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Endometriosis is a disorder that commonly affects females of reproductive age and is defined as the presence of endometrial glands or stroma outside the uterine cavity. Patients typically present with cyclical pain during menses. Endometriosis can be characterized as endopelvic or extrapelvic depending on the sites involved. We report a case of a 40-year-old, right-hand-dominant, female who presented with a painful mass in her right proximal forearm. She was ultimately diagnosed with intramuscular endometriosis and underwent surgical excision. [ABSTRACT FROM AUTHOR]

Abstract Background Traumatic musculoskeletal injuries are a common presentation to emergency care, the first-line investigation often being plain radiography. The interpretation of this imaging frequently falls to less experienced clinicians despite well-established challenges in reporting. This study presents novel data of clinicians’ confidence in interpreting trauma radiographs, their perception of AI in healthcare, and their support for the development of systems applied to skeletal radiography. Methods A novel questionnaire was distributed through a network of collaborators to clinicians across the Southeast of England. Over a three-month period, responses were compiled into a database before undergoing statistical review. Results The responses of 297 participants were included. The mean self-assessed knowledge of AI in healthcare was 3.68 out of ten, with significantly higher knowledge reported by the most senior doctors (Specialty Trainee/Specialty Registrar or above = 4.88). 13.8% of participants reported an awareness of AI in their clinical practice. Overall, participants indicated substantial favourability towards AI in healthcare (7.87) and in AI applied to skeletal radiography (7.75). There was a preference for a hypothetical system indicating positive findings rather than ruling as negative (7.26 vs 6.20). Conclusions This study identifies clear support, amongst a cross section of student and qualified doctors, for both the general use of AI technology in healthcare and in its application to skeletal radiography for trauma. The development of systems to address this demand appear well founded and popular. The engagement of a small but reticent minority should be sought, along with improving the wider education of doctors on AI.

The radiologic evaluation of the sagittal angulation of the distal humerus is commonly based on standard lateral radiographs. However, lateral radiographs do not allow to examine the lateral angulation of the capitulum and the trochlea, separately. Although this problem could be approached via computed tomography, there are no data available describing the difference between the angulation of the capitulum and trochlea. Therefore, we aimed to assess sagittal angles of the capitulum and trochlea in relation to the humeral shaft based on 400 CT-scans of the elbow in healthy adults. Angles were measured in sagittal planes at the capitulum center and three anatomically defined trochlea locations and were spanned between the axis of the joint component and the humerus shaft. Angles were tested for differences between measurement locations and correlation with patient characteristics (age, sex, trans-epicondylar distance). Angles increased from lateral to medial measurement locations (107.4 ± 9.6°, 167.4 ± 8.2°, 171.8 ± 7.3°, 179.1 ± 7.0°; p < 0.05). Largest angle differences were detected between the capitulum and trochlea with smallest angles measured at the capitulum. Patient characteristics did not correlate with angles (p > 0.05). Intra-rater-reliability was r = 0.79–0.86. As CT-imaging allows to distinguish between sagittal capitulum and trochlea locations, it might benefit the radiologic diagnostic of sagittal malalignments of the distal humerus at the capitulum and trochlea, separately. [ABSTRACT FROM AUTHOR]

Background: Traumatic musculoskeletal injuries are a common presentation to emergency care, the first-line investigation often being plain radiography. The interpretation of this imaging frequently falls to less experienced clinicians despite well-established challenges in reporting. This study presents novel data of clinicians' confidence in interpreting trauma radiographs, their perception of AI in healthcare, and their support for the development of systems applied to skeletal radiography. Methods: A novel questionnaire was distributed through a network of collaborators to clinicians across the Southeast of England. Over a three-month period, responses were compiled into a database before undergoing statistical review. Results: The responses of 297 participants were included. The mean self-assessed knowledge of AI in healthcare was 3.68 out of ten, with significantly higher knowledge reported by the most senior doctors (Specialty Trainee/Specialty Registrar or above = 4.88). 13.8% of participants reported an awareness of AI in their clinical practice. Overall, participants indicated substantial favourability towards AI in healthcare (7.87) and in AI applied to skeletal radiography (7.75). There was a preference for a hypothetical system indicating positive findings rather than ruling as negative (7.26 vs 6.20). Conclusions: This study identifies clear support, amongst a cross section of student and qualified doctors, for both the general use of AI technology in healthcare and in its application to skeletal radiography for trauma. The development of systems to address this demand appear well founded and popular. The engagement of a small but reticent minority should be sought, along with improving the wider education of doctors on AI. [ABSTRACT FROM AUTHOR]

