To establish evidence-based consensus statements on imaging of scaphoid fractures. Nineteen hand surgeons formulated a preliminary list of eleven questions on imaging of scaphoid fractures. Based on this preliminary list, radiologists crafted statements considering literature and their clinical experience, then refined them through an iterative Delphi process to revise the questions and statements. A maximum of three Delphi rounds was scheduled until group consensus was achieved for an individual statement, whichever arose first. Twenty-eight radiologists drafted the statements and acted as Delphi panellists. Panellists rated their level of agreement with each statement on an 11-point numeric rating scale, the score ‘0’ indicated complete disagreement and the score ‘10’ indicated complete agreement, respectively. Group consensus was specified as a score of ‘8’ or higher for ≥ 23/28 panellists. Eight of eleven questions and statements achieved group consensus in the first Delphi round. The remaining three questions and statements achieved group consensus in the second Delphi round, indicating more controversial topics. It was agreed that radiographs are the initial imaging technique of choice for suspected scaphoid fractures. MRI or CT are advocated for suspected radiographically occult scaphoid fractures. CT is the method of choice for assessment of osseous consolidation. Contrast-enhanced MRI is the preferred imaging modality for assessing vascularisation of scaphoid nonunion. CT is the most valuable technique in the postoperative evaluation of scaphoid fractures. Delphi-based consensus statements suggest imaging pathways to diagnose scaphoid fractures, assess osseous fracture consolidation and evaluate pre- and postoperative fractures. Question How can an international and interdisciplinary team of hand surgeons and musculoskeletal radiologists develop practical consensus statements on imaging of scaphoid fractures? Findings All eleven statements achieved group consensus among experts using the Delphi technique for consensus-building. Imaging pathways were suggested to diagnose and assess scaphoid fractures. Clinical relevance statement International, interdisciplinary and evidence-based consensus statements on imaging of scaphoid fractures were achieved using the Delphi technique. The focus of the statements was to diagnose scaphoid fractures, assess osseous fracture consolidation and evaluate pre- and postoperative fractures.

Context:Noninvasive measurement of bone marrow adipose tissue using magnetic resonance imaging and proton density fat fraction (PDFF) may enhance clinical fractures prediction in postmenopausal women. Objective:This study aimed to assess the association between PDFF measurements and clinical fracture incidence. Methods:A longitudinal study was conducted. Postmenopausal women with recent osteoporotic fractures (<12 months) and with osteoarthritis without fractures were included. Lumbar spine and proximal femur PDFFs were measured at baseline using water-fat imaging (WFI) and dual-energy x-ray absorptiometry scans. Clinical fractures were recorded during follow-up. Results:Among 195 participants (mean age 67.4 ± 10.0 years, body mass index 27.2 ± 5.9 kg/m²), the PDFF (WFI-based) was higher at the proximal femur, particularly at the femoral head (90.0% ± 4.9%), compared to the lumbar spine (57.8% ± 9.6%). Over a mean follow-up period of 37.2 ± 11.6 months, 7 participants died, 29 (14.9%) experienced incident clinical fractures, and 1 was lost to follow-up. The lack of an association between WFI-based PDFFs and the incidence of clinical fractures was demonstrated regardless of the region of measurement (hazard ratio [HR] = 0.95 [95% CI 0.67-1.35], P = 0.77 at the lumbar spine, HR = 1.07 [95% CI 0.71-1.63], P = 0.74 at the femoral neck). Stepwise regression analysis did not alter these findings, and the variable "recent osteoporotic fractures" was found to be significantly associated with incident clinical fractures. Conclusion:This study found no evidence of a relationship between PDFF and clinical fracture incidence in postmenopausal women. Further studies are necessary involving larger cohorts and longer follow-up periods.

