Soft Tissue CAM Impingement in Adolescents: MRI reveals impingement lesions underappreciated on x-ray (138)

Objectives: The presence of femoroacetabular impingement (FAI) in adolescents has been established. However, the existence of a non-ossified CAM lesion in adolescent femoracetabular impingement (FAI) is not well described. The purpose of this study is to evaluate the presence of a non-ossified or soft CAM lesion in adolescent patients with FAI. Methods: A review of a prospective cohort of patients with symptomatic FAI in an institutional registry was performed. Subjects were included if they had an MRI and lateral x-ray of the hip (45o Dunn, Cross Table, or frog) at a baseline visit. On MRI, evaluation of the anterolateral femoral head was evaluated using radial, coronal, sagittal, or axial oblique sequences. When a soft CAM lesion was identified (all found between 2-5 o’clock), an alpha angle was performed on MRI and plain radiograph. The cohort of soft CAM lesions was reviewed and differences between radiographic and MRI alpha angles were assessed using a paired T-Test. Results: Thirty-one (9.3%) of 332 hips (mean age 16.4 yrs, range 13.66-19.59 yrs; 83.9% F) were identified with a soft impinging lesion at the femoral head-neck junction on MRI. The most common primary sport was track & field (4), the average duration of symptoms was 92.4 weeks and a majority with insidious onset (77.4%). The average alpha angle on MRI was greater than on x-ray [63.53 ± 7.94o vs 51.25 ± 7.92o; p<.05]. All subjects with soft CAM lesions demonstrated soft tissue consistent with extension of the physis (n=1),thickening of the peri-chondral ring (n=22), or thickening of the periosteum (n=8). Twenty-two of these patients (71%) with soft impingement underwent hip preservation surgery (n=13 labral repairs) with improvements in clinical outcome. Conclusions: In adolescent patients with symptomatic hip impingement, MRI may be useful to identify soft CAM lesions (non-ossified) that are under-represented on x-ray.

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SOFT TISSUE CAM IMPINGEMENT IN ADOLESCENTS: MRI REVEALS IMPINGEMENT LESIONS UNDERAPPRECIATED ON X-RAY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00063 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0006

Author(s):

Benjamin L. Johnson ◽

Hamza Alizai ◽

Montanez Ben ◽

K. John Wagner ◽

Tyler Youngman ◽

...

Keyword(s):

Soft Tissue ◽

Femoral Head ◽

Plain Radiograph ◽

Alpha Angle ◽

Duration Of Symptoms ◽

X Ray ◽

Insidious Onset ◽

Adolescent Patients ◽

Cam Impingement ◽

Soft Impingement

Background: The presence of femoroacetabular impingement (FAI) in adolescents has been established. However, the existence of a non-ossified CAM lesion in adolescent femoracetabular impingement (FAI) is not well described. Hypthesis/Purpose: The purpose of this study is to evaluate the presence of a non-ossified or soft CAM lesion in adolescent patients with FAI. Methods: A review of a prospective cohort of patients with symptomatic FAI in an institutional registry was performed. Subjects were included if they had an MRI and lateral x-ray of the hip (45o Dunn, Cross Table, or frog) at a baseline visit. On MRI, evaluation of the anterolateral femoral head was evaluated using radial, coronal, sagittal, or axial oblique sequences. When a soft CAM lesion was identified (all found between 2-5 o’clock), an alpha angle was performed on MRI and plain radiograph. The cohort of soft CAM lesions was reviewed and differences between radiographic and MRI alpha angles were assessed using a paired T-Test. Results: Thirty-one (9.3%) of 332 hips (mean age 16.4 yrs, range 13.66-19.59 yrs; 83.9% F) were identified with a soft impinging lesion at the femoral head-neck junction on MRI. The most common primary sport was track & field (4), the average duration of symptoms was 92.4 weeks and a majority with insidious onset (77.4%). The average alpha angle on MRI was greater than on x-ray [63.53 ± 7.94o vs 51.25 ± 7.92o; p<0.05]. All subjects with soft CAM lesions demonstrated soft tissue consistent with extension of the physis (n=1),thickening of the peri-chondral ring (n=22), or thickening of the periosteum (n=8). Twenty-two of these patients (71%) with soft impingement underwent hip preservation surgery (n=13 labral repairs) with improvements in clinical outcome. Conclusion: In adolescent patients with symptomatic hip impingement, MRI may be useful to identify soft CAM lesions (non-ossified) that are under-represented on x-ray.

