1
|
Ponsiglione A, Campo I, Sachs C, Sofia C, Álvarez-Hornia Pérez E, Ciabattoni R, Sharaf DE, Causa-Andrieu P, Stanzione A, Cuocolo R, Zawaideh J, Brembilla G. Extraprostatic incidental findings on prostate mpMRI: A pictorial review from the ESUR junior network. Eur J Radiol 2023; 166:110984. [PMID: 37480649 DOI: 10.1016/j.ejrad.2023.110984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
The role of multiparametric MRI (mpMRI) in prostate cancer setting is increasingly consolidated and, as a result, its usage in clinical practice is in exponential growth. However, beyond the prostate gland, several key structures are included in the field of view of mpMRI scans. Consequently, various extra-prostatic incidental findings (IFs) belonging to different anatomical systems can be accidentally recognized. Therefore, it is mandatory for a radiologist to be familiar with the wide range of pathologies potentially encountered, to guide management and avoid patient anxiety and costs due to additional work-up prompted by clinically insignificant extra-prostatic findings. With this pictorial review, we aim to illustrate a wide range of IFs that can be detected when performing mpMRI of the prostate, focusing on their imaging characteristics, differential diagnosis, and clinical relevance. Additionally, we propose the CheckDEEP, the Checklist for DEtection of ExtraProstatic findings, to be used for a thorough evaluation of target areas within each anatomical system.
Collapse
Affiliation(s)
- Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Irene Campo
- Radiology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Camilla Sachs
- Department of Radiology, Ospedale Ca' Foncello, 31100, Treviso, Italy
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | | | - Riccardo Ciabattoni
- Department of Radiology, Ospedale San Salvatore di Pesaro, Azienda Sanitaria Territoriale Pesaro Urbino, Pesaro, Italy
| | - Doaa E Sharaf
- Department of Radiology, Urology & Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Jeries Zawaideh
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgio Brembilla
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
2
|
Pirola FJC, Dório M, Fuller R, Cobra JF, Sales LP, Figueiredo CP. A rare giant geode of humeral head in an uncontrolled rheumatoid arthritis: a case report. BMC Musculoskelet Disord 2023; 24:572. [PMID: 37452411 PMCID: PMC10347715 DOI: 10.1186/s12891-023-06695-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Rheumatoid Arthritis (RA) is a chronic inflammatory disease depicted by peripheral bone erosive damage leading to joint destruction, deformity and functional impairment. Shoulder involvement is less frequent than hands, wrists and feet, and relevant joint damage may be underdiagnosed if a lower threshold for careful analysis of this joint is not settled, especially in uncontrolled disease. CASE REPORT A 70-year-old male with a difficult-to-manage RA since 2010, presenting severe shoulder arthritis with MRI showing a striking giant geode in the left humeral head. CONCLUSION An impressive MRI image showing a giant geode in poorly controlled RA should alert rheumatologists to raise suspicion of shoulder involvement for early investigation and treatment.
Collapse
Affiliation(s)
- Fernanda Junqueira Cesar Pirola
- Department of Medical Science, Medical School, Pontifícia Universidade Católica de São Paulo, Sorocaba, Brazil
- Instituto de Reumatologia de São Paulo, São Paulo, Brazil
| | - Murillo Dório
- Instituto de Reumatologia de São Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Fuller
- Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Lucas Peixoto Sales
- Instituto de Reumatologia de São Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Camille Pinto Figueiredo
- Instituto de Reumatologia de São Paulo, São Paulo, Brazil.
- Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| |
Collapse
|
3
|
Jamshidi K, Kargar Shooroki K, Sharifi Dalooei SMA, Mirzaei A. Intraosseous Ganglion Cyst of the Talus Treated With Curettage and Bone Grafting Through a Medial Malleolus Osteotomy. Foot Ankle Int 2023; 44:118-124. [PMID: 36571389 DOI: 10.1177/10711007221141671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Intraosseous ganglion cyst (IGC) of the talus is a rare entity. There is no consensus regarding the best surgical approach to the talus. In this study, we evaluated the outcomes of curettage and bone grafting of the talus IGC via medial malleolus osteotomy. METHODS Seventeen patients with talus IGC who were treated between 2002 and 2020 using curettage and bone grafting through a medial malleolus osteotomy were included. The outcome measures were ankle range of motion (ROM), pain, and function. The ankle pain was evaluated by the visual analog scale (VAS). The ankle function was evaluated by the Toronto extremity salvage score (TESS) and Musculoskeletal Tumor Society (MSTS) score. RESULTS The study population included 10 men and 7 women with a mean age of 34.9 ± 18.8 years and a mean follow-up of 5.4 ± 3 years. The mean size of the lesion was 2.6 ± 0.8 cm. Postoperatively, mean ankle dorsiflexion and plantar flexion were 19.4 ± 5.8 degrees and 36.7 ± 5.3 degrees, respectively. The mean VAS was 0.9 ± 1.1. The mean MSTS score and TESS were 96.2 ± 3.5 and 94.5 ± 4.1, respectively. Two patients developed ankle osteoarthritis after 3 years (1 stage I and 1 stage II). One of these patients (stage II) also had recurrence after 6 months (recurrence rate: 6.7%). CONCLUSION Talus IGC could be adequately managed with curettage and bone grafting through a medial malleolus osteotomy. Even so, mild pain and reduced ankle ROM remain in some patients. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
Collapse
Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Khalil Kargar Shooroki
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyyed Mohammad Ata Sharifi Dalooei
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Pattamapaspong N, Peh WCG. Benign incidental do-not-touch bone lesions. Br J Radiol 2023; 96:20211334. [PMID: 35604667 PMCID: PMC9975527 DOI: 10.1259/bjr.20211334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 01/27/2023] Open
Abstract
Benign bone lesions may occasionally be incidentally detected on radiographs and are also increasingly found on CT or MRI performed for other clinical indications. Although mostly asymptomatic or associated with minor symptoms, these lesions may simulate true pathological lesions, causing problems in diagnosis. For instance, asymptomatic benign bone lesions can be misinterpreted as metastasis when incidentally encountered in a patient with known cancer. Recognising these entities as "do-not-touch" lesions helps avoid unnecessary further investigation or harmful intervention. In this review, we highlight three groups of bone incidentalomas found in adults, namely: osteolytic lesions, osteoblastic lesions, and bone protuberances. We aim to review the key imaging features of selected common and less common conditions in these three groups, so as to help radiologists confidently identify these benign do-not-touch lesions and to distinguish them from more sinister pathological lesions.
