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ZusammenfassungDie primäre Gicht ist eine erbliche Störung des Nukleotidstoffwechsels. Neben typischen Manifestationen an Füßen, Händen und den großen Gelenken kann es selten zu atypischen Verläufen im HNO-Bereich kommen. Wir berichten von einem Fall der tophösen Gicht im Temporomandibulargelenk mit Symptomen einer präaurikulären Schwellung und progredienter Hörminderung. Klinisch zeigte sich ein verlegter Gehörgang, bildgebend ein destruierender Prozess, der unter anderem die Schädelbasis involvierte. Die Diagnosesicherung gelang radiologisch und bioptisch.

Purpose Posterior lateral meniscus root (PLMR) tears are injuries that commonly occur together with anterior cruciate ligament (ACL) tears. The aim of this study was to evaluate the clinical and radiological outcome of PLMR repair accompanying ACL reconstruction. Specifically, PLMR healing rates, meniscal extrusion behavior and their influence on patient-reported outcome measures (PROMs) were analyzed. It was hypothesized that PLMR repair shows satisfactory healing rates and coronal meniscal extrusion does not increase significantly following PLMR repair. Methods Patients that underwent PLMR repair between 2014 and 2019 were evaluated at least 12 months postoperatively. At follow-up, magnetic resonance imaging (MRI) was performed in order to evaluate the PLMR healing behavior (complete vs. partial vs. no healing) as well as the coronal and sagittal meniscal extrusion in comparison with the preoperative MRI. Additionally, patient-reported outcome measures (PROMs; Lysholm score, International Knee Documentation Committee subjective knee form [IKDC]) were compiled. Pre- and postoperative meniscal extrusion were tested for statistical significance using the paired t test. The Kruskal–Wallis test was used to compare extrusion values and PROMs in relation to different healing states. A correlation analysis was conducted using the Pearson correlation coefficient between differences in meniscal extrusion and PROMs. Results Out of 25 patients, 18 patients (72.0%; 11 male and seven female) were available for final assessment at a mean follow-up of 40.8 ± SD 17.5 months. One revision PLMR repair was performed five months after the initial repair. In 14 cases (77.8%), healing of the lateral meniscus was observed (6 × complete, 8 × partial). Coronal extrusion of the lateral meniscus did not increase significantly following PLMR repair (2.0 ± 1.5 mm vs. 2.1 ± 1.3 mm; p = 0.645). Sagittal extrusion increased significantly (25.7 ± 2.4 mm vs. 27.0 ± 1.4 mm; p p > 0.05). But a higher increase in coronal meniscal extrusion negatively affected PROMs (Lysholm score: p = 0.046, r = − 0.475; IKDC: p = 0.003, r = − 0.651). Conclusion High healing rates of the PLMR and no significant increase in coronal extrusion may be expected following combined PLMR repair and ACL reconstruction. But a greater increase in postoperative coronal meniscal extrusion correlates with less favorable clinical results. A greater increase in sagittal extrusion was observed, but this did not influence the clinical outcome. Level of evidence Retrospective Case Series; IV.

The term chest wall tumor summarizes a heterogeneous group of malignant and benign tumors, whereby primary and secondary chest wall tumors are differentiated. The incidence of secondary chest wall tumors is higher than that of primary tumors. Primary chest wall tumors can arise from any anatomic structure of the chest wall. Surgical resection is usually the treatment of choice. Resection status and tumor differentiation are relevant prognostic factors. Treatment of secondary chest wall tumors is performed depending on the patient's symptoms and prognosis of the underlying disease. Lung carcinomas infiltrating the chest wall can be resected primarily or secondarily as part of multimodal therapeutic strategies. Anatomic lung resections combined with chest wall resection have a higher mortality than standard resections. Chest wall reconstruction after resection has the goal of reducing paradoxical respiratory motion, although not every chest wall defect requires reconstruction.