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Deriving alpha angle from anterior-posterior dual-energy x-ray absorptiometry scans: an automated and validated approach

Wellcome Open Research ◽

10.12688/wellcomeopenres.16656.1 ◽

2021 ◽

Vol 6 ◽

pp. 60

Author(s):

Benjamin G. Faber ◽

Raja Ebsim ◽

Fiona R. Saunders ◽

Monika Frysz ◽

George Davey Smith ◽

...

Keyword(s):

Femoral Head ◽

Alpha Angle ◽

Hip Osteoarthritis ◽

Dual Energy ◽

Final Version ◽

X Ray ◽

Automated Method ◽

Dxa Scans ◽

Cam Morphology ◽

Anterior Posterior

Introduction: Alpha angle (AA) is a widely used measure of hip shape that is commonly used to define cam morphology, a bulging of the lateral aspect of the femoral head. Cam morphology has shown strong associations with hip osteoarthritis (OA) making the AA a clinically relevant measure. In both clinical practice and research studies, AA tends to be measured manually which can be inconsistent and time-consuming. Objective: We aimed to (i) develop an automated method of deriving AA from anterior-posterior dual-energy x-ray absorptiometry (DXA) scans; and (ii) validate this method against manual measures of AA. Methods: 6,807 individuals with left hip DXAs were selected from UK Biobank. Outline points were manually placed around the femoral head on 1,930 images before training a Random Forest-based algorithm to place the points on a further 4,877 images. An automatic method for calculating AA was written in Python 3 utilising these outline points. An iterative approach was taken to developing and validating the method, testing the automated measures against independent batches of manually measured images in sequential experiments. Results: Over the course of six experimental stages the concordance correlation coefficient, when comparing the automatic AA to manual measures of AA, improved from 0.28 [95% confidence interval 0.13-0.43] for the initial version to 0.88 [0.84-0.92] for the final version. The inter-rater kappa statistic comparing automatic versus manual measures of cam morphology, defined as AA ³≥60°, improved from 0.43 [80% agreement] for the initial version to 0.86 [94% agreement] for the final version. Conclusions: We have developed and validated an automated measure of AA from DXA scans, showing high agreement with manually measuring AA. The proposed method is available to the wider research community from Zenodo.

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The Role of Ultrasonography in Detection and Localization of Radiolucent Foreign Body in Soft Tissues of Extremities

Journal of Nepal Medical Association ◽

10.31729/jnma.174 ◽

2009 ◽

Vol 48 (173) ◽

Cited By ~ 1

Author(s):

Dipak Shrestha ◽

UK Sharma ◽

R Mohammad ◽

D Dhoju

Keyword(s):

Foreign Body ◽

Soft Tissue ◽

Foreign Bodies ◽

Anatomical Location ◽

Local Health ◽

Duration Of Symptoms ◽

X Ray ◽

Linear Probe ◽

Detection And Localization ◽

Ct And Mri

INTRODUCTION:Retained non-radiopaque foreign body inside soft tissue can be a cause of prolonged morbidity. Detection and localization is difficult task with conventional radiography. Ultrasonography, CT and MRI are other modes of evaluation but both of CT and MRI are expensive and not easily available.METHODS:Twenty three patients were evaluated with ultrasonography (8 MHz linear probe) and X-ray for clinically suspicious non-radiopaque foreignbody in soft tissue of extremities. Clinical presentation, duration of symptoms, anatomical location and foreign bodies retrieved after surgical explorations were recorded.RESULTS:X-ray could not detect any foreign body in all 23 patients. Ultrasound findings were suggestive of foreign body in 19 patients (male: female=2:1, mean age 31.68+/-11.8 years, range 12 - 54 years) which was confirmed after surgical exploration except in one where only foreign bodygranuloma was found. 4 (21%) were not aware of prick injury. Fifteen patients had attempted removal of foreign body themselves or at medical shop or local health post. Interval between injury / symptoms appearance to hospital ranged from 4-56 days. Foot and ankle was involved in 10 (52.6%), calf in 3 (15%), dorsum of hand in 2 (10.5%), palm in 2 (10.5%), shoulder in 1 (5.2%) and knee in 1 (5.2%) case. Foreign bodies retrieved were wood in 12 (63%), thorn in 4 (21%) and bamboo twig in 2 (10.5%) patients.CONCLUSION:Plain X-ray isn't sensitive for detection of non-radiopaque foreign body in soft tissue. Ultrasonography is sensitive and specific fordetection and localization of foreign body which should be included in evaluation for clinically suspicious retained non-radiopaque foreign body in softtissue of extremities.KEYWORDS:non-radiopaque foreign body; sensitivity; specificity; ultrasonography

