Differentiation between spinal subchondral bone metastasis with focal pathologic endplate fracture and oedematous Schmorl's node.

INTRODUCTION: We aimed to identify imaging-based findings that can differentiate between spinal subchondral bone metastasis with focal pathologic endplate fracture and oedematous Schmorl's nodes that have been histopathologically confirmed. METHODS: Between March 2010 and April 2016, 11 patients who had undergone spinal magnetic resonance (MR) imaging or computed tomography (CT) with final radiologic reports that included 'subchondral bone metastasis with focal pathologic endplate fracture' or 'edematous Schmorl's node' and had also undergone percutaneous imaging-guided spinal biopsies were included. Two radiologists retrospectively evaluated the following imaging features in consensus: size, location, presence of sclerotic margin, presence of intralesional or perilesional enhancement and opposite endplate enhancement of the involved disc, presence of disc height loss and presence of metabolic uptake at a corresponding lesion on nuclear medicine imaging. RESULTS: A total of 11 patients, including six patients with spinal subchondral bone metastasis with focal pathologic endplate fracture and five patients with oedematous Schmorl's nodes, were included in this study (median age, 58 years; range, 50-63 years; six men). Sclerotic margin (P = 0.002) and enhancement on the opposite endplate of the involved disc (P = 0.047) were significantly different between oedematous Schmorl's node and subchondral bone metastasis with focal pathologic endplate fracture. CONCLUSION: Sclerotic margin and enhancement on the opposite endplate of the involved disc suggest oedematous Schmorl's node rather than subchondral bone metastasis with focal pathologic endplate fracture. Decreased disc height is likely to be an oedematous Schmorl's node rather than subchondral bone metastasis with focal pathologic endplate fracture.

Effectiveness of percutaneous cement injection on proximal junctional failure after posterior lumbar interbody fusion: Preliminary study.

Proximal junctional failure (PJF) is the greatest challenge after posterior lumbar interbody fusion (PLIF). The aim of this study was to evaluate the effectiveness of percutaneous cement injection (PCI) for PJF after PLIF patients requiring surgical revision.In this retrospective clinical study, we reviewed 7 patients requiring surgical revision for PJF after PLIF with 18 months follow-up. They received PCI at the collapsed vertebral body and supra-adjacent vertebra, with or without intervertebral disc intervention. The outcome measures were radiographic findings and revision surgery. Two different radiographic parameters (wedging rate (%) of the fractured vertebral body and local kyphosis angle) were used, and were performed before and immediately after PCI, and 18 month after the PCI.In our study, we showed that 5 of 7 patients who experienced PJF after PLIF did not receive any revision surgery after PCI. Immediately after cement injection, the anterior wedging rate (%) and the local kyphosis angle were significantly improved (P = .018, P = .028). The anterior wedging rates (%) and local kyphosis angle, at pre-PCI, immediate after PCI, and at final follow-up, were not significantly different between the non-revision surgery and revision surgery groups.Five of 7 patients who experienced PJF after PLIF did not receive revision surgery after PCI. Considering that general anesthesia and open surgery are high-risk procedures for geriatric patients, our results suggest that non-surgical PCI could be a viable alternative treatment option for PJF.SMC2017-01-011-001. Retrospectively registered 18 January 2017.

Percutaneous Image-Guided Spinal Lesion Biopsies: Factors Affecting Higher Diagnostic Yield.

