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Expósito D, Martel J, Alvarez de Sierra B, Bueno A, Vilanova C, Vilanova JC. Neoplastic and Non-neoplastic Bone Lesions of the Knee. Semin Musculoskelet Radiol 2024; 28:225-247. [PMID: 38768589 DOI: 10.1055/s-0044-1781471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Numerous anatomical variants are described around the knee, many of which look like bony lesions, so it is important to know them to avoid unnecessary complementary tests and inadequate management. Likewise, several alterations in relation to normal development can also simulate bone lesions.However, numerous pathologic processes frequently affect the knee, including traumatic, inflammatory, infectious, and tumor pathology. Many of these entities show typical radiologic features that facilitate their diagnosis. In other cases, a correct differential diagnosis is necessary for proper clinical management.Despite the availability of increasingly advanced imaging techniques, plain radiography is still the technique of choice in the initial study of many of these pathologies. This article reviews the radiologic characteristics of tumor and nontumor lesions that may appear around the knee to make a correct diagnosis and avoid unnecessary complementary radiologic examinations and inadequate clinical management.
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Affiliation(s)
- Diana Expósito
- Department of Radiology, Hospital Sanitas La Moraleja, Madrid, Spain
| | - José Martel
- Department of Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Angel Bueno
- Department of Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Cristina Vilanova
- Department of Orthopaedic Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Joan C Vilanova
- Department of Radiology, Clínica Girona, Institute of Diagnostic Imaging (IDI) Girona, University of Girona, Girona, Spain
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2
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Saifuddin A, Tyler P, Rajakulasingam R. Imaging of bone marrow pitfalls with emphasis on MRI. Br J Radiol 2023; 96:20220063. [PMID: 35522786 PMCID: PMC9975530 DOI: 10.1259/bjr.20220063] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 01/27/2023] Open
Abstract
Normal marrow contains both hematopoietic/red and fatty/yellow marrow with a predictable pattern of conversion and skeletal distribution on MRI. Many variations in normal bone marrow signal and appearances are apparent and the reporting radiologist must differentiate these from other non-neoplastic, benign or neoplastic processes. The advent of chemical shift imaging has helped in characterising and differentiating more focal heterogeneous areas of red marrow from marrow infiltration. This review aims to cover the MRI appearances of normal marrow, its evolution with age, marrow reconversion, variations of normal marrow signal, causes of oedema-like marrow signal, and some common non-neoplastic entities, which may mimic marrow neoplasms.
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Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Philippa Tyler
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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3
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Utility of dual energy computed tomography in the evaluation of infiltrative skeletal lesions and metastasis: a literature review. Skeletal Radiol 2022; 51:1731-1741. [PMID: 35294599 DOI: 10.1007/s00256-022-04032-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 02/02/2023]
Abstract
Computed tomography (CT) is routinely used to diagnose and evaluate metastatic lesions in oncology. CT alone suffers from lack of sensitivity, especially for skeletal lesions in the bone marrow and lesions that have similar attenuation profiles to surrounding bone. Magnetic resonance imaging and nuclear medicine imaging remain the gold standard in evaluating skeletal lesions. However, compared to CT, these modalities are not as widely available or suitable for all patients. Dual energy computed tomography (DECT) exploits variations in linear attenuation coefficient of materials at different photon energy levels to reconstruct images based on material composition. DECT in musculoskeletal imaging is used in the imaging of crystal arthropathy and detecting subtle fractures, but it is not broadly utilized in evaluating infiltrative skeletal lesions. Malignant skeletal lesions have different tissue and molecular compositions compared to normal bone. DECT may exploit these physical differences to delineate infiltrative skeletal lesions from surrounding bone better than conventional monoenergetic CT. Studies so far have examined the utility of DECT in evaluating skeletal metastases, multiple myeloma lesions, pathologic fractures, and performing image-guided biopsies with promising results. These studies were mostly retrospective analyses and case reports containing small samples sizes. As DECT becomes more widely used clinically and more scientific studies evaluating the performance of DECT are published, DECT may eventually become an important modality in the work-up of infiltrative skeletal lesions. It may even challenge MRI and nuclear medicine because of relatively faster scanning times and ease of access.
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4
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Djuricic G, Milojkovic D, Mijucic J, Ducic S, Bukva B, Radulovic M, Rajovic N, Milcanovic P, Milic N. The Magnetic Resonance Imaging Pattern of the Lesions Caused by Knee Overuse in the Pediatric Population. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081107. [PMID: 36013574 PMCID: PMC9416774 DOI: 10.3390/medicina58081107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Excessive use of the knee in patients with immature locomotor systems leads to a whole spectrum of morphological changes with possible consequences in adulthood. This study aimed to examine the morphological pattern in magnetic resonance imaging (MRI) that is associated with recurrent pain due to increased physical activity in children. Materials and Methods: This was a retrospective study conducted among pediatric patients treated at the University Children’s Hospital in Belgrade in 2018 and 2019. MRI findings of patients who reported recurrent pain in the knee joint during physical activity and who were without any pathological findings on both clinical examination and knee radiographs were included in the study. Results: MRI findings of 168 patients (73 boys and 95 girls, mean age 14.07 ± 3.34 years) were assessed. Meniscus and cartilage lesions were the most commonly detected morphological findings: meniscus lesions in 49.4%, cartilage ruptures in 44.6%, and cartilage edema in 26.2% of patients. The medial meniscus was more often injured in girls (p = 0.030), while boys were more prone to other joint injuries (p = 0.016), re-injury of the same joint (p = 0.036), bone bruises (p < 0.001), and ligament injuries (p = 0.001). In children older than 15 years, tibial plateau cartilage edema (p = 0.016), chondromalacia patellae (p = 0.005), and retropatellar effusion (p = 0.011) were detected more frequently compared to younger children. Conclusions: Children reporting recurrent knee pain due to increased physical activity, without any detected pathological findings on clinical examination and knee radiography, may have morphological changes that can be detected on MRI. Timely diagnosis of joint lesions should play a significant role in preventing permanent joint dysfunction in the pediatric population as well as in preventing the development of musculoskeletal diseases in adulthood.
