Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive disorder caused by mutations in the neurotrophic tyrosine receptor kinase 1 (NTRK1) gene, characterized by impaired pain perception, autonomic dysfunction, and progressive musculoskeletal damage. A 6-year-old girl with ocular and cutaneous albinism, psychomotor retardation, and bilateral hip dislocation was diagnosed with CIPA due to the presence of atraumatic lower limb fractures. Genetic testing revealed a novel NTRK1 splice site mutation (c.851-2A>G). The patient experienced bilateral medial longitudinal arch injuries, multiple Salter-Harris fracture patterns, and imaging characteristics suggestive of neuropathic arthropathy and an unusual periosteal reaction during the course of an 8-year follow-up. Recurrent septic arthritis also resulted in severe deformity of the elbow joint. Unusual periosteal reaction, complex physeal injuries, and synchronous bilateral medial longitudinal arch fractures are among the novel radiologic findings highlighted in this case of CIPA. In this potentially fatal condition, early identification of such patterns is essential for diagnosis, interdisciplinary care, and prevention of irreversible joint damage.
To evaluate the diagnostic ability of combined clinical and MRI findings in a cohort of patients initially diagnosed with axial spondyloarthritis (axSpA) and to detect potential patients with osteitis condensans ilii (OCI) for further analyses. We conducted a retrospective follow-up study of 129 consecutive patients aged ≥ 18 years (49 women/80 men) diagnosed with axSpA during the period 2012–2023. Uniform baseline MRI of the sacroiliac joints (SIJ) and spine with concomitant radiography and/or CT were reassessed by an experienced radiologist using fulfillment of thresholds for SIJ MRI changes consistent with axSpA and a global assessment of all imaging material. Clinical and biochemical findings at baseline and during follow-up were reevaluated and in combination with imaging findings used as a reference standard for axSpA and OCI changes, respectively. Imaging findings consistent with OCI were confirmed by a second experienced radiologist and OCI imaging characteristics were systematically assessed. axSpA was confirmed in 95 patients. Seven women had OCI and 27 (15 women/12 men) had non-specific SIJ bone marrow edema (BME). None of the OCI women fulfilled radiographic criteria for axSpA, but all fulfilled fat deposition thresholds on MRI consistent with axSpA and five also fulfilled thresholds for BME. The detected OCI MRI characteristics were as follows: sclerosis predominating at the anterior-middle iliac joint areas with BME and fat deposition at the periphery, and subchondral BME and fat deposition predominantly in the sacrum. The location of sclerosis, BME, and fat deposition can be used to diagnose OCI changes on MRI.
Recurrent anterior shoulder dislocation often causes progressive damage and bone loss of the anteroinferior glenoid rim, which is a key factor in persistent shoulder instability. Correct measurement of bone loss is essential before surgery, as it helps decide whether a soft tissue repair is sufficient or if a bone graft procedure, such as the Latarjet, is required. In the past, arthroscopy was considered the standard method for evaluating glenoid bone loss, using the so-called “bare spot” as a reference point. However, this landmark is not always visible and has shown poor reliability, which has reduced its clinical value. For this reason, imaging methods with CT and MRI are now preferred. One of the best-known imaging techniques is the PICO CT method, which calculates bone loss by inscribing the glenoid in a circle. Although widely used, this method has significant limitations because the glenoid surface is not truly circular. As a result, variability between observers is high, and clinical accuracy is reduced. To improve precision, the PARMA method was developed. This technique uses curved multiplanar CT reconstructions (cMPRs) to follow the real concavity of the glenoid surface. Cadaveric studies have shown that PARMA is more accurate and reproducible than traditional CT methods, with good agreement compared to high-precision laser scanning. In addition, Hill–Sachs lesions must also be evaluated. The on-track/off-track concept combines humeral and glenoid bone loss to predict the risk of recurrent dislocation. Off-track lesions have a higher chance of surgical failure if treated with soft tissue repair alone and usually require bone procedures. Overall, modern CT-based techniques and combined lesion assessment improve accuracy and allow more tailored treatment of shoulder instability. The aim of this review is to provide an overview of the CT methods most employed to quantify glenoid bone loss in traumatic shoulder instability, emphasizing their strengths and limitations.
