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Seminars in Musculoskeletal Radiology

Thomas Mücke, Christian R Krestan, David A Mitchell, Jan S Kirschke, Arno Wutzl
For patients with malignant disease taking bisphosphonates and denosumab, the incidence of medication-related osteonecrosis of the jaw (MRONJ) is up to 15% in contrast to 0.01% in patients with osteoporosis. Clinical presentation of MRONJ extends from asymptomatic exposure of bone in 94% of patients to severe cases of mandibular fractures in a minority of 4.5%. The strongest risk factors for MRONJ are invasive dental procedures and dental infections. Advances in imaging provide more preoperation information compared with panoramic radiograph...
July 2016: Seminars in Musculoskeletal Radiology
Ursula Heilmeier, Janina M Patsch
Skeletal fragility has been recognized as an important feature of diabetes mellitus type 1 (T1D) and type 2 (T2D). While patients with DM1 typically display low bone mineral density (BMD) and concomitant increases in fracture risk, T2D bone disease is more complex and less understood. Although BMD is often normal or even slightly elevated, the risk of fragility fractures is disproportionally high. Alterations in bone quality (i.e., bone microstructure and matrix properties) have been reported by independent groups of researchers...
July 2016: Seminars in Musculoskeletal Radiology
Radhesh Krishna Lalam, Victor N Cassar-Pullicino, Naomi Winn
Paget disease (PD) is a common disease of bone associated with abnormal bone turnover that in turn is due to an imbalance between osteoclastic and osteoblastic activity. There is good evidence that PD is reducing in incidence, prevalence, and severity. The disease is most often asymptomatic and is usually detected incidentally on imaging examinations performed for other reasons. The features of PD are relatively specific on radiographs and computed tomography. However, the appearances on magnetic resonance imaging are subtle and nonspecific, although it has become the initial imaging choice for several clinical indications including back pain, neurologic dysfunction, and knee pain...
July 2016: Seminars in Musculoskeletal Radiology
Anastasia N Fotiadou, Michele Calleja, Rikin Hargunani, Richard Keen
The skeletal manifestations of osteogenesis imperfecta are investigated. The antenatal and postnatal diagnosis of the disease is briefly mentioned and the characteristic appearances of bone deformities are analyzed in detail. The distinctive bony manifestations of osteogenesis imperfecta are illustrated using typical examples. Finally, we comment on the differential diagnosis.
July 2016: Seminars in Musculoskeletal Radiology
Thomas M Link, Ursula Heilmeier
Both bone mass and quality are responsible for bone strength. Whereas bone mass is measured with bone mineral density, quantification of bone quality is more complex and involves bone architecture, texture, and mechanical parameters. Over the last decade, significant progress has been made in developing technologies to measure bone quality. These include novel low-cost modalities such as trabecular bone score measured on dual-energy X-ray absorptiometry images and quantitative ultrasound as well as more advanced imaging modalities such as multidetector computed tomography, magnetic resonance imaging, and high-resolution peripheral quantitative computed tomography...
July 2016: Seminars in Musculoskeletal Radiology
Judith E Adams
Maximizing peak bone mass in childhood is relevant to optimizing bone health in later life, so the study of the skeleton in children in health and disease is important. Dual-energy X-ray absorptiometry (DXA) is the most widely used clinical tool for the assessment of bone status in children. Technological developments in DXA enable vertebral fracture assessment at much lower ionizing radiation doses than spinal radiographs. Quantitative computed tomography remains predominantly a research tool but has some advantages over DXA in not being size dependent...
July 2016: Seminars in Musculoskeletal Radiology
Carmelo Messina, Luca Maria Sconfienza, Michele Bandirali, Giuseppe Guglielmi, Fabio Massimo Ulivieri
Several imaging methods for the diagnosis and management of osteoporosis exist. Dual-energy X-ray absorptiometry (DXA) is the most widely available and commonly used for measuring bone mineral density (BMD). Central DXA has several advantages: It has very good reproducibility, administers a negligible radiation dose to the patient, and BMD values obtained by DXA relate to fracture risk. Nevertheless, DXA has some technical limitations that should be recognized by those physicians who interpret and report this examination...
July 2016: Seminars in Musculoskeletal Radiology
Yiru Lorna Fan, Wilfred C G Peh
Osteoporosis, a systemic metabolic disease of bone, is characterized by low bone mass and altered trabecular pattern, leading to increased risk of fractures. It increases in prevalence with age, especially in postmenopausal women, and can have other secondary causes. Radiologic evaluation of osteoporosis has historically used conventional radiography, which demonstrates cortical thinning, increased radiolucency, and altered trabecular patterns, and also aids in assessing vertebral fractures. Many indexes have been devised, such as the Saville index for the degree of radiolucency, and the Genant grading system for vertebral fractures...
July 2016: Seminars in Musculoskeletal Radiology
Giuseppe Guglielmi, Michelangelo Nasuto
No abstract text is available yet for this article.
July 2016: Seminars in Musculoskeletal Radiology
Ramya Srinivasan
The first metatarsophalangeal joint and hallucal-sesamoid complex are critical structures in weightbearing and susceptible to several pathologies including turf toe, sesamoiditis, degenerative or inflammatory arthritides, infection, and avascular necrosis. This review article summarizes the complex anatomy of the region, covers common pathologies while clarifying terms such as turf toe and sesamoiditis, reviews imaging techniques, and discusses management.