Collapse
Affiliation(s)
- Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wilfred CG Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Yishun Central, Singapore
| |
Collapse
|
5
|
Kaspiris A, Hadjimichael AC, Lianou I, Iliopoulos ID, Ntourantonis D, Melissaridou D, Savvidou OD, Papadimitriou E, Chronopoulos E. Subchondral Bone Cyst Development in Osteoarthritis: From Pathophysiology to Bone Microarchitecture Changes and Clinical Implementations. J Clin Med 2023; 12:jcm12030815. [PMID: 36769464 PMCID: PMC9917649 DOI: 10.3390/jcm12030815] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/22/2023] Open
Abstract
Osteoarthritis is a degenerative joint disease affecting middle-aged and elderly patients. It mainly involves weight-bearing joints such as the hip, knee and spine as well as the basilar joint of the thumb, causing dysfunction and painful symptoms. Often, joint arthritis is accompanied by cartilage defects, joint space narrowing, osteophytes, bone sclerosis and subchondral bone cysts (SBC). The aim of the present study was to explore the pathophysiology responsible for the development of SBCs as well as the association between SBCs and disease progress, the level of clinical symptoms and their impact on postoperative outcomes and risk of possible complications following joint replacements if left untreated. A literature review on PubMed articles was conducted to retrieve and evaluate all available evidence related to the main objective mentioned above. A few theories have been put forth to explain the formation process of SBCs. These involve MMPs secretion, angiogenesis, and enhanced bone turnover as a biological response to abnormal mechanical loads causing repeated injuries on cartilage and subchondral tissue during the development of arthritis. However, the application of novel therapeutics, celecoxib-coated microspheres, local administration of IGF-1 and activated chondrocytes following surgical debridement of SBCs hinders the expansion of SBCs and prevents the progression of osteoarthritis.
Collapse
Affiliation(s)
- Angelos Kaspiris
- Laboratory of Molecular Pharmacology, Department of Pharmacy, School of Health Sciences, University of Patras, 26504 Patras, Greece
- Correspondence: ; Tel.: +30-2610962336; Fax: +30-2610623049
| | - Argyris C. Hadjimichael
- Department of Orthopaedics, St Mary’s Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK
| | - Ioanna Lianou
- Department of Orthopaedic Surgery, “Rion” University Hospital and Medical School, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Ilias D. Iliopoulos
- Department of Orthopaedic Surgery, “Rion” University Hospital and Medical School, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Dimitrios Ntourantonis
- Accident and Emergency Department, “Rion” University Hospital and Medical School, School of Health Sciences, University of Patras, 26500 Patras, Greece
| | - Dimitra Melissaridou
- First Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, “ATTIKON” University General Hospital, Rimini 1, 12462 Athens, Greece
| | - Olga D. Savvidou
- First Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, “ATTIKON” University General Hospital, Rimini 1, 12462 Athens, Greece
| | - Evangelia Papadimitriou
- Laboratory of Molecular Pharmacology, Department of Pharmacy, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Efstathios Chronopoulos
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, 14561 Athens, Greece
| |
Collapse
|
6
|
Shafiei M, Chalian M, Luna R, Ahlawat S, Fayad LM. Imaging in Musculoskeletal Oncology. Radiol Clin North Am 2022; 60:657-668. [DOI: 10.1016/j.rcl.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
Grunz JP, Gietzen CH, Christopoulos G, van Schoonhoven J, Goehtz F, Schmitt R, Hesse N. Osteoarthritis of the Wrist: Pathology, Radiology, and Treatment. Semin Musculoskelet Radiol 2021; 25:294-303. [PMID: 34374064 DOI: 10.1055/s-0041-1730948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Osteoarthritis (OA) is a degenerative disease that can manifest in any synovial joint under certain conditions. It leads to destruction of articular cartilage and adjacent bone, as well as formation of osteophytes at the edges of afflicted joint surfaces. Regarding the wrist, typical degenerative arthritis affects particular joints at a specific patient age, due to asymmetric load distribution and repetitive microtrauma. However, in the presence of instability or systemic diseases, early-onset degeneration can also impair the range of motion and grip strength in younger patients. Although advanced stages of OA display characteristic signs in radiography, the detection of early manifestations frequently requires computed tomography or magnetic resonance imaging (in some cases with additional arthrography). If a wrist becomes unstable, timely diagnosis and precise treatment are essential to prevent rapid disease progression. Therefore, close collaboration between radiologists and hand surgeons is obligatory to preserve the carpal function of patients.
