Systematic Review of Recent Lipidomics Approaches Toward Inflammatory Bowel Disease

Researchers have endeavored to identify the etiology of inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis. Though the pathogenesis of inflammatory bowel diseases remains unknown, dysregulation of the immune system in the host gastrointestinal tract is believed to be the major causative factor. Omics is a powerful methodological tool that can reveal biochemical information stored in clinical samples. Lipidomics is a subset of omics that explores the lipid classes associated with inflammation. One objective of the present systematic review was to facilitate the identification of biochemical targets for use in future lipidomic studies on inflammatory bowel diseases. The use of high-resolution mass spectrometry to observe alterations in global lipidomics might help elucidate the immunoregulatory mechanisms involved in inflammatory bowel diseases and discover novel biomarkers for them. Assessment of the characteristics of previous clinical trials on inflammatory bowel diseases could help researchers design and establish patient selection and analytical method criteria for future studies on these conditions. In this study, we curated literature exclusively from four databases and extracted lipidomics-related data from literature, considering criteria. This paper suggests that the lipidomics approach toward research in inflammatory bowel diseases can clarify their pathogenesis and identify clinically valuable biomarkers to predict and monitor their progression.

Clinical and Neuroimaging Features in Charcot-Marie-Tooth Patients with GDAP1 Mutations

Background@#and Purpose Mutations in the ganglioside-induced differentiation-associated protein 1 gene (GDAP1) are known to cause Charcot-Marie-Tooth disease (CMT). These mutations are very rare in most countries, but not in certain Mediterranean countries. The purpose of this study was to identify the clinical and neuroimaging characteristics of Korean CMT patients with GDAP1 mutations. @*Methods@#Gene sequencing was applied to 1,143 families in whom CMT had been diagnosed from 2005 to 2020. PMP22 duplication was found in 344 families, and whole-exome sequencing was performed in 699 patients. Magnetic resonance imaging (MRI) were obtained using either a 1.5-T or 3.0-T MRI system. @*Results@#We found ten patients from eight families with GDAP1 mutations: five with autosomal dominant (AD) CMT type 2K (three families with p.R120W and two families with p.Q218E) and three with autosomal recessive (AR) intermediate CMT type A (two families with homozygous p.H256R and one family with p.P111H and p.V219G mutations). The frequency was about 1.0% exclusive of the PMP22 duplication, which is similar to that in other Asian countries. There were clinical differences among AD GDAP1 patients according to mutation sites. Surprisingly, fat infiltrations evident in lower-limb MRI differed between AD and AR patients. The posterior-compartment muscles in the calf were affected early and predominantly in AD patients, whereas AR patients showed fat infiltration predominantly in the anterolateral-compartment muscles. @*Conclusions@#This is the first cohort report on Korean patients with GDAP1 mutations. The patients with AD and AR inheritance routes exhibited different clinical and neuroimaging features in the lower extremities. We believe that these results will help to expand the knowledge of the clinical, genetic, and neuroimaging features of CMT.

Diffusion-Weighted Magnetic Resonance Imaging of Spine

In this study, we evaluated the technical characteristics and usefulness of diffusion-weighted magnetic resonance imaging for discrimination between benign and malignant vertebral fractures, for detection and differentiation of multiple myeloma or metastases, and for response monitoring in malignant vertebral lesions after anticancer drug therapy or radiation therapy.

Ultrasonography-guided intra-articular steroid injection in the hip for symptomatic round ligament partial tear or degeneration

Purpose@#The objectives of this study were to demonstrate the benefits of ultrasonography-guided intra-articular steroid injection in the hip (UISIH) for the treatment of partial tear or degeneration of the round ligament of the femur and to determine the prognostic factors for this treatment. @*Methods@#We retrospectively analyzed the records of 40 patients who were diagnosed with a partial tear or degeneration of the round ligament of the femur and who underwent UISIH between August 2014 and November 2018. The inclusion criteria were a lack of history of UISIH or other interventional procedure and the presence of follow-up records after the hip injection. The short-term clinical outcome was evaluated at the first follow-up appointment after UISIH. Possible prognostic factors for UISIH such as age, sex, injection side, and average follow-up time were analyzed using the chi-square test, the Fisher exact test, and the t test. @*Results@#UISIH was found to have been effective in 35 of the 40 patients (87.5%) at the first follow-up visit. The average follow-up time was 43 days. No significant differences were observed in the clinical outcome of UISIH with respect to age, sex, injection side, or follow-up time. @*Conclusion@#In this study, we demonstrated that UISIH was a safe and effective treatment in patients with a partial tear or degeneration of the round ligament of the femur over the course of short-term follow-up. Age, sex, injection side, and follow-up time were not identified as prognostic factors for this treatment.

