Objective: Augmented reality (AR) can improve ultrasonography (US)-guided procedures by placing images in the operator's line of sight. Published Apple Vision Pro (AVP) US workflows are scarce. This study compared the feasibility and accuracy of an AR US system versus conventional sonography.Materials and Methods: This was designed as a prospective crossover feasibility study. The AR system used a Clarius L15 HD linear transducer streamed to an AVP headset and conventional ultrasound equipment system. Participants placed a 22-gauge spinal needle into eight clay targets (e.g., 0.5-2.0 cm) in a gelatin phantom with both systems. The primary outcome was accuracy (i.e., hits/attempts). Feasibility was assessed with an eight item, 5-point Likert-type survey. The data analyses were completed with descriptive output.Results: Three radiologists experienced in US guidance achieved 23/24 first-pass hits (i.e., 96%) using AR US guidance versus 24/24 (i.e., 100%) with conventional sonography. Ratings for AR US guidance were high for hand-eye coordination (e.g., 5.0 +/- 0.0), image stability (e.g., 4.7 +/- 0.6), and overall satisfaction (e.g., 4.7 +/- 0.6), with greater ease of use than conventional sonography (e.g., 3.3 +/- 0.6). The study limitations included visualization (e.g., 2.0 +/- 1.7), headset comfort (e.g., 2.3 +/- 1.5), and technical reliability (e.g., 2.7 +/- 0.6).Conclusion: For this cohort of users, streaming US to AVP, enabled accurate, feasible AR US-guided needle placement with performance comparable to conventional sonography.

Primary spinal osseous tumors are relatively rare, comprising ~5–10% of spinal bone neoplasms, whereas metastases account for the vast majority of spinal lesions. Patients commonly present with insidious back pain, sometimes with a focal mass, and constitutional symptoms are uncommon early in the disease course. As clinical features are often nonspecific and may overlap with degenerative, infectious, and metastatic disease, imaging plays an important role in lesion identification, characterization, and treatment planning. Computed tomography helps to define osseous architecture and matrix characteristics. Magnetic resonance imaging can assess marrow involvement, soft tissue extension, neural compression and intra-canal disease, and tumor vascularity. Together, advanced imaging modalities guide further workup, optimize biopsy planning, inform prognostic assessment and therapeutic decision-making, and anticipate mechanical instability or neural compromise. This narrative pictorial review synthesizes radiographic, CT, and MRI appearances of primary spinal tumors across major histologic lineages (e.g., osteogenic, chondrogenic, notochordal, vascular), illustrated with representative cases. We correlate imaging with clinical presentation to distinguish typical from atypical variants and highlight mimics and pitfalls with implications for diagnostic interpretation and management.

Knee osteoarthritis is often treated surgically (knee joint replacement) or nonsurgically (physiotherapy, pharmacological treatment). However, interventional radiologists can also offer a number of image-guided percutaneous therapies, including pharmacological treatments (intra-articular steroid, local anesthetic, and hyaluronic acid injections), biological options (platelet-rich plasma or mesenchymal stem cell injections), and newer nonpharmacological therapies (neuroablation, neuromodulation, and genicular artery embolization). Intra-articular steroid injection is the most widely used radiologically guided therapy; it provides pain relief and can help confirm the joint as the source of pain. However, platelet-rich plasma injection may provide greater pain relief and functional improvement compared with other intra-articular injections. Mesenchymal stem cell injections may improve pain, function, and cartilage volume, but the therapy is still under clinical investigation. Neu-roablation and neuromodulation achieve pain reduction by targeting the sensory nerves of the knee joint. Radiofrequency ablation has been shown to be more effective than intra-articular steroid injections at treating knee osteoarthritis pain and function. Potential advantages of neuromodulation over conventional radiofrequency ablation include less intraprocedural pain and lower risk of thermal damage to adjacent structures. Genicular artery embolization aims to downregulate inflammation and its downstream effects by altering synovial blood flow; it is considered a promising therapy for osteoarthritis-associated knee pain.

[This corrects the article DOI: 10.1016/j.radcr.2024.01.016.].

Chronic non-bacterial osteomyelitis (CNO), also known as non-bacterial osteitis, is a chronic autoinflammatory disease of unknown aetiology that primarily occurs in the paediatric population, although rare cases of adult-onset disease also exist. CNO has non-specific clinical and radiological presentations, and the affected population often present with bone pain of insidious onset secondary to sterile bony inflammation that can be associated with swelling, focal tenderness, and warmth at the affected sites. The pattern of bony involvement appears to be dependent on the age of onset, with adults frequently having axial skeletal lesions and children and adolescents often being affected in the appendicular skeletal sites. CNO is a diagnosis of exclusion, and imaging is heavily relied on to identify and characterise the bony lesions in addition to exclude diseases that can mimic CNO. Magnetic resonance imaging is often the reference standard with biochemical and histopathological findings being complementary. Although combining imaging methods can be used to facilitate the diagnosis, a single technique could be adequate depending on the clinical picture. Given the relatively rare incidence of CNO, limited awareness of the disease among care providers, and its similarity in clinical and radiological presentation to various bony diseases, there are often long delays in diagnosis, with adults being unfavourably affected compared to paediatrics and adolescents. This review of CNO will describe the condition, overview its clinical presentation, highlight the radiological features, and emphasise clinical pearls that can aid in diagnosis and ruling out the mimics.

