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Hand and wrist soft tissue masses may be classified as pseudotumors, benign neoplasms, or malignant neoplasms. The vast majority of hand lesions are benign. Consideration of the location of the lesion and its imaging characteristics often leads to a specific diagnosis. Pseudotumors discussed in this article are ganglion cysts, accessory muscles, and inflammatory lesions. True tumors are described according to their tissue type: nerve sheath tumors, adipocytic tumors, so-called fibrohistiocytic tumors, pericytic tumors, and vascular lesions. We also outline the imaging features of masses encountered in the hand and wrist., Competing Interests: None declared., (Thieme. All rights reserved.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

No official data exist on the status of musculoskeletal (MSK) radiology in Europe. The Committee for National Societies conducted an international survey to understand the status of training, subspecialization, and local practice among the European Society of Musculoskeletal Radiology (ESSR) partner societies. This article reports the results of that survey. An online questionnaire was distributed to all 26 European national associations that act as official partner societies of the ESSR. The 24 questions were subdivided into six sections: society structure, relationship with the national radiological society, subspecialization, present radiology practice, MSK interventional procedures, and MSK ultrasound. The findings of our study show a lack of standardized training and/or accreditation methods in the field of MSK radiology at a national level. The European diploma in musculoskeletal radiology is directed to partly overcome this problem; however, this certification is still underrecognized. Using certification methods, a more homogeneous European landscape could be created in the future with a view to subspecialist training. MSK ultrasound and MSK interventional procedures should be performed by a health professional with a solid knowledge of the relevant imaging modalities and sufficient training in MSK radiology. Recognition of MSK radiology as an official subspecialty would make the field more attractive for younger colleagues as well as attracting the brightest and best, an important key to further development of both clinical and academic radiology. KEY POINTS: · Standardized training and/or accreditation methods in the field of MSK radiology is lacking at a national level.. · With certification methods, such as the European diploma in musculoskeletal radiology, a more homogeneous European landscape could be created in the future with a view to subspecialist training.. · Recognition of MSK radiology as an official subspecialty would make the field more attractive for younger colleagues as well as attracting the brightest and best, an important key to further development of both clinical and academic radiology.., Competing Interests: None declared., (Thieme. All rights reserved.)

Purpose: The goal of this data challenge was to create a structured dynamic with the following objectives: (1) teach radiologists the new rules of General Data Protection Regulation (GDPR), while building a large multicentric prospective database of ultrasound, computed tomography (CT) and MRI patient images; (2) build a network including radiologists, researchers, start-ups, large companies, and students from engineering schools, and; (3) provide all French stakeholders working together during 5 data challenges with a secured framework, offering a realistic picture of the benefits and concerns in October 2018., Materials and Methods: Relevant clinical questions were chosen by the Société Francaise de Radiologie. The challenge was designed to respect all French ethical and data protection constraints. Multidisciplinary teams with at least one radiologist, one engineering student, and a company and/or research lab were gathered using different networks, and clinical databases were created accordingly., Results: Five challenges were launched: detection of meniscal tears on MRI, segmentation of renal cortex on CT, detection and characterization of liver lesions on ultrasound, detection of breast lesions on MRI, and characterization of thyroid cartilage lesions on CT. A total of 5,170 images within 4 months were provided for the challenge by 46 radiology services. Twenty-six multidisciplinary teams with 181 contestants worked for one month on the challenges. Three challenges, meniscal tears, renal cortex, and liver lesions, resulted in an accuracy>90%. The fourth challenge (breast) reached 82% and the lastone (thyroid) 70%., Conclusion: Theses five challenges were able to gather a large community of radiologists, engineers, researchers, and companies in a very short period of time. The accurate results of three of the five modalities suggest that artificial intelligence is a promising tool in these radiology modalities., (Copyright © 2019 Soci showét showé françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Dixon techniques are part of the methods used to suppress the signal of fat in MRI. They present many advantages compared with other fat suppression techniques including (1) the robustness of fat signal suppression, (2) the possibility to combine these techniques with all types of sequences (gradient echo, spin echo) and different weightings (T1-, T2-, proton density-, intermediate-weighted sequences), and (3) the availability of images both with and without fat suppression from one single acquisition. These advantages have opened many applications in musculoskeletal imaging. We first review the technical aspects of Dixon techniques including their advantages and disadvantages. We then illustrate their applications for the imaging of different body parts, as well as for tumors, neuromuscular disorders, and the imaging of metallic hardware., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Objective: The thymus plays a crucial role in immune system homeostasis. Thymic abnormalities have been reported in many autoimmune diseases, but data for systemic sclerosis (SSc) and rheumatoid arthritis (RA) are sparse. The aim of this study was to evaluate the prevalence and correlates of radiological incomplete involution of the thymus in SSc and RA patients, and in a non-autoimmune group of controls., Methods: All patients were at least 40 years old: 96 SSc patients (median age 59 years, 80% women) and 65 RA patients (median age 57 years, 88% women) were compared with 32 control individuals (median age 63 years, 62% women). Pulmonary CT-scans performed for lung assessment were available for all individuals. For the purpose of our study, complete involution of the thymus was defined as the absence of a residual thymus or a gland thickness, corresponding to the short axis on the axial slice, of less than 7 mm. We defined incomplete involution of the thymus as a residual thymic tissue more than 7 mm thick., Results: The frequency of incomplete thymus involution was significantly higher in SSc and RA patients (respectively 15 and 14%) than in the control group (0%; P<0.05). Incomplete thymus involution was associated with pulmonary restrictive syndrome in SSc patients, and with biotherapy and an absence of antinuclear antibodies in RA patients., Conclusion: Our findings show that two autoimmune diseases, SSc and RA, are associated with incomplete thymus involution., (Copyright © 2012 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.)

