Excellent long-term pain response and local control following postoperative radiotherapy in patients with multiple myeloma.

PURPOSE: Multiple myeloma is associated with osteolytic bone lesions, often requiring surgery of the spine and postoperative radiotherapy (RT). Although common, data for clinical and informed decision-making are sparse. In this monocentric retrospective study, we aim to report the outcome of patients who underwent spinal surgery and postoperative RT due to multiple myeloma. METHODS: A total of 54 patients with multiple myeloma who underwent prior spinal surgery and postoperative RT at our institution between 2009 and 2020 were analyzed. Spinal instability neoplastic score (SINS) and Bilsky score, posttherapeutic adverse events, clinical data, and outcomes were collected and analyzed. The primary endpoint of this study was overall survival (OS), secondary endpoints were progression-free survival (PFS), pain response, local control, and skeletal-related events (SRE). RESULTS: The 3­ and 5­year overall survival (OS) was 74.9% (95% confidence interval [CI]: 63.5-88.4%) and 58% (95% CI: 44.5-75.6%), respectively. Median survival was not reached and 75% survival was 34.3 months (95% CI: 28.7-95.4 months). Median follow-up was 63 months (95% CI: 49-94 months). The number of patients with good to adequate performance status (Karnofsky performance score [KPS] ≥ 70) significantly increased after surgery (p < 0.01). We observed no grade 3/4 toxicity and only 13 (24%) grade 1/2 adverse events. Two patients (4%) experienced SRE. Overall, 92% of patients reported reduced pain after radiotherapy, with 66% reporting complete pain response. There was no difference in pain response between patients with different Bilsky scores. Bisphosphonate therapy and lower Bilsky score at the start of RT were associated with improved OS in univariate analysis (all p < 0.05). Multivariate Cox regression confirmed a Bilsky score of 2 or 3 as an independent negative prognostic factor (HR 3.89; 95 CI 1.4-10.7; p < 0.01). We observed no in-field recurrences. CONCLUSION: In this study, we were able to show that the current standard of RT after spinal surgery of osteolytic lesions is safe. In addition, we observed a very low rate of SRE (4%) and no in-field recurrences, demonstrating the local efficacy of RT in multiple myeloma patients. Higher Bilsky scores were associated with worse OS in multivariate analysis, but had no effect on pain response.

A Comparison of Clinical and Radiological Presentations of Sporadic and Tuberous Sclerosis Complex-Associated Lymphangioleiomyomatosis.

This research aims to compare and assess the clinical and radiological presentations of tuberous sclerosis complex (TSC)-associated lymphangioleiomyomatosis (LAM) and sporadic LAM. A retrospective medical record review was conducted for 90 patients with confirmed LAM diagnoses. Radiologists who were blinded to the LAM type evaluated CT images of the chest and abdomen for the presence of four CT phenotypes: multiple sclerotic bone lesions (SBLs), multifocal micronodular pneumocyte hyperplasia (MMPH), hepatic fat-containing lesions, and cardiac fat-containing lesions. Statistical analyses were then completed to analyze the differences between TSC-LAM and sporadic LAM. Sporadic LAM patients reported a greater number of clinical symptoms at the time of diagnosis than TSC-LAM patients. All four CT phenotypes were present among the TSC-LAM patient population, whereas hepatic fat containing lesions were the only phenotype present in sporadic LAM patients evaluated in this study. The clinical and radiological presentations of sporadic LAM and TSC-LAM differ significantly, suggesting that the diagnostic criteria for sporadic LAM and/or TSC itself could be adapted accordingly. However, the similarities in the presentation of the LAM types are also important to note as these trends inform theories surrounding the potential underlying pathogenic mechanisms of sporadic LAM.

Recommendations for the Management of Incidental Musculoskeletal Findings on MRI and CT.