Fibrous dysplasia (FD) is a rare, benign, chronic, slowly progressive bone disorder characterized by the replacement of normal bone and bone marrow by fibrous tissue, leading to deformity, pain and functional impairment. It was considered a disease of unknown etiology, uncertain pathogenesis and diverse histopathology. It was later discovered that was caused by a non-heritable activating mutation in the a-subunit gene of the stimulatory G-protein coding gene. Temporal bone involvement is the least frequently reported type, especially in children. The purpose of the current manuscript was to report a rare case of fibrous dysplasia of the left temporal bone of a 17-year-old child who came to the emergency room of our hospital with otalgia and progressive hearing loss on the left ear. [ABSTRACT FROM AUTHOR]

Three types of resorption (endosteal, intracortical [Haversian], and periosteal envelope [subperiosteal]) have been observed in hyperparathyroidism. The current manuscript addresses the one manifestation that seems to have specificity, subperiosteal bone resorption, and allows us to distinguish the resultant subperiosteal resorption from the unrelated accretion phenomenon, periosteal reaction. Skeletons of 2906 individuals in the Hamann‐Todd Human Skeletal Collection were visually (macroscopically) examined to identify surface resorption and tuft alterations. Surface resorption was present bilaterally in 18 of 94 individuals with renal disease‐derived hyperparathyroidism, but absent in the other 2812 individuals examined. Manual tuft resorption was present in four individuals with hyperparathyroidism and absent in all others examined. Given its limitation to individuals with known hyperparathyroidism, the presence of subperiosteal resorption appears diagnostic. The 4% prevalence of subperiosteal reaction in the Hamman‐Todd cohort with hyperparathyroidism is indistinguishable from that reported in clinical samples. Subperiosteal resorption appears be a phenomenon in the archeological record that is pathognomonic for the diagnosis of hyperparathyroidism. Such biologically remodeled bone is easily distinguished from post‐mortem damage and its position subjacent to the periosteum facilitates distinguishing it from periosteal reaction. While the presence of subperiosteal bone resorption appears to have great specificity, its sensitivity is low as it was found only in 19% of individuals examined in this study. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to explore authorship trends within the musculoskeletal radiology subspecialty-focused journal, Skeletal Radiology, from inception to 2020. Materials and methods: Skeletal Radiology articles published in 1976, 1986, 1996, 2006, 2016, and 2020 were reviewed. For each article, the number of authors, the number of distinct institutions, the names of first and last authors, the country of the first author, the article length, and the number of article references were recorded. Results: A total of 885 articles passed the exclusion criteria to be included in the study. Since inception, there has been a significant increase in the number of SR articles published (P = 0.02), the mean number of authors per article (P < 0.01), the mean number of references per article (P < 0.01), the mean number of distinct institutions per article (P = 0.02), and the mean number of pages per article (P < 0.01). The proportion of female first and last authors significantly increased (P = 0.02, P = 0.02). There was a significant increase in the proportion of articles published from Asia (P = 0.04). However, no significant changes in the proportion of articles published from other regions were observed. Conclusion: Similar to authorship trends in other medical journals, Skeletal Radiology demonstrated upward trends in authorship count, distinct institutional count, and article length. A rise in first and last female authorship was observed. Finally, an increase in the proportion of authors from Asia was observed while no significant changes in the proportion of authors from other regions were demonstrated. [ABSTRACT FROM AUTHOR]

There is an increasing trend towards deploying reporting radiographers in Danish hospitals who, among various professional groups, interpret and report skeletal radiographs from the emergency department (ED). This study aimed to compare the quality of the reports issued by reporting radiographers to three different groups of medical doctors (MDs) who interpret or report skeletal radiographs at the ED. Four professional groups (i.e. four reporting radiographers, two radiology trainees, two orthopaedic senior trainees, and two orthopaedic trainees) reported 100 radiographs of the appendicular skeleton. The Consequence of clinical Outcome score (CO-score), accuracy, sensitivity, and specificity of each group were compared. The relative risk of a false-negative, false-positive or wrong result, the risk of a serious error, as well as the odds ratio of a more severe CO-score for each of the three MD groups, were compared to the reporting radiographers. There was a significant difference between the groups in reference to the CO-score (P ≤ 0.001), accuracy (P =.003), specificity (P =.022), and in the proportion of serious errors (P ≤ 0.001). Compared to the reporting radiographers, all three groups of MDs showed a significantly higher CO-score and a significantly increased risk of a wrong result. Moreover, two of the MD groups showed a significantly increased risk of a false-positive result and for severe errors. Based on the CO-score, the relative risk of errors, which could potentially cause malpractice in treatment and patient recall, significantly decreased when the reports were completed by reporting radiographers. To explore the need for a 24-h radiographer reporting service to the EDs, an upscaled study, like the current, with more participants representing the professional groups is highly recommended. [ABSTRACT FROM AUTHOR]