Pain on the ulnar side of the wrist is common among elite tennis players. Ten years of experience has allowed identification of a pathology involving the extensor carpi ulnaris (ECU) tendon. On the basis of 28 clinical cases seen over the last five years, three clinical patterns are described: (a) acute instability of the ECU; (b) tendinopathy; (c) ECU rupture. Each of these clinical entities requires a different therapeutic approach. A review of the relevant anatomy is provided.

We present three cases of finger distal interphalangeal joint reconstruction in children using a new donor site, the middle phalanx of the fifth toe, transferred as a non-vascularized graft. The patients were followed a minimum of 36 months with serial radiographs, magnetic resonance imaging and photographs. Alignment was improved and persisting growth was demonstrated in all cases. Postoperative magnetic resonance imaging of the grafted phalanx and control toe showed comparable signals. The absence of a proximal epiphysis of these toe phalanges may have an important role in their survival after free transplantation, and may promote continued growth.

Objectives: We assessed the influence of patient positioning and radiographic procedure, and defined a smallest detectable difference (SDD) in hip osteoarthritis (OA)., Methods: OA hip patients each had a standardized pelvic radiograph and, 5 min later, a modified pelvic radiograph with the feet internally rotated 5 degrees (part 1 of the study), the X-ray beam centred on the umbilicus (part 2), or another standardized pelvic radiograph (part 3)., Results: Corresponding mean differences in joint space width (JSW) measurements (limits of agreement) between views were +0.03 (-0.53 to +0.59), -0.31 (-1.15 to +0.53) and -0.02 (-0.48 to +0.44) mm. The two views differed significantly in mean JSW in part 2 of the study (P=1.6x10(-4)), but not in part 1 (P=0.375) and part 3 (P=0.580). The SDD estimate was 0.46 mm., Conclusions: Modifying the X-ray beam and foot rotation increases variability in JSW measurements. Use of urograms to evaluate radiological progression should be avoided. A change greater than 0.46 mm could define radiological hip OA progression.