Patellofemoral instability results from impaired engagement of the patella in the trochlear groove at the start of flexion and may lead to pain and lateral patellar dislocation. It occurs most frequently in adolescents and young adults during sporting activities. Trochlear dysplasia, patella alta, and excessive lateralization of the tibial tuberosity are the most common risk factors for patellar instability. The main role of imaging is to depict and assess these anatomical factors and highlight features indicating previous lateral dislocation of the patella.

Context: Bone marrow adiposity (BMAT) alterations in patients with type 2 diabetes mellitus (T2DM) may contribute to adverse bone effects. Objective: Characterization of BMAT content and composition in patients with well-controlled T2DM. Methods: This cross-sectional study included 2 groups of postmenopausal women: one with T2DM and the other without. The proton density fat fraction (PDFF) of the lumbar spine and proximal femur, comprising the femoral head, neck, and diaphysis, was assessed using chemical shift-based water-fat separation imaging (WFI). Magnetic resonance imaging with spectroscopy (H-1-MRS) was performed in a subgroup of participants to confirm the PDFF measurements and determine the apparent lipid unsaturation level (aLUL) at the L3 vertebrae and femoral neck. The association of imaging-based PDFFs and aLUL between diabetes groups was investigated by adjusting for confounding factors using a linear mixed model. Results: Among 199 participants, patients with T2DM (n = 29) were significantly heavier (P < .001) and had a higher bone mineral density (BMD) (P < .001 for all sites) than nondiabetic patients (n = 170). When PDFFs were compared after adjusting for age, body mass index (BMI), and BMD, the femoral head WFI-based PDFF was lower in patients with T2DM (mean [standard error] 88.0% [0.7] vs 90.6% [0.3], P < .001). Moreover, the aLUL at the L3 vertebrae was lower in patients with T2DM (n = 16) than in without (n = 97) (mean [standard error] 3.9% [0.1] vs 4.3% [0.1], P = .02). Conclusion: The content and composition of BMAT are modified in postmenopausal women with T2DM and these changes occur at specific sites.

Reaching equity in the distribution of opportunity between men and women is in the agenda of premier international agencies worldwide, and in the last decades a significant improvement in women’s access to care and education as well as in terms of equality in the labor market has been achieved. In the medical field and, in particular, in radiology, the number of women progressively increased but still much has to be done to guarantee equal opportunities. Aiming to provide an overview of the European musculoskeletal imaging community regarding gender equity, we developed a 39-item survey addressed to the 2481 members of the European Society of Musculoskeletal Imaging (ESSR). The responses of the 74 participants (3%) demonstrated that for most of the addressed clinical, academic, and ESSR-related questions, no statistically significant differences gender-related occurred except for instance for the experienced gender discrimination, which affected women more often (55% of women vs 21.9% of men; p = 0.017). Despite the low participation rate, our results suggest that there is hope of ‘suffrage’ with leadership and steering roles in the Executive Committee and Subcommittees and a real-time reduction in the gender gap.

Apply a modified Delphi-based approach and produce a practical, radiology-specific set of definitions for interpretation and standardization of the multiple MRI findings in axial spondyloarthritis (ax-SpA), specifically to aid the general radiologist with a musculoskeletal interest, working with gold standard basic MRI protocols. We report the results of a modified Delphi-based consensus of 35 experts from 13 countries in the Arthritis Subcommittee of the European Society of Musculoskeletal Radiology (ESSR). Seventeen definitions were created (i.e., nine for the spine and eight for the sacroiliac joint) and two Delphi rounds were conducted on an electronic database, collated and revised by the project leader with agreement. Group leads were appointed for each definition following the first round. Final definitions included only those that reached a consensus > 80