The Canadian Association of Radiologists (CAR) Incidental Findings Working Group consists of both academic subspeciality and general radiologists tasked with either adapting American College of Radiology (ACR) guidelines to meet the needs of Canadian radiologists or authoring new guidelines where appropriate. In this case, entirely new guidelines to deal with incidental musculoskeletal findings that may be encountered on thoracoabdominal computed tomography or magnetic resonance imaging were drafted, focussing on which findings should prompt recommendations for further workup. These recommendations discuss how to deal with incidental marrow changes, focal bone lesions, abnormalities of the pubic symphysis and sacroiliac joints, fatty soft tissue masses, manifestations of renal osteodystrophy and finally discuss opportunistic osteoporosis evaluation.

Automated detection and segmentation of sclerotic spinal lesions on body CTs using a deep convolutional neural network.

PURPOSE: To develop a deep convolutional neural network capable of detecting spinal sclerotic metastases on body CTs. MATERIALS AND METHODS: Our study was IRB-approved and HIPAA-compliant. Cases of confirmed sclerotic bone metastases in chest, abdomen, and pelvis CTs were identified. Images were manually segmented for 3 classes: background, normal bone, and sclerotic lesion(s). If multiple lesions were present on a slice, all lesions were segmented. A total of 600 images were obtained, with a 90/10 training/testing split. Images were stored as 128 × 128 pixel grayscale and the training dataset underwent a processing pipeline of histogram equalization and data augmentation. We trained our model from scratch on Keras/TensorFlow using an 80/20 training/validation split and a U-Net architecture (64 batch size, 100 epochs, dropout 0.25, initial learning rate 0.0001, sigmoid activation). We also tested our model's true negative and false positive rate with 1104 non-pathologic images. Global sensitivity measured model detection of any lesion on a single image, local sensitivity and positive predictive value (PPV) measured model detection of each lesion on a given image, and local specificity measured the false positive rate in non-pathologic bone. RESULTS: Dice scores were 0.83 for lesion, 0.96 for non-pathologic bone, and 0.99 for background. Global sensitivity was 95% (57/60), local sensitivity was 92% (89/97), local PPV was 97% (89/92), and local specificity was 87% (958/1104). CONCLUSION: A deep convolutional neural network has the potential to assist in detecting sclerotic spinal metastases.

[Positron emission tomography/computed tomography (PET/CT) in multiple myeloma]. / Positronen-Emissions-Tomographie/Computertomographie (PET/CT) beim multiplen Myelom.

BACKGROUND: Imaging plays a pivotal role in the management of multiple myeloma (MM). Besides morphological imaging methods, such as whole-body X­ray, computed tomography (CT) and magnetic resonance imaging (MRI), the hybrid modality positron emission tomography/CT (PET/CT) using the glucose analogue 18F­fluorodeoxyglucose (18F­FDG) as radiotracer is increasingly used. OBJECTIVES: Aim of this review article is to outline the major applications of PET/CT in the diagnosis and management of MM, and to provide hints on the reading and interpretation. MATERIALS AND METHODS: Background knowledge and guideline recommendations on imaging of MM are outlined and complemented by recent study results. RESULTS: Although 18F­FDG PET/CT is not currently considered a standard method for the diagnosis of MM, it is a very powerful diagnostic tool for the detection of medullary and extramedullary disease, a reliable predictor of survival and the most robust modality for treatment response evaluation. Moreover, it plays a significant role in minimal residual disease (MRD) assessment. On the other hand, practical considerations on local availability and costs limit the widespread use of PET/CT. In addition, false-negative and the seldom false-positive results and the heterogeneity of MM presentation inevitably make interpretation of PET/CT images challenging. CONCLUSIONS: PET/CT has a high value in the diagnosis, prognosis, and assessment of treatment response in patients with MM. Therefore, the role of the modality in the management of the disease is expected to increase in the near future.

Benign skull and subdural lesions in patients with prior medulloblastoma therapy.

