Imaging of musculoskeletal tuberculosis.

Tuberculosis (TB) represents a major public health problem worldwide. Any tissue may be infected. Involvement of the musculoskeletal (MSK) system account for 1-3% of all tuberculous infections. MSK TB may manifest as tuberculous spondylitis, arthritis, osteomyelitis, and soft tissue infections. Although TB spondylitis may present with distinctive imaging features compared to pyogenic infections of the spine, the imaging semiology of extra-spinal TB infections is mostly nonspecific and may mimic other lesions. TB infections should therefore always be considered in the differential diagnosis, particularly in immunocompromised patients. The aim of this article is to review the imaging features of spinal and extra-spinal MSK TB. Magnetic resonance imaging is considered the modality of choice to make the diagnosis and to evaluate the extent of the disease.

Computer Vision Syndrome: Darkness Under the Shadow of Light.

Radiologists typically spend long hours staring at the computer monitor. This unavoidable nature of our work can lead to detrimental effects on the eyes. Moreover, there is little awareness among radiologists with regards to such potential harm. Ocular hazards, such as computer vision syndrome, are increasingly becoming more relevant to the radiology community. In this article, we discuss the ocular occupational hazards faced by radiologists and suggestions that may help in minimizing such hazards.

Imaging of Gastrointestinal and Abdominal Emergencies in Binge Drinking.

Excess alcohol consumption is a leading cause of preventable morbidity and mortality globally. The pattern of consumption of alcoholic beverages has changed in our society in the recent past, with binge drinking becoming more and more common, especially among young adults. Abdominal pain following alcohol consumption can be secondary to a wide range of pathologies, the treatment algorithm of which can range from medical supportive treatment to more invasive life-saving procedures such as transarterial embolization and emergency laparotomy. Correct diagnosis, differentiation among these conditions, and implementing the correct management algorithm is heavily reliant on accurate and appropriate imaging. We review the pathophysiology, clinical presentation, imaging features and management options of acute abdominal emergencies secondary to binge drinking, based on a selection of illustrative cases.

Magnetic Resonance Imaging of Cysts, Cystlike Lesions, and Their Mimickers Around the Knee Joint.

While interpreting routine magnetic resonance imaging (MRI) of the knee joint, a radiologist may encounter various cystic lesions such as ganglion, synovial, and meniscal cysts, among others. In some cases, MRI may demonstrate cystlike lesions around the knee due to fluid distention of normal bursa and recesses, the diagnosis of which should not be difficult if a radiologist is familiar with their characteristic location and MRI appearance. In addition, there are cyst mimickers such as hematomas, abscesses, vascular lesions, and neoplasms around knee joint that may pose a diagnostic challenge on routine MRI. Due to their atypical location and variable morphology, contrast administration is helpful as the enhancement pattern aids to differentiate them from cysts and cystlike lesions. This pictorial essay aims to classify cysts, cystlike lesions, and cyst mimickers in and around the knee joint based on their anatomic location and highlight their characteristic MRI features.

Imaging of Ankle Impingement Syndromes.

Ankle impingement syndromes are a commonly encountered clinical entity seen in athletes, secondary to repetitive forceful microtrauma. Symptoms are related to impingement of osseous or soft tissue abnormalities in the ankle joint, in particular the tibiotalar joint, which may result in painful limitation of ankle movements. Imaging modalities, such as radiographs and magnetic resonance imaging, are very useful in diagnosing osseous and soft tissue abnormalities seen in different types of ankle impingement syndromes. This article reviews the classification of ankle impingement syndromes, their etiology, and clinical and radiological findings.

Greening the Radiology Department: Not a Big Mountain to Climb.

An environmental-friendly radiology department should be a requirement of the future era. The aim of this article is to make radiologists aware of their responsibilities for a greener world. We have suggested a number of minor but important changes in various sections of a radiology department that can make the radiology department more environmentally friendly. These small steps require relatively little effort on our part but cumulatively, may have a huge positive impact on our environment.

Radiology of Osteoporosis: Old and New Findings.

