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Professor Romeo Canini’s name did not appear in the list of authors of the following abstract that was presented at the Special Scientific session of the ISS held in Athens in September 2010 and published in Skeletal Radiology (2010,10,1051). The title and complete list of authors is as follows; New dual-energy x-ray absorptiometry equipments in the assessment of vertebral fractures: technical limits and software accuracy. Alberto Bazzocchi, Danila Diano, Claudia Sassi, Giuseppe Battista, Giuseppe Guglielmi, Romeo Canini.

The Society of Skeletal Radiology (SSR) Practice Guidelines and Technical Standards Committee identified musculoskeletal infection as a White Paper topic, and selected a Committee, tasked with developing a consensus on nomenclature for MRI of musculoskeletal infection outside the spine. The objective of the White Paper was to critically assess the literature and propose standardized terminology for imaging findings of infection on MRI, in order to improve both communication with clinical colleagues and patient care.A definition was proposed for each term; debate followed, and the committee reached consensus. Potential controversies were raised, with formulated recommendations. The committee arrived at consensus definitions for cellulitis, soft tissue abscess, and necrotizing infection, while discouraging the nonspecific term phlegmon. For bone infection, the term osteitis is not useful; the panel recommends using terms that describe the likelihood of osteomyelitis in cases where definitive signal changes are lacking. The work was presented virtually to SSR members, who had the opportunity for review and modification prior to submission for publication.

Patient-reported outcomes (PROs) provide an essential understanding of the impact a condition or treatment has on a patient, while complementing other, more traditional outcomes information like survival and time to symptom resolution. PROs have become increasingly important in medicine with the push toward patient-centered care. The creation of a PROs database within an institution or practice provides a way to collect, understand, and use this kind of patient feedback to inform quality improvement and develop the evidence base for medical decision-making and on a larger scale could potentially help determine national standards of care and treatment guidelines. This paper provides a first-hand account of our experience setting up an imaging-based PROs database at our institution and is organized into steps the reader can follow for creating a PROs database of their own. Given the limited use of PROs within both diagnostic and interventional radiology, we hope our paper stimulates a new interest among radiologists who may have never considered outcomes work in the past.

The 18th Annual Congress of the ESSR was hosted in Greece, on the beautiful island of Crete, 9–11 June 2011, with nearly 500 registrants present. The congress president was Prof Apostolos Karantanas. The meeting followed the same format as previous years with a musculoskeletal ultrasound course on the first day. The remaining 2 days of the meeting comprised the refresher course which concentrated on the topic of bone marrow disorders, with further focus sessions including arthritis, intervention, sports imaging, tumours and advances in MSK imaging. Fifty papers were accepted for presentation in the scientific sessions, with a further 77 papers accepted for the electronic poster exhibition. The abstracts for the scientific papers were published in the June 2011 edition of Skeletal Radiology [1]. This article summarises the highlights of the scientific program.

Plagiarism is defined as “using someone else’s words, ideas or results without attribution” [7]. Plagiarism can occur in two forms: (a) self-plagiarism, when authors reuse portions of their own previous writings in a subsequent paper [8], i.e., redundant and duplicate publications; and (b) “salami slicing”—i.e., dividing reports of the outcome of a research project into as many papers as possible in order to maximize the number of potential scientific publications [9]. The causes of plagiarism lie on a spectrum. At one end, there is a clear intent to deceive. At the other end lies unintentional plagiarism, perhaps due to naivete, ignorance, or “cryptomnesia,” a term defined as “memories that are hidden from consciousness and subjectively are not recognized as such” [10].

Awise old physician once told me that he would never agree to do a book review because reviewing someone’s book is a bit like reviewing their spouse. There is no “constructive criticism” that is welcome. For a scholarly publication such as Skeletal Radiology, letters to the Editor can pose a similar risk. As pointed out by Wikipedia (http://en.wikipedia.org/wiki/Letter_to_the_ editor), “In academic publishing, letters to the editor of an academic journal are usually open postpublication reviews of a paper, often critical of some aspect of the original paper. ” Such letters are likely to be critical of the author, the reviewers who accepted the paper, and, by implication, the editors who selected it. Letters are not subject to the same standards of evidence and peer review as a scientific publication; they can therefore be seen as a “cheap shot” taken at someone’s hard work. Despite growth in recent years, the world of musculoskeletal diagnosis is a small one; it is highly likely that the authors of a letter and the authors of the paper it addresses will be known to each other. For these reasons, Skeletal Radiology has, with very rare exceptions, declined the publication of letters to the editor. And yet, letters can also add a certain amount of liveliness to a publication. The letter writer might have arcane knowledge to share, and the author gets the satisfaction of knowing that someone somewhere has read and thought about what he or she has written. Should we change our policy and accept letters? The Editors request your feedback on this issue.

To analyse and compare all papers published to date (August 2000) that quantify the effectiveness, defined as the impact of clinician's diagnosis or management plans, or patient outcome, of MRI of the shoulder.A computerised search of Index Medicus with a broad search strategy relating to shoulder MRI was performed. Manual assessment of all papers listed was undertaken with classification of each paper depending on whether it addressed questions of (1) technical performance, (2) diagnostic performance or (3) outcome.Four of 265 qualifying papers addressed aspects of effectiveness and these were reviewed. The impact on the clinician's diagnosis varied widely between papers: the primary diagnosis was altered in 23% to 68% of cases, and the management plans were subsequently changed in 15% to 61% of cases. Only one paper addressed the impact on patient health.The effectiveness of MRI of the shoulder depends on the clinical skills of the referring clinician and prevalence of disease in the study population. This will have implications when the effectiveness of an imaging technique between different institutions is compared, and this in turn will influence any comparisons of cost-effectiveness.

Following the 2008 European Society of Musculoskeletal Radiology meeting in Galway, the presented papers and posters were reviewed again. This article highlights those papers that are felt to be of wider interest to the readers of the journal. Work reporting on new innovations and imaging and therapeutic techniques is emphasised in the hope that it will be of use to researchers and those in clinical practice.

