46-year-old patient:
– With right hip pain
– X-rays unremarkable
– MRI requested
Near-complete rupture of the right hamstring tendons with moderate retraction and preserved muscle bellies
Reference: https://radiologyassistant.nl/musculoskeletal/muscle/hamstring-injury
15-year-old patient with left hip pain:
– X-rays requested
MRI
Femoral stress fracture
MRI findings linear low-signal pattern on the medial aspect of the femoral neck, accompanied by bone marrow oedema
Surrounding cortical thickening and solid periosteal reaction
Reference: Shelat NH et al: Pediatric stress fractures: a pictorial essay. Iowa Orthop J. 36:138-46, 2016
35-year-old patient:
– With persistent right hip pain
– Pain exacerbated by abduction/external rotation
– MRI arthrogram requested
Showing images from an MR-arthrography:
There is a complete tear in the anterosuperior labrum, located around the 2 o’clock position.
Reference: Schmaranzer F et al: Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison. Eur Radiol. 25(6):1721-30, 2014
52-year-old patient:
·With chronic right hip pain
MRI findings:
– A subchondral insufficiency fracture accompanied by bone marrow edema is noted
– The presence of additional bone marrow edema in the right femoral neck, particularly in the anterolateral region, is likely indicative of an insufficiency response
– Complete cartilage damage is observed
-Pelvic insufficiency fractures typically manifest in the lateral aspect of the femoral neck, while stress fractures tend to occur on the medial aspect
-Additionally, damage to the articular surface can result from cartilage loss, a condition distinct from osteonecrosis
Reference: Peh WC et al: Imaging of pelvic insufficiency fractures. Radiographics. 16(2):335-48, 1996
51-year-old patient:
* Present with a painful lump in right thigh
* No history of trauma
* MRI requested
– Perform an X-ray to exclude the presence of calcifications
– Confirm that there is no prior history of trauma
The patient had been involved in a car accident five months before the lump was detected
Perform a follow-up X-ray in three months
Myositis ossificans
It should be distinguished from parosteal osteosarcoma and soft tissue sarcoma
Key imaging characteristics to consider include:
-The zonal phenomenon: Mineralization typically initiates and progresses from the periphery towards the center. The absence of this phenomenon should raise concerns.
-Soft tissue edema is more common around myositis ossificans than around sarcomas. It may show marrow edema, periosteal reaction, and peripheral edema at any stage better expressed
Reference: McCarthy EF et al: Heterotopic ossification: a review. Skeletal Radiol. 34(10):609-19, 2005
Young male patent:
– Presented with elbow pain post-fall of bicycle
Olecranon process fracture
Elevated posterior fat pad projecting posterior to the distal humerus indicative of the presence of an intracapsular effusion in the elbow
53-year-old male:
– Persistent right shoulder pain, no movement limitations.
– No previous trauma.
– Shoulder MRI is performed
What do you see?
Quadrangular/Quadrilateral space syndrome
– Posteroinferior paralabral cyst (arrow) extending into the quadrangular space
– Teres minor mild fatty infiltration – atrophy (circle)
– Neurovascular compression syndrome of the posterior humeral circumflex artery (PHCA) and/or the axillary nerve or one of its major branches in the quadrangular space
– Multiple causes of compression: fibrotic bands, ganglion/cysts, aneurysms, tumours
– MRI may demonstrate atrophy and/or denervation edema of the teres minor and/or deltoid muscles
– Differential diagnosis: Parsonage-Turner sd, disuse atrophy
8-year-old patient:
– With a chronically painful right knee and ankle
– Patient with no relevant clinical history
– Parents mention a difficulty when running, the patient trips very easily and sometimes struggles to use the right leg. The right leg is often painful
Showing the X-ray right knee and the pelvis
Eccentric, lytic bone lesions with sharp margins
No periosteal reaction
Ground-glass matrix of the lesion in the right tibial diaphysis
Soap-bubbly appearance of the lesion in the femoral diaphysis
Expansile bone lesion with ground glass matrix in the right femoral neck, extending into the proximal diaphysis
Slight varus deformity of the femoral neck
Similar lesion in the right iliac wing/acetabular region
A CT was performed:
Showing X-ray of both feet.
Expansile bone lesion with ground glass matrix involving the 1st metatarsal and proximal and distal phalanges of the left foot
Soap-bubbly lesions of the talus and 5th metatarsal
– Multiple bone lesions with benign appearance
– Expansile lesion with ground-glass matrix in the femoral neck virtually pathognomonic for fibrous dysplasia
– Genetic testing could not reveal mutations of the GNAS gene: no syndromic association in this patient
Benign bone lesions
– Usually central in bone
– Varying degrees of expansion
– Ground-glass matrix (mildly sclerotic)
– Lack of aggressive features (no periosteal reaction, no cortical breakthrough or soft tissue mass)
Aetiology: developmental dysplasia
Fibrous dysplasia is polyostotic in 15–20%, often in syndromic association (mutations of the GNAS gene)
– McCune-Albright syndrome (in combination with endocrine dysfunctions)
– Mazabraud syndrome
38-year-old with left knee pain.
Showing multiple images:
Left knee X-ray:
STIR:
* Relatively common intramedullary cartilage neoplasms with benign imaging features
* Constitute ~5% (range 3–10%) of all bone tumors and ~17.5% (range 12–24%) of benign bone tumors
* Narrow zone of transition
* Sharply defined margins
* Chondroid calcification, however, purely lytic in the hands/feet
* Sometimes expansile – more commonly in hands/feet
* Mild endosteal scalloping
* Do not “grow” through cortex (unless pathologic fracture)
* No bone destruction
* No periosteal reaction
* No soft tissue mass
* Pathological fracture
* Malignant transformation into chondrosarcoma
* Bone infarct
* Chondrosarcoma
* Intraosseous ganglion
* Murphey MD, Flemming DJ, Boyea SR et-al. Enchondroma versus chondrosarcoma in the appendicular skeleton: differentiating features. Radiographics. 18 (5): 1213-37. Radiographics (abstract) – Pubmed citation
* Walden MJ, Murphey MD, Vidal JA. Incidental enchondromas of the knee. AJR Am J Roentgenol. 2008;190 (6): 1611-5. doi:10.2214/AJR.07.2796 – Pubmed citation
* Douis H, Saifuddin A. The imaging of cartilaginous bone tumours. I. Benign lesions. Skeletal Radiol. 2012;41 (10): 1195-212. doi:10.1007/s00256-012-1427-0 – Pubmed citation
* Mulligan ME. How to Diagnose Enchondroma, Bone Infarct, and Chondrosarcoma. (2019) Current problems in diagnostic radiology. 48 (3): 262-273. doi:10.1067/j.cpradiol.2018.04.002 – Pubmed
30-year-old male:
· Persistent pain in his right ankle, for a year long, a synovial mass was demonstrated on ultrasound. · Ankle MRI was performed
* Benign proliferative condition affecting the synovial membrane. Most commonly monoarticular
* MRI: Mass-like synovial proliferation with lobulated margins and articular erosions
– Signal -> T1: low-intermediate ; DPFS/STIR: heterogeneous with areas of high signal ; GE: blooming artifact ; T1GD: variable enhancement.
Differential diagnosis includes:
* Scarring – capsulitis
* Siderotic synovitis
* Synovial sarcoma