OBJECTIVE: The objectives of this study were to determine the diagnostic yield of percutaneous biopsy of osseous spinal lesions under CT and fluoroscopy guidance and to analyze lesion-related and technical factors affecting higher diagnostic yield. MATERIALS AND METHODS: We retrospectively reviewed 247 consecutive percutaneous spinal biopsies and recorded the following information: size, anatomic location, and bone matrix of lesions; guiding modality; years of attending physicians' experience; number of approaches; pathologic result of initial biopsy; and final diagnosis. The pathologic results of the initial biopsies were classified as diagnostic or nondiagnostic. All variables were compared using Pearson chi-square test or Fisher exact test. Multivariate logistic regression was also conducted. RESULTS: Of the initial 247 biopsies, 197 (80%) biopsies were diagnostic. On multivariate analysis, size, bone matrix, and final diagnosis of lesion were significant factors affecting biopsy yield. Biopsies of large lesions (≥ 20 mm) showed higher diagnostic yield than biopsies of small lesions (p = 0.006). Biopsies of lytic lesions had the highest diagnostic yield (88%), followed by biopsies of mixed (84%), sclerotic (67%), and isodense lesions (61%). Differences were significant for diagnostic yields of biopsies of lytic versus sclerotic lesions (p = 0.004) and lytic versus isodense lesions (p = 0.031). Biopsies of metastases had significantly highest diagnostic yield (97%), followed by biopsies of primary malignancies (84%) and benign lesions (39%) (p < 0.05). CONCLUSION: For percutaneous image-guided biopsies of spinal tumorous lesions, diagnostic yield was 80%. Size, bone matrix, and final diagnosis of lesions affected diagnostic yield of percutaneous image-guided biopsies.

Ultrasonographic Findings of Subcutaneous Angioleiomyomas in the Extremities Based on Pathologic Subtypes.

Objective: The purpose of this study was to describe the ultrasonographic findings of angioleiomyoma based on pathological subtypes. Materials and Methods: Thirty-nine patients with subcutaneous angioleiomyomas in the extremities were retrospectively reviewed by two radiologists and a pathologist. Sonographic images were analyzed to evaluate each tumor's anatomic location, size, shape, margin, heterogeneity, echogenicity, associated findings, and vascularity. Results: Angioleiomyomas were divided into 3 subtypes: capillary (n = 16), venous (n = 22), and cavernous (n = 1). The one cavernous angioleiomyoma was a hypoechoic mass with rich vascularity. Hypoechogenicity was more frequently observed for venous tumors (77.3%) than for capillary tumors (43.8%), and isoechogenicity was more frequently observed for capillary tumors (56.2%) than for venous tumors (22.7%). Moderate vascularity was more frequently observed for venous tumors (59.1%) than for capillary tumors (12.5%), and little vascularity was more frequently observed for capillary tumors (62.5%) than for venous tumors (13.6%). The aforementioned findings including echogenicity (p = 0.034) and vascularity (p = 0.003) were statistically significant. Conclusion: Awareness of sonographic findings of angioleiomyomas based on pathologic subtypes could be helpful for diagnosing angioleiomyoma and could increase diagnostic accuracy for superficial soft-tissue masses in our practice.

The role of epidural contrast distribution in predicting the effectiveness of steroid and local anesthetic injection in patients with lumbar spinal stenosis.

STUDY DESIGN: A prospective observational comparative study. BACKGROUND: Because epidural corticosteroids are more effective for pain relief when delivered close to the site of pathology, lumbar spinal stenosis with multilevel stenotic areas can be treated more effectively when medications cover all of the stenotic areas. Distribution of medications to the pathologic sites is considered an important factor in the effectiveness of inter-laminar epidural injection. OBJECTIVE: To determine whether spread of a lidocaine and triamcinolone mixture over the stenotic areas improves clinical symptom of spinal stenosis more effectively. METHODS: Twenty-four patients with lumbar spinal stenosis were enrolled in this study. A lumbar inter-laminar epidural injection under fluoroscopic guidance was administered to each patient. A numeric rating scale (NRS), claudication distance, the Romberg test, and the Oswestry Disability Index (ODI) were checked pre-injection and at 2, 6, and 12 weeks after the epidural injection. Vertebrae that showed more than moderate stenosis were considered stenosis levels. Inter-laminar epidural injection was performed with radiopaque contrast and lidocaine mixed with triamcinolone acetate. When the contrast covered all of the stenosis levels, this was considered a sufficient distribution (SD) and when the contrast did not cover all stenosis levels, this was considered an insufficient distribution (ID). RESULTS: At 2 weeks, percentages of NRS improvement were 71.4 (IQR, 20.2) in SD group and 50.0 (IQR, 31.4) in ID group (P= 0.02), changes in Romberg test time were 0.0 (IQR, 35.0) in SD group and -3.0 (IQR, 12.0) in ID group (P= 0.02), decreases in ODI were 9.6 (IQR, 11.2) in SD group and 0.0 (IQR, 7.8) in ID group (P= 0.02). However, these parameters were not significantly different at 6 weeks and 12 weeks. Claudication distance showed no significant group difference. CONCLUSION: Coverage of the stenotic area by the lidocaine, triamcinolone, and contrast dye mixture during inter-laminar epidural injection was an important predictor of acute pain reduction.