Lumbar facet joint (LFJ) arthrography with intraarticular injections of long-acting steroids and local anesthetics is routinely used for therapeutic purposes in selected patients for relief of low back pain. The procedure may also be used for diagnostic reasons to establish the source of such pain. However, because direct access to the LFJ space is not always possible owing to degenerative changes such as osteophytes, another posterior approach has been proposed for LFJ arthrography. With the patient in the prone position, a spinal needle is inserted vertically into the inferior recess of an LFJ with fluoroscopic guidance and the patient under local anesthesia. To facilitate puncture, cushions are placed under the patient's abdomen to flatten normal lumbar lordosis, which enlarges the inferior recess of the LFJ. Use of cushions also results in a decrease in tissue thickness in the patient, thereby improving image quality and decreasing radiation exposure. LFJ arthrography can demonstrate the causative role of facet disease in abnormalities responsible for low back pain or sciatica and can be performed easily and rapidly with this direct posterior approach.

Objectives: (1) To assess reproducibility of medial knee joint space width (JSW) measurement in healthy subjects and osteoarthritic (OA) patients. (2) To define minimal relevant radiological change in knee JSW based on the reproducibility of its measurement., Patients and Methods: (1) Healthy volunteers: in the first part of the study, 20 knees of healthy adult volunteers were radiographed in the weightbearing, anteroposterior extended view, twice, two weeks apart, using three different radiographic procedures: (a) without guidelines, (b) with guidelines and without fluoroscopy, (c) with guidelines and fluoroscopy. (2) Knee OA patients: in the second part of the study, 36 knees of OA patients were radiographed twice with guidelines and without fluoroscopy. JSW was measured blindly using a graduated magnifying glass. Based on the Bland and Altman graphic approach, cut off points defining minimal relevant radiological change are proposed., Results: Standard deviation (SD) of differences in JSW measurement between two sets of knee radiographs in healthy subjects were 0.66 mm for radiography performed without guidelines, 0.37 mm for radiography performed with guidelines and without fluoroscopy, and 0.31 mm for radiography with guidelines and fluoroscopy. SD of differences in JSW measurement in OA patients were 0.32 mm for radiography performed with guidelines and without fluoroscopy. A minimal relevant change in JSW between two radiographs performed in healthy subjects can be defined by a change of at least 1.29 or 0.59 mm when radiographs are taken without guidelines, and with guidelines and fluoroscopy, respectively. When radiographs are taken with guidelines and without fluoroscopy, the change must be at least 0.73 mm. A similar figure, 0.64 mm was observed in knee OA patients., Conclusion: Definition of radiological progression varies greatly according to the radiographic procedure chosen. Use of guidelines reduces the threshold of progression required to consider that change between two measures is relevant.

OBJECTIVE: To determine whether belt wearing causes changes in lumbar posture and motion during standing and work-related activities. DESIGN: The lumbar spine sagittal kinematics of healthy subjects were assessed with an electrogoniometer during a dynamic test and continuous recording with and without a lumbar support. Correlation between data from electrogoniometer and X-ray was established in preliminary experiments. BACKGROUND: The effects of a lumbar support were previously investigated in few patients using radiological or invasive techniques under laboratory conditions, with special regard to the restriction of global motion in flexion and extension. Whether lumbar posture may also be involved during belt wearing remains unclear. There is also no evidence that these changes affecting lumbar motion and posture persist during prolonged activities. METHODS: The correlation between electrogoniometer and radiographic data was assessed in 12 subjects. Lumbar curve angles were evaluated in 15 healthy subjects, with and without one type of lumbar support, during standing in orthostatic, fully-flexed and fully-extended positions and during work-related activities with a portable computer. Lumbar motion parameters were flexion, extension and total range of motion. Lumbar posture parameters were lumbar curve angle in orthostatic position and mean lumbar curve angle during continuous recording. RESULTS: Electrogoniometric and radiographic data from lumbar curve angles and motion changes during flexion/extension of the spine were slightly different but reasonably well correlated (r = 0.58-0.77). The lumbar support decreased the mean total range of motion of the lumbar spine during a single flexion/extension movement by 17% and during continuous recording by 22%. The lumbar curve angle in the orthostatic position was reduced by 3 degrees and the mean lumbar curve (assessed by continuous recording) was reduced by 4 degrees (mean for 15 subjects). There were major individual changes in these two parameters and the reduction in lumbar curvature was correlated with the initial (r = 0.66-0.72). CONCLUSION: Electrogoniometer data on lumbar motion are reasonably well correlated with X-ray data. The comparative values registered during flexion/extension tests and continuous recording confirm that a support belt limits slightly global lumbar motion. As changes affecting postural parameters (orthostatic or mean values during continuous recording) depend on subject morphometry, individual parameters should be taken in account when evaluating and using a lumbar support.