Primary gout is a hereditary disorder in nucleotide metabolism. In addition to typical manifestations in the feet, hands, and large joints, there may be rare manifestations in the head and neck. We report a case of tophaceous gout in the temporomandibular joint in a patient who presented with preauricular swelling and progressive hearing impairment. Physical examination showed obliteration of the auditory canal and imaging revealed a destructive process involving the skull base. The diagnosis was confirmed by imaging and biopsy.Die primäre Gicht ist eine erbliche Störung des Nukleotidstoffwechsels. Neben typischen Manifestationen an Füßen, Händen und den großen Gelenken kann es selten zu atypischen Verläufen im HNO-Bereich kommen. Wir berichten von einem Fall der tophösen Gicht im Temporomandibulargelenk mit Symptomen einer präaurikulären Schwellung und progredienter Hörminderung. Klinisch zeigte sich ein verlegter Gehörgang, bildgebend ein destruierender Prozess, der unter anderem die Schädelbasis involvierte. Die Diagnosesicherung gelang radiologisch und bioptisch.

Lateral epicondylitis is a common orthopaedic condition often massively restricting the quality of life of the affected patients. There are a wide variety of treatment options - with varying levels of evidence.The following statements and recommendations are based on the current German S2k guideline Epicondylopathia radialis humeri (AWMF registry number: 033 - 2019). All major German specialist societies participated in this guideline, which is based on a systematic review of the literature and a structured consensus-building process.Lateral epicondylitis should be diagnosed clinically and can be confirmed by imaging modalities. The Guidelines Commission issues recommendations on clinical and radiological diagnostic workup. The clinical condition results from the accumulated effect of mechanical overload, neurologic irritation and metabolic changes. Differentiating between acute and chronic disorder is helpful. Prognosis of non-surgical regimens is favourable in most cases. Most cases spontaneously resolve within 12 months. In case of unsuccessful attempted non-surgical management for at least six months, surgery may be considered as an alternative, if there is a corresponding structural morphology and clinical manifestation. At present, it is not possible to recommend a specific surgical procedure.This paper provides a summary of the guideline with extracts of the recommendations and statements of its authors regarding the pathogenesis, prevention, diagnostic workup as well as non-surgical and surgical management.Die Epicondylopathia humeri radialis (Epicondylitis humeri radialis) ist ein Krankheitsbild, das häufig mit massiven Einschränkungen für die Lebensqualität der betroffenen Patienten einhergeht und für das eine Vielzahl an unterschiedlichen Therapien – mit schwankender Evidenz – existiert.Die nachfolgenden Ausführungen und Empfehlungen basieren auf der aktuellen S2k-Leitlinie Epicondylopathia radialis humeri (AWMF-Registernummer: 033-019). Diese Leitlinie wurde unter Beteiligung aller relevanten Fachgesellschaften, basierend auf einer systematischen Literaturanalyse und durch eine strukturierte Konsensusfindung, erstellt.Die Diagnose sollte klinisch gestellt werden und kann durch bildgebende Verfahren bestätigt werden. Empfehlungen zur klinischen und radiologischen Diagnostik werden durch die Leitlinienkommission gegeben. Das Krankheitsbild entsteht aufgrund eines kumulativen Effekts von mechanischer Überbelastung, neurologischer Irritation und metabolischen Veränderungen. Eine Unterscheidung einer akuten von einer chronischen Form ist sinnvoll. Die Prognose bei konservativer Therapie ist günstig. In der Mehrheit der Fälle kommt es innerhalb von 12 Monaten zur spontanen Beschwerderegredienz. Bei frustranem konservativen Therapieversuch von mindestens 6 Monaten kann bei einem strukturell-morphologischen und klinischen Korrelat über eine operative Therapiealternative diskutiert werden. Eine abschließende Empfehlung für ein spezifisches operatives Verfahren kann aktuell nicht ausgesprochen werden.Der vorliegende Artikel dient einer Zusammenfassung der Leitlinie mit daraus erzielten Auszügen der Empfehlungen und Statements der Autoren zur Pathogenese, Prävention, Diagnostik sowie konservativen und operativen Therapie.