MRI assessment of sacroiliitis for the diagnosis of axial spondyloarthropathy: comparison of fat-saturated T2, STIR and contrast-enhanced sequences.

OBJECTIVE: To evaluate whether there are significant differences between contrast-enhanced fat-saturated T1 weighted imaging and non-enhanced fat-suppression imaging for diagnosing sacroiliitis in patients with inflammatory back pain. METHODS: 92 patients, consisting of 46 males and 46 females (mean age: 34 years; range: 15-63 years), who met at least 4 out of 5 Assessment in SpondyloArthritis international Society criteria for inflammatory low back pain were enrolled in this study. All patients underwent MRI consisting of a coronal short tau inversion recovery (STIR) sequence, axial fat-saturated T2 weighted imaging (T2FS), and coronal and axial contrast-enhanced fat-saturated T1 weighted imaging (c & a T1CE). Two observers independently reviewed an image set of coronal STIR with axial T2FS, and an image set of c & a T1CE, at separate times. The degree of bone marrow edema and osteitis was evaluated from each image set. A decision for sacroiliitis positivity for each image set was made based on the findings. The presence of additional active inflammatory findings of spondyloarthropathy such as synovitis, enthesitis and capsulitis were also evaluated. RESULTS: Interobserver and intersequence agreement for the degree of bone marrow edema and osteitis were good or excellent in all quadrants. Cohen's kappa coefficients for sacroiliitis positivity between the two observers were 0.978 and 0.956, and Cohen's kappa coefficients between the two image sets for each observer were 0.892 and 0.870, respectively. The intersequence agreement of additional active inflammatory findings was substantial, and the interobserver agreement was almost perfect or substantial. CONCLUSION: STIR with T2FS image is comparable to T1CE image for diagnosing spondyloarthropathy. T1CE images may have a role in evaluating additional active inflammatory findings of spondyloarthropathy such as synovitis, enthesitis and capsulitis. Advances in knowledge: Coronal STIR with axial T2FS may be sufficient for diagnosis spondyloarthropathy without use of contrast administration.

Percutaneous CT-guided sternal biopsy: factors affecting the diagnostic yield.

Background Sternal lesions are occasionally seen in clinical practice and their diagnosis can be important, especially for oncologic patients. However, percutaneous computed tomography (CT)-guided biopsy of sternal lesions is rarely performed. Purpose To assess the diagnostic yield of percutaneous CT-guided sternal biopsies and to analyze the factors that affect diagnostic yield. Material and Methods A retrospective review of 34 patients who underwent CT-guided sternal biopsy was carried out at a single institution. Pre-biopsy CT density, location, penetration length of biopsy needle, number of biopsy attempts, angle of needle approach, final diagnosis, and operator experience level were recorded. A biopsy was considered as diagnostic if it provided a confident pathologic result. All variables were compared using Chi-square tests. Results Twenty-two of the 34 (64.7%) biopsy procedures yielded a diagnostic sample and 12 (35.3%) were non-diagnostic. Eight participants in the non-diagnostic group were clinically diagnosed with inflammatory arthritis of the manubriosternal or costosternal joints. Longer penetration distance of the tumor by the biopsy needle showed higher diagnostic yield ( P = 0.031). Osteoblastic lesions ( P < 0.001), lesions in the manubriosternal joint ( P = 0.018) and approaches using more obtuse angles ( P = 0.009) were associated with significantly lower diagnostic yields. Malignancy in the final diagnosis led to a higher diagnostic yield than benign lesions ( P < 0.001). Conclusion CT-guided percutaneous sternal biopsy has a relatively lower diagnostic yield. However, acute angle of needle approach may help increase biopsy success rate. Osteoblastic lesions and lesions in the manubriosternal joint tend to have lower diagnostic yield.