Select members of the Editorial Board of Skeletal Radiology and select members of the International Skeletal Society have read the following two manuscripts; Oh CW, Shingade VU, Song HR, Suh SW, Hong JS, Lee SH. Sagging rope sign in achondroplasia is different from Perthes disease. J. Pediatr. Orthop. (2005) 25:722–724 and Shingade VU, Song HR, Lee SH, Suh SW, Oh CW, Hong JS. The sagging rope sign in achondroplasia-different from Perthes disease. Skeletal Radiol. (2006) 35:923–928 and concluded that the publication in Skeletal Radiology presents the same patient data and observations as appeared in the Journal of Pediatric Orthopaedics. The Editors, who have re-read the papers in the context of Dr. Shingade’s explanatory letter as corresponding author for the paper in Skeletal Radiology and a letter from one of his co-author’s who stated he was unaware of the Skeletal Radiology submission, have come to the conclusion that the paper in Skeletal Radiology represents a dual publication. Skeletal Radiol (2007) 36:905 DOI 10.1007/s00256-007-0361-z

Epithelioid hemangioma of the bone is a rare kind of vascular neoplasm posing a diagnostic challenge because of its ability to mimic malignant tumors. We report a case of a fast-growing, talofibular joint-involving epithelioid hemangioma, which was suspectedly initiated by vascular damage due to trauma and arthroscopy. The ankle mass appeared as a lytic lesion on the CT images and as a T1 hypo-, T2 mildly hyperintense, lobulated structure on the MRI scans. The contrast enhancement pattern was typical to vascular neoplasms. Histologically the lesion consisted of well-formed vessels lined with epithelioid cells with a slightly atypical nuclear morphology, inflammation with a significant number of eosinophils, and low mitotic rate. Immunohistochemistry analysis showed the presence of vascular markers but no rearrangements characteristic of soft tissue sarcomas were registered by the next-generation sequencing. The surgical treatment was curative. The report presents current imaging methods and summarizes the imaging findings of transarticular spreading tumors. The paper also highlights that for the differential diagnosis of vascular tumors showing signs of aggressivity, the pathological analysis is inevitable. Correct diagnosis of the epithelioid hemangioma is essential, as the treatment of more malignant entities is substantially different. An added value of the report is that to the best of our knowledge, a transarticular spreading epithelioid hemangioma of the ankle has never been described before.

Fatty or part-fatty intraosseous lesions are occasionally encountered while imaging the skeletal system. A number of case reports have proposed involution of calcaneal bone cysts to intraosseous lipomas, but this has never been proven. This paper sets out to prove that simple bone cysts (SBCs) can involute to fatty lesions indistinguishable from intraosseous lipomas. The pathology and PACS databases at 2 specialist orthopedic hospitals were retrospectively interrogated for all cases of intraosseous lipomas or SBCs with cross-sectional imaging follow-up for SBCs and precursor or follow-up imaging for intraosseous lipomas, in the time period from August 2007 to December 2016. For intraosseous lipoma cases, these were only included if change in imaging appearances was observed. There was no case of change in the appearance in intraosseous lipomas. Six cases of SBC with cross-sectional imaging follow-up were identified in one participating hospital and none in the other. The 6 cases were comprised of 4 male and 2 female patients. Two were located in the proximal humerus, one in the proximal tibia, and 3 in the os calcis. All cases demonstrated filling in of the cystic lesion with fat from the periphery, in 2 cases complete filling in, and in 4 cases partial fatty conversion. SBCs can heal with fatty conversion of the cystic cavity, with partly cystic remnants. It is proposed that at least part of the so-called intraosseous lipomas are healed simple bone cysts.

To review the efficacy of percutaneous thermal ablation (TA) of bone metastases (radiofrequency ablation [RFA], microwave ablation [MWA], cryoablation [CA], and MR-guided focused ultrasound [MRgFUS]) in reducing pain in patients with advanced stage cancer. We searched MEDLINE/PubMed, MEDLINE In-Process, BIDS ISI, Embase, CINAHL, and the Cochrane database using the keywords “ablation,” “painful,” “bone,” and “metastases” combined in multiple algorithms. Inclusion criteria were: original clinical studies published between 2001 and 2018; performance of RFA, MWA, CA or MRgFUS; and quantitative pain assessment before/after TA of bone metastasis. Eleven papers (3 on RFA, 1 on MWA, 2 on CA, and 5 on MRgFUS) involving 364 patients were reviewed. A technical success rate of 96–100% was reported, with follow-up for up to 6 months. At baseline, pain scores ranged from 5.4 to 8, at 1–4 weeks from 0.5 to 5, and at 12 weeks from 0.3 to 4.5. Mean pain reduction compared with baseline ranged from 26 to 91% at 4 weeks and from 16% to 95% at 12 weeks. MWA treatments caused no complications, whereas MRgFUS showed the highest complication rate. The number of minor complications observed ranged from 0 to 59 (complication ratio 0–1.17), whereas the number of significant adverse effects ranged from 0 to 4 (complication ratio 0–0.04). All techniques achieved pain relief after 1 and 3 months, in up to 91% and 95% of patients respectively. MWA showed a negligible complication rate, whereas MRgFUS is associated with a noteworthy rate of adverse events. Future studies should adopt a standardized pain reporting scale to allow for meta-analysis.

COVID-19 has presented with a variety of manifestations including peripheral neurological symptoms. The most commonly associated peripheral neuropathies described with COVID-19 are Guillain-Barre syndrome and its variants as well as critical illness polyneuropathy. We report in this paper the distinct MRI findings of an unusual case of peripheral neuropathy associated with COVID-19. These findings are similar to those seen in Guillain-Barre syndrome or one of its variants, although differing from the classic condition in certain key clinical and radiological features.