Effectiveness of preoperative ultrasound-guided charcoal tattooing for localization of metastatic melanoma

Purpose@#Excision of metastatic lesions is an important treatment strategy in patients with malignant melanoma, both at the initial diagnosis and upon recurrence. Since nonpalpable lesions cannot be easily visualized in the surgical field, we evaluated the effectiveness of ultrasound (US)-guided tattooing using a charcoal suspension for the localization of nonpalpable metastatic lesions of malignant melanoma. @*Methods@#Between November 2009 and June 2019, we retrospectively reviewed 65 nonpalpable lesions in 29 patients with malignant melanoma who underwent preoperative US-guided tattooing using a charcoal suspension for histologically confirmed or suspected metastases. The characteristics of the tattooed lesions were analyzed. The effectiveness of the procedure was evaluated based on the detection rate in the surgical field and the presence or absence of residua on postoperative follow-up US. Procedure-related complications were also analyzed. @*Results@#Of 65 lesions, 33 (50.8%) were histologically confirmed as metastases before the tattooing procedure, while the other 32 were suspected of being metastases based on imaging studies. The mean lesion size was 9.8 mm (range, 1.3 to 24.4 mm). The final pathology revealed metastases in 59 lesions (90.8%), including lymph node (n=51), muscle (n=5), and in-transit (n=3) metastases. Sixty-one lesions (93.8%) were successfully detected intraoperatively and removed without residua on follow-up US. Four residual lesions were removed after repeated localization (n=2) or by intraoperative US (n=2). No relevant complications were noted. @*Conclusion@#Preoperative US-guided tattooing localization can safely and effectively delineate nonpalpable metastatic melanoma lesions to aid in successful surgical excision.

The First Korean Case of Gorlin?Goltz Syndrome Caused by a PTCH2 Pathogenic Variant Identified via Whole Exome Sequencing

Gorlin–Goltz syndrome, also known as basal cell nevus syndrome, is a condition that affects several body parts and increases the risk of developing various cancerous and noncancerous tumors. This syndrome is mostly caused by the pathogenic variants of the PTCH1 and SUFU genes; however, it is rarely diagnosed due to limited prevalence. PTCH2 has rarely been identified as a pathogenic variant in patients with the Gorlin–Goltz syndrome in China and Japan. Here, we report the case of a 30-year-old woman who was diagnosed with the Gorlin–Goltz syndrome—based on multiple calcifications on the body—who carried a frame shift pathogenic variant of the PTCH2 gene (c.1172_1173del) identified via whole exome sequencing. The patient did not present the typical phenotypes of the Gorlin–Goltz syndrome, such as basal cell carcinoma, palmar/plantar pits, macrocephaly, and keratocystic odontogenic tumors. Based on these observations, we suggest that a pathogenic variant of PTCH2 can manifest a milder phenotype of the Gorlin–Goltz syndrome.

Shear-Wave and Strain Ultrasound Elastography of the Supraspinatus and Infraspinatus Tendons in Patients with Idiopathic Adhesive Capsulitis of the Shoulder: A Prospective Case-Control Study

OBJECTIVE: To compare the elasticity of the supraspinatus tendon (SST) and infraspinatus tendon (IST) in patients with idiopathic adhesive capsulitis of the shoulder (ACS) with those in the control groups and to evaluate the relationship between age and tendon elasticity. MATERIALS AND METHODS: The Institutional Review Board approved this prospective, case-control study, which was conducted between November 2017 and March 2018, and informed consent was obtained from all participants. Control groups comprised healthy individuals or those with asymptomatic contralateral shoulders. Twenty-five shoulders in 20 participants in the ACS group (14 women; 53.5 ± 7.9 years) and 24 shoulders in 18 participants in the control group (6 women; 52.6 ± 10.5 years) were included. Elastography was performed in the oblique coronal plane at the neutral shoulder position. Mean/maximum/minimum velocity and stiffness from the shear-wave ultrasound elastography (SWE) and strain ratio (subcutaneous fat/target-tendon) from the strain ultrasound elastography (SE) of the SST and IST were evaluated. Statistical analyses were performed using the Mann-Whitney U test, receiver operating characteristic (ROC) curve, and Spearman correlation. RESULTS: Both velocity and stiffness in SWE were higher, and the strain ratio in SE was lower in participants with symptomatic shoulders than in those with normal shoulders (p 0.970). The elastic modulus was little correlated with age (ρ = −0.340–0.239). CONCLUSION: SWE and SE indicated that SST and IST were stiffer in patients with ACS than in those with normal shoulders regardless of aging.