Comparison Study between Conventional Sequence and Slice-Encoding Metal Artifact Correction (SEMAC) in the Diagnosis of Postoperative Complications in Patients Receiving Lumbar Inter-Body Fusion and Pedicle Screw Fixation Surgery.

BACKGROUND AND PURPOSE: Slice-Encoding Metal Artifact Correction (SEMAC) sequence is one of the metal artifact reduction techniques of anatomical structure, but there has been no report about evaluation of post-operative complications. The purpose of this article is to compare the anatomical visibility between fast spin echo (FSE) and FSE-SEMAC and to evaluate the additional value of FSE-SEMAC in diagnostic confidence of the complications. MATERIALS AND METHODS: We conducted a retrospective study with 54 patients who received lumbar spinal surgery and MR images including FSE-SEMAC. For the semi-quantitative evaluation, the visibility of anatomical structures (neural foramen, bone-inter-body cage interface, central canal, nerve root in epidural space, back muscle, and bone-pedicle screw interface) was evaluated. For qualitative evaluation, we evaluated FSE and FSE with FSE-SEMAC independently, and recorded the diagnostic confidence level of post-operative complications. Generalized estimating equation regression analysis was used for statistical analysis, and a weighted kappa was used for inter-observer agreement. RESULTS: Scores of 6 imaging findings with FSE-SEMAC were significantly higher than that of FSE (P-value < .0001). Inter-observer agreements show good reliability (weighted kappa = 0.45-0.75). Both reviewers deemed 37 (reviewer 1) or 19 more (reviewer 2) post-operative complications with FSE plus FSE-SEMAC, compared to FSE only. Except for central canal stenosis (P-value = .2408), diagnostic confidence level for other post-operative complications were significantly higher with FSE plus FSE-SEMAC (P-value = .0000) than FSE. CONCLUSIONS: FSE-SEMAC significantly reduces image distortion, compared to FSE sequence in 3.0-T MR. Also, diagnostic confidence for post-operative complications was higher when FSE with additional FSE-SEMAC compared to FSE only.

How many times should we repeat measuring liver stiffness using shear wave elastography?: 5-repetition versus 10-repetition protocols.

The purpose of this study is to evaluate whether a 5-repetition liver stiffness (LS) measurement as the standard protocol of shear wave elastography (SWE) is comparable to a conventional 10-repetition measurement protocol and to identify factors that influence the reliability of the 5-repetition protocol. A total of 346 patients (mean, 48.0years; range, 15-81years, M:F=192:154) who underwent SWE were enrolled. The median, first quartile, third quartile, and interquartile range divided by the median (IQR/M) of LS measurement were calculated and compared between 5-repetition and 10-repetition protocols. Subgroup analyses were also performed to identify factors associated with measurement reliability. The overall mean LS from the 10-repetition protocol was 7.97kPa, which was not significantly different from the mean LS of the 5-repetition protocol (7.91kPa; p=0.192). However, the third quartile and IQR/M values of the two groups were significantly different from each other (p=0.003 and <0.001). Subgroup analysis revealed that the 5-repetition results were significantly different from the 10-repetition results in the fatty liver and high LS subgroups. Therefore, the 5-repetition SWE measurement protocol can replace the conventional 10-repetition protocol, with the exception of patients with fatty liver disease or an LS value higher than 10kPa.

Imaging findings of various talus bone tumors-clinico-radiologic features of talus bone tumors.

Osseous neoplasms of the foot are uncommon, accounting for only 3.3% of all primary bone tumors. Bone tumors of the talus are even rarer, and there are not many publications that comprehensively evaluate the imaging findings of talus tumors. The purpose of this article is to review the benign and malignant bone tumors affecting this uncommon site and to describe the clinical and radiologic features of each tumor.

Digital Subtraction Cystography for Detection of Communicating Holes of Spinal Extradural Arachnoid Cysts.