OBJECTIVES:The purpose of this agreement was to establish evidence-based consensus statements on imaging of distal radioulnar joint (DRUJ) instability and triangular fibrocartilage complex (TFCC) injuries by an expert group using the Delphi technique. METHODS:Nineteen hand surgeons developed a preliminary list of questions on DRUJ instability and TFCC injuries. Radiologists created statements based on the literature and the authors' clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panelists consisted of twenty-seven musculoskeletal radiologists. The panelists scored their degree of agreement to each statement on an 11-item numeric scale. Scores of "0," "5," and "10" reflected complete disagreement, indeterminate agreement, and complete agreement, respectively. Group consensus was defined as a score of "8" or higher for 80% or more of the panelists. RESULTS:Three of fourteen statements achieved group consensus in the first Delphi round and ten statements achieved group consensus in the second Delphi round. The third and final Delphi round was limited to the one question that did not achieve group consensus in the previous rounds. CONCLUSIONS:Delphi-based agreements suggest that CT with static axial slices in neutral rotation, pronation, and supination is the most useful and accurate imaging technique for the work-up of DRUJ instability. MRI is the most valuable technique in the diagnosis of TFCC lesions. The main indication for MR arthrography and CT arthrography are Palmer 1B foveal lesions of the TFCC. CLINICAL RELEVANCE STATEMENT:MRI is the method of choice for assessing TFCC lesions, with higher accuracy for central than peripheral abnormalities. The main indication for MR arthrography is the evaluation of TFCC foveal insertion lesions and peripheral non-Palmer injuries. KEY POINTS:• Conventional radiography should be the initial imaging technique in the assessment of DRUJ instability. CT with static axial slices in neutral rotation, pronation, and supination is the most accurate method for evaluating DRUJ instability. • MRI is the most useful technique in diagnosing soft-tissue injuries causing DRUJ instability, especially TFCC lesions. • The main indications for MR arthrography and CT arthrography are foveal lesions of the TFCC.

Algorithms for fracture detection are spreading in clinical practice, but the use of X-ray-only ground truth can induce bias in their evaluation. This study assessed radiologists’ performances to detect wrist and hand fractures on radiographs, using a commercially-available algorithm, compared to a computerized tomography (CT) ground truth. Post-traumatic hand and wrist CT and concomitant X-ray examinations were retrospectively gathered. Radiographs were labeled based on CT findings. The dataset was composed of 296 consecutive cases: 118 normal (39.9

Introduction: Bone marrow adipose tissue (BMAT) is associated with aging, osteoporosis, and chronic kidney disease (CKD). To date, the association between BMAT and kidney function in postmenopausal women has not been thoroughly investigated. The main purpose of this study was to determine whether a relationship exists between proton density fat fraction (PDFF) and kidney function in postmenopausal women. Methods: We investigated the cross-sectional association between estimated glomerular filtration rate (eGFR) - calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation - and PDFF - measured at the lumbar spine and proximal femur using Water Fat Imaging (WFI) MRI - in 199 postmenopausal women from the ADIMOS cohort study. We also performed DXA scans and laboratory measurements of sclerostin and c-terminal Fibroblast Growth Factor 23 (cFGF23). Results: Participants' mean age was 67.5 (standard deviation, SD 10.0) years. Their median eGFR was 85.0 (interquartile range, IQR 72.2-95.0) ml/min/1.73 cm2, and their mean lumbar spine PDFF was 57.9 % (SD 9.6). When classified by eGFR-based CKD stages, 41.7 % of the cohort had an eGFR >= 90 (n = 83), 47.2 % had an eGFR of 60-89.9 (n = 94), and 11.1 % had an eGFR of 30-59.9 (n = 22). Participants with eGFR >= 90 had a lower lumbar spine PDFF than those with eGFR 60-89.9 (mean 55.8 % (9.8) vs. 58.9 % (9.0), p = 0.031) and those with eGFR 30-59.9 (55.8 % (9.8) vs. 60.8 % (9.8), p = 0.043). However, the differences did not remain significant after adjusting for predetermined confounders, including age, diabetes, Charlson comorbidity index, recent history of fragility fracture, appendicular lean mass, and lumbar spine BMD. The inclusion of sclerostin and/or cFGF23 as suspected mediators did not alter the findings. When proximal hip imaging-based PDFF was considered, no significant differences were found between the eGFR categories in the unadjusted and adjusted analyses. Conclusion: No evidence of an association between kidney function and bone marrow adiposity was found either in the lumbar spine or proximal femur in a cohort of postmenopausal women.

