This study aimed to explore the anatomy and injury patterns of trapeziometacarpal (TMC) joint ligaments by using magnetic resonance imaging (MRI). In total, 32 asymptomatic healthy volunteers (16 women, 16 men; mean age, 34.5 ± 5.4 years) and 18 patients (12 women, 6 men; mean age, 43.6 ± 10.4 years) were recruited between January 2019 and November 2024. All participants underwent MRI of the TMC joint using T1-weighted imaging and proton density-weighted imaging with fat suppression. Two musculoskeletal radiologists independently analyzed the MRI features of the TMC joint ligaments in volunteers and patients. In asymptomatic volunteers, the normal anterior oblique ligament (AOL), dorsal radial ligament (DRL), and posterior oblique ligament appeared as slender, low-signal fibrous structures on MRI, whereas the normal intermetacarpal ligament exhibited a striated signal. The AOL was significantly thinner in women than in men, and there were no significant sex differences for other ligaments. Ligament injuries were characterized by changes in MRI signal: Sprains showed high-signal alterations, partial tears displayed thickening and partially discontinuous fibers with disrupted signals, and complete ruptures were characterized by ligament retraction and fluid-filled gaps. Among the ligaments, the AOL was most susceptible to injury, followed by the DRL. Magnetic resonance imaging is an accurate method for assessing the anatomy and pathological conditions of the TMC joint ligaments, thus aiding in the accurate diagnosis and management of ligament injuries.
Bone marrow reconversion is a physiological response to increased hematopoietic demand and is common in chronic anemia. Magnetic resonance imaging (MRI) enables noninvasive assessment of marrow composition; however, visual evaluation remains subjective. Because the psoas signal is largely unaffected by hematologic status, it can serve as a stable internal reference. To quantify lumbar vertebral marrow signal alterations in women with iron deficiency anemia (IDA) and evaluate the diagnostic performance of the T1-weighted signal ratio between the lumbar vertebrae and the psoas muscle as a predictor of anemia. This retrospective study analyzed lumbar spine MRIs and laboratory data of 141 women (83 IDA, 58 controls). On sagittal T1-weighted images, circular regions of interest were placed in the L1 vertebral body and adjacent psoas muscle to calculate the vertebra/psoas signal ratio. Group comparisons, correlation, and receiver operating characteristic (ROC) analysis with 95
BACKGROUND:Osteoporosis is frequently underdiagnosed in trauma patients. However, contrast-enhanced whole-body computed tomography (WBCT) in polytrauma care enables opportunistic assessment of bone status without additional radiation exposure. The aim of this study was to investigate whether vertebral, femoral, and dentomaxillofacial CT parameters can identify patients with documented osteopenia or osteoporosis and whether a combined score improves classification. MATERIALS AND METHODS:This retrospective, single-center study included 60 WBCT cases. Twenty patients with osteopenia or osteoporosis documented in their initial trauma report were compared with 20 age- and sex-matched reference patients and 20 younger patients. The final classification of bone status was based on an evaluation of patient records, including dual-energy X‑ray absorptiometry (DXA) data (where available), and medical history. Trabecular density was measured in the lumbar spine (L1-L3), femoral neck, and maxillary alveolar ridge. Hard palate cortical thickness (HPT) was measured in millimeters. The whole-body osteoporosis screening score was defined as WBOS = ƒ(HPT, hip HU, lumbar HU). RESULTS:Measurements of HPT, maxilla, hip, and lumbar spine decreased significantly in patients with osteopenia/osteoporosis patients. The combined WBOS score demonstrated the best exploratory performance, with a sensitivity of 100.0%, a specificity of 97.1%, an accuracy of 98.3%, and an AUC of 0.994 at a preliminary threshold of 361. CONCLUSION:Opportunistic multisite assessment of bone status using WBCT in polytrauma appears feasible. The WBOS showed the best exploratory discrimination but requires further validation against DXA or quantitative CT before clinical implementation.