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Affiliation(s)
- Goran Djuricic
- University Children’s Hospital, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | | | - Jovana Mijucic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Sinisa Ducic
- University Children’s Hospital, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Bojan Bukva
- University Children’s Hospital, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Radulovic
- Institute of Oncology and Radiology of Serbia, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nina Rajovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Petar Milcanovic
- Laboratory for Sports Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55901, USA
- Correspondence:
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5
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Mills MK, Leake RL, Crawford AM, Soltanolkotabi M, Hansford BG. Concepts in Musculoskeletal Bone and Soft Tissue Biopsy. Semin Musculoskelet Radiol 2021; 25:711-724. [PMID: 34937112 DOI: 10.1055/s-0041-1735471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Imaging-guided needle biopsy of musculoskeletal lesions is a high-yield and low-risk procedure that can be used for definitive characterization of indeterminate bone and soft tissue lesions. Familiarity with the preprocedural, technical, and postprocedural steps is vital for the appropriate management of these cases. Biopsy request triage requires an awareness of definitively benign conditions and other tumor mimics. A complete clinical, laboratory, and imaging work-up is essential for procedural planning and determining pathologic concordance. Consultation with an orthopaedic oncologist is a requisite step to ensure maximizing biopsy yield and to avoid interference with any future limb-sparing surgical intervention. Knowledge of the equipment, pertinent medications, and appropriate biopsy technique can minimize the risk of periprocedural complications. Finally, the radiologist may be required to discuss the concordance of histopathology with preprocedure imaging, perform repeat image-guided biopsy, and carefully interpret sarcoma surveillance imaging examinations.
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Affiliation(s)
- Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Richard L Leake
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Amanda M Crawford
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Maryam Soltanolkotabi
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Barry G Hansford
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon
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6
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[Radiological aspects in the diagnostics of pathological fractures]. Unfallchirurg 2021; 124:695-703. [PMID: 34324034 DOI: 10.1007/s00113-021-01067-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
Radiological diagnostics play a key role in the identification and assessment of pathological fractures. Conventional projection radiography is still the mainstay of imaging investigations. With knowledge of the patient history, the morphology and location of a fracture as well as concomitant findings, such as osteolysis or periosteal reactions can add valuable information on the origin of the fracture. Magnetic resonance imaging (MRI) is the imaging modality of choice for the local diagnostic work-up as it provides insights into the medullary cavity and visualizes potential extraosseous tumor tissue in the fracture zone. Computed tomography (CT) imaging provides valuable information on the morphological features of fractures and is useful for the planning of the surgical approach. Furthermore, it is the modality of choice for whole-body staging. In most cases of pathological fractures without a history of malignancy, a biopsy and histological work-up is recommended.
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7
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Abstract
Atraumatic fractures of femur, although not as common as traumatic fractures, are frequently encountered in the clinical practice. They present with non-specific symptoms and can be occult on initial imaging making their diagnosis difficult, sometimes resulting in complications. Overlapping terminologies used to describe these fractures may hamper effective communication between the radiologist and the clinician. In this article, we review various atraumatic fractures of femur, terminologies used to describe them, their imaging findings and differential diagnosis. The article also describes the aetiology, pathophysiology and relevant biomechanics behind these fractures. An approach to atraumatic femoral fractures has been outlined.
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Affiliation(s)
- Ganesh Hedge
- Department of Radiology, Royal Lancaster Infirmary, Lancaster, UK
| | - Siddharth Thaker
- Department of Musculoskeletal Radiology, Leeds Teaching Hospitals, Leeds, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Richard Fawcett
- Department of Musculoskeletal Radiology, Leeds Teaching Hospitals, Leeds, UK
| | - Harun Gupta
- Department of Musculoskeletal Radiology, Leeds Teaching Hospitals, Leeds, UK
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8
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Meek RD, Mills MK, Hanrahan CJ, Beckett BR, Leake RL, Allen H, Williams DD, Tommack M, Schmahmann S, Hansford BG. Pearls and Pitfalls for Soft-Tissue and Bone Biopsies: A Cross-Institutional Review. Radiographics 2021; 40:266-290. [PMID: 31917660 DOI: 10.1148/rg.2020190089] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Management of soft-tissue and bone neoplasms depends on a definitive histologic diagnosis. Percutaneous image-guided biopsy of bone and soft-tissue tumors is a cost-effective and accurate method to obtain a histopathologic diagnosis. Biopsy requests must be approached thoughtfully to avoid numerous potential pitfalls. Hasty biopsy planning places the patient at increased risk for misdiagnosis, delayed therapy, repeated invasive procedures, and substantial morbidity. Biopsy planning begins with a thorough review of the relevant clinical history and pertinent imaging. The biopsy route must be planned in concert with the referring orthopedic oncologist to preserve limb-sparing options. Carefully selecting the most appropriate imaging modality to guide the biopsy increases the chances of reaching a definitive diagnosis. It is also critical to identify and target with expertise the part of the lesion that is most likely to yield an accurate diagnosis. Percutaneous biopsy is a safe procedure, and familiarity with preprocedural laboratory testing parameters, anticoagulation guidelines, and commonly used sedation medications minimizes the risk of complications while ensuring patient comfort. Nondiagnostic biopsy results are not infrequent and may still have value in guiding patient treatment. Awareness of the imaging manifestations of tumor recurrence is also important. The aim of this article is to provide a comprehensive review of pertinent preprocedural, periprocedural, and postprocedural considerations for bone and soft-tissue musculoskeletal biopsies.The online slide presentation from the RSNA Annual Meeting is available for this article.©RSNA, 2020.
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Affiliation(s)
- Ryan D Meek
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239 (R.D.M., B.R.B., S.S., B.G.H.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (M.K.M., C.J.H., R.L.L., H.A.); Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (D.D.W.); and private practice, Eugene, Ore (M.T.)
| | - Megan K Mills
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239 (R.D.M., B.R.B., S.S., B.G.H.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (M.K.M., C.J.H., R.L.L., H.A.); Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (D.D.W.); and private practice, Eugene, Ore (M.T.)
| | - Christopher J Hanrahan
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239 (R.D.M., B.R.B., S.S., B.G.H.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (M.K.M., C.J.H., R.L.L., H.A.); Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (D.D.W.); and private practice, Eugene, Ore (M.T.)
| | - Brooke R Beckett
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239 (R.D.M., B.R.B., S.S., B.G.H.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (M.K.M., C.J.H., R.L.L., H.A.); Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (D.D.W.); and private practice, Eugene, Ore (M.T.)
| | - Richard L Leake
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239 (R.D.M., B.R.B., S.S., B.G.H.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (M.K.M., C.J.H., R.L.L., H.A.); Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (D.D.W.); and private practice, Eugene, Ore (M.T.)