Le septum dorsal capsulo-scapholunaire (DCSS) est une structure capsulo-ligamentaire récemment décrite entre le faisceau dorsal du ligament scapholunaire (LSL) et la capsule articulaire du poignet. Cette structure serait un stabilisateur secondaire de l’articulation scapholunaire. Le but de cette étude était d’évaluer la visibilité et l’aspect normal du DCSS en échographie à haute fréquence. Le DCSS serait analysable en échographie à haute fréquence. Trois poignets de cadavre ont été disséqués pour étudier le DCSS, l’un sans marquage, les deux autres après marquage sous contrôle échographique. Sur deux autres poignets, une corrélation entre la structure considérée comme le DCSS en échographie et les coupes arthroscannographiques et anatomiques correspondantes a été réalisée. Enfin, des coupes échographiques sagittales de la région du DCSS sur 42 poignets sains ont été analysées rétrospectivement. En dissection, le DCSS correspondait à une structure fibreuse s’étendant jusqu’à la face dorsale du scaphoïde et du lunatum, certaines fibres convergeant vers le LSL. En échographie à haute fréquence, une structure fibrillaire hyperéchogène était visualisée à la position théorique du DCSS. Les dissections réalisées après transfixion échoguidée montraient que ses limites correspondaient aux limites du DCSS. Les coupes anatomiques, arthroscannographiques et échographiques dans la région du DCSS étaient concordantes. Le DCSS était visible rétrospectivement sur au moins une coupe échographique de référence sur 90,5 % des poignets sains, et était toujours hyperéchogène. Son épaisseur moyenne était de 1,38 ± 0,24 mm. Notre étude décrit les caractéristiques échographiques normales du DCSS, visible chez une majorité de patients sains en échographie à haute fréquence. L’analyse des caractéristiques échographiques du DCSS en contexte traumatique aigu du poignet devraient être évaluées et un arbre décisionnel diagnostique a été proposé. IV.

CONTEXT:Noninvasive assessment of proton density fat fraction (PDFF) by magnetic resonance imaging (MRI) may improve the prediction of fractures.OBJECTIVE:This work aimed to determine if an association exists between PDFF and fractures.METHODS:A case-control study was conducted at Lille University Hospital, Lille, France, with 2 groups of postmenopausal women: one with recent osteoporotic fractures, and the other with no fractures. Lumbar spine and proximal femur (femoral head, neck, and diaphysis) PDFF were determined using chemical shift-based water-fat separation MRI (WFI) and dual-energy x-ray absorptiometry scans of the lumbar spine and hip. Our primary objective was to determine the relationship between lumbar spine PDFF and osteoporotic fractures in postmenopausal women. Analysis of covariance was used to compare PDFF measurements between patient cases (overall and according to the type of fracture) and controls, after adjusting for age, Charlson comorbidity index (CCI) and BMD.RESULTS:In 199 participants, controls (n = 99) were significantly younger (P < .001) and had significantly higher BMD (P < 0.001 for all sites) than patient cases (n = 100). A total of 52 women with clinical vertebral fractures and 48 with nonvertebral fractures were included. When PDFFs in patient cases and controls were compared, after adjustment on age, CCI, and BMD, no statistically significant differences between the groups were found at the lumbar spine or proximal femur. When PDFFs in participants with clinical vertebral fractures (n = 52) and controls were compared, femoral neck PDFF and femoral diaphysis PDFF were detected to be lower in participants with clinical vertebral fractures than in controls (adjusted mean [SE] 79.3% [1.2] vs 83.0% [0.8]; P = 0.020, and 77.7% [1.4] vs 81.6% [0.9]; P = 0.029, respectively).CONCLUSION:No difference in lumbar spine PDFF was found between those with osteoporotic fractures and controls. However, imaging-based proximal femur PDFF may discriminate between postmenopausal women with and without clinical vertebral fractures, independently of age, CCI, and BMD.