Temporal Evolution of a Chronic Expanding Organizing Hematoma on MRI, Including Functional MR Imaging Techniques: a Case Report

Chronic expanding organizing hematoma (CEH) occasionally mimics a soft tissue tumor on MRI, which becomes more problematic in patients with a history of surgical resection for musculoskeletal malignancy. Herein, we present a case of CEH which we were able to differentiate from recurrent tumor through MRI follow-up, including diffusion-weighted imaging (DWI) and dynamic contrast enhanced (DCE) imaging. A 66-year-old male visited our institution under suspicion of recurrent leiomyosarcoma of the thigh, 19 months after surgery and radiation therapy. Due to inconclusive results, three US-guided biopsies and 6 MRI examinations were performed over 2 years. In the end, we could diagnose a CEH using conventional and functional MRI techniques, and it was histopathologically confirmed after surgical resection. A CEH may occur remotely after an initiating event, and it may persist and expand over several years. Functional MR sequences, in addition to conventional sequences, are helpful in differentiating CEH from malignant neoplasms.

Assessment of Coronal Plane Malalignment Following Reduction of Trochanteric Fractures-Simple Intraoperative Guideline Using Greater Trochanter Orthogonal Line

PURPOSE: There is no consensus on a clear intraoperative guideline for judging the coronal plane alignment following reduction of trochanteric fractures. Complex angular measurements using fluoroscope monitors are tedious. Therefore the relation of the horizontal line from the tip of the greater trochanter (GT orthogonal) and femur head center (HC orthogonal) was studied to define this line as a criterion for predicting varus-valgus malalignment. MATERIALS AND METHODS: We studied this relation in 200 standing orthoradiograms which included 100 males and 100 females. The images were digitally analyzed using the picture archiving and communication system. GT orthogonal line and HC orthogonal line were evaluated. The distance of these lines was measured as trochanter center distance (TCD) and its correlation with angular parameters like neck shaft angle, medial proximal femoral angle with reference to anatomical axis (aMPFA) and lateral proximal femoral angle with reference to mechanical axis (mLPFA) were analyzed. RESULTS: In all patients, the GT orthogonal line passed either at or above the center of the head. Overall mean of TCD was 7.22 mm, ranging from 0 to 17.57 mm. TCD was found to show strong correlation with angular parameters like aMPFA, mLPFA and neck shaft angle. TCD was less than one fourth of the corresponding head diameter in around 90%. Therefore following reduction of trochanteric fractures, the GT orthogonal line should pass through the superior juxta central quadrant of the femoral head. CONCLUSION: This line can be represented by a guide wire with fluoroscopy during surgery. The GT orthogonal line can be used intraoperatively as a simplified tool for prediction of varus/valgus malalignment following the reduction of trochanteric fractures.

Interposition of the Posterior Cruciate Ligament into the Medial Compartment of the Knee Joint on Coronal Magnetic Resonance Imaging

OBJECTIVE: The purpose of our study was to evaluate the overall prevalence and clinical significance of interposition of the posterior cruciate ligament (PCL) into the medial compartment of the knee joint in coronal magnetic resonance imaging (MRI). MATERIALS AND METHODS: We retrospectively reviewed 317 consecutive patients referred for knee MRI at our institution between October 2009 and December 2009. Interposition of the PCL into the medial compartment of the knee joint on proton coronal MRI was evaluated dichotomously (i.e., present or absent). We analyzed the interposition according to its prevalence as well as its relationship with right-left sidedness, gender, age, and disease categories (osteoarthritis, anterior cruciate ligament tear, and medial meniscus tear). RESULTS: Prevalence of interposition of PCL into the medial compartment of the knee joint was 47.0% (149/317). There was no right (50.0%, 83/166) to left (43.7%, 66/151) or male (50.3%, 87/173) to female (43.1%, 62/144) differences in the prevalence. There was no significant association between the prevalence and age, or the disease categories. CONCLUSION: Interposition of the PCL into the medial compartment of the knee joint is observed in almost half of patients on proton coronal MRI of the knee. Its presence is not associated with any particular factors including knee pathology and may be regarded as a normal MR finding.