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Role of plain radiograph versus MRI in avascular necrosis of femoral head

MedPulse International Journal of Radiology ◽

10.26611/10131224 ◽

2021 ◽

Vol 12 (2) ◽

pp. 69-71

Author(s):

Amit H Deshmukh ◽

Keyword(s):

Femoral Head ◽

Avascular Necrosis ◽

Joint Destruction ◽

Plain Radiograph ◽

Health Care Centre ◽

X Ray ◽

One Year ◽

The One ◽

Necrosis Of Femoral Head

Background: Avascular necrosis of the femoral head (AVN) is an increasingly common cause of musculoskeletal disability, and it poses a major diagnostic and therapeutic challenge. Although patients are initially asymptomatic, AVN usually progresses to joint destruction, usually before the fifth decade. Aims and Objectives: To study role of plain radiograph versus MRI in Avascular Necrosis of Femoral head. Methodology: This was a cross-sectional study carried out in the patients clinically suspected of avascular necrosis of femur at tertiary health care centre during the one year period i.e. January 2018 to January 2019 during the one year period there were 37 patients suspected of avascular necrosis of Femur The sensitivity and specificity was calculated by ROC curves from the medcal software.Result: In our study we have seen that the sensitivity (Sn)and Specificity (Sp) for X-ray and MRI respectively for various stages was For STAGE Iwas34.29, 29.12and98.45,95.12 ;forSTAGE IIwas 75.12,68.23 and 99.17,98.27;forSTAGE III98.56,93.12and99.69,98.36;forSTAGE IV99.34,92.19and100,99.19 . Conclusion: It can be concluded from our study that in the early stages of disease MRI was highly sensitive and specific as compared to plain X-ray hence MRI should be preferred over the plain X-ray in the confirmation and early surgical intervention if any.

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Lateral Soft Tissue Neck X-ray a Tool for the Otorhinolaryngology Surgeon

International Journal of TROPICAL DISEASE & Health ◽

10.9734/ijtdh/2019/v39i230201 ◽

2019 ◽

pp. 1-10

Author(s):

Ibekwe Matilda Uju ◽

Oghenekaro Edirin

Keyword(s):

Foreign Body ◽

Soft Tissue ◽

Plain Radiograph ◽

Retropharyngeal Abscess ◽

X Ray ◽

Investigative Tool ◽

Soft Tissue Neck ◽

Laryngeal Tumour ◽

Laryngeal Tumours ◽

Operative Findings

Background: Management of aerodigestive emergencies can prove a challenge especially in this sub-Saharan region where there is a dearth of specialized equipment. In some areas, a plain radiograph may be the only investigative tool readily available to the surgeon. It is routinely done in most of these cases. In our environment health care is often financed by the patients through out of pocket expenses since most do not have health insurance. Affordability of a particular treatment becomes paramount. This study, therefore, is aimed at assessing the use of lateral soft tissue neck X-ray and its reliability as a diagnostic tool in aerodigestive emergencies. Objective: To determine the relevance or effectiveness of plain radiograph of the lateral soft tissue neck in patients with upper aerodigestive emergencies and therefore its use as a tool to the otorhinolaryngology (ORL) surgeon as the first-line investigation in these patients. Patients and Methods: It is a prospective study of all patients that presented to the ENT surgery department of UPTH from April 2018 to April 2019 with upper aerodigestive emergencies. Patients who presented in the ENT clinic, accident and emergency department, children`s emergency wards and the clinics with upper aerodigestive emergencies were recruited in this study. All the patients had X-ray lateral soft tissue of the neck done on presentation and the results were then compared with the final operative findings in the operation theatre. Some patients had also chest radiograph done however; the diagnosis was done based on the lateral soft tissue neck finding. Patients that had radiologic investigation other than radiograph of the lateral soft tissue neck as the main investigative tool were excluded from the study. The radiologist opinion was obtained for all the radiographs as a routine. The results were analyzed using the SPSS 20 and presented in simple statistical tables. Results: Sixteen patients were studied. Males were 14(87.5%) while females were 2(12.5%). Age range was from 1.5 to 77 years with children comprising only 31.25% of the study population. The commonest presenting complaint was voice change 68.75%. Positive findings on the x-ray neck were seen as soft signs in 62.5% and radio-opacity in 18.75%. In n=14(87.5%) the lateral neck x-ray positive findings were corroborated by the operative findings. The tool has a specificity of 100% for both foreign body inhalation/ingestion and laryngeal tumour but the sensitivity of 80% in laryngeal tumours but 100% for the foreign body. Conclusion: Study concludes that lateral soft tissue neck x-ray was found to be a good and useful tool in the diagnosis of a good number of upper aerodigestive emergencies such as foreign body ingestion/inhalation and patients with upper airway obstruction caused by laryngeal tumours and some infective conditions such as a retropharyngeal abscess.