This chapter discusses imaging findings in the most common inflammatory arthropathies affecting the foot and ankle, belonging to the two main subgroups: connective tissue diseases and spondyloarthritis. The connective tissue subgroup is comprised of rheumatoid arthritis, juvenile idiopathic arthritis, adult-onset Still’s disease, systemic lupus erythematosus, systemic sclerosis, polymyositis, and dermatomyositis. The spondyloarthritis subgroup is comprised of ankylosing spondylitis, reactive arthritis, arthritis associated with inflammatory bowel diseases, psoriatic arthritis, and undifferentiated spondyloarthritis. Radiography, ultrasonography and magnetic resonance imaging features are listed for each of the aforementioned entities in adults and juveniles. Pathological findings and imaging features for a wide spectrum of diseases are presented. The main roles of imaging in achieving an early diagnosis, monitoring disease progression, and assessing remission are illustrated.

Purpose: In 2022, the French Society of Radiology together with the French Society of Thoracic Imaging and CentraleSupelec organized their 13th data challenge. The aim was to aid in the diagnosis of pulmonary embolism, by identifying the presence of pulmonary embolism and by estimating the ratio between right and left ventricular (RV/LV) diameters, and an arterial obstruction index (Qanadli's score) using artificial intelligence.Materials and methods: The data challenge was composed of three tasks: the detection of pulmonary embolism, the RV/LV diameter ratio, and Qanadli's score. Sixteen centers all over France participated in the inclusion of the cases. A health data hosting certified web platform was established to facilitate the inclusion process of the anonymized CT examinations in compliance with general data protection regulation. CT pulmonary angiography images were collected. Each center provided the CT examinations with their annotations. A randomization process was established to pool the scans from different centers. Each team was required to have at least a radiologist, a data scientist, and an engineer. Data were provided in three batches to the teams, two for training and one for evaluation. The evaluation of the results was determined to rank the participants on the three tasks.Results: A total of 1268 CT examinations were collected from the 16 centers following the inclusion criteria. The dataset was split into three batches of 310, 580 and 378 C T examinations provided to the participants respectively on September 5, 2022, October 7, 2022 and October 9, 2022. Seventy percent of the data from each center were used for training, and 30% for the evaluation. Seven teams with a total of 48 participants including data scientists, researchers, radiologists and engineering students were registered for participation. The metrics chosen for evaluation included areas under receiver operating characteristic curves, specificity and sensitivity for the classification task, and the coefficient of determination r(2) for the regression tasks. The winning team achieved an overall score of 0.784.Conclusion: This multicenter study suggests that the use of artificial intelligence for the diagnosis of pulmonary embolism is possible on real data. Moreover, providing quantitative measures is mandatory for the interpretability of the results, and is of great aid to the radiologists especially in emergency settings.(c) 2023 Societe francaise de radiologie. Published by Elsevier Masson SAS. All rights reserved.