Bone Tunnel Diameter Measured with CT after Anterior Cruciate Ligament Reconstruction Using Double-Bundle Auto-Hamstring Tendons: Clinical Implications

OBJECTIVE: To evaluate the correlation between bone tunnel diameter after anterior cruciate ligament (ACL) reconstruction measured by computed tomography (CT) using multiplanar reconstruction (MPR) and stability or clinical scores. MATERIALS AND METHODS: Forty-seven patients (41 men and 6 women, mean age: 34 years) who had undergone ACL reconstruction with the double bundle technique using auto-hamstring graft and had subsequently received CT scans immediately after the surgery (T1: range, 1-4 days, mean, 2.5 days) and at a later time (T2: range, 297-644 days, mean, 410.4 days) were enrolled in this study. The diameter of each tunnel (two femoral and two tibial) at both T1 and T2 were independently measured using MPR technique by two radiologists. Stability and clinical scores were evaluated with a KT-2000 arthrometer, International Knee Documentation Committee objective scores, and the Lysholm score. Statistical analysis of the correlation between the diameter at T2 or the interval diameter change ratio ([T2 - T1] / T1) and clinical scores or stability was investigated. RESULTS: The tibial bone tunnels for the anteromedial bundles were significantly widened at T2 compared with T1 (observer 1, 0.578 mm to 0.698 mm, p value of 0.8) for both observers. Interobserver agreement for measurement was excellent (> 0.8) except for the most distal portion of the femoral bone tunnel for anterior medial bundle in immediate postoperative CT, which showed moderate agreement (concordance correlation coefficient = 0.6311). CONCLUSION: Neither the diameter nor its change ratio during interval follow-up is correlated with stability or clinical scores.

Cervical Interlaminar Epidural Steroid Injection for Unilateral Cervical Radiculopathy: Comparison of Midline and Paramedian Approaches for Efficacy

OBJECTIVE: The objective of this study was to compare the clinical outcomes of the cervical interlaminar epidural steroid injection (CIESI) for unilateral radiculopathy by the midline or paramedian approaches and to determine the prognostic factors of CIESI. MATERIALS AND METHODS: We retrospectively analyzed 182 patients who underwent CIESI from January 2009 to December 2012. Inclusion criteria were no previous spinal steroid injection, presence of a cross-sectional image, and presence of follow-up records. Exclusion criteria were patients with bilateral cervical radiculopathy and/or dominant cervical axial pain, combined peripheral neuropathy, and previous cervical spine surgery. Short-term clinical outcomes were evaluated at the first follow-up after CIESI. We compared the clinical outcomes between the midline and paramedian approaches. Possible prognostic factors for the outcome, such as age, gender, duration of radiculopathy, and cause of radiculopathy were also analyzed. RESULTS: Cervical interlaminar epidural steroid injections were effective in 124 of 182 patients (68.1%) at the first follow-up. There was no significant difference in the clinical outcomes of CIESI, between midline (69.6%) and paramedian (63.7%) approaches (p = 0.723). Cause of radiculopathy was the only significant factor affecting the efficacy of CIESI. Patients with disc herniation had significantly better results than patients with neural foraminal stenosis (82.9% vs. 56.0%) (p < 0.001). CONCLUSION: There is no significant difference in treatment efficacy between the midline and paramedian approaches in CIESI, for unilateral radiculopathy. The cause of the radiculopathy is significantly associated with the treatment efficacy; patients with disc herniation experience better pain relief than those with neural foraminal stenosis.

Comparison of Three-Dimensional Isotropic and Two-Dimensional Conventional Indirect MR Arthrography for the Diagnosis of Rotator Cuff Tears