We aimed to explore the use of deep learning image reconstruction (DLIR) to improve virtual non-contrast (VNC) images from enhanced dual-energy computed tomography (DECT). A total of 91 patients undergoing treatment for liver lesions from September to December 2024 were analyzed. All patients underwent true non-contrast (TNC) and dual-phase enhanced DECT with medium-level DLIR (DLIR-M). The VNC images were generated from arterial phase (VNCA) and venous phase (VNCV) scans. The CT values and standard deviations of liver, spleen, bilateral erector spinae, and liver lesions were measured across the three image groups, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Two radiologists subjectively scored the image quality. Measurements and quality scores were statistically compared among the groups. There was no difference in CT values among the three groups (P > 0.05); VNCA and VNCV images did not alter the primary imaging characteristics of hypervascular liver lesions. The VNCA and VNCV images had lower image noise than the TNC images, with VNCV images having the lowest noise. Except for the spleen, VNCA and VNCV images had higher SNR than TNC images, with VNCV images having the best SNR. The subjective scores of the TNC, VNCA, and VNCV images were all greater than 3, showing good consistency between the two observers (kappa = 0.78, 0.76, and 0.83, respectively).There was no difference between the subjective evaluation of VNCA and TNC (P > 0.05), while VNCV had better image quality than TNC (P < 0.05). The total effective radiation dose was 8.55 ± 0.38 mSv; thus, replacing TNC with VNC would reduce the dose by 33.4
Osteoporosis is frequently underdiagnosed in trauma patients. However, contrast-enhanced whole-body computed tomography (WBCT) in polytrauma care enables opportunistic assessment of bone status without additional radiation exposure. The aim of this study was to investigate whether vertebral, femoral, and dentomaxillofacial CT parameters can identify patients with documented osteopenia or osteoporosis and whether a combined score improves classification. This retrospective, single-center study included 60 WBCT cases. Twenty patients with osteopenia or osteoporosis documented in their initial trauma report were compared with 20 age- and sex-matched reference patients and 20 younger patients. The final classification of bone status was based on an evaluation of patient records, including dual-energy X‑ray absorptiometry (DXA) data (where available), and medical history. Trabecular density was measured in the lumbar spine (L1–L3), femoral neck, and maxillary alveolar ridge. Hard palate cortical thickness (HPT) was measured in millimeters. The whole-body osteoporosis screening score was defined as WBOS = ƒ(HPT, hip HU, lumbar HU). Measurements of HPT, maxilla, hip, and lumbar spine decreased significantly in patients with osteopenia/osteoporosis patients. The combined WBOS score demonstrated the best exploratory performance, with a sensitivity of 100.0
We explored the feasibility of reducing both radiation and contrast doses while improving image quality using low-energy virtual monochromatic images (VMIs) in dual-energy computed tomography (CT) pulmonary angiography (DECTPA) with deep learning image reconstruction at a high setting (DLIR-H). A total of 60 patients scheduled for CTPA were randomly divided into two groups: group A (n = 30) with 120 kV, contrast dose of 0.8 mL/kg, and adaptive statistical iterative reconstruction‑V (ASIR-V) at a 60
BACKGROUND:We explored the feasibility of reducing both radiation and contrast doses while improving image quality using low-energy virtual monochromatic images (VMIs) in dual-energy computed tomography (CT) pulmonary angiography (DECTPA) with deep learning image reconstruction at a high setting (DLIR-H). MATERIALS AND METHODS:A total of 60 patients scheduled for CTPA were randomly divided into two groups: group A (n = 30) with 120 kV, contrast dose of 0.8 mL/kg, and adaptive statistical iterative reconstruction‑V (ASIR-V) at a 60% strength level, and group B (n = 30) with dual-energy CT (DECT), contrast dose of 0.6 mL/kg, and DLIR‑H at 40 keV, 50 keV, 60 keV and 70 keV VMIs. The CT and standard deviation (SD) values of the pulmonary arteries were measured to calculate the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Image quality was subjectively scored blindly by two radiologists using a five-point scale. RESULTS:There were no differences in general patient demographics between the two groups (all p > 0.05). In group B, the contrast and radiation doses decreased by 29.6% and 53.1%, respectively, compared to group A (p < 0.05). Compared to group A, group B had significantly higher CT and SNR values for the 40 keV-60 keV VMIs and higher CNR for the 40 keV-70 keV VMIs (all p < 0.05), with similar image noise at 60 keV. The two radiologists had substantial agreement in subjective scoring (kappa > 0.80). There were significantly higher scores for the 40 keV-60 keV VMIs in group B compared to group A (all p < 0.05), with the 40 keV VMIs having the highest scores. CONCLUSION:Combining DLIR‑H with VMIs, especially 40 keV, in DECTPA leads to reduced contrast and radiation doses while improving image quality.