PURPOSE: To report on our institutional cohort of patients and review the literature of medulloblastoma patients who developed skull/subdural-based lesions following treatment. METHODS: Following institutional review board (IRB) approval, we retrospectively reviewed the medical records of four children with a history of treated medulloblastoma who developed non-specific skull-based/subdural lesions incidentally found on surveillance imaging. RESULTS: Biopsies of the lesions proved the pathology to be low grade and included inflammatory myofibroblastic tumor, cortical fibrous defect consistent with fibroma, fibrous tissue, and fibrous dysplasia. The finding of calvarial or subdural fibrous lesions in children following therapy for medulloblastoma was noted in four out of 201 (136 with available follow-up data) medulloblastoma patients seen or discussed in our institution over the past 10 years. CONCLUSIONS: These lesions can grow over time and pose a differential diagnostic challenge with metastatic disease when identified. The skull and subdural space should be scrutinized for secondary lesions on surveillance imaging of patients with medulloblastoma who have received craniospinal irradiation as knowledge of this benign occurrence will assist with management.

Computed tomography characteristics of multiple myeloma and other osteolytic metastatic bone lesions.

BACKGROUND: Differentiation of multiple myeloma (MM) from osteolytic metastatic (OM) bone lesions may be critical in patients with lytic bone lesions but can be challenging for radiologists. PURPOSE: To determine whether computed tomography (CT) can be used to distinguish between MM and other OM bone lesions. MATERIAL AND METHODS: In this retrospective study, 320 lesions of 207 patients diagnosed with MM or OM, based on biopsy or clinical examination, were evaluated. Eight qualitative features were evaluated by two radiologists blinded to the diagnoses. The chi-square and Fisher exact tests, and logistic regression analysis, were used to evaluate the relationships between the CT findings and diagnoses. RESULTS: High-density areas were more common in OM than MM lesions (85.2% and 19%, P < 0.001), as were perilesional sclerosis (38.9% vs. 13.2%, P < 0.001), heterogeneity (on non-contrast CT images, 60% vs. 19.1%, P < 0.001; on contrast enhanced CT images, 80.6% vs. 28.2%, P < 0.001), and ill-defined margins (34.6% vs. 9.1%, P < 0.001). Similarly, OM lesions showed high-density areas more than MM in evaluation of skeletal system subgroups (vertebrae, 93.8% vs. 29.8%, P < 0.0001; thoracic cage bones, 69.6% vs. 19.2%, P < 0.001; pelvic bones and sacrum, 84.8% vs. 7.7%, P < 0.001; peripheral skeletal bones, 81.5% vs. 8.3%, P < 0.001). Logistic regression analysis revealed that the presence of a high-density area in the lesion increased the probability of a metastasis 25.88-fold (R2 = 0.516, P < 0.001). CONCLUSION: MM and OM lesions can be differentiated by CT; OM lesions exhibit high- density areas.

Cytological diagnosis of osteosarcoma with emphasis on diagnostic pitfalls.

INTRODUCTION: Fine needle aspiration is a well-established technique for evaluating primary and secondary bony lesions. With use in selected cases, it achieves a diagnostic yield comparable to biopsies. METHODS: Cases of osteosarcoma (OS) with available histological follow-up were retrieved over a 10-year period. Detailed morphological evaluation was done, with special emphasis on pitfalls in the diagnosis of OS on cytology and the various variants of OS. RESULTS: Of the 41 cases with available follow-up histology, 56% were correctly diagnosed as OS on cytology. The most common false-negative cytological diagnosis of OS, in 17% cases, was giant cell tumour. The possible explanations for this included low cellularity, minimal atypia, absence of typical osteoid, misinterpretation of metachromatic osteoid material as fibro-collagenous material and non-availability of radiology at time of aspiration. CONCLUSION: A triple-phase evaluation including clinical evaluation, appropriate radiological correlation and cytology/histopathology, is important to clinch an accurate diagnosis.

The imaging role for diagnosis of idiopathic osteosclerosis: a retrospective approach based on records of 33,550 cases.

