Lee F. Rogers

Imaging of musculoskeletal soft tissue infections

Prompt and appropriate imaging work-up of the various musculoskeletal soft tissue infections aids early diagnosis and treatment and decreases the risk of complications resulting from misdiagnosis or delayed diagnosis. The signs and symptoms of musculoskeletal soft tissue infections can be nonspecific, making it clinically difficult to distinguish between disease processes and the extent of disease. Magnetic resonance imaging (MRI) is the imaging modality of choice in the evaluation of soft tissue infections. Computed tomography (CT), ultrasound, radiography and nuclear medicine studies are considered ancillary. This manuscript illustrates representative images of superficial and deep soft tissue infections such as infectious cellulitis, superficial and deep fasciitis, including the necrotizing fasciitis, pyomyositis/soft tissue abscess, septic bursitis and tenosynovitis on different imaging modalities, with emphasis on MRI. Typical histopathologic findings of soft tissue infections are also presented. The imaging approach described in the manuscript is based on relevant literature and authors’ personal experience and everyday practice.

CT Findings of Rupture, Impending Rupture, and Contained Rupture of Abdominal Aortic Aneurysms

OBJECTIVEnWith the increasing use of cross-sectional imaging for a variety of medical and surgical conditions affecting the abdomen and pelvis, familiarity with the imaging features of aneurysm rupture--and the findings suspicious for impending or contained aneurysm rupture--is crucial for all radiologists. This pictorial essay will review the imaging findings of rupture of abdominal aortic aneurysms and of complicated aneurysms.nnnCONCLUSIONnPrompt detection of abdominal aortic aneurysm rupture or impending rupture is critical because emergent surgery may be required and patient survival may be at stake.

Diagnosis of Proximal Femoral Insufficiency Fractures in Patients Receiving Bisphosphonate Therapy

OBJECTIVEnThe purpose of this article is to describe the imaging features of proximal femoral insufficiency fractures in patients on long-term bisphosphonate therapy.nnnCONCLUSIONnThe imaging findings of bisphosphonate-related femoral insufficiency fractures, which include a typical proximal diaphyseal location and transverse liner radiolucency through localized thickening of the lateral cortex, allow a specific diagnosis.

Sonography and Sonoarthrography of the Scapholunate and Lunotriquetral Ligaments and Triangular Fibrocartilage Disk Initial Experience and Correlation With Arthrography and Magnetic Resonance Arthrography

The purpose of this study was to determine the utility of sonography and sonoarthrography in evaluation of dorsal bands of the scapholunate ligament (SLL), lunotriquetral ligament (LTL), and triangular fibrocartilage (TFC) disk in correlation with arthrography and magnetic resonance arthrography (MRA).

US of the Intrinsic and Extrinsic Wrist Ligaments and Triangular Fibrocartilage Complex—Normal Anatomy and Imaging Technique

Injuries of the intrinsic and extrinsic wrist ligaments can lead to chronic wrist pain and carpal instability, while injuries of the triangular fibrocartilage complex are a frequent cause of ulnar-sided wrist pain. Currently, magnetic resonance (MR) arthrography is the preferred imaging modality for the evaluation of these structures, but good results can also achieved with MR imaging without preceding arthrography and computed tomographic (CT) arthrography. Promising results have been published on ultrasonography (US) and sonoarthrography of the intrinsic wrist ligaments and the triangular fibrocartilage complex and on US of the majority of extrinsic wrist ligaments. Visualization of these structures can be achieved by using high-frequency linear transducers. US has the advantages of MR imaging and MR arthrography: lower cost, no known contraindication for imaging, and real-time technique with possible dynamic evaluation. This technique does not require imaging guided intraarticular injection of contrast medium prior to MR arthrography or CT arthrography and does not use ionizing radiation; however, US is operator dependent, which can be compensated for by using standardized imaging techniques. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.e44/-/DC1.

Update on imaging and treatment of Ewing sarcoma family tumors: What the radiologist needs to know

This review article provides an update on multimodality imaging characteristics of Ewing sarcoma family tumors. Pathology of this tumor and current trends in medical and surgical treatment are briefly discussed.