To identify radiographic and computed tomography (CT) parameters predictive of cruciate ligament avulsion fractures in patients with tibial plateau fractures (TPFs). We retrospectively analyzed 127 patients with TPFs, categorized by the presence (n = 39) or absence (n = 88) of cruciate ligament avulsion fractures. Demographic variables, fracture classification, and radiographic parameters measured on plain radiographs and CT images were compared using univariate analysis. Multivariate logistic regression and Receiver Operating Characteristic (ROC) analysis were performed to identify independent associated factors and diagnostic thresholds. Cruciate ligament avulsion fractures occurred in 30.7
To compare the distribution of anterior inferior iliac spine (AIIS) morphology on three-dimensional computed tomography (3D-CT) among hips with femoroacetabular impingement syndrome (FAIS), developmental dysplasia of the hip (DDH), and an asymptomatic control cohort. In this single-center retrospective cross-sectional study, AIIS morphology was classified on 3D-CT using a four-subtype system. Asymptomatic control hips were selected from individuals undergoing abdominopelvic CT for non-orthopaedic indications, whereas FAIS and DDH hips were identified from patients evaluated for hip-preservation surgery. Lateral center–edge angle (LCEA) was measured on clinical anteroposterior pelvic radiographs or CT-derived anteroposterior digitally reconstructed radiographs, as applicable. AIIS morphology distributions were compared among groups using chi-square testing with post hoc pairwise analyses. Multivariable logistic regression was used to identify independent predictors of Type III morphology after adjustment for diagnostic group, LCEA, age, and sex. A total of 1,420 hips were analyzed, including 800 asymptomatic hips, 500 FAIS hips, and 120 DDH hips. AIIS morphology distribution did not differ significantly between the FAIS and asymptomatic cohorts. Type III morphology was identified in 9.2
To conduct a comprehensive bibliometric analysis of 50 years of publications in Skeletal Radiology to evaluate publication trends, citation impact, authorship patterns, institutional contributions, international collaboration, and research themes. Data were retrieved from the Scopus database on 1 May 2026, covering all publications indexed in Skeletal Radiology from 1976 to 2025. A total of 8258 documents were analyzed using VOSviewer for network visualization (co-authorship and keyword co-occurrence) and Microsoft Excel for descriptive and statistical analyses. Key metrics included total publications (TP), total citations (TC), citations per paper (CPP), relative citation index (RCI), and total link strength (TLS). The journal demonstrated steady growth with an average of 168.5 papers per year and a 6.5
Lumbar puncture (LP) is the most common approach for cerebrospinal fluid (CSF) access, but anatomical abnormalities may prevent this safe procedure. We describe the use of CT-guided thoracic puncture in a patient whom conventional lumbar and cervical approaches were unsafe and discuss procedural safety considerations. A patient with history of meningomyelocele and Chiari malformation presented with suspected meningitis requiring CSF analysis. Standard LP and cervical puncture were considered unsafe due to patient’s complex anatomy. Therefore, a CT-guided thoracic puncture was performed to obtain CSF. Procedural planning, imaging guidance and safety measures were utilized to minimize the risk of spinal cord injury and other complications. CT-guided thoracic puncture was successfully performed using a carefully planned oblique approach, allowing acquisition of adequate CSF for diagnostic evaluation. The procedure was completed without immediate or delayed complications. Although thoracic puncture is generally considered a high-risk procedure, it may represent an effective alternative in selected patients with contraindications to lumbar or cervical puncture. However, the absence of complications in this single case does not establish the safety of this approach and this procedure should be performed by experienced physicians after careful assessment of patient’s anatomy.
Chondromyxoid fibroma (CMF) is a benign cartilaginous neoplasm that accounts for less than 1
Sports participation among children predisposes the immature skeleton to unique patterns of injury. In contrast to the mature skeleton, the growth plates of the immature skeleton are biomechanically vulnerable sites of weakness, susceptible to not only acute traumatic but also repetitive overuse injuries. This latter pattern of injury, better known as physeal stress injuries (PSIs), has received increased attention, because undiagnosed and untreated injuries can result in long-term morbidity and risk for future growth disturbance, particularly when involving the physis underlying the epiphysis. This article reviews the anatomy and physiology of the primary epiphyseal growth plate complex, focusing on how injuries centered at the metaphyseal osteochondral junction can disrupt the final step of endochondral ossification. In the second half of this article stereotypical patterns of PSI in three distinct groups of youth athletes are reviewed: the proximal humerus in baseball players, the distal radius in gymnasts, and the phalanges in rock climbers. For each group, sport-specific epidemiologic data, clinical presentation, and characteristic imaging findings are discussed. Multimodality imaging features are discussed, prioritizing the capability of MRI to characterize the spectrum of injury ranging from patterns of ongoing stress to irreversible growth disturbance. By synthesizing the current literature and consolidating imaging characteristics, this article seeks to guide clinicians and radiologists in the timely diagnosis of epiphyseal PSI, ensuring early intervention where treatment is less invasive and often more effective.
