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Fat suppression technique is a valuable resource in musculoskeletal magnetic resonance (MR) imaging that is helpful in the diagnosis and differentiation of various pathologies. Multiple different techniques are available for fat suppression, including frequency selective pulse sequence, inversion recovery, hybrid technique, chemical shift imaging (CSI) and the related Dixon based approach. The utility of CSI and Dixon approach is not well recognized in the domain of musculoskeletal MR imaging. The aim of this article is to review the various options for fat suppression and present focused discussion of the role of CSI and Dixon techniques for musculoskeletal MR imaging.

Extra- and intraneural ganglion cysts have been described in the literature. The tibial nerve ganglion is uncommon and its occurrence without intra-articular extension is atypical. The pathogenesis of cystic degeneration localized to connective and perineural tissue secondary to chronic mechanical irritation or idiopathic mucoid degeneration is hypothesized. Since the above pathology is extremely rare and the magnetic resonance imaging examination detects the defining characteristics of the intrinsic alterations of the tibial nerve, the authors illustrate such a case of tibial intaneural ganglion cyst with its magnetic resonance neurography and sonography appearances.

Chronic pelvic pain can result from various intra- and extra-pelvic etiologies. Although patient history and physical examination may narrow the differential diagnosis, frequently, the different etiologies have overlapping presentations. Imaging examinations such as US and/or MR imaging may help delineate the cause of pain, particularly when related to intra-pelvic organs, pelvic floor dysfunction or prolapse, synthetic material such as pelvic mesh or slings, and in some cases of neuropathic pain. Etiologies of neuropathic pain can also be assessed with non-imaging tests such as nerve conduction studies, electromyography, and testing of sacral reflexes.

Superior capsular reconstruction (SCR) is a novel technique for treating irreparable rotator cuff tears in younger patients in whom a reverse total shoulder arthroplasty is not the optimal treatment choice. This case study describes a middle-aged male with a recurrent, massive, irreparable rotator cuff tear treated with SCR that subsequently failed at the glenoid attachment. The patient underwent successful arthroscopic revision of the SCR. The case illustrates the MRI and arthroscopic correlations of the failed dermal allograft reconstruction, which to our knowledge has not been previously shown in the radiology literature.

Magnetic resonance neurography (also called MRN or MR neurography) refers to MR imaging dedicated to the peripheral nerves. It is a technique that enhances selective multiplanar visualisation of the peripheral nerve and pathology by encompassing a combination of two-dimensional, three-dimensional and diffusion imaging pulse sequences. Referring physicians who seek imaging techniques that can depict and diagnose peripheral nerve pathologies superior to conventional MR imaging are driving the demand for MRN. This article reviews the pathophysiology of peripheral nerves in common practice scenarios, technical considerations of MRN, current indications of MRN, normal and abnormal neuromuscular appearances, and imaging pitfalls. Finally, the emerging utility of diffusion-weighted and diffusion tensor imaging is discussed and future directions are highlighted. • Lesion relationship to neural architecture is more conspicuous on MRN than MRI. • 3D multiplanar imaging technique is essential for pre-surgical planning. • Nerve injuries can be classified on MRN using Sunderland’s classification. • DTI provides quantitative information and insight into intraneural integrity and pathophysiology.

Peroneal tendon pathology is an important cause of lateral ankle pain and instability. Typical peroneal tendon disorders include tendinitis, tenosynovitis, partial and full thickness tendon tears, peroneal retinacular injuries, and tendon subluxations and dislocations. Surgery is usually indicated when conservative treatment fails. Familiarity with the peroneal tendon surgeries and expected postoperative imaging findings is essential for accurate assessment and to avoid diagnostic pitfalls. Cross-sectional imaging, especially ultrasound and MRI provide accurate pre-operative and post-operative evaluation of the peroneal tendon pathology. In this review article, the normal anatomy, clinical presentation, imaging features, pitfalls and commonly performed surgical treatments for peroneal tendon abnormalities will be reviewed. The role of dynamic ultrasound and kinematic MRI for the evaluation of peroneal tendons will be discussed. Normal and abnormal postsurgical imaging appearances will be illustrated.

Inflammatory arthropathy predominantly affecting the axial skeleton can cause pain, stiffness, disability, and ankylosis. This article discusses the use of cross-sectional imaging in the domain of inflammatory pelvic and axial arthropathy highlighting the key distinguishing features of common known diseases and their differential diagnoses.

Chronic pelvic pain syndrome is commonly caused by nerve injury, inflammation, or entrapment. Owing to the complex anatomy and branching patterns of pelvic nerves, pelvic neuropathies are often difficult to illustrate and diagnose. High-resolution 3-T magnetic resonance neurography is a promising technique for the evaluation of peripheral neuropathy. In this article, the authors discuss the normal anatomy of major pelvic nerves, technical considerations of high-resolution imaging, and normal and abnormal imaging appearances with relevant case examples.

The purpose of this work is to simulate radiographs from isotropic 3D MRI data, compare relationship of angle and joint space measurements on simulated radiographs with corresponding 2D MRIs and real radiographs (XR), and compare measurement times among the three modalities. Twenty-four consecutive ankles were included, eight males and 16 females, with a mean age of 46 years. Segmented joint models simulating radiographs were created from 3D MRI data sets. Three readers independently performed blinded angle and joint space measurements on the models, corresponding 2D MRIs, and XRs at two time points. Linear mixed models and the intraclass correlation coefficient (ICC) was ascertained, with p values less than 0.05 considered significant. Simulated radiograph models were successfully created in all cases. Good agreement (ICC > 0.65) was noted among all readers across all modalities and among most measurements. Absolute measurement values differed between modalities. Measurement time was significantly greater (p

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.

The maxillofacial region is complex in its anatomy and in its variation in the presentation of neurologic disorders. The diagnosis and management of neurologic disorders in clinical practice remains a challenge. A good understanding of the neurologic disorder in its entirety helps dentists in the diagnosis and appropriate referral to a specialist for further investigations and management of the condition. Neurologic disorders described in this article are under broad categories of sensory and motor disturbances as well as movement disorders and infections. This article summarizes the most common maxillofacial neurologic disorders that dentists might encounter in clinical practice.