OBJECTIVE: The purpose of this study was to demonstrate the usefulness of digital subtraction cystography to identify communicating holes between a spinal extradural arachnoid cyst (SEAC) and the subarachnoid space prior to cyst removal and hole closure. MATERIALS AND METHODS: Six patients with SEAC were enrolled in this retrospective study. Digital subtraction cystography and subsequent CT myelography were performed for every patient. The presence and location of the communicating holes on cystography were documented. We evaluated the MRI characteristics of the cysts, including location, size, and associated spinal cord compression; furthermore, we reviewed cystographic images, CT myelograms, procedural reports, and medical records for analysis. If surgery was performed after cystography, intraoperative findings were compared with preoperative cystography. RESULTS: The location of the communicating hole between the arachnoid cyst and the subarachnoid space was identified by digital subtraction cystography in all cases (n = 6). Surgical resection of SEAC was performed in 4 patients, and intraoperative location of the communicating hole exactly corresponded to the preoperative identification. CONCLUSION: Fluoroscopic-guided cystography for SEAC accurately demonstrates the presence and location of dural defects. Preoperative digital subtraction cystography is useful for detection of a communicating hole between a cyst and the subarachnoid space.

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.

CT-guided aspiration and steroid injection of symptomatic paralabral cysts of the hip.

PURPOSE: The objective of this article is to present the clinical use of aspiration and steroid injection under CT guidance for symptomatic paralabral cysts of the hip. MATERIALS AND METHODS: Four cases of symptomatic paralabral cysts of the hip were treated with aspiration and steroid injection after MR examinations had been performed. The imaging characteristics of the cysts, including the location, size, extracapsular extension, and associated labral tears, were evaluated. Under CT guidance, an 18-gauge spinal needle punctured the cyst, and aspiration was performed using local anesthesia. After irrigation with 50 % diluted iodine contrast material, steroid alone or a mixture of steroid and 1 % lidocaine was injected into the cyst. CT images during and after the procedure, procedural reports, and medical records were reviewed for analysis. RESULTS: Three cysts were located in the anteroinferior region, while one cyst was located in the posterior region. At the 1-month follow-up, symptom improvement had been achieved in all four patients. However, in the patient who had the largest cyst with extracapsular extension, symptoms recurred after 5 months, and the patient underwent surgery. CONCLUSION: CT-guided aspiration and steroid injection were feasible for the treatment of symptomatic paralabral cysts of the hip. During the procedures, all four cysts collapsed.

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.

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.

Analysis of cyclops lesions after different anterior cruciate ligament reconstructions: a comparison of the single-bundle and remnant bundle preservation techniques.

OBJECTIVE: The aim of this work was to compare the prevalence of cyclops lesions after anterior cruciate ligament reconstruction (ACLR) using the single-bundle and remnant bundle preservation techniques. MATERIALS AND METHODS: One hundred consecutive patients, who had undergone postoperative MRI of the knee followed by arthroscopic ACLR with the remnant bundle preservation technique (R) between February 2007 and August 2010, were enrolled in this study. Thirty-six consecutive patients who underwent ACLR using the single-bundle technique (S) were also included in this study as a control group. The MR findings were scored based on the presence of pre-ACL graft lesion as 0, 1, 2, or 3 on the sagittal images. The sixty-one specimens by second-look surgery (20 in S, 41 in R) were pathologically examined. RESULTS: The numbers of patients with scores of 0, 1, 2, and 3 were 1, 18, 14, and 3 in group S and 4, 60, 29, and 7, in group R, respectively. Of the 61 patients who underwent second-look surgery (20 in S, 41 in R), eight had a cyclops lesion (three in group S and five in group R). The prevalence of cyclops lesion was not significantly different in group R and group S (p = 0.761). CONCLUSIONS: The prevalence of a cyclops lesion was similar in both groups.

Sclerosing epithelioid fibrosarcoma: cytogenetic analysis of FUS rearrangement.

Sclerosing epithelioid fibrosarcoma (SEF) is a rare but distinct variant of fibrosarcoma. A 43-year-old man presented with a lesion in his back that had been present for three years but had recently increased in size. Magnetic resonance imaging (MRI) revealed a 6-cm sized ovoid mass showing low intensities on T1 and T2 weighted images. Histologically, the tumor was of moderate cellularity, and the cells were relatively uniform in size and shape. The cells were epithelioid, round, oval and polygonal with clear and slightly eosinophilic cytoplasm, forming nests, cords, or sheet-like patterns with a dense collagenous and hyalinized matrix. The tumor was positive for vimentin, but negative for smooth muscle actin, desmin, HMB45, and CD34. Although the tumor showed nuclear overexpression of beta-catenin protein, the CTNNB1 exon3 mutation was not detected. Fluorescent in situ hybridization for FUS using dual color break-apart probes showed rearrangement of the FUS. In accordance with previous studies, our case showed positive findings of FUS rearrangement, reinforcing the notion of a close relationship between low grade fibromyxoid sarcoma and SEF.