Collapse
Affiliation(s)
- Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Carsten Herbert Gietzen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Georgios Christopoulos
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Jörg van Schoonhoven
- Clinic for Hand Surgery, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Florian Goehtz
- Clinic for Hand Surgery, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Rainer Schmitt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany.,Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nina Hesse
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
8
|
Giant intraosseous ganglion of the fibula: multimodality imaging. Skeletal Radiol 2020; 49:2063-2067. [PMID: 32524167 DOI: 10.1007/s00256-020-03489-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023]
Abstract
Intraosseous ganglia around the knee are most commonly located in the proximal tibia and limited to the epiphyseal-metaphyseal region. We report the case of a giant intraosseous ganglion of the fibula. MRI demonstrated the fluid avascular content of the lesion. CT arthrography of the knee demonstrated partial opacification of the lesion through a cortical bone defect. The lesion was treated with curettage and bone grafting. Anatomopathological examination confirmed the medical imaging diagnosis of intraosseous ganglion. This case highlights the value of joint opacification with CT arthrography to demonstrate the communication between the articular cavity and the ganglion.
Collapse
|
9
|
Abstract
OBJECTIVE. The purpose of this article is to summarize the nomenclature of nonneoplastic conditions affecting subchondral bone through a review of the medical literature and expert opinion of the Society of Skeletal Radiology Subchondral Bone Nomenclature Committee. CONCLUSION. This consensus statement summarizes current understanding of the pathophysiologic characteristics and imaging findings of subchondral nonneoplastic bone lesions and proposes nomenclature to improve effective communication across clinical specialties and help avoid diagnostic errors that could affect patient care.
Collapse
|
10
|
Uncommon observation of bifocal giant subchondral cysts in the hip: diagnostic role of CT arthrography and MRI, with pathological correlation. Skeletal Radiol 2018; 47:587-592. [PMID: 29164284 DOI: 10.1007/s00256-017-2819-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/26/2017] [Accepted: 10/31/2017] [Indexed: 02/02/2023]
Abstract
Subchondral cysts (or geodes) are common in osteoarthritis (OA), usually in association with other typical signs, i.e., joint space narrowing, subchondral bone sclerosis, and osteophytosis. However, large lesions without the typical signs of OA or lesions located outside the weight-bearing areas are unusual and may be confused for other conditions, in particular, those of tumoral origin. We report the findings in a 48-year-old man who had been complaining of left buttock pain for 3 years, getting worse over the last year, and an evolutive limited range of motion of the hip. The pain was increased by weight-bearing and was not relieved by nonsteroidal anti-inflammatory drugs. Radiographs and CT showed a large multilocular lytic lesion within the femoral head and a large lytic lesion in the left ilio-ischiatic ramus, raising the question of bifocal tumoral involvement. On MRI, the lesions had low signal intensity on T1- and high signal intensity on T2-weighted MR images, with subtle peripheral enhancement on post-contrast T1-weighted images. CT arthrography, by demonstrating a communication between the femoral head and ischiatic cysts and the joint space allowed us to definitively rule out malignant conditions and to make the diagnosis of subchondral bone cysts. Total hip arthroplasty was performed. Pathological analysis of the resected femoral head and of material obtained at curettage of the ischiatic lesion confirmed the diagnosis of degenerative geodes. This case illustrates an atypical bifocal location of giant subchondral cysts in the hip joint mimicking lytic tumors, in the absence of osteoarthritis or rheumatoid arthritis, and highlights the role of CT arthrography in identifying this condition.
Collapse
|
11
|
Llopis E, Kroon HM, Acosta J, Bloem JL. Conventional Radiology in Rheumatoid Arthritis. Radiol Clin North Am 2017; 55:917-941. [PMID: 28774455 DOI: 10.1016/j.rcl.2017.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In clinical practice, the conventional radiography is still the radiologic method for the diagnosis of rheumatoid arthritis (RA). Moreover, it provides a quick overview of the symptomatic joints to narrow the differential diagnosis and to evaluate progression. RA is a polyarticular disease with bilateral and symmetric involvement of the peripheral joints, especially small joints, and less frequently, the cervical spine. The radiologic features are soft tissue swelling, periarticular osteoporosis, erosions, loss of joint space, and in advanced disease, osteolysis and typical subluxations or deformities, such as ulnar deviation.
Collapse
Affiliation(s)
- Eva Llopis
- Department of Radiology, Hospital de la Ribera, Carretera Corbera km1, Alzira, Valencia 46600, Spain.
| | - Herman M Kroon
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden 233 ZA, The Netherlands
| | - Jose Acosta
- Department of Radiology, Hospital Universitario Ramon y Cajal, Carretera de Colmenar Viejo KM 9, 100, Madrid 28034, Spain
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden 233 ZA, The Netherlands
| |
Collapse
|
12
|
Changes in the osteochondral unit during osteoarthritis: structure, function and cartilage-bone crosstalk. Nat Rev Rheumatol 2016; 12:632-644. [PMID: 27652499 DOI: 10.1038/nrrheum.2016.148] [Citation(s) in RCA: 501] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In diarthrodial joints, the articular cartilage, calcified cartilage, and subchondral cortical and trabecular bone form a biocomposite - referred to as the osteochondral unit - that is uniquely adapted to the transfer of load. During the evolution of the osteoarthritic process the compositions, functional properties, and structures of these tissues undergo marked alterations. Although pathological processes might selectively target a single joint tissue, ultimately all of the components of the osteochondral unit will be affected because of their intimate association, and thus the biological and physical crosstalk among them is of great importance. The development of targeted therapies against the osteoarthritic processes in cartilage or bone will, therefore, require an understanding of the state of these joint tissues at the time of the intervention. Importantly, these interventions will not be successful unless they are applied at the early stages of disease before considerable structural and functional alterations occur in the osteochondral unit. This Review describes the changes that occur in bone and cartilage during the osteoarthritic process, and highlights strategies for how this knowledge could be applied to develop new therapeutic interventions for osteoarthritis.