Chronic groin pain can be due to a variety of causes and is the most common complication of inguinal hernia repair surgery. The etiology of pain after inguinal hernia repair surgery is often multifactorial though injury to or scarring around the nerves in the operative region, namely the ilioinguinal nerve, genital branch of the genitofemoral nerve, and the iliohypogastric nerve, is thought to be a key factor in causing chronic post-operative hernia pain or inguinal neuralgia. Inguinal neuralgia is difficult to treat and requires a multidisciplinary approach. Radiologists play a key role in the management of these patients by providing accurate image-guided injections to alleviate patient symptoms and identify the pain generator. Recently, ultrasound-guided microwave ablation has emerged as a safe technique, capable of providing durable pain relief in the majority of patients with this difficult to treat condition. The objectives of this paper are to review the complex nerve anatomy of the groin, discuss diagnostic ultrasound-guided nerve injection and patient selection for nerve ablation, and illustrate the microwave ablation technique used at our institution.

Calcific tendinopathy typically affects the shoulder rotator cuff tendons. Its management includes shock wave therapy and US-guided percutaneous irrigation, with surgery being less and less used. Extra-shoulder calcific tendinopathy is relatively infrequent and typically affects the hip. While the diagnostic techniques and the treatment options for shoulder calcific tendinopathy have been extensively described, there are only anecdotic reports on the other sites. In this paper, we have reported an unusual case of non-insertional Achilles calcific tendinopathy which occurred many years after Achilles surgical repair. This condition, which presented similar appearance to that of the rotator cuff calcific tendinopathy, is totally different from the well-known and more common insertional calcific Achilles tendinopathy in terms of pathophysiological, imaging, and clinical findings. Further, we have shown that US-guided percutaneous irrigation might be a safe, technically feasible, mini-invasive, and effective treatment also for Achilles calcific tendinopathy.

This paper summarizes the highlights of the Scientific Sessions of the 46th Annual Scientific Meeting of the International Skeletal Society (ISS) which was hosted in Vancouver, Canada, in September 2019.

Calcification of the medial collateral ligament (MCL) of the knee is rare. The literature reports no positive outcomes when conservative treatment has been followed. This paper reports a case of such calcification and its treatment using ultrasound-guided percutaneous lavage (UGPL). A 66-year-old patient presented with medial knee pain. X-ray, ultrasound, and magnetic resonance (MR) examinations revealed calcific bursitis of the MCL, which was treated by UGPL. One month after treatment the patient was asymptomatic. X-ray, ultrasound, and MR examinations confirmed the almost complete disappearance of the calcification; only very tiny fragments remained. Calcific bursitis of the MCL of the knee is very uncommon, but should be taken into account in differential diagnoses for medial knee pain. UGPL is proposed as a treatment for this condition.

This paper summarizes the main aspects of the 24th Annual Scientific Meeting of the European Society of Musculoskeletal Radiology (ESSR), which was hosted in Bari (Italy) in June 2017.

The original version of this paper unfortunately contained mistakes in the affiliations for all authors.

Medical services at the Glasgow 2014 Commonwealth Games (CWG) were provided though a purpose-built medical polyclinic, which had a fully equipped radiology department along with other services, set up within the main Games Village. Data analysis of radiology services offered at CWG has not been published before. Imaging services within the polyclinic, Athletes Village, Glasgow 2014 CWG. The aim of the paper is to analyse data on radiological investigations and assess the demand and distribution of workload on imaging services at CWG 2014. Data on radiology investigations at the CWG 2014 was retrieved from the Carestream picture archiving and communication system (PACS) and Pharmasys (CWG official centralised electronic database system) and analysed. Six hundred ninety-seven diagnostic and interventional procedures were performed. Of these 37.9 % were magnetic resonance imaging (MRI) scans, 22 % were diagnostic ultrasound (US) examinations, 33.1 % were radiographs, 4.3 % were computed tomography (CT) scans and 2.7 % were imaging-guided interventional procedures. 88 % of imaging was performed on athletes and the remainder were performed on team officials and workforce. Demand on radiology services gradually picked up through the pre-competition period and peaked half way through the CWG. Radiology played a vital role in the successful provision of medical services at the Glasgow 2014 CWG. High demand on imaging services can be expected at major international sporting events and therefore pre-event planning is vital. Having back-up facilities in case of technical failure should be given due importance when planning radiology services at future CWG events.

After implantation of a metal-on-metal total hip arthroplasty (MoM THA), a large incidence of pseudotumor formation has been described recently. Several centers have invited patients for follow-up in order to screen for pseudotumor formation. The spectrum of abnormalities found by CT in MoM THA patients can be unfamiliar to radiologists and orthopedic surgeons. Previously, a CT five-point grading scale has been published. In this paper, a simplification into a three-point classification system gives insight in the morphological distinction of abnormalities of the postoperative hip capsule in MoM implants in relation to the decision for revision. The reliability of this simplified classification regarding intra- and interrater reliability and its association with revision rate is investigated and discussed. All patients who underwent MoM THA in our hospital were invited for screening. Various clinical measures and CT scan were obtained in a cross-sectional fashion. A decision on revision surgery was made shortly after screening. CT scans were read in 582 patients, of which 82 patients were treated bilaterally. CT scans were independently single read by two board-certified radiologists and classified into categories I-V. In a second meeting, consensus was obtained. Categories were subsequently rubricated in class A (categories I and II), B (category III), and C (categories IV and V). Intra- and inter-radiologist agreement on MoM pathology was assessed by means of the weighted Cohen's kappa. Categorical data were presented as n (%), and tested by means of Fisher's exact test. Continuous data were presented as median (min-max) and tested by means of Mann-Whitney U test (two group comparison) or Kruskal-Wallis test (three group comparison). Logistic regression analysis was performed in order to study independence of CT class for association with revision surgery. Univariate statistically significant variables were entered in a multiple model. All statistical analysis was performed two-tailed using alpha 5 % as the significance level. In total, 664 scores from 664 MoM hips obtained by two observers were available for analyses. Interobserver reliability for the non-simplified version (I-V) was κw = 0.71 (95 % CI: 0.62-0.79), which indicates good agreement between the two musculoskeletal radiologists. Intra- and interobserver reliability for the simplified version (A-C) were respectively κw 0.78 (95 % CI: 0.68-0.87), and κw = 0.71 (95 % CI: 0.65-0.76). This indicates good agreement within and between the two observers. The simplified A-C version is significantly associated with revision exclusively due to MoM pathology, in both patients with unilateral MoM THA (p

This paper summarizes the highlights of the Special Scientific Sessions of the 44th Annual Scientific Meeting of the International Skeletal Society (ISS), which was hosted in New York, NY, in August 2017.

