Society of Skeletal Radiology 2014 annual meeting summary.

Peer-reviewed abstracts presented at the 2014 Society of Skeletal Radiology (SSR) annual meeting were reviewed following oral presentation. Topics felt to be of potential interest to musculoskeletal (MSK) investigators and practicing clinicians are highlighted in this compilation and analysis of the meeting. New concepts regarding MSK imaging and intervention, MSK protocols and techniques, radiology education and quality improvement are included. ePoster highlights are also presented.

Artroresonancia directa, indirecta y artrotomografía para lesiones del mango rotador y Slap. Estado actual / Direct magnetic resonance arthrography, indirect magnetic resonance arthrography, and computed tomography arthrography for rotator cuff lesions and superior labral anterior and posterior tears: state of the art

La evolución constante de las modalidades diagnósticas para el hombro han mejorado la resolución, la sensibilidad y la especificidad. No hay consenso sobre cuál es el mejor método entre la resonancia magnética simple, artroRM directa, indirecta y artrotomografía computarizada. Las publicaciones, de orígenes muy diversos, plantean diferentes criterios para seleccionar la técnica a emplear. La aplicación de protocolos de estudio rígidos que no incluyan todas las alternativas de imágenes no ayudan a los pacientes y restringen la creatividad, particularmente en nuestros países donde la limitación de los recursos es una constante. Es importante usar racionalmente las técnicas dependiendo del paciente y del lugar, teniendo en cuenta la edad, las enfermedades relacionadas, la posibilidad quirúrgica, las complicaciones y los equipos disponibles. En este artículo se revisa el estado actual de las imágenes para las lesiones del manguito de los rotadores y del labrum, considerando sus indicaciones, ventajas y desventajas (AU)

Continual improvements in diagnostic modalities used for shoulder imaging have led to better resolution, sensitivity, and specificity. There is no consensus about whether conventional MRI, direct MR arthrography, indirect MR arthrography, or CT arthrography is the best method. Many publications from very diverse origins propose different criteria for selecting the technique to apply in different patients. However, the application of rigid protocols that do not include all the imaging options does not help patients. Moreover, this approach also restricts radiologists’ creativity, especially in countries in which resources are more limited. It is important to ensure the rational use of the techniques depending on the patient and the place, considering the patient’s age, associated diseases, surgical possibilities, complications, and available equipment. This article reviews the state of the art in imaging rotator cuff and superior labral anterior and posterior lesions, considering the indications, advantages, and advantages of the different techniques in different cases (AU)

CT in children's bones and joints: when, how and common findings.

Radiologic evaluation of musculoskeletal abnormalities in children is now usually performed by ultrasound and magnetic resonance imaging, owing to their excellent anatomic detail and lack of ionizing radiation. There remains a group of certain congenital and acquired conditions in which computed tomography (CT) can deliver invaluable information, and thus its application is justified in some pediatric patients. This article provides an overview of the most current imaging techniques for the latest generation of CTs, with particular emphasis on dose reduction. We also discuss the most important pathologic entities in which CT significantly contributes to the diagnostic workup or post-therapy follow-up.

Emerging topics on the hip: ligamentum teres and hip microinstability.

Microinstability and ligament teres lesions are emergent topics on the hip pathology. These entities are an increasingly recognized cause of persistent hip pain and should be considered in the differential diagnosis of the patient with hip pain. Conventional (non-arthrographic) CT and MR have a very limited role in the evaluation of these entities. CTa and MRa have emerged as the modalities of choice for pre-operative imaging of ligamentum teres injuries and microinstability. To date, pre-operative imaging detection of these pathologies is not widespread but with appropriate imaging and a high index of suspicion, preoperative detection should improve. This article discusses current concepts regarding anatomy, biomechanics, clinical findings, diagnosis and treatment of ligament teres lesions and microinstability.

Can we improve radiological analysis of osseous lesions in chronic anterior shoulder instability?

