Biblio.ugent.be



Title: Radiographic/MRI Correlation of Soft TissuesSynopsisMRI is nowadays regarded as the preferred imaging modality for evaluation of soft tissue lesions. As plain radiographs are often the first step in evaluation of musculoskeletal disorders, identification of subtle soft tissue signs may be helpful to select patients that need to be referred for subsequent MRI. Although not very sensitive, certain plain film findings, such as intralesional calcification or gas, may allow to make to a more specific tissue diagnosis and may obviate the need for invasive diagnostic procedures and potential harmful treatment.KeywordsRadiography – Magnetic Resonance Imaging - Soft Tissue Musculoskeletal Disease.Introduction Due to its high soft tissue contrast and exquisite anatomic resolution, Magnetic Resonance Imaging (MRI) is regarded as the imaging modality of choice for evaluation of musculoskeletal soft tissue l lesions.However, most of these abnormalities may be suspected on Conventional Radiography (CR) by analysis of subtle or indirect signs. These signs are well recognized by experienced radiologists, but are less known and often forgotten by young colleagues who are currently well-trained in interpretation of MRI. As CR remains often the initial imaging tool in the evaluation of many musculoskeletal disorders, it is important to remember these signs as potential markers of relevant soft tissue pathology. Correct identification and interpretation of soft tissue signs on CR may be helpful to select patients that need to be referred for further MRI. On the other hand, in certain scenario’s, meticulous analysis of plain film findings may even lead to a more specific tissue diagnosis of soft tissue abnormalities, such as demonstration of phleboliths in slow flow vascular malformation or the presence of peripheral calcifications in myositis ossificans.Therefore, correlation of MRI findings and radiographic findings is highly recommended, as the information derived from both imaging techniques is often complementary. The aim of this article is to remind the most valuable signs that may suggest the presence of soft tissue pathology on CR and to discuss their diagnostic strength compared to MRI findings.Discussion of musculoskeletal soft tissue diseases on plain films will be done along with the radiographic density of its major macroscopic components (Table 1). LESIONS CONTAINING SOFT TISSUE MINERALISATIONMineralization in the soft tissues may occur in a large spectrum of disorders including congenital, metabolic, endocrine, traumatic and parasitic infections. Mineralization is often far better identified on plain films or CT than on MRI. In addition, meticulous analysis of the pattern of intralesional calcification or ossification may be helpful for a more tissue specific diagnosis of a soft tissue lesion ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/978-3-319-46679-8_2","ISBN":"978-3-319-46677-4","author":[{"dropping-particle":"","family":"Botchu","given":"R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"James","given":"S. L.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Davies","given":"A. M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Imaging of Soft Tissue Tumors","edition":"4th","editor":[{"dropping-particle":"","family":"Vanhoenacker","given":"F.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parizel","given":"P.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gielen","given":"J.L.","non-dropping-particle":"","parse-names":false,"suffix":""}],"id":"ITEM-1","issued":{"date-parts":[["2017"]]},"page":"41-57","publisher":"Springer International Publishing","publisher-place":"Cham","title":"Radiography and Computed Tomography","type":"chapter"},"uris":[""]}],"mendeley":{"formattedCitation":"¹","plainTextFormattedCitation":"1","previouslyFormattedCitation":"¹"},"properties":{"noteIndex":0},"schema":""}1 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.path.2015.05.004","ISSN":"18759181","author":[{"dropping-particle":"","family":"Cho","given":"Soo-Jin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Horvai","given":"Andrew","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Surgical Pathology Clinics","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2015","9"]]},"page":"419-444","title":"Chondro-Osseous Lesions of Soft Tissue","type":"article-journal","volume":"8"},"uris":[""]}],"mendeley":{"formattedCitation":"²","plainTextFormattedCitation":"2","previouslyFormattedCitation":"²"},"properties":{"noteIndex":0},"schema":""}2.Basic Calcium Phosphate (BCP) crystal deposition diseaseBasic Calcium Phosphate (BCP) crystal deposition disease consists of BCP crystals deposition in either periarticular soft tissues or less frequently the joints. It is also designated as hydroxyapatite deposition disease (HADD), as the deposits are predominantly composed of hydroxyapatite and less commonly of tricalcium phosphate and octacalcium phosphate ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s13244-018-0619-0","ISSN":"1869-4101","PMID":"29882050","abstract":"Musculoskeletal calcifications are frequent on radiographs and sometimes problematic. The goal of this article is to help radiologists to make the correct diagnosis when faced with an extraosseous musculoskeletal calcification. One should first differentiate a calcification from an ossification or a foreign body and then locate the calcification correctly. Each location has a specific short differential diagnosis, with minimal further investigation necessary. Intra-tendon calcifications are most frequently associated with hydroxyapatite deposition disease (HADD). In most cases, intra-articular calcifications are caused by calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. Soft tissue calcification can be caused by secondary tumoural calcinosis from renal insufficiency, or collagen vascular diseases and by vascular calcifications, either arterial or venous (phlebolith). TEACHING POINTS ? Calcifications have to be differentiated form ossification and foreign body. ? A musculoskeletal MRI study must always be correlated with a radiograph. ? The clinical manifestations of calcifications may sometimes mimic septic arthritis or sarcoma. ? HADD and CPPD crystal deposition have a distinct appearance on radiograph. ? Calcinosis is more frequently caused by chronic renal failure and scleroderma.","author":[{"dropping-particle":"","family":"Freire","given":"Véronique","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moser","given":"Thomas P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lepage-Saucier","given":"Marianne","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Insights into Imaging","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2018","8","7"]]},"page":"477-492","title":"Radiological identification and analysis of soft tissue musculoskeletal calcifications","type":"article-journal","volume":"9"},"uris":[""]}],"mendeley":{"formattedCitation":"³","plainTextFormattedCitation":"3","previouslyFormattedCitation":"³"},"properties":{"noteIndex":0},"schema":""}3 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.rcl.2017.04.004","ISSN":"1557-8275","PMID":"28774457","abstract":"This article reviews the main radiographic features of crystal deposition diseases. Gout is linked to monosodium urate crystals. Classic radiographic features include subcutaneous tophi, large and well-circumscribed paraarticular bone erosions, and exuberant bone hyperostosis. Calcium pyrophosphate deposition (CPPD) can involve numerous structures, such as hyaline cartilages, fibrocartilages, or tendons. CPPD arthropathy involves joints usually spared by osteoarthritis. Basic calcium phosphate deposits are periarticular or intraarticular. Periarticular calcifications are amorphous, dense, and round or oval with well-limited borders, and most are asymptomatic. When resorbing, they become cloudy and less dense with an ill-defined shape and can migrate into adjacent structures.","author":[{"dropping-particle":"","family":"Jacques","given":"Thibaut","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Michelin","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Badr","given":"Sammy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nasuto","given":"Michelangelo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lefebvre","given":"Guillaume","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Larkman","given":"Neal","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cotten","given":"Anne","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiologic clinics of North America","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2017","9"]]},"page":"967-984","title":"Conventional Radiology in Crystal Arthritis: Gout, Calcium Pyrophosphate Deposition, and Basic Calcium Phosphate Crystals.","type":"article-journal","volume":"55"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴","plainTextFormattedCitation":"4","previouslyFormattedCitation":"⁴"},"properties":{"noteIndex":0},"schema":""}4. Calcific