OBJECTIVE: The study aimed to describe the diagnostic imaging features of idiopathic osteosclerosis (IO) to aid in differential diagnosis of similar dentomaxillomandibular conditions. MATERIALS AND METHODS: An archive of 550 dentomaxillofacial radiographic (panoramic radiography (PR) and cone beam computed tomography (CBCT)) images and 33,000 histopathological records were reviewed to identify IO cases. Chi-square, Student's t test, and ANOVA tests, with a significance of p < 0.05, were applied for comparative analysis. In addition, we analyzed various studies to present a short review. RESULTS: After meticulous observation, 36 images of 34 patients revealed 60 IO lesions in 31 PR and 5 CBCT. Sex, age group, anatomical site, shape, regularity, and root relationship showed statistical significance: sex and age group (p = 0.046), sex and IO regularity (p = 0.007), age group and IO regularity (p = 0.014), anatomical site and IO shape (p = 0.010), anatomical site and IO regularity (p = 0.003), and IO shape and IO regularity (p = 0.002). We presented a short review from 26 articles, including retrospective, cross-sectional, and longitudinal studies, documenting 2307 patients with 2435 IO lesions from 51,160 imagiological examinations. CONCLUSIONS: A radiographic diagnostic profile of IO may guide the clinical practitioners in differentiating an incidental radiopacity. PR is a preliminary examination, with CBCT facilitating the IO diagnosis. CLINICAL RELEVANCE: Knowledge of imaging characteristics variability of idiopathic osteosclerosis is crucial for accurate diagnosis process when incidental radiopacities are found in the panoramic radiographs, thus avoiding unnecessary biopsies. CBCT scans facilitate the interpretation of idiopathic osteosclerosis overlapping the mandibular canal.

A Histopathology-based Assessment of Biological Behavior in Oral Hyalinizing Odontogenic Tumors and Bone Lesions by Differential Stains.

AIM: Odontogenic tumors (OTs) and bone lesions of the oral cavity present diverse histological features and varying clinical behavior that makes predicting their biologic behavior difficult. The research undertaken in the current study aims to predict the biological behavior of oral hyalinizing odontogenic and bone lesions (OHO-BL) for the first time by employing four differential stains with clinicopathologic correlation. MATERIALS AND METHODS: The study was performed on retrospectively diagnosed formalin-fixed paraffin-embedded cases of OTs (n = 53) and bone lesions (n = 10). The severity of hyalinization (SOH) was assessed from stained tissue sections. Polarizing microscopy was used to analyze hyalinization in tissues stained with differential special stains, namely periodic acid-Schiff (PAS), Safranin-O, Alcian Blue, and Picrosirius red. SOH was also analyzed for possible correlation with recurrence and clinicopathologic correlation in OHO-BL. RESULTS: Intense staining was observed with PAS, Alcian Blue, and Safranin-O in OTs with increased SOH with a statistical significance. Polarizing greenish yellow color correlated significantly with the recurrence potential of the OT group. Recurrence in individual lesions of the OT group showed a statistically significant association with SOH. Such individual correlation was not observed in bone diseases. CONCLUSION: PAS, Alcian Blue, Safranin-O, and Picrosirius red are reliable stains to assess hyalinization in OHO-BL. Picrosirius red-polarizing microscopy is a dependable tool for identifying recurrent odontogenic lesions. CLINICAL SIGNIFICANCE: SOH can be considered a histological predictor of aggressive biologic behavior in oral hyalinizing odontogenic lesions that can enable the surgeon to arrive at an appropriate management protocol.

Clinical presentation, imaging and response to interferon-alpha therapy in Erdheim-Chester disease: case-based review.

