Incidence of avascular necrosis of native femur following hip transposition surgery for periacetabular malignancies: a single-centre experience.

BACKGROUND: Hip transposition surgery after surgical resection of large pelvic tumours is a well-established alternate to endoprosthetic reconstruction. The major goals of surgery are to ensure adequate resection margins with limb salvation, albeit with acceptable levels of morbidity. While surveillance is aimed at diagnosing local recurrence or distant metastasis primarily, other complications may occasionally be seen.The aim of this study was to assess incidence of avascular necrosis (AVN) in the preserved native femoral heads after hip transposition surgery for periacetabular malignancies, also known as hanging hip surgery. PATIENTS AND METHODS: Patient records and follow-up imaging of 22 patients who had undergone hanging hip surgery from 1999 to 2020 were retrospectively analysed to assess for any probable causes of AVN. RESULTS: Of the 22 patients, 5 (22.7%) had developed AVN on follow-up with a mean time of onset of about 10.5 months from surgery (5 months-2 years). A review of the patient demographics, surgical notes, preoperative management did not offer any clues as to the cause of AVN in these patients. Osteopenia was the most common radiological finding (59%) in most patients, but this also did not herald AVN onset. CONCLUSIONS: The theory that loss of major vascular supply to the femoral head from capsular disruption during hip transposition surgery would lead to AVN in most patients did not hold true as AVN occurred in a small number of patients.

Self-reducing intrathoracic organo-axial gastric volvulus with paraoesophageal hiatus hernia in a toddler.

A toddler presented with complaints of multiple episodes of vomiting lasting 1 week. He had a history of similar episodes of vomiting several times as an infant. Clinically, he was underweight and had tachypnoea and tachycardia. Laboratory investigations revealed hyponatraemic metabolic acidosis. His chest radiograph revealed an intrathoracic herniation of the stomach with an atypical presence towards the right hemithorax, suggestive of a torsion. A contrast-enhanced CT of the chest and abdomen confirmed an intrathoracic gastric herniation, with an organo-axial gastric volvulus, with no features of strangulation. He underwent an emergency laparotomy and intraoperatively the stomach was found to have reduced to its intra-abdominal position, and the hernia and volvulus had also self-reduced. In view of the multiple symptomatic episodes, an anterior gastropexy was performed to prevent recurrences. The patient recuperated well and has not had any recurrences in the follow-up period. This report adds to the minimalistic literature.

Periostitis Ossificans: Largest Case Series with Review of Literature.

Background Periostitis ossificans (PO) are rare, benign ossifying surface lesions characterized by the centripetal ossification with osseous and soft-tissue edema. Their clinicoradiological appearances can easily mimic those of more sinister or infective surface lesion. Objective This study aimed to explore the various anatomical locations and muscle attachment at the site of PO, and evaluate the role of complementary image findings in patients presenting at our tertiary orthopaedic referral center. Patients and Methods A retrospective review of our oncology and radiology databases was undertaken to identify patients with PO reported on radiographs, magnetic resonance imaging (MRI) and computed tomography (CT) over the past 13 years (2007-2020). Patient demographics, sites of PO, muscle attachment at the site of PO, findings on complementary imaging, and clinical management outcome were documented. Results We identified 38 patients with PO with a mean age of 24 years (range: 4-66 years). Muscle attachment was seen at the site of PO in the majority of cases (89%). The majority of PO were in the lower limb and commonly seen around the attachment of quadriceps. Deltoid attachment was commonly involved in the upper limb. Conclusion Muscle attachment is commonly seen at the site of PO, which results in stripping of the periosteum resulting in soft-tissue and osseous edema and centripetal ossification.

Piggyback Technique-A Safe Way of Performing Rib Biopsy.

Rib biopsy can be challenging. A spectrum of bone biopsy techniques are available to undertake Rib Bone biopsy and yield a histological specimen. In this technical report, we described a new Piggyback technique of performing rib biopsy to decrease the incidence of pneumothorax and consolidate diagnostic accuracy.

The T1 Ratio of Marrow (TROM) as a Novel Tool to Identify Metastatic from Nonmalignant Marrow Lesions of the Spine: A Pilot Study.