tendinopathy of the shoulder tendons is the most common manifestation, accounting for 60% of cases, followed by involvement of the tendons of the hip, knee, elbow, wrist and hand ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.rcl.2017.04.004","ISSN":"1557-8275","PMID":"28774457","abstract":"This article reviews the main radiographic features of crystal deposition diseases. Gout is linked to monosodium urate crystals. Classic radiographic features include subcutaneous tophi, large and well-circumscribed paraarticular bone erosions, and exuberant bone hyperostosis. Calcium pyrophosphate deposition (CPPD) can involve numerous structures, such as hyaline cartilages, fibrocartilages, or tendons. CPPD arthropathy involves joints usually spared by osteoarthritis. Basic calcium phosphate deposits are periarticular or intraarticular. Periarticular calcifications are amorphous, dense, and round or oval with well-limited borders, and most are asymptomatic. When resorbing, they become cloudy and less dense with an ill-defined shape and can migrate into adjacent structures.","author":[{"dropping-particle":"","family":"Jacques","given":"Thibaut","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Michelin","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Badr","given":"Sammy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nasuto","given":"Michelangelo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lefebvre","given":"Guillaume","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Larkman","given":"Neal","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cotten","given":"Anne","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiologic clinics of North America","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2017","9"]]},"page":"967-984","title":"Conventional Radiology in Crystal Arthritis: Gout, Calcium Pyrophosphate Deposition, and Basic Calcium Phosphate Crystals.","type":"article-journal","volume":"55"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴","plainTextFormattedCitation":"4","previouslyFormattedCitation":"⁴"},"properties":{"noteIndex":0},"schema":""}4. Virtually any tendon can be involved. Other periarticular tissues such as bursae (Fig. 1), capsule and ligaments may be involved as well. The disease can be divided in a pre-calcific, calcific and post-calcific stages, of which the calcific stage is further subdivided into formative, resting and resorptive phases ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"1940-5480","PMID":"10797220","abstract":"Calcific tendinopathy, or calcifying tendinitis, is a disease characterized by multifocal, cell-mediated calcification of living tissue. After spontaneous disappearance of the calcific deposits or, less frequently, surgical removal, the tendon reconstitutes itself. Attention to the clinical presentation and the radiologic, morphologic, and gross characteristics of the calcium deposit will facilitate differentiation between the formative phase and the resorptive phase, which is of paramount importance in the management of this disease. Should conservative treatment fail, surgical removal may be indicated during the formative phase, but only under exceptional circumstances during the resorptive phase. Aspiration and lavage of the deposit should be performed only during the latter phase.","author":[{"dropping-particle":"","family":"Uhthoff","given":"","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Loehr","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Journal of the American Academy of Orthopaedic Surgeons","id":"ITEM-1","issue":"4","issued":{"date-parts":[["1997","7"]]},"page":"183-191","title":"Calcific Tendinopathy of the Rotator Cuff: Pathogenesis, Diagnosis, and Management.","type":"article-journal","volume":"5"},"uris":[""]}],"mendeley":{"formattedCitation":"⁵","plainTextFormattedCitation":"5","previouslyFormattedCitation":"⁵"},"properties":{"noteIndex":0},"schema":""}5.In the formative and resting phases, dense, homogeneous and well-defined calcium deposits are seen on plain radiographs. Calcifications in the formative and resting stages are often more difficult to characterize on MRI, because of the low contrast with surrounding tendons.Patients are often asymptomatic at these stages or may present with only a mild discomfort. On the contrary, acute pain typically accompanies the resorptive phase, in which deposits migrate in surrounding tissues, bursae, joints or even bones. On radiographs, the calcification becomes fluffy, ill-defined and less dense or may even become invisible ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s13244-018-0619-0","ISSN":"1869-4101","PMID":"29882050","abstract":"Musculoskeletal calcifications are frequent on radiographs and sometimes problematic. The goal of this article is to help radiologists to make the correct diagnosis when faced with an extraosseous musculoskeletal calcification. One should first differentiate a calcification from an ossification or a foreign body and then locate the calcification correctly. Each location has a specific short differential diagnosis, with minimal further investigation necessary. Intra-tendon calcifications are most frequently associated with hydroxyapatite deposition disease (HADD). In most cases, intra-articular calcifications are caused by calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. Soft tissue calcification can be caused by secondary tumoural calcinosis from renal insufficiency, or collagen vascular diseases and by vascular calcifications, either arterial or venous (phlebolith). TEACHING POINTS ? Calcifications have to be differentiated form ossification and foreign body. ? A musculoskeletal MRI study must always be correlated with a radiograph. ? The clinical manifestations of calcifications may sometimes mimic septic arthritis or sarcoma. ? HADD and CPPD crystal deposition have a distinct appearance on radiograph. ? Calcinosis is more frequently caused by chronic renal failure and scleroderma.","author":[{"dropping-particle":"","family":"Freire","given":"Véronique","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moser","given":"Thomas P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lepage-Saucier","given":"Marianne","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Insights into Imaging","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2018","8","7"]]},"page":"477-492","title":"Radiological identification and analysis of soft tissue musculoskeletal calcifications","type":"article-journal","volume":"9"},"uris":[""]}],"mendeley":{"formattedCitation":"³","plainTextFormattedCitation":"3","previouslyFormattedCitation":"³"},"properties":{"noteIndex":0},"schema":""}3. Associated bone erosions, bone marrow edema on MRI, intraosseous migration or increased uptake on nuclear medicine studies may mimic a tumor or infection ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s00256-015-2165-x","ISSN":"0364-2348","PMID":"25975184","abstract":"Calcium hydroxyapatite crystal deposition is a common disorder, which sometimes causes acute pain as calcifications dissolve and migrate into adjacent soft tissue. Intraosseous calcium penetration has also been described. We illustrate the appearance of these lesions using a series of 35 cases compiled by members of the French Society of Musculoskeletal Imaging (Société d'Imagerie Musculo-Squelettique, SIMS). The first group in our series (7 cases) involved calcification-related cortical erosions of the humeral and femoral diaphyses, in particular at the pectoralis major and gluteus maximus insertions. A second group (28 cases) involved the presence of calcium material in subcortical areas. The most common site was the greater tubercle of the humerus, accompanying a calcifying tendinopathy of the supraspinatus. In addition, an extensive intramedullary diffusion of calcium deposits was observed in four of these cases, associated with cortical erosion in one case and subcortical lesions in three cases. Cortical erosions and intraosseous migration of calcifications associated with calcific tendinitis may be confused with neoplasm or infection. It is important to recognize atypical presentations of hydroxyapatite deposition to avoid unnecessary investigation or surgery.","author":[{"dropping-particle":"","family":"Malghem","given":"Jacques","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Omoumi","given":"Patrick","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lecouvet","given":"Frédéric","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Berg","given":"Bruno","non-dropping-particle":"Vande","parse-names":false,"suffix":""}],"container-title":"Skeletal Radiology","id":"ITEM-1","issue":"10","issued":{"date-parts":[["2015","10","15"]]},"page":"1403-1412","title":"Intraosseous migration of tendinous calcifications: cortical erosions, subcortical migration and extensive intramedullary diffusion, a SIMS series","type":"article-journal","volume":"44"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶","plainTextFormattedCitation":"6","previouslyFormattedCitation":"⁶"},"properties":{"noteIndex":0},"schema":""}6 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"17802393","author":[{"dropping-particle":"","family":"El-Essawy","given":"M.T.