Muscle injuries are one of the major problems facing elite athletes, representing a significant source of time lost from competition, with substantial consequences for teams and athletes. There are considerable pressures for a rapid return, but players who return to competition too soon have an increased risk of recurrent muscle injuries, which are associated with longer lay-offs. Imaging plays a key role in achieving the correct diagnosis, and magnetic resonance imaging (MRI) has emerged as the method of choice for skeletal muscle imaging. Several authors have reported prognostic MRI features, but it is difficult to predict the exact length of time to return to full training afterwards due to considerable discrepancy and overlap between different injuries. Therefore, development of a universally applicable classification and grading system is challenging. This paper aims to: (a) review the contemporary role of imaging in the setting of muscle injuries, with special focus on thigh muscles; (b) list the most accepted terminology used to describe muscle injuries

The soleus sling has been recently identified as a site of compression of the tibial nerve resulting in tibial neuropathy. Diagnosis of soleal sling syndrome is difficult, and has been based mainly on clinical examination. Advances in MR imaging with high-resolution 3-Tesla scanners have made direct visualization of nerve pathology possible. With the use of high-resolution imaging and fat-suppression protocols, tibial nerve compression at the soleal fascial arch can be demonstrated in a subset of patients presenting with idiopathic tibial neuropathy. The purpose of this paper is to confirm the ability of MR imaging to demonstrate pathologic changes in the tibial nerve in patients presenting with soleal sling syndrome. Additionally, patients presenting with tibial neuropathy and ganglion cysts, both extra- and intraneural, were examined to determine if the site of compression corresponded to the region of the soleus sling. Nine patients were included in the study, two with idiopathic soleus sling syndrome, four with extraneural, and three with intraneural ganglion cysts. In the patients presenting with idiopathic soleus sling syndrome, MR imaging demonstrated a thickened soleus sling with T2 hyperintensity of the tibial nerve at the level of the sling and denervation changes in muscles of the posterior compartment of the leg. In patients with extraneural ganglion cysts, MR imaging demonstrated a "sandwich"-like compression of the tibial nerve between the cyst and the soleus sling with corresponding tibial nerve T2 hyperintensity and denervation change in posterior compartment muscles. No compression of the tibial nerve at the soleus sling was found in the intraneural ganglion population. We conclude that MR imaging is effective in demonstrating pathologic changes in the tibial nerve at the soleus sling. Based on the MRI findings, we also believe that the soleus sling is a component of the compression when patients present with extraneural ganglion cysts and tibial neuropathy near the knee; in these patients, we recommend release of the soleus sling as part of the definitive management.

A look back at Skeletal Radiology in 2016 reveals a sizable number of publications that significantly advanced the state of knowledge about diseases of the musculoskeletal system. This review summarizes the content of some of the most intriguing papers of the year.

Melorheostosis is a very rare disorder characterized by irregular cortical thickening seen on radiographs. In this paper, we present a case of melorheostosis with microscopically confirmed soft-tissue components. The patient was a 51-year-old man who complained of severe pain in the lateral aspect of his right knee. The excision of an ossified soft-tissue lesion relieved intractable pain that had lasted 20 years. Microscopically, the cortex of the affected fibula was composed of thick compact bone and the soft-tissue component consisted of dense compact bone without endochondral ossification. The presence of soft-tissue osseous nodules around the joints is one of the specific conditions for melorheostosis and should be differentiated from synovial chondromatosis. The ossified soft-tissue lesion in our patient is to our knowledge the first reported case of the histologically confirmed soft-tissue component of melorheostosis, which differs from that of synovial chondromatosis.

In the last two decades, training programs in musculoskeletal imaging in North America have flourished, increasing both in number and in quality, guaranteeing an ample supply of well-trained and motivated specialists who are populating academic medical centers and private practice venues and, in doing so, guaranteeing quality care for countless patients for years to come. This is in stark contrast to the situation not so long ago, in the 1970s, when few such programs existed, qualified applicants were difficult to find, and specific guidelines for these training programs were not in place. It was at this precise time that we, here at the University of California, San Diego (UCSD), began our bone imaging fellowship program. Although we were clearly not the first with such a program, as I look back on our 35 year history, I can identify a few specific things that we did that are still in place today and, for which I think we can be proud. I have been asked by the Editors of Skeletal Radiology to put pencil to paper (yes, I still do it this way) and to detail a few of the things that I regard as essential to the success of a musculoskeletal imaging fellowship. I fully recognize that there are many fellowship directors who already know what follows and whose programs require no modifications. But being one of the more senior bone fellowship directors, perhaps my perspective will have some value. “Friendly” Environment with international flavor

Cam hips are commonly quantified using the two-dimensional α angle. The accuracy of this measurement may be affected by patient position and the technician's experience. In this paper, we describe a method of measurement that provides a quantitative definition of cam hips based upon three-dimensional computed tomography (CT) images.CT scans of 47 (24 cam, 23 normal) femurs were segmented. A sphere was fitted to the articulating surface of the femoral head, the radius (r) recorded, and the femoral neck axis obtained. The cross sectional area at four locations spanning the head neck junction (r/4, r/2, 3r/4 and r), perpendicular to the neck axis, was measured. The ratios (Neck/Head) between the areas at each cut relative to the surface area at the head centre were calculated and aggregated.Normal and cam hips were significantly different: the sum of the head-neck ratios (HNRs) of the cam hips were always smaller than normal hips (p0.01). A cut off point of 2.55 with no overlap was found between the two groups, with HNRs larger than this being cam hips, and smaller being normal ones.Owing to its sensitivity and repeatability, the method could be used to confirm or refute the clinical diagnosis of a cam hip. Furthermore it can be used as a tool to measure the outcome of cam surgery.