Osseous lesions of the glenoid cavity and humeral head are predictive of recurrence after Bankart arthroscopic procedures. The objective of this study was to analyze, for each glenoid and humeral defect plain x-ray criteria of the Instability Severity Index Score (ISIS), two aspects: inter- and intraobserver reliability of their qualitative and quantitative assessment and correlations between positive criteria and their quantitative measurement. Thirty-one medical files were retained for evaluation of the glenoid and 26 for humeral notch assessment. The yes or no response for the ISIS criterion was completed by its quantitative measurement using the Griffiths and Sugaya CT methods for the glenoid and the P/R index calculation on plain x-rays with internal rotation for the Hill-Sachs lesion. Three observers provided two consecutive readings for each criterion. The analysis of the glenoid radiological criterion of the ISIS seems sufficiently reproducible for daily practice. When the evaluation is positive, bone loss is greater than 15%, without a maximum value established. In this study, the analysis of the ISIS humeral notch criterion was not reproducible. It can be improved using the P/R index and should be completed by CT imaging.

Computational radiology in skeletal radiography.

Recent years have brought rapid developments in computational image analysis in musculo-skeletal radiology. Meanwhile the algorithms have reached a maturity that makes initial clinical use feasible. Applications range from joint space measurement to erosion quantification, and from fracture detection to the assessment of alignment angles. Current results of computational image analysis in radiography are very promising, but some fundamental issues remain to be clarified, among which the definition of the optimal trade off between automatization and operator-dependency, the integration of these tools into clinical work flow and last not least the proof of incremental clinical benefit of these methods.

Recurrencia de la enfermedad de Legg-Calve-Perthes. Caso clínico / No disponible

No disponible

Optimización de las dosis de radiación en la artrografía de hombro / Optimization of the dose of radiation in shoulder arthrography

Objetivo: El objetivo de este estudio fue reducir la dosis de radiación recibida por los pacientes sometidos a una artrografía de hombro y en los que se utiliza como sistema de guiado una placa con coordenadas radiopacas situada sobre el área de interés. Material y métodos: La dosis a la entrada se obtuvo en 34 pacientes con edades comprendidas entre 15 y 75 años, media de 44 años. La dosis a órganos de riesgo y la dosis efectiva se estimaron mediante técnicas de Monte Carlo, donde los parámetros de entrada son: anatomía del paciente, geometría de la exploración y kerma en aire a la entrada del paciente sin retrodispersión. Las artrografías se realizaron en un equipo telemando y las imágenes se obtuvieron mediante adquisición digital sin fluoroscopia. Resultados: El espesor medio de los hombros estudiados fue 14,6±2,1 cm (9-20 cm). Las imágenes se obtuvieron con 80±10kVp (60-85kVp) y 6,5±3,5 mAs (1,4-17 mAs). El tiempo medio de irradiación para cada paciente fue 20 ± 6ms (6,9-47,9ms). El kerma en aire calculado fue de 0,41 ± 0,19 mGy y la dosis efectiva de 0,79 ± 0,40 μ Sv. Conclusiones: La técnica descrita en este trabajo ha permitido reducir la dosis de radiación al paciente respecto a otros procedimientos descritos en la bibliografía y que el radiólogo que realiza la artrografía no se irradie durante el procedimiento (AU)

Objective: The aim of this study was to determine whether using a film with radiopaque coordinates placed over the region of interest to guide shoulder arthrography can reduce the dose of radiation received by patients. Material and methods: The entrance dose was obtained in 34 patients (mean age, 44 years; range, 15 to 75 years). The dose received by organs at risk and the effective dose were estimated with Monte Carlo techniques using the following input parameters: patient anatomy, examination geometry, and air kerma at the entrance to the patient without backscattering. Arthrography was performed with a remote controlled device and images were acquired digitally without fluoroscopy. Results: The mean thickness of the shoulders studied was 14.6±2.1cm (9–20cm). Images were obtained with 80±10kVp (60–85kVp) and 6.5±3.5mAs (1.4–17mAs). The mean time of irradiation for each patient was 20±6ms (6.9–47.9ms). The calculated air kerma was 0.41±0.19mGy and the effective dose was 0.79±0.40 μSv. Conclusions: The technique described in this study has enabled us to reduce the dose of radiation received by patients undergoing shoulder arthrography in comparison with other techniques described in the literature and to ensure that the radiologist performing the procedure is not irradiated (AU)

Magnetic resonance arthrography.