Objectives:Although paravertebral intramuscular fatty infiltration (known as myosteatosis) following a vertebral fracture is well-known, scarce data are available regarding interactions between muscle, bone, and other fat depots. Based on a homogeneous cohort comprising postmenopausal women with or without a history of fragility fracture, we aimed to better depict the interrelationship between myosteatosis and bone marrow adiposity (BMA).Methods:102 postmenopausal women were included, 56 of whom had a fragility fracture. Mean proton density fat fraction (PDFF) was measured in the psoas (PDFFPsoas) and paravertebral (PDFFParavertebral) muscles at the lumbar level, as well as in the lumbar spine and non-dominant hip using chemical shift encoding-based water-fat imaging. Visceral adipose tissue (VAT) and total body fat (TBF) were assessed using dual X-ray absorptiometry. Statistical models were adjusted for age, weight, height (all comparisons), and bone mineral density (when considering BMA).Results:PDFF in the psoas and paravertebral muscles was higher in the fracture group compared to controls even after adjustment for age, weight, and height (PDFFPsoas = 17.1 ± 6.1% versus 13.5 ± 4.9%, p=0.004; PDFFParavertebral = 34.4 ± 13.6% versus 24.9 ± 8.8%, p=0.002). Higher PDFFParavertebral was associated with lower PDFF at the lumbar spine (β = -6.80 ± 2.85, p=0.022) among controls but not in the fracture group. In both groups, a significant relationship between higher PDFFPsoas and higher VAT was observed (β = 20.27 ± 9.62, p=0.040 in the fracture group, and β = 37.49 ± 8.65, p<0.001 in the control group). Although solely observed among controls, a similar relationship was observed between PDFFParavertebral and TBF (β = 6.57 ± 1.80, p<0.001). No significant association was observed between BMA and other fat depots.Conclusion:Myosteatosis is not associated with BMA among postmenopausal women with fragility fractures. Whereas myosteatosis was associated with other fat depots, BMA appears uniquely regulated.

Gout, calcium pyrophosphate deposition disease, and apatite calcifications, the three main crystal disorders, may involve the spine. These disorders can be completely asymptomatic or associated with various clinical symptoms, such as acute flares and more chronic manifestations. This article presents the typical and more unusual imaging features encountered in these disorders.

We discuss several variants of the metaphyseal and diaphyseal bone surfaces that may be misleading in clinical practice. They include metaphyseal stripes, spiculated metaphyseal cortex, cortical desmoid, laminated lateral supracondylar ridge, cortical vascular canals, variations in shape or lucency of normal tuberosities, cortical thickening of normal ridges, and well-organized undulated hyperostosis at the proximal phalanges.

Rationale and Objectives: To develop a model using artificial intelligence (A.I.) able to detect post-traumatic injuries on pediatric elbow X-rays then to evaluate its performances in silico and its impact on radiologists’ interpretation in clinical practice. Material and Methods: A total of 1956 pediatric elbow radiographs performed following a trauma were retrospectively collected from 935 patients aged between 0 and 18 years. Deep convolutional neural networks were trained on these X-rays. The two best models were selected then evaluated on an external test set involving 120 patients, whose X-rays were performed on a different radiological equipment in another time period. Eight radiologists interpreted this external test set without then with the help of the A.I. models . Results: Two models stood out: model 1 had an accuracy of 95.8% and an AUROC of 0.983 and model 2 had an accuracy of 90.5% and an AUROC of 0.975. On the external test set, model 1 kept a good accuracy of 82.5% and AUROC of 0.916 while model 2 had a loss of accuracy down to 69.2% and of AUROC to 0.793. Model 1 significantly improved radiologist's sensitivity (0.82 to 0.88, P = 0.016) and accuracy (0.86 to 0.88, P = 0,047) while model 2 significantly decreased specificity of readers (0.86 to 0.83, P = 0.031). Conclusion: End-to-end development of a deep learning model to assess post-traumatic injuries on elbow X-ray in children was feasible and showed that models with close metrics in silico can unpredictably lead radiologists to either improve or lower their performances in clinical settings.

Anatomical variants are frequently encountered when assessing the sacroiliac joints (SIJ) using magnetic resonance imaging. When not located in the weight-bearing part of the SIJ, variants associated with structural and edematous changes can be misinterpreted as sacroiliitis. Their correct identification is necessary to avoid radiologic pitfalls. This article reviews five SIJ variants involved in the dorsal ligamentous space (accessory SIJ, iliosacral complex, semicircular defect, bipartite iliac bony plate, and crescent iliac bony plate) and three SIJ variants involved in the cartilaginous part of the SIJ (posterior dysmorphic SIJ, isolated synostosis, and unfused ossification centers).