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06:42 CET
VoE 62 - Musculoskeletal
Musculoskeletal
Wednesday, February 28, 10:00 - 11:00
Moderator: A. Barile (L'Aquila/IT)


C-1320
10:00
Lupus: From Head to Toe
W. Morales Borrero1, L. R. Rodriguez-Ortiz1, F. G. Rodriguez-Ruiz2, A. Bravo1, J. Vidal1; 1San Juan/US 2Caguas/US

Learning objectives:
To highlight some of the most common and rare manifestations of Systemic Lupus Erythematosus along with their imaging characteristics. Among the highlighted conditions included: Lupus-associated stroke, Posterior Reversible Encephalopathy Syndrome (PRES), Diffuse Alveolar Hemorrhage, Lupus Enteri[...]
Background:
Systemic Lupus Erythematosus (SLE) is a chronic inflammatory autoimmune disease able to affect every organ system. Its precise etiology remains unknown. However, it is characterized by immunologic abnormalities and production of antinuclear antibodies. Clinical presentation is variable from patient [...]
Findings and procedure details:
Central Nervous System CNS Ischemia Overview: SLE is an independent factor for ischemic events in patients younger than 50 years of age. [1] Patients are most prone to suffer these events in the first 5 years following diagnosis. [1] Most common etiologies are cardiogenic emboli (i.e. Libm[...]
Conclusion:
As suggested by this exhibtion work, SLE is among one of the greatest mimickers of modern medicine. High clinical suspicion and awareness when confronted by unusual clinical manifestations in young patients (particularly females) is imperative for quick identification and prevention of life-threaten[...]
Personal information:
Walter J. Morales-Borrero, MD University of Puerto Rico, Medical Sciences Campus, Department of Radiology e-mail: walter.morales@upr.edu
References:
Goh YP, Naidoo P, Ngian GS. Imaging of systemic lupus erythematosus. Part I: CNS, cardiovascular, and thoracic manifestations. Clin Radiol. 2013; 68: 181-191 Lalani TA, Kanne JP, Hatfield GA, et al. Imaging Findings in Systemic Lupus Erythematosus. Radiographics. 2004; 24: 1069-1086 Hinchey J, C[...]

C-1461
10:07
Orthopaedic oncology :simplied by Interventional radiology
V. Bhargavi, I. Subbanna, S. S. SWAMY; Bangalore/IN

Learning objectives:
Describe the image guided interventional procedures in the management of orthopedic oncological cases To assess the role of each procedure in management of benign and malignant tumours To familiarize with the indications and techniques of each procedure Illustrate the adjuvant role of interventional[...]
Background:
Management of orthopedic oncology cases are complex necessitating a multidisciplinary approach. Interventional radiology is emerging as an adjuvant tool to orthopedic oncology forming an important part of the integrated team. Image guided interventional procedures in orthopedic oncology includes: [...]
Findings and procedure details:
Image guided Biopsies [1,2]: Image-guided MSK biopsies are safe, minimally invasive, and effective procedures with high diagnostic accuracy, lower risk, better recovery , lower patient morbidity, lower cost compared with open biopsies. Technique: Generally, an 11-15G Trephine Bone Biopsy Need[...]
Conclusion:
Image-guided biopsies are safe, minimally invasive, and effective procedures with high diagnostic accuracy, lower risk, better recovery, lower patient morbidity, lower cost compared with open biopsies. Percutaneous ablation maybe curative in some benign bone conditions , result in significant pallia[...]
Personal information:
References:
Le Et Al. Image-Guided Musculoskeletal Biopsies . Semin Intervent Radiol 2010;27:191–198 Himanshu Pendse , Aniruddha Kulkarni, Manish Agarwal. Role of Image Guided Interventions in Orthopaedic Oncology. Journal of Bone and Soft Tissue Tumors 2015 Sep-Dec;1(2):25-29 Motamedi et al.Image-Guided Treat[...]

C-1587
10:14
Adductor insertion avulsion (Thigh Splints): imaging spectrum of an uncommon condition.
U. Wegner1, J. Hennebry1, A. Stroiescu1, C. Daly1, A. G. Ryan2; 1Waterford/IE 2Waterford City/IE

Learning objectives:
To present uncommon tendinous insertion avulsion injuries of the thigh and their imaging features, including those that mimic sinister pathology. To illustrate thigh splints in the setting of chronic stress injuries including Vastus Intermedius and Adductor Magnus insertion avulsion syndromes.
Background:
The adductor magnus, vastus medialis or vastus intermedius muscles of the upper leg exert traction forces on the femoral shaft at their tendinous insertions resulting in periosteal elevation. Adductor magnus, vastus medialis and vastus intermedius avulsion injuries (thigh splints) are painful, overu[...]
Findings and procedure details:
Conventional radiographs demonstrate very subtle periosteal reaction or cortical elevation in the acute phase (Figure 1a and 2a) and thickened cortex in the later phase on subsequent imaging (Figures 1b, 1c and 2b). Ongoing healing and repetitive stress resulting in cortical thickening may progress [...]
Conclusion:
Knowledge of the patient’s medical history and activities, understanding the mechanism of injury, awareness of the diagnosis and acquaintance with the possible imaging spectrum increases our ability to diagnose these rare injury patterns and to distinguish them from malignant entities. Follow-up ima[...]
Personal information:
The Authors thank to Dr. Jun Nishio from Fukuoka University in Japan for permitting use of his figures.
References:
1 Nishio J, Hara M, naito M. Adductor Insertion Avulsion Syndrome Mimicking Neoplastic Processes in a 14 year - old Long- distance Runner. Orthopedics 2012, 2 Adductor Insertion Avulsion Syndrome ( Thigh Splints ) Mark W. Anderson, Phoebe A. Kaplan, Robert G. Dussault 3 Anderson SE, Johnston JO[...]