The aim of this paper is to demonstrate the usefulness of 2D multiplanar reformatting images (MPR) obtained from rotational acquisitions with cone-beam computed tomography technology during percutaneous extra-vascular spinal procedures performed in the angiography suite. We used a 3D rotational angiographic unit with a flat panel detector. MPR images were obtained from a rotational acquisition of 8 s (240 images at 30 fps), tube rotation of 180° and after post-processing of 5 s by a local work-station. Multislice CT (MSCT) is the best guidance system for spinal approaches permitting direct tomographic visualization of each spinal structure. Many operators, however, are trained with fluoroscopy, it is less expensive, allows real-time guidance, and in many centers the angiography suite is more frequently available for percutaneous procedures. We present our 6-year experience in fluoroscopy-guided spinal procedures, which were performed under different conditions using MPR images. We illustrate cases of vertebroplasty, epidural injections, selective foraminal nerve root block, facet block, percutaneous treatment of disc herniation and spine biopsy, all performed with the help of MPR images for guidance and control in the event of difficult or anatomically complex access. The integrated use of “CT-like” MPR images allows the execution of spinal procedures under fluoroscopy guidance alone in all cases of dorso-lumbar access, with evident limitation of risks and complications, and without need for recourse to MSCT guidance, thus eliminating CT-room time (often bearing high diagnostic charges), and avoiding organizational problems for procedures that need, for example, combined use of a C-arm in the CT room.

A tailored review of peer-reviewed abstracts presented at the 2010 Radiological Society of North America (RSNA) Annual Meeting was performed following oral presentation. This review will highlight 15 formal and informal scientific paper presentations focusing on three main topics: (1) 3D isotropic MR imaging of joints, (2) diffusion tensor imaging of peripheral nerves, and (3) dual-energy CT in the diagnosis of Gout.

This paper assesses interscan, interreader, and intrareader variability of C-arm CT and compares it to that of flat-panel volume-CT (fpVCT) and high-definition multi-detector-CT (HD-MDCT).Five cadaver knee specimens were imaged using C-arm-CT, fpVCT, and HD-MDCT. Apparent (app.) trabecular bone volume fraction (BV/TV), app. trabecular number (TbN), app. trabecular spacing (TbSp), and app. trabecular thickness (TbTh) of the proximal tibia were measured by three readers. Interreader, intrareader, and interscan variability for C-arm CT was expressed as coefficient of variation (CV), standard deviation (SD), and intraclass correlation coefficient (ICC).With the exception of app.TbSp (CV: 7.05-9.35%, SD: 0.06-0.09, ICC: 0.89-0.94), the variability of C-arm CT was low (CV: 2.41-6.43%, SD: 0.01-0.048, ICC: 0.65-0.98). Its interreader reliability (CV: 2.66-4.55%, SD: 0.01-0.03, ICC: 0.81-0.95) was comparable to that of HD-MDCT (CV: 2.41-4.08%, SD: 0.014-0.016, ICC: 0.95-0.96), and fpVCT (CV: 3.13-5.63%, SD: 0.009-0.036, ICC: 0.64-0.98) for all parameters except app.TbSp.C-arm CT is a reliable method for assessing trabecular bone architectural parameters with the exception of app.TbSp due to spatial resolution limitation.

The aim of this paper is to evaluate the frequency of limb shortening in the course of solitary bone cyst treatment. The correlation between the mode of treatment as well as the occurrence of pathological fracture, cyst location, volume, and locularity were examined. A retrospective analysis was carried out on 135 patients where 80 underwent curettage and bone grafting and 55 were administered methylprednisolone injection with a mean time to follow-up of 12 years. Based on clinical and radiological evaluation, limb shortening was found in ten patients when the data before and after treatment was compared. Limb shortening ranging from 1 to 5 cm during the course of the treatment was observed: six in humerus, two in femur, two in tibia. Those with epiphyseal changes, magnetic resonance imaging to evaluate the degree of growth plate damage was performed. Patients with and without limb shortening did not differ statistically regarding the applied method of treatment. The cyst volume was significantly larger in the group of patients with limb shortening when compared to the group of patients with no limb shortening. In patients treated with curettage and bone grafting, the mode of treatment does not increase the frequency of occurrence of iatrogenic limb shortening. In patients with limb shortening, a statistically significant larger volume of the cyst was observed.

Fractures of the scapula due to direct violence are relatively common. Wilber and Evans [18] reported 40 scapular fractures and reviewed the literature. All those injured had received direct trauma to the shoulder and they were able to divide their cases into two groups, based on anatomical location and functional results. Scapular fractures due to avulsion of the muscular attachments are uncommon and, as reports of these injuries in the literature are usually confined to single cases, no classification has been established which takes account of the anatomical sites at which these fractures occur and the mechanism of injury involved. In this paper the more common sites of avulsion injury of the scapula are described and illustrated by case reports. In several of these the skeletal injury resulted from muscle contraction against a resisted force on the upper limb during the course of an accident. This mechanism has been implicated in fractures of the coracoid and acromion, but is shown in this paper to contribute to other avulsion fractures.

