Ryan Ka Lok Lee

Ultrasound of Musculoskeletal Soft-Tissue Tumors Superficial to the Investing Fascia

OBJECTIVEnThe objective of our study was to evaluate the diagnostic accuracy of ultrasound in assessing musculoskeletal soft-tissue tumors superficial to the investing fascia.nnnMATERIALS AND METHODSnSeven hundred fourteen superficial soft-tissue tumors evaluated with ultrasound by two musculoskeletal radiologists were retrospectively reviewed. In all ultrasound reports, the reporting radiologists provided one, two, or three diagnoses depending on their perceived level of diagnostic certainty. Two hundred forty-seven tumors had subsequent histologic correlation, thus allowing the accuracy of the ultrasound diagnosis to be determined. Images of the lesions with a discordant ultrasound diagnosis and histologic diagnosis were reviewed, and the ultrasound features were further classified as concordant with the known histologic diagnosis, concordant with the known histologic diagnosis with atypical features present, or discordant with the known histologic diagnosis. Four hundred sixty-seven tumors without pathologic confirmation were followed up clinically.nnnRESULTSnOverall the accuracy of ultrasound examination for assessing superficial soft-tissue masses was 79.0% when all differential diagnoses were considered and 77.0% when only the first differential diagnosis was considered. The sensitivity and specificity of the first ultrasound diagnosis were 95.2% and 94.3%, respectively, for lipoma; 73.0% and 97.7% for vascular malformation; 80.0% and 95.4% for epidermoid cyst; and 68.8% and 95.2% for nerve sheath tumor. Reduced observer awareness of specific tumor entities tended to contribute to underdiagnosis more than poor specificity of ultrasound findings. Most tumors (236/247, 96%) were benign. The sensitivity and specificity of ultrasound for identifying malignant superficial soft-tissue tumors was 94.1% and 99.7%, respectively.nnnCONCLUSIONnThe diagnostic accuracy of ultrasound in the assessment of superficial musculoskeletal soft-tissue tumors is high and can be improved through increased radiologist awareness of less frequently encountered tumors. Ultrasound is accurate for differentiating benign from malignant superficial soft-tissue tumors.

High accuracy of ultrasound in diagnosing the presence and type of groin hernia

To evaluate the accuracy of ultrasound (US) in diagnosing the the presence and type of groin hernia.

Sonography of the chest wall: A pictorial essay

Ultrasound (US) is increasingly being used as the first‐line imaging modality for investigating the chest wall for soft tissue and bony lesions. This article describes the technique used for the US examination, the relevant chest‐wall anatomy, and the appearances on US scanning of pathologic entities either unique to or common in the region of the chest wall.

Imaging of radial wrist pain. I. Imaging modalities and anatomy

Radial wrist pain is a common clinical complaint. The relatively complex anatomy in this region, combined with the small size of the anatomical structures and occasionally subtle imaging findings, can pose problems when trying to localize the exact cause of pain. To fully comprehend the underlying pathology, one needs a good understanding of both radial-sided wrist anatomy and the relative merits of the different imaging techniques used to assess these structures. In part I of this review, these aspects will be discussed.

Phalangeal microgeodic disease: report of two cases and review of imaging

Phalangeal microgeodic disease is a rare disease that is frequently (though not invariably) related to cold exposure. In most cases, the clinical and radiographic findings of phalangeal microgeodic disease are sufficient to reach the diagnosis. The magnetic resonance imaging (MRI) findings of phalangeal microgeodic disease have been described in four cases in the English literature with two additional cases presented here. MRI allows a greater appreciation of affected bone areas and adds specificity to radiography with regard to diagnosis. In this sense, MRI is a helpful investigation in those cases of phalangeal microgeodic disease when doubt still exists following clinical and radiographic assessment.

Non-Hodgkin's Lymphoma of the Knee: A Case Report

Primary musculoskeletal lymphoma presenting as monoarthritis is very rare. Less than 20 cases have been reported. The ultrasound appearances have not been reported to date. We present a young female of primary knee lymphoma with synovial involvement presenting as monoarthritis. The ultrasound and MRI features are discussed.

Ultrasound carpal tunnel syndrome: additional criteria for diagnosis

AIMnTo define the usefulness of the cross-sectional area (CSA) of the median nerve distal to the carpal tunnel in addition to other established common parameters in the diagnosis of carpal tunnel syndrome (CTS).nnnMATERIALS AND METHODSnForty-four wrists from 24 symptomatic CTS patients and 32 wrists from 17 asymptomatic volunteers were evaluated by ultrasound. The CSA of the median nerve was measured at four pre-selected levels, i.e., proximal, inlet, outlet, and distal to the carpal tunnel. The flattening ratio, intraneural vascularity, neural fasciculation, and retinacular palmar bowing were also assessed.nnnRESULTSnSignificant differences were found between the CTS and control groups for median nerve CSA proximal and distal (p<0.001) to the tunnel as well as retinacular bowing (p<0.001). Using the receiver operating characteristic (ROC) curve, the sensitivity, specificity, and accuracy of using a cut-off of >14xa0mm2 of CSA proximal and distal to the tunnel were 75%, 87.5%, 86.8% and 63.6%, 100%, 78.9%, respectively. Using either CSA proximal or distal to the tunnel or bowing retinaculum at the outlet >1xa0mm yielded a sensitivity, specificity, and accuracy of 100%, 84.3% and 93.4%, respectively.nnnCONCLUSIONnThe median nerve CSA proximal and distal to the carpal tunnel and bowing of the retinaculum at the outlet are helpful in diagnosis of CTS.

Ankle Traction During MRI of Talar Dome Osteochondral Lesions

OBJECTIVEnThe objective of our study was to assess the impact of axial traction during MRI of talar dome osteochondral lesions using a small-FOV coil.nnnSUBJECTS AND METHODSnA prospective study of 33 patients undergoing high-resolution MRI of the ankle using a microscopy coil with and without axial traction was performed. Two radiologists independently measured the tibiotalar joint space width and semiquantitatively graded intraarticular joint fluid dispersion, cartilage surface visibility of the osteochondral lesion, and cartilage surface visibility elsewhere in the tibiotalar joint before and after traction. Patients were instructed to report any discomfort during ankle traction.nnnRESULTSnNone of the patients reported discomfort or other symptoms during ankle traction. The tibiotalar joint space significantly increased (increase in cartilage-cartilage distance, 0.5-0.7 mm; all, p < 0.05) after traction compared with before traction. The degree of intraarticular joint fluid dispersion and the cartilage surface visibility at the osteochondral lesion and elsewhere in the tibiotalar joint improved after traction (all, p < 0.05).nnnCONCLUSIONnTraction MRI of the ankle is safe and technically feasible. This study is the first to date to investigate the effect of ankle traction on the MRI assessment of talar dome osteochondral lesions. Traction improves cartilage surface visibility of talar dome osteochondral lesions.

Sonographic examination of the buttock

The buttock is a common site of pathology and ultrasound and is often the first‐line imaging modality to examine soft tissue lesions of the buttock region. This review describes the ultrasound technique used, the relevant ultrasound anatomy, and the sonographic appearances of common and uncommon pathological conditions found in the buttock region.

Imaging bicipitoradial bursitis: a pictorial essay

Although bicipitoradial bursitis is not commonly seen, when it does occur, it can frequently lead to diagnostic difficulty, mimicking either a soft-tissue tumor or infection. Lack of awareness of this uncommon entity can lead to unnecessary anxiety or tissue biopsy. This pictorial essay discusses the normal anatomy of the bicipitoradial bursa and the spectrum of imaging findings of bicipital bursitis.