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Scoliosis is a common orthopedic problem in patients with neurofibromatosis 1 (NF1). Spinal deformities are found in 77% of all NF1 cases, with no widely accepted etiology. This study aimed to evaluate the frequency and types of scoliosis in NF1 patients using whole-body magnetic resonance imaging and to assess the association of intraspinal and paraspinal tumors with the imaging findings of scoliosis.A total of 122 NF1 patients with whole-body magnetic resonance imaging were found from the electronic medical records. Ninety-seven cases that met the inclusion criteria were identified. All patients underwent 3-T magnetic resonance imaging with automated software fusion of the 3 sets of short TI inversion recovery and 3-dimensional T1-weighted coronal images. Frequency and location of scoliosis and intraspinal and paraspinal tumors were recorded. Patients with severe dystrophic-type scoliosis were separately identified, and Cobb angles were measured for all such cases. Association analysis was performed. A P value less than 0.05 was considered statistically significant.Ninety-seven patients with NF1 were evaluated. Two had prior spinal surgery and were excluded. The final sample of 95 patients included 33 (35%) men and 62 (65%) women with a mean ± SD body mass index of 25.82 (4.96) kg/m2. Of the 95 patients, 43 (45.3%) had scoliosis, 13 of 43 (30.2%) of which were severely angled. Of the 95 patients, 25 (26.3%) had locoregional tumor presence. Intraclass correlation for Cobb angles measured 0.99 (confidence interval, 0.98-1.0). Fisher exact test determined no association between scoliosis and presence of either paraspinal or intraspinal tumors (P = 0.485). There was also no association between the tumors and severe dystrophic scoliosis (P = 1.0).This study found no association between the presence of locoregional spinal tumors and scoliosis in NF1 patients. This work adds to the body of knowledge of scoliosis in NF1 patients and infers that presence of scoliosis should not mandate immediate search for locoregional spinal tumors.

OBJECTIVE To develop and validate an Osseous Tumor Reporting and Data System (OT-RADS) with the hypothesis that the proposed guideline is reliable and assists in separating benign from malignant osseous tumors with a good area under the curve, and that could assist further patient management. METHODS In this multireader cross-sectional validation study, an agreement was reached for OT-RADS categories based on previously described magnetic resonance imaging features and consensus of expert musculoskeletal radiologists. World Health Organization classification was used, and a wide spectrum of benign and malignant osseous tumors was evaluated. Magnetic resonance imaging categories were as follows: OT-RADS 0-incomplete imaging; OT-RADS I-negative; OT-RADS II-definitely benign; OT-RADS III-probably benign; OT-RADS IV-suspicious for malignancy or indeterminate; OT-RADS V-highly suggestive of malignancy; and OT-RADS VI-known biopsy-proven malignancy or recurrent malignancy in the tumor bed. Four blinded readers categorized each tumor according to OT-RADS classification. Intraclass correlation (ICC) and Conger κ were used. Diagnostic performance measures including area under the receiver operating curve were reported. Osseous Tumor Reporting and Data System was dichotomized as benign (I-III) and malignant (IV and V) for calculating sensitivity and specificity. RESULTS Interreader agreement for OT-RADS (ICC = 0.78) and binary distinction of benign versus malignant (κ = 0.67) were good to excellent, while agreement for individual tumor feature characteristics were poor to fair (ICC = 0.25-0.36; κ = 0.16-0.39). The sensitivities, specificities, and area under the receiver operating curve of the readers ranged from 0.93-1.0, 0.71-0.86, and 0.92-0.97, respectively. CONCLUSIONS Osseous Tumor Reporting and Data System lexicon is reliable and helps stratify tumors into benign and malignant categories. It can be practically used by radiologists to guide patient management, improve multidisciplinary communications, and potentially impact outcomes.