To validate the feasibility of a three-dimensional dual-echo-steady-state (3D-DESS) sequence at 7-T MRI to reliably depict the detailed anatomy in the cervical spine. Seventy-eight asymptomatic volunteers (age 36.4 ± 11.6 years) were imaged, using a 3D-DESS sequence at 7-T MRI. The course of the vertebral artery (VA) and the visualization of dorsal root ganglia (DRG) were analyzed by two fellowship-trained musculoskeletal radiologists. Additionally, degenerative changes were graded. Uncovertebral arthrosis was present in 47.4
Ankle impingement syndromes comprise a heterogeneous group of osseous and soft tissue pathologies caused by abnormal contact between articular or peri-articular structures, resulting in chronic pain and restricted motion. They are anatomically classified into posterior compartment (posterior proper and posteromedial), anterior compartment (including anterior proper, anterolateral and anteromedial), and extra-articular lateral hindfoot impingement (ELHFI). Posterior impingement is most commonly related to os trigonum or a prominent Stieda process, with MRI demonstrating marrow edema and posterior soft tissue hypertrophy, while ultrasound enables dynamic assessment and image-guided intervention. Anterior impingement results from repetitive microtrauma leading to osteophyte formation and capsular fibrosis; radiography and CT depict osseous abnormalities, whereas MRI and ultrasound characterize associated soft tissue changes. Anterolateral impingement and anteromedial impingement are typically post-traumatic, with fibrosis and ligamentous injury within the joint recesses, best evaluated on MRI, and ultrasound providing dynamic assessment. ELHFI is an under-recognized entity associated with posterior tibial tendon dysfunction and medial arch collapse, resulting in talocalcaneal or subfibular impingement. Weight-bearing radiographs and CT assess hindfoot alignment, while MRI delineates tendon, ligamentous, and marrow abnormalities. Ultrasound plays an adjunctive role in evaluating tendon pathology and guiding interventions. This review summarizes current evidence on the imaging features, pathomechanisms, and management of ankle impingement syndromes, with particular emphasis on extra-articular lateral hindfoot impingement. It emphasizes the value of a multimodality imaging approach and underscores the evolving role of ultrasound in both diagnosis and management, supporting its integration as a frontline modality in appropriately selected clinical and interventional settings.
Badminton is characterized by distinctive biomechanical demands: high-velocity overhead strokes combined with forceful lunging, landing, and rapid multidirectional movement. These repetitive high-load mechanics generate a broad spectrum of musculoskeletal abnormalities, ranging from acute ligamentous and tendon injuries to cumulative stress-related remodeling. The shoulder and lower extremities are most frequently affected, reflecting the dual demands of explosive upper limb acceleration and high-impact lower limb deceleration. From an imaging standpoint, accurate evaluation requires recognition of these sport-specific patterns and appropriate modality selection. Radiography remains the first-line imaging modality in examinations of acute trauma, enabling assessment of fractures, avulsion injuries, and joint misalignment. Ultrasound, meanwhile, provides dynamic, real-time evaluation of tendons and ligaments, facilitating detection of tendinopathy, partial tears, ligament sprains, and Doppler hyperemia in active overuse conditions, while also enabling image-guided intervention when clinically indicated. MRI offers comprehensive evaluation of deep soft-tissue structures, cartilage surfaces, capsulolabral complexes, menisci, cruciate ligaments, and bone marrow. Fluid-sensitive sequences are essential for identifying stress reactions, subtle tendon signal abnormalities, and osseous contusions associated with pivoting or landing injuries, particularly when pathology is multifocal or internal derangement is suspected. Importantly, many imaging findings in badminton athletes are subtle and multifocal. Tendon thickening, low-grade partial tears, labral signal alterations, ligament attenuation, and stress-related marrow edema may represent repetitive mechanical loading or stress-related injury rather than overt structural failure. Therefore, integration of biomechanics, imaging characteristics, and clinical presentation is essential to differentiate clinically significant injury from asymptomatic or low-grade imaging findings and to guide appropriate management and return-to-play decisions.
