Abstract Primary vertebral tumors and tumor-like lesions in skeletally immature patients are uncommon yet clinically consequential causes of pain, deformity, and neurological compromise. Compared with adults, pediatric lesions arise in a spine with open physes, evolving marrow composition, and substantial remodeling capacity—features that shape tumor biology and imaging appearance. This pictorial review summarizes malignant tumors, benign tumors, and tumor-like lesions of the pediatric spine, adopting a modality-first, compartment-aware approach. Useful highlights include vertebra plana in Langerhans cell histiocytosis, posterior-element bias in lesions such as osteoid osteoma/osteoblastoma, and the role of whole-body magnetic resonance imaging patterns in chronic nonbacterial osteomyelitis/chronic recurrent multifocal osteomyelitis. We also update terminology and concepts for entities such as vertebral hemangioma (venous malformation) and aneurysmal bone cyst. Throughout, we couple modality choice with pediatric anatomy and growth considerations, as well as illustrating the discussion with real-life cases from our teaching files.
Abstract Objective: To propose a novel ultrasound-based classification system for muscle injuries in soccer players, termed the Sonographic Muscle Injury Classification in Soccer (SOMICS), and to evaluate its association, ordinal consistency, and agreement with the British Athletics Muscle Injury Classification (BAMIC). Materials and Methods: This was a cross-sectional observational study including 51 adolescent male soccer players (11–19 years of age) with suspected acute myotendinous injuries. All athletes underwent ultrasound and magnetic resonance imaging (MRI) within 24 h after injury. Four experienced radiologists, working independently, reviewed the images. Results: Interobserver agreement was substantial for ultrasound (κ = 0.65) and MRI (κ = 0.70). A strong ordinal correlation was observed between SOMICS and BAMIC categories (ρ = 0.80; p < 0.001), with a statistically significant association (χ2 = 52.53; p < 0.001). Conclusion: The SOMICS demonstrated significant association, ordinal consistency, and substantial agreement with the BAMIC for severity stratification of muscle injuries. Although not intended to replace MRI-based classifications for prognostic decision-making, the SOMICS provides a structured, reproducible ultrasound-based approach that may be useful in clinical settings where MRI is not readily available or as a first-line imaging tool.
Abstract Objective: To describe the contributions of conventional single-photon emission computed tomography (SPECT) and subtraction ictal-interictal SPECT coregistered to magnetic resonance imaging (SISCOM) for the preoperative identification of the epileptogenic zone (EZ) in patients with frontal lobe epilepsy (FLE). Materials and methods: In this retrospective study, we reviewed medical records of all patients with refractory FLE who underwent frontal lobectomy at our institution between 2015 and 2020, all of whom had undergone at least one ictal SPECT, one interictal SPECT, one high-resolution magnetic resonance imaging examination, SISCOM, and at least one year of follow-up. Fourteen patients met the inclusion criteria. Results: After a mean follow-up of 32 months (range, 14–60 months), surgical outcomes were classified as good in five patients (35.7%) and poor in nine (64.3%). For localizing the EZ, SISCOM achieved the highest sensitivity (80%), negative predictive value (85%), and overall diagnostic accuracy (71%), whereas ictal SPECT had the highest specificity (70%) and interictal SPECT had the lowest performance overall. Conclusion: In patients with FLE, ictal and interictal SPECT alone do not seem to predict the surgical outcome. However, SISCOM seems to perform better for that purpose.
Abstract Fasciculations are a key manifestation of lower motor neuron dysfunction in amyotrophic lateral sclerosis (ALS). Al-though electromyography is considered the gold-standard method for the detection of fasciculations, its sensitivity for that purpose depends on the muscle sampled and the examination time. Muscle ultrasound has emerged as a dynamic, noninvasive technique with high sensitivity for detecting spontaneous muscle activity. This updated system-atic review compares ultrasound and electromyography in terms of their performance for the detection of muscle fas-ciculations in ALS, with stratification by muscle group and observation time. A comprehensive search of the literature identified studies evaluating both techniques. Data were synthesized descriptively and, when possible, quantitatively. Ultrasound demonstrated higher or comparable detection rates across most muscle groups, particularly in muscles that are large or deep, such as the biceps brachii, tibialis anterior, and vastus lateralis. Longer ultrasound observation times, especially 60 s, were associated with substantially higher detection rates without a loss of specificity. Although electromyography is still essential for electrophysiological characterization, ultrasound offers broader muscle cover-age, excellent reproducibility, and a noninvasive approach. These findings support muscle ultrasound as a valuable complementary tool for the detection and assessment of fasciculations in patients with motor neuron disease.