This paper aims to evaluate the presence of endplate sclerosis in different types of Modic changes and to assess the capability of MRI in detecting endplate sclerosis within these changes. The lumbar spines (L3-S1) of 70 patients were retrospectively reviewed to determine Modic changes and disc degeneration from MRI and endplate sclerosis from CT. T1- and T2-weighted signal intensity and Hounsfield unit (HU) measurements of type I and II Modic changes were recorded and the association of both Modic types I and II with endplate sclerosis was analyzed with a Mann–Whitney test. Altogether 82 Modic changes in 36 subjects were recorded: 13% were type I, 12% mixed type I/II, 65% type II, 9% mixed type II/III, and 1% type III. Thirty-eight percent of the endplates with Modic changes had sclerosis in CT. Of specific Modic types, mixed I/II and II/III associated significantly with endplate sclerosis. Endplate sclerosis was not detected in MRI in a quantitative analysis. Endplate sclerosis exists in all types of Modic changes, especially in mixed Modic types, and not only in type III changes, as previously assumed. Endplate sclerosis was not detected in MRI, which may depend on the amount of mineralization of the bone marrow.

The objective of this paper was to demonstrate the prevalence of shoulder magnetic resonance imaging (MRI) abnormalities, including abnormal bone marrow signal at the acromioclavicular (AC) joint in symptomatic and asymptomatic Ironman Triathletes. The shoulders of 23 Ironman Triathletes, seven asymptomatic (group I) and 16 symptomatic (group II), were studied by MRI. A separate, non-triathlete group was evaluated specifically for AC joint marrow signal abnormalities to compare with the Ironman Triathletes. Partial thickness tears of the rotator cuff, rotator cuff tendinopathy, and AC joint arthrosis were common findings in both groups of triathletes. Tendinopathy was the only finding that was more prevalent in the symptomatic group, but this was not a statistically significant difference (p = 0.35). There were no tears of the glenoid labrum seen in group I or II subjects. Of note is that 71% (5/7) of group I subjects and 62% (10/16) of group II subjects had increased signal changes in the marrow of the AC joint (p = 0.68). The comparison group showed a lower prevalence (35%, p = 0.06) of this finding. No statistically significant difference was found among the findings for group 1, group 2, or the comparison group, although the difference between the comparison group and Ironman Triathletes approached statistical significance when evaluating for AC joint abnormal signal. Shoulder MRI of Ironman Triathletes should be interpreted with an appreciation of the commonly seen findings in asymptomatic subjects.

This paper presents a first dry-bone study of the anatomy of an absent cervical spine pedicle and briefly reviews the literature involving this anomaly. The case study is of the absence of the right cervical spine pedicle at C6 in a mediaeval skeleton from England. Key features of the anomaly, including, in addition to the absent pedicle, dysplasia of the ipsilateral transverse process, dorsal displacement of the articular pillar, and reversal of the ipsilateral facet articulation with the supra-adjacent vertebra, are illustrated. Compromise of cervical spine stability is demonstrated. Literature review revealed 69 cases of absent cervical spine pedicle; all were unilateral, and there was no side or gender preference. The current case is a first description of an absent cervical spine pedicle in an archaeological skeleton. It indicates the presence of the anomaly in a European population more than 600 years before the first clinical description. Absent cervical spine pedicle appears to be a rare variant today; the paucity of archaeological cases shows that this was also the case in the past.

The etiology of Kienbock disease, or avascular necrosis of the lunate, is controversial, and there are a myriad of treatments aimed at correcting the various hypothesized pathologies. Interventions to reduce mechanical stress on the lunate have been used for decades, including radial osteotomy with or without radial shortening, ulnar lengthening and metaphyseal core decompression procedures. However, these procedures require preservation of lunate architecture. Newer procedures to revascularize the lunate bone have emerged in the last 10 years, such as pedicled corticoperiosteal vascularized bone grafting. Once there is collapse of the radiocarpal joint or midcarpal arthrosis, the conventional treatments have included proximal row carpectomy and complete or partial wrist joint arthrodesis. Newer salvage procedures such as lunate excision with autologous or synthetic interposition grafts are now being used when possible. As this disease is relatively rare, radiologists may not be familiar with the expected post-operative radiologic findings and complications, especially of the newer treatments. The goals of this paper are to review the available treatment options and their expected appearance on postoperative imaging, with discussion of possible complications when appropriate.

The scapholunate joint is one of the most involved in wrist injuries. Its stability depends on primary and secondary stabilisers forming together the scapholunate complex. This ligamentous complex is often evaluated by wrist arthroscopy. To avoid surgery as diagnostic procedure, optimization of MR imaging parameters as use of three-dimensional (3D) sequences with very thin slices and high spatial resolution, is needed to detect lesions of the intrinsic and extrinsic ligaments of the scapholunate complex. The paper reviews the literature on imaging of radial-sided carpal ligaments with advanced computed tomographic arthrography (CTA) and magnetic resonance arthrography (MRA) to evaluate the scapholunate complex. Anatomy and pathology of the ligamentous complex are described and illustrated with CTA, MRA and corresponding arthroscopy. Sprains, mid-substance tears, avulsions and fibrous infiltrations of carpal ligaments could be identified on CTA and MRA images using 3D fat-saturated PD and 3D DESS (dual echo with steady-state precession) sequences with 0.5-mm-thick slices. Imaging signs of scapholunate complex pathology include: discontinuity, nonvisualization, changes in signal intensity, contrast extravasation (MRA), contour irregularity and waviness and periligamentous infiltration by edema, granulation tissue or fibrosis. Based on this preliminary experience, we believe that 3 T MRA using 3D sequences with 0.5-mm-thick slices and multiplanar reconstructions is capable to evaluate the scapholunate complex and could help to reduce the number of diagnostic arthroscopies.