Objective The purpose of this study was to analyze quantitative values of normal and abnormal marrow on T1-weighted images of spine, to propose a ratio for T1 values of abnormal to normal vertebrae, and to assess whether this ratio could be helpful in predicting presence of neoplastic lesions in the spine. Materials and Methods One-hundred randomly selected magnetic resonance imagings of lumbar spine without infection, fracture, and tumor were selected to form normal cohort. A second cohort of 100 metastasis of lumbar spine was identified. Ratio of T1 value of vertebral body to the T1 value of the inferior vertebral body was performed for normal cohort from D11 to L5. Ratio of T1 value of metastasis to adjacent normal vertebral body was done for metastatic cohort. Data was analyzed using standard t -test and kappa was performed for intra- and inter-observer reliability. Results A decline in T1 value of abnormal to normal marrow was seen in patients with metastasis that was statistically significant. We call this the T1 ratio of marrow (TROM). The sensitivity and accuracy with the cutoff value of TROM at 0.7 (92% sensitivity, 97.1% accuracy) are better than at 0.6 (75% sensitivity, 96.2% accuracy) or 0.5 (47% sensitivity, 93.2% accuracy). A subset analysis of the other T1 hypointense benign lesions including atypical hemangiomas and focal marrow hyperplasia, however, revealed overlapping TROM values with the metastatic cohort. Conclusion Using the TROM on T1-weighted images could not confidently differentiate malignant from benign T1 hypointense lesions of the spine.

The Linear Coronal Knee Offset (LCKO)-Preliminary Study of New Method of Measuring Knee Varus/Valgus Malalignment.

Introduction Considerable attention is focused on preoperative templating of radiological images in patients undergoing total knee arthroplasty to obtain optimal alignment and outcome. Several radiological measurements have been described. Purpose In this study, we illustrate a new linear measurement: The linear coronal knee offset (LCKO) that can be used to analyze the coronal configuration on long leg alignment radiographs commonly undertaken during preoperative templating. Methods A retrospective search was performed of our Picture Archiving and Communication System and Radiology Information System to identify 100 lower limbs anteroposterior, weight bearing, long leg alignment view radiographs of patients referred to knee clinics over 1 year with knee pain. Demographic details, clinical indication, standard radiological measurement of the anatomical tibiofemoral angle, and the LCKO were measured and data were analyzed using Student's t -test. In addition, intraclass correlation coefficient was used to analyze for intraclass reliability. Results The average age of patients was 36.3 years (range: 12-80 years) with a male predominance. The LCKO was statistically significant between the three cohorts of patients. The mean LCKO in normal cohorts was 0.24 cm, varus was -0.6 cm, and valgus was 1.72cm. There was good inter and interobserver reliability (Kappa of 0.8 and 0.8, respectively). Conclusion The novel LCKO measurement provides a simpler method in assessing coronal lower limb malalignment and can easily identify a normal, varus, or valgus knee deformity.

Does Chemical Shift Magnetic Resonance Imaging Improve Visualization of Pars Interarticularis Defect?

Introduction A unilateral or bilateral pars interarticularis defect (spondylolysis) is a leading cause of axial back pain in adolescent athletes. Currently, a spectrum of imaging modalities is used for assessment of pars interarticularis defects. Objectives The aim of this study is to compare the accuracy of chemical shift sequence (magnetic resonance imaging [MRI]) technique to conventional MRI sequences in the detection of pars defects. Patients and Methods Conventional T1, T2, and short tau inversion recovery sagittal and axial, as well as "in-" and "out-" phase chemical shift sagittal MRI sequences of 70 consecutive patients referred for low back pain were reviewed. Demographic details, clinical indication, and presence/diagnosis of pars defects using a 5-point Likert scale on both conventional and chemical shift MRI sequences. Spearman's correlation was used for statistical analysis. Intraclass correlation coefficient analysis was evaluated to assess the intraclass reliability between observers. Data were analyzed using DATAtab web-based statistics software (2022). Results A total of 70 patients with an average age of 54.34 years with a female predominance were included. There were 11 pars defects in the cohort. Both in and out phases of chemical shift imaging were able to identify pars defect and intact pars. However, out phase was relatively better in delineating pars defects, while the in phase was superior in identifying an intact pars, though this was not statistically significant. There was good intra- and interobserver reliabilities. Conclusion Chemical shift MRI sequence is a quicker, complementary technique to assess and analyze pars interarticularis confidently than conventionally utilized MRI sequences in patients being evaluated for axial back pain.