Osteoporosis, a systemic metabolic disease of bone, is characterized by low bone mass and altered trabecular pattern, leading to increased risk of fractures. It increases in prevalence with age, especially in postmenopausal women, and can have other secondary causes. Radiologic evaluation of osteoporosis has historically used conventional radiography, which demonstrates cortical thinning, increased radiolucency, and altered trabecular patterns, and also aids in assessing vertebral fractures. Many indexes have been devised, such as the Saville index for the degree of radiolucency, and the Genant grading system for vertebral fractures. Other grading systems have been produced to assess the change in trabecular patterns in the proximal femur and the calcaneus. Differentiating osteoporosis from other bone disorders, such as malignancy, endocrinologic or metabolic diseases, and other causes is also important. Bone scintigraphy, although useful in excluding other metabolic bone diseases and determining the age of vertebral fractures, is less useful for diagnosis of osteoporosis. More recently, the measurement of Hounsfield units on multidetector computed tomography has emerged as a possible modality for opportunistic screening of osteoporosis when being performed for other indications.

Artifacts in musculoskeletal MR imaging.

MR imaging has become an important diagnostic tool in the evaluation of a vast number of pathologies and is of foremost importance in the evaluation of spine, joints, and soft tissue structures of the musculoskeletal system. MR imaging is susceptible to various artifacts that may affect the image quality or even simulate pathologies. Some of these artifacts have gained special importance with the use of higher field strength magnets and with the increasing need for MR imaging in postoperative patients, especially those with previous joint replacements or metallic implants. Artifacts may arise from patient motion or could be due to periodic motion, such as vascular and cardiac pulsation. Artifacts could also arise from various protocol errors including saturation, wraparound, truncation, shading, partial volume averaging, and radiofrequency interference artifacts. Susceptibility artifact occurs at interfaces with different magnetic susceptibilities and is of special importance with increasing use of metallic joint replacement prostheses. Magic angle phenomenon is a special type of artifact that occurs in musculoskeletal MR imaging. It is essential to recognize these artifacts and to correct them because they may produce pitfalls in image interpretation.

Variants and pitfalls in MR imaging of the spine.

MR imaging is a valuable tool in investigating the spine and is the diagnostic modality of choice in an increasing number of conditions. Advent of newer 3-T machines has taken MR imaging to a different level, with increased image resolution. Higher field strength magnets have also resulted in an increased number of artifacts. A sound knowledge of human anatomy and awareness of the common anatomical variants is an essential prerequisite in MR imaging of the spine because a variety of normal variants and benign conditions may potentially be confused with serious pathologies. This can significantly affect patient management, and it is essential to avoid such misdiagnoses. Identifying and eliminating the common artifacts on MR imaging can result in a significantly improved image quality. Awareness and knowledge of the common variants, common artifacts, and important distinguishing features among similar-appearing pathologies are important in avoiding the various potential pitfalls in spine imaging.

Variants and pitfalls in MR imaging of shoulder injuries.

Shoulder MR imaging and MR arthrography are frequently used to evaluate shoulder pain and instability and to assess different types of shoulder injuries. We review different normal variants that can mimic pathologic conditions and some pitfalls that may be encountered in image interpretation. A proper knowledge of normal anatomy is necessary to prevent or minimize errors in diagnosing shoulder injuries.

Variants and pitfalls in MR imaging of knee injuries.

MR imaging is an established tool for the detection and diagnosis of various injuries and internal derangements of the knee, enabling excellent anatomical visualization and producing good soft tissue contrast and characterization. However, numerous normal variants and potential pitfalls may lead to diagnostic errors. Understanding the basic MR imaging principles, applying the correct technique, knowing the normal anatomy and variants, recognizing artifacts, and assuring good clinical and radiographic correlation helps avoid these potential pitfalls.

Variants and pitfalls in MR imaging of foot and ankle injuries.

Foot and ankle injuries are very common, particularly among young active athletic individuals. MR imaging has become one of the modalities of choice in the assessment of foot and ankle injuries. Accurate interpretation of MR images and diagnosis of pathology requires familiarity with normal anatomical variants and common diagnostic pitfalls. This article describes the common anatomical variants and technical pitfalls in MR imaging of the foot and ankle.

Imaging of musculoskeletal tuberculosis.