PURPOSE: We assessed the prevalence of low bone mineral density (BMD) in oncologic patients undergoing F-18-FDG-PET/CT. MATERIALS AND METHODS: Retrospective analysis of 100 patients who underwent F-18-FDG-PET/CT at a single center from October 2015 till May 2016. Quantitative computed tomography (QCT) was used to assess BMD at the lumbar spine (BMD(QCT)) and femoral necks (BMD(CTXA)). SUV(max) was used to evaluate metabolic activity of the bone marrow. Risk of osteoporosis-related fractures was calculated with femoral neck BMD(CTXA) and the FRAX® algorithm, which was compared against measurements of CT attenuation of the trabecular bone at L1 (L1(HU)). RESULTS: Osteoporosis/osteopenia were respectively present in 16%/46% of patients ≥ 50 years old. Bone marrow SUV(max) was correlated with BMD at the lumbar spine (ρ=0.36, p

Retrospective clinical case series.To study the role of magnetic resonance neurography (MRN) of the lumbosacral plexus in management of patients with failed back surgery syndrome (FBSS).FBSS is one of the major problems in health care, affecting up to 40% of patients after spine surgery. To date, no imaging modality has been used to effectively classify nerve compression, because nerve injuries are challenging to detect on conventional lumbar spine magnetic resonance imaging (MRI). To our knowledge, no previous studies have addressed the use of MRN in FBSS or compared it to lumbar spine MRI.From 203 consecutive 3 T MRN studies of lumbosacral plexus in 1 year, 12% (25/203) presented as FBSS. Demographic data, number of previous lumbar MRIs and their findings, MRN findings, interval between MRI and MRN, pre-and post-MRN diagnosis, pain levels, and treatments were recorded. Changes in diagnosis, treatment, and outcomes after MRN were determined.The final sample of 25 patients had a mean age 62 ± 15 and male to female ratio 1:1.08. Approximately 88% (22/25) had previous lumbar MRI, of which 27% had 3 or more. Most common imaging findings were neuroforaminal stenosis 22.6% (7/31) on MRI and neuropathy 22.9% (19/83) on MRN. Mean interval between MRI and MRN was 13.9 ± 28.3 months. Lumbar MRIs were inconclusive in 36% (8/22). MRN detected 63% (52/83) more findings and changed the diagnosis and treatment in 12% and 48% of FBSS cases, respectively. Favorable outcomes were recorded in 40% to 67% of patients following MRN-guided treatments.FBSS is a complex problem and MRN of lumbosacral plexus impacts its management by better directing source of symptoms.4.

Incidence of chronic postoperative neurogenic pain after open and laparoscopic trunk operations is reported between 1 and 20 percent, rendering a large population in the United States and worldwide. One possible treatment is selective surgical neurectomy.All patients who underwent neurectomy for chronic trunk or groin postoperative neurogenic pain were identified. Based on individual history and examination, patients underwent neurectomies of the ilioinguinal, iliohypogastric, genitofemoral, lateral-femoral cutaneous, or intercostal nerves. Recorded preoperative pain levels (Likert score ranging from 0 to 10) were compared to postoperative pain levels and quality-of-life indices were assessed.Fifty-six patients (32 men and 24 women) were included. Mean age was 49 years. All patients underwent preoperative nerve blocks by either surgeon, radiologist, or referring physician, and had either complete or significant response defined as over 50 percent relief. Forty-five patients completed the survey. Median follow-up was 2.8 years (range, 1.0 to 5.7 years). Average pain level was 9.0 preoperatively and 3.5 postoperatively. Quality-of-life impairment improved from 8.3 preoperatively to 3.5 postoperatively. A subset of patients (n = 12) had minimal improvement, reporting a decrease in pain from 8.5 to 7.2 and quality-of-life improvement from 8.5 to 7.1.Complete avoidance of nerve injury during all trunk and groin operations is likely unattainable. When chronic postoperative neurogenic pain develops, neurectomy can be an effective means of treatment, significantly improving pain and quality of life in most patients. Better insight is necessary into a patient subset responding to nerve blocks yet experiencing minimal postoperative improvement.Therapeutic, IV.