| | - Hailey Allen
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239 (R.D.M., B.R.B., S.S., B.G.H.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (M.K.M., C.J.H., R.L.L., H.A.); Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (D.D.W.); and private practice, Eugene, Ore (M.T.)
| | - Don D Williams
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239 (R.D.M., B.R.B., S.S., B.G.H.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (M.K.M., C.J.H., R.L.L., H.A.); Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (D.D.W.); and private practice, Eugene, Ore (M.T.)
| | - Matthew Tommack
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239 (R.D.M., B.R.B., S.S., B.G.H.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (M.K.M., C.J.H., R.L.L., H.A.); Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (D.D.W.); and private practice, Eugene, Ore (M.T.)
| | - Sandra Schmahmann
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239 (R.D.M., B.R.B., S.S., B.G.H.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (M.K.M., C.J.H., R.L.L., H.A.); Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (D.D.W.); and private practice, Eugene, Ore (M.T.)
| | - Barry G Hansford
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239 (R.D.M., B.R.B., S.S., B.G.H.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (M.K.M., C.J.H., R.L.L., H.A.); Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (D.D.W.); and private practice, Eugene, Ore (M.T.)
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9
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Jia C, Crim J, Evenski A, Layfield LJ. Solitary fibrous tumor of bone developing lung metastases on long-term follow-up. Skeletal Radiol 2020; 49:1865-1871. [PMID: 32519181 DOI: 10.1007/s00256-020-03493-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023]
Abstract
Solitary fibrous tumors are rare mesenchymal neoplasms of fibroblastic or myofibroblastic origin. Primary solitary fibrous tumors arising in bone are extremely rare and rarely metastasize. We present a case of solitary fibrous tumor where the diagnosis was delayed due to a failure to recognize the subtle, lytic lesion underlying a fracture of the left humerus. The patient underwent proximal humeral replacement and was followed closely with imaging of humerus and chest. A small lung metastasis was found on CT scan 38 months later and was resected. Two additional small metastases were found and resected 62 months after initial tumor resection. The purpose of this case report is both to highlight the radiologic challenges which can lead to overlooking a lytic lesion underlying a fracture and to show the importance of long-term follow-up in patients with solitary fibrous tumor.
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Affiliation(s)
- Cassie Jia
- University of Missouri at Columbia, Columbia, MO, USA.
| | - Julia Crim
- University of Missouri at Columbia, Columbia, MO, USA
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10
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Wuennemann F, Kintzelé L, Weber MA, Kauczor HU, Rehnitz C. [Radiologic diagnosis of pathologic fractures]. Radiologe 2020; 60:498-505. [PMID: 32410104 DOI: 10.1007/s00117-020-00693-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pathologic fractures are fractures that occur without an adequate traumatic event due to focal benign or malignant skeletal lesions. The most common causes of pathologic fractures are cystic bone lesions, plasmocytoma or multiple myeloma, and the development of osseous metastases, which is increasing due to an aging general population and advances in cancer treatment. The differentiation of pathologic fractures from stress fractures, especially osteoporotic insufficiency fractures is crucial for correct treatment planning. OBJECTIVES This review intends to explain the imaging characteristics of pathologic fractures. Moreover, it explains the role of imaging when pathologic fractures are suspected. In addition, the Mirels' score and the SINS (Spinal Instability Neoplastic Score), which are powerful yet easy-to-use tools for the assessment of the fracture risk of benign or malignant bony lesions of the extremities and the vertebral column, shall be introduced. MATERIALS AND METHODS A PubMed literature search with the following terms was conducted: "pathologic fracture", "fatigue fracture", "insufficiency fracture", "treatment of pathologic fractures", "imaging of pathologic fractures", "fracture risk", "bone metastases", "MRI of pathologic fractures", "CT of pathologic fractures", "differentiation of pathologic and insufficiency fractures", "Mirels' score", "SINS" and "spinal instability neoplastic score". RESULTS The definitions of pathologic, fatigue, and insufficiency fractures are explained. Moreover, the role of imaging in the clinical workup of suspected pathologic fractures and the differentiation of pathologic fractures from fatigue or insufficiency fractures as well as common scoring systems to assess the fracture risk of pathologic fractures are described.
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Affiliation(s)
- Felix Wuennemann
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - Laurent Kintzelé
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - Marc-André Weber
- Institut für diagnostische und interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland
| | - Hans-Ulrich Kauczor
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - Christoph Rehnitz
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
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11
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Hansford BG, Hanrahan CJ, Girard N, Silbermann R, Morag Y. Untreated plasmacytoma of bone containing macroscopic intralesional fat and mimicking intraosseous lipoma: A case report and review of the literature. Clin Imaging 2020; 64:18-23. [PMID: 32208179 DOI: 10.1016/j.clinimag.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 02/20/2020] [Accepted: 03/11/2020] [Indexed: 11/16/2022]
Abstract
Solitary plasmacytoma is a rare form of plasma cell neoplasm defined by local neoplastic accumulation of monoclonal plasma cells in the absence of systemic proliferative plasma cell disease. In this case report, a 65-year-old female with remote past medical history of papillary thyroid cancer presented with shoulder pain and radiographs showing an aggressive osteolytic lesion presumed to represent an osseous metastasis. The subsequent MRI and CT examinations demonstrated diffuse intralesional macroscopic fat without a nonlipogenic soft tissue component or focal, nodular mass-like enhancement. The presence of macroscopic fat in an untreated osseous lesion suggested a benign lesion with the favored diagnosis an intraosseous lipoma with non-displaced pathological fracture. Therefore, the decision was made to forego image-guided percutaneous biopsy and instead proceed directly to open surgical biopsy and partial distal claviculectomy. Pathology of the resected specimen showed focally dense infiltration of plasma cells within the marrow space and scant hematopoiesis compatible with a plasma cell neoplasm. To the best of our knowledge, this is first case report of solitary plasmacytoma of bone, or any untreated plasma cell neoplasm, containing macroscopic fat upon imaging. The decision to forego image-guided percutaneous biopsy had significant treatment implications as the primary therapy for patients with SPB is not surgical, but localized radiation therapy. Based on this case, solitary plasmacytoma of bone may be included as one of the rare fat containing malignant bone lesions and imaging guided percutaneous biopsy should be considered in symptomatic fat-containing bone lesions.