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Plain X-Ray and MRI Evaluation of Painful Hip Joint

Asian Journal of Medical Radiological Research ◽

10.47009/ajmrr.2020.8.2.5 ◽

2020 ◽

Vol 8 (2) ◽

pp. 31-35

Author(s):

S. Althaf Ali ◽

Dwara Manojna Devi

Keyword(s):

Articular Cartilage ◽

Soft Tissue ◽

Metastatic Disease ◽

Hip Joint ◽

Joint Pain ◽

Plain Radiograph ◽

Joint Effusion ◽

X Rays ◽

X Ray ◽

Hip Disease

Background: Hip joint pain is a frequent problem in current practice and can be due to different causes since the investigations are invariably used to diagnose the source of the injury. The primary examination is accompanied by MRI, which is a valuable instrument in hip disease evaluation since it requires a detailed study of articular cartilage, epiphysis, joint fluids, bone marrow and extra-articular soft tissue which may be impaired by hip disease. Subjects and Methods: In a total of 60 individuals who had hip joint pain and subsequently had plain radiographs accompanied by the hip joint MRI was studied in a prospective cross-sectional analysis. The data is interpreted and the results of basic X-rays are compared to the MRI. Results: Of the 70 cases the males (67%) are commonly affected than females (33%). The majority of the patients fall under the age group of 31-40 years (28.33%). In our study, we find the commonest pathology for the hip joint pain is AVN of femoral head 20 cases (28.57%), followed by joint effusion 15 cases (21.42%), Osteoarthritis 13 cases (18.57%), TB hip 10 cases (14.28%), Perthes 4 cases (5.71%), DDH 4 cases (5.71%) and metastatic disease 4 cases (5.71%). Of the twenty AVN cases, only 6 (30%) are found on a plain x-ray whereas all 20 (100%) are detected on MRI. Similarly, out of 15 cases diagnosed as joint effusion, only 5cases (33.33%) are detected on plain radiograph, but all the 12 cases (100%) are detected on MRI. The remaining 100% pathologies are observed on X-ray and MRI; moreover, MRI helps to improve the identification of articular cartilage, epiphysis, and additional soft tissue articular anomalies. Conclusion: MRI is a better way to identify joint effusion and synovial proliferation. Unlike standard x-rays. In proven cases with clear radiography such as Perthe’s and metastatic disease, Hip MRI helps to enhance disease staging, clinical implication, and soft tissue expansion.

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Drilling and plombage (core decompression) of a femoral head avascular necrosis

Osteologie/Osteology ◽

10.1055/s-0037-1619921 ◽

2010 ◽

Vol 19 (01) ◽

pp. 36-39 ◽

Cited By ~ 1

Author(s):

P. Chládek ◽

V. Havlas ◽

T. Trc

Keyword(s):

Surgical Treatment ◽

Femoral Head ◽

Core Decompression ◽

Effective Treatment Option ◽

Simple Method ◽

X Ray ◽

Large Femoral Head ◽

Press Fit ◽

Round Shape ◽

Late Stages

SummaryThe treatment of femoral head necrosis of adults is still rather problematic. Conservative treatment has been reported relatively unsuccessful and surgical treatment does not show convincing results either. The most effective seems to be a surgical treatment in early stages of the disease, however, the diagnosis still remains relatively complicated. For the late stages (2B and above) the most effective treatment option is represented by core decompression and vascular grafting. However, drilling and plombage (especially when using press-fit technique) seems to be successful, although not excellent. The authors describe their own method of drilling and plombage of the necrotic zone of the femoral head in 41 patients with X-ray detected necrotic changes of the femoral head. The pain measured by VAS was seen to decrease after surgery in all patients significantly. The Jacobs score was also observed to have increased (from fair to good outcome). We have not observed any large femoral head collapse after surgery, moreover, in some cases an improvement of the round shape of the femoral head was seen. It is important to mention that in all cases femoral heads with existing necrotic changes (flattening or collapse) were treated. Although the clinical improvement after surgery was not significantly high, the method we describe is a safe and simple method of diminishing pain in attempt to prepare the femoral head for further treatment in a future, without significant restriction of the indication due to necrosis (osteochondroplasty, resurfacing, THR).