Primary aim was to evaluate whether presence of osteoarthritis (OA), as assessed by ordinal grading on whole-body computed tomography (CT), is associated with 68 Ga fibroblast activation protein inhibitor (FAPI) positron emission tomography (PET) tracer uptake as a measure of fibroblastic activation. Secondary aim was to evaluate whether OA disease severity is positively correlated with increased tracer uptake and to evaluate reliability. In a retrospective study design, patients who had undergone 68 Ga-FAPI PET-CT for a spectrum of clinical reasons were included. Whole-body CT was assessed for OA using the OsteoArthritis Computed Tomography‐Score in multiple joints and the spine. Maximum standard uptake value (SUVmax) was determined correspondingly. Logistic regression and correlation analyses were used to describe associations between structural OA and 68 Ga-FAPI PET activity. Fifty-four patients were included. Presence of OA in the acromioclavicular joints (ACJ) was associated with odds of SUVmax being in the highest tertile. Increased odds were seen for one location of the cervical spine (OR 5.7, 95
Persistent occipital headache after cervical arthrodesis is a disabling complication, often due to iatrogenic injury to the greater or lesser occipital nerves. Clinical overlap with primary headaches may delay diagnosis. High-resolution ultrasound (HRUS) has emerged as a reliable tool for evaluating superficial peripheral nerves and postoperative changes. We report a case illustrating its diagnostic value in occipital nerve injury, with a focused review of sonoanatomy. A 45-year-old woman developed refractory bilateral occipital pain consistent with occipital neuralgia after cervical arthrodesis for disc herniation. HRUS (24 MHz) using a standardized protocol revealed postsurgical changes and focal fusiform thickening with loss of fascicular architecture of the right greater occipital nerve at its muscular perforation site, consistent with iatrogenic neuroma. These findings guided targeted management. This case underscores the diagnostic challenge of postsurgical occipital neuralgia and the utility of HRUS. Knowledge of occipital nerve sonoanatomy and its relationship to adjacent cervical muscles is essential. HRUS enables real-time evaluation of nerve morphology and continuity, detecting focal thickening often missed by other imaging methods. HRUS allowed diagnosis and percutaneous treatment of greater occipital nerve neuroma in this patient.
Denosumab is a monoclonal antibody targeting RANKL, FDA-approved for the treatment of giant cell tumor of bone (GCTB). While it has shown efficacy in tumor regression and bone preservation, rare cases of malignant transformation to osteosarcoma have been associated with denosumab treatments. Previous literature has attributed such cases to either initial misdiagnosis of a malignant giant cell tumor at baseline presentation or, more rarely, transformation of previously histologically benign GCTB to a secondary malignant GCTB. To our knowledge, these cases involved or arose from an existing giant cell tumor neoplasm. We present a unique case of a patient who developed de novo osteosarcoma at a distant location from their original GCTB tumor following prolonged denosumab therapy, highlighting the clinical course, diagnostic challenges, and therapeutic considerations.
The study aims to characterize the postoperative MRI appearance of double-bundle PCL graft reconstructions (DB-PCL-R) with correlation to clinical PCL stability. A retrospective evaluation of 23 patients, 37 MRIs (12/37, 0–3 months; 8/37, 3–12 months; 17/37, > 12 months) following DB-PCL-R for MRI findings, integrity of the anterolateral (ALB) and posteromedial (PMB) bundles, position of tunnels, peritunnel marrow edema, graft fixation, graft signal, graft-bundle thickening, and synovitis or arthrofibrosis was performed. MRI findings were categorized by time interval postoperatively. PCL stability was assessed clinically (grade 0–III) in all patients. Chi-square or Fisher’s exact analysis was performed to explore associations between MRI findings and PCL stability. Graft bundles appeared intact in all cases. PMB graft femoral tunnel was inferiorly positioned in 2/23 patients. The tibial tunnel was inferiorly positioned in 5/23 and superiorly positioned in 2/23 patients. Displaced/fractured fixation hardware related to the PMB tunnel was observed in 3/23 patients, and in the tibial tunnel in 2/23 patients. The highest prevalence of peritunnel marrow edema (50–81.8