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Affiliation(s)
- Barry G Hansford
- Oregon Health & Science University, Department of Radiology, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States of America.
| | - Christopher J Hanrahan
- University of Utah, Department of Radiology, 50 N. Medical Drive, Salt Lake City, UT 84132, United States of America
| | - Nicole Girard
- University of Utah, Department of Pathology, 50 N. Medical Drive, Salt Lake City, UT 84132, United States of America
| | - Rebecca Silbermann
- Oregon Health & Science University, Department of Hematology/Medical Oncology, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States of America
| | - Yoav Morag
- University of Michigan, Department of Radiology, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States of America
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12
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Issa G, Mulligan M. Dual energy CT can aid in the emergent differentiation of acute traumatic and pathologic fractures of the pelvis and long bones. Emerg Radiol 2020; 27:285-292. [PMID: 31982986 DOI: 10.1007/s10140-020-01753-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine whether dual energy CT (DECT) scanning can aid in the differentiation between acute traumatic and pathologic fractures of the pelvis and long bones. METHODS Retrospective review of 11 patients with 15 pathologic fractures proven by biopsy and/or other advanced imaging modalities. Age- and sex-matched patients with non-pathologic traumatic fractures were used as controls. Studies were reviewed by two readers on syngo.via software before and after the creation of virtual bone marrow color maps. Hounsfield units (HU) of the marrow space at the level of the fracture were recorded on both reviews. Differences between the HU of the bone marrow of traumatic and pathologic fractures were compared using two-tailed unpaired t-test. RESULTS A statistically significant difference was found in the HU of the affected bone marrow on DECT virtual noncalcium bone marrow color maps between the pathologic group (mean HU:4.89) and the non-pathologic group (mean HU: - 286.2) (p = 0.0177). HU measurements on the mixed kVp images were 150.4 for the pathologic and 94.1 for the non-pathologic fracture groups, respectively, with no statistical significance (p = 0.272). CONCLUSIONS DECT scanning can aid in the differentiation between hematoma at acute traumatic fracture sites and neoplasm at pathologic fracture sites. HU of the bone marrow is higher for pathologic fractures, and the difference in bone marrow attenuation is more evident on the virtual bone marrow color maps.
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Affiliation(s)
- Ghada Issa
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine and Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Michael Mulligan
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine and Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.
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13
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Abstract
Members of the International Skeletal Society compiled a glossary of terms for musculoskeletal radiology. The authors also represent national radiology or pathology societies in Asia, Australia, Europe, and the USA. We provide brief descriptions of musculoskeletal structures, disease processes, and syndromes and address their imaging features. Given the abundance of musculoskeletal disorders and derangements, we chose to omit most terms relating to neoplasm, spine, intervention, and pediatrics. Consensus agreement was obtained from 19 musculoskeletal radiology societies worldwide.
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14
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Marshall RA, Mandell JC, Weaver MJ, Ferrone M, Sodickson A, Khurana B. Imaging Features and Management of Stress, Atypical, and Pathologic Fractures. Radiographics 2019; 38:2173-2192. [PMID: 30422769 DOI: 10.1148/rg.2018180073] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Traumatic and atraumatic fractures are entities with distinct but often overlapping clinical manifestations, imaging findings, and management protocols. This article is a review of terminology, etiology, and key imaging features that affect management of atraumatic fractures including stress fractures, atypical femoral fractures, and pathologic fractures. The terminology of atraumatic fractures is reviewed, with an emphasis on the distinctions and similarities of stress, atypical, and pathologic fractures. The basic biomechanics of normal bone is described, with an emphasis on the bone remodeling pathway. This framework is used to better convey the shared etiologies, key differences, and important imaging findings of these types of fractures. Next, the characteristic imaging findings of this diverse family of fractures is discussed. For each type of fracture, the most clinically relevant imaging features that guide management by the multidisciplinary treatment team, including orthopedic surgeons, are reviewed. In addition, imaging features are reviewed to help discriminate stress fractures from pathologic fractures in patients with challenging cases. Finally, imaging criteria to risk stratify an impending pathologic fracture at the site of an osseous neoplasm are discussed. Special attention is paid to fractures occurring in the proximal femur because the osseous macrostructure and mix of trabecular and cortical bone of the proximal femur can function as a convenient framework to understanding atraumatic fractures throughout the skeleton. Atraumatic fractures elsewhere in the body also are used to illustrate key imaging features and treatment concepts. ©RSNA, 2018.
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Affiliation(s)
- Richard A Marshall
- From the Departments of Radiology (R.A.M., J.C.M., A.S., B.K.) and Orthopedic Surgery (M.J.W., M.F.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Jacob C Mandell
- From the Departments of Radiology (R.A.M., J.C.M., A.S., B.K.) and Orthopedic Surgery (M.J.W., M.F.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Michael J Weaver
- From the Departments of Radiology (R.A.M., J.C.M., A.S., B.K.) and Orthopedic Surgery (M.J.W., M.F.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Marco Ferrone
- From the Departments of Radiology (R.A.M., J.C.M., A.S., B.K.) and Orthopedic Surgery (M.J.W., M.F.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Aaron Sodickson
- From the Departments of Radiology (R.A.M., J.C.M., A.S., B.K.) and Orthopedic Surgery (M.J.W., M.F.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Bharti Khurana
- From the Departments of Radiology (R.A.M., J.C.M., A.S., B.K.) and Orthopedic Surgery (M.J.W., M.F.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
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15
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Rao A, Parampalli R. Role of MDCT as an effective imaging tool in detection of complications amongst oncological patients in a tertiary care oncology institute. Emerg Radiol 2019; 26:283-294. [DOI: 10.1007/s10140-019-01671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
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16
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Is routine MRI necessary to exclude pathological fractures in patients with an oncological history? Arch Orthop Trauma Surg 2018; 138:1633-1637. [PMID: 30062457 DOI: 10.1007/s00402-018-3012-z] [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: 03/20/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is the radiological modality of choice for diagnosing pathological fractures in situations of diagnostic uncertainty. With the increasing availability of MRI, we have observed a disturbing trend in utilising routine MRI scans to exclude pathological fractures in all patients with a history of cancer. The study objective was to determine if routine use of MRI scans in such patients is truly necessary and if other predictive factors can be utilised in lieu of the MRI scan. MATERIALS AND METHODS A 3-year retrospective study was conducted reviewing all extremity MRI scans performed for suspected pathological fractures and compared to X-rays. All patients presented with an extremity fracture, a known diagnosis of solid organ cancer and had an MRI to determine if the fracture was pathological. Subjects were followed up with serial X-rays up to 1 year. RESULTS 84 subjects were recruited. Comparing X-rays alone with MRI scans revealed 92% sensitivity and 98% specificity in detecting pathological fractures. Using X-rays in combination with an absent history of trauma increases the sensitivity to 100% but reduced the specificity to 91%. None of subjects in cancer remission had pathological fractures. CONCLUSIONS MRI is an imperative tool for operative planning in pathological fractures; however, we recommend against the routine use of MRI to diagnose pathological fractures in oncological patients. Patients with solid organ cancer remission, a positive history of significant trauma prior to sustaining the fracture, and the absence of pathological features on plain radiographs are strongly predictive against pathological fractures.