Background/aim Myxofibrosarcoma (MFS) is characterized by an infiltrative growth pattern. This study aimed to determine the correlation between overall survival (OS) and morphological features of MFS as well as examine the reproducibility of these findings on preoperative magnetic resonance imaging (MRI). Patients and methods Fifty-eight MFS patients underwent preoperative MR imaging with the following features analysed: i) tumour size, ii) localization, iii) margins, iv) morphology, v) signal characteristics, vi) contrast enhancement, vii) presence and extent of perilesional oedema, and viii) presence of the tail sign. Results Only circumscribed perilesional oedema was associated with a significantly better survival compared to diffuse oedema (p=0.010), which was found in the majority of cases. The tail sign was found in less than 50% of the cases. Cohen's kappa coefficients confirmed a relatively high interrater variability. Conclusion Perilesional diffuse oedema on MR imaging of MFS is significantly correlated with a poor overall survival. The interrater variability in interpretation of MR examinations varies from slight to substantial agreement. Preoperative MR imaging with detailed planning of the resection seem to be a logical approach to achieve negative resection margins and recurrence-free survival.

Purpose Ultrasound (US) examination of the medial joint space of the knee has played a subordinate diagnostic role up till now. The purpose of the present study was to describe mean values of medial joint width and to investigate the impact of gender, age, and body mass index (BMI) on medial joint laxity in healthy knees using modern, dynamic US in a standardized fashion in unloaded and standardized loaded conditions. Methods A total of 65 subjects with 79 healthy knees were enrolled in this study. All volunteers underwent clinical examination of the knee. The medial knee joint width was determined using US in a supine position at 0° and 30° of knee flexion in unloaded and standardized loaded (= 15 Dekanewton, daN) conditions using a specific device. Mean values were described and correlations between medial knee joint width and gender, age, and BMI were assessed. Results Thirty-two females and 33 males were enrolled in this study. The mean medial joint width in 0° unloaded was 5.7 ± 1.2 mm and 7.4 ± 1.4 mm loaded. In 30° of knee flexion, the mean medial joint width was 6.1 ± 1.1 mm unloaded and 7.8 ± 1.2 mm loaded. The average change between unloaded and loaded conditions in 0° was 1.7 ± 1.0 mm and in 30° 1.7 ± 0.9 mm. A significant difference between genders was evident for medial joint width in 0° and 30° of flexion in unloaded and loaded conditions (p p = 0.032). No significant correlation between BMI and medial joint width in US could be found. Conclusion Mean values of medial joint width in unloaded and standardized loaded conditions using a fixation device could be demonstrated. Based on the results of this study, medial knee joint width in US is gender- and age-related in healthy knees. These present data may be useful for evaluating patients with acute or chronic pathologies to the medial side of the knee. Level of evidence III.

Die Omarthrose verursacht starke Schmerzen und eine eingeschrankte Gelenkfunktion. Ziel ist es, Fruhzeichen des degenerativen Prozesses zu erkennen, um gelenkerhaltende Masnahmen zu gewahrleisten. Dabei steht die Visualisierung von Knorpellasionen im Vordergrund. Wahrend Rontgenaufnahmen nur den Nachweis einer bereits fortgeschrittenen Arthrose ermoglichen, gehoren die Computertomographie(CT)-Arthographie und die Magnetresonanz(MR)-Arthrographie mit der nativen Magnetresonanztomographie (MRT) zu den etablierten Techniken fur die direkte Beurteilung des glenohumeralen Gelenkknorpels. Dieser Artikel erlautert die verschiedenen Modalitaten und Techniken der radiologischen Bildgebung und gibt einen Uberblick uber die Moglichkeiten der Diagnostik sowie die Einteilung von degenerativen Veranderungen im Schultergelenk.