Collapse
|
13
|
Omoumi P, Zufferey P, Malghem J, So A. Imaging in Gout and Other Crystal-Related Arthropathies. Rheum Dis Clin North Am 2016; 42:621-644. [PMID: 27742018 DOI: 10.1016/j.rdc.2016.07.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In this article, the authors consider the manifestations of intraarticular and periarticular crystal deposits. Most cases of crystal deposits are asymptomatic and represent incidental findings at imaging. In symptomatic arthropathies, imaging can play an important role in the diagnosis and assessment of disease progression and the extent of crystal deposits. Conventional radiography is the most common imaging modality. But ultrasound, conventional computerized tomography (CT), dual-energy CT, and MRI play an increasing role. The authors review typical radiographic features of crystal-induced arthropathies and findings that help to differentiate them. The authors also emphasize the increasing role of complementary imaging techniques.
Collapse
Affiliation(s)
- Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne 1011, Switzerland.
| | - Pascal Zufferey
- Department of Rheumatology, Lausanne University Hospital, Av Pierre Decker 5, Lausanne 1011, Switzerland
| | - Jacques Malghem
- Department of Radiology, Saint Luc University Hospital, UC Louvain, Av Hippocrate 10, Brussels 1200, Belgium
| | - Alexander So
- Department of Rheumatology, Lausanne University Hospital, Av Pierre Decker 5, Lausanne 1011, Switzerland
| |
Collapse
|
14
|
Li G, Ma Y, Cheng TS, Landao-Bassonga E, Qin A, Pavlos NJ, Zhang C, Zheng Q, Zheng MH. Identical subchondral bone microarchitecture pattern with increased bone resorption in rheumatoid arthritis as compared to osteoarthritis. Osteoarthritis Cartilage 2014; 22:2083-92. [PMID: 25205016 DOI: 10.1016/j.joca.2014.08.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/21/2014] [Accepted: 08/29/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To analyze the differences in microarchitecture and bone remodeling of subchondral bone in femoral heads from patients with rheumatoid arthritis (RA) and osteoarthritis (OA). DESIGNS Peri-articular bone samples, including subchondral trabecular bone (STB) and deeper trabecular bone (DTB) were extracted from the load-bearing region of femoral heads from 20 patients with RA and 40 patients with OA during hip replacement surgery. Micro-CT, histomorphometry and backscatter scanning electron microscopy (BSEM) were performed to assess microarchitecture and bone histology parameters. RESULTS In both RA and OA, STB showed more sclerotic microarchitecture and more active bone remodeling, compared to DTB. RA and OA showed similar microarchitecture characteristics in both STB and DTB, despite STB in RA exhibiting higher bone resorption. In addition, there was no difference in the frequency of bone cysts in STB between RA and OA. In STB, the trabecular bone surrounding subchondral bone cysts (Cys-Tb) was more sclerotic than the trabecular bone found distant to cysts (Peri-Tb), with a higher level of bone remodeling. Both Cys-Tb region and Peri-Tb region were detected to have similar microarchitectural and bone remodeling characteristics in RA and OA. CONCLUSIONS Apart from higher bone resorption in the general subchondral bone of RA samples, the peri-articular bone exhibited similar microarchitectural and bone remodeling characteristics in RA and OA.
Collapse
Affiliation(s)
- G Li
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated the Sixth People's Hospital, Shanghai, China; Centre for Orthopaedic Research, School of Surgery, The University of Western Australia, Perth, Australia.
| | - Y Ma
- Division of Orthopaedic Surgery, Guangdong General Hospital, Guangzhou, China.
| | - T S Cheng
- Centre for Orthopaedic Research, School of Surgery, The University of Western Australia, Perth, Australia.
| | - E Landao-Bassonga
- Centre for Orthopaedic Research, School of Surgery, The University of Western Australia, Perth, Australia.
| | - A Qin
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - N J Pavlos
- Centre for Orthopaedic Research, School of Surgery, The University of Western Australia, Perth, Australia.
| | - C Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated the Sixth People's Hospital, Shanghai, China.
| | - Q Zheng
- Division of Orthopaedic Surgery, Guangdong General Hospital, Guangzhou, China.
| | - M H Zheng
- Centre for Orthopaedic Research, School of Surgery, The University of Western Australia, Perth, Australia.
| |
Collapse
|
15
|
Li G, Yin J, Gao J, Cheng TS, Pavlos NJ, Zhang C, Zheng MH. Subchondral bone in osteoarthritis: insight into risk factors and microstructural changes. Arthritis Res Ther 2014; 15:223. [PMID: 24321104 PMCID: PMC4061721 DOI: 10.1186/ar4405] [Citation(s) in RCA: 470] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/02/2013] [Indexed: 12/11/2022] Open
Abstract
Osteoarthritis (OA) is a major cause of disability in the adult population. As a
progressive degenerative joint disorder, OA is characterized by cartilage damage,
changes in the subchondral bone, osteophyte formation, muscle weakness, and
inflammation of the synovium tissue and tendon. Although OA has long been viewed as a
primary disorder of articular cartilage, subchondral bone is attracting increasing
attention. It is commonly reported to play a vital role in the pathogenesis of OA.