Purpose Axial spondyloarthritis (SpA) is a group of diseases with temporally disseminated symptoms and clinical signs, which render the diagnosis challenging. Laboratory and MRI findings are used in addition for confirming the diagnosis and evaluation of disease activity. The purpose of this study was to evaluate clinically suspected axial SpA to determine the technical success of a multiparametric and 3D rheumatology lumbosacral MR imaging (MRLI) protocol and to assess the disease distribution, inter-reader reliability, and impact on patient management. Methods A consecutive series of patients with clinical suspicion of axial SpA were included. Two rheumatologists recorded the clinical findings and disease activity on a confidence scale before and after MRLI. Two musculoskeletal (MSK) radiologists read the imaging data including enthesitis, arthritis, osseous lesions, ADC values, and enhancement. Prevalence-adjusted and bias-adjusted kappa (PABAK), ICC and Fisher exact test were calculated. Results There were 41 patients including 31 females and 10 males with ages of 41 ± 10 and 41 ± 12 (mean ± SD), respectively. The spine T2W imaging received the highest quality scores followed by whole abdomen-pelvis 3D-T2W imaging, 3D-CEMR (contrast-enhanced MRI), and DWI. On spine imaging, acute and chronic lesions of lumbar spine and sacroiliac joints were seen in 4/41, 18/41 and 6/41, and 27/41 of the patients, respectively. Several additional enthesopathy lesions were seen on the whole abdomen-pelvis 3D sequence. ADC value of bone lesions was different 0.95 ± 0.23 (mean ± SD) than normal bone (0.20 ± 0.1). PABAK for acute and chronic findings ranged 0.70–1.0 and 0.41-0.51, respectively. Imaging changed the diagnosis in 17 of 41 patients. No association was noted with respect to treatment change (p = 1) or clinical response (p = 0.2). Conclusion Multiparametric lumbosacral MR imaging is a technically successful modality to identify multiple spinal and additional extraspinal sites of involvement in SpA, which are helpful in establishing the diagnosis of axial SpA. Larger patient population study is warranted to evaluate further impact on the treatment efficacy.

Purpose: To evaluate interreader performance in the measurement of the cross-sectional area and myosteatosis of pelvic skeletal muscles using fat quantification magnetic resonance imaging (MRI) and correlate with patient anthropomorphic characteristics. Materials and Methods: A Health Insurance Portability and Accountability Act–compliant retrospective cross-sectional study was performed. Between January and April 2016, 61 patients (26 males and 35 females) underwent a lumbosacral plexus 3T MRI with a modified three-dimensional spoiled gradient echo sequence dedicated to fat quantification (mDixon Quant; Philips Healthcare). Two independent reviewers outlined muscle cross-sectional area on axial images using a freehand region of interest tool and documented proton-density fat fraction (FF) and muscle area (cm2) of the psoas, gluteus medius, gluteus maximus, and rectus femoris muscles on each side. Interreader agreement was assessed by intraclass correlation coefficient (ICC), and correlation between the measurements and subject’s age, gender, and body mass index (BMI) was assessed using multiple linear regression analysis. Results: Excellent interreader agreement was obtained (ICC ≥0.74) for all muscle groups except for the left gluteus medius area and right psoas FF which showed good agreement (0.65 and 0.61, respectively). Statistically significant (P ≤ 0.05) positive correlation was seen between the gluteal muscle FF and area with BMI, and rectus muscle FF with age and BMI. Statistically significant negative correlation between the rectus femoris area and age was also observed. Conclusion: Fat quantification MRI is a highly reproducible imaging technique for the assessment of myosteatosis and muscle size. Intramuscular FF and cross-sectional area were correlated with age and BMI across multiple muscle groups.

Hallux valgus is a common condition estimated to affect as many as 23% of adults. The condition is associated with a variety of debilitating symptoms leading to significant morbidity and quality of life issues. Proper evaluation of this deformity and the timely management of its symptoms can improve hallux valgus-related symptomatology and quality of life. The most commonly used and readily reproduced measurements for assessing hallux valgus are the inter-metatarsal angle and the hallux valgus angle. These angles are helpful for choosing and planning surgical intervention for patients who fail initial conservative measures with distal osteotomies reserved for mild or moderate hallux valgus and proximal osteotomies indicated for more moderate to severe deformities. After reading this review article, readers will gain knowledge of the etiopathogenesis of hallux valgus, measurement parameters, and treatment strategies with representative case examples.

Magnetic resonance imaging (MRI) is the recommended diagnostic imaging technique for diabetic foot osteomyelitis (DFO). The gold standard to diagnose osteomyelitis is bone biopsy with a positive culture and/or histopathology finding consistent with osteomyelitis. The purpose of this study is to assess the accuracy of MRI readings in biopsy-proven diabetic foot osteomyelitis with a second read done by a blinded, expert musculoskeletal radiologist. A retrospective chart review of 166 patients who received a bone biopsy to confirm the diagnosis of a suspected DFO at a large county hospital between 2010 and 2014. A second, blinded musculoskeletal radiologist reviewed the images for accuracy, once the official reading was recorded. Imaging results were correlated with the final diagnosis of osteomyelitis determined by bone biopsy. In 17 of 58 patients (29.3%), the diagnosis of DFO by MRI was not confirmed by bone biopsy. There were 12 false positives and 5 false negatives. After the second expert read, there were 5 false positives and 4 false negatives. The overall accuracy was 84% for the second read. Our study demonstrated results comparable to the previously reported meta-analysis findings. There is a clear variation on the read of MRI that could lead to an incorrect diagnosis of DFO. An integrated approach with evaluation of clinical findings, communication with radiologist about the MRI results when indicated, and bone biopsy is warranted for accurate diagnosis management of DFO.

Pediatric musculoskeletal tumors comprise approximately 10% of childhood neoplasms, and MR imaging has been used as the imaging evaluation standard for these tumors. The role of MR imaging in these cases includes identification of tumor origin, tissue characterization, and definition of tumor extent and relationship to adjacent structures as well as therapeutic response in posttreatment surveillance. Technical advances have enabled quantitative evaluation of biochemical changes in tumors. This article reviews recent updates to MR imaging of pediatric musculoskeletal tumors, focusing on advanced MR imaging techniques and providing information on the relevant physics of these techniques, clinical applications, and pitfalls.