Eine Periarthritis aufgrund von Kalkablagerungen im Schultergelenk ist eine haufig gestellte Diagnose. Selten konnen auch andere Gelenke betroffen sein. Der vorliegende Fallbericht beschreibt den Fall einer Periarthritis des Ellenbogengelenks aufgrund eines Kalkdepots im Rahmen der Kalziumhydroxylapatitablagerungserkrankung („calcium hydroxyapatite deposition disease“, CHADD). Die Symptomatik umfasste starkste Schmerzen, Schwellung und eine Funktionseinschrankung. Die Diagnose wurde mit Hilfe von radiologischer Diagnostik gestellt. Die Therapie umfasste primar konservativ eine Ruhigstellung und die Gabe von Diclofenac, wobei der Verlauf meist selbstlimitierend ist.

Diese Kasuistik behandelt den Fall eines 16-jahrigen mannlichen Patienten mit einem paraossalen Low-grade-Osteosarkom mit fokaler Dedifferenzierung am distalen Femur. Vorgestellt werden Anamnese, Krankheitsverlauf und der diagnostische Prozess sowie das operative Vorgehen und die pathologische Aufarbeitung mit finaler Diagnosestellung. Relevante radiologische und pathologische Differenzialdiagnosen sowie Fallstrickdiagnosen werden ausfuhrlich erlautert und diskutiert. Zudem werden postoperative therapeutische Optionen aufgezeigt.

It has been brought to our attention that there were two author names that weremisspelled in the above article in Seminars in Musculoskeletal Radiology, Volume 24, Number 3, 2020 (DOI: https://doi.org/10.1055/s-0040-1713119). The author names Andreas Heuck and Enzo Silvestri have been corrected in the byline above.

This case study deals with the case of a 16-year-old male patient with a low-grade parosteal osteosarcoma of the distal femur with focal differentiation. Case history, disease course, and surgery as well as the pathological workup with final diagnosis are presented. Relevant radiologic and pathologic differential diagnoses und diagnostic pitfalls are explained in detail and discussed. Additionally, postoperative treatment options are illustrated.

Item does not contain fulltext 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..

Objectives Peripheral bone infection (PBI) and prosthetic joint infection (PJI) are two different infectious conditions of the musculoskeletal system. They have in common to be quite challenging to be diagnosed and no clear diagnostic flowchart has been established. Thus, a conjoined initiative on these two topics has been initiated by the European Society of Radiology (ESR), the European Association of Nuclear Medicine (EANM), the European Bone and Joint Infection Society (EBJIS), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). The purpose of this work is to provide an overview on the two consensus documents on PBI and PJI that originated by the conjoined work of the ESR, EANM, and EBJIS (with ESCMID endorsement).Methods and results After literature search, a list of 18 statements for PBI and 25 statements for PJI were drafted in consensus on the most debated diagnostic challenges on these two topics, with emphasis on imaging.Conclusions Overall, white blood cell scintigraphy and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities for the diagnosis of PBI and PJI. However, the choice of which advanced diagnostic modality to use first depends on several factors, such as the benefit for the patient, local experience of imaging specialists, costs, and availability. Since robust, comparative studies among most tests do not exist, the proposed flowcharts are based not only on existing literature but also on the opinion of multiple experts involved on these topics.Key PointsFor peripheral bone infection and prosthetic joint infection, white blood cell and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities.Two evidence- and expert-based diagnostic flowcharts involving variable combination of laboratory tests, biopsy methods, and radiological and nuclear medicine imaging modalities are proposed by a multi-society expert panel.Clinical application of these flowcharts depends on several factors, such as the benefit for the patient, local experience, costs, and availability.