OBJECTIVE: To compare the accuracy between a three-dimensional (3D) indirect isotropic T1-weighted fast spin-echo (FSE) magnetic resonance (MR) arthrography and a conventional two-dimensional (2D) T1-weighted sequences of indirect MR arthrography for diagnosing rotator cuff tears. MATERIALS AND METHODS: The study was approved by our Institutional Review Board. In total, 205 patients who had undergone indirect shoulder MR arthrography followed by arthroscopic surgery for 206 shoulders were included in this study. Both conventional 2D T1-weighted FSE sequences and 3D isotropic T1-weighted FSE sequence were performed in all patients. Two radiologists evaluated the images for the presence of full- or partial-thickness tears in the supraspinatus-infraspinatus (SSP-ISP) tendons and tears in the subscapularis (SSC) tendons. Using the arthroscopic findings as the reference standard, the diagnostic performances of both methods were analyzed by the area under the receiver operating characteristic curve (AUC). RESULTS: Arthroscopy confirmed 165 SSP-ISP tendon tears and 103 SSC tendon tears. For diagnosing SSP-ISP tendon tears, the AUC values were 0.964 and 0.989 for the 2D sequences and 3D T1-weighted FSE sequence, respectively, in reader I and 0.947 and 0.963, respectively, in reader II. The AUC values for diagnosing SSC tendon tears were 0.921 and 0.925, respectively, for reader I and 0.856 and 0.860, respectively, for reader II. There was no significant difference between the AUC values of the 2D and 3D sequences in either reader for either type of tear. CONCLUSION: 3D indirect isotropic MR arthrography with FSE sequence and the conventional 2D arthrography are not significantly different in terms of accuracy for diagnosing rotator cuff tears.

T2 Values of Femoral Cartilage of the Knee Joint: Comparison between Pre-Contrast and Post-Contrast Images

OBJECTIVE: To retrospectively evaluate the relationship between T2 values of pre- and post-contrast magnetic resonance (MR) images of femoral cartilage in patients with varying degrees of osteoarthritis. MATERIALS AND METHODS: A total of 19 patients underwent delayed gadolinium-enhanced MRI of cartilage. Six regions of interest for T2 value measurement were obtained from pre- and post-contrast T2-weighted, sagittal, multi-slice, multi-echo, source images in each subject. Regions with modified Noyes classification grade 2B and 3 were excluded. Comparison of T2 values between pre- and post-contrast images and T2 values among regions with the grade 0, 1 and 2A groups were statistically analyzed. RESULTS: Of a total of 114 regions, 79 regions showing grade 0 (n = 46), 1 (n = 18), or 2A (n = 15) were analyzed. The overall and individual T2 values of post-contrast images were significantly lower than those of pre-contrast images (overall, 35.3 +/- 9.2 [mean +/- SD] vs. 29.9 +/- 8.2, p < 0.01; range of individual, 28.9-37.6 vs. 27.1-36.4, p < 0.01). Pearson correlation coefficients showed a strong positive correlation between pre- and post-contrast images (rho-Pearson = 0.712-0.905). T2 values of pre- and post-contrast images of the grade 0 group were significantly lower than those of the grade 1/2A group (pre T2, p = 0.003; post T2, p = 0.006). CONCLUSION: T2 values of the femoral cartilage of the knee joint are significantly lower on post-contrast images than on pre-contrast images. Furthermore, these T2 values have a strong positive correlation between pre- and post-contrast images.

Diffusion-weighted and Dynamic Contrast-enhanced MRI of Metastatic Bone Tumors: Correlation of the Apparent Diffusion Coefficient, K(trans) and ve values

PURPOSE: To investigate whether quantitative parameters derived from Diffusion-weighted magnetic resonance imaging (DW-MRI) correlate with those of Dynamic contrast-enhanced MRI (DCE-MRI). MATERIALS AND METHODS: Thirteen patients with pathologically or clinically proven bony metastasis who had undergone MRI prior to treatment were included. The voxel size was 1.367 x 1.367 x 5 mm. A dominant tumor was selected and the apparent diffusion coefficient (ADC) value and DCE-MRI parameters were obtained by matching voxels. DCE-MRI data were analyzed yielding estimates of K(trans) (volume transfer constant) and ve. (extravascular extracellular volume fraction). Statistical analysis of ADC, K(trans), and ve value was conducted using Pearson correlation analyses. RESULTS: Fifteen lesions in pelvic bones were evaluated. Of these, 11 showed a statistically significant correlation (P < 0.05) between ADC and K(trans). The ADC and K(trans) were inversely related in 7 lesions and positively related in 4 lesions. This did not depend on the primary cancer or site of metastasis. The ADC and ve of 9 lesions correlated significantly. Of these, 4 lesions were inversely related and 5 lesions were positively related. CONCLUSION: Unlike our theoretic hypothesis, there was no consistent correlation between ADC values and K(trans) or between ADC values and ve in metastatic bone tumors.