Magnetic resonance neurography (MRN), also known as MR neurography, is a dedicated imaging technique for the peripheral nerves, used both in a clinical setting and research. However, like any other new diagnostic processes, there are technical, cost, and patient selection issues to overcome as well as potential imaging pitfalls to recognize before MRN can be adopted efficiently into routine clinical practice. This review focuses on the 10 most important practical tips to get started with MRN with a view to shortening the time needed for radiologists to implement this clinically useful technique into their imaging practices.

Professional organizations recommend against repeat radiographs for routine follow-up of osteoarthrosis. However, clinics frequently obtain radiographs during or before the clinical visit. The purpose of our project was to determine the baseline frequency of unnecessary knee radiographs and whether educational interventions can reduce this frequency. This QI project was exempt from IRB review. Radiology reports of knee radiographs were searched in our database filtered by presence of the words “severe”, “degenerative”, “osteoarthritis”, and similar variants. We reviewed 500 consecutive corresponding medical records to confirm the presence of severe osteoarthritis, and presence of a repeat radiograph within 6 months. Indications for repeat radiographs were determined. Repeat radiographs were counted as “non-indicated” when medical records revealed no new symptoms. A focused educational intervention was provided to the orthopedic and family practice departments. An additional 500 radiology reports were evaluated 9 months after intervention in the same manner and the rate of non-indicated radiographs was calculated. Follow-up review of additional 500 radiology reports at 1-year time point was performed. Our initial search returned 1517 reports. Upon evaluation of 500 studies, there were 112/500 repeat radiographs (22%); 77/500 (15%) of knee radiographs were not indicated. Upon initial follow-up evaluation of 500 studies, there were 52/500 repeat radiographs (10%) and 40/500 (8%) radiographs were not indicated. The reduction of unnecessary repeat knee radiographs rate was sustained at 1 year. Focused educational intervention results in a substantial (50%) reduction of the number of unnecessary repeat knee radiographs in patients with known severe OA.

A single ADC value is used in clinical practice on multi b-value acquisitions. Low b-value acquisitions are affected by intravoxel incoherent motion, which is dependent on perfusion. Giant cell tumors (GCTs) are known to exhibit early arterial enhancement and low ADC values. Mean, minimum and fractional ADC characteristics of osseous and tenosynovial GCTs are systematically evaluated. Tenosynovial and osseous GCTs were included. Each lesion was evaluated on conventional MRI and DWI by two musculoskeletal radiologists. ADC was measured by placing an ROI on the most confluent enhancing portion of the lesion. Fractional and best fit ADC calculations were performed using MATLAB software. No statistically significant difference was found between tenosynovial and osseous lesions’ ADC values. Mean ADC for all lesions was 1.0 × 10−3 mm2/s (SD = 0.2 × 10−3 mm2/s) and minimum ADC was 0.5 × 10−3 mm2/s (SD = 0.3 × 10−3 mm2/s). Average mean ADC value obtained from B50–B400 slope was 1.1 × 10−3 mm2/s (SD = 0.2 × 10−3 mm2/s), and the average mean ADC value obtained from B400–B800 slope was 0.8 × 10−3 mm2/s (SD = 0.1 × 10−3 mm2/s) [p-value

To analyze regional muscle CT density and bulk in femoroacetabular impingement (FAI) and hip dysplasia (HD) versus controls. Patients who obtained perioperative CT imaging for FAI and HD before surgery were retrospectively studied. Asymptomatic controls included for comparison. Two readers independently evaluated regional hip muscle [iliopsoas (IP), rectus femoris (RF), gluteus minimus (Gm), and medius (GM)] density, muscle area, and muscle circumference. Inter-observer reliability calculated using intra-class correlation coefficient (ICC). A consecutive series of 25 FAI patients, 16 HD patients, and 38 controls were recruited in the study. FAI patients had significantly greater Gm and GM circumferences as well as greater RF and IP areas on the normal side compared to the asymptomatic control group (p values 0.004, 0.032, 0.033, and 0.028, respectively). In addition, Gm and RF circumferences and RF area were significantly larger (p values 0.029, 0.036, and 0.014, respectively) in FAI patients on the affected side compared to the control group. HD patients had significantly smaller Gm and GM circumferences on the affected side than normal side measurements in FAI group (p values 0.043 and 0.003, respectively). Normal side GM circumference was also smaller in HD patients than normal side FAI hips (p value 0.02). There was no significant difference between the measurements on normal and abnormal sides in each disease group. No significant difference was found between measurements of HD compared to controls (p > 0.05). No muscle density differences were seen among different groups. There was moderate to excellent inter-reader reliability for all measurements except Gm muscle density. Muscle analysis was able to quantify differences among patients with FAI, HD, and asymptomatic controls. These changes could indicate either a muscle imbalance contributing to the pathology or disuse atrophy, which may have implications for specific muscle-strengthening therapies and rehabilitation procedures in such patients.

Chronic neuralgia of the border nerves (ilioinguinal, iliohypogastric, and genitofemoral) is difficult to diagnose and treat clinically. We examined the role of MR neurography (MRN) in the evaluation of border nerve abnormalities and the results of treatments directed at the MRN-detected nerve abnormalities.This retrospective cross-sectional study included 106 subjects with groin or genital pain (mean [± SD] age, 50.7 ± 15.4 years) who showed mono- or multifocal neuropathy of the border nerves at 3-T MRN. Subjects who underwent CT-guided perineural injection were assessed for pain response. Injection responses were categorized as positive, possible positive, and negative. Subjects who received hyaluronidase, continuous radiofrequency ablation, or surgery were also evaluated for treatment outcomes.One hundred forty abnormal nerves were positive for neuropathy in 106 studies. Eighty of 106 subjects had single neuropathy, and 26 had multifocal neuropathy. Fifty-eight subjects underwent CT-guided perineural injections, with five receiving bilateral injections (63 injections). Improvement in subjective pain was seen in 53 of 63 cases (84.2%). A statistically significant improvement in pain response was noted in the isolated ilioinguinal nerve block group as compared with the isolated genitofemoral nerve block group (p = 0.0085). Thirteen of 58 subjects received multiple nerve injections at the same sitting. Both groups receiving single or multiple nerve injections had similar improvement in pain scores of 84% and 85%, respectively, although this difference was not statistically significant.Our retrospective analysis showed improved pain relief in subjects who underwent CT-guided nerve blocks on the basis of a positive MRN.

