Popliteal Artery-Related Pathologies in Athletes-A Primer for Musculoskeletal Radiologists.

Vascular complications in athletes are common and mimic musculoskeletal injuries such as muscle sprains, fractures, and cartilage abnormalities. They include traumatic vascular injuries and more subtle pathologies like entrapment syndromes, pseudoaneurysms, arterial occlusions, and venous thrombosis. Such vascular complications may be occult on imaging and can be difficult for a musculoskeletal radiologist to diagnose, resulting in a lack of timely diagnosis and potentially limb-threatening consequences. Although the final diagnosis may require multidisciplinary input from orthopaedic, sports and exercise medicine, and vascular and interventional radiology inputs, a musculoskeletal radiologist with prior knowledge of such conditions can be the first to diagnose such conditions aiding the athlete's performance. A musculoskeletal radiologist should pay due attention to anatomical courses of vascular channels and look for potential causes of vascular compression, aberrant myotendinous bands, accessory muscles, etc., before concluding a computed tomography (CT) or magnetic resonance imaging (MRI) as normal. Doppler ultrasound, CT, or MR angiography are commonly employed techniques for primary evaluation, whereas digital subtraction angiography is generally reserved for troubleshooting as advanced dynamic imaging.

Beyond the Hip Labrum: A Pictorial Review.

Magnetic resonance arthrography and 3T magnetic resonance imaging of the hip are a technique commonly performed in young, physically active patients presenting with pain relating to the hip, with the focus on assessing for the presence of labral tears and femoroacetabular impingement. Abnormal signal within the labrum can be misleading, however, as labral tears are a frequent incidental finding and have been identified in a large proportion of the asymptomatic population. A range of extralabral conditions can cause hip-related pain in young patients, including pathology related to the bones, joints, and periarticular soft tissues. It is vital that the radiologist is aware for these pathologies and examines for them even in the presence of a confirmed labral tear. In this article, we review a range of common extralabral pathologies responsible for hip pain and highlight review areas that aid in their diagnosis.

Dorsalis pedis artery thrombosis in an elite rugby player: an unusual cause of pedal claudication in a high-risk ankle.

Vascular thrombosis in young elite athletes is uncommon, usually affecting calf veins and arteries beyond the knee joint. Arterial thrombosis, especially in the dorsalis pedis artery, is very rare without premature atherosclerosis or trauma. Its clinical presentation with progressive claudication of insidious onset is nonspecific and overlaps with the symptoms of deep peroneal nerve compression as a part of anterior ankle impingement, a more common entity in athletes. Ultrasound can evaluate pedal claudication in athletes differentiating vascular and neural causes expediting diagnosis, management and, in turn, return to play. Furthermore, imaging-Doppler ultrasound and MR angiography in particular-plays a vital role in the evaluation of potential aetiology and evolution (i.e., collateral development and recanalization) of the occluded vessel. We present a case of dorsalis pedis artery thrombosis with both MRI and ultrasound findings in a professional rugby player who had no systemic comorbidity, but numerous previous surgical interventions around the ankle joint in both the remote and recent past, putting the adjacent DPA at increased risk for developing thrombosis. In this high-risk ankle, the dorsalis pedis thrombosis may be iatrogenic or due to sports-related, arterial wall injury with superimposed thrombosis.

Reliability of slice-encoding for metal artefact correction (SEMAC) MRI to identify prosthesis loosening in patients with painful total hip arthroplasty - a single centre, prospective, surgical validation study.

OBJECTIVES: To validate reliability of slice-encoding for metal artefact correction (SEMAC)-MRI findings in prosthesis loosening detection by comparing them to surgical outcomes (gold standard) in symptomatic patients following hip arthroplasties. To evaluate periprosthetic anatomical structures in symptomatic patients to identify an alternative cause of hip symptoms. METHODS: We prospectively followed 47 symptomatic patients (55 hips, 39 painful hips - group P and 16 control hips - group C) at our institution from 2011 to 2016. We acquired 1.5 T MRI conventional and SEMAC-MRI images for all patients. Two consultants scored MRI for osteolysis and marrow oedema zone-wise using predefined signal characteristics and settled scoring variations by consensus. We used Spearman Rank-Order Correlation for correlation analysis and used OMERACT (Outcome Measures in Rheumatology) filter pillars to validate SEMAC-MRI findings. RESULTS: Eleven patients needed revision surgery, all from group P. None from group C required revision surgery. Remaining 28 hips in the group P were managed conservatively pain completely resolved in 21 hips, eight hips had trochanteric bursitis, eight had extraarticular cause and the remaining five hips had spontaneous pain resolution. We found moderate-to-weak correlation between SEMAC-MRI findings for prosthesis loosening and revision surgery outcomes. Sensitivity, Specificity, PPV and NPV in Group P were (72.7, 64.3, 44.4, 85.7%) in T1W-SEMAC, (90.9, 46.4, 40.0, 92.9%) in STIR-SEMAC and (36.3, 78.5, 40.0, 75.8%) in PDW-SEMAC. CONCLUSION: Negative SEMAC-MRI results can effectively exclude prosthesis loosening confirmed on revision surgery and SEMAC-MRI can detect alternative cause of hip pain accurately. ADVANCES IN KNOWLEDGE: Negative SEMAC-MRI in painful THA patients can effectively exclude prosthesis loosening as a cause.

