Pictural assay: femoroacetabuler impingement

Bu derleme yazısında son yıllarda kalça ağrılarının etyolojisinde sıklıkla vurgulanan Femoroasetabular impingement (FAİ) sendromuna dair son literatür bilgileri tartışılmıştır. Klinik pratikte oldukça atlanan bu konu, klinik ve radyolojik açıdan ele alınmış; tedavi yaklaşımları gözden geçirilmiştir. FAİ sendromu ile ilgili fiziksel tıp ve rehabilitasyon alanında yapılan çalışmalar oldukça yetersizdir. Kalça osteoartriti gelişiminde hatırı sayılır bir yeri olan bu sendroma karşı farkındalığın artması ile bir çok hasta erken tedavi imkanı bulacak ve hastaların yaşam kalitesi artacaktır. Bu nedenle bu konuda daha fazla klinik ve radyolojik çalışmaya ihtiyaç vardır. Bu çalışmalar ışığında ortaya çıkacak yeni tanı ve tedavi algoritmaları ile ağrı yakınmaları karşılıksız kalan bir çok hasta da şifa bulabileceklerdir.In this pictural assay, the femoroasetabular impingement (FAI) syndrome that emphasized in the etiology of hip pain was discussed with the light of recent literatures. This topic that was usually skipped in clinical practice was examined with clinical and radiological aspects and treatment approaches were discussed. Studies related to FAI syndrome are very limited in the field of physical medicine and rehabilitation. In clinical practice with the consideration of this syndrome which has place in the etiology of hip osteoarthritis; early treatment of many patients could be possible, and patients' quality of life would increased. Therefore, further clinical and radiological studies are required about this issue. In the light of these studies new diagnostic and therapeutic algorithms will be revealed and in many patients who complaints of pain remaining insoluble would able to find cure

Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2023-overview, and primary local imaging: how and where?

OBJECTIVES: Early, accurate diagnosis is crucial for the prognosis of patients with soft tissue sarcomas. To this end, standardization of imaging algorithms, technical requirements, and reporting is therefore a prerequisite. Since the first European Society of Musculoskeletal Radiology (ESSR) consensus in 2015, technical achievements, further insights into specific entities, and the revised WHO-classification (2020) and AJCC staging system (2017) made an update necessary. The guidelines are intended to support radiologists in their decision-making and contribute to interdisciplinary tumor board discussions. MATERIALS AND METHODS: A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements were scored online by level of agreement (0 to 10) during two iterative rounds. Either "group consensus," "group agreement," or "lack of agreement" was achieved. RESULTS: Eight sections were defined that finally contained 145 statements with comments. Overall, group consensus was reached in 95.9%, and group agreement in 4.1%. This communication contains the first part consisting of the imaging algorithm for suspected soft tissue tumors, methods for local imaging, and the role of tumor centers. CONCLUSION: Ultrasound represents the initial triage imaging modality for accessible and small tumors. MRI is the modality of choice for the characterization and local staging of most soft tissue tumors. CT is indicated in special situations. In suspicious or likely malignant tumors, a specialist tumor center should be contacted for referral or teleradiologic second opinion. This should be done before performing a biopsy, without exception. CLINICAL RELEVANCE: The updated ESSR soft tissue tumor imaging guidelines aim to provide best practice expert consensus for standardized imaging, to support radiologists in their decision-making, and to improve examination comparability both in individual patients and in future studies on individualized strategies. KEY POINTS: • Ultrasound remains the best initial triage imaging modality for accessible and small suspected soft tissue tumors. • MRI is the modality of choice for the characterization and local staging of soft tissue tumors in most cases; CT is indicated in special situations. Suspicious or likely malignant tumors should undergo biopsy. • In patients with large, indeterminate or suspicious tumors, a tumor reference center should be contacted for referral or teleradiologic second opinion; this must be done before a biopsy

Meme karsinomlu olguda yaygın kostal ve sternal metastazının dina- mik, difüzyon ağırlıklı ve üç boyutlu meme manyetik rezonans görün- tüleme bulguları