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Imaging features of hemangioma in long tubular bones

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03882-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Lei Cao ◽

Jin-Xu Wen ◽

Shu-Man Han ◽

Hui-Zhao Wu ◽

Zhi-Gang Peng ◽

...

Keyword(s):

Soft Tissue ◽

Plain Radiograph ◽

Ground Glass Opacity ◽

Plain Radiography ◽

Long Bone ◽

Imaging Features ◽

Mri Imaging ◽

Soft Tissue Density ◽

Tissue Density ◽

Hyperintense Signal

Abstract Background To investigate the imaging features of hemangiomas in long tabular bones for better diagnosis. Methods Twenty-four patients with long bone hemangiomas confirmed by pathology were enrolled. Nineteen patients had plain radiography, fourteen patients had computed tomography (CT) and eleven had magnetic resonance imaging (MRI). The hemangioma was divided into medullary [13], periosteal [6] and intracortical type [5]. Results Among 19 patients with plain radiography, eleven patients were medullary, three periosteal, and five intracortical. In the medullary type, the lesion was primarily osteolytic, including five cases with irregular and unclear rims and one lesion having osteosclerotic and unclear rims. In three patients with the periosteal type, the lesion had clear rims with involvement of the cortical bone in the form of bone defect, including two cases with local thickened bone periosteum and one case having expansile periosteum. Five intracortical hemangiomas had intracortical osteolytic lesions with clear margins. Among 14 patients with CT imaging, 8 cases were medullary, three periosteal, and three intracortical. Among 8 medullary hemangiomas, one had ground glass opacity, and seven had osteolytic, expansile lesions like soft tissue density with no calcification. In three periosteal cases, the lesion was osteolytic with thickened periosteum and narrowed medullary cavity. In three intracortical hemangiomas, the lesion was of even soft tissue density with no calcification. Among 11 patients with MRI imaging, seven were medullary, two periosteal, and two intracortical. Among 7 medullary lesions, six were of hypointense signal on T1WI and hyperintensesignal on T2 WI. In two periosteal cases, the periosteum was thickened, with one case being of equal signal, and the other having no signal. Two intracortical hemangiomas were both of slightly low signal on T1WI but hyperintense signal on T2WI. Conclusions The long bone hemangiomas had characteristic cystic honeycomb-like presentations in plain radiograph. CT and MRI imagings are helpful for diagnosis of hemangiomas in long bone.

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Visualization Ability of Phase-Contrast Synchrotron-Based X-Ray Imaging Using an X-Ray Interferometer in Soft Tissue Tumors

Technology in Cancer Research & Treatment ◽

10.1177/15330338211010121 ◽

2021 ◽

Vol 20 ◽

pp. 153303382110101

Author(s):

Thet-Thet Lwin ◽

Akio Yoneyama ◽

Hiroko Maruyama ◽

Tohoru Takeda

Keyword(s):

Computed Tomography ◽

Soft Tissue ◽

Spatial Resolution ◽

Phase Contrast ◽

Soft Tissue Tumors ◽

X Ray ◽

3 Dimensional ◽

Computed Tomography Images ◽

X Ray Imaging ◽

X Ray Computed

Phase-contrast synchrotron-based X-ray imaging using an X-ray interferometer provides high sensitivity and high spatial resolution, and it has the ability to depict the fine morphological structures of biological soft tissues, including tumors. In this study, we quantitatively compared phase-contrast synchrotron-based X-ray computed tomography images and images of histopathological hematoxylin-eosin-stained sections of spontaneously occurring rat testicular tumors that contained different types of cells. The absolute densities measured on the phase-contrast synchrotron-based X-ray computed tomography images correlated well with the densities of the nuclear chromatin in the histological images, thereby demonstrating the ability of phase-contrast synchrotron-based X-ray imaging using an X-ray interferometer to reliably identify the characteristics of cancer cells within solid soft tissue tumors. In addition, 3-dimensional synchrotron-based phase-contrast X-ray computed tomography enables screening for different structures within tumors, such as solid, cystic, and fibrous tissues, and blood clots, from any direction and with a spatial resolution down to 26 μm. Thus, phase-contrast synchrotron-based X-ray imaging using an X-ray interferometer shows potential for being useful in preclinical cancer research by providing the ability to depict the characteristics of tumor cells and by offering 3-dimensional information capabilities.

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