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Hillyard KCL, Shabbir S, Sirisena UN, Hogarth M, Sahu A. Insufficiency fractures: A rare cause of foot and ankle pain in three patients with rheumatoid arthritis. Radiol Case Rep 2018; 13:855-861. [PMID: 30002787 PMCID: PMC6039983 DOI: 10.1016/j.radcr.2018.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/24/2018] [Accepted: 05/26/2018] [Indexed: 11/23/2022] Open
Abstract
Insufficiency fractures are recognized but rare complications in patients with longstanding rheumatoid arthritis. Such fractures are typically solitary and are rarely seen to affect the foot and ankle. We describe 3 women with longstanding rheumatoid arthritis, treated with one, or a combination of, corticosteroids, DMARDs and anti-TNF, presenting with foot and ankle pain with no prior history of trauma. MRIs showed rare multiple florid insufficiency fractures of the foot and ankle, in 2 cases bilaterally, which were managed conservatively. These cases highlight the importance of considering insufficiency fractures in similar patients presenting with foot and ankle pain. Radiographs may fail to demonstrate these lesions, delaying diagnosis, and worsening patient outcome, therefore in such cases MRI is a valuable modality.
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Affiliation(s)
| | - Shabnam Shabbir
- Radiology Department, Ealing Hospital, Uxbridge Rd, Southall, London UB1 3HW, UK
| | | | - Maxine Hogarth
- Radiology Department, Ealing Hospital, Uxbridge Rd, Southall, London UB1 3HW, UK
| | - Ajay Sahu
- Radiology Department, Ealing Hospital, Uxbridge Rd, Southall, London UB1 3HW, UK
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18
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Mandell JC, Khurana B, Smith SE. Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis. Skeletal Radiol 2017; 46:1165-1186. [PMID: 28343329 DOI: 10.1007/s00256-017-2632-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/22/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023]
Abstract
Stress fractures of the foot and ankle are a commonly encountered problem among athletes and individuals participating in a wide range of activities. This illustrated review, the second of two parts, discusses site-specific etiological factors, imaging appearances, treatment options, and differential considerations of stress fractures of the foot and ankle. The imaging and clinical management of stress fractures of the foot and ankle are highly dependent on the specific location of the fracture, mechanical forces acting upon the injured site, vascular supply of the injured bone, and the proportion of trabecular to cortical bone at the site of injury. The most common stress fractures of the foot and ankle are low risk and include the posteromedial tibia, the calcaneus, and the second and third metatarsals. The distal fibula is a less common location, and stress fractures of the cuboid and cuneiforms are very rare, but are also considered low risk. In contrast, high-risk stress fractures are more prone to delayed union or nonunion and include the anterior tibial cortex, medial malleolus, navicular, base of the second metatarsal, proximal fifth metatarsal, hallux sesamoids, and the talus. Of these high-risk types, stress fractures of the anterior tibial cortex, the navicular, and the proximal tibial cortex may be predisposed to poor healing because of the watershed blood supply in these locations. The radiographic differential diagnosis of stress fracture includes osteoid osteoma, malignancy, and chronic osteomyelitis.
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Affiliation(s)
- Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
| | - Bharti Khurana
- Division of Emergency Radiology, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stacy E Smith
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
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Kwee TC, de Klerk JMH, Nix M, Heggelman BGF, Dubois SV, Adams HJA. Benign Bone Conditions That May Be FDG-avid and Mimic Malignancy. Semin Nucl Med 2017; 47:322-351. [PMID: 28583274 DOI: 10.1053/j.semnuclmed.2017.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Positron emission tomography with the radiotracer 18F-fluoro-2-deoxy-d-glucose (FDG) plays an important role in the evaluation of bone pathology. However, FDG is not a cancer-specific agent, and knowledge of the differential diagnosis of benign FDG-avid bone alterations that may resemble malignancy is important for correct patient management, including the avoidance of unnecessary additional invasive tests such as bone biopsy. This review summarizes and illustrates the spectrum of benign bone conditions that may be FDG-avid and mimic malignancy, including osteomyelitis, bone lesions due to benign systemic diseases (Brown tumor, Erdheim-Chester disease, Gaucher disease, gout and other types of arthritis, Langerhans cell histiocytosis, and sarcoidosis), benign primary bone lesions (bone cysts, chondroblastoma, chondromyxoid fibroma, desmoplastic fibroma, enchondroma, giant cell tumor and granuloma, hemangioma, nonossifying fibroma, and osteoid osteoma and osteoblastoma), and a group of miscellaneous benign bone conditions (post bone marrow biopsy or harvest status, bone marrow hyperplasia, fibrous dysplasia, fractures, osteonecrosis, Paget disease of bone, particle disease, and Schmorl nodes). Several ancillary clinical and imaging findings may be helpful in discriminating benign from malignant FDG-avid bone lesions. However, this distinction is sometimes difficult or even impossible, and tissue acquisition will be required to establish the final diagnosis.
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Affiliation(s)
- Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.
