The multifaceted musculoskeletal hydatid disease.

Musculoskeletal hydatid disease is rare and can be located anywhere but most commonly the bone and muscles of the spine, pelvis, then the lower limbs. Imaging is essential for its diagnosis, performing the pre-therapeutic assessment, guiding possible percutaneous treatments, and providing post-therapeutic follow-up. Musculoskeletal hydatidosis can take several forms that may suggest other infections and tumors or pseudotumors. MRI and CT are superior for its diagnosis but ultrasound and radiography remain the most accessible examinations in developing countries where this parasitosis is endemic. In this review, we provide an overview of this disease and describe its different imaging patterns in soft tissue and bone involvement that should be sought to support the diagnosis.

Imaging of supra-thoracic tuberculosis.

Tuberculosis (TB) typically affects the lungs, but may involve many extra-pulmonary sites; with the latter especially prone in patients with human immunodeficiency virus infection. The clinical features of extra-pulmonary TB are often non-specific, mimicking many different disease entities. Application of the most appropriate imaging modality and knowing the imaging findings with clinical context awareness help initiation of further investigations, diagnosis and early treatment. This pictorial essay highlights the imaging spectrum of extra-pulmonary TB affecting the supra-thoracic region, i.e. brain, neck, and ear, nose and throat.

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.

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.

Early Identification of Sacroiliitis in Patients with Suspected Spondyloarthritis: A Challenging Task.

OBJECTIVE: The purpose of this study was to assess the performance of computed tomography (CT) scan and magnetic resonance imaging (MRI) for detecting sacroiliitis in nonradiographic SpA (nr-SpA). METHODS: This cross-sectional monocentric double-blind study included 63 patients consulting for symptoms suggestive of SpA between February 2014 and February 2017. Patients with conventional radiographs showing a confirmed sacroiliitis (grade 3 or 4) were not included. Eligible patients underwent CT and MRI of sacroiliac joints (SIJ). CT and MR images were interpreted by 2 experienced musculoskeletal radiologists blinded to clinical and laboratory data. Two professors in rheumatology blinded to radiologists' conclusions analyzed clinical data, laboratory tests, HLA typing, X-rays, CT and MRI images, and divided the patients into 2 groups: confirmed nr-SpA or no SpA. This classification was considered the gold standard when analyzing the results. RESULTS: 46 women and 17 men were included in this study. 47 patients were classified as confirmed nr-SpA (74.6%) and 16 patients as no SpA (25.4%). Sensitivity, specificity, and positive and negative predictive values of CT and MRI for detecting sacroiliitis were, respectively, estimated at 71.7%, 71.4%, 89.2%, 43.5%, and 51.2%, 100%, 100%, and 40%. CT and MRI findings were found to be statistically associated (p<0.001). CONCLUSION: SIJ MRI is a highly specific method in the detection of sacroiliitis, but with a moderate sensitivity. SIJ CT scan, usually known as the third option after radiography and MRI, has much greater diagnostic utility than it has been documented previously.

Granulomatous spondylodiscitis: A case series with focus on histopathological features.

Objective: To report a series of Granulomatous Spondylodiscitis (GS) with focus on the histopathological features of the different forms of GS.Design: Case series.Setting: Pathology department of Charles Nicolle's Hospital of TunisiaParticipants: This study included 57 patients diagnosed with GS. There were 44 (77.2%) female patients and 13 (22.8%) male patients (sex ratio = 0.28).Intervention: Not applicable.Outcome measures: Clinical, microbiological and histopathological features were assessed in this study.Results: Fifty-seven patients with GS were enrolled: 51 tuberculous spondylodiscitis (TS), 2 fungal spondylodiscitis (FS), 3 brucellar spondylodiscitis (BS) and 1 case of sarcoidosis. Granulomas with necrosis were seen in 38 (66.6%) cases: 36 TS and 2 FS, while granulomas without necrosis were observed in the remaining 19 cases: 15 TS, 3 BS and 1 sarcoidosis. In all cases of TS, granulomas were epithelioid type, associated with histiocytic type granulomas in 7 cases. Caseous necrosis was seen in 35 cases of TS and suppurative granuloma in one case. The 3 cases of BS exhibited non-necrotizing and histiocytic type granulomas. The 2 cases of FS showed histiocytic, epithelioid and necrotizing granulomas. Necrosis was mixed: suppurative and caseous in both cases of FS. Sarcoidosis was characterized with epithelioid type granulomas without necrosis.Conclusion: Granuloma with caseous necrosis is highly suggestive of TS but does not rule out FS. Certain fungi can exhibit this type of necrosis as do tuberculosis species. Suppurative inflammation, although rare in TS, does exist. Histiocytic type granuloma without necrosis is suggestive of brucellosis.