Objective: To evaluate the utility and efficacy of MR neurography (MRN) in the diagnostic work-up for intercostal neuralgia and to assess the treatment course and outcomes in MRN-imaged clinically suspected intercostal neuropathy cases of chronic chest and abdominal wall pain syndromes. Methods: Following a retrospective cross-sectional study, a consecutive series of patients who underwent MRN of torso for suspected intercostal neuralgia were included. Patient demographics, pain location/level/duration, previous work-up for the same indication, MRN imaging results, and MRN cost per patient were recorded. An inter-reader reliability assessment was performed on the MRN findings using Cohen’s weighted κ analysis. Post-MRN treatment choice, as well as success rates of MRN directed perineural injections and surgical management were also evaluated. Results: A total of 28 patients (mean ± SD age, 48.3 ± 18.0 years, female/male = 3.0) were included. Pain and/or numbness in the right upper quadrant were the most common complaints. The mean maximum pain level experienced was 7.4 ± 2.5 on a 1 (lowest pain level) - 10 (highest pain level) visual analog scale. The duration of pain before MRN work-up was 36.9 ± 37.9 months. The patients had seen an average of 5 ± 2.8 physicians for such syndromes. 20 (71%) patients had one or multiple other imaging studies for prior work-up. MRN identified positive intercostal nerve abnormality in 19 cases with clinical symptoms of intercostal neuralgia. From the inter-reader reliability assessment, a Cohen’s weighted κ value of 0.78 was obtained. The costs of work-up was about one-third with MRN for diagnostic purposes with less financial and psychological harm. Among the MRN-positive cases, 9/19 patients received perineural injections, of which 6 reported improvement after their first round, lasting an average of 41.1 ± 83 days. Among the nine MRN-negative cases, two received perineural injections, of which none reported improvement. Surgical management was mostly successful with a positive outcome in six out of seven operated cases (85.7%). Conclusion: MRN is useful in diagnostic algorithm of intercostal neuralgia and MRN-positive cases demonstrate favorable treatment response to perineural injections and subsequent surgical management. Advances in knowledge: The use of MRN in intercostal neuralgia is an application that has not been previously explored in the literature. This study demonstrates that MRN offers superior visualization of pathology in intercostal neuralgia and confirms that treatment directed at MRN identified neuropathy results in good outcomes while maintaining cost efficiency.

Background Data describing the effect of obesity on anti-TNF treatment response in inflammatory bowel disease (IBD) are conflicting. This likely reflects the shortcomings of using body mass index (BMI) to capture an individual’s adipose stores. Recent studies have found visceral adipose tissue (VAT), not BMI, is associated with IBD-related complications and post-operative recurrence. However, the relationship between VAT and treatment response is unclear. We aim to evaluate the effect of VAT on anti-TNF treatment response. Methods IBD patients starting anti-TNF agents between 1/1/2009 to 7/31/2019 at two academic medical centers were included. Three-dimensional VAT volume was measured from CT scans with Aquarius (iNtuition, Foster City, CA). Patients were categorized by predefined volume cutoffs: 3000cm3. Primary outcomes included composite endpoint of corticosteroid-free response (CFR) at 6 and 12 months defined by meeting one of the following: a) clinical response based on Harvey Bradshaw Index for Crohn’s disease (CD) or Lichtiger score for ulcerative colitis (UC) b) endoscopic improvement based on ulcer healing for CD and Mayo score for UC compared to baseline or c) 50% improvement or normalization of CRP or fecal calprotectin. Secondary outcomes included IBD-related surgery at 6 and 12 months. We performed a multivariable logistic regression on CFR and surgery, adjusting for age, gender, IBD diagnosis, disease duration, active tobacco use, and immunomodulator exposure, to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI). Results We included 182 patients. Table 1 summarizes differences in baseline characteristics. There were no differences in CFR at 6 months. Compared to those with VAT volume 3000cm3 (aOR 0.45, [95%CI 0.13–1.50], Figure 1b). With respect to surgery within 6 months, patients with volume >3000cm3 were significantly more likely to undergo surgery than those with VAT volume 3000cm3 having the highest risk of surgery (aOR: 3.55 [95%CI 0.87–14.61], Figure 1c and d). Conclusion In this retrospective, multicenter, cohort study, we found VAT influences treatment response but not in a dose-dependent manner as previously hypothesized. If confirmed by future prospective studies, VAT may be employed as a biomarker to better inform treatment decisions and improve outcomes, especially considering the growth of artificial intelligence in medical imaging.

To determine the diagnostic accuracy and interobserver performance of diffusion tensor imaging (DTI) in diabetic peripheral neuropathy (DPN) and detect correlations with electrophysiology.Twelve healthy volunteers (controls) and ten DPN patients were enrolled to undergo MR examinations. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of tibial nerve (TN) and common peroneal nerve (CPN) were measured. Unpaired t test and Levene tests were performed to assess differences between the two groups. Receiver operating characteristic (ROC) analysis was performed for FA and ADC values. Pearson correlation coefficient was used to assess the correlation between DTI and electrophysiology parameters in the patient group.The FA values of TN and CPN in the DPN group were significantly lower and ADC were higher than the control group (p 0.05). Interobserver agreement was excellent. FA positively correlated and ADC negatively correlated with motor nerve conduction velocity (MCV) (p 0.05). There were no significant differences between motor nerve conduction amplitude and DTI parameters (p 0.05). Moderate diagnostic accuracy of DTI was seen in the diagnosis of DPN.DTI demonstrates moderate diagnostic accuracy and excellent interobserver performance in the detection of DPN involving the TN and CPN. There is moderate correlation with MCV.• FA values of TN and CPN are significantly lower in DPN. • ADC values of TN and CPN are significantly higher in DPN. • DTI demonstrates moderate diagnostic accuracy in detection of DPN. • There is excellent interobserver performance in DTI measurements. • Moderate correlation is seen between DTI parameters and MCV.