| | - John M H de Klerk
- Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands
| | - Maarten Nix
- Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Ben G F Heggelman
- Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Stefan V Dubois
- Department of Pathology, Meander Medical Center, Amersfoort, The Netherlands
| | - Hugo J A Adams
- Department of Radiology and Nuclear Medicine, Deventer Ziekenhuis, Deventer, The Netherlands
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20
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Magnetic Resonance Imaging of Nontraumatic Musculoskeletal Emergencies. Magn Reson Imaging Clin N Am 2016; 24:369-89. [DOI: 10.1016/j.mric.2015.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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21
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Harborne K, Hazlehurst JM, Shanmugaratnam H, Pearson S, Doyle A, Gittoes NJ, Choudhary S, Crowley RK. Compliance with established guidelines for the radiological reporting of atypical femoral fractures. Br J Radiol 2015; 89:20150443. [PMID: 26508355 DOI: 10.1259/bjr.20150443] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Atypical femoral fractures (AFFs) are important to diagnose early to avoid progression to complete fracture. We set out to determine the reporting accuracy of AFFs. METHODS We conducted a retrospective analysis of imaging performed between November 2010 and June 2013 to analyse the X-ray reporting of AFFs and to describe the key clinical considerations. Radiological reports were reviewed from the 3805 separate femoral images for search terms thought likely to identify AFFs. This identified 1558 patients. The identified radiographs were reviewed by radiologists with reference to the 2010 American Society of Bone and Mineral Research (ASBMR) criteria. RESULTS Within these 1558 patients, 16 patients met the radiological criteria for AFF according to the 2010 ASBMR task force statement of which, although all were identified as fractures, 15 were not reported as "atypical" by the original reporting author and none was formally classified as AFF by the original reporting author. Within the 1558 patients, there were an additional 17 patients labelled as having "atypical" fracture features originally, although only 1 patient met the 2010 ASBMR task force criteria for AFF. Only 13 of 16 patients had imaging of the contralateral femur, and there was a significant delay for those who were imaged (111 ± 44 days). Furthermore, two of the patients with an AFF had previous radiographs demonstrating cortical changes indicative of AFFs prior to formal diagnosis. CONCLUSION Whilst AFFs are rare diagnoses, the compliance with published guidelines for their radiological classification is low. ADVANCES IN KNOWLEDGE We have raised awareness of the importance of recognizing AFFs to guide management.
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Affiliation(s)
- Katrina Harborne
- 1 Department of Radiology, University Hospitals Birmingham, Birmingham, UK
| | - Jonathan M Hazlehurst
- 2 Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Hari Shanmugaratnam
- 3 Department of Endocrinology, University Hospitals Birmingham, Birmingham, UK
| | - Samuel Pearson
- 3 Department of Endocrinology, University Hospitals Birmingham, Birmingham, UK
| | - Alison Doyle
- 4 Falls and Fracture Prevention Service, University Hospitals Birmingham, Birmingham, UK
| | - Neil J Gittoes
- 3 Department of Endocrinology, University Hospitals Birmingham, Birmingham, UK
| | - Surabhi Choudhary
- 1 Department of Radiology, University Hospitals Birmingham, Birmingham, UK
| | - Rachel K Crowley
- 5 Department of Endocrinology, St Vincent's Hospital, Elm Park, Dublin & University College, Dublin, Ireland
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22
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Sadro CT, Sandstrom CK, Verma N, Gunn ML. Geriatric Trauma: A Radiologist’s Guide to Imaging Trauma Patients Aged 65 Years and Older. Radiographics 2015; 35:1263-85. [DOI: 10.1148/rg.2015140130] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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23
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Anwander H, Siebenrock KA, Rakhra KS, Beaulé PE. Magnetic Resonance Imaging of the Native Hip Joint. JBJS Rev 2015; 3:01874474-201505000-00004. [PMID: 27491057 DOI: 10.2106/jbjs.rvw.n.00086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Helen Anwander
- Division of Orthopedic Surgery (H.A. and P.E.B.), Department of Diagnostic Imaging (K.S.R.), The Ottawa Hospital, 501 Smyth Road, CCW 1646, Ottawa, Ontario, Canada
| | - Klaus A Siebenrock
- Department of Orthopedic Surgery, Inselspital, University of Bern, Freiburgstrasse 4, 3010 Bern, Bern, Switzerland
| | - Kawan S Rakhra
- Division of Orthopedic Surgery (H.A. and P.E.B.), Department of Diagnostic Imaging (K.S.R.), The Ottawa Hospital, 501 Smyth Road, CCW 1646, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopedic Surgery (H.A. and P.E.B.), Department of Diagnostic Imaging (K.S.R.), The Ottawa Hospital, 501 Smyth Road, CCW 1646, Ottawa, Ontario, Canada
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24
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Ghazizadeh S, Foss EW, Didier R, Fung A, Panicek DM, Coakley FV. Musculoskeletal pitfalls and pseudotumours in the pelvis: a pictorial review for body imagers. Br J Radiol 2014; 87:20140243. [PMID: 25096891 DOI: 10.1259/bjr.20140243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Many musculoskeletal abnormalities in the pelvis are first seen by body imagers while reviewing pelvic cross-sectional studies, and some of these abnormalities may mimic malignancy or another aggressive process. This article describes nine musculoskeletal pseudotumours and interpretative pitfalls that may be seen on CT, MRI and ultrasound imaging of the pelvis. Awareness of these pitfalls and pseudotumours may help avoid misdiagnosis and prevent inappropriate intervention or management.
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Affiliation(s)
- S Ghazizadeh
- 1 School of Medicine, Oregon Health and Science University, Portland, OR, USA
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25
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MRI of Sports Injuries in Children and Adolescents: What’s Different from Adults. CURRENT RADIOLOGY REPORTS 2014. [DOI: 10.1007/s40134-014-0045-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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26
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Dreizin D, Ahlawat S, Del Grande F, Fayad LM. Gradient-echo in-phase and opposed-phase chemical shift imaging: role in evaluating bone marrow. Clin Radiol 2014; 69:648-57. [PMID: 24613580 DOI: 10.1016/j.crad.2014.01.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 01/31/2014] [Indexed: 12/16/2022]
Abstract
Chemical shift imaging (CSI) provides valuable information for assessing the bone marrow, while adding little to total examination time. In this article, we review the uses of CSI for evaluating bone marrow abnormalities. CSI can be used for differentiating marrow-replacing lesions from a range of non-marrow-replacing processes, although the sequence is associated with technical limitations and pitfalls. Particularly at 3 T, susceptibility artefacts are prevalent, and optimal technical parameters must be implemented with appropriate choices for echo times.
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Affiliation(s)
- D Dreizin
- Department of Radiology, John Hopkins Hospital, Baltimore, MD, USA
| | - S Ahlawat
- Department of Radiology, John Hopkins Hospital, Baltimore, MD, USA
| | - F Del Grande
- Department of Radiology, John Hopkins Hospital, Baltimore, MD, USA; Servizio di Radiologia, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - L M Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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27
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Choi HS, Yoo IR, Park HL, Choi EK, Kim SH, Lee WH. Role of 18F-FDG PET/CT in differentiation of a benign lesion and metastasis on the ribs of cancer patients. Clin Imaging 2014; 38:109-14. [DOI: 10.1016/j.clinimag.2013.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 10/27/2013] [Accepted: 11/19/2013] [Indexed: 11/29/2022]
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Khoo MMY, Saifuddin A. The role of MRI in image-guided needle biopsy of focal bone and soft tissue neoplasms. Skeletal Radiol 2013; 42:905-15. [PMID: 23644880 DOI: 10.1007/s00256-013-1630-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/12/2013] [Accepted: 04/14/2013] [Indexed: 02/02/2023]
Abstract
Magnetic resonance imaging (MRI) plays a critical role in the management pathway of both soft tissue and bone neoplasms, from diagnosis through to post-treatment follow-up. There are a wide range of surgical, oncological, and combined treatment regimes but these rely on accurate histopathological diagnosis. This article reviews the role of MRI in the planning of image-guided needle biopsy for suspected soft tissue and bone tumors.