US Findings of Extensor Hood Injury in Metacarpophalangeal Joint after Acute Trauma and Corresponding MRI Findings

Extensor hood is a structure that stabilizes the extensor tendon at the dorsal side of the metacarpophalangeal joints and keeps the tendon in place during extension and flexion of the joint. Diagnosis of Extensor hood injury of a metacarpophalangeal joint is difficult to diagnose because its clinical symptoms are nonspecific such as pain and swelling. And swelling can interfere with the accurate physical examination. So the imaging findings are important for diagnosis of extensor hood injury. Magnetic resonance image (MRI) and ultrasonography (US) are both good imaging tools. An advantage of ultrasonography is dynamic assessment of extensor tendon and extensor hood. Here, we describe a case of US findings of extensor hood injury with dynamic approach and corresponding MRI findings.

Qualitative and Quantitative Assessment of Isotropic Ankle Magnetic Resonance Imaging: Three-Dimensional Isotropic Intermediate-Weighted Turbo Spin Echo versus Three-Dimensional Isotropic Fast Field Echo Sequences

OBJECTIVE: To compare the image quality of volume isotropic turbo spin echo acquisition (VISTA) imaging method with that of the three-dimensional (3D) isotropic fast field echo (FFE) imaging method applied for ankle joint imaging. MATERIALS AND METHODS: MR imaging of the ankles of 10 healthy volunteers was performed with VISTA and 3D FFE sequences by using a 3.0 T machine. Two radiologists retrospectively assessed the tissue contrast between fluid and cartilage (F-C), and fluid and the Achilles tendon (F-T) with use of a 4-point scale. For a quantitative analysis, signal-to-noise ratio (SNR) was obtained by imaging phantom, and the contrast ratios (CRs) were calculated between F-T and F-C. Statistical analyses for differences in grades of tissue contrast and CRs were performed. RESULTS: VISTA had significantly superior grades in tissue contrast of F-T (p = 0.001). Results of 3D FFE had superior grades in tissue contrast of F-C, but these result were not statistically significant (p = 0.157). VISTA had significantly superior CRs in F-T (p = 0.002), and 3D FFE had superior CRs in F-C (p = 0.003). The SNR of VISTA was higher than that of 3D FFE (49.24 vs. 15.94). CONCLUSION: VISTA demonstrates superior tissue contrast between fluid and the Achiles tendon in terms of quantitative and qualitative analysis, while 3D FFE shows superior tissue contrast between fluid and cartilage in terms of quantitative analysis.

Nontuberculous Mycobacterial Tenosynovitis in the Hand: Two Case Reports with the MR Imaging Findings

Nontuberculous mycobacterial infections can cause destructive tenosynovitis of the hand. We report on and discuss the clinical course and distinctive radiologic findings of two patients with hand tenosynovitis secondary to M. marinum and intracellulare infection, which are different from those of the nontuberculous mycobacterial infections reported in the previous literature.

Imaging Diagnosis of Sports Injury

Increased number of population participating in sports results in unavoidably increase of incidence of sports injury. It also causes a rise of total healthcare expenditure. Because the technology of a variety of imaging modalities and treatment for sports injury is rapidly developed, an up-to-date knowledge on technology is critical for the sports physician. Advances in areas of nuclear medicine, magnetic resonance imaging, ultrasonography, and multi-detector computed tomography, provides a variety of options to physician in the process of patient evaluation. Therefore, they should be aware of strength, limitation, indications, contraindications, and diagnostic accuracy of diagnostic tools.

Slot-Scan Digital Radiography of the Lower Extremities: a Comparison to Computed Radiography with Respect to Image Quality and Radiation Dose

OBJECTIVE: To compare the slot-scan digital radiography (SSDR) of the lower extremity region and the computed radiography (CR) method with respect to the image quality and radiation exposure. MATERIALS AND METHODS: We enrolled 54 patients who underwent both the SSDR and CR of the lower extremities. The study evaluated and statistically compared the image quality of four features (outer cortex, inner cortex, trabeculae and intermuscular fat) at six different levels (pelvis, hip, femur, knee, tibia and ankle) between each method. The image quality was evaluated using a visibility scale, and the entrance skin dose was measured using a dosimeter at three different levels of a phantom (hip, knee, and ankle). RESULTS: The mean image visibility scale values for the SSDR method were significantly higher than for the CR method. The entrance skin dose for the SSDR method was 278 micro Gy at each level, compared to the entrance skin doses of the CR method, which were 3,410 micro Gy for the hip, 1,152 micro Gy for the knee, and 580 microGy for the ankle. CONCLUSION: Both the image quality and patient entrance skin dose data suggest that the SSDR method is superior to the CR method for the lower extremity musculoskeletal examination.