Extra-pulmonary tuberculosis (TB) of the musculoskeletal system usually manifests with non-specific clinical features, mimicking a variety of diseases. Diagnosis and treatment of spinal and extra-spinal musculoskeletal TB are often challenging. Imaging has an important role in detecting this disease, aiding diagnosis, identifying complications, and monitoring disease progression. Radiographs and magnetic resonance imaging are the key imaging modalities utilized. Radiologists should aim to be familiar with the spectrum of imaging features of TB affecting spinal and extra-spinal locations in the musculoskeletal system.

Imaging of infra-thoracic tuberculosis.

Tuberculosis (TB) is a potentially curable disease that is a leading cause of death globally. While it typically affects the lungs, this disease may involve many extra-pulmonary sites, particularly in patients with risk factors. Extra-pulmonary TB often mimics a variety of different diseases, posing a diagnostic dilemma. Imaging aids in early diagnosis of TB, especially in patients with non-specific or atypical symptoms found at extra-pulmonary infra-thoracic locations. Imaging also helps guide appropriate laboratory investigation, monitor disease progress, and response to treatment. This review aims to highlight the imaging spectrum of TB affecting the infra-thoracic region, that is, gastrointestinal tract, abdominal lymph nodes, peritoneal cavity, intra-abdominal solid organs, and urogenital system.

Pictorial essay: pitfalls in magnetic resonance imaging of the shoulder.

Numerous imaging pitfalls of normal variants due to imaging technique and artifacts can be seen on routine magnetic resonance imaging of the shoulder. Familiarity with these pitfalls is crucial to avoiding diagnostic errors. Understanding of the common causes of shoulder imaging artifacts will enable the radiologist to make rational changes in imaging technique to eliminate or reduce the effects of artifacts on magnetic resonance images. This pictorial essay highlights possible pitfalls that arise from imaging techniques, imaging artifacts, and normal variations, and how they may be recognized.

Imaging-guided biopsy in musculoskeletal infections.

Biopsies may be required in patients suspected to have musculoskeletal infections to confirm the diagnosis and also to identify the causative organism. Imaging-guided biopsies have gained increased acceptance to obtain various types of tissues for diagnosis. Under image guidance, biopsies are done percutaneously, usually under local anesthesia. They are relatively safe, and complications are significantly less compared with open biopsies. In this article, we review the planning, indications, technique, and complications of imaging-guided percutaneous biopsy performed for musculoskeletal infections.

Tuberculous osteomyelitis and spondylodiscitis.

Tuberculosis (TB) is no longer a disease limited to developing nations and is still a major cause of significant morbidity and mortality worldwide. The indolent clinical presentation, emergence of multidrug-resistant mycobacteria, and association with human immunodeficiency virus infection poses obstacles for early diagnosis and management. Compared with the other forms of TB, musculoskeletal involvement is relatively rare. Tuberculous spondylitis is the most common form of musculoskeletal TB and accounts for ~50% of cases. Extraspinal musculoskeletal TB shows a predilection for large weightbearing joints, long bones, and the skull. This article reviews the radiologic features of diverse forms of osseous TB and the diagnostic value of the different imaging techniques. It also reviews the imaging differential diagnoses, including other infections and malignancies/metastases. Conventional radiography is of key value in the diagnosis of musculoskeletal TB. Computed tomography, magnetic resonance imaging, and bone scintigraphy also play key roles in the early detection of disease and in demonstrating the extent of disease process and soft tissue involvement. Because delay in treatment significantly reduces the cure rate and increases the rate of complications and morbidity, early radiological diagnosis of TB is of paramount importance for appropriate management.

Tropical pyomyositis and necrotizing fasciitis.

Pyomyositis is a purulent infection of skeletal muscle that arises from hematogenous spread, usually with abscess formation. Necrotizing fasciitis is a more severe, rapidly progressive infection involving the superficial and deep fascia with necrosis and fluid collections that can be life threatening if left untreated. Both conditions may coexist, and concomitant cellulitis is often seen. A high incidence of these diseases occurs in the tropics, but they are increasingly being seen in temperate countries, due in part to their association with immunodeficiency conditions such as human immunodeficiency virus (HIV) infection, diabetes mellitus, and organ transplantation. This article aims to familiarize physicians with these entities, review their clinical manifestations and imaging features, and highlight the role of imaging in the management of patients with these conditions.