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"F.M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"JBR-BTR","id":"ITEM-1","issue":"6","issued":{"date-parts":[["2012"]]},"page":"374","title":"Calcific tendinopathy of the pectoralis major insertion with intracortical protrusion of calcification","type":"article-journal","volume":"95"},"uris":[""]}],"mendeley":{"formattedCitation":"⁷","plainTextFormattedCitation":"7","previouslyFormattedCitation":"⁷"},"properties":{"noteIndex":0},"schema":""}7. The clue to the correct diagnosis is the location of the lesion at its specific tendon insertion at the bone and correlation of MRI with the presence of calcification on plain radiographs. A targeted CT scan may be useful to demonstrate minute calcifications and bone erosions in complex anatomical areas such as the pelvis (Fig. 2).Symptomatic BCP in the capsule and ligaments may be associated with adjacent bone marrow and soft tissue edema on MRI, whereas the underlying calcification is better seen on corresponding radiographs (Fig. 3).Calcific tendinopathy of the longus colli is a specific spinal manifestation of BCP disease and may clinically and on MRI mimic a retropharyngeal abscess. The identification of calcifications in the longus colli underneath the anterior arc of C1 is the clue to the correct diagnosis (Fig. 4) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.ijscr.2017.10.063","ISSN":"22102612","PMID":"29145108","abstract":"INTRODUCTION Acute calcific longus colli tendinitis, also known as retropharyngeal or acute calcific prevertebral tendinitis, is a reactive self-limiting inflammatory response to acute or subacute deposition of amorphous calcium hydroxyapatite crystals in the tendons of the longus colli muscle, anterior to the C1-C2 disk space. CASE PRESENTATION A 53-year-old man presented with a complaint of neck pain and odynophagia over a few days. Blood test findings showed mild leukocytosis and elevated C-reactive protein level. Computed tomography findings showed mild edematous prevertebral thickening involving the retropharyngeal space, predominantly on the left side, with no appreciable surrounding peripheral enhancement. A small amount of linear calcification/ossification involving the superior fibers of the left longus colli muscle, anterior to the C1 arch were also noted. DISCUSSION The patient's presentation could be easily misdiagnosed as a retropharyngeal abscess. However, the presence of subtle findings on CT would lead to the correct diagnosis. The management of this condition is mainly with nonsteroidal anti-inflammatory drugs. CONCLUSION This study presents the characteristic radiological features of retropharyngeal calcific tendinitis. These features are subtle and could be missed. Once an accurate diagnosis is made, treatment with nonsteroidal anti-inflammatory drugs is indicated. The purpose of this case report is to highlight this rare condition's diagnosis and management.","author":[{"dropping-particle":"","family":"Alamoudi","given":"Uthman","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Al-Sayed","given":"Ahmed A.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"AlSallumi","given":"Yasser","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rigby","given":"Matthew H.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Taylor","given":"S. Mark","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hart","given":"Robert D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Trites","given":"Jonathan R.B.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"International Journal of Surgery Case Reports","id":"ITEM-1","issued":{"date-parts":[["2017"]]},"page":"343-346","title":"Acute calcific tendinitis of the longus colli muscle masquerading as a retropharyngeal abscess: A case report and review of the literature","type":"article-journal","volume":"41"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸","plainTextFormattedCitation":"8","previouslyFormattedCitation":"⁸"},"properties":{"noteIndex":0},"schema":""}8 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2169/internalmedicine.0160-17","ISSN":"0918-2918","PMID":"29709928","abstract":"The diagnosis of longus colli tendinitis (LCT) is sometimes challenging, especially when laboratory data show marked inflammation and neuroimaging studies do not indicate calcification within the tendon of the longus colli muscles. We herein report a case of LCT that presented with elevated inflammation parameters without calcification on imaging. Findings characteristic of LCT, such as prevertebral hyperintensity areas on T2-weighted images and no signs of purulent diseases, informed our diagnosis of LCT. Enhanced computed tomography and magnetic resonance imaging are useful procedures when diagnosing LCT after ruling out other critical purulent diseases.","author":[{"dropping-particle":"","family":"Uchida","given":"Takayasu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kanzaki","given":"Mami","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kakumoto","given":"Toshiyuki","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Uesaka","given":"Yoshikazu","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Internal Medicine","id":"ITEM-1","issue":"18","issued":{"date-parts":[["2018","9","15"]]},"page":"2759-2761","title":"Longus Colli Tendinitis in a Patient Presenting with Neck Pain and Acute Systemic Inflammation","type":"article-journal","volume":"57"},"uris":[""]}],"mendeley":{"formattedCitation":"⁹","plainTextFormattedCitation":"9","previouslyFormattedCitation":"⁹"},"properties":{"noteIndex":0},"schema":""}9 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.3122/jabfm.2009.01.080034","ISSN":"1557-2625","PMID":"19124639","abstract":"Retropharyngeal calcific tendonitis is an inflammatory process of the superior oblique tendons of the longus colli muscle, a neck flexor in the upper cervical spine, caused by deposition of calcium hydroxyapatite crystals; the definitive diagnostic test is computed tomography (CT). Presented in this article are two cases seen at our institution. Patients typically present with acute onset of neck pain/spasm, odynophagia, dysphagia, and/or low grade fevers. Leukocytosis and elevated erythrocyte sedimentation rate may be noted. It is important to understand this entity because its signs and symptoms are mimickers of those of the more serious condition of retropharyngeal space abscess. Calcific tendonitis is managed conservatively whereas retropharyngeal abscess requires incision and drainage. Some may argue that this entity is a zebra because its reported incidence in the literature is low. However, most of these studies were done in an era when CT was not yet in vogue. With today's widespread use of CT and its superb ability to visualize the calcification, the true incidence of this condition is probably higher and, thus, it is important for the family practitioner to be aware of this entity. The astute clinician may save the patient from unnecessary diagnostic workup, undue anxiety, and delays in hospital discharge.","author":[{"dropping-particle":"","family":"Razon","given":"Rhea Victoria B","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nasir","given":"Asad","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wu","given":"George S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Soliman","given":"Manal","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Trilling","given":"Jeffrey","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of the American Board of Family Medicine : JABFM","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2009","1","1"]]},"page":"84-8","publisher":"American Board of Family Medicine","title":"Retropharyngeal calcific tendonitis: report of two cases.","type":"article-journal","volume":"22"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁰","plainTextFormattedCitation":"10","previouslyFormattedCitation":"¹⁰"},"properties":{"noteIndex":0},"schema":""}10. Calcium pyrophosphate dihydrate (CPPD) crystal depositionCalcium pyrophosphate dihydrate (CPPD) crystal deposition disease refers to deposition of Calcium pyrophosphate dihydrate in hyaline cartilages and fibrocartilage of the joints (menisci, acetabular labrum, pubic symphysis and intervertebral discs), but also in other soft tissue such as ligaments, capsules and tendons. Both articular and periarticular deposition may be complicated by subsequent inflammation and may result in CPPD arthropathy or painful tophaceous pseudogout of the soft tissues respectively. In the soft tissues, radiographs show a more linear and/or stratified appearance compared to BCP (HADD) and occurs in an older population ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s13244-018-0619-0","ISSN":"1869-4101","PMID":"29882050","abstract":"Musculoskeletal calcifications are frequent on radiographs and sometimes problematic. The goal of this article is to help radiologists to make the correct diagnosis when faced with an extraosseous musculoskeletal calcification. One should first differentiate a calcification from an ossification or a foreign body and then locate the calcification correctly. Each location has a specific short differential diagnosis, with minimal further investigation necessary. Intra-tendon calcifications are most frequently associated with hydroxyapatite deposition disease (HADD). In most cases, intra-articular calcifications are caused by calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. Soft tissue calcification can be caused by secondary tumoural calcinosis from renal insufficiency, or collagen vascular diseases and by vascular calcifications, either arterial or venous (phlebolith). TEACHING POINTS ? Calcifications have to be differentiated form ossification and foreign body. ? A musculoskeletal MRI study must always be correlated with a radiograph. ? The clinical manifestations of calcifications may sometimes mimic septic arthritis or sarcoma. ? HADD and CPPD crystal deposition have a distinct appearance on radiograph. ? Calcinosis is more frequently caused by chronic renal failure and scleroderma.","author":[{"dropping-particle":"","family":"Freire","given":"Véronique","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moser","given":"Thomas P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lepage-Saucier","given":"Marianne","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Insights into Imaging","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2018","8","7"]]},"page":"477-492","title":"Radiological identification and analysis of soft tissue musculoskeletal calcifications","type":"article-journal","volume":"9"},"uris":[""]}],"mendeley":{"formattedCitation":"³","plainTextFormattedCitation":"3","previouslyFormattedCitation":"³"},"properties":{"noteIndex":0},"schema":""}3. Overall, the use of MRI for evaluation of CPPD of the soft tissues is disappointing or may mimic other soft tissue lesions ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s11926-015-0496-1","ISSN":"1523-3774","PMID":"25761927","abstract":"Calcium pyrophosphate deposition disease (CPPD) is a common and clinically heterogeneous form of arthritis caused by the deposition of calcium pyrophosphate (CPP) crystals in articular tissues. The diagnosis of CPPD is supported by the presence of radiographic chondrocalcinosis; yet, conventional radiography detects only about 40?% of clinically important CPPD. Here, we critically review the recent literature on imaging in CPPD. New studies inform our use of conventional radiographic screening methodologies for CPPD and provide additional evidence for the utility of diagnostic ultrasound. Recent work also highlights the polyarticular nature of CPPD, its association with tissue damage, and the high prevalence of tendon involvement. While dual energy CT and diffraction-enhanced synchrotron imaging remain research tools, they present potential avenues for improved visualization of CPP deposits. Advances in imaging in CPPD will increase diagnostic accuracy and eventually result in better management of this common form of arthritis.","author":[{"dropping-particle":"","family":"Miksanek","given":"Jennifer","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rosenthal","given":"Ann K.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Current Rheumatology Reports","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2015","3","12"]]},"page":"20","title":"Imaging of Calcium Pyrophosphate Deposition Disease","type":"article-journal","volume":"17"},"uris":[""]}],"mendeley":{"formattedCitation":"¹¹","plainTextFormattedCitation":"11","previouslyFormattedCitation":"¹¹"},"properties":{"noteIndex":0},"schema":""}11. On MRI, CPPD deposits are of low signal on all pulse sequences. Like other calcifications, they are often difficult to detect and characterize on MRI. Gradient-echo sequences may enhance their conspicuityADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/S0033-8389(03)00160-X","ISSN":"0033-8389","PMID":"15049531","abstract":"Calcium pyrophosphate dihydrate crystal deposition disease and calcium hydroxyapatite deposition disease are common crystal diseases that have characteristic imaging appearances. This article gives a background on each disorder and discusses the qualities that distinguish them from each other and from other arthropathies.","author":[{"dropping-particle":"","family":"Steinbach","given":"Lynne S","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiologic clinics of North America","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2004","1"]]},"page":"185-205, vii","title":"Calcium pyrophosphate dihydrate and calcium hydroxyapatite crystal deposition diseases: imaging perspectives.","type":"article-journal","volume":"42"},"uris":[""]}],"mendeley":{"formattedCitation":"¹²","plainTextFormattedCitation":"12","previouslyFormattedCitation":"¹²"},"properties":{"noteIndex":0},"schema":""}12. As meniscal chondrocalcinosis can mimic a meniscal tear, correlation of radiographs with all MRI is very important to avoid overdiagnosis ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s13244-018-0619-0","ISSN":"1869-4101","PMID":"29882050","abstract":"Musculoskeletal calcifications are frequent on radiographs and sometimes problematic. The goal of this article is to help radiologists to make the correct diagnosis when faced with an extraosseous musculoskeletal calcification. One should first differentiate a calcification from an ossification or a foreign body and then locate the calcification correctly. Each location has a specific short differential diagnosis, with minimal further investigation necessary. Intra-tendon calcifications are most frequently associated with hydroxyapatite deposition disease (HADD). In most cases, intra-articular calcifications are caused by calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. Soft tissue calcification can be caused by secondary tumoural calcinosis from renal insufficiency, or collagen vascular diseases and by vascular calcifications, either arterial or venous (phlebolith). TEACHING POINTS ? Calcifications have to be differentiated form ossification and foreign body. ? A musculoskeletal MRI study must always be correlated with a radiograph. ? The clinical manifestations of calcifications may sometimes mimic septic arthritis or sarcoma. ? HADD and CPPD crystal deposition have a distinct appearance on radiograph. ? Calcinosis is more frequently caused by chronic renal failure and scleroderma.","author":[{"dropping-particle":"","family":"Freire","given":"Véronique","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moser","given":"Thomas P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lepage-Saucier","given":"Marianne","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Insights into Imaging","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2018","8","7"]]},"page":"477-492","title":"Radiological identification and analysis of soft tissue musculoskeletal calcifications","type":"article-journal","volume":"9"},"uris":[""]}],"mendeley":{"formattedCitation":"³","plainTextFormattedCitation":"3","previouslyFormattedCitation":"³"},"properties":{"noteIndex":0},"schema":""}3 (Fig. 5).Calcifications involving the transverse ligament and adjacent to the odontoid process, designated as the crowned dens syndrome, is a spinal manifestation of CPPD. It is often an incidental finding on imaging, but it may be associated with fever, neck pain and stiffness and may even mimic meningitis clinically ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s13244-018-0619-0","ISSN":"1869-4101","PMID":"29882050","abstract":"Musculoskeletal calcifications are frequent on radiographs and sometimes problematic. The goal of this article is to help radiologists to make the correct diagnosis when faced with an extraosseous musculoskeletal calcification. One should first differentiate a calcification from an ossification or a foreign body and then locate the calcification correctly. Each location has a specific short differential diagnosis, with minimal further investigation necessary. Intra-tendon calcifications are most frequently associated with hydroxyapatite deposition disease (HADD). In most cases, intra-articular calcifications are caused by calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. Soft tissue calcification can be caused by secondary tumoural calcinosis from renal insufficiency, or collagen vascular diseases and by vascular calcifications, either arterial or venous (phlebolith). TEACHING POINTS ? Calcifications have to be differentiated form ossification and foreign body. ? A musculoskeletal MRI study must always be correlated with a radiograph. ? The clinical manifestations of calcifications may sometimes