BACKGROUND AND PURPOSE: Chronic cauda equina syndrome, defined as persistent damage of the cauda equina nerve roots within the spinal canal can be a challenging diagnosis with varied presentations. MR neurography imaging is more commonly being used to evaluate the lumbosacral spine of patients suspected of having subacute or chronic cauda equina syndrome. Our aim was to evaluate the impact of lumbosacral plexus MR neurography in the diagnostic thinking and therapeutic management of patients presenting with chronic pelvic pain and dysfunction and suspected chronic cauda equina syndrome. MATERIALS AND METHODS: Consecutive MR neurography lumbosacral plexus examinations at our institution were reviewed retrospectively. Relevant data collected included the following: patient demographics, clinical history, pertinent physical examination findings, preimaging diagnostic impression, prior MR imaging lumbar spine findings, MR neurography findings, postimaging diagnosis, and postimaging treatment plan. The impact of imaging on the preimaging clinical diagnosis and therapeutic management was evaluated. RESULTS: Of 185 studies of patients who presented with chronic pelvic pain and/or dysfunction, 23 with clinically suspected chronic cauda equina syndrome and imaging findings were included in the study (2 subjects were lost to follow-up). The mean ages were 53 ± 12 years and 53 ± 16 years for men and women, respectively. The common etiologies included arachnoiditis (n = 8), tethered cord (n = 2), and simple/Tarlov cysts (n = 3). Eighteen of 23 (78%) subjects had a change in diagnosis resulting from MR neurography findings, and 5/23 (22%) had no change. Seventeen of 21 (81%) subjects had a change in management, and 4/21 (19%) had no change. CONCLUSIONS: MR neurography impacts the diagnosis and therapeutic management of patients with suspected chronic cauda equina syndrome.

Segmentation of whole-body MRI (WBMRI) to assess the feasibility, quantitate the total tumor volume (tumor burden) in patients with neurofibromatosis type 1 (NF1) and examine associations with demographic, disease-related and anthropomorphic features. A consecutive series of patients with NF1 underwent WBMRI and were reviewed for tumors. Tumors were segmented using a semiautomated software-based tool. Tumors were classified as superficial or deep and discrete or plexiform. Segmentation times were recorded. Segmentation yielded the quantity and tumor burden of superficial, internal and plexiform tumors. Correlations between segmentation data and demographic, disease-related and anthropomorphic features were examined. Fifteen patients were evaluated (42.3 ± 13.6 years, 10 female, 5 male). Segmentation times were a median of 30 min and yielded 2,328 tumors (1,582 superficial, 746 internal and 23 plexiform). One tumor was malignant. Tumor counts ranged from 14 to 397. Tumor burden ranged from 6.95 cm3 to 571 cm3. Individual tumor volume ranged from 0.0120 cm3 to 298 cm3. Significant correlation was found between the total volume of superficial tumors and height (ρ = 0.5966, p

Pudendal neuralgia is being increasingly recognized as a cause of chronic pelvic pain, which may be related to nerve injury or entrapment. Due to its complex anatomy and branching patterns, the pudendal nerve abnormalities are challenging to illustrate. High resolution 3 T magnetic resonance neurography is a promising technique for the evaluation of peripheral neuropathies. In this article, the authors discuss the normal pudendal nerve anatomy and its variations, technical considerations of pudendal nerve imaging, and highlight the normal and abnormal appearances of the pudendal nerve and its branches with illustrative case examples.

To investigate the feasibility of diffusion-weighted magnetic resonance neurography (DW-MRN) in the visualisation of extremity nerves in the wrist and palm. Thirty-two volunteers and 21 patients underwent imaging of the wrist and palm on a 3-T MR scanner. In all subjects, two radiologists evaluated the image quality on DW-MRN using a four-point grading scale. Kappa statistics were obtained for inter-observer performance. In volunteers, the chi-squared test was used to assess the differences in nerve visualisation on DW-MRN and axial fat-suppressed proton density weighted imaging (FS-PDWI). In volunteers, the mean image quality scores for the median nerve (MN) and ulnar nerve (UN) were 3.71 ± 0.46 and 3.23 ± 0.67 for observer 1, and 3.70 ± 0.46 and 3.22 ± 0.71 for observer 2, respectively. The inter-observer agreement was excellent (k = 0.843) and good (k = 0.788), respectively. DW-MRN provided significantly improved visualisations of the second and the third common palmar digital nerves and three branches of UN compared with FS-PDWI (P

Purpose The purpose was to evaluate feasibility of bone and joint segmentations from three-dimensional magnetic resonance imaging (3D MRI). Methods Segmented joint models from 3D MRI data set were obtained for 42 patients. Blinded angular and joint space measurements were performed on 3D MRI model, two-dimensional (2D) MRI, and radiography (XR). Results Medial joint space was similar on both XR and 3D MRI ( P =.3). The XR measurements were statistically different but closer to 3D MRI for lateral patellar tilt angle, patellar tendon length, and lateral knee joint space, whereas 2D MRI measurements were closer to XR in terms of trochlear depth, sulcal angle, and patellar length. Conclusion 3D bone and joint segmentations are feasible from isotropic MRI data sets.

This article summarizes the clinical definition of ankylosing spondylitis and axial spondyloarthritis, discusses the pathogenesis of these conditions, and reviews approaches to management.

The purpose of this article is to evaluate the significance of subspecialty second-opinion consultations for CT and MRI examinations in musculoskeletal (MSK) radiology.All 3165 MSK CT and MRI examinations referred to one academic institution for second-opinion consultation during a 24-month period were reviewed by three MSK-trained radiologists. Outside and inside reports were compared by two independent MSK radiology fellows using a previously published 5-point scale. Clinically important differences (categories 4 and 5) were defined as those likely to change patient management. Statistical comparisons of rates were performed using a chi-square test with Bonferroni corrections. Interobserver reliability was reported using linear weighted kappa statistics and the percentage of agreement.Of all second-opinion examinations, 73.5% (2326/3165) had an outside report available for comparison and inclusion in this study. There were 610 of 2326 (26.2%) examinations with clinically important differences. The rate of clinically important discrepant readings was even higher in oncologic cases (36.3%; 331/911). When the final diagnosis was determined from pathology reports performed after internal interpretation, the second-opinion consultation was noted to be correct in 82.0% (334/407) of examinations with category 4 or 5 discrepancies. There was very good agreement (κ = 0.93) in scoring the discrepancies between second-opinion consultants.The subspecialty second-opinion consultation was more accurate than outside reports in 82.0% of examinations when pathologic confirmation was made. A moderate rate (26.2%) of discrepant interpretations was noted between outside and inside MSK imaging examinations, especially in tumor cases (36.3%). Most discrepancies were in interpreting rather than detecting abnormalities.