We retrospectively determined imaging characteristics of primary tumors of the ribs in conventional radiography (CR), computed tomography (CT), and magnetic resonance imaging (MRI) to differentiate between benign and malignant lesions. A total of 124 patients with 179 primary tumors of the ribs were included and analyzed for morphologic features in CR, CT, and MRI including localization, tumor size and extension, lytic or sclerotic appearance, and signal characteristics. In addition to epidemiological data, clinical parameters such as comorbidity, tobacco consumption, and local pain symptoms were collected from all patients. The data collected were grouped into subcollectives and statistically analyzed concerning distinctive features between malignant and benign tumors. The majority of primary tumors of the rib were benign (74
Knochenmarkinzidentalome werden durch die zunehmende Anwendung der Magnetresonanztomographie (MRT) immer häufiger detektiert. Dabei müssen benigne Veränderungen sicher von abklärungsbedürftigen malignen Läsionen differenziert werden. Ziel ist die Darstellung der Bildcharakteristika zur praxisnahen Differenzierung maligner und benigner Zufallsbefunde des Knochenmarks. Narrative Literaturübersicht mit Fokus auf eine musterbasierte Vorgehensweise am spinalen und extraspinalen Skelett. Signalverhalten, Morphologie und Lokalisation des Knochenmarkinzidentaloms sind entscheidend für die Einordnung der Läsion. Bei der Wirbelsäule ist die Zuordnung der Läsion in das diffuse, fokale, mikrofokale oder regionale Muster hilfreich, um Differenzialdiagnosen einzugrenzen. Osteolytische Läsionen sind hypointens in T1w und hyperintens in T2w, sklerosierte Läsionen sind signalfrei in allen Sequenzen und fettreiche Läsionen sind hyperintens in T1w und T2w. Mikro- oder makroskopisches Fett in einer Läsion ist ein Benignitätskriterium. Mittels weniger Sequenzen im MRT und der Korrelation mit Röntgenaufnahme und Computertomographie (CT) ist meist eine zuverlässige Einordnung von Knochenmarkinzidentalomen möglich.
BACKGROUND:Bone marrow incidentalomas are being detected with increasing frequency due to the growing use of magnetic resonance imaging (MRI). It is essential to distinguish benign from malignant lesions that require further investigation. OBJECTIVES:The aim is to describe the imaging characteristics to facilitate the practical differentiation between malignant and benign incidental findings in bone marrow. METHODS:A narrative literature review focusing on a pattern-based approach to the spinal and extraspinal skeleton. RESULTS:The signal characteristics, morphology, and location of the bone marrow incidentaloma are crucial for classifying the lesion. In the spine, classifying the lesion as diffuse, focal, microfocal, or regional helps limit the differential diagnoses. Osteolytic lesions are hypointense on T1w- and hyperintense on T2w-imaging; sclerotic lesions are signal-free on all sequences; and fatty lesions are hyperintense on both T1w- and T2w-imaging. The presence of micro- or macroscopic fat within a lesion is a criterion for benignity. CONCLUSION:By using a few MRI sequences and correlating them with X‑ray and computed tomography (CT) images, it is possible to reliably classify incidental bone marrow lesions.
