a deformed little finger
Lam PL, Chan CH, Wong D and Wong KC
Rare presentation of primary synovial chondrosarcoma arising in the shoulder: a case report
Kawaguchi K, Endo M, Sagiyama K, Maekawa A, Nabeshima A, Fujiwara T, Oda Y and Nakashima Y
Synovial chondrosarcoma (CHS) is a rare malignant tumor arising from the synovial tissue and is often associated with synovial chondromatosis. Herein, we present a unique case of primary synovial CHS in the shoulder joint without evidence of synovial chondromatosis. A 60-year-old man presented to our hospital with a complain of left shoulder pain that persisted for 6 years, which was initially misdiagnosed as synovitis. Radiography revealed an osteolytic lesion involving the humerus and the scapula. Histologically, the tumor exhibited features of grade 2 synovial CHS, infiltrating the trabecular bones and intra-articular space. Wide resection led to a 9-year recurrence-free survival. This case underscores the challenges in diagnosing and managing synovial CHS, particularly in cases with atypical presentations lacking synovial chondromatosis, necessitating careful follow-up and adequate surgical intervention.
Visual assessment and quantitative analysis of dual-energy CT virtual non-calcium in imaging diagnosis of multiple myeloma
Liang L, Xiao F, Liang L, Luo C, Peng F, Ning X, Tang C, Chen R, Huang F and Peng P
To evaluate the reliability and diagnostic performance of dual-energy CT virtual non-calcium imaging in diagnosing bone marrow infiltration in multiple myeloma.
Lumbar localized fat distribution parameters are independent predictors of osteoporotic vertebral compression re-fractures (OVCRFs) following Percutaneous Kyphoplasty (PKP): a retrospective matched case-control study
Zhang FY, Zhu L, Shi H, Wang F, Chen L, Zhang ZJ, Jiang ZL, Yao J and Wu XT
To investigate potential risk factors for osteoporotic vertebral compression re-fractures (OVCRFs) following percutaneous kyphoplasty (PKP).
Review of the updated definitions and concepts of spinal lesions in axial spondyloarthritis
Massignan Â, Knabben MM, da Silva TB and Hohgraefe Neto G
Spinal imaging may support the diagnosis of axial spondyloarthritis when typical findings are recognized in an appropriate clinical context and it can also indicate disease activity. In May 2022, the definitions for inflammatory and structural spinal lesions in axial spondyloarthritis were updated and validated by the Assessment of SpondyloArthritis international Society (ASAS) magnetic resonance imaging (MRI) working group. The aims of this paper are to demonstrate and describe imaging findings of the spine in patients with axial SpA, including the latest updated definitions by the ASAS, and to show complications in patients with long-standing disease.
Intramuscular myxoma: unusual observation of spontaneous tumor size shrinkage
Khoury CE, Taihi L, Evrard R, De Roo AK, Lecouvet F and Schubert T
Soft tissue tumors, whether benign or malignant, may grow over time or remain stable, but they usually do not spontaneously decrease in size. However, there are exceptions, such as inflammatory conditions, desmoid tumors, or benign cysts. Intramuscular myxomas are benign soft tissue tumors that typically present as a solitary, slow-growing, painless mass. They are generally treated by surgical resection, after which recurrence is rare. Here, we present a brief series of three unusual cases of intramuscular myxomas that spontaneously decreased in size. They were located in the cervical region, the right lower extremity, and the paravertebral lumbar region. Imaging findings and percutaneous biopsies confirmed the diagnosis in all cases. Follow-up imaging showed a spontaneous reduction in lesion volume over time, far exceeding the amount of tissue sample removed during biopsy. This unusual observation of spontaneous shrinkage may call into question the subsequent therapeutic approach to these lesions.
Anatomy and pathology of adductor canal (Hunter's canal)
Mettu S, Saran S, Shirodkar K, Shah AB, Shah BR, Siddi Ganie I, Raghu Teja KJSS, Iyengar KP and Botchu R
Adductor canal (Hunter's canal) pathologies are often underdiagnosed, with the saphenous nerve being the most commonly affected. While uncommon, involvement of the femoral artery and vein can cause severe and irreversible complications if not detected early. Significant attention must be given to adductor canal pathologies because the musculoaponeurotic tunnel is predominantly fibrotic with minimal adipose tissue. As a result, any edema or space-occupying lesion can lead to early compression of the structures within the adductor canal. Incorporating adductor canal syndrome into the imaging differential diagnosis is essential. For diagnosing and sometimes managing these conditions. In this article, we describe the anatomy and spectrum of pathologies involving the Hunter's canal.
Long-term effectiveness and feasibility of CT-guided cryoablation as a novel treatment option for symptomatic lumbar synovial cysts
Heran MKS, Jackson EKY, Nersesyan N, Craig MG, Fisher CG and Dos Santos MP
To present a case series with a long-term follow-up of CT-guided cryoablation procedure for the minimally invasive treatment of symptomatic lumbar facet synovial cyst with a mean follow-up of 38 months (range, 15-55).
Multiple myeloma: What is the most cost-effective imaging strategy for initial detection of bone lesions?
Gyftopoulos S, Hanly A, Subhas N, Raje N and Chang CY
To determine the cost-effectiveness of different imaging modalities for initial detection of multiple myeloma (MM)-defining bone lesions.
Imaging modalities for atraumatic shoulder hypermobility: a scoping review
Diep D, Gemae MR, Farag J, Tay MRJ, Mohankumar R and Mittal N
Objective measures from imaging studies have the potential to assist in timely diagnosis of atraumatic shoulder hypermobility to better guide management. The aim of this scoping review is to examine imaging modalities and techniques used to characterize atraumatic shoulder hypermobility.