Subchondral bone sclerosis, together with progressive cartilage degradation, is
widely considered as a hallmark of OA. Despite the increase in bone volume fraction,
subchondral bone is hypomineralized, due to abnormal bone remodeling. Some
histopathological changes in the subchondral bone have also been detected, including
microdamage, bone marrow edema-like lesions and bone cysts. This review summarizes
basic features of the osteochondral junction, which comprises subchondral bone and
articular cartilage. Importantly, we discuss risk factors influencing subchondral
bone integrity. We also focus on the microarchitectural and histopathological changes
of subchondral bone in OA, and provide an overview of their potential contribution to
the progression of OA. A hypothetical model for the pathogenesis of OA is
proposed.
Collapse
|
16
|
Kaspiris A, Khaldi L, Grivas TB, Vasiliadis E, Kouvaras I, Dagkas S, Chronopoulos E, Papadimitriou E. Subchondral cyst development and MMP-1 expression during progression of osteoarthritis: an immunohistochemical study. Orthop Traumatol Surg Res 2013; 99:523-9. [PMID: 23809184 DOI: 10.1016/j.otsr.2013.03.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 03/18/2013] [Accepted: 03/21/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Subchondral bone cyst (SBC) formation is often identified in patients with osteoarthritis. Furthermore, several studies have shown that expression of matrix metalloproteinases (MMPs) is elevated in patients with OA. OBJECTIVES The aim of our study is to correlate the presence of SBCs and MMP-1 expression with the osteochondral alterations during OA progression. METHODS We studied the cartilage and subchondral bone of 15 patients who had undergone total knee or hip replacement due to primary OA. As controls, we used the femoral heads of three patients without macroscopic OA changes. We evaluated three specimens per patient. RESULTS Specimens were divided in four groups based on the Mankin histological severity score. Using immunohistochemistry, we noted SBCs at the site of greatest disease severity. Specifically, these were present more frequently in group III (Mankin score: 6-7) and IV (Mankin: ≥ 8), compared with group I (Mankin: 1-3) and II (Mankin: 4-5). Mild OA stages (Mankin: 1-6) were characterized by degeneration and thinning of the cartilage, followed by increased osteoblast and osteoclast activity of the subjacent bone and the subsequent appearance of SBCs. Simultaneously, we observed expression of MMP-1 in groups I and II in the cartilage and III and IV in both the cartilage and the subchondral bone. Moreover, osteoblast-like cells in the lining of the SBCs showed an increased expression of MMP-1 in stages III and IV. CONCLUSION Our study provides immunohistological evidence that SBCs accumulate in advanced OA and contain activated cells, which express MMP-1, suggesting that they may thus participate in the osteochondral changes of OA. LEVEL OF EVIDENCE Level III; prospective comparative study.
Collapse
Affiliation(s)
- A Kaspiris
- Department of Trauma and Orthopaedics, Thriasio General Hospital of Attica - NHS, G. Gennimata avenue, Magoula, 19600 Athens, Greece.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Paparo F, Fabbro E, Piccazzo R, Revelli M, Ferrero G, Muda A, Cimmino MA, Garlaschi G. Multimodality imaging of intraosseous ganglia of the wrist and their differential diagnosis. Radiol Med 2012; 117:1355-73. [DOI: 10.1007/s11547-012-0875-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 09/30/2011] [Indexed: 02/06/2023]
|
18
|
Goldring SR. Alterations in periarticular bone and cross talk between subchondral bone and articular cartilage in osteoarthritis. Ther Adv Musculoskelet Dis 2012; 4:249-58. [PMID: 22859924 DOI: 10.1177/1759720x12437353] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The articular cartilage and the subchondral bone form a biocomposite that is uniquely adapted to the transfer of loads across the diarthrodial joint. During the evolution of the osteoarthritic process biomechanical and biological processes result in alterations in the composition, structure and functional properties of these tissues. Given the intimate contact between the cartilage and bone, alterations of either tissue will modulate the properties and function of the other joint component. The changes in periarticular bone tend to occur very early in the development of OA. Although chondrocytes also have the capacity to modulate their functional state in response to loading, the capacity of these cells to repair and modify their surrounding extracellular matrix is relatively limited in comparison to the adjacent subchondral bone. This differential adaptive capacity likely underlies the more rapid appearance of detectable skeletal changes in OA in comparison to the articular cartilage. The OA changes in periarticular bone include increases in subchondral cortical bone thickness, gradual decreases in subchondral trabeular bone mass, formation of marginal joint osteophytes, development of bone cysts and advancement of the zone of calcified cartilage between the articular cartilage and subchondral bone. The expansion of the zone of calcified cartilage contributes to overall thinning of the articular cartilage. The mechanisms involved in this process include the release of soluble mediators from chondrocytes in the deep zones of the articular cartilage and/or the influences of microcracks that have initiated focal remodeling in the calcified cartilage and subchondral bone in an attempt to repair the microdamage. There is the need for further studies to define the pathophysiological mechanisms involved in the interaction between subchondral bone and articular cartilage and for applying this information to the development of therapeutic interventions to improve the outcomes in patients with OA.