Ultrasound evaluation of the rotator interval and adjoining tendons in shoulders with restricted movements: a technical note describing a simplified shoulder position.

The rotator interval (RI) is a critical but complex anatomical structure for which musculoskeletal ultrasound provides an excellent imaging evaluation. In the patients with restricted and painful movements, the RI may not be visualised optimally as the conventional 'Modified Crass' positions may not be achievable. It can also be difficult to optimally evaluate the anterior supraspinatus and subscapularis tendons in such patients. We describe a simple shoulder position obviating need of pronounced supraspinatus stretch for better evaluation of the rotator interval and adjoining rotator cuff structures.

Multimodality imaging of greater trochanter lesions.

PURPOSE: Greater trochanter (GT) lesions are relatively uncommon. They can be traumatic, infective including tuber-culosis, inflammatory, and neoplastic (primary and metastatic osseous lesions). Although imaging of greater trochanter lesions remains essential for differential diagnoses, an image-guided biopsy is a mainstay for diagnosis and to guide subsequent management. MATERIAL AND METHODS: A retrospective search for the word 'greater trochanter' was performed of a computerised radiology information system (CRIS) of a tertiary referral centre for orthopaedic oncology over a period of 12 years (2007-2019). This revealed 6019 reports with 101 neoplasms. The imaging, histology, and demography were reviewed by a dedicated musculoskeletal radiologist. RESULTS: We identified 101 GT neoplasms with a mean age of 51.5 years (range 6 to 85 years) and a slight female predominance of 1.2 : 1 (46 males and 55 females). Using 30 years of age as a cut-off, we further segregated the patient cohort into 2 groups: 26 (25.74%) lesions in patients less than 30 years age and the remaining 75 (74.26%) lesions in patients over 30 years old. Chondroblastoma was the most common neoplasm in patients below 30 years of age, and metastases were the most common neoplasms in patients over 30 years of age. CONCLUSIONS: Greater trochanter pathologies show a broad spectrum of aetiologies. Imaging including radiographs, computed tomography, magnetic resonance imaging, and nuclear medicine scans help to narrow down the differen-tials diagnosis.

Atraumatic fractures of the femur.

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.

Sonographic "speech bubble/speech box sign" in clinically occult femoral hernias: ultrasound findings and anatomical basis.

Femoral hernia is the protrusion of a peritoneal sac through the femoral ring into the femoral canal lying deep and inferior to the inguinal ligament. The hernia sac usually contains preperitoneal fat, omentum, bowel, or fluid. Ultrasound is recommended as the first-line investigation for diagnosing clinically occult femoral hernias in nonemergency settings, whereas CT is the imaging of choice in emergency settings. High accuracy of the ultrasound in clinically occult femoral hernia is further validated with further CT and MRI. In this article, we propose sonographic detection of the physiological peritoneal fluid herniating through capacious femoral ring manifesting as a "speech bubble/speech box appearance." This is a potentially invaluable sonographic sign for clinically occult femoral hernias, differentiating them from inguinal hernias and cysts of the canal of Nuck in females and preventing inadvertent attempts to aspirate.

Imaging of the lesions in the lateral muscle compartment of the forearm, alias mobile wad of Henry: Demographics, radiological anatomy and surgical relevance.