Magnetic resonance arthrography is widely used throughout the world for joint imaging. It extends the capabilities of conventional MR imaging because contrast solution distends the joint capsule, outlines intraarticular structures, and extends into soft tissue tears and defects. MR arthrography exploits the natural advantages gained from a joint effusion and can be performed on any joint.

MR-guided direct arthrography of the glenohumeral joint.

AIM: To evaluate the feasibility of magnetic resonance (MR)-guided direct arthrography of the glenohumeral joint with a 1.5 T MR system, performing the entire procedure in a single MR examination. MATERIALS AND METHODS: MR-guided direct arthrography was performed on 11 patients. MR imaging guidance and interactive MR fluoroscopy, with in-room control and display system, were used for needle placement and contrast medium injection. The outcome measures were success or failure of joint puncture, the time taken for introduction of contrast medium, and the diagnostic quality of the subsequent MR arthrography images. RESULTS: Contrast medium was successfully instilled into the joint and diagnostic quality MR arthrography images were obtained in all cases. The median time from initial placement of the skin marker to introduction of the contrast medium was 17 min (range 11-29 min). There were no immediate post-procedure complications. CONCLUSION: Accurate needle placement is feasible in a single MR examination on a commercial 1.5 T closed-bore MR system, using an in-room control and display system together with interactive fluoroscopic imaging, and this was used to provide direct MR arthrography in this study.

Multidetector spiral CT arthrography of the shoulder. Clinical applications and limits, with MR arthrography and arthroscopic correlations.

Although MR imaging and MR arthrography are the first choice modalities for shoulder imaging, CT arthrography (CTA) may be used successfully to address many clinical questions. The advent of submillimeter multiple detector CT technology and subsequent excellent three-plane resolution has considerably increased the quality of CTA examinations and has propelled this technique to the forefront in a growing number of indications. The combined use of iodinated contrast material for fluoroscopic confirmation of the articular position of the needle before injection of gadolinium chelates for MR arthrography offers the unique opportunity to compare CTA and MRA findings in carefully selected cases. This paper illustrates capabilities and limits of CTA for the study of rotator cuff tears, shoulder instability, cartilage lesions, anatomical variants and abnormalities of the glenoid labrum, with correlations to MR arthrography and surgical findings.

[Computer assisted radiological diagnostics of arthritic joint alterations]. / Computerassistierte radiologische Diagnostik arthritischer Gelenkveränderungen.

Computer assisted diagnosis (CAD) schemes are currently used in the field of musculoskeletal diseases to quantitatively assess vertebral fractures, joint space narrowing, andr erosion. Most systems work semi-automatically, i.e. they are operator dependent in the selection of anatomical landmarks. Fully automatic programs are currently under development. Some CAD products have already been successfully used in clinical trials.

Imaging osteoarthritis: magnetic resonance imaging versus x-ray.

Until recently, imaging evaluation of osteoarthritis has relied primarily on conventional radiography. Using radiography in clinical practice or clinical research, however, has been fraught with difficulty. Techniques for reproducibly acquiring serial radiographs of joints have improved considerably over the past several years. However, the greatest promise for advancing knowledge about osteoarthritis and its treatment lies in MRI and its unique ability to examine the joint as a whole organ. In contrast to conventional radiography, MRI can directly visualize the articular cartilage, synovium, menisci, and other intra-articular structures important to the functional integrity of joints. There have been considerable advances in MRI of articular cartilage in particular over the past several years. However, much of this has come from small cross-sectional studies. Larger, longitudinal studies are ongoing, and publications are just emerging. This paper reviews the current status of x-ray and MRI in osteoarthritis and points to where changes might be anticipated in the future.