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Affiliation(s)
- M M Y Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
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Gaeta M, Mileto A, Ascenti G, Bernava G, Murabito A, Minutoli F. Bone stress injuries of the leg in athletes. Radiol Med 2013; 118:1034-44. [PMID: 23801398 DOI: 10.1007/s11547-013-0951-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 04/16/2012] [Indexed: 11/24/2022]
Abstract
Bone stress injuries, whose incidence is increasing among competitive and recreational athletes, represent a pathophysiological continuum along which a bone responds to a changing mechanical environment. Frank stress fracture is the endpoint of this process, resulting from the accumulation of microinjuries due to repeated abnormal stresses. The legs are largely the most frequently affected bone district. The aim of this paper is to review the imaging findings of the whole spectrum of stress-induced bone lesions of the leg in athletes. We emphasise the role of computed tomography and magnetic resonance imaging, which allow recognition of early alterations.
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Affiliation(s)
- Michele Gaeta
- Department of Radiological Sciences, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
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Imaging differentiation of pathologic fractures caused by primary and secondary bone tumors. Eur J Radiol 2013; 82:e36-42. [DOI: 10.1016/j.ejrad.2012.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 08/23/2012] [Accepted: 08/24/2012] [Indexed: 11/15/2022]
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Haworth AE, Webb J. Skeletal complications of bisphosphonate use: what the radiologist should know. Br J Radiol 2012; 85:1333-42. [PMID: 22972971 DOI: 10.1259/bjr/99102700] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Bisphosphonates are widely used for prevention of fractures in patients at risk, mainly in the presence of osteoporosis and bone metastases. A number of adverse effects of prolonged bisphosphonate treatment have emerged. We would like to highlight the skeletal complications from which a radiologist may be the first healthcare professional to recognise the association with bisphosphonate therapy. We illustrate these complications (namely osteonecrosis of the jaw and less well-known atypical femoral shaft fractures), presenting radiological findings in our patients. Recommendations for safer use of bisphosphonates are included in the conclusion of our review.
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Affiliation(s)
- A E Haworth
- Department of Radiology, University Hospital Aintree, Liverpool, UK
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Stress fractures in elderly patients. INTERNATIONAL ORTHOPAEDICS 2012; 36:2581-7. [PMID: 23138969 DOI: 10.1007/s00264-012-1708-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 10/23/2012] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to investigate specific risk factors, common fracture locations and possible sex-specific differences in elderly patients with stress fractures. METHODS This analysis enrolled 105 patients (83 women, 22 men) with stress fractures. For the analysis of possible risk factors related to increasing age, data from 82 patients (67 women, 15 men) aged 40 years and older (mean age of 57.4 ± 11.0 years) were compared with that from a younger control group [23 patients (16 women, seven men), mean age 28.4 ± 6.7 years]. Bone mineral density (BMD) was determined using dual-energy X-ray absorptiometry bone densitometry (DXA) and blood samples were taken. RESULTS A total of 211 stress fractures were found. Of these, 177 were found in the study group, of which 90.4 % were located in the lower limb. Lumbar and femoral BMD was significantly lower in elderly patients; however, the BMD of most patients was within the osteopenic or normal range. Within the study group, a total of 83.8 % had a vitamin D insufficiency (<30 μg/l); 75.5 % were not engaged in regular physical activity more than once a week. Overweight patients within the study group had significantly more stress fractures compared to normal weight patients (2.6 ± 1.7 vs. 1.9 ± 1.1, p<0.05). CONCLUSIONS A similar contribution of risk factors has been found for stress fractures in elderly patients and younger controls of the general population. Stress fracture incidence seems to be rather multifactorial and not based on osteoporotic changes alone. A balanced calcium and vitamin D metabolism seems to be of paramount importance for stress fracture prevention in elderly patients.
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Mouzopoulos G, Kanakaris NK, Kontakis G, Obakponovwe O, Townsend R, Giannoudis PV. Management of bone infections in adults: the surgeon's and microbiologist's perspectives. Injury 2011; 42 Suppl 5:S18-23. [PMID: 22196905 DOI: 10.1016/s0020-1383(11)70128-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Bone infection in adults is a potentially devastating complication following trauma or surgery. The clinician should diagnose osteomyelitis based on certain clinical manifestations and on laboratory and imaging findings. For pathogen identification, the treating surgeon should take appropriate tissue samples. Close collaboration with microbiologists is of paramount importance to dictate the appropriate duration and type of antibiotics to be administered. Treatment of acute osteomyelitis requires surgical debridement and prolonged course of antibiotics. Debate exists regarding the maintenance or the removal of any internal fixation device. Treatment of chronic osteomyelitis is more complicated. For its eradication the treatment course is often prolonged and frustrating. Based on the current literature an algorithm of treatment for both acute and chronic bone infections is recommended.
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Affiliation(s)
- G Mouzopoulos
- Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, UK
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Spina A, Clemente A, Vancini C, Fejzo M, Campioni P. Spontaneous talar and calcaneal fracture in rheumatoid arthritis: a case report. J Radiol Case Rep 2011; 5:15-23. [PMID: 22470803 DOI: 10.3941/jrcr.v5i7.735] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Rheumatoid arthritis (RA) leads to a progressive weakening of the skeleton which may result in bone fractures. However, spontaneous fractures (exclusive of stress fractures, vertebral collapse, and superficial articular fragmentation) in patients with rheumatoid arthritis have been only occasionally reported in the medical literature. A case of spontaneous talar and calcaneal fracture in rheumatoid arthritis is described. Bone lesions were identified on radiographs, MR images and scintigraphy in a patient with right ankle pain. The absence of episodes of acute trauma, and the presence of acute clinical manifestations should guide the clinical suspicion.
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Affiliation(s)
- Antonio Spina
- Department of Radiology, Ferrara University, Ferrara, Italy.