Das menschliche Knochenmark und dessen Stoffwechsel – insbesondere die Zusammensetzung des Knochenmarkfettgewebes („bone marrow adipose tissue“, BMAT) – ist im Verlauf des Lebens physiologischen Veränderungen unterworfen, jedoch auch bei pathologischen Prozessen involviert und verändert. Moderne Techniken der quantitativen Magnetresonanztomographie (MRT) erlauben inzwischen eine objektive und quantitative Evaluation solcher Prozesse. Radiologische Standardverfahren bestehen in der T1- und T2-gewichteten MRT des Knochens bzw. Knochenmarks. Methodische Innovationen bestehen in der „Chemical-Shift-Encoding-based (CSE)“ Wasser-Fett-Bildgebung und der (1H)-MR-Spektroskopie (MRS). Insbesondere der Quantifizierung mittels „Proton Density Fat Fraction“ (PDFF) kommt Bedeutung bei physiologischen als auch pathologischen Veränderungen des BMAT vor. Die Bestimmung der PDFF—insbesondere mittels (1H)-MRS—wird zunehmend verwendet zur Evaluation des BMAT, ist jedoch weiterhin kein Standardverfahren. Die Kenntnis der typischen Signalgebung des BMAT ist wichtig, um physiologische Veränderungen von pathologischen Veränderungen sicher zu unterscheiden—sowohl in Bezug auf die visuelle Darstellung als auch die Quantifizierung.
Some diseases, such as neurofibromatosis type 1, Langerhans cell histiocytosis, SAPHO (an acronym for synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome, chronic nonbacterial osteomyelitis, or psoriatic arthropathy, present with manifestations affecting both the skin and the skeleton. Since these diseases can easily be overlooked in diagnostic radiology, an accurate diagnosis relies on the combined evaluation of bone and skin findings. The bidirectional interaction between cutaneous and skeletal tissues is mediated by genetic predispositions as well as immune-inflammatory mechanisms and is summarized under the term SKIBO ("skin-bone interaction"). This CME overview presents the most important SKIBO disorders-which every radiologist should be familiar with-from both radiological and dermatological perspectives, with the aim of raising radiologists' awareness of relevant skin findings in everyday clinical practice.
CLINICAL/METHODICAL ISSUE:Human bone marrow and its metabolism-particularly the composition of bone marrow adipose tissue (BMAT)-are subject to physiological changes throughout the lifespan. However, they are also involved in and altered by pathological processes. Modern techniques of quantitative magnetic resonance imaging (MRI) now enable an objective and quantitative evaluation of such processes. STANDARD RADIOLOGICAL METHODS:Standard radiological procedures consist of T1- and T2-weighted MRI of the bone (marrow). METHODICAL INNOVATIONS:Methodological innovations consist of chemical shift encoding-based (CSE) water-fat imaging and proton (1H) MR spectroscopy (MRS). PERFORMANCE:In particular, quantification using the proton density fat fraction (PDFF) is of relevance for both physiological and pathological changes of BMAT. ACHIEVEMENTS:The determination of the PDFF-particularly by means of (1H)-MRS-is increasingly being used for the evaluation of BMAT, but it remains a non-standard procedure. PRACTICAL RECOMMENDATIONS:Knowledge of the typical signal characteristics of BMAT is essential for reliably discriminating physiological from pathological changes-both in terms of visual image reading and quantification.
Manche Erkrankungen wie Neurofibromatose Typ 1, Langerhans-Zell-Histiozytose, SAPHO(Akronym aus Synovitis/Akne/Pustulosis/Hyperostose/Osteitis)-Syndrom, chronische nichtbakterielle Osteomyelitis oder Psoriasisarthropathie zeigen Manifestationen sowohl an der Haut als auch am Skelett. Da diese Krankheiten in der diagnostischen Radiologie schwierig zu diagnostizieren sind, stützt sich eine korrekte Diagnose auf die kombinierte Beurteilung von Knochen- und Hautbefunden. Das bidirektionale Zusammenspiel zwischen kutanen und skelettalen Geweben wird durch genetische Prädispositionen sowie immun-inflammatorische Mechanismen vermittelt und unter dem Begriff SKIBO („skin-bone interaction“) zusammengefasst. Die wichtigsten SKIBO-Erkrankungen, die jeder Radiologe kennen sollte, werden in dieser CME-Übersicht radiologisch und dermatologisch vorgestellt und sollen Radiologinnen und Radiologen für relevante Hautbefunde im klinischen Alltag sensibilisieren.