A comparison of ChatGPT-generated articles with human-written articles.

OBJECTIVE: ChatGPT (Generative Pre-trained Transformer) is an artificial intelligence language tool developed by OpenAI that utilises machine learning algorithms to generate text that closely mimics human language. It has recently taken the internet by storm. There have been several concerns regarding the accuracy of documents it generates. This study compares the accuracy and quality of several ChatGPT-generated academic articles with those written by human authors. MATERIAL AND METHODS: We performed a study to assess the accuracy of ChatGPT-generated radiology articles by comparing them with the published or written, and under review articles. These were independently analysed by two fellowship-trained musculoskeletal radiologists and graded from 1 to 5 (1 being bad and inaccurate to 5 being excellent and accurate). RESULTS: In total, 4 of the 5 articles written by ChatGPT were significantly inaccurate with fictitious references. One of the papers was well written, with a good introduction and discussion; however, all references were fictitious. CONCLUSION: ChatGPT is able to generate coherent research articles, which on initial review may closely resemble authentic articles published by academic researchers. However, all of the articles we assessed were factually inaccurate and had fictitious references. It is worth noting, however, that the articles generated may appear authentic to an untrained reader.

Imaging of Cartilage and Chondral Defects: An Overview.

A healthy articular cartilage is paramount to joint function. Cartilage defects, whether acute or chronic, are a significant source of morbidity. This review summarizes various imaging modalities used for cartilage assessment. While radiographs are insensitive, they are still widely used to indirectly assess cartilage. Ultrasound has shown promise in the detection of cartilage defects, but its efficacy is limited in many joints due to inadequate visualization. CT arthrography has the potential to assess internal derangements of joints along with cartilage, especially in patients with contraindications to MRI. MRI remains the favored imaging modality to assess cartilage. The conventional imaging techniques are able to assess cartilage abnormalities when cartilage is already damaged. The newer imaging techniques are thus targeted at detecting biochemical and structural changes in cartilage before an actual visible irreversible loss. These include, but are not limited to, T2 and T2* mapping, dGEMRI, T1ρ imaging, gagCEST imaging, sodium MRI and integrated PET with MRI. A brief discussion of the advances in the surgical management of cartilage defects and post-operative imaging assessment is also included.

Ultrasound of the Hook of Hamate Region: Pictorial Review.

The hook of hamate is a complex anatomical region with many small but important structures. A sound knowledge of anatomy along with a systematic ultrasound technique can help delineate a variety of disorders. In this pictorial review, we discuss the ultrasound anatomy and the possible pathologies that can be encountered in this region.

Angle of BRINK - a new way to measure Haglund's deformity.

INTRODUCTION: Haglund's deformity, an abnormality of the postero-superior corner of the calcaneum, is a common, critically debated cause of posterior heel pain. Several radiological indices such as Fowler-Philip angle, Ruch pitch, Chauveaux-Liet angle, calcaneal pitch angle, parallel pitch lines, and X-Y ratio have been described to measure this deformity. However, most of these lack specificity and have variable intra- and inter-observer reliability. PURPOSE: The study aims to describe a new radiological "angle of BRINK" (Botchu-Reilly-Iyengar-Nischal-Kakarala) to measure Haglund's deformity. PATIENT AND METHODS: We performed a retrospective cohort analysis, assessing 20 weight-bearing lateral ankle radiographs of patients with Haglund's deformity (Haglund's cohort) and 100 radiographs without the deformity (normal cohort). Demographic details and angle of BRINK to measure Haglund's deformity were measured for each patient. Statistical analysis was performed using t-test and inter-observer reliability was calculated using kappa coefficient. RESULTS: The mean angle of BRINK to measure Haglund's deformity in the normal cohort was 20.04° (SD 4.88), and in the Haglund's cohort was 25.1° (SD 3.3). This was statistically significant with a p-value of less than 0.0001. There was excellent intra- and inter-observer reliability with kappa value of 0.8. CONCLUSION: Our proposed radiological angle of BRINK to measure Haglund's deformity is simple and easy to calculate on standard weight-bearing radiographs. Contrary to the traditional measurements used to estimate the deformity, it has shown a good intra- and inter-observer reliability and can support surgical decision-making process for management of patients with symptomatic Haglund's deformity.