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Dixon S, Newton J, Teh J. Stress fractures in the young athlete: a pictorial review. Curr Probl Diagn Radiol 2011; 40:29-44. [PMID: 21081210 DOI: 10.1067/j.cpradiol.2009.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Stress fractures are an uncommon but important source of pain and disability in young athletes. The presentation and differential diagnosis of stress fractures in young athletes differs from that of older athletes. This pictorial review outlines the pathogenesis and imaging features of stress fractures. Other pathologies that can mimic stress fractures and the advantages of the use of magnetic resonance imaging will be discussed. An imaging algorithm for a suspected stress fracture is suggested.
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Affiliation(s)
- Shaheen Dixon
- Department of Radiology, the Nuffield Orthopaedic Centre NHS Trust, Headington, Oxford, United Kingdom
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Bodor D, Awh MH, Stadnick ME. Orthopaedic Magnetic Resonance Imaging Challenge. Sports Health 2010; 2:351-5. [PMID: 23015959 PMCID: PMC3445086 DOI: 10.1177/1941738110373452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Fatigue-type stress fractures of the lower limb associated with fibrous cortical defects/non-ossifying fibromas in the skeletally immature. Clin Radiol 2010; 65:382-6. [DOI: 10.1016/j.crad.2010.01.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 01/11/2010] [Accepted: 01/13/2010] [Indexed: 11/17/2022]
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Krestan C, Hojreh A. Imaging of insufficiency fractures. Eur J Radiol 2009; 71:398-405. [PMID: 19700255 DOI: 10.1016/j.ejrad.2008.04.059] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2008] [Accepted: 04/30/2008] [Indexed: 11/30/2022]
Abstract
This review focuses on the occurrence, imaging and differential diagnosis of insufficiency fractures. Prevalence, the most common sites of insufficiency fractures and their clinical implications are discussed. Insufficiency fractures occur with normal stress exerted on weakened bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. Other conditions which affect bone turnover include osteomalacia, hyperparathyroidism, chronic renal failure and high-dose glucocorticoid therapy. It is a challenge for the radiologist to detect and diagnose insufficiency fractures, and to differentiate them from other bone lesions. Radiographs are still the most widely used imaging method for identification of insufficiency fractures, but sensitivity is limited, depending on the location of the fractures. Magnetic resonance imaging (MRI) is a very sensitive tool to visualize bone marrow abnormalities associated with insufficiency fractures. Thin section, multi-detector computed tomography (MDCT) depicts subtle fracture lines allowing direct visualization of cortical and trabecular bone. Bone scintigraphy still plays a role in detecting fractures, with good sensitivity but limited specificity. The most important differential diagnosis is underlying malignant disease leading to pathologic fractures. Bone densitometry and clinical history may also be helpful in confirming the diagnosis of insufficiency fractures.
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Affiliation(s)
- Christian Krestan
- Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna, Austria.
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40
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Fottner A, Baur-Melnyk A, Birkenmaier C, Jansson V, Dürr HR. Stress fractures presenting as tumours: a retrospective analysis of 22 cases. INTERNATIONAL ORTHOPAEDICS 2007; 33:489-92. [PMID: 18084759 DOI: 10.1007/s00264-007-0488-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 10/02/2007] [Accepted: 10/18/2007] [Indexed: 10/22/2022]
Abstract
Frequently, the imaging features of stress fractures may be misinterpreted as tumour-like lesions. The aim of this study was to analyse the quality of different examinations in detecting stress fractures mimicking tumour-like lesions in magnetic resonance imaging (MRI). We evaluated 22 cases which were referred to our department with the suspected diagnosis of bone tumours turning out to be stress fractures. Whenever the MRI did not lead to a diagnosis after a second review, computed tomography (CT) scans and, if still required, additional examinations were performed until the fracture was detected. A stress fracture was diagnosed in 15 cases after the additional CT scan, in five cases with the review of the MRI and in two cases with a combination of several examinations. Especially in stress fractures of the tibia and the femur, CT scanning was essential for making a diagnosis by detecting the fracture line. Bone scans and biopsies, in contrast, were not helpful in making a correct diagnosis.
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Hartmann A, Eid K, Dora C, Trentz O, von Schulthess GK, Stumpe KDM. Diagnostic value of 18F-FDG PET/CT in trauma patients with suspected chronic osteomyelitis. Eur J Nucl Med Mol Imaging 2006; 34:704-714. [PMID: 17136411 DOI: 10.1007/s00259-006-0290-4] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Accepted: 09/08/2006] [Indexed: 01/26/2023]
Abstract
PURPOSE To retrospectively evaluate the diagnostic value of (18)F-FDG PET/CT in trauma patients with suspected chronic osteomyelitis. METHODS Thirty-three partial body (18)F-FDG PET/CT scans were performed in 33 patients with trauma suspected of having chronic osteomyelitis. In 10 and 23 patients, infection was suspected in the axial and appendicular skeleton, respectively. In 18 patients, PET/CT was performed in the presence of metallic implants. Histopathology or bacteriological culture was used as the standard of reference. For statistical analysis, sensitivity, specificity and accuracy were calculated in relation to findings of the reference standard. RESULTS Of 33 PET/CT scans, 17 were true positive, 13 true negative, two false positive and one false negative. Eighteen patients had chronic osteomyelitis and 15 had no osseous infection according to the reference standard. Sensitivity, specificity and accuracy for (18)F-FDG PET/CT was 94%, 87% and 91% for the whole group, 88%, 100% and 90% for the axial skeleton and 100%, 85% and 91% for the appendicular skeleton, respectively. CONCLUSION (18)F-FDG PET/CT is a highly sensitive and specific method for the evaluation of chronic infection in the axial and appendicular skeleton in patients with trauma. PET/CT allows precise anatomical localisation and characterisation of the infectious focus and demonstrates the extent of chronic osteomyelitis with a high degree of accuracy.
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Affiliation(s)
- Anna Hartmann
- Department of Medical Radiology, Division of Nuclear Medicine, University Hospital, 8091, Zurich, Switzerland
| | - Karim Eid
- Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland
| | - Claudio Dora
- Department of Orthopedic Surgery, Orthopedic University Hospital Balgrist, Zurich, Switzerland
| | - Otmar Trentz
- Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland
| | - Gustav K von Schulthess
- Department of Medical Radiology, Division of Nuclear Medicine, University Hospital, 8091, Zurich, Switzerland
| | - Katrin D M Stumpe
- Department of Medical Radiology, Division of Nuclear Medicine, University Hospital, 8091, Zurich, Switzerland.
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