Collapse
Affiliation(s)
- Steven R Goldring
- The Hospital for Special Surgery, 535 East 70th Street, New York, USA
| |
Collapse
|
19
|
An in vivo investigation of the initiation and progression of subchondral cysts in a rodent model of secondary osteoarthritis. Arthritis Res Ther 2012; 14:R26. [PMID: 22304985 PMCID: PMC3392819 DOI: 10.1186/ar3727] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 01/10/2012] [Accepted: 02/03/2012] [Indexed: 01/25/2023] Open
Abstract
Introduction Subchondral bone cysts (SBC) have been identified in patients with knee osteoarthritis (OA) as a cause of greater pain, loss of cartilage and increased chance of joint replacement surgery. Few studies monitor SBC longitudinally, and clinical research using three-dimensional imaging techniques, such as magnetic resonance imaging (MRI), is limited to retrospective analyses as SBC are identified within an OA patient cohort. The purpose of this study was to use dual-modality, preclinical imaging to monitor the initiation and progression of SBC occurring within an established rodent model of knee OA. Methods Eight rodents underwent anterior cruciate ligament transection and partial medial meniscectomy (ACLX) of the right knee. In vivo 9.4 T MRI and micro-computed tomography (micro-CT) scans were performed consecutively prior to ACLX and 4, 8, and 12 weeks post-ACLX. Resultant images were co-registered using anatomical landmarks, which allowed for precise tracking of SBC size and composition throughout the study. The diameter of the SBC was measured, and the volumetric bone mineral density (vBMD) was calculated within the bone adjacent to SBC. At 12 weeks, the ACLX and contralateral knees were processed for histological analysis, immunohistochemistry, and Osteoarthritis Research Society International (OARSI) pathological scoring. Results At 4 weeks post-ACLX, 75% of the rodent knees had at least 1 cyst that formed in the medial tibial plateau; by 12 weeks all ACLX knees contained SBC. Imaging data revealed that the SBC originate in the presence of a subchondral bone plate breach, with evolving composition over time. The diameter of the SBC increased significantly over time (P = 0.0033) and the vBMD significantly decreased at 8 weeks post-ACLX (P = 0.033). Histological analysis demonstrated positive staining for bone resorption and formation surrounding the SBC, which were consistently located beneath the joint surface with the greatest cartilage damage. Trabecular bone adjacent the SBC lacked viable osteocytes and, combined with bone marrow changes, indicated osteonecrosis. Conclusions This study provides insight into the mechanisms leading to SBC formation in knee OA. The expansion of these lesions is due to stress-induced bone resorption from the incurred mechanical instability. Therefore, we suggest these lesions can be more accurately described as a form of OA-induced osteonecrosis, rather than 'subchondral cysts'.
Collapse
|
20
|
Mohan G, Perilli E, Kuliwaba JS, Humphries JM, Parkinson IH, Fazzalari NL. Application of in vivo micro-computed tomography in the temporal characterisation of subchondral bone architecture in a rat model of low-dose monosodium iodoacetate-induced osteoarthritis. Arthritis Res Ther 2011; 13:R210. [PMID: 22185204 PMCID: PMC3334663 DOI: 10.1186/ar3543] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 11/08/2011] [Accepted: 12/21/2011] [Indexed: 01/15/2023] Open
Abstract
Introduction Osteoarthritis (OA) is a complex, multifactorial joint disease affecting both the cartilage and the subchondral bone. Animal models of OA aid in the understanding of the pathogenesis of OA and testing suitable drugs for OA treatment. In this study we characterized the temporal changes in the tibial subchondral bone architecture in a rat model of low-dose monosodium iodoacetate (MIA)-induced OA using in vivo micro-computed tomography (CT). Methods Male Wistar rats received a single intra-articular injection of low-dose MIA (0.2 mg) in the right knee joint and sterile saline in the left knee joint. The animals were scanned in vivo by micro-CT at two, six, and ten weeks post-injection, analogous to early, intermediate, and advanced stages of OA, to assess architectural changes in the tibial subchondral bone. The articular cartilage changes in the tibiae were assessed macroscopically and histologically at ten weeks post-injection. Results Interestingly, tibiae of the MIA-injected knees showed significant bone loss at two weeks, followed by increased trabecular thickness and separation at six and ten weeks. The trabecular number was decreased at all time points compared to control tibiae. The tibial subchondral plate thickness of the MIA-injected knee was increased at two and six weeks and the plate porosity was increased at all time points compared to control. At ten weeks, histology revealed loss of proteoglycans, chondrocyte necrosis, chondrocyte clusters, cartilage fibrillation, and delamination in the MIA-injected tibiae, whereas the control tibiae showed no changes. Micro-CT images and histology showed the presence of subchondral bone sclerosis, cysts, and osteophytes. Conclusions These findings demonstrate that the low-dose MIA rat model closely mimics the pathological features of progressive human OA. The low-dose MIA rat model is therefore suitable to study the effect of therapeutic drugs on cartilage and bone in a non-trauma model of OA. In vivo micro-CT is a non-destructive imaging technique that can track structural changes in the tibial subchondral bone in this animal model, and could also be used to track changes in bone in preclinical drug intervention studies for OA treatments.