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis associated with BRAFV600E mutations in more than 50% of cases and presenting with 95% with skeletal lesions. However, cutaneous, pulmonary, large vessels and central nervous system involvement can also occur. We report a case of a 25-year-old woman who was admitted in 2018 for exploration of diffuse bone pain and rashes on the face. Her current symptoms had started 14 months earlier and consisted of bone pain, affecting the legs. She had periodic low-grade fever, asthenia and xanthelasma-like papules appeared on face. At admission, physical examination showed bilateral and symmetrical long bone pain, especially in the knees and multiple xanthelasma-like papules around the eyelids, cheeks and chin. Laboratory tests revealed elevated erythrocyte sedimentation rate and C-reactive protein. Magnetic resonance (MR) imaging showed multiple mixed bone lesions with a hyperintensive MR signal on PD FS and hypointense signal on T1of the femur and tibia. Bone scintigraphy indicated bilateral and symmetrical metaphyseal and diaphyseal increased uptake. Abdominal computed tomography (CT) scan showed infiltration of the perirenal fat. Biopsy of the skin revealed histiocytic infiltration, which was CD68-positive and CD100-positive, confirming the diagnosis of ECD. Patient was treated with interferon-α (IFN-α) plus methylprednisolone. After 6 months of treatment her clinical condition partly improved: a reduction of pain on visual analogue scale (VAS) scale, significant decrease of methylprednisolone dose and specific dynamics according to bone MR imaging data, however, no change in symptoms attributed to skin rash was noted. We also provide the literature review results of IFN-α treatment efficacy in Erdheim-Chester disease involving the skin and musculoskeletal system with MR imaging changes.

Finally, a step forward in nomenclature of subchondral nonneoplastic bone lesions.

This paper is a commentary on the article entitled "Nomenclature of Subchondral Nonneoplastic Bone.Lesions1" by Gorbachova, Amber, Beckmann, Bennett, Chang, Davis, Gonzalez, Hansford, Howe, Lenchik, Winalski, and Bredella. The purpose of this commentary is to provide an orthopaedic perspective on the aforementioned article and critique their analysis and proposal regarding nomenclature of subchondral bone lesions. It provides an overview and a section by section evaluation of a well-designed and executed article.

Ultrasound examination for the detection of simulated periapical bone lesions in bovine mandibles: an ex vivo study.

AIM: To evaluate the accuracy of ultrasound examination (USE) for the detection of artificial bone defects in bovine mandibles in the absence of complete erosion of the cortical bone plate and to determine the minimum cortical thickness that constitutes a barrier for ultrasound waves. METHODOLOGY: Sixty bovine mandibular anatomical blocks were harvested and uniformly distributed amongst six experimental groups. The negative control consisted of blocks with no intra-bony defects, whereas the positive control consisted of blocks with an artificial lesion of 2 mm diameter that perforated the buccal cortical bone plate. Two experimental groups comprised blocks with small (2 mm) and large (5 mm) artificial defects created under a cortical plate thinned to varying thicknesses. Two additional groups had small (2 mm) and large (5 mm) artificial defects that did not involve the cortical plate. After USE, the scans were saved and submitted to three blinded examiners. Sensitivity, specificity, predictive values and receiver-operating characteristics (ROC) were analysed. The significance of the findings (P < 0.05) was appraised using the chi-square statistics with the Yates correction, whilst the intra- and inter-examiner agreements were evaluated through Kappa statistics. RESULTS: USE was associated with high sensitivity (97.3%) and negative predictive value (89%), and a perfect score for specificity and positive predictive value. The ROC curve analysis revealed an accuracy of 97.8%. The k-values were 0.86 and 0.89 for the first and second examinations, respectively, demonstrating very high inter-observer agreement. The intra-observer agreement was also high (k-value = 0.92). A significant correlation between the echographic diagnosis and the presence or absence of artificial intraosseous lesions in the anatomical blocks of bovine mandibles was observed (P < 0.0001). CONCLUSIONS: USE was highly accurate and reliable for the detection of artificial lesions within bovine mandibles, regardless of the thickness or presence of the cortical plate.

The effectiveness of ultrasound examination to assess the healing process of bone lesions of the jaws: a systematic review.