C-1992
10:21
MRI evaluation of the characteristics of the cervical spine intervertebral disc in subjects with and without minor vertebral contusion.
C. Van Langenhove1, T. Saveyn2, L. Jans2, K. L. Verstraete2; 1Ghent/BE 2Gent/BE

Aims and objectives:
To determine the magnetic resonance imaging (MRI) characteristics of normal and pathologic cervical discs and adjacent vertebral bodies in young patients with non-traumatic cervical pain and patients who suffered from a minor vertebral contusion.
Methods and materials:
Cervical spine MRI examinations of patients with neck pain without trauma (n=86) and after a minor trauma (n=506) were investigated ( Table 1 ). Investigated parameters were: Modic changes, uncovertebral joint arthrosis, disc herniation, annular fissures, high intensity zones (HIZs), the position of[...]
Results:
Signal intensity of the nucleus pulposus In the non-traumatic group (age 18–36 y) the SI of the NP decreased at all levels with increasing age ( Fig. 2 ). This finding was significant at levels C2-C3, C6-C7 and C7-T1. In the trauma group, the SI of the NP decreased significantly at all levels with [...]
Conclusion:
We found previously unreported findings: All HIZs are present at the caudal part of the annulus Discs with a HIZ have no reduced height There is no correlation between scoliosis and the location of extrusions Discs with uncovertebral arthrosis or adjacent Modic changes have reduced height Extrusio[...]
Personal information:
Charlotte Van Langenhove, MD Department of Radiology, Ghent University Hospital, Ghent University, Belgium E-mail: van.langenhove.charlotte@gmail.com Thiebault Saveyn, MD Department of Radiology, Ghent University Hospital, Ghent University, Belgium E-mail: thiebault.saveyn@ugent.be Lennart Jans,[...]
References:
Chen C et al. Quantitative T2 magnetic resonance imaging compared to morphological grading of the early cervical intervertebral disc degeneration: an evaluation approach in asymptomatic young adults. PLoS One. 2014. Siivola SM, Levoska S, Tervonen O, Ilkko E, Vanharanta H, Keinanen-Kiukaanniemi S. M[...]

C-2078
10:28
Anatomy and pathology of the nail and subungual space: benign lesions.
S. Rodriguez, V. A. Villota Delgado, N. Zuñiga, M. Renjifo; Cali/CO

Learning objectives:
To describe the anatomy of the nail and subungual space and anatomic landmarks by ultrasound and magnetic resonance. To be familiarized with the terminology used to describe the alterations of the nail and the subungual space. To describe the main imaging characteristics of some of the benign lesio[...]
Background:
ANATOMY OF THE NAIL AND SUBUNGUAL SPACE (Fig. 1) ( Fig. 2 ) Nail plate (dorsal, intermediate and ventral plate): Keratinized structured produced throughout life. Results from maturation and keratinization of the nail matrix epithelium. Histologically it is formed by cornified dead cells. The dorsa[...]
Findings and procedure details:
INFECTIOUS DISEASES Onychomycosis ( Fig. 4 ) Fungal infection of the nail. It may involve any component of the nail unit. Caused by dermatophytes (Tricophyton, Epidermophyton, Mycrosporum), non-dermatophytes and Candida. Clinical criteria include white/yellow/brown patches or streaks on the nail[...]
Conclusion:
The lesions that involve the subungual space comprise various etiologies, which may be similar in clinical presentation, almost always with nail deformity. Imaging studies are helpful in the characterization of these lesions, narrowing the differential diagnosis and guiding an appropriate treatment.
Personal information:
References:
1. Baek HJ, Lee SJ, Cho KH, Choo HJ, Lee SM, Lee YH, et al. Subungual tumors: clinicopathologic correlation with US and MR imaging findings. Radiographics. 2010;30(6):1621-36. 2. Dooley TP, Kindt KE, Baratz ME. Subungual tumors. Hand (N Y). 2012;7(3):252-8. 3. Gungor F, Akyol KC, Eken C, Kesapli M, [...]