Abstract Fibrous dysplasia (FD) is a congenital disorder arising from sporadic mutation of the α-subunit of the Gs stimulatory protein. Osseous changes are characterised by the replacement and distortion of normal bone with poorly organised, structurally unsound, fibrous tissue. The disease process may be localised to a single or multiple bones. In McCune-Albright syndrome (MAS), fibrous dysplasia is associated with hyperfunction of endocrine organs and overproduction of melanin in the skin, while Mazabraud syndrome FD is associated with intramuscular myxomas. In radiology, FD is very often automatically associated with the term “ground glass matrix”. However, FD is a complex disease, and knowledge of its unique pathogenesis and course are crucial to understanding imaging findings and potential complications. This article aims to not only summarise the spectrum of radiological findings of osseous and extra-osseous abnormalities associated with FD but also to highlight the pathological base of the disease evolution, corresponding imaging changes and complications based on the disease distribution. We also have provided current recommendations for clinical management and follow-up of patients with FD. Teaching Points • FD is often a part of complex disease, involving not only bone but also multiple other organs. • FD lesions are characterised by age-related histological, radiographical and clinical transformations. • Radiologists play a crucial role in the identification of osseous complications associated with FD. • The craniofacial form of the disease is the most common type of FD and the most difficult form to manage. • Patients with McCune-Albright syndrome may have different extra-skeletal abnormalities, which often require follow-up.

Abstract: Fibrous dysplasia (FD) is a congenital disorder arising from sporadic mutation of the α-subunit of the Gs stimulatory protein. Osseous changes are characterised by the replacement and distortion of normal bone with poorly organised, structurally unsound, fibrous tissue. The disease process may be localised to a single or multiple bones. In McCune-Albright syndrome (MAS), fibrous dysplasia is associated with hyperfunction of endocrine organs and overproduction of melanin in the skin, while Mazabraud syndrome FD is associated with intramuscular myxomas. In radiology, FD is very often automatically associated with the term "ground glass matrix". However, FD is a complex disease, and knowledge of its unique pathogenesis and course are crucial to understanding imaging findings and potential complications. This article aims to not only summarise the spectrum of radiological findings of osseous and extra-osseous abnormalities associated with FD but also to highlight the pathological base of the disease evolution, corresponding imaging changes and complications based on the disease distribution. We also have provided current recommendations for clinical management and follow-up of patients with FD.Teaching Points: • FD is often a part of complex disease, involving not only bone but also multiple other organs.• FD lesions are characterised by age-related histological, radiographical and clinical transformations.• Radiologists play a crucial role in the identification of osseous complications associated with FD.• The craniofacial form of the disease is the most common type of FD and the most difficult form to manage.• Patients with McCune-Albright syndrome may have different extra-skeletal abnormalities, which often require follow-up. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To assess the role of whole-body low-dose computed tomography (WBLDCT) in the diagnosis and staging of patients with suspicion of multiple myeloma (MM). Materials and methods: A total of 138 patients (76 male and 62 female; mean age 63.5 years, range 50–81 years), with early MM, underwent WBLDCT protocol study, performed on 16-slice scanner (Brilliance, Philips Medical System, Eindhoven, The Netherlands): tube voltage 120kV; tube current time product 40mAs. Diagnosis of osteolytic lesions was performed on the basis of axial and multiplanar reformatted images, whereas the assessment of spinal misalignment and fracture was done by using multiplanar reformatted images. The overall dose delivered to each patient was 4.2mSv. Every patient gave personal informed consent, as required by our institution guidelines. Results: The diagnosis was established either by histopathology or imaging follow-up (size increase of over a period time). In all 138 patients, image resolution was diagnostic, enabling correct classification of multiple myeloma patients. WBLDCT showed a total of 328 pathologic bone findings in 81/138 patients. CT scanning resulted in complete evaluation of the bone lesions in these areas of the skeleton: skull (42), humerus (15), femur (20), ribs (7), scapulae (13), pelvis (35), clavicle (13), sternum (10), cervical (39), dorsal (65), lombar (48) and sacral rachis (21). In 40/81 bone involvement detected by CT was the only CRAB criterion present. Furthermore, WBLDCT demonstrated pleuro-pulmonary lesions in 20 patients (11 infective, 9 as MM localizations) and 1 renal neoplasia. Conclusion: WBLDCT, detecting bone marrow localizations and demonstrating extra-osseous findings, with a fast scanning time and high resolution images, is a reliable imaging-based tool for a proper management of MM patients. [Copyright &y& Elsevier]