Accurate diagnosis and prompt therapy of musculoskeletal infections are important prognostic factors. In most cases, clinical history, examination and laboratory findings help one make the diagnosis, and routine magnetic resonance imaging (MRI) is useful to identify the extent of the disease process. However, in many situations, a routine MRI may not be specific enough especially if the patient cannot receive contrast intravenously, thereby delaying the appropriate treatment. Diffusion-weighted imaging (DWI) can help in many such situations by providing additional information, accurate characterization and defining the extent of the disease, so that prompt treatment can be initiated. In this article, we illustrate the imaging findings of the spectrum of musculoskeletal infections, emphasizing the role of DWI in this domain. • Abscess in background cellulitis is detected on DWI. • Infectious tenosynovitis shows diffusion restriction as compared to mechanical tenosynovitis. • Pyomyositis with abscess can be differentiated from diabetic myonecrosis on DWI. • Intraosseous abscess is bright on DWI versus devitalized tissue, sequestrum and air. • DWI can be used to differentiate spine infection from simple Modic changes.

PURPOSE To evaluate the feasibility of whole-body magnetic resonance neurography (WBMRN) in polyneuropathy for technical feasibility, distribution of nerve abnormalities, and differentiation. MATERIALS AND METHODS Twenty WBMRN examinations were performed on a 3T scanner over 2 years. Patient demographics including history of hereditary and acquired neuropathy were recorded. The images were evaluated by two independent readers with nerve imaging experience for quality. The nerve signal and size alterations were measured in the brachial plexus, lumbosacral plexus, and femoral and sciatic nerves; diffusion tensor imaging parameters (fractional anisotropy [FA] and apparent diffusion coefficient [ADC]) were determined in plexuses, and tractography was performed. Nonparametric Wilcoxon rank sum test, receiver operating characteristic (ROC) analysis, and intraclass correlation coefficients (ICCs) were obtained. RESULTS Excellent image quality was obtained for the majority of lumbosacral (LS) plexus (18/20) and 50% of brachial plexus (10/20) regions. Qualitatively among cases, the nerve hyperintensity and/or thickening involved the brachial plexus (11/11), LS plexus (7/11), and both plexuses (7/11), with most nerve thickenings observed in Charcot-Marie-Tooth disease type 1. The nerve signal intensity alterations were significantly different for both brachial (P < 0.05) and LS (P < 0.05) plexuses in cases versus controls. The femoral and sciatic nerve size alterations were different (P < 0.05), while signal intensity differences were not significant (P = 0.1-0.97). Transverse dimensions of C8 (4 mm), L5 (6.2 mm) and S1 (5.1 mm) nerve roots, and sciatic nerves (10.2 mm) were the most accurate diagnostic performance measures in distinguishing cases from controls. CONCLUSION WBMRN is feasible for use in the clinical practice for the identification and potential characterization of polyneuropathy. J. Magn. Reson. Imaging 2016;44:1513-1521.

Purpose Panoramical radiographs or cone-beam computed tomography (CT) are the standard-of-care in dental imaging to assess teeth, mandible, and mandibular canal pathologies, but do not allow assessment of the inferior alveolar nerve itself nor of its branches. We propose a new technique for “MR neurographic orthopantomograms” exploiting ultrashort echo-time (UTE) imaging of bone and teeth complemented with high-resolution morphological and functional MR neurography. Materials and Methods The Institutional Review Board approved the study in 10 healthy volunteers. Imaging of the subjects mandibles at 3.0T (Magnetom Skyra, Siemens-Healthcare) using a 64-channel head coil with isotropic spatial resolution for subsequent multiplanar reformatting, was performed. Bone images were acquired using a 3D PETRA sequence (TE, 0.07 msec). Morphological nerve imaging was performed using a dedicated 3D PSIF and 3D SPACE STIR sequence. Functional MR neurography was accomplished using a new accelerated diffusion-tensor-imaging (DTI) prototype sequence (2D SMS-accelerated RESOLVE). Qualitative and quantitative image analysis was performed and descriptive statistics are provided. Results Image acquisition and subsequent postprocessing into the MR neurographic orthopantomogram by overlay of morphological and functional images were feasible in all 10 volunteers without artifacts. All mandibular bones and mandibular nerves were assessable and considered normal. Fiber tractography with quantitative evaluation of physiological diffusion properties of mandibular nerves yielded the following mean ± SD values: fractional anisotropy, 0.43 ± 0.07; mean diffusivity (mm2/s), 0.0014 ± 0.0002; axial diffusivity, 0.0020 ± 0.0002, and radial diffusivity, 0.0011 ± 0.0001. Conclusion The proposed technique of MR neurographic orthopantomogram exploiting UTE imaging complemented with high-resolution morphological and functional MR neurography was feasible and allowed comprehensive assessment of osseous texture and neural microarchitecture in a single examination. J. Magn. Reson. Imaging 2016;44:393–400.

This tertiary care experience examines the utility of magnetic resonance neurography (MRN) in the management of peripheral trigeminal neuropathies.Seventeen patients with clinically suspected peripheral trigeminal neuropathies (inferior alveolar nerve and lingual nerve) were imaged uniformly with 1.5-T examinations. MRN results were correlated with clinical and surgical findings in operated patients and the impact on clinical management was assessed.Clinical findings included pain (14/17), sensory changes (15/17), motor changes (2/17) and palpable masses (3/17). Inciting events included prior dental surgery (12/17), trauma (1/17) and idiopathic incidents (4/17). Non-affected side nerves and trigeminal nerves in the intracranial and skull base course were normal in all cases. Final diagnoses on affected sides were nerve inflammation (4/17), neuroma in continuity (2/17), LN transection (1/17), scar entrapment (3/17), infectious granuloma (1/17), low-grade injuries (3/17) and no abnormality (3/17). Associated submandibular gland and sublingual gland oedema-like changes were seen in 3/17 cases because of parasympathetic effects. Moderate-to-excellent MRN-surgical correlation was seen in operated (8/17) patients, and neuroma and nerve transection were prospectively identified in all cases.MRN is useful for the diagnostic work-up of suspected peripheral trigeminal neuropathy patients with significant impact on clinical management and moderate-to-excellent correlation with intra-operative findings.• MRN substantially impacts diagnostic thinking and management in peripheral trigeminal neuropathy. • MRN has moderate-to-excellent correlation with intra-operative findings. • MRN should be considered in pre-surgical planning of peripheral trigeminal neuropathy subjects.