mimic septic arthritis or sarcoma. ? HADD and CPPD crystal deposition have a distinct appearance on radiograph. ? Calcinosis is more frequently caused by chronic renal failure and scleroderma.","author":[{"dropping-particle":"","family":"Freire","given":"Véronique","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moser","given":"Thomas P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lepage-Saucier","given":"Marianne","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Insights into Imaging","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2018","8","7"]]},"page":"477-492","title":"Radiological identification and analysis of soft tissue musculoskeletal calcifications","type":"article-journal","volume":"9"},"uris":[""]}],"mendeley":{"formattedCitation":"³","plainTextFormattedCitation":"3","previouslyFormattedCitation":"³"},"properties":{"noteIndex":0},"schema":""}3 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.3171/jns.1996.85.5.0803","ISSN":"0022-3085","PMID":"8893717","abstract":"<p content-type=\"fine-print\"> ? Between 1984 and 1996, seven patients with symptomatic masses located posterior to the odontoid process and containing calcium pyrophosphate dihydrate crystals were evaluated by the senior author (A.H.M.). All patients presented with distal paresthesias and myelopathy and underwent transoral-transpharyngeal resection of the anterior arch of C-1, the odontoid process, and the compressing mass. Histological examination revealed the characteristic changes of calcium pyrophosphate dihydrate (CPPD) deposition disease, with nodular deposits of birefringent rhomboid crystals. On magnetic resonance imaging, the masses appeared predominantly isointense with neural tissue on T ₁ -weighted images and iso- to hyperintense on T ₂ -weighted images. On computerized tomography scans, small areas of calcifications within the masses were apparent in all cases. All patients improved postoperatively, with six of seven patients requiring posterior fixation for instability as a second procedure. Calcium pyrophosphate dihydrate deposition causing periodontoid mass lesions is a distinct clinical disease entity that probably is underdiagnosed. In the authors' opinion, the diagnosis can often be established preoperatively by the distinctive neuroradiological appearance of the masses. Therefore, CPPD deposition disease should be considered in the differential diagnosis of masses of the craniocervical junction, because it is amenable to early surgical intervention. The consulting neuropathologist should be made aware of this diagnostic possibility at the time of surgery. </p>","author":[{"dropping-particle":"","family":"Zünkeler","given":"Bernhard","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schelper","given":"Robert","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Menezes","given":"Arnold H.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Neurosurgery","id":"ITEM-1","issue":"5","issued":{"date-parts":[["1996","11"]]},"page":"803-809","title":"Periodontoid calcium pyrophosphate dihydrate deposition disease: “pseudogout” mass lesions of the craniocervical junction","type":"article-journal","volume":"85"},"uris":[""]}],"mendeley":{"formattedCitation":"¹³","plainTextFormattedCitation":"13","previouslyFormattedCitation":"¹³"},"properties":{"noteIndex":0},"schema":""}13.Traction fibroosteosis at the insertion of tendons at the bonesBone production at the insertion of tendons at the bones is very common at different locations are usually incidental findings on imaging. It is readily detected on plain films but is often more difficult to detect on corresponding MRI unless it is accompanied by surrounding inflammation or if contains fatty bone marrow (Fig. 6). Collagen vascular disease Soft tissue calcifications are also a typical manifestation in collagen vascular disorders such as progressive systemic sclerosis, systemic lupus erythematosus, dermatomyositis and polymyositis. Calcifications associated with progressive systemic sclerosis involve the hands and wrists. In systemic lupus erythematosus (SLE) they are preferentially located in the lower extremity, whereas calcifications in polymyositis and dermatomyositis typically affect the fasciae and subcutaneous tissues ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2214/ajr.157.3.1872239","ISSN":"0361-803X","PMID":"1872239","abstract":"Although soft-tissue calcification is common in collagen vascular disease, paraspinal calcification in the cervical spine has not been described before. We studied five women with large, lobulated, predominantly homogeneous calcific masses centered on synovial articulations in the neck. Changes consisting of either osteolysis or erosions were evident. All patients had radiculopathy, focal pain, or stiffness. In two patients, the presence of hydroxyapatite crystals was confirmed on biopsy. Symptomatic cervical paraspinal calcifications in patients with collagen vascular disease cause large soft-tissue masses that mimic tumoral calcinosis.","author":[{"dropping-particle":"","family":"Schweitzer","given":"M E","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cervilla","given":"V","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Manaster","given":"B J","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gerharter","given":"J","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dalinka","given":"M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Peck","given":"W W","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Resnick","given":"D","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"AJR. American journal of roentgenology","id":"ITEM-1","issue":"3","issued":{"date-parts":[["1991","9"]]},"page":"523-5","title":"Cervical paraspinal calcification in collagen vascular diseases.","type":"article-journal","volume":"157"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁴","plainTextFormattedCitation":"14","previouslyFormattedCitation":"¹⁴"},"properties":{"noteIndex":0},"schema":""}14 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"00217646","abstract":"Although soft-tissue calcifications are well known to occur as a late manifestation in scleroderma, symptomatic paraspinal calcinosis is very rare. Clinically, patients present with focal neck pain, weakness or radiculopathy, and decreased range of motion of the neck. We describe the imaging features of a rare case of cervical paraspinal calcinosis in a 74-year-old woman with longstanding scleroderma. Standard radiography is usually sufficient to confirm the diagnosis, but CT-scan allows a more precise location of the calcifications around the facet joints, sometimes with associated erosions. The advantage of MRI is to evaluate the possible intraspinal extension of the calcifications in case of focal neurological symptomatology.","author":[{"dropping-particle":"","family":"Perre","given":"S.","non-dropping-particle":"Van de","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"F.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Beeck","given":"B.","non-dropping-particle":"Op De","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gielen","given":"J.L.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schepper","given":"A.M.","non-dropping-particle":"De","parse-names":false,"suffix":""}],"container-title":"JBR-BTR","id":"ITEM-1","issue":"2","issued":{"date-parts":[["2003"]]},"page":"80-82","title":"Paraspinal cervical calcifications associated with scleroderma","type":"article-journal","volume":"86"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁵","plainTextFormattedCitation":"15","previouslyFormattedCitation":"¹⁵"},"properties":{"noteIndex":0},"schema":""}15.Scleroderma-associated calcinosis are usually seen in the finger tips and around the synovial joints of the hands, knees, and elbows ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.3171/jns.1997.87.5.0761","ISSN":"0022-3085","PMID":"9347987","abstract":"The authors describe a case of paraspinal calcinosis in a 65-year-old woman with progressive systemic sclerosis. Although calcinosis occurs in up to 27% of cases of progressive systemic sclerosis, symptomatic paraspinal calcinosis is extremely rare. In the case reported here, multiple cervical facet joints were compromised by progressive calcinosis, leading to glacial spinal instability. Internal fixation was indicated to correct the instability and decompress the spinal canal. Medical therapy was instituted to arrest or reverse the ongoing calcinosis.","author":[{"dropping-particle":"","family":"Arginteanu","given":"M S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Perin","given":"N I","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of neurosurgery","id":"ITEM-1","issue":"5","issued":{"date-parts":[["1997","11"]]},"page":"761-3","title":"Paraspinal calcinosis associated with progressive systemic sclerosis. Case report.","type":"article-journal","volume":"87"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁶","plainTextFormattedCitation":"16","previouslyFormattedCitation":"¹⁶"},"properties":{"noteIndex":0},"schema":""}16.Patients with scleroderma may present with one or more components of the ‘CREST’ (Calcinosis- Raynaud - Esophageal dysfunction - Sclerodactyly- Teleangiectases) syndrome. ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.3171/jns.1997.87.5.0761","ISSN":"0022-3085","PMID":"9347987","abstract":"The authors describe a case of paraspinal calcinosis in a 65-year-old woman with progressive systemic sclerosis. Although calcinosis occurs in up to 27% of cases of progressive systemic sclerosis, symptomatic paraspinal calcinosis is extremely rare. In the case reported here, multiple cervical facet joints were compromised by progressive calcinosis, leading to glacial spinal instability. Internal fixation was indicated to correct the instability and decompress the spinal canal. Medical therapy was instituted to arrest or reverse the ongoing calcinosis.","author":[{"dropping-particle":"","family":"Arginteanu","given":"M S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Perin","given":"N I","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of neurosurgery","id":"ITEM-1","issue":"5","issued":{"date-parts":[["1997","11"]]},"page":"761-3","title":"Paraspinal calcinosis associated with progressive systemic sclerosis. Case report.","type":"article-journal","volume":"87"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁶","plainTextFormattedCitation":"16","previouslyFormattedCitation":"¹⁶"},"properties":{"noteIndex":0},"schema":""}16. Mixed connective tissue disease consists of a combination of SLE, scleroderma and polymyositis. On MRI, calcified lesions are of low signal intensity both on T1- as on T2-weighted images and show no contrast uptake after administration of gadolinium contrast ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"00217646","abstract":"Although soft-tissue calcifications are well known to occur as a late manifestation in scleroderma, symptomatic paraspinal calcinosis is very rare. Clinically, patients present with focal neck pain, weakness or radiculopathy, and decreased range of motion of the neck. We describe the imaging features of a rare case of cervical paraspinal calcinosis in a 74-year-old woman with longstanding scleroderma. Standard radiography is usually sufficient to confirm the diagnosis, but CT-scan allows a more precise location of the calcifications around the facet joints, sometimes with associated erosions. The advantage of MRI is to evaluate the possible intraspinal extension of the calcifications in case of focal neurological symptomatology.","author":[{"dropping-particle":"","family":"Perre","given":"S.","non-dropping-particle":"Van de","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"F.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Beeck","given":"B.","non-dropping-particle":"Op De","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gielen","given":"J.L.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schepper","given":"A.M.","non-dropping-particle":"De","parse-names":false,"suffix":""}],"container-title":"JBR-BTR","id":"ITEM-1","issue":"2","issued":{"date-parts":[["2003"]]},"page":"80-82","title":"Paraspinal cervical calcifications associated with scleroderma","type":"article-journal","volume":"86"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁵","plainTextFormattedCitation":"15","previouslyFormattedCitation":"¹⁵"},"properties":{"noteIndex":0},"schema":""}15 (Fig. 7). Active inflammation may be of high signal intensity on fluid-sensitive sequences.OsteochondromatosisSynovial osteochondromatosis (SC) is characterized by the formation of numerous metaplastic cartilaginous or osteocartilaginous nodules of small size, within the joint, tendon sheath ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1148/rg.275075116","ISSN":"1527-1323","PMID":"17848703","abstract":"Primary synovial chondromatosis represents an uncommon benign neoplastic process with hyaline cartilage nodules in the subsynovial tissue of a joint, tendon sheath, or bursa. The nodules may enlarge and detach from the synovium. The knee, followed by the hip, in male adults are the most commonly involved sites and patient population. The pathologic appearance may simulate chondrosarcoma because of significant histologic atypia, and radiologic correlation to localize the process as synovially based is vital for correct diagnosis. Radiologic findings are frequently pathognomonic. Radiographs reveal multiple intraarticular calcifications (70%-95% of cases) of similar size and shape, distributed throughout the joint, with typical \"ring-and-arc\" chondroid mineralization. Extrinsic erosion of bone is seen in 20%-50% of cases. Computed tomography (CT) optimally depicts the calcified intraarticular fragments and extrinsic bone erosion. Magnetic resonance (MR) imaging findings are more variable, depending on the degree of mineralization, although the most common pattern (77% of cases) reveals low to intermediate signal intensity with T1-weighting and very high signal intensity with T2-weighting with hypointense calcifications. These signal intensity characteristics on MR images and low attenuation of the nonmineralized regions on CT scans reflect the high water content of the cartilaginous lesions. CT and MR imaging depict the extent of the synovial disease (particularly surrounding soft-tissue involvement) and lobular growth. Secondary synovial chondromatosis can be distinguished from primary disease both radiologically (underlying articular disease and fewer chondral bodies of variable size and shape) and pathologically (concentric rings of growth). Treatment of primary disease is surgical synovectomy with removal of chondral fragments; recurrence rates range from 3% to 23%. Malignant transformation to chondrosarcoma is unusual (5% of cases) and, although difficult to distinguish from benign disease, is suggested by multiple recurrences and marrow invasion. Recognizing the appearances of primary synovial chondromatosis, which reflect their underlying pathologic characteristics, improves radiologic assessment and is important to optimize patient management.","author":[{"dropping-particle":"","family":"Murphey","given":"Mark D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vidal","given":"Jorge A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fanburg-Smith","given":"Julie C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gajewski","given":"Donald A","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiographics","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2007","1"]]},"page":"1465-88","title":"Imaging of synovial chondromatosis with radiologic-pathologic correlation.","type":"article-journal","volume":"27"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁷","plainTextFormattedCitation":"17","previouslyFormattedCitation":"¹⁷"},"properties":{"noteIndex":0},"schema":""}17 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s00256-010-1012-3","ISSN":"1432-2161","PMID":"20711779","abstract":"OBJECTIVES: Our purpose was to identify imaging characteristics of tenosynovial and bursal chondromatosis.\n\nMATERIALS AND METHODS: We retrospectively reviewed 25 pathologically confirmed cases of tenosynovial (n?=?21) or bursal chondromatosis (n?=?4). Patient demographics and clinical presentation were reviewed. Imaging was evaluated by two musculoskeletal radiologists with agreement by consensus, including radiography (n?=?21), bone scintigraphy (n?=?1), angiography (n?=?1), ultrasonography (n?=?1), CT (n?=?8), and MR (n?=?8). Imaging was evaluated for lesion location/shape, presence/number of calcifications, evidence of bone involvement, and intrinsic characteristics on ultrasonography/CT/MR.\n\nRESULTS: Average patient age was 44?years (range 7 to 75?years) with a mild male predilection (56%). A slowly increasing soft tissue mass was the most common clinical presentation (53%). Lesion locations included the foot (n?=?8), hand (n?=?6), shoulder (n?=?3), knee (n?=?2), ankle (n?=?2) and one each in the upper arm, forearm, wrist, and cervical spine. All lesions were located in a known tenosynovial (21 cases, 84%) or bursal (four cases, 16%) location. All cases of bursal chondromatosis were round/oval in shape. Tenosynovial lesions were fusiform (65%) or round/oval (35%). Radiographs commonly showed a soft tissue mass (86%) and calcification (90%). Calcifications were predominantly chondroid (79%) or osteoid (11%) in character with >10 calcified bodies in 48%. CT detected calcifications in all cases. The intrinsic characteristics of the nonmineralized component showed low attenuation on CT (75%), high signal intensity on T2-weighted MR (76%) and a peripheral/septal contrast enhancement pattern (100%).