The study of the cartilage is relatively easy with modern imaging. If the interpretation of MRI cartilage remains difficult arthro-CT images are easy to obtain. Arthro-CT is much preferable to simple arthrography. These two steps are in fact complementary: the global study of the joint is made with arthrography while the accurate assessment of cartilage is obtained with thin CT native slices acquired in an adapted plane and completed with reformatted images. The detection of small lesions, such as a faint thinning of the cartilage, or a focal fissure is only possible with a long and meticulous examination. The pathological value of the images still depends on the clinical examination, because of the high incidence of asymptomatic chondromalacia in elderly patients. The assessment of the cartilage overlying osteochondritis or osteochondral fractures is of particular clinical interest. The detection of post-traumatic cartilaginous lesions may also be valuable in medicolegal problems.

Tumours of the nail apparatus are often the subject of diagnostic dilemma. Until now, no reliable imaging methods have been available to assess these lesions correctly. We report the results of high and very high-resolution magnetic resonance imaging (MRI), which have been correlated with the anatomical findings in 14 cases of nail apparatus pathology, and discuss the possible contribution of MRI to diagnosis. With very high-resolution MRI, accurate analysis of the anatomy of the nail apparatus is possible, and lesions as small as 1 mm can be detected. An expansive process can be excluded when results are negative. Glomus tumour, mucoid pseudocyst, fibrokeratoma, and exostosis can be differentiated because of their different MRI characteristics. This is of importance when the exact nature of a subungual tumour cannot be determined by clinical findings alone. Measurement, determination of the exact localization of the tumour, and the study of its relationship to the other structures, can provide guidance for subsequent surgical procedures. MRI is reliable and accurate in the delineation of lesions, and provides a new tool for the investigation of pathology of the nail apparatus.

This retrospective study included eight patients with villonodular synovitis of the knee (7 nodular forms and one villous form) who underwent magnetic resonance imaging and at least one arthroscopy. Joint enlargement and mild pain were the main manifestations. Other imaging studies provided little information. Magnetic resonance imaging showed highly suggestive hemosiderin-laden masses. Hemosiderin was most clearly seen on gradient echo sequences. Magnetic resonance imaging was also useful for determining the distribution of lesions. Intravenous gadolinium provided no additional information. Arthroscopy allowed to collect biopsy specimens and to perform synovectomy when called for. In our opinion, after a physical examination and plain roentgenograms, magnetic resonance imaging and arthroscopy should both be performed to determine the extent of lesions and to allow histological diagnosis and synovectomy, respectively.

For many years now percutaneous techniques have proved effective in the curative treatment of lumbar disc herniation, mostly in young subjects. This technique, however, is seldom indicated, let alone performed, in the cervical spine for a variety of reasons: a) the neck contains several closely arranged structures such as the vasculo-nervous bundles, the airway-digestive tract and the cervical spine around the spinal cord; b) the disc is approached by the anterior route, in contrast with the lumbo-sacral spine where the approach is posterolateral; c) the manufacturers insist on restrictions in the use of chymopapain in view of the potential risk of spinal cord damage, either by possible breaks in the meninges of by accidental diffusion of the enzyme into perimedullary epidural structures which support a particularly developed venous plexus; d) legal protection may be denied to operators who perform cervical chemonucleolysis, since the product has not yet been officially authorized, in France and perhaps elsewhere*, for treatment of cervical disc herniation. Several years of experience in the practice of cervical nucleolysis have convinced the authors that this method is remarkably effective and can be used in the treatment of cervicobrachial neuralgia (CBN) occurring in young subjects. Radiculalgia is essentially due to a disc fragment being positioned within the vertebral canal or a foramen, thereby compressing the nerve roots. During several years microsurgery of the disc has been effective in the treatment of refractory radiculalgia, and to compete with this procedure familiar to neurosurgeons cervical nucleolysis must convincingly demonstrate that its therapeutic value is at least as good as that of surgery. Finally, the vast majority of cervical disc herniations is made up of free disc fragments located within the meshes of the posterior longitudinal ligament of the spine (transligamentous fragment). Cervical nucleolysis was introduced in France by Bonafe and Lazorthes made enthusiastic by their first studies, and the idea of this procedure, developed by a radio-neurosurgical team, has gradually been gaining ground. The decision to intervene is made when the radiculalgia is recurrent or resistant to a well-conducted medical treatment of several weeks duration. Therefore all disc herniations that would have been treated surgically can be treated by injection of an enzyme. This point is very important, and in fact the well-codified and effective surgical procedure has progressively been abandoned by the operators, in view of the simplicity of nucleolysis and the rapid pain relief it procures.(ABSTRACT TRUNCATED AT 400 WORDS)