Imaging Characteristics of Diffuse Idiopathic Skeletal Hyperostosis With an Emphasis on Acute Spinal Fractures: Review

OBJECTIVEnThe educational objectives of this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of the imaging of diffuse idiopathic skeletal hyperostosis (DISH), with emphasis on acute spinal fractures.nnnCONCLUSIONnUnderstanding the pathomechanics of the fractures in the ankylosed spine is important in the differentiation of the acute spinal fractures in DISH and ankylosing spondylitis. This article emphasizes the imaging features of spinal DISH and acute spinal fractures in DISH, distinguishing them specifically from those in ankylosing spondylitis.

Humeral Avulsion of the Inferior Glenohumeral Ligament in College Female Volleyball Players Caused by Repetitive Microtrauma

Background: Humeral avulsion of the inferior glenohumeral ligament is a rare injury resulting from hyperabduction and external rotation, and it is most commonly seen with sports-related injuries, including those from volleyball. The anterior band of the inferior glenohumeral ligament is most commonly injured (93%), whereas the posterior band is infrequently injured. The axillary pouch humeral avulsion of the inferior glenohumeral ligament as a result of repetitive microtrauma has not been yet described in the English literature. Hypothesis: Humeral avulsions of the inferior glenohumeral ligaments are identifiable in volleyball players without acute injuries, and they have a unique pathologic pattern in these athletes. Study Design: Case series; Level of evidence, 4. Methods: Four female college volleyball players with pain in their dominant shoulder and with inferior capsular laxity and/or instability—without a known history of trauma or dislocation of the same shoulder—were referred by an experienced sports medicine orthopaedic surgeon for the magnetic resonance arthrogram procedure of the same shoulder. The imaging findings were retrospectively correlated with the initial interpretation and arthroscopic findings. Results: All 4 patients had an axillary pouch humeral avulsion of the inferior glenohumeral ligament. Three had articular surface partial-thickness rotator cuff tear, and 3 had a labral tear. All were outside hitters or middle blockers who consequently performed multiple hitting maneuvers in practice and games. Conclusion: Repetitive microtrauma from overhead hitting in volleyball generates forces on the inferior capsule of the shoulder joint that may cause inferior capsular laxity and subsequent failure of the humeral side of the axillary pouch portion of the inferior glenohumeral ligament.

FDA statement on relationship between bisphosphonate use and atypical subtrochanteric and femoral shaft fractures: a considered opinion.

563 The location and description of the lowimpact fractures reported was consistent, and all patients had been undergoing longterm bisphosphonate therapy. To these authors, the fracture location and appearance was unique, unlike those seen in other conditions or causes. Specifically, insufficiency fractures of the lateral cortex of the femur with or without associated frank, complete fractures in patients with osteoporosis who do not take bisphosphonates are exceedingly rare, if indeed they occur at all. Schilcher and Aspenberg [6] calculated that when this pattern of femoral fracture was identified, the chance that the patient was undergoing longterm bisphosphonate therapy was 46 to 1. The association of this very specific pattern of femoral fracture and long-term bisphosphonate therapy seemed clear. These reports did not maintain that all fractures of the femur were related to long-term bisphosphonate use, only that this specific pattern of femoral fracture appeared to be so related. Furthermore, they did not claim that bisphosphonates have increased the number of femoral fractures. Many patients undergo bisphosphonate therapy. On the other hand, the related femoral fractures are quite rare. The signal-to-noise ratio is therefore quite low. Such fractures are difficult to identify in databases without specific information on the nature and specific imaging features of such fractures.

The Importance of Sagittal 2D Reconstruction in Pelvic and Sacral Trauma: Avoiding Oversight of U-Shaped Fractures of the Sacrum

OBJECTIVEnThe U-shaped sacral fracture can be overlooked without appropriate imaging. Radiographic and CT imaging of seven patients with U-shaped sacral fractures was reviewed.nnnCONCLUSIONnAlthough it is difficult to discern on anteroposterior radiographs and axial or coronal CT, the fracture is easily identifiable on CT images in the sagittal plane. We advocate reconstruction of CT images of the sacrum in the sagittal plane in trauma to prevent failure of identification.