Recent advances in percutaneous image-guided techniques have empowered interventional radiologists with diverse treatment options for the management of musculoskeletal lesions. Of note, there is growing utility for cementoplasty procedures, with indications ranging from stabilization of bone metastases to treatment of painful vertebral compression fractures. Likewise, cryoablation has emerged as a viable adjunct in the treatment of both primary and secondary bone and soft tissue neoplasms. These treatment options have been progressively incorporated into the multidisciplinary approach to holistic care of patients, alongside conventional radiotherapy, systemic therapy, surgery, and analgesia. This review article serves to outline the indications, technical considerations, latest developments, and evidence for the burgeoning role of cementoplasty and cryoablation in the musculoskeletal system, with an emphasis on pain palliation and tumour control.

Retained needle fragments commonly serve as sources of recurrent infections with a potential to embolize to the heart and lungs and can lead to life-threatening consequences. Here, we report a case of a 46-year-old male with a history of intravenous drug user and chronic forearm wounds, presenting with sepsis. Several retained needles are identified on CT scan, several days postadmission. This case highlights the importance of timely assessment of infectious sources in patients with history of intravenous drug abuse.

Dual-energy CT (DECT) is an exciting application in CT technology conferring many advantages over conventional single-energy CT at no additional with comparable radiation dose to the patient. Various emerging and increasingly established clinical DECT applications in musculoskeletal (MSK) imaging such as bone marrow oedema detection, metal artefact reduction, monosodium urate analysis, and collagen analysis for ligamentous, meniscal, and disc injuries are made possible through its advanced DECT post-processing capabilities. These provide superior information on tissue composition, artefact reduction and image optimization. Newer DECT applications to evaluate fat fraction for sarcopenia, Rho/Z application for soft tissue calcification differentiation, 3D rendering, and AI integration are being assessed for future use. In this article, we will discuss the established and developing applications of DECT in the setting of MSK radiology as well as the basic principles of DECT which facilitate them.

In the short report published by Siek and Spinek, the femoral metaphyseal lesion in question was described as potentially the first described case of a simple bone cyst (SBC) from a Polish background. However, on review of the single radiograph available, we feel the primary and differential diagnoses offered are misleading from a radiographic perspective, with the imaging features overall favoring fibrous dysplasia-probable cystic subtype. As magnetic resonance imaging (MRI) or a histological diagnosis would not be possible in skeletonized remains, the diagnosis must rest on opinion-based radiology. In this commentary, we illustrate why fibrous dysplasia is the most likely radiological diagnosis and describe why the differentials offered in the original article should not be entertained.

Cancer is a leading cause of death, with the spine being the most common site for skeletal metastasis. The spine is also a site for primary malignancy, such as sarcoma and chordoma, as well as non-neoplastic pathologies. An accurate diagnosis of spinal neoplastic diseases is crucial in determining appropriate management. With the advent of personalised oncology, the need to establish a definitive histopathologic diagnosis to guide management is more important than ever. Percutaneous biopsy has proven to be safe and efficient in establishing a reliable histopathologic diagnosis. The spine, however, can be a challenging site to biopsy, due to the proximity of critical neurovascular, respiratory, and gastrointestinal structures. Successful spine biopsy depends on several factors: suspected diagnosis, size of the lesion, location within the spine, modality for best imaging guidance, operator experience, technical equipment considerations, and desired approach and associated limitations. The specimen must also be obtained with a biopsy route amenable to any future surgical intervention, with surgical input often sought, frequently in a multidisciplinary setting, to confirm procedure-specific goals and expectations. Knowledge of the requisite local anatomy, procedural and patient-specific indications, and contraindications and various approaches that may be used to access different segments of the spine, potential complications, and how to address these are keys to a successful percutaneous spinal biopsy, even in the most challenging of circumstances.

Purpose: To determine the sensitivity and specificity of dual-energy CT (DECT) virtual noncalcium images (VNCa) with bone and soft tissue reconstructions in the diagnosis of osteomyelitis. Materials & Methods: Between December 1, 2014 to December 1, 2020, 91 patients who had 99 DECT performed for a clinical indication of osteomyelitis with corresponding MRI, triphasic bone scan and/or white blood cell scintigraphy with CT/SPECT performed either 2 weeks before or 1 month after the DECT were retrospectively identified. The presence or absence of osteomyelitis was established using a second imaging test, bone biopsy or surgery. Two radiologists interpreted VNCa images alone and with bone and soft tissue reconstructions for osteomyelitis. Fleiss k statistics was used to assess inter-level agreement. Results: Osteomyelitis was present in 26 cases (26.2%), of which 4 cases (4%) had co-existing septic arthritis. DECT was performed at the following sites: ankle/foot (n = 59), calf (n = 12), knee (n = 3), thigh (n = 7), hip (n = 9), pelvis (n = 6), wrist/hand (n = 1), and shoulder (n = 2). Sensitivity with VNCa images alone was 53.8% and 73.1% and specificity was 84.9% and 71.2%. Sensitivity with VNCa images and bone and soft tissue reconstructions was 80.8% and 80.8% and specificity was 80.8% and 72.6%. Interobserver agreement was 76.7% (76 of 99 cases), for VNCa images alone (k = .487), and 66.7% (66 of 99 patients) for bone and soft tissue reconstructions with VNCa images together (k = .390). Conclusion: When VNCa images were combined with bone and soft tissue reconstructions, there is improved sensitivity in the diagnosis of osteomyelitis.