The authors have attempted to establish by MRI morphological criteria for the so-called "aggressive" intracranial meningiomas. The MRI features of 20 meningiomas histologically aggressive (numerous mitoses and small necrotic foci) or malignant (same plus invasion of the subjacent brain tissue) were compared with those of a control population of 26 patients with benign meningioma. The site of the tumour and its histological type had little predictive value, but there was a remarkably high proportion of male patients in the group with aggressive meningioma (9/20 versus 2/26). More than other varieties, aggressive meningiomas frequently emitted, on both T1- and T2-weighted sequences, a heterogeneous signal due to a necrotic focus (P less than 0.01). The high-intensity signal observed on T2-weighted sequences (11/20) was suggestive of syncitial or angioblastic meningioma. Cystic meningiomas were present in virtually equal proportions (3/20 versus 3/26) in the two populations and could raise problems concerning the diagnosis of nature, especially when intraventricular. Gadolinium injection provided further evidence of aggressiveness, such as irregular tumour outline or even contrast enhancement of brain tissue in malignant cases (3/4), but enhancement of the dura mater was equally frequent in both groups (P greater than 0.2). Massive peritumoral oedema was significantly more frequent in aggressive melanomas (P less than 0.01).

Thirty two patients with confirmed Crohn's disease were examined from october 1983 to may 1985 by ultrasound (42 examinations) and by Conventional Contrast Radiology (Barium Contrast Studies). The well-know "target" pattern is the most frequent feature (88%) which is characteristic of the thickening bowel wall. The thickening is more important for the small bowel wall than the large bowel wall. But the "target" pattern is not the single pattern of inflammation involving the bowel. We also find a "rosette" pattern. This third ring is hypo or hyperechogenic or more complex. Other infrequent features are noted: solid abdominal masses, distended loops, luminal narrowing, fistula and stiffness. Because sonography is noninvasive and simple to perform without radiation exposure, it must often be used as the initial diagnostic tool and as the follow-up test for young people.

The authors report two cases of primary malignant melanoma. These primary neoplasms are exceptional on the GI tract. The diagnostical problems are discussed. The radiological features are a nodular lesion like an under-mucosa tumor.

Chordoma of base of skull is a rare tumor in children. The case reported was atypical by its slow course, the initial clinical signs resulting from the development of the tumoral process in the posterior fossa at the level of the petrous and pontocerebellar angle. Neuro-ophthalmologic manifestations appeared at a late stage only.

The authors report their findings in a series of 51 patients suffering from typical cervical radiculopathy. With the aid of the CT scanner and intravenous injection of a contrast medium, the quality and resolution of the resulting images allowed neurosurgical intervention in 42 patients in whom the symptomatology alone was not sufficiently informative to allow successful treatment. In most cases the CT images allowed an accurate diagnosis and revealed a free fragment that had torn the common posterior vertebra ligament.

During seven years, 212 small bowel examinations are made on patients with suspected small bowel obstruction by barium infusion. We find all the main small bowel pathology: Crohn's disease (16.5%), carcinomatosis (14.6%), neoplasia (10.3%), vascular disease (17.8%), actinic enteritis (9.5%) and miscellanous (18%). The small bowel infusion is normal in 15%. Surgery is avoided in 51% of the cases. There is non complications associated with the examination but in 12% of the cases, the examination is unsuccessful.