Objective This study aimed to investigate whether patellofemoral T2 cartilage changes are associated with lateral patellofemoral friction syndrome (PFS), as indicated by an edema-like signal within the superolateral infrapatellar (Hoffa) fat pad. Methods In this institutional review board-approved retrospective study of 510 consecutive patients, 49 patients with 50 knee magnetic resonance imaging examinations demonstrating normal or low-grade patellofemoral cartilage abnormalities (whole-organ magnetic resonance imaging score [WORMS] score, ≤2) were included. Twenty-two examinations with PFS (cases) were compared with an age- and sex-matched cohort of 28 examinations without PFS (controls). A 3-T magnetic resonance imaging was performed with multi-echo, spin-echo T2 mapping. Two readers measured in consensus malalignment parameters, including patellar height index, tibial tuberosity to trochlear groove distance, and sulcus angle. Bulk T2 cartilage values in the lateral and medial patellofemoral compartment, central weight-bearing medial and lateral femoral condyles were measured independently. Interobserver agreement was quantified using concordance correlation coefficients. Demographics, anatomic measurements, whole-organ magnetic resonance imaging scores, and cartilage T2 values were compared between cases and controls using Fisher exact test, Wilcoxon rank sum test, and mixed-effects models. Results Cases demonstrated higher patellar height index (P = 0.002) and tibial tuberosity to trochlear groove distance (P = 0.02). Interobserver agreement for T2 values was good overall (concordance correlation coefficient range, 0.65-0.93). Cases demonstrated higher medial facet patellar bulk T2 (38.1 [7.5] ms) versus controls (33.6 [7.3] ms) (P = 0.02); otherwise, there were no significant differences in regional T2 values. Conclusions T2 mapping in patients with PFS demonstrates increased cartilage T2 in the medial patellar facet, possibly reflecting collagen alteration from early chondromalacia (softening) or increased water content related to altered contact pressures.

The authors described 2 cases of pisotriquetral instability, which were diagnosed in patients presenting with ulnar wrist clicking and pain. The diagnosis was made first using 4-dimensional computed tomography, which helped further interventions and management in both patients.

OBJECTIVE To examine diagnostic accuracy of semiquantitative and qualitative magnetic resonance neurography criteria in common peroneal nerve (CPN) neuropathy. MATERIALS AND METHODS Institutional review board approval was obtained with a waiver of informed consent for this Health Insurance Portability and Accountability Act-compliant retrospective study. A review of 28 knees in 28 subjects (12 males and 16 females; age range, 13-84 years; mean [SD] age, 42 [20] years) who had undergone magnetic resonance neurography of the knee was performed. Thirteen patients who had a final diagnosis of CPN were classified as cases, and 15 patients who lacked a final diagnosis of CPN neuropathy were classified as controls. Morphological characteristics of the CPN, including nerve T2 signal intensity, nerve size, nerve course, fascicles morphology, regional muscle edema, and fatty infiltration, and an overall assessment of the CPN as being normal or abnormal were evaluated by 2 independent radiologists blinded to the clinical history. Overall sensitivity, specificity, and accuracy compared against our reference standards were expressed as percentages. Interobserver agreements were assessed using linear weighted κ statistics. RESULTS Common peroneal nerve T2 signal abnormality had the highest sensitivity (77%) in identifying CPN neuropathy. Except for T2 signal abnormality, overall specificity for the nerve morphological parameters and muscle denervation change assessed was fairly high, ranging from 94% to 100%. The consensus accuracy ranged from 68% to 79% for the morphological characteristics assessed. The interobserver reproducibility was very good (k = 0.90 to 0.91) for assessment of regional muscle denervation changes and moderate (k = 0.46 to 0.59) for morphological CPN characteristics. CONCLUSION Magnetic resonance neurography is a useful modality in supplementing the diagnosis of CPN. Using predefined classification criteria helps standardize the morphological criteria of CPN neuropathy diagnosis.

Magnetic resonance imaging (MRI) remains the imaging modality of choice for morphological and compositional evaluation of the articular cartilage. Accurate detection and characterization of cartilage lesions are necessary to guide the medical and surgical therapy and are also critical for longitudinal studies of the cartilage. Recent work using 3.0-T MRI systems shows promise in improving detection and characterization of the cartilage lesions, particularly with increasing use of high-resolution and high-contrast 3-dimensional sequences, which allow detailed morphological assessment of cartilage in arbitrary imaging planes. In addition, implementation of biochemical sequences in clinically feasible scan times has a potential in the early detection of cartilage lesions before they become morphologically apparent. This article discusses relative advantages and disadvantages of various commonly used as well as experimental MRI techniques to directly assess the morphology and indirectly evaluate the biochemical composition of the articular cartilage.

We describe interesting imaging features on a FDG-PET scan in a patient with bony metastases from a rare tumor. The lesions were obscured by intense bone marrow activity after the administration of hematopoietic factor at the time of diagnosis. Correlative MRI, CT scan, and pathology findings have also been illustrated. Follow-up FDG-PET scan demonstrated the hypermetabolic lesions.