Clicking shoulder due to snapping Subacromial subdeltoid (SASD) bursitis: a case report of an unusual presentation in clinical practice with imaging features.

A spectrum of pathologies can cause clicking, popping or snapping of the shoulder joint. These can lead to a patient seeking attention in clinical practice due to pain, discomfort and impact on activities of daily living. Traditionally these can originate from pathologies which involve biceps tendon, tears of the rotator cuff or the glenoid labrum, articular cartilage or due to loose bodies and scapulothoracic joint dysfunction [Guillin et al. in Br J Radiol 85:1343-1353, 2012; Vidoni et al. in Indian J Musculoskelet Radiol 4:61-69, 2022]. Subacromial subdeltoid (SASD) bursitis is a well-described entity and one of the commonest causes of shoulder pain. We present SASD bursitis as an unusual cause of clicking/snapping in the shoulder without associated pain in a healthy young male. The clinical presentation, diagnostic strategy with complementary imaging and the role of interventional radiology in its effective management is highlighted to support clinicians faced with a diagnostic dilemma.

Performance Evaluation of High-Resolution Ultrasound versus Magnetic Resonance Imaging in Diagnosing Peripheral Nerve Pathologies.

Background High-resolution ultrasound (HRUS) and magnetic resonance neurography (MRN) are considered complementary to clinical and neurophysiological assessment for neuropathies. Aims The aim of our study was to compare the accuracy of HRUS and MRN for detecting various peripheral nerve pathologies, to choose the correct investigation to facilitate prompt patient management. Materials and Methods This prospective study was done using HRUS with 14 MHz linear-transducer and 3 or 1.5T MR in cases referred for the assessment of peripheral nerve pathologies. Image interpretation was done using a scoring system (score 0-3 confidence level) to assess for nerve continuity/discontinuity, increased nerve signal/edema, fascicular change, caliber change, and neuroma/mass lesion. We determined the accuracy, sensitivity, and specificity of these modalities compared with the diagnostic standard determined by surgical and/or histopathological, if not performed then clinical and/or electrodiagnostic evaluation. Results The overall accuracy of MRN was 89.3% (specificity: 66.6%, sensitivity: 92.6%, negative predictive value [NPV]: 57.1%, positive predictive value [PPV]: 95%) and that of HRUS was 82.9% (specificity: 100%, sensitivity: 80.4%, NPV: 42.8, PPV: 100). The confidence level for detecting nerve discontinuity and change in nerve caliber was found to be higher on ultrasonography than magnetic resonance imaging (MRI) (100 vs. 70% and 100 vs. 50%, respectively). Pathology of submillimeter caliber nerves was accurately detected by HRUS and these could not be well-visualized on MRI. Conclusion HRUS is a powerful tool that may be used as the first-line imaging modality for the evaluation of peripheral nerve pathologies, and a better means of evaluation of peripheral nerves with submillimeter caliber.

Quantitative Evaluation of the Diffusion Tensor Imaging Matrix Parameters and the Subsequent Correlation with the Clinical Assessment of Disease Severity in Cervical Spondylotic Myelopathy.

STUDY DESIGN: We performed a prospective observational study of 52 patients who were clinically suspected of cervical spondylotic myelopathy (CSM), based on the modified Japanese Orthopaedic Association (mJOA) score, and were referred for magnetic resonance imaging (MRI) of the cervical spine. PURPOSE: To evaluate the quantitative parameters of the diffusion tensor imaging (DTI) matrix (fractional anisotropy [FA] and apparent diffusion coefficient [ADC] values) and determine the subsequent correlation with the clinical assessment of disease severity in CSM. OVERVIEW OF LITERATURE: Conventional MRI is the modality of choice for the identification of cervical spondylotic changes and is known to have a low sensitivity for myelopathy changes. DTI is sensitive to disease processes that alter the water movement in the cervical spinal cord at a microscopic level beyond the conventional MRI. METHODS: DTI images were processed to produce FA and ADC values of the acquired axial slices with the regions of interest placed within the stenotic and non-stenotic segments. The final quantitative radiological derivations were matched with the clinical scoring system. RESULTS: Total 52 people (24 men and 28 women), mean age 53.16 years with different symptoms of myelopathy, graded as mild (n=11), moderate (n=25), and severe (n=16) as per the mJOA scoring system, underwent MRI of the cervical spine with DTI. In the most stenotic segments, the mean FA value was significantly lower (0.5009±0.087 vs. 0.655.7±0.104, p<0.001), and the mean ADC value was significantly higher (1.196.5±0.311 vs. 0.9370±0.284, p<0.001) than that in the non-stenotic segments. The overall sensitivity in identifying DTI metrics abnormalities was more with FA (87.5%) and ADC (75.0%) than with T2 weighted images (25%). CONCLUSIONS: In addition to the routine MRI sequences, DTI metrics (FA value better than ADC) can detect myelopathy even in patients with a mild grade mJOA score before irreversible changes become apparent on routine T2 weighted imaging and thus enhance the clinical success of decompression surgery.