\n\nCONCLUSIONS: Imaging of tenosynovial and bursal chondromatosis is often characteristic with identification of multiple osteochondral calcifications (90% by radiographs; 100% by CT). CT and MR also revealed typical intrinsic characteristics of chondroid tissue and lesion location in a known tendon sheath or bursa.","author":[{"dropping-particle":"","family":"Walker","given":"Eric A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Murphey","given":"Mark D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fetsch","given":"John F","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Skeletal radiology","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2011","3"]]},"page":"317-25","title":"Imaging characteristics of tenosynovial and bursal chondromatosis.","type":"article-journal","volume":"40"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁸","plainTextFormattedCitation":"18","previouslyFormattedCitation":"¹⁸"},"properties":{"noteIndex":0},"schema":""}18 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1177/1753193411421419","ISSN":"1753-1934","PMID":"21987274","abstract":"Benign extraosseous cartilage tumours of the hand and wrist comprise soft tissue chondromas, synovial chondromatosis and tenosynovial chrondromatosis. These tumours can significantly affect patients as they are often painful, functionally limiting and cosmetically displeasing. Although each tumour is generally considered to be a distinct entity, they share radiological and histopathological similarities. Occasionally, all three tumours may be seen in the same patient. This is an important consideration because of the risk of recurrence that may not necessarily occur at the same anatomical site but instead extend to different sites, such as a tendon sheath and/or joint.","author":[{"dropping-particle":"","family":"Christoforou","given":"D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Strauss","given":"E. J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Abramovici","given":"L.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Posner","given":"M. a.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Hand Surgery (European Volume)","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2012","1"]]},"page":"8-13","title":"Benign extraosseous cartilage tumours of the hand and wrist","type":"article-journal","volume":"37"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁹","plainTextFormattedCitation":"19","previouslyFormattedCitation":"¹⁹"},"properties":{"noteIndex":0},"schema":""}19 or bursa ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0009-921X","PMID":"3180568","abstract":"Synovial osteochondromatosis may occur within an otherwise normal synovial joint (primary disease), within a diseased joint (secondary disease), within tendon sheaths, and within extraarticular bursal cavities. Each of these four types of disease can present in one of three progressive morphologic stages in which the intrasynovial proliferations of cartilage and bone break free to form loose bodies. A 61-year-old man presented with loose bodies about his right shoulder. This case report demonstrates that the disease was a true example of bursal osteochondromatosis of the subacromial bursa, Stage III, rather than synovial osteochondromatosis of the shoulder joint. Well-documented cases of bursal osteochondromatosis are rare.","author":[{"dropping-particle":"","family":"Milgram","given":"J W","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hadesman","given":"W M","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Clinical orthopaedics and related research","id":"ITEM-1","issue":"236","issued":{"date-parts":[["1988","11"]]},"page":"154-9","title":"Synovial osteochondromatosis in the subacromial bursa.","type":"article-journal"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁰","plainTextFormattedCitation":"20","previouslyFormattedCitation":"²⁰"},"properties":{"noteIndex":0},"schema":""}20. Synovial osteochondromatosis commonly occurs in large joints ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1148/rg.275075116","ISSN":"1527-1323","PMID":"17848703","abstract":"Primary synovial chondromatosis represents an uncommon benign neoplastic process with hyaline cartilage nodules in the subsynovial tissue of a joint, tendon sheath, or bursa. The nodules may enlarge and detach from the synovium. The knee, followed by the hip, in male adults are the most commonly involved sites and patient population. The pathologic appearance may simulate chondrosarcoma because of significant histologic atypia, and radiologic correlation to localize the process as synovially based is vital for correct diagnosis. Radiologic findings are frequently pathognomonic. Radiographs reveal multiple intraarticular calcifications (70%-95% of cases) of similar size and shape, distributed throughout the joint, with typical \"ring-and-arc\" chondroid mineralization. Extrinsic erosion of bone is seen in 20%-50% of cases. Computed tomography (CT) optimally depicts the calcified intraarticular fragments and extrinsic bone erosion. Magnetic resonance (MR) imaging findings are more variable, depending on the degree of mineralization, although the most common pattern (77% of cases) reveals low to intermediate signal intensity with T1-weighting and very high signal intensity with T2-weighting with hypointense calcifications. These signal intensity characteristics on MR images and low attenuation of the nonmineralized regions on CT scans reflect the high water content of the cartilaginous lesions. CT and MR imaging depict the extent of the synovial disease (particularly surrounding soft-tissue involvement) and lobular growth. Secondary synovial chondromatosis can be distinguished from primary disease both radiologically (underlying articular disease and fewer chondral bodies of variable size and shape) and pathologically (concentric rings of growth). Treatment of primary disease is surgical synovectomy with removal of chondral fragments; recurrence rates range from 3% to 23%. Malignant transformation to chondrosarcoma is unusual (5% of cases) and, although difficult to distinguish from benign disease, is suggested by multiple recurrences and marrow invasion. Recognizing the appearances of primary synovial chondromatosis, which reflect their underlying pathologic characteristics, improves radiologic assessment and is important to optimize patient management.","author":[{"dropping-particle":"","family":"Murphey","given":"Mark D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vidal","given":"Jorge A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fanburg-Smith","given":"Julie C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gajewski","given":"Donald A","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiographics","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2007","1"]]},"page":"1465-88","title":"Imaging of synovial chondromatosis with radiologic-pathologic correlation.","type":"article-journal","volume":"27"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁷","plainTextFormattedCitation":"17","previouslyFormattedCitation":"¹⁷"},"properties":{"noteIndex":0},"schema":""}17 but virtually any joint may be involved ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1148/rg.275075116","ISSN":"1527-1323","PMID":"17848703","abstract":"Primary synovial chondromatosis represents an uncommon benign neoplastic process with hyaline cartilage nodules in the subsynovial tissue of a joint, tendon sheath, or bursa. The nodules may enlarge and detach from the synovium. The knee, followed by the hip, in male adults are the most commonly involved sites and patient population. The pathologic appearance may simulate chondrosarcoma because of significant histologic atypia, and radiologic correlation to localize the process as synovially based is vital for correct diagnosis. Radiologic findings are frequently pathognomonic. Radiographs reveal multiple intraarticular calcifications (70%-95% of cases) of similar size and shape, distributed throughout the joint, with typical \"ring-and-arc\" chondroid mineralization. Extrinsic erosion of bone is seen in 20%-50% of cases. Computed tomography (CT) optimally depicts the calcified intraarticular fragments and extrinsic bone erosion. Magnetic resonance (MR) imaging findings are more variable, depending on the degree of mineralization, although the most common pattern (77% of cases) reveals low to intermediate signal intensity with T1-weighting and very high signal intensity with T2-weighting with hypointense calcifications. These signal intensity characteristics on MR images and low attenuation of the nonmineralized regions on CT scans reflect the high water content of the cartilaginous lesions. CT and MR imaging depict the extent of the synovial disease (particularly surrounding soft-tissue involvement) and lobular growth. Secondary synovial chondromatosis can be distinguished from primary disease both radiologically (underlying articular disease and fewer chondral bodies of variable size and shape) and pathologically (concentric rings of growth). Treatment of primary disease is surgical synovectomy with removal of chondral fragments; recurrence rates range from 3% to 23%. Malignant transformation to