Differentiation of nonovarian from ovarian lesions is a diagnostic challenge. MRI (Magnetic Resonance Imaging) of the pelvis provides excellent tissue characterization and high contrast resolution, allowing for detailed evaluation of adnexal lesions. Salient MRI characteristics of predominantly cystic lesions and predominantly solid adnexal lesions are presented along with epidemiology and clinical presentation. Due to its excellent soft tissue resolution, MRI may be able to characterize indeterminate adnexal masses and aid the radiologist to arrive at the correct diagnosis, thus positively affect patient management.

Category: Trauma; Hindfoot Introduction/Purpose: Fractures of the calcaneus are life-changing events with a major socioeconomic impact from lost productivity. Traditional operative treatment with the extensile lateral approach has shown relatively high rates of wound complications. Less invasive approaches can improve fracture alignment and decrease wound healing complications. The purpose of this study is to report our experience with the sinus tarsi approach in treating calcaneus fractures. Methods: We retrospectively identified patients at our institution treated with a limited sinus tarsi approach for calcaneus fractures from 2009-2018. Demographic and radiographic data were collected including: age, sex, mechanism of injury, occupation, presence of diabetes, smoking status, Sanders classification, Bohler and Gissane angles. Postoperatively, we recorded the presence of complications, return-to-work time, and radiographic measurements. Results: Our analysis included 105 fractures in 100 patients: 86% males, 42% smokers, 4% diabetics, with an average body mass index of 26.5. The fractures were: Sanders type 2 (32%), type 3 (48%), type 4 (18%), and 2% were a tongue-type variant. Preoperatively 38% of fractures displayed a negative angle, 50% had an angle 0-20 degrees, and 12% over 20 degrees; postoperatively 13% had an angle 0-20 degrees, and 87% had an angle over 20 degrees. Of patients working prior to the injury, 72% had returned to work by 6 months, and 89% by 12 months. The wound complication rate was 12% (12/100), with only 2% (2/100) requiring additional procedures. There was no significant difference in wound complication rates in smokers versus nonsmokers (11.9% vs 12.2%, p=0.55). Conclusion: The limited sinus tarsi approach for depressed calcaneus fractures allows radiographic restoration of calcaneal height with a low rate of wound complications, even amongst active smokers. To the authors’ best knowledge, this is the largest published case series of calcaneus fractures treated with the sinus tarsi approach. Further follow up is needed to determine the success of this approach in mitigating long term complications.

Hyaline cartilage lining the surfaces of diarthrodial joints is an important construct for transmission of load and to reduce friction between the bones. Normal wear and tear accounts for about 3-5 percent knee cartilage loss ever year in otherwise healthy people after the age of 30 years. Several conditions and diseases lead to premature cartilage degeneration. Standardized description of cartilage loss, detailed evaluation of the joint health and determining the underlying etiology of cartilage loss are important for effective reporting, multidisciplinary communications and patient management. In this article, the authors discuss normal and abnormal imaging appearances of the hyaline cartilage of knee with focus on using controlled terminology and MRI classifications. The reader will benefit and learn key MR imaging features of a spectrum of common and uncommon conditions and diseases affecting the knee cartilage, such as trauma, secondary injury associated with meniscus and ligament injury related instability, arthritis, ischemia, idiopathic, and hereditary conditions including Matrix metalloproteinase-2 (MMP-2) mutations and mucopolysaccharidosis type IX disease with illustrative case examples.

Highlights • The periosteum has different characteristics between genders and age groups, and may change with the use of medications. • Conventional plain radiography can often determine the aggressiveness of periosteal reactions. • Knowledge of the periosteum’s anatomy eases the understanding of its periosteal reactions. • Systemic periosteal reactions are generally underdiagnosed, due to compartmentalized analysis., Periosteum is a fibrous sheath, coating the external bone, except in the articular surfaces, tendon insertions and sesamoid bone surface¹. It changes its aspects and characteristics with aging, becoming progressively less elastic and more firm. It is composed of two different layers: outer fibrous (firm, collagen-filled) and inner proliferative (cambium, containing osteoprogenitor cells)². Four vascular systems are responsible for the blood supply of the periosteum: the intrinsic periosteal system, located between fibrous and proliferative layer; the periosteocortical, the main nutritional arteries of the periosteum; the musculoperiosteal, responsible for the callus formation after fractures; the fascioperiosteal, specifically for each bone.³ It is crucial to bone formation and resorption, reacting to insults in the cortical bone, such as tumors, infections, traumas, medications and arthritic diseases. The aggressiveness of the reaction can be suggested by its radiological aspect and appearance4. The periosteum in children is looser compared to adults, resulting in earlier and more exuberant reactions. All these aspects will be detailed, so the essential information all radiologists need to know will be discussed.

To quantitatively characterize diabetic amyotrophy (DA), or diabetic lumbosacral radiculoplexopathy, and compare with controls using magnetic resonance neurography (MRN). Forty controls and 23 DA cases were analyzed qualitatively and quantitatively. Cross-sectional areas (CSAs) of bilateral L3 through S2 lumbosacral nerve roots, femoral nerves, and sciatic nerves (proximal and distal measurements) were measured. A linear model was used to assess the nerve location and case/control effect on angle-corrected CSAs. Intra- and inter-reader analysis was performed using intraclass correlation (ICC). In DA cases, abnormalities of the lumbosacral nerve roots, sciatic, femoral, and obturator nerves were seen in 21/23, 16/23, 21/23, and 9/23, respectively. Denervation abnormalities of multiple abdominopelvic muscles were seen. Quantitatively, the CSA of all measured LS plexus nerve roots and bilateral femoral nerves were significantly larger in DA cases vs. controls by 45% (95% CI, (30%, 49%); p