Spondyloarthropathy - Is sacroiliac joint imaging sufficient? A study of 431 patients.

BACKGROUND: Sacroiliac (SI) joint involvement (sacroiliitis) is considered as major criteria for diagnosing Spondyloarthropathy (SpA), although involvement of spine and hip can also occur. The aim of our study was to assess the utility of including sagittal short-tau inversion recovery (STIR) sequence of dorsolumbar spine and coronal STIR/proton density (PD) fat saturated sequence through both hips, to routine SI joint magnetic resonance (MR) imaging protocol, in patients clinically suspected to have SpA. MATERIAL AND METHODS: A retrospective observational study was conducted between February 2013 and February 2018 on clinically suspected SpA patients referred to our department for imaging. The images obtained using this new SI joint protocol were evaluated for findings suggesting SpA diagnosis as per the Assessment of SpondyloArthritis international Society criteria. Other differentials for similar symptoms were also looked for. RESULTS: Of the 431 patients (313 M and 118 F), 255 had features confirming the diagnosis of SpA and 176 had no radiological manifestations of SpA (56 were normal and 120 had other findings to suggest clinical symptoms; e.g., degenerative SpA, Pott's spine, skeletal metastases, early AVN of hip, cysticercus, iliofemoral impingement). 19/255 patients had normal SI joints but other findings to suggest diagnosis of SpA, e.g. romanus lesions, costovertebritis/costotransversitis, pubic symphysitis, inflammatory hip arthropathy, enthesitis, iliofemoral/trochanteric bursitis. 33/61 patients with chronic sacroiliitis had disease activity in spine or hip. CONCLUSION: Inclusion of sections through dorsolumbar spine and both hips to routine SI joint protocol, helped in identifying: (a) early disease in 19 patients, who had normal SI joints and may have otherwise been missed with routine only SI joint imaging, (b) additional findings in SpA-related sacroiliitis, (c) disease activity in chronic sacroiliitis, and (d) other causes of low back pain and thus helped in further patient management.

Solid Pseudopapillary Neoplasm of the Pancreas Clinicopathological Characteristics and Long-Term Outcome: a Single-Center Experience.

Solid pseudopapillary neoplasm is a rare tumor of the pancreas. These tumors are considered to have low malignant potential with good prognosis. Due to its rarity, details about clinical presentation and management of the disease are not very clear. This study aims to share our experience and to describe management of the disease. We retrospectively evaluated patients 13 patients diagnosed with SPT on histopathological examination of resected specimen. Data on their clinicopathological, management-related factors, and follow-up was collected. All the patients were females, with a median age of 20 years. Abdominal pain was the most common presentation. The mean tumor size was 6.5 cm and majority of tumors were located in the head region. R0 resection was obtained in all the patients. All patients were disease-free with a median follow-up of 68 months. Excellent prognosis can be achieved with a margin-negative resection in these tumors. Adjacent organ or vascular involvement is not a contraindication for surgical resection.

Segmental dilatation of ileum in a young patient presenting with anemia.

Segmental dilatation of ileum (SDI) is a less known uncommon entity with a confusing clinical scenario and no definite etiopathogenesis. The preoperative diagnosis is of exclusion. However, it has an excellent prognosis after surgery. We describe a case of a young patient who presented with anemia without any overt gastrointestinal (GI) bleed. Thorough radiological examinations were needed to reach the diagnosis of SDI which was confirmed postoperatively.