Radiologic knowledge of different fracture patterns involving the shoulder girdle is an important tool to generate clinically relevant reports, identify concomitant injuries, guide management decisions, and predict and minimize complications, such as nonunion, osteoarthritis, osteonecrosis, and hardware failure. Complex unstable injuries like scapulothoracic dissociation can also occur because of shoulder girdle trauma. Management options may vary from conservative to surgical, depending on the fracture type and patient factors. Injuries around the shoulder girdle can involve the glenohumeral articulation, scapula, superior shoulder suspensory complex, acromioclavicular joints, and scapulothoracic articulation.

Image guided percutaneous biopsy has become the initial procedure of choice in most cases for obtaining bone samples for histological and microbiological assessment. It is a minimally invasive procedure which offers multiple advantages over open surgical biopsy including maintenance of bone structure, minimal soft tissue injury, reduced need of general anesthesia, reduced hospital stay and a low rate of post-procedure complications. In some cases, it can be combined with therapeutic procedures such as cementoplasty and cryoablation via the same access route. For the radiologist, knowledge of the key principles is essential for a safe and effective procedure, particularly when a sarcoma of bone is in the differential diagnosis. In this article we cover the core concepts of percutaneous bone biopsy including indications and contraindications, essential planning steps, appropriate imaging modalities, equipment selection, common approaches, technique as well as avoiding, recognizing and treating complications. Recent technological advancements in this field are also discussed.

Snow and ice were historically used in cold climates as a means of transportation. On snow, variations of skiing and sledding served as modes of locomotion. On ice, skating could facilitate transport. Eventually, as more leisure time became available, sports were developed related to ice skating, skiing, and sledding. Winter sports were originally only played in Nordic climates and were predominantly recreational. But with the advent of artificial ice and snow, winter sports greatly increased in popularity, even in warmer climates.

Sir—A recent position paper from the Royal College of Radiologists 1 The Royal College of Radiologists, UK Radiological guidance for the recognition and reporting of osteoporotic vertebral fragility fractures (OVFF). May 2021www.rcr.ac.ukDate accessed: September 30, 2021 Google Scholar rightly highlights numerous reports that document the failure of radiologists to report osteoporotic vertebral fragility fractures (OVFF) when observed incidentally on imaging performed for other reasons; however, the authors' fail to make a clear recommendation concerning the approaches available with respect to the diagnosis of OVFF. They observe that there is no conclusive evidence to justify a choice between the diagnostic tools available. We respectfully submit that there does exist a strong evidentiary basis to support such a choice. 2 Lentle B. Koromani F. Brown J. et al. The radiology of osteoporotic vertebral fractures revisited. J Bone Miner Res. 2019; 34: 409-418 Crossref PubMed Scopus (33) Google Scholar

Periarticular calcification and ossification is a frequent finding on imaging and may sometimes pose a diagnostic challenge. The differential diagnoses for this radiological finding are wide and can be classified into broad groups such as idiopathic, developmental, trauma, burns, infection, tumor, connective tissue disease, crystalline, metabolic, vascular, and foreign bodies. With careful consideration of the clinical and imaging findings as well as awareness of mimickers of periarticular mineralization, the list of differential diagnoses can be narrowed down. This article aims to review the clinical-radiologic findings of periarticular calcified or ossified lesions with relevant imaging illustrations.

Gout, a crystalline arthropathy caused by the deposition of monosodium urate crystals in the articular and periarticular soft tissues, is a frequent cause of painful arthropathy. Imaging has an important role in the initial evaluation as well as the treatment and follow up of gouty arthropathy. The imaging findings of gouty arthropathy on radiography, ultrasonography, computed tomography, dual energy computed tomography, and magnetic resonance imaging are described to include findings of the early, acute and chronic phases of gout. These findings include early monosodium urate deposits, osseous erosions, and tophi, which may involve periarticular tissues, tendons, and bursae. Treatment of gout includes non-steroidal anti-inflammatories, colchicine, glucocorticoids, interleukin-1 inhibitors, xanthine oxidase inhibitors, uricosuric drugs, and recombinant uricase. Imaging is critical in monitoring response to therapy; clinical management can be modulated based on imaging findings. This review article describes the current standard of care in imaging and treatment of gouty arthropathy.