To qualitatively and quantitatively characterize the nerves of patients with diabetic amyotrophy (DA) using magnetic resonance neurography (MRN) with diffusion tensor imaging (DTI). Forty controls and 13 DA cases were analyzed. 1.5-Tesla and 3.0-Tesla MRN with DTI was used. Qualitative data from 13 patient records were recorded. Region of interest (ROI) measurements were taken of bilateral L3 through S2 lumbosacral nerve roots, femoral nerves, and sciatic nerves. An ANOVA and multiple linear regression analysis were performed. An intraclass correlation coefficient (ICC) was calculated between two readers. In DA cases, abnormalities of the lumbosacral nerve roots (n = 11 patients), sciatic (n = 10), femoral (n = 13), and obturator nerves (n = 4) were seen; denervation changes of the abdominopelvic muscles were also identified. Quantitatively, minimum and mean nerve signals on B600 were significantly less than controls (p

To introduce MRI-based International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification system of meniscal tears and correlate it to the surgical findings from arthroscopy. We hypothesized that the ISAKOS classification will provide good inter-modality and inter-rater reliability for use in the routine clinical practice of radiologists and orthopedic surgeons. In this HIPAA-compliant cross-sectional study, there were 44 meniscus tears in 39 patients (26 males, 16 females). Consecutive arthroscopy-proven meniscal tears (March 2017 to December 2017) were evaluated by two board-certified musculoskeletal radiologists using isotropic three-dimensional (3D) MRI user-defined reconstructions. The surgically validated ISAKOS classification of meniscal tears was used to describe medial meniscus (MM) and lateral meniscus (LM) tears. Prevalence-adjusted bias-adjusted kappa (PABAK) and conventional kappa, and paired t test and intra-class correlation coefficient (ICC) were calculated for categorical and numerical variables, respectively. For the MM, the PABAK for location, depth, length (ICC), pattern, quality of meniscus tissue, and zone was 0.7–1, 0.65, 0.57, 0.67, 0.78, and 0.39–0.7, respectively. For the LM, the PABAK for location, depth, length (ICC), pattern, quality of meniscus tissue, zone, and central to popliteus hiatus was 0.57–0.95, 0.57, 0.74, 0.93, 0.38, 0.52–0.67, and 0.48, respectively. The mean tear lengths were larger on MRI than on arthroscopy (mean difference MM 9.74 mm (6.66 mm, 12.81 mm; p

AIM To evaluate initial experience with computed tomography (CT)-guided pulsed radiofrequency ablation (pRFA) of the pudendal nerve in cases of recalcitrant neuropathic pelvic pain. Endpoints include technical feasibility, safety, and efficacy of therapy. MATERIALS AND METHODS Ten patients who underwent pRFA ablation for neuropathic pudendal nerve pain during the trial period were followed for response to treatment for 6 months. Each patient was treated with pRFA under CT-guidance with concurrent perineural injection of anaesthetic and/or corticosteroid. Pain scores were then measured using a numeric rating scale at fixed intervals up to 6 months. RESULTS All procedures were considered technically successful with no immediate complications. pRFA demonstrated improved duration of pain improvement compared to the most recent perineural injection (p=0.0195), but not compared to the initial injection (p=0.64). Reported pain scores were lower with pRFA than with both the first and most recent injection but this did not reach statistical significance (p=0.1094 and p=0.7539, respectively). CONCLUSION Overall, pRFA of the pudendal nerve using CT-guidance can be a safe and effective therapy. This technique provides direct visualisation of the nerve to maximise safety and efficacy while offering a novel form of therapy for patients with chronic, recalcitrant pelvic pain.

OBJECTIVE: Evaluate feasibility and reliability of 3DCT semi-automatic segmentation and volumetrics of CAM lesions in femoroacetabular impingement and determine correlations with anthropometrics. METHODS: A consecutive series of 43 patients with CAM type FAI underwent 3DCT. 20 males and 23 females (30 unilateral and 13 bilateral symptomatic hips) were included. 56 CAM lesions and femoral heads were segmented by two readers. Radial images were obtained for alpha angles. Pearson and ICC correlations were used for analysis. RESULTS: In 43 patients (male: female = 1 : 1.15), mean ± SD of age, height, BMI were 36.6 ± 11.47 years, 1.72 ± 0.10 meters and 26.25 ± 4.31 kg m(−)². Femoral head and bumps were segmented in 4 min. Inter reader reliability was good to excellent for volumetrics and poor for alpha angles. Mean ± SD of CAM lesion and femoral head volumes were significantly larger (6.7 ± 2.5 cc(3) and 62.9 ± 10.8 cc(3)) for males than females (p < 0.001) and these increased with increasing patient height (Pearson correlation and p-values = 0.45, 0.0006; 0.82, < 0.0001 respectively). CONCLUSION: Volumetric analysis of CAM lesion shows better inter reader reliability than alpha angle measurements. CAM and femoral head volumes exhibit significant positive correlations with patient heights and male gender that may aid in pre-operative planning for femoroplasty. ADVANCES IN KNOWLEDGE: Femoral head & CAM volumes are segmented three times faster than alpha angles with superior inter reader reliability than alpha angles. Femoral head & CAM volumes are significantly larger in males and positively correlate with patients’ heights.

To evaluate proven soft tissue musculoskeletal malignancies blinded to their Federation Nationale des Centres de Lutte Contre le Cancer histologic grades to identify the predictive values of conventional MR findings and best fit region of interest (ROI) apparent diffusion coefficient (ADC) measurements. Fifty-one consecutive patients with different histologic grades were evaluated by four readers (R1–4) of different experience levels. Quantitatively, the maximum longitudinal size, tumor to muscle signal intensity ratios, and ADC measurements and, qualitatively, the spatial location of the tumor, its signal alterations, heterogeneity, intralesional hemorrhage or fat, and types of enhancement were assessed. Intraclass correlation, weighted kappa, ANOVA, and Fisher exact tests were used. There were 22/51 (43%) men (mean age ± SD = 52 ± 16 years) and 29/51 (57%) women (mean age ± SD = 54± 17 years), with the majority of tumors 38/51 (75%) in the lower extremities. Histologic grades were I in 8/51 (16%), II in 17/51 (33%), and III in 26/51 (51%), respectively. The longitudinal dimensions were different among three grades (p = 0.0015), largest with grade I. More central enhancements and deep locations were seen in grade III tumors (p = 0.0191, 0.0246). The ADC mean was significantly lower in grade III than in grade I or II (p