OBJECTIVE: To assess the potential of ultrasound examination (USE) as an adjunctive method to conventional radiology to evaluate the healing processes occurring after the treatment of bone lesions of the jaws. The research question was: what is the effectiveness of USE to evaluate the healing of intra-osseous bone lesions when compared to radiological or clinical examination? MATERIALS AND METHODS: Six databases (PubMed, the Web of Science, Scopus, Embase, the Cochrane Library, and Best Evidence) were searched from their inception (PROSPERO CRD42019134482). A quality assessment was performed combining the Downs and Black tool and the Newcastle-Ottawa scale. The risk of bias was calculated using the Cochrane collaboration tool to assess the risk of bias. RESULTS: A total of 4404 records were screened, and 7 studies meeting the inclusion criteria were included in the systematic review. USE allowed to evaluate the healing of jaw bone lesions by assessing their reduction in size, the increase in echogenicity of the affected area, and the progressive decrease\disappearance of the vascular flow signal within the lesions. CONCLUSIONS: USE implemented with color power Doppler is an advanced imaging technique feasible to monitor the early and long-term response of the intra-osseous lesions of the jaws to both surgical and nonsurgical treatment. CLINICAL RELEVANCE: This systematic review brought evidence that USE can constitute a safe alternative imaging technique in the dental clinical practice for the management of central lesions of the maxillary bones.

Bone lesions in systemic mastocytosis: Bone histomorphometry and histopathological mechanisms.

Osteoporosis is considered the most frequent skeletal manifestation of systemic mastocytosis (SM). We performed a retrospective analysis of sixty patients (37 males and 23 females) who underwent a bone biopsy in the assessment of SM or in the assessment of unexplained bone fragility. Thirty-three had simultaneously a bone marrow biopsy with a Jamshidi's needle; this sample was used for immunohistochemical analysis (tryptase, c-KIT. CD20, VCAM-1). Bone biopsy was realized in 42 cases in the assessment of SM to provide histologic proof of the disease and in 18 cases in the assessment of unexplained bone fragility and surprisingly revealed a SM. An increased bone turnover was observed in patients with SM with elevated eroded surfaces, osteoclast number and bone formation rate. In addition to nodules of mast cells (MC), a high number of MC was directly apposed on the trabeculae, affixed on the osteoblasts or the lining cells. The VCAM-1 adhesion protein recognizing α4ß7 and α4ß1 integrins may be a candidate to explain this particular adherence. One third of the bone marrow biopsies did not exhibit MC nodules or MC infiltration and led to a false negative diagnosis for SM. SM can be discovered in the assessment of fracture or osteoporosis. Transiliac bone biopsy allows for the diagnosis of the disease more accurately than bone marrow biopsy; it also provides a histomorphometric analysis of bone remodeling.

Focal skeletal FDG uptake indicates poor prognosis in cHL regardless of extent and first-line chemotherapy.

18 F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) is used for staging classical Hodgkin lymphoma (cHL) with high sensitivity for skeletal involvement. However, it is unclear whether a single bone lesion carries the same adverse prognosis as multifocal lesions and if this is affected by type of chemotherapy [ABVD (adriamycin, bleomycin, vincristine, dacarbazine) versus BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone)]. We reviewed the clinico-pathological and outcome data from 209 patients with newly diagnosed cHL staged by FDG-PET/CT. Patterns of skeletal/bone marrow uptake (BMU) were divided into 'low' and 'high' diffuse BMU (i.e. without focal lesions), and unifocal or multifocal lesions. Additional separate survival analysis was performed, taking type of chemotherapy into account. Forty patients (19·2%) had skeletal lesions (20 unifocal, 20 multifocal). The 3-year progression-free-survival (PFS) was 80% for patients with 'low BMU', 87% for 'high BMU', 69% for 'unifocal' and 51% for 'multifocal' lesions; median follow-up was 38 months. The presence of bone lesions, both uni- and multifocal, was associated with significantly inferior PFS (log rank P = 0·0001), independent of chemotherapy type. Thus, increased diffuse BMU should not be considered as a risk factor in cHL, whereas unifocal or multifocal bone lesions should be regarded as important predictors of adverse outcome, irrespective of the chemotherapy regimen used.

Fibrous dysplasia of the jaws: Integrating molecular pathogenesis with clinical, radiological, and histopathological features.