Femoroacetabular impingement syndrome (FAI) is a pathologic entity which can lead to chronic symptoms of pain, reduced range of motion in flexion and internal rotation, and has been shown to correlate with degenerative arthritis of the hip. History, physical examination, and supportive radiographic findings such as evidence of articular cartilage damage, acetabular labral tearing, and early-onset degenerative changes can help physicians diagnose this entity. Several pathologic changes of the femur and acetabulum are known to predispose patients to develop FAI and recognition of these findings can ultimately lead to therapeutic interventions. The two basic mechanisms of impingement-cam impingement and pincer impingement-are based on the type of anatomic anomaly contributing to the impingement process. These changes can be found on conventional radiography, MR imaging, and CT examinations. However, the radiographic findings of this entity are not widely discussed and recognized by physicians. In this paper, we will introduce these risk factors, the proposed supportive imaging criteria, and the ultimate interventions that can help alleviate patients' symptoms.

This paper presents four generations of a family with radiographically demonstrated congenital vertical talus (CVT) in whom a HOXD10 gene mutation was identified. Some members of the family with this mutation exhibited cavo-varus foot deformity consistent with a Charcot-Marie-Tooth (CMT)-like disorder. Physical examination was performed on nearly all of the affected and unaffected family members. DNA was extracted from blood obtained from 14 subjects who showed radiographic and clinical features of CVT (two of whom also had CMT), from two subjects with features of CMT but not CVT, and from 20 related family members who were clinically normal. Radiographs show the appearance of uncorrected CVT in infancy, in childhood, and in adulthood. DNA analysis revealed a mutation in a HOXD10 gene located on chromosome 2 in all of the affected but none of the unaffected family members. There is an autosomal-dominant-inherited mutation with complete penetrance which is found in all members of a pedigree with CVT, some of whom exhibit a CMT-like foot disorder. Radiologic findings vary depending on the severity of involvement, treatment provided and age of the patient.

Objective. To bring attention to the MR imaging appearance of epidural hematoma (EDH) in the lumbar spine as a small mass often associated with disk herniation or an acute event. This paper will show our experience with this entity and describe criteria for its MR imaging appearance. Design and patients. Thirteen cases of prospectively diagnosed EDH of the lumbar spine were compared with 12 cases of prospectively diagnosed prominent epidural extrusion. Our criteria were retrospectively evaluated by the two authors for their presence or absence in each case. The chi-square test for nominal data was applied. MR imaging criteria utilized to distinguish EDH from disk herniation at our institution include: (1) signal different from disk, (2) high signal on T1-weighted images, either centrally or peripherally, (3) teardrop- or egg-shaped mass, in the sagittal plane, (4) size greater than half the vertebral body height in a craniocaudal dimension, (5) primarily retrosomatic epidural location, (6) plasticity – the mass is seen to conform closely to the contours of bone (e.g., in the lateral recess), (7) little or no disk space narrowing unless associated with disc herniation. Results. Chi-square analysis demonstrated each criterion to significantly differentiate between EDH and extrusion. Only six of 13 EDH cases went to surgery in spite of their relatively large size. Two of six patients were diagnosed as having epidural clot consistent with hematoma at the time of surgery. The four patients who were not diagnosed at surgery revealed only small disk herniations or fragments of disk. Conclusions. The occurrence of EDH is more frequent than previously suspected. Spontaneous EDH is frequently associated with disk herniation and acute events such as sneezing or coughing. Most cases of spontaneous EDH will resolve prior to surgery with only the minority becoming chronic in order to be seen at surgery as an encapsulated mass. MR imaging can reliably identify EDH and distinguish between EDH and large disk extrusions.

The Colombian ISS outreach program was conducted in collaboration with the Department of Diagnostic Imaging of the University Hospital of San Ignacio at the Pontificia Universidad Javeriana (PUJ) in Bogota and as a part of the XXXV Congress of the Colombian Radiological Association (ACR) in Cartagena from August 3 to 6, 2010. Both meetings were enthusiastically attended with an average of 140 participants per day. Members of the ISS outreach team included Dr. Javier Beltran from Brooklyn, NY, Dr. Diego Jaramillo from Philadelphia, PA, and Jenny T. Bencardino from New York, NY. All lectures were given in Spanish. The program in Bogota was held at the Carlos Galan Auditorium of the PUJ from August 3 to 4, 2010. Bogota is the capital city of Colombia and has a population of over 8 million people. Currently, there are more than 100 higher education institutes and ten medical schools in Bogota, which play a vital role in the life of the city and its economy. In 2007, Bogota was named a World Book Capital City by UNESCO [1]. Bogota is the first Latin American city to receive this recognition, and the second one in the Americas after Montreal. No wonder that many refer to Colombia’s capital as “The Athens of South America” [2]. The attendees to the outreach program in Bogota were radiologists, orthopedic surgeons, technologists, residents, and fellows in radiology and orthopedics. The audience was very engaged, and the use of a digital interactive response system added greatly to their learning experience. The Outreach program in Cartagena was held at the Julio Cesar Turbay Ayala Convention Center, from August 5 to 6. Cartagena is a city of almost 1 million people located on the Colombian Caribbean coast. Its colonial walled city and fortresses have been designated a UNESCO World Heritage Site. Gabriel Garcia Marquez’s novel Love in the Time of Cholera is set in Cartagena. The city is very often used as a gathering place for international and national conventions. The 2010 ACR annual meeting in Cartagena had an attendance of 800 radiologists both local and from other Latin American countries. The musculoskeletal program lasted 2 days. The topics of the Outreach Program in Colombia were both basic and advanced in the areas of general and pediatric musculoskeletal radiology with an average of eight lectures per faculty member. All of the ISS Outreach Program teachers participated as jurors of the Evaluating Committee scoring scientific papers and educational exhibits presented at the ACR meeting in Cartagena. The Colombian outreach program provided us with a unique opportunity to interact academically and share professional experiences with a large body of radiologists from Colombia and other Latin American countries. Some of the information presented in this report was collected informally during our visit. Located in northern South America, Colombia is bordered to the north by the Caribbean Sea between Panama and Venezuela, to the east by Venezuela and J. T. Bencardino (*) Department of Radiology, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA e-mail: jenny.bencardino@nyumc.org