Meme manyetik rezonans görüntüleme (MRG) meme kanserinin lokal evre lemesinde kullanılan yüksek duyarlılık ve doğruluğa sahip bir inceleme yön temidir. Bu inceleme sırasında başta sternum ve ön kostalar olmak üzere gö rüntü alanına giren toraks ön duvarı kemik yapıları da görüntülenir. Patolo jik kırık oluşmadan, sadece medüller kemik infiltrasyonu bulunan olgularda kosta metastazlarının direkt grafi ve bilgisayarlı tomografi ile görüntülenme si güçtür. Dinamik meme MRG, meme karsinomunda kortikal destrüksiyon oluşmadan önce kemik metastazını saptayabilir. Özellikle postkontrast subs trakte görüntülerden elde olunan multiplanar maksimum intensite projeksi yon (MIP) görüntüler, kemik tutulumunun saptanmasında yararlıdır. Koronal MIP görüntüler kemik kostalardaki infiltrasyonu netlikle gösterirken, metas tazın çok nadir olduğu kıkırdak kostaların ise korunması dikkat çekicidir. Ke mik metastazı için altın standart olarak kabul edilen kemik sintigrafisine kı yasla meme MRG’de uzaysal rezolüsyon oldukça yüksektir. Meme malignite si olgularında metastatik tutulumun sık görüldüğü kemik, plevra, periton ve karaciğer gibi oluşumlar meme MRG’de dikkatle değerlendirilmelidir. MIP ve difüzyon ağırlıklı görüntülerin tanısal katkı sağladığı unutulmamalıdır.Breast magnetic resonance imaging (MRI) is used in local staging of breast carcinoma with high sensitivity and accuracy. During this technique bony structures of the thorax such as sternum and anterior ribs are also evaluated. Direct graphy and computed tomography are not diagnostic in the patients with costal metastasis which have medullary bone infiltration without pathological fracture. Dynamic breast MRI can determine bone metastasis without cortical destruction. Especially multiplanary maximum intensity projection (MIP) images which are obtained from postcontrast substructed images are helpful in determining bone metastasis. Coronal MIP images can show infiltration of bony costas. Chondromateus costas are usually preserved. Bone syntigraphy is accepted as the gold standard for determining bone metastasis, however the spatial resolution of MRI is higher than scintigraphy. In breast carcinoma cases, bone, pleura, peritonum and liver metastasis are seen commonly and these localizations must be evaluated carefully with breast MRI. MIP and diffusion weighted images provide diagnostic contributions

Contribution of Kinetic Characteristics of Axillary Lymph Nodes to the Diagnosis in Breast Magnetic Resonance Imaging

Objective: To assess the contribution of kinetic characteristics in the discrimination of malignant-benign axillary lymph nodes. Material and Methods: One hundred fifty-five female patients were included in the study. Following magnetic resonance imaging (MRI) examinations post-processing applications were applied, dynamic curves were obtained from subtracted images. Types of dynamic curves were correlated with histopathological results in malignant cases or final clinical results in patients with no evidence of malignancy. Sensitivity, specificity, positive likehood ratio (+LHR), negative (-LHR) of dynamic curves characterizing the axillary lymph nodes were calculated.Results: A total of 178 lymph nodes greater than 8 mm were evaluated in 113 patients. Forty-six lymph nodes in 24 cases had malignant axillary involvement. 132 lymph nodes in 89 patients with benign diagnosis were included in the study. The sensitivity of type 3 curve as an indicator of malignancy was calculated as 89%. However the specificity, +LHR, -LHR were calculated as 14%, 1.04, 0.76 respectively. Conclusion: Since kinetic analysis of both benign and malignant axillary lymph nodes, rapid enhancement and washout (type 3) they cannot be used as a discriminator, unlike breast lesions. MRI, depending on the kinetic features of the axillary lymph nodes, is not high enough to be used in the clinical management of breast cancer patients