Fibrous dysplasia is a non-neoplastic developmental process that affects the craniofacial bones, characterized by painless enlargement as a result of bone substitution by abnormal fibrous tissue. Postzygotic somatic activating mutations in the GNAS1 gene cause fibrous dysplasia and have been extensively investigated, as well as being helpful in the differential diagnosis of the disease. Fibrous dysplasia may involve one (monostotic) or multiple bones (polyostotic), sporadically or in association with McCune-Albright syndrome, Jeffe-Lichenstein syndrome, or Mazabreud syndrome. This review summarizes the current knowledge on fibrous dysplasia, emphasizing the value of integrating the understanding of its molecular pathogenesis with the clinical, radiological, and histopathological features. In addition, we address important aspects related to the differential diagnosis and patient management.

SAPHO syndrome with pathological fractures of vertebral bodies: a case report.

BACKGROUND: It's difficult to diagnose and treat synovitis-acne-pustulosis-hyperostosis-osteomyelitis (SAPHO) syndrome due to its rare and unknown pathogenesis. There is no effective treatment for SAPHO syndrome and the consequences of empirical treatment are unpredictable. This study reports a case of a young female diagnosed as SAPHO syndrome with pathological fractures of vertebral bodies. CASE PRESENTATION: A 29-year-old female complained of the right sternoclavicular joint and back pain accompanied limited activities and cutaneous lesions. Laboratory assays revealed abnormal inflammatory factors. Multiple imaging studies illustrated bone lesions and pathological fractures of vertebral bodies. A diagnosis of SAPHO syndrome was made. The patient was treated with Compound Troxerutin and Poreine Cerebroside Injection, non-steroidal anti-inflammatory drugs (NSAIDs), bisphosphonates, corticosteroids and the thoracolumbar brace. The patient was followed up for 6 months and showed improved results. CONCLUSIONS: The case supports that multiple image inspections and laboratory tests contribute to diagnose SAPHO syndrome, and combination therapies of Compound Troxerutin and Poreine Cerebroside Injection, NSAIDs, bisphosphonates, corticosteroids and the thoracolumbar brace in the treatment of SAPHO syndrome with pathological fractures of vertebral bodies are crucial to regain health.

The Dixon technique for MRI of the bone marrow.

Dixon sequences are established as a reliable MRI technique that can be used for problem-solving in the assessment of bone marrow lesions. Unlike other fat suppression methods, Dixon techniques rely on the difference in resonance frequency between fat and water and in a single acquisition, fat only, water only, in-phase and out-of-phase images are acquired. This gives Dixon techniques the unique ability to quantify the amount of fat within a bone lesion, allowing discrimination between marrow-infiltrating and non-marrow-infiltrating lesions such as focal nodular marrow hyperplasia. Dixon can be used with gradient echo and spin echo techniques, both two-dimensional and three-dimensional imaging. Another advantage is its rapid acquisition time, especially when using traditional two-point Dixon gradient echo sequences. Overall, Dixon is a robust fat suppression method that can also be used with intravenous contrast agents. After reviewing the available literature, we would like to advocate the implementation of additional Dixon sequences as a problem-solving tool during the assessment of bone marrow pathology.

Idiopathic osteosclerosis in the maxillomandibular area.

OBJECTIVES: To test a more complete set of morphometric radiographic parameters to evaluate the idiopathic osteosclerosis (IO) lesions located in the maxillomandibular area and to know their features during routine radiographic evaluation. MATERIALS AND METHODS: Radiographs from patients attending the oral diagnosis clinic of our institution were reviewed. Evaluated parameters were gender and age of the patients, size, side, homogeneity, morphology, radiodensity, mineralization, borders, relation to roots, affected tooth or teeth and location of the analyzed lesions. RESULTS: Of the 6340 assessed patients, 354 (5.6%) harbored 362 lesions. IOs were more common during 2nd to 4th decades (mean age = 39 years). IO frequency rose from 1st to 3rd decades and then decreased. Size varied from 0.1 to 5.8 cm, and its frequency increased from 7 to 30 years age and then decreased too. The mandible and molar region were more commonly affected. Radiopaque image, radicular location, round shape, homogeneous core and well-defined boundaries were the more frequent IO features. CONCLUSIONS: Our method allows to analyze IO lesions with precise parameters. Analysis of the results does not support the previously suggested theories to explain their origin, and these figures suggest that the so-called IOs are developmental alterations of the bone.