Objectives To assess whether bone marrow edema in patients with acute vertebral fractures can be accurately diagnosed based on three-material decomposition with dual-layer spectral CT (DLCT). Materials and methods Acute (n = 41) and chronic (n = 18) osteoporotic thoracolumbar vertebral fractures as diagnosed by MRI (hyperintense signal in STIR sequences) in 27 subjects (72 ± 11 years; 17 women) were assessed with DLCT. Spectral data were decomposed into hydroxyapatite, edema-equivalent, and fat-equivalent density maps using an in-house-developed algorithm. Two radiologists, blinded to clinical and MR findings, assessed DLCT and conventional CT independently, using a Likert scale (1 = no edema; 2 = likely no edema; 3 = likely edema; 4 = edema). For DLCT and conventional CT, accuracy, sensitivity, and specificity for identifying acute fractures (Likert scale, 3 and 4) were analyzed separately using MRI as standard of reference. Results For the identification of acute fractures, conventional CT showed a sensitivity of 0.73–0.76 and specificity of 0.78–0.83, whereas the sensitivity (0.93–0.95) and specificity (0.89) of decomposed DLCT images were substantially higher. Accuracy increased from 0.76 for conventional CT to 0.92–0.93 using DLCT. Interreader agreement for fracture assessment was high in conventional CT (weighted κ [95% confidence interval]; 0.81 [0.70; 0.92]) and DLCT (0.96 [0.92; 1.00]). Conclusions Material decomposition of DLCT data substantially improved accuracy for the diagnosis of acute vertebral fractures, with a high interreader agreement. This may spare patients additional examinations and facilitate the diagnosis of vertebral fractures.

Objectives: Meniscal extrusion in MRI is normally described as pathologic finding and associated with a loss of function of the affected meniscus. We hypothesize that in healthy knees there is also physiological meniscal extrusion as a functional adjustment on various load bearing condition. Therefore[for full text, please go to the a.m. URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018)

Osteochondrale Lasionen stellen einen Hauptrisikofaktor fur die Entwicklung einer Arthrose am Sprunggelenk dar. Es sollen ein Uberblick uber therapierelevante klinische Bildgebungsverfahren zur Knorpelbildgebung an Fus und Sprunggelenk gegeben und typische osteochondrale Verletzungen demonstriert werden. Eine intensive Literaturrecherche wurde durchgefuhrt und mit personlicher Erfahrung unterstrichen. Die Knorpelbildgebung zur Detektion osteochondraler Lasionen an Fus und Sprunggelenk bleibt eine Herausforderung. Dennoch konnen dezidierte morphologische und quantitative magnetresonanztomographische (MR-)Bildgebungsmethoden klinisch wichtige Informationen zur Verfugung stellen, die hilfreich bei Therapieentscheidungen z. B. hinsichtlich einer knorpelchirurgischen Masnahme sind. Die Sensitivitat der MR-Arthrographie (MR-A) und computertomographischen Arthrographie (CT-A) ist der nativen Magnetresonanztomographie (MRT) bezuglich der Detektion osteochondraler Lasionen uberlegen. Im Bereich der kleineren Gelenke des Fuses werden vor allem fortgeschrittene degenerative Veranderungen mittels konventioneller Rontgendiagnostik detektiert; nur in ausgewahlten Fallen spielt die MR- und CT-Diagnostik dieser kleineren Gelenken eine Rolle. Wahrend die dezidierte Knorpelbildgebung mit CT und MRT im Bereich der kleinen Fusgelenke eine geringere Rolle spielt, wird sie im Bereich des Sprunggelenks aufgrund der verfugbaren therapeutischen Optionen wie verschiedenen knorpelchirurgischen Verfahren immer wichtiger fur die klinische Diagnostik.

This case report presents an osteosclerotic bone lesion in a 49-year-old man with MDM2 amplification. The final diagnosis shows metastasis to the bones from stomach cancer. In primary bone tumours, the MDM2 amplifications observed have been described for many other tumour entities as well, and therefore do not exclude bone metastasis from a carcinoma.