Knochenmarkveränderungen sind häufige radiologische Befunde mit breitem Spektrum von physiologischer Konversion/Rekonversion bis zu maligner Infiltration. Die Arbeit fasst wichtige Differenzialdiagnosen maligner Knochenmarkläsionen zusammen und stellt einen praxisorientierten diagnostischen Ansatz vor. Narrative Übersichtsarbeit auf Basis aktueller Literatur mit Fokus auf Magnetresonanztomographie (MRT), Computertomographie (CT) sowie ergänzende Techniken wie Chemical-Shift-Imaging (CSI), Dixon-Sequenzen, diffusionsgewichtete Bildgebung (DWI) und Positronen-Emissions-Tomographie (PET)/CT. Die T1-gewichtete MRT ohne Fettsättigung ist zentral für die Beurteilung des Knochenmarks. Ein Signal unterhalb von Muskulatur oder Bandscheibe spricht gegen einfache Rekonversion und sollte an Infiltration denken lassen. CSI- und Dixon-Techniken helfen durch Nachweis intraläsionalen Fetts bei der Abgrenzung benigner Mimics. Wichtige Differenzialdiagnosen umfassen Metastasen, Leukämien, Lymphome, myeloproliferative Erkrankungen, Myelom, Rekonversion, Knocheninfarkte, chronische nichtbakterielle Osteomyelitis (CNO)/chronisch-rezidivierende multifokale Osteomyelitis (CRMO), Langerhans-Zell-Histiozytose (LCH), Enostome und Osteomyelitis. Die Diagnose erfordert die Zusammenschau von Bildmuster, Fettgehalt, Mineralisation, Alter, Klinik, Tumoranamnese und Verlauf. Bei unklaren oder aggressiven Befunden ist eine Kontrolle oder Biopsie erforderlich.
Nach radiologischer Diagnostik endet die Versorgung nicht mit der Befundung. Häufig entstehen Anschlussfragen zu Befundzugang, Bildmitnahme, Nachsorge, Zweitmeinung und Terminsteuerung. Digitale Patientenportale können diesen Übergang strukturieren, sind jedoch funktional sehr unterschiedlich ausgeprägt. Welche Funktion haben digitale Patientenportale nach radiologischer Diagnostik, und wie lassen sie sich klinisch einordnen? Narrative Übersichtsarbeit mit Fokus auf radiologische Patientenportale, direkten Ergebniszugang, Bildfreigabe, patientenkontrollierten Bildaustausch, Benachrichtigung bei Folgeempfehlungen sowie Notaufnahme- und Notfallkontexte. Nach radiologischer Diagnostik übernehmen Patientenportale vor allem 6 Aufgaben: Bereitstellung von Bericht und Bild, Kontextualisierung des Befunds, sichere Kommunikation, Weitergabe an externe Behandler, Nachverfolgung von Folgeempfehlungen und Navigation in die Anschlussversorgung. Studien zeigen, dass viele Patientinnen und Patienten radiologische Ergebnisse aktiv online aufrufen, Berichte häufiger als Bilder. Der größte Nutzen entsteht, wenn Bericht, Bilder und konkrete Handlungsoptionen gemeinsam angeboten werden. Nach radiologischer Diagnostik wird das Patientenportal zur digitalen Brücke zwischen Bildgebung und weiterer Versorgung. Radiologische Qualität bemisst sich deshalb nicht nur an Untersuchungs- und Befundqualität, sondern zunehmend auch daran, ob nach dem Befund klar ist, was der nächste sinnvolle Schritt ist.