Abstract: Purpose: The aim of the study was to investigate possible linear intra-bone geometry dependencies by determining the relation between the maximum radius length and maximum distal width in two independent populations and test for possible gender or age effects. A strong correlation can help develop more representative fracture models and osteosynthetic devices as well as aid gender and height estimation in anthropologic/forensic cases. Methods: First, maximum radius length and distal width of 100 consecutive patients, aged 20–70 years, were digitally measured on standard lower arm radiographs by two independent investigators. Second, the same measurements were performed ex vivo on a second cohort, 135 isolated, formalin fixed radii. Standard descriptive statistics as well as correlations were calculated and possible gender age influences tested for both populations separately. Results: The radiographic dataset resulted in a correlation of radius length and width of r =0.753 (adj. R 2 =0.563, p <0.001) with sex having a significant (p =0.005, adj. R 2 =0.592) and side no influence on the correlation. Radius length–width correlation for the isolated radii was r =0.621 (adj. R 2 =0.381, p <0.001) with sex significantly influencing this correlation (p <0.001, adj. R 2 =0.598). Conclusion: A relatively strong radius length–distal width correlation was found in two different populations, indicating that linear body proportions might not only apply to body height and axial length measurements of long bones but also to proportional dependency of bone shapes in general. [Copyright &y& Elsevier]

Abstract: The primary objective of this study was to evaluate, if in multidetector computed tomography (MDCT) of the wrist a good image quality can be maintained while radiation dose is substantially reduced. In a second approach one solely parameter change that allows for the best trade-off between dose reduction and image quality should be identified. Twenty wrist specimens were examined with a 16-slice MDCT in different parameter combinations: 120 and 100kV, 100, 70 and 40electronicmAs, pitch factor 0.9 and 1.5. Images were reconstructed in four standard planes (slice thickness 1.0mm, increment 0.5mm, hard kernel) resulting into a total number of 960 images. Two observers evaluated image quality in a blinded and randomized consensus scheme. Detail quality of corticalis, spongiosa, articular surface and soft tissues was graded according to a four-point scale (1=excellent, 2=good, 3=sufficient, and 4=poor). The scan protocol with the best trade-off between radiation exposure and image quality had a parameter constellation of 100kV, 70electronicmAs (78effectivemAs) and a pitch of 0.9 (DLP 63mGycm). This represented a dose reduction of 55%. A solely decrease of voltage lead to a dose reduction of 36% without any loss of image quality. An increase of the pitch factor to 1.5 and a decrease from 70 to 40mAs caused the most distinct impairment of image quality. In MDCT of the wrist good image quality could be maintained while radiation dose was considerably reduced. A reduction of voltage offers the best result for a solely parameter change. [Copyright &y& Elsevier]

The influences of single-gene missense mutations expressing diabetes ( db/db), obese ( ob/ob) or dystrophia ( dy/dy) dysregulated metabolic syndromes on hind limb bone maturation and cytodevelopment in C57BL/KsJ mice were evaluated by radiological, macro- and cytomorphometric analysis of the resulting variances in os coxae, femur and tibia osteodevelopment indices relative to control parameters between 8 and 16 weeks of age. Associated with obesity and hyperglycaemic/hyperinsulinaemic states, both db/db and ob/ob mutants demonstrated significant suppression of hind limb maturation (length) and cytodensity indices relative to control growth parameters. By contrast, skeletal growth suppression induced by dy/dy mutation expression was associated with lean body mass and normoglycaemic/hypoinsulinaemic systemic endometabolic indices. In both db/db and ob/ob mutation syndromes, osteovascular, -interstitial and -cytolipidaemia were prominent cytochemical aberrations of the osteopaenic states relative to the dyslipidaemia/fibrodysplasia characteristic of dy/dy osteomaturation. Between 8 and 16 weeks of age, both ob/ob and db/db groups demonstrated extensive cortical interstitial (laminal) osteolipidaemia and suppressed cytodensities compared to control indices. These data demonstrate that the abnormal hyperglycaemic/hyperinsulinaemic endometabolic states associated with the expression of db/db and ob/ob genomutations promote extensive lipidaemia-induced osteopaenia, compromising hind limb osteomaturation and cytodensity indices, as compared to the hyperfibritic osteopaenia characteristic of dy/dy mutation syndromes. Recognized therapeutic modulation of the hypercytolipidaemic component of diabetes–obesity syndromes may prove to be effective towards amelioration of the deleterious influences of these expressed hyperglycaemic, dysregulated lipometabolic conditions on osteomaturation and cytodevelopment. [ABSTRACT FROM AUTHOR]

Abstract: Diagnostic procedures performed on patients with multiple myeloma typically reveal lytic bone lesions, osteopenia or osteoporosis, bone marrow infiltration by plasma cells as well as overproduction of immunoglobulin or light chains in the serum or urine. Skeletal manifestations are extremely variable and the unusual forms have been described extensively. Extramedullary plasma-cell tumours (plasmocytoma) are found in about 5% of newly diagnosed patients with multiple myelomas. In this paper we present eight patients with atypical forms of multiple myeloma. [Copyright &y& Elsevier]

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