Quiste de Baker: prevalencia y enfermedades asociadas / Baker's cyst: prevalence and associated diseases

Introducción: El quiste de Baker (QB), o quiste poplíteo, es una colección anormal de líquido sinovial en la bursa gastrocnemiosemimembranosa, cuyo diagnóstico se basa en la presencia de datos clínicos característicos y su confirmación mediante técnicas de imagen. En su patogenia intervienen todos aquellos procesos capaces de incrementar la producción del líquido sinovial. Objetivo: Conocer las enfermedades asociadas al QB en reumatología. Material y métodos: Hemos efectuado una revisión sistemática de todos los informes con el diagnóstico de QB, realizados desde junio de 1995 hasta octubre del 2002 en la consulta de ecografía musculoesquelética de nuestro Servicio de Reumatología, completada con la recopilación de datos clínicos de las historias de los pacientes. Se han recogido las siguientes variables: edad, sexo, enfermedad asociada, existencia o no de QB complicado, existencia o no de derrame suprapatelar y sospecha clínica o no de QB. Resultados: Presentaron QB 174 pacientes, de los que en 145 casos (27 varones y 118 mujeres) se consiguieron datos válidos para el estudio. Las edades estaban comprendidas entre 33 y 84 años (edad media 66,8). Asimismo, se han recogido 25 roturas de QB con datos clínicos completos en 22. La enfermedad asociada a QB con más frecuencia fue la artrosis (53,7 por ciento), seguida de la artritis reumatoide (20,68 por ciento). Al analizar los QB rotos, la etiología cambiaba, y la patología inflamatoria (72,77 por ciento) era más frecuente que la degenerativa (22,72 por ciento). En 23 pacientes no se encontró derrame suprapatelar y en 35 (24,13 por ciento) el clínico no había sospechado la existencia de QB (AU)

New developments in imaging in rheumatoid arthritis.

Despite the advances made in medical imaging over the past 3 decades and the central role that magnetic resonance imaging and other sophisticated technologies now play in routine clinical practice, patients with rheumatoid arthritis have benefited relatively little from these advances thus far. Over the past few years, however, evidence has accumulated to show that magnetic resonance imaging and ultrasonography can identify joint damage in patients with rheumatoid arthritis earlier and more sensitively than other techniques can, and that these techniques can directly visualize and monitor changes in synovium and bone that precede actual bone erosion. Much of this development is being driven by the pharmaceutical and biotechnology industries as they search for novel therapies to combat this disease. Accordingly, the imaging tools that ultimately will be used to direct patients to specific therapies and then to monitor treatment effectiveness and safety are currently being refined and validated in rigorous multicenter and multinational clinical trials aimed at gaining regulatory approval of these new therapies. As these therapies become available for clinical use, we can anticipate increased demand for expertise and experience in evaluating disease progression and treatment response, and to the emergence of magnetic resonance imaging systems specifically adapted for this application. The following discussion reviews the current status of this development, and notable advances that have been reported in the literature in the past year.

Imaging of the disease process.

Until recently, imaging evaluation of osteoarthritis (OA) has relied primarily on conventional radiography. Using radiography in clinical practice or clinical research, however, has been fraught with difficulty. Techniques for reproducibly acquiring serial radiographs of joints have improved considerably over the past several years. However, the greatest promise for advancing knowledge about OA and its treatment lies in magnetic resonance imaging (MRI) and its unique ability to examine the joint as a whole organ. In contrast to conventional radiography, MRI can directly visualize the articular cartilage, synovium, menisci, and other intra-articular structures important to the functional integrity of joints. There have been considerable advances in MRI of articular cartilage in particular over the past several years. However, much of this has come from small cross-sectional studies, and published longitudinal studies remain quite scant. The following discussion reviews the current status of imaging in OA and points to where changes might be anticipated in the future.