INTRODUCTION: Mobile wad of Henry (MOH) is a preferred surgical term used to describe the lateral compartment muscles of the forearm consisting of brachioradialis, extensor carpi radialis longus and brevis. The lesions in this compartment are uncommon. In this paper, we describe the largest series of the MOH lesions including their demographics, imaging appearances and importance of surgical anatomy whilst managing MOH lesions via radiological or surgical interventions. METHODS: A retrospective search of oncology database for lesions in MOH at our tertiary orthopaedic oncology institute was performed for the last 12 years (2007-2019) after obtaining institutional review board approval. We further analyse data to obtain further clarity of various neoplasms occurring at this particular anatomical site. RESULTS: We identified 28 patients with MOH lesions with an age range of 8 to 84 years and a male predominance. Imaging-wise, majority of lesions were benign following characteristics of lipomatous tumours, lipomas being the commonest. Other relatively uncommon benign lesions were nodular fasciitis, myositis ossificans and brachioradialis muscle injury; whereas aggressive MOH soft tissue neoplasms included synovial sarcoma and fibrohistiocytoma. CONCLUSION: Although majority of MOH lesions are benign, one needs to be aware of spectrum containing uncommon benign and aggressive MOH lesions. When posed with dilemma, the MOH lesions require multidisciplinary approach with close collaboration of the radiologist, the surgeon and the pathologist to decide further management.

Exploring the correlation between increased femoral anteversion and pars interarticularis defects in the lumbar spine: A single center experience.

INTRODUCTION: Altered femoral version can result in lumbar hyperlordosis and hip spine syndrome. We conducted a retrosepctive study to evalute if there is correlation between altered femoral version and pars defect. MATERAL AND METHODS: A cohort of pateints with CT rotational profile and MR of lumbar spine over a 12 year period were included in the sutdy. The femoral version was calculated and the MR was evaluated for pars defect. RESULTS: 130 patients had CT rotational profile and MR of lumbar spine with a female predomiannce (94 female and 36 males) and average age of 24.3 years. There were 6 patients with bilateral pars defects involving L5 (3 with increased femoral version, 2 with decreased version and one had normal version). CONCLUSION: Increased femoral anterversion is not associated with increased prevalence of pars defects.

Insights into obtaining FRCR and beyond: Obstacles, opportunities and post-relocation dilemma - An Indian perspective.

Indian radiology trainees and radiologists are interested to have FRCR (Fellow of the Royal College of Radiologists) qualification for various reasons including academic career progression, subspecialty interest and other socioeconomic factors. The path for acquiring FRCR qualification is adventurous yet onerous and exhausting. Perseverance, meticulous planning and clarity in the vision are essential prerequisites for an Indian graduate aiming to complete FRCR qualification, and one may require to invest an average of 1.5-2 years even if there is no reattempt in this tripartite examination. Indian doctors including radiologists are considered amongst the finest across global medical fraternities. However, the Indian medical education is skewed and variably distributed over the subcontinent due to organisational inability to provide single radiology curriculum-based education to all radiology training programmes. Parallel educational boards and a variety of institutions such as government, trust-funded and private organisations provide radiology training to further complicate the grand picture of radiology education in India. Conversely, UK radiology education is uniform nationally and rigorously enforced by deaneries based upon state-provided guidelines. UK training opportunities are essentially academically rewarding experience but they require herculean efforts to gain access to one. One should constantly focus on building a resume at par with that of a UK trainee by obtaining experience required to fulfil checklist for such opportunities. Alongwith addressing local (UK) competition thoughtfully, hard work, diligence, and high standards of work ethics are absolute musts to build a great resume, to obtain training opportunity and, in turn, to satisfy the ultimate goal of carrier advancement.

Multimodality Imaging Spectrum of the Extranodal Lymphomas in the Head and Neck-A Pictorial Review.

Lymphoma is the second most common malignant neoplasm of the head and neck region, involving the nodal and/or extranodal sites or both in a variable fashion. Lymphoma may mimic a variety of tumors in this region depending on the subsite involved. The usual presentation of lymphomatous disease is presence of multiple enlarged, often conglomerate, lymph nodes without significant necrosis. Extranodal lymphomas demonstrate more complex radiologic features, but careful evaluation can identify distinct imaging patterns to suggest extranodal lymphomatous disease from other more common lesions. Knowledge of these imaging features can help raise suspicion for lymphoma as a differential consideration. This can be of critical importance since further work-up and management can be vastly different between lymphomatous disease and other disease entities. The authors present a pictorial review of the spectrum of imaging findings in extranodal head and neck lymphomas.

Musculoskeletal imaging in preventive medicine.

The aim is to review the modalities in musculoskeletal imaging with view on the prognostic impact for the patient's and for social outcome and with view on three major fields of preventive medicine: nutrition and metabolism, sports, and patient education. The added value provided by preventive imaging is (1) to monitor bone health and body composition with a broad spectrum of biomarkers, (2) to detect and quantify variants or abnormalities of nerves, muscles, tendons, bones, and joints with a risk of overuse, rupture, or fracture, and (3) to develop radiology reports from the widely used narrative format to structured text and multimedia datasets. The awareness problem is a term for describing the underreporting and the underdiagnosis of fragility fractures in osteoporosis.