To evaluate superb microvascular imaging (SMI) for detecting microvascularity in chronic plantar heel pain and to assess its clinical correlation in comparison with grayscale ultrasound and conventional Doppler, using a standardized clinical diagnosis as the reference standard. In this prospective study, 29 patients (58 fasciae) with bilateral plantar fasciosis and 30 matched asymptomatic controls (60 fasciae) underwent ultrasound examinations. Assessments included grayscale parameters (thickness > 4 mm, swelling hypoechogenicity), color/power Doppler, and SMI. Pain and function were evaluated using the VAS and FAOS-derived impairment scores. Discriminative ability was assessed via receiver operating characteristic (ROC) curves. Symptomatic fasciae had significantly greater fascial thickness (5.02 ± 1.29 mm vs. 3.27 ± 0.56 mm, p < 0.001) and exceeded 4 mm in 82.8
Athletes are commonly imaged for focal swelling, persistent pain, or a new palpable abnormality after training or injury. These imaging findings are frequently not neoplastic, although several benign processes can appear sufficiently mass-like or aggressive to raise concern for sarcoma or an aggressive lesion. Such "pseudotumors" are more common in routine musculoskeletal practice than primary malignancy. This review approaches the problem as it is encountered in practice: first, the palpable abnormality that prompts imaging, and second, the incidental or symptomatic injury-related lesion that appears worrisome on radiographs, ultrasound, CT, or MRI. Radiographs should be obtained as a first line of imaging. Both radiographs and CT remain essential when evaluating mineralization, ossification, periosteal reaction, cortical injury, or stress fracture. Ultrasound is particularly useful for imaging evaluation of superficial lesions, fluid collections, vascular abnormalities, and dynamic processes such as muscle herniation. MRI is the principal problem-solving modality for deep or indeterminate lesions because it shows compartment of origin, tissue plane affected, internal architecture, marrow involvement, and enhancement patterns. In athletes, the most useful question is often whether the finding fits the story. A benign injury-related lesion should occur in a plausible location, involve the expected tissue plane, and change over time in a predictable way. Discordant features, including progressive enlargement, unexplained deep location, infiltrative margins, nodular internal enhancement, bone destruction, neurovascular encasement, or failure to evolve as expected, should prompt further imaging evaluation to exclude a more ominous diagnosis.
High ankle sprains represent a distinct subset of ankle injuries involving disruption of the distal tibiofibular syndesmosis. Although less common than lateral ankle sprains, these injuries are frequently underdiagnosed on initial clinical and radiographic assessment and carry significant implications for ankle stability and long-term function. In the athletic setting, high ankle sprains are associated with an increased return-to-play time compared to lateral ligament injuries. Accurate diagnosis relies heavily on imaging, with weight-bearing radiographs and computed tomography aiding in assessment of syndesmotic alignment and fractures, whilst MRI allows for direct visualisation of the ligaments and associated injuries. This review provides a comprehensive, imaging-centred overview of the spectrum of high ankle sprain injuries with a focus on lower energy mechanisms, which occur more commonly in sport. We will discuss and review the relevant anatomy, biomechanics, injury patterns, common associated injuries, the phases of healing, postoperative appearances and common complications. • MRI is pivotal in diagnosis of high ankle sprains, injury grading, evaluation of associated injuries, assessment of ligament healing and demonstration of postoperative complications. • The sagittal and coronal planes are key in initial MRI assessment of the AITFL. Axial plane assessment is limited due to obliquity of the AITFL and resultant partial sampling. • The AITFL is the first ligament to fail, usually towards the fibular attachment. • The IIOL usually fails toward the tibial attachment. • The PITFL typically fails at the inferior, lateral border of the tibial attachment, with variable propagation superiorly and medially often associated with periosteal stripping and tibial plafond chondral injury.
To determine the MRI prevalence of the semimembranosus–lateral meniscus (SM–LM) attachment and the imaging plane on which it is most conspicuous, and to evaluate its relationships with the meniscofemoral ligaments and the oblique popliteal ligament (OPL). In this retrospective single-center study, 205 1.5-T knee MRI examinations in patients ≥ 18 years (134 women, 71 men; median age, 38 years) were evaluated by a musculoskeletal radiologist, with a random subset of 100 independently evaluated by a second reader; those with prior ipsilateral knee trauma or surgery or Kellgren–Lawrence grade 3–4 osteoarthritis were excluded. Interobserver agreement was evaluated with Cohen κ; logistic regression and chi-square analyses were performed. The SM–LM attachment was identified in 32 of 205 knees (15.6