Skeletal fluorosis: don't miss the diagnosis!

Skeletal fluorosis is a rare toxic osteopathy characterized by massive bone fixation of fluoride. The disease occurs as an endemic problem in some parts of the world and is the result of prolonged ingestion or rarely by inhalation of high amounts of fluoride. Radiographic presentation is mainly characterized by bone changes with osteocondensation and later ossification of many ligaments and interosseous membranes. Skeletal fluorosis is not clinically obvious and can be confused with other rheumatologic disorders. Its severity lies in the development of skeletal deformities and neurological complications. Management of fluorosis generally focuses on symptom treatment.

Traumatic Meniscus and Cruciate Ligament Tears in Young Patients: A Comparison of 3T Versus 1.5T MRI.

OBJECTIVE: To compare diagnosis value of 1.5T and 3T MRI in the detection of traumatic knee injuries in young patients by reference to arthroscopy. MATERIALS AND METHODS: One hundred patients were prospectively included. All patients randomly underwent standardized knee 1.5T or 3T MRI with subsequent knee arthroscopy. Meniscus and cruciate ligaments tears were blindly assessed by two independent musculoskeletal radiologists. RESULTS: Comparison of 1.5T and 3T MRI groups in the diagnosis of medial and lateral meniscal tears showed significantly higher sensitivity (p = 0.015) of 1.5T MRI in the diagnosis of lateral meniscal tears. Sensitivity and specificity for complete ACL tears were 100 percent [35/35] and 100 percent [23/23] at 1.5T MRI (p = < 0.0001) versus 95.5 percent [21/22] and 100 percent [16/16] at 3T MRI (p = < 0.0001).Only three complete PCL tears were observed in this study. Sensitivity and specificity for all complete CL tears were 100 percent [37/37]; 100 percent [77/77] for 1.5T MRI (p < 0.0001); and 95.7 percent [22/23] and 100 percent [59/59] for 3-T MRI (p < 0.0001). Diagnosis value of 1.5T and 3T MRI was equal for ACL and PCL complete tears. CONCLUSION: Diagnosis value of 1.5T was similar to 3T MRI for medial meniscal and cruciate ligament tears of the knee in symptomatic patients and higher for lateral meniscal tears.

Noncontiguous multifocal spondylitis: an exceptional presentation of spinal brucellosis.

AIM: The aim of this study was to describe the imaging features of multilevel brucellar spondylitis and discuss the diagnostic challenges CASE: The authors report describes one case of noncontiguous synchronous multifocal involvement of thoracic and lumbar spine. RESULTS: Brucellosis is a zoonosis of worldwide distribution, relatively frequent in Mediterranean countries and in the Middle East that can involve many organs and tissues. The spine is the most common site of musculoskeletal involvement, but multilevel involvement is uncommon and only ten cases were reported in literature. CONCLUSION: Although it is an exceptional form, multifocal brucellar spondylitis is worth to be known to avoid diagnostic mistakes.

Periosteal chondrosarcoma.

OBJECTIVE: The purpose of this article is to identify the typical imaging features of periosteal chondrosarcoma on radiography, CT, and MRI. CONCLUSION: Periosteal chondrosarcoma is a rare low-grade malignant cartilaginous tumor arising from the external surface of bone. Imaging features are often specific. Recognizing periosteal chondrosarcoma and differentiating it from other surface tumors is of capital importance because the prognosis is excellent after adequate local surgery alone.

Elastofibroma dorsi: A report on 6 cases.

Elastofibromas are slow growing fibroblastic proliferations, which occur mainly in elderly women. They are typically located in the right subscapular region and are usually asymptomatic. The characteristic findings in ultrasonography, computed tomography and magnetic resonance imaging usually allow to make the diagnosis. We report six cases of elastofibroma dorsi, the clinical presentation and radiology findings are reviewed and compared with literature.

Primary leiomyosarcoma of bone: report of 4 cases.

Primary leiomyosarcoma of bone is a very rare tumor. Four cases are reported: 3 tumors were located in the femur and 1 in the talus. Clinical and imaging findings including radiographs, CT, and MRI are described. The final diagnosis was made by histopathological, immunohistochemical, and/or ultrastructural study after biopsy.