IntroductionThe 16th annual congress of the European Society ofMusculoskeletal Radiology (ESSR) took place in Genoa,Italy, on 12 and 13 June 2009. The meeting was held jointlywith the Italian Congress of Musculoskeletal Radiology,which took place on 11 June. A successful musculoskeletalultrasound course was also run in the afternoon of 11 June,organised by the society’s ultrasound subcommittee.Asusual,themeetingcomprisedarefreshercourse,which,this year, took the hip and bony pelvis as its theme, scientificsessions, special-focus sessions and a scientific e-posterexhibition. There were 688 delegates attending the ESSRmeeting, coming from right across Europe and beyond, while703 attended the Italian Society meeting. In total 181electronic posters were exhibited, and 49 scientific presenta-tions were made. The posters and presentations covered thewhole spectrum of musculoskeletal imaging, including noveltechnologies and techniques and new perspectives on well-recognisedconditions.Theabstractsofpaperspresentedatthemeeting appeared in the June 2009 edition of SkeletalRadiology [1]. This article attempts to highlight some ofthe presentations that might be of interest.Techniques and technologyAs might be expected, a number of papers focused onapplications for 3 T magnetic resonance (MR) imaging. Agroup from Munich published their first results of the use ofan isotropic three-dimensional (3D) turbo-spin echo (TSE)sequence for imaging the knee [2]. Total imaging time forthe sequence was in the order of 12.5 min, and the readersused 1 mm-thick multiplanar reconstructions for review.They found the 3D sequence images to be at leastcomparative with state-of-the-art two-dimensional (2D)sequences, but, of course, they had the advantage of beingable to undertake oblique reconstructions or review ofthinner slices. A group from Ireland and the Netherlandsshowed that 3 T magnetic resonance imaging (MRI) wasable to identify the double-bundle anatomy of the anteriorcruciate ligament (ACL) in 94% of patients in a retrospec-tive review of 50 patients with intact ACLs [3]; while theutility of 3 T MRI for evaluating upper limb nerve structureusing diffusion imaging and tractography was demonstratedby an Austrian group [4].In an interesting study looking at the effects of cartilageloading and unloading on T1-weighted gadolinium-enhanced(T1-Gd) relaxation times using the gadolinium-enhancedmagnetic resonance imaging of cartilage (dGEMRIC) tech-nique,workersshowedthatloadingarticularcartilagereducedthe mean T1-Gd relaxation time by approximately 50 ms [5].They emphasised that this needed to be considered when thedGEMRIC technique is to be used to assess glycosamino-glycan depletion in cartilage disease, which is also seen as areduction in T1-Gd relaxation time.A study from Switzerland looked at the use of advancedMRI techniques for the diagnosis and prediction ofoutcome in patients with Perthes’ disease [6]. They useddiffusion-weighted MRI and dynamic gadolinium-enhancedsubtraction techniques, comparing them with pinholescintigraphy. They identified increased apparent diffusioncoefficients (ADCs) in the femoral epiphyses as beingsensitive and specific for the diagnosis, but they found that

We report the case of a 48-year-old man who presented with an erosive, seronegative, HLA-B27-negative, peripheral polyarthritis, associated with hidradenitis suppurativa of axillae and buttocks. The pertinent literature is reviewed. This paper is the second devoted to this topic in a radiological journal and the first to document erosion of the posterior aspect of the calcaneus.

The medical literature is huge and continuously growing. A substantial effort is required to keep abreast of publications in a single field. For those whose interest is in the musculoskeletal system, material of interest may be found in publications related to many different specialties, as well as in general medicine and science (Table 1). Therefore, we thought it would be of interest to summarize some of the articles that have appeared recently in a wide range of publications. We considered all articles from the 22 journals in the table for the years 2007–2008 to identify those papers that we believe likely to be the most influential. This list is subjective and incomplete, but perhaps, it will serve as a stimulus for further exploration.

Focal fibrocartilaginous dysplasia (FFCD) is a rare condition causing tibia vara in childhood. It is characterized by progressive tibia vara in young children with a characteristic radiographic lesion. This paper is thought to be the first to describe FFCD exhibiting florid periosteal reaction at the time of presentation with a subtle faint osteolytic lesion in the diametaphysis of the proximal tibia.

We reviewed 845 cases of benign and 356 cases of malignant cartilaginous tumors from a total of 3067 primary bone tumors in our database. Benign cartilaginous lesions are unique because the epiphyseal plate has been implicated in the etiology of osteochondroma, enchondroma (single or multiple), periosteal chondromas and chondroblastoma. In the first part of this paper, we will review important clinical, radiologic and histologic features of intramedullary cartilaginous lesions in an attempt to support theories related to anatomic considerations and pathogenesis.

Nephropathic cystinosis is an autosomal recessive lysosomal storage disorder in which intracellular cystine accumulates. It is caused by mutations in the CTNS gene. Clinical manifestations include renal tubular Fanconi syndrome in the first year of life, rickets, hypokalaemia, polyuria, dehydration and acidosis, growth retardation, hypothyroidism, photophobia and renal glomerular deterioration. Late complications include myopathy, pancreatic insufficiency and retinal blindness. Skeletal manifestations described in these patients include failure to thrive, osteomalacia, rickets and short stature. This paper describes progressive bony abnormalities in three unrelated patients with nephropathic cystinosis that have not been reported previously.

Reconstruction of the anterior cruciate ligament (ACL) is a well-established surgical procedure. However, post-operative imaging in the early phase is not routinely performed. The rationale for performing such imaging is to provide a baseline examination for future controls, to provide immediate feedback to surgeons regarding tunnel placement, and to assess placement of fixation devices. The purpose of this paper is to enable the reader to accurately read post-operative radiographs and CT scans after single-bundle ACL reconstruction.