April 2016: Seminars in Musculoskeletal Radiology
O Kenechi Nwawka, Yoshimi Endo
Pathologic conditions in the midfoot and forefoot may be diagnosed and treated using image-guided intervention. Image-guided techniques to treat arthrosis, tendinopathy, nerve disorders, and other miscellaneous midfoot and forefoot conditions are described, with a focus on sonographic guidance.
April 2016: Seminars in Musculoskeletal Radiology
Caio Nery, Hilary Umans, Daniel Baumfeld
The plantar plate has recently gained more attention as an important structure contributing to lesser metatarsophalangeal joint stability. This has prompted a significant growth of interest in the anatomy and biomechanics of the plantar plate and in the diagnosis and treatment of its injuries. Improved understanding of plantar plate function and predictable patterns of degeneration and failure has led to the development of a clinical staging and surgical grading system of plantar plate lesions. Relatively recent innovations allow the surgeon to access and repair plantar plate tears directly with reinsertion onto the base of the proximal phalanx...
April 2016: Seminars in Musculoskeletal Radiology
James M Linklater, Stephen J Bird
Plantar plate degeneration and tear is a common cause of forefoot pain, typically involving the second metatarsophalangeal joint at the proximal phalangeal insertion laterally, frequently confused with the second web space Morton neuroma. The condition has received increased attention with the development of surgical techniques that can result in successful repair of the plantar plate and substantial improvement in patient symptoms. High-resolution MRI or ultrasound can confirm a diagnosis of plantar plate degeneration and tear and exclude other pathologies, particularly Morton neuroma...
April 2016: Seminars in Musculoskeletal Radiology
Kassel Wai Kan Tsang, William B Morrison
Pedal infection is a difficult diagnostic problem for clinicians and radiologists alike, especially in patients with diabetes. Vascular and neuropathic disease complicates the clinical picture and imaging appearance. Radiographs are usually the first examination ordered, offering an excellent overview of previous surgery, structural deformities, and neuropathic joint disease. Ultrasound and computed tomography are occasionally useful to answer specific questions. Scintigraphy has become less popular because MRI provides high sensitivity and specificity as well as detailed anatomical information...
April 2016: Seminars in Musculoskeletal Radiology
Victoria H Wilkinson, Emma L Rowbotham, Andrew J Grainger
The foot and ankle are commonly involved in a range of arthritides that affect the joints, bones, and soft tissues. Accurate plain film interpretation can often aid the diagnosis and monitor disease progression and treatment response. Ultrasound and MRI afford superior depiction of the soft tissues, and advances over recent years have centered on early detection of synovitis, enabling earlier diagnosis and treatment. Advantages and disadvantages of the imaging techniques of radiography, multidetector computed tomography, ultrasound, and MRI are discussed, as is optimization of these modalities for the assessment of the anatomically complex joints of the foot and ankle...
April 2016: Seminars in Musculoskeletal Radiology
Victor Longo, Jon A Jacobson, Qian Dong, Sung Moon Kim
The differential diagnosis for a midfoot or forefoot mass or mass-like abnormality includes several common benign and malignant pathologies. Evaluation with imaging can often provide a diagnosis, or at least several likely etiologies, and guide management. Determining if a mass is cystic or solid with ultrasound or MRI can limit the differential diagnosis. Identifying the abnormality at a specific anatomical site, such as a bursa, peripheral nerve, plantar aponeurosis, or tendon, can often suggest a correct diagnosis...
April 2016: Seminars in Musculoskeletal Radiology
Eva Llopis, Javier Carrascoso, Inigo Iriarte, Mariano de Prado Serrano, Luis Cerezal
The Lisfranc joint is composed of the cuneiform bones and the cuboid and metatarsal bases, united by a synovial capsule and ligamentous complex. Familiarity with the anatomy is essential for image planning and for understanding injury patterns. The more important structures are the Lisfranc ligament and the plantar ligaments that can be visualized with MR, although careful attention to technique and orientation of scan planes is required for accuracy. A combination of conventional radiographs, computed tomography, and MR allow precise diagnosis of Lisfranc fractures, fracture dislocation, and subtle Lisfranc injuries to guide clinical management and surgical planning...
April 2016: Seminars in Musculoskeletal Radiology
Hilary Umans
No abstract text is available yet for this article.
April 2016: Seminars in Musculoskeletal Radiology
Jan Fritz, Joerg C Henes, Matthew K Fuld, Elliot K Fishman, Marius S Horger
Gout is a true crystal deposition arthropathy caused by the precipitation of monosodium urate into joints and periarticular soft tissues. It is the most common inflammatory arthropathy in men and women of older age with a male-to-female ratio of 3 to 8:1. The disease may progress from asymptomatic hyperuricemia through symptomatic acute gout attacks with asymptomatic periods into chronic symptomatic tophaceous gout. Although invasive arthrocentesis and demonstration of monosodium urate crystals on polarized light microscopy is definitive for the diagnosis of gout, dual-energy computed tomography (CT) allows for noninvasive visualization and reproducible volume quantification of monosodium urate crystals...
February 2016: Seminars in Musculoskeletal Radiology
Monica Khanna, Miny Walker, Dimitri Amiras, Peter Rosenfeld
This review article describes the potential range of image-guided interventional procedures performed following foot and ankle ligament and/or tendon repair. Diagnosis of the cause of recurrent or persistent pain/symptoms in this postoperative group is challenging and requires a coordinated clinical and radiologic assessment. This directs appropriate treatment including image-guided intervention that may be used both as a diagnostic tool and a therapeutic option. There is a paucity of high-quality studies on the role of image-guided intervention in the foot and ankle after ligament/tendon repair...
February 2016: Seminars in Musculoskeletal Radiology
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