Collapse
Affiliation(s)
- Geetha Mohan
- Bone and Joint Research Laboratory, Directorate of Surgical Pathology, SA Pathology and Hanson Institute, Frome Road, Adelaide, SA 5000, Australia.
| | | | | | | | | | | |
Collapse
|
21
|
McCanless JD, Jennings LK, Cole JA, Bumgardner JD, Haggard WO. In vitro differentiation and biocompatibility of mesenchymal stem cells on a novel platelet releasate-containing injectable composite. J Biomed Mater Res A 2011; 100:220-9. [DOI: 10.1002/jbm.a.33256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 09/02/2011] [Accepted: 09/06/2011] [Indexed: 12/30/2022]
|
22
|
McErlain DD, Milner JS, Ivanov TG, Jencikova-Celerin L, Pollmann SI, Holdsworth DW. Subchondral cysts create increased intra-osseous stress in early knee OA: A finite element analysis using simulated lesions. Bone 2011; 48:639-46. [PMID: 21094285 DOI: 10.1016/j.bone.2010.11.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 10/13/2010] [Accepted: 11/11/2010] [Indexed: 11/22/2022]
Abstract
AIM OF STUDY To investigate the role of intra-osseous lesions in advancing the pathogenesis of Osteoarthritis (OA) of the knee, using Finite Element Modeling (FEM) in conjunction with high-resolution imaging techniques. METHODS Twenty early stage OA patients (≤ Grade 2 radiographic score) were scanned with a prototype, cone-beam CT system. Scans encompassed the mid-shaft of the femur to the diaphysis of the proximal tibia. Individual bones were segmented to create 3D geometric models that were transferred to FE software for loading experiments. Patient-specific, inhomogeneous material properties were derived from the CT images and mapped directly to the FE models. Duplicate models were also created, with a 3D sphere (range 3-12 mm) introduced into a weight-bearing region of the joint, mimicking the size, location, and composition of a subchondral bone cyst (SBC). A spherical shell extending 1mm radially around the SBC served as the sample volume for measurements of von Mises equivalent stress. Both models were vertically loaded with 750 N, or approximately 1 body weight during a single-leg stance. RESULTS All FE models exhibited a physiologically realistic weight-bearing distribution of stress, which initiated at the joint surface and extended to the cortical bone. Models that contained the SBC experienced a nearly two-fold increase in stress (0.934 ± 0.073 and 1.69 ± 0.159 MPa, for the non-SBC and SBC models, respectively) within the bone adjacent to the SBC. In addition, there was a positive correlation found between the diameter of the SBC and the resultant intra-osseous stress under load (p = 0.004). CONCLUSIONS Our results provide insights into the mechanism by which SBC may accelerate OA, leading to greater pain and disability. Based on these findings, we feel that patient-derived FE models of the OA knee - utilizing in vivo imaging data - present a tremendous potential for monitoring joint mechanics under physiological loads.
Collapse
Affiliation(s)
- David D McErlain
- Imaging Laboratories, Robarts Research Institute,Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
23
|
Tzaveas AP, Villar RN. Cyst-like lesion of the acetabular roof - an abnormal finding or an anatomical variant? Hip Int 2010; 20:258-60. [PMID: 20544663 DOI: 10.1177/112070001002000219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2010] [Indexed: 02/04/2023]
Abstract
Cyst-like lesions are frequently found in the area of the acetabulum on MRI scans. However, their presence is not always abnormal. We report four patients with such lesions found on MRI where, during hip arthroscopy, an area resembling a horseshoe-like extension of the cotyloid fossa was found. Clinicians must be aware that not all cystic acetabular lesions are pathological and may simply represent a normal anatomical or developmental variant of the hip joint. They do not always represent an indication for hip arthroscopic surgery.
Collapse
|
24
|
Groth AM, Benigni L, Moores AP, Lamb CR. Spectrum of computed tomographic findings in 58 canine elbows with fragmentation of the medial coronoid process. J Small Anim Pract 2009; 50:15-22. [DOI: 10.1111/j.1748-5827.2008.00656.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
25
|
Abstract
Much of the attention in developing diagnostic tools and therapeutic interventions for the management of osteoarthritis (OA) has focused on the preservation or repair of articular cartilage. It is clear that all of the joint components, including the ligaments, tendons, capsule, synovial lining, and periarticular bone, undergo structural and functional alterations during the course of OA progression. This article focuses on the specific skeletal features of OA and the putative mechanisms involved in their pathogenesis.
Collapse
Affiliation(s)
- Steven R Goldring
- The Hospital for Special Surgery, Weill College of Medicine of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
| |
Collapse
|
26
|
Marra MD, Crema MD, Chung M, Roemer FW, Hunter DJ, Zaim S, Diaz L, Guermazi A. MRI features of cystic lesions around the knee. Knee 2008; 15:423-38. [PMID: 18559292 DOI: 10.1016/j.knee.2008.04.009] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 04/22/2008] [Accepted: 04/25/2008] [Indexed: 02/02/2023]
Abstract
Cystic lesions around the knee are a diverse group of entities, frequently encountered during routine MRI of the knee. These lesions range from benign cysts to complications of underlying diseases such as infection, arthritis, and malignancy. MRI is the technique of choice in characterizing lesions around the knee: to confirm the cystic nature of the lesion, to evaluate the anatomical relationship to the joint and surrounding tissues, and to identify associated intra-articular disorders. We will discuss the etiology, clinical presentation, MRI findings, and differential diagnosis of various cystic lesions around the knee including meniscal and popliteal (Baker's) cysts, intra-articular and extra-articular ganglia, intra-osseous cysts at the insertion of the cruciate ligaments and meniscotibial attachments, proximal tibiofibular joint cysts, degenerative cystic lesions (subchondral cyst), cystic lesions arising from the bursae (pes anserine, prepatellar, superficial and deep infrapatellar, iliotibial, tibial collateral ligament, and suprapatellar), and lesions that may mimic cysts around the knee including normal anatomical recesses. Clinicians must be aware about the MRI features and the differential diagnosis of cystic lesions around the knee to avoid misdiagnosis.