Introduction In adults with a suspicion of peripheral bone infection, evidence-based guidelines in choosing the most accurate diagnostic strategy are lacking. Aim and methods To provide an evidence-based, multidisciplinary consensus document on the diagnostic management of adult patients with PBIs, we performed a systematic review of relevant infectious, microbiological, orthopedic, radiological, and nuclear medicine literature. Delegates from four European societies (European Bone and Joint Infection Society, European Society of Microbiology and Infectious Diseases, European Society or Radiology, and European Association of Nuclear Medicine) defined clinical questions to be addressed, thoroughly reviewed the literature pertinent to each of the questions, and thereby evaluated the diagnostic accuracy of each diagnostic technique. Inclusion of the papers per statement was based on a PICO (Population/problem – Intervention/indicator – Comparator – Outcome) question following the strategy reported by the Oxford Centre for Evidence-based Medicine. For each statement, the level of evidence was graded according to the 2011 review of the Oxford Centre for Evidence-based Medicine. All approved statements were addressed taking into consideration the available diagnostic procedures, patient acceptance, tolerability, complications, and costs in Europe. Finally, a commonly agreed-upon diagnostic flowchart was developed. Electronic supplementary material The online version of this article (10.1007/s00259-019-4262-x) contains supplementary material, which is available to authorized users.

Background: Septic arthritis (SA) of the knee after anterior cruciate ligament reconstruction (ACLR) is a rare but potentially devastating condition. In certain cases, graft removal becomes necessary. Purpose: To evaluate clinical, subjective, and radiologic outcomes of patients with SA after ACLR and assess whether graft retention has superior clinical results as compared with graft removal. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who were at least 12 months out from arthroscopic treatment of SA after isolated ACLR at our institution were eligible for inclusion. Patients were categorized into 2 groups: group 1, patients with initial graft retention; group 2, patients with initial graft removal. Group 2 was subdivided into 2 groups: group 2a, patients with graft reimplantation; group 2b, patients without graft reimplantation. Objective and subjective assessments were obtained at follow-up, including the International Knee Documentation Committee (IKDC) knee examination form, KT-1000 arthrometer measurements, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score, Lysholm score, and IKDC subjective evaluation. Radiologic assessment was performed with pre- and postoperative magnetic resonance imaging. Results: Of the 41 patients included, 33 (81%) were available for follow-up at a mean ± SD 54.7 ± 24.4 months at an age of 28.4 ± 9.3 years. When compared with patients from group 2 (n = 12), patients from group 1 (n = 21) obtained significantly better results on the objective IKDC score (normal or nearly normal: group 1, 66.6%; group 2, 36.4%; P = .047) and KT-1000 measurements (group 1, 1.3 ± 1.0 mm; group 2, 2.9 ± 1.5 mm; P = .005). Group 1 also scored better than group 2 on the Lysholm ( P = .007), IKDC subjective ( P = .011), and WOMAC ( P = .069) measures. Between groups 2a (n = 4) and 2b (n = 8), no significant differences in outcomes could be detected ( P values, .307-.705), although patients with anterior cruciate ligament graft reimplantation showed a clear tendency toward better results in objective and not subjective parameters. Magnetic resonance imaging evaluation showed higher rates of cartilage damage and meniscal tears among patients with graft resection versus graft retention. Conclusion: Patients with graft retention showed superior postoperative results when compared with patients who underwent initial graft resection, although subanalysis showed comparable outcomes between graft retention and reimplantation. Thus, while graft-retaining protocols should have the highest priority in the treatment of SA after ACLR, graft reimplantation should be performed in cases where graft resection becomes necessary, to avoid future cartilage and meniscal lesions. Finally, further studies with larger numbers of patients are needed to gain a better understanding of the outcomes of patients with SA after ACLR.

To show descriptive clinical and magnetic resonance (MR) imaging results after an additional periosteal flap augmentation in mini-open rotator cuff reconstruction and to evaluate potential healing improvement at long-term follow-up. Twenty-three patients with degenerative rotator cuff tears were followed after receiving a mini-open single-row repair with a subtendinous periosteal flap augmentation. Data were collected preoperatively, after 12 months and after 11 years. Clinical examination, simple shoulder test (SST), Constant–Murley Score (CS), ultrasonography examination and 3T MR imaging were performed. Out of 23 patients, 20 were available for short-term and 19 for final follow-up at a median of 11.5 years (range 10.4–13.0). Questions answered with “yes” in SST improved from baseline 5.0 (range 1.0–8.0) to short 10.5 (range 8.0–12.0) and final follow-up 12.0 (range 7.0–12.0). CS improved from 53.5 (range 25.0–66.0) to 80.8 (range 75.9–89.3) and finally to 79.8 points (range 42.3–95.4). Improvement was highly significant (p