C-2507
10:35
Ultrasound (US)-guided arthrography: Useful tips and tricks
T. Hebar, M. Kljaic Dujic; Maribor/SI

Learning objectives:
Demonstrate and explain techniques to optimize needle visualization during US-guided arthrography
Background:
US-guided arthrography is a low-cost and radiation-free method of joint injection. The transducer is placed on the patient’s skin in the appropriate location, which is indicated by the target and relevant anatomic structures. Local anesthesia administration follows. The needle is advanced through th[...]
Findings and procedure details:
There are two methods to direct the needle relative to the transducer and ultrasound beam: the in-plane approach and the out-of-plane approach. With the in-plain approach, the needle is inserted parallel to the transducer and the entire needle shaft and tip is visible at all times during the procedu[...]
Conclusion:
Mastering the above-mentioned techniques to optimize needle visualization during US-guided arthrography can help you be faster with a decrease risk of injury to the neighboring soft tissue structures.
Personal information:
Timea Hebar Radiology resident in training. Department of Radiology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia. Email: timea.heabar@gmail.com Milka Kljaić Dujić Msuculoskeletal Radiology Section. Department of Radiology, University Medical Centre Maribor, Ljubl[...]
References:
Adler, RS (2018). Musculoskeletal interventions. In Diagnostic Ultrasound (pp.898–914). Philadelphia, USA: Elsevier. Adler R, Sofka C. Percutaneous ultrasound guided injections in the musculoskeletal system. Ultrasound Q 2003; 19:3–12. Barr L, Hatch N, Roque PJ, Wu TS. Basic ultrasound guided pro[...]

C-2789
10:42
Spinal involvement in mucopolysaccharidoses
A. Leone1, M. Cortese2, V. Zecchi1, C. Vitiello1, C. Colosimo1; 1Rome/IT 2Roma/IT

Learning objectives:
To provide the fundamental radiological aspects in diagnosing spinal involvement in mucopolysaccharidoses (MPS) To assess the role of imaging in diagnosis and patient management.
Background:
· MPSs represent a rare group of inherited metabolic diseases, caused by genetic mutation of specific enzymes involved in the sequential catabolism of long-chain complex carbohydrates known as glycosaminoglycans (GAGs) or mucopolysaccharides. GAGs are components of proteoglycans (glycosylated prote[...]
Findings and procedure details:
Spinal involvement is a common and prominent feature in patients with MPS: · IVA (Morquio A syndrome) · VI (Maroteaux-Lamy syndrome) · I (Hurler syndrome) It has also been described in cases of MPS II, III (Sanfilippo syndrome), and VII (Sly syndrome). The various patte[...]
Conclusion:
Spinal abnormalities, which are prominent features of many MPS types, are chronic, progressive, often debilitating, and a major cause of mortality Imaging is very helpful for screening patients with MPS, optimizing the time for surgical intervention, and for assessing the impact of treatment. In[...]
Personal information:
References:
1. Leone A, Rigante D, Amato DZ, Casale R, Pedone L, Magarelli N, Colosimo C (2014). Spinal involvement in mucopolysaccharidoses: a review. Childs Nerv Syst. 2015 Feb;31(2):203-12. 2. Lehman TJA, Miller N, Norquist B, Underhill L, Keutzer J (2011). Diagnosis of the mucopolysaccharidoses. [...]

C-2922
10:49
Osteoid Osteoma: typical and atypical radiological findings
F. Barbiera1, E. Murmura1, B. Murmura2, M. Accardi1, A. Botta1, A. Aiello1, T. smeraldi2, L. La Grutta2, R. Lagalla2; 1Sciacca/IT 2Palermo/IT

Learning objectives:
To describe radiologic findings of osteoid osteoma, in particular atypical findings, and its variants and mimics.
Background:
Osteoid osteoma is a small spherical tumor with a diameter of 2 cm or less, composed of a central zone named nidus which is an atypical bone completely enclosed within a well-vascularized stroma (1). The peripheral sclerotic reaction zone is composed of osteoblasts, osteoclasts and dilated capillar[...]
Findings and procedure details:
Typical radiographic findings: In plain radiographs the lesion is characterized by a small nidus surrounded by dense bone; the nidus is mostly seen as a radiolucent area significantly or mildly calcified depending on the disease duration (1). At CT, the nidus is well defined and round or oval with[...]
Conclusion:
To make the correct diagnosis, it is important to be familiar with the radiologic findings of osteoid osteoma, its mimics and confusing imaging findings.
Personal information:
Dr. Filippo Barbiera UO Radiologia - Ospedale "Giovanni Paolo II" - Sciacca - ASP AG2 - Via Pompei, 92019 Sciacca AG Email:filippo.barbiera@gmail.com Dr. Bruno Murmura Resident in training. Università degli Studi di Palermo - DiBiMed - Scienze radiologiche - Policlinico Universitario A.O.U.P. [...]
References:
1. Hashemi J, Gharahdaghi M, Ansaripour E, Jedi F, Hashemi S. Radiological Features of Osteoid Osteoma: Pictorial Review. Iran J Radiol. 2011;8(3):182-189. DOI:0.5812/kmp.iranjradiol.17351065.3392 2. Chai JW, Hong SH, Choi JY, Koh YH, Lee JW, Choi JA, Kang HS, Radiologic Diagnosis of Osteoid Osteom[...]

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