Collapse
Affiliation(s)
- Monica D Marra
- Department of Radiology, Boston University Medical Center, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA 02118, United States.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Mellado JM, Bencardino JT, Pérez del Palomar L. Magnetic Resonance Imaging Features of the Discrete Epiphyseal Radiolucency: A Problem-Solving Approach to Differential Diagnosis. Curr Probl Diagn Radiol 2008; 37:243-61. [DOI: 10.1067/j.cpradiol.2007.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
28
|
|
29
|
Gould CF, Ly JQ, Lattin GE, Beall DP, Sutcliffe JB. Bone Tumor Mimics: Avoiding Misdiagnosis. Curr Probl Diagn Radiol 2007; 36:124-41. [PMID: 17484955 DOI: 10.1067/j.cpradiol.2007.01.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Whether discovered incidentally or as part of a focused diagnostic evaluation, the finding of a benign osseous lesion that has radiologic features resembling a bone tumor is not uncommon. Some of the more common benign and nonneoplastic entities that can sometimes be confused with tumors are the following: cortical desmoid, Brodie abscess, synovial herniation pit, pseudocyst, enostosis, intraosseous ganglion cyst, fibrous dysplasia, stress fracture, avulsion fracture (healing stage), bone infarct, myositis ossificans, brown tumor, and subchondral cyst. Accurate diagnosis and management of these lesions require a basic understanding of their epidemiology, clinical presentations, anatomic distributions, imaging features, differential considerations, and therapeutic options. This in-depth review of 13 potential bone tumor mimics will assist the radiologist in correctly identifying these benign lesions and in avoiding misdiagnosis and related morbidity. This review will also aid the radiologist in making appropriate recommendations to the referring physician for management or further imaging.
Collapse
Affiliation(s)
- C Frank Gould
- Naval Aerospace Medical Institute, Pensacola, FL, USA
| | | | | | | | | |
Collapse
|
30
|
Abstract
Cystic lesions around the knee comprise a diverse group of entities, ranging from benign cysts to complications of underlying diseases such as infection, arthritis, and malignancy. Their diverse causes result in varied prognoses and therapeutic options. Although the presentation of cystic masses may be similar, their management may differ, thus highlighting the importance of appropriate categorization. MR aids in the characterization of lesions by first localizing them, and then defining their relationship with adjacent structures and identifying any additional abnormalities. For the purpose of this article, the authors limit the scope of their discussion to benign cysts, ganglia, and bursae about the knee.
Collapse
Affiliation(s)
- Francesca D Beaman
- Center Radiology, PC, Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010, USA
| | | |
Collapse
|
31
|
|
32
|
Lien LC, Hunter JC, Chan YS. Tubular Acetabular Intraosseous Contrast Tracking in MR Arthrography of the Hip: Prevalence, Clinical Significance, and Mechanisms of Development. AJR Am J Roentgenol 2006; 187:807-10. [PMID: 16928949 DOI: 10.2214/ajr.05.0588] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to describe tubular intraosseous tracking of contrast medium in the acetabular fossa, to our knowledge a previously undocumented imaging finding in MR arthrography of the hip, and to discuss its prevalence, clinical significance, and possible mechanisms of development. CONCLUSION Tubular acetabular intraosseous contrast tracking is a common MR arthrographic finding that seems to have little clinical significance. Although the exact pathophysiologic mechanism is unknown, we presume repeated pumping of joint fluid through the nutrient foramina of the acetabular fossa may be one mechanism.
Collapse
Affiliation(s)
- Li-Chang Lien
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5 Fu-Hsing St., Gui-Shan, Tao-Yuan 33300, Taiwan.
| | | | | |
Collapse
|
33
|
Kainberger F, Peloschek P, Langs G, Boegl K, Bischof H. Differential diagnosis of rheumatic diseases using conventional radiography. Best Pract Res Clin Rheumatol 2004; 18:783-811. [PMID: 15501183 DOI: 10.1016/j.berh.2004.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The approach to the differential diagnosis of rheumatic diseases using conventional radiography is systematic and module-oriented, which, with respect to future developments, forms the basis for computer-assisted diagnosis (CAD). The indications follow consensus-based referral criteria and attempts should be made to raise the evidence level of the recommendations. Investigation techniques have been improved in the last few years with the use of digital radiography. New imaging technologies may be available in the future that will achieve at least the same quality of images, while exposing patients to a significantly lower radiation dose. The interpretation of radiographical signs could be enhanced through a correlation with other imaging modalities. Computer-assisted techniques with image processing tools for automated measurements, lesion detection and in the form of expert systems are under development. With conventional radiography embedded in CAD systems, promising options will be available to enhance the differential diagnosis of rheumatic diseases.
Collapse
Affiliation(s)
- Franz Kainberger
- Department of Diagnostic Radiology, Medical University of Vienna,18-20, Waehringer Guertel, A-1090 Vienna, Austria.
| | | | | | | | | |
Collapse
|