3D isotropic turbo spin-echo intermediate-weighted sequence with refocusing control in knee imaging: comparison study with 3D isotropic fast-field echo sequence.

BACKGROUND: Three-dimensional (3D) turbo spin-echo (TSE) images have been used in imaging of the extremities and comparable diagnostic performance to two-dimensional (2D) TSE images has been reported in several studies. However, comparison of the 3D isotropic TSE intermediate-weighted sequence and 3D FFE sequence in terms of image quality has not been investigated. PURPOSE: To compare the image quality of a 3D isotropic TSE intermediate-weighted sequence with refocusing control (volume isotropic turbo spin echo acquisition [VISTA]) and a 3D isotropic fast-field echo (FFE) sequence of the knee joint. MATERIAL AND METHODS: 3.0 T knee MRI with VISTA and 3D FFE sequences was performed in 10 healthy volunteers (3 men, 7 women; age range 26-30 years). Two radiologists with specialties in the musculoskeletal system assessed tissue contrast between the fluid-cruciate ligament (F-L), fluid-meniscus (F-M), and fluid-cartilage (F-C) based on a 4-point scale (1, poor; 2, fair; 3, good; and 4, excellent). Statistical analysis for inter-observer agreement and differences in grades in tissue contrast between VISTA and 3D FFE images (Wilcoxon signed-rank) were performed. For a quantitative analysis, the signal-to-noise ratio (SNR) was obtained by imaging phantom and noise-only image. Image contrast ratios (CRs) were calculated between F-L, F-M, and F-C in volunteer images of VISTA and 3D FFE and compared statistically with a paired t-test. RESULTS: Based on qualitative analysis, VISTA had statistically superior grades of tissue contrast in F-L (P < 0.001) and F-M (P < 0.001). 3D FFE had superior but not statistically significant (P = 0.317) grades in F-C. Based on quantitative analysis, the SNR of the phantom imaging was higher in VISTA than that in 3D FFE (28.18 vs. 14.90). VISTA had superior CRs in F-L (P < 0.001) and F-M (P < 0.001). 3D FFE had superior CR in F-C (P = 0.038). CONCLUSION: The VISTA sequence was superior in tissue contrast between F-M and F-L, and 3D FFE was superior in tissue contrast between F-C, subjectively and quantitatively.

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.

Feasibility of whole-body MRI for detecting metastatic myxoid liposarcoma: a case series.

No feasible method currently exists to evaluate systemic metastasis in patients with myxoid liposarcoma. The purpose of this study was to determine the feasibility of performing whole-body magnetic resonance imaging (MRI) to detect metastatic myxoid liposarcoma. From June 2008 to May 2010, all patients who were newly diagnosed with myxoid liposarcomas at our institution underwent whole-body MRI along with other conventional imaging methods. We divided the whole body into 38 sections (7 soft tissue sections and 31 bone tissue sections). In total, there were 570 regions (105 soft tissue regions and 465 bony regions) in 15 patients (10 men and 5 women) who underwent whole-body MRI.Of 105 soft tissue regions, there were 4 true positives, 3 false positives, 1 false negative, and 97 true positives. Of 465 bone tissue regions, there were 11 true positives, 5 false positives, 2 false negatives, and 447 true negatives. In soft tissue, whole-body MRI for the detection of metastatic lesion showed a sensitivity of 80%, a specificity of 97.0%, a positive predictive value of 57.1%, and a negative predictive value of 99.0%. In bone tissue, whole-body MRI had a sensitivity of 84.6%, a specificity of 98.9%, a positive predictive value of 68.8%, and a negative predictive value of 99.6%.Whole-body MRI is feasible and effective for detecting bone and soft tissue metastasis in patients with myxoid liposarcoma.