A Radiological Scoring System for Differentiation between Enchondroma and Chondrosarcoma

Background: It is challenging to differentiate between enchondromas and atypical cartilaginous tumors (ACTs)/chondrosarcomas. In this study, correlations between radiological findings and final diagnosis were investigated in patients with central cartilaginous tumors. Methods: To evaluate the diagnostic usefulness of radiological findings, correlations between various radiological findings and final diagnoses were investigated in a cohort of 81 patients. Furthermore, a new radiological scoring system was developed by combining radiological findings. Results: Periosteal reaction on X-ray (p = 0.025), endosteal scalloping (p = 0.010) and cortical defect (p = 0.002) on CT, extraskeletal mass (p < 0.001), multilobular lesion (p < 0.001), abnormal signal in adjacent tissue (p = 0.004) on MRI, and increased uptake in bone scan (p = 0.002) and thallium scan (p = 0.027) was significantly correlated with final diagnoses. Based on the correlations between each radiological finding and postoperative histological diagnosis, a radiological scoring system combining these findings was developed. In another cohort of 17 patients, the sensitivity, specificity, and accuracy of the radiological score rates for differentiation between enchondromas and ACTs/chondrosarcomas were 88%, 89%, and 88%, respectively (p = 0.003). Conclusion: Radiological assessment with combined radiological findings is recommended to differentiate between enchondromas and ACT/chondrosarcomas.

Sonographic Findings in Adult Congenital Madelung Deformity: A Case Study

This case study describes six sonographic findings, with correlative imaging, in an adult patient with congenital Madelung deformity. Two are typical of congenital Madelung deformity: a thick volar hyperechoic band extending from the ulnar side of the distal radius toward the lunate-triquetrum area, the so-called Vickers ligament, adjacent to the radiotriquetral ligament, and a cortical defect on the ulnar and volar side of the distal radius. Other findings may be also observed, such as a narrowed distance between the Lister tubercle and the distal radioulnar joint, a dorsal subluxation of the ulnar head, an extensor tendons entrapment and pronator quadratus modifications. Although the diagnosis of congenital Madelung deformity is based usually on clinical examination, this rare malformation may remain undiscovered until adulthood. When sonography is used as the first imaging technique, the sonographic findings of congenital Madelung deformity can facilitate diagnosis and the appropriate radiographs.