Purpose To study the effects of refocusing angle modulation with 3D turbo spin echo (TSE) on signal and sharpness of small oblique nerves embedded in muscle and suppressed fat in the lumbar plexus. Materials and Methods Flip angle trains were generated with extended phase graphs (EPG) for a sequence parameter subspace. Signal loss and width broadening were simulated for a single-pixel nerve embedded in muscle and suppressed fat to prescribe a flip angle modulation that gives the best compromise between signal and sharpness of small nerves. Two flip angle trains were defined based on the simulations of small embedded nerves: design denoted A, predicting maximum global signal, and design denoted B, predicting maximum signal for minimum width broadening. In vivo data of the lumbar plexus in 10 healthy volunteers was acquired at 3.0T with 3D TSE employing flip angle trains A and B. Quantitative and qualitative analyses of the acquired data were made to assess changes in width and signal intensity. Results Changing flip angle modulation from A to B resulted in: 1) average signal losses of 23% in (larger) L5 nerves and 9% in (smaller) L3 nerves; 2) average width reductions of 4% in L5 nerves and of 16% in L3 nerves; and 3) statistically significant sharpness improvement (P = 0.005) in L3 nerves. Conclusion An optimized flip angle train in 3D TSE imaging of the lumbar plexus considering geometry-specific blurring effects from both the nerve and the surrounding tissue can improve the delineation of small nerves. J. Magn. Reson. Imaging 2015.

Benign bone tumors are rare but are more common than primary malignant bone tumors. The early accurate diagnosis and reliable differentiation of these rare benign tumors and tumor mimickers from the even rarer malignant tumors with subsequent appropriate treatment or watchful waiting is crucial for the clinical outcome. Bone tumors are often a source of diagnostic and therapeutic uncertainty. Thus this European Society of Musculoskeletal Radiology consensus document is intended to help radiologists in their decision making and support discussion among clinicians who deal with patients with suspected or proven bone tumors. Evaluating these tumors starts with a patient history and physical examination. Radiography is the principal imaging modality and often can reliably diagnose a benign bone tumor by providing information about localization, matrix, aggressiveness, size, and (potential) multiplicity. In a significant number of cases, additional imaging is not necessary. Potentially malignant entities recognized by radiography should be referred for magnetic resonance imaging, which also serves as a preoperative local staging modality, with specific technical requirements. Indeterminate tumors, or tumors in which therapy depends on histology results, should be biopsied. For biopsy, we strongly recommend referral to a specialist regional sarcoma treatment center (RSTC), where a multidisciplinary tumor team, including a specialist pathologist, radiologist, and sarcoma surgeon, are involved. Additional staging modalities are entity specific and should be performed according to the recommendations of the RSTC.

Presently, the degree of the hemophilic arthropathy is estimated by the classification system of Pettersson, which is recommended by the Orthopedic Advisory Committee of the World Federation of Hemophilia. This classification system bases upon plain radiographs of the joints and analyses only those changes which represent the progression of the arthropathy. The value of this classification system has been established by interobserver studies. However, it shows drawbacks at the exact definition of some parameters. Presently, it is more valuable for longitudinal than for transversal studies. Due to the possibilities of an adequate substitution therapy, only minor degrees of an arthropathy are observed in children. The ankle joints are more severly affected than the elbow joints and they more than the knee joints. This distribution is explained by an increasing sports activity in children. If more than 3 joint bleedings occur within a year the invent of an arthropathy must be presumed. Because the classification system of Pettersson analyses only osseous changes representing late changes, important early changes like hypertrophy of the synovialis and focal destruction of the joint cartilage are overlooked. Magnetic resonance imaging is suitable to show these early changes reliably. MRI can be recommended for the investigation of recurrently bleeding joints without evidence of major osseous changes and for decision making to perform a synovectomy.