chondrosarcoma is unusual (5% of cases) and, although difficult to distinguish from benign disease, is suggested by multiple recurrences and marrow invasion. Recognizing the appearances of primary synovial chondromatosis, which reflect their underlying pathologic characteristics, improves radiologic assessment and is important to optimize patient management.","author":[{"dropping-particle":"","family":"Murphey","given":"Mark D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vidal","given":"Jorge A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fanburg-Smith","given":"Julie C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gajewski","given":"Donald A","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiographics : a review publication of the Radiological Society of North America, Inc","id":"ITEM-1","issue":"5","issued":{"date-parts":[["0","1"]]},"page":"1465-88","title":"Imaging of synovial chondromatosis with radiologic-pathologic correlation.","type":"article-journal","volume":"27"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁷","plainTextFormattedCitation":"17","previouslyFormattedCitation":"¹⁷"},"properties":{"noteIndex":0},"schema":""}17ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1148/rg.275075116","ISSN":"1527-1323","PMID":"17848703","abstract":"Primary synovial chondromatosis represents an uncommon benign neoplastic process with hyaline cartilage nodules in the subsynovial tissue of a joint, tendon sheath, or bursa. The nodules may enlarge and detach from the synovium. The knee, followed by the hip, in male adults are the most commonly involved sites and patient population. The pathologic appearance may simulate chondrosarcoma because of significant histologic atypia, and radiologic correlation to localize the process as synovially based is vital for correct diagnosis. Radiologic findings are frequently pathognomonic. Radiographs reveal multiple intraarticular calcifications (70%-95% of cases) of similar size and shape, distributed throughout the joint, with typical \"ring-and-arc\" chondroid mineralization. Extrinsic erosion of bone is seen in 20%-50% of cases. Computed tomography (CT) optimally depicts the calcified intraarticular fragments and extrinsic bone erosion. Magnetic resonance (MR) imaging findings are more variable, depending on the degree of mineralization, although the most common pattern (77% of cases) reveals low to intermediate signal intensity with T1-weighting and very high signal intensity with T2-weighting with hypointense calcifications. These signal intensity characteristics on MR images and low attenuation of the nonmineralized regions on CT scans reflect the high water content of the cartilaginous lesions. CT and MR imaging depict the extent of the synovial disease (particularly surrounding soft-tissue involvement) and lobular growth. Secondary synovial chondromatosis can be distinguished from primary disease both radiologically (underlying articular disease and fewer chondral bodies of variable size and shape) and pathologically (concentric rings of growth). Treatment of primary disease is surgical synovectomy with removal of chondral fragments; recurrence rates range from 3% to 23%. Malignant transformation to chondrosarcoma is unusual (5% of cases) and, although difficult to distinguish from benign disease, is suggested by multiple recurrences and marrow invasion. Recognizing the appearances of primary synovial chondromatosis, which reflect their underlying pathologic characteristics, improves radiologic assessment and is important to optimize patient management.","author":[{"dropping-particle":"","family":"Murphey","given":"Mark D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vidal","given":"Jorge A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fanburg-Smith","given":"Julie C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gajewski","given":"Donald A","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiographics","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2007","1"]]},"page":"1465-88","title":"Imaging of synovial chondromatosis with radiologic-pathologic correlation.","type":"article-journal","volume":"27"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁷","plainTextFormattedCitation":"17","previouslyFormattedCitation":"¹⁷"},"properties":{"noteIndex":0},"schema":""}17 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1594/EURORAD/CASE.13176","author":[{"dropping-particle":"","family":"Guffens","given":"F","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dom","given":"M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"Filip","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Eurorad","id":"ITEM-1","issued":{"date-parts":[["2015"]]},"language":"eng","publisher":"European Society of Radiology (ESR)","title":"Case report: primary osteochondromatosis of the right TMJ","type":"article"},"uris":[""]}],"mendeley":{"formattedCitation":"²¹","plainTextFormattedCitation":"21","previouslyFormattedCitation":"²²"},"properties":{"noteIndex":0},"schema":""}21. Primary SC (Fig. 8) is defined by cartilaginous metaplasia, synovial hyperplasia, and production of round cartilaginous nodules of similar size. The joint space is spared or may be even enlarged due to pressure erosion. This occurs preferentially in joints with a very tense capsule, such as the hip joint ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1148/rg.275075116","ISSN":"1527-1323","PMID":"17848703","abstract":"Primary synovial chondromatosis represents an uncommon benign neoplastic process with hyaline cartilage nodules in the subsynovial tissue of a joint, tendon sheath, or bursa. The nodules may enlarge and detach from the synovium. The knee, followed by the hip, in male adults are the most commonly involved sites and patient population. The pathologic appearance may simulate chondrosarcoma because of significant histologic atypia, and radiologic correlation to localize the process as synovially based is vital for correct diagnosis. Radiologic findings are frequently pathognomonic. Radiographs reveal multiple intraarticular calcifications (70%-95% of cases) of similar size and shape, distributed throughout the joint, with typical \"ring-and-arc\" chondroid mineralization. Extrinsic erosion of bone is seen in 20%-50% of cases. Computed tomography (CT) optimally depicts the calcified intraarticular fragments and extrinsic bone erosion. Magnetic resonance (MR) imaging findings are more variable, depending on the degree of mineralization, although the most common pattern (77% of cases) reveals low to intermediate signal intensity with T1-weighting and very high signal intensity with T2-weighting with hypointense calcifications. These signal intensity characteristics on MR images and low attenuation of the nonmineralized regions on CT scans reflect the high water content of the cartilaginous lesions. CT and MR imaging depict the extent of the synovial disease (particularly surrounding soft-tissue involvement) and lobular growth. Secondary synovial chondromatosis can be distinguished from primary disease both radiologically (underlying articular disease and fewer chondral bodies of variable size and shape) and pathologically (concentric rings of growth). Treatment of primary disease is surgical synovectomy with removal of chondral fragments; recurrence rates range from 3% to 23%. Malignant transformation to chondrosarcoma is unusual (5% of cases) and, although difficult to distinguish from benign disease, is suggested by multiple recurrences and marrow invasion. Recognizing the appearances of primary synovial chondromatosis, which reflect their underlying pathologic characteristics, improves radiologic assessment and is important to optimize patient management.","author":[{"dropping-particle":"","family":"Murphey","given":"Mark D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vidal","given":"Jorge A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fanburg-Smith","given":"Julie C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gajewski","given":"Donald A","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiographics","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2007","1"]]},"page":"1465-88","title":"Imaging of synovial chondromatosis with radiologic-pathologic correlation.","type":"article-journal","volume":"27"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁷","plainTextFormattedCitation":"17","previouslyFormattedCitation":"¹⁷"},"properties":{"noteIndex":0},"schema":""}17. Secondary SC (Fig. 9) is part of degenerative joint disease, arthritis or trauma, resulting in dislodgement of bony or cartilaginous tissue undergoing concentric layering. The nodules are more irregular, often larger and of heterogeneous size compared to nodules of the primary form ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1148/rg.275075116","ISSN":"1527-1323","PMID":"17848703","abstract":"Primary synovial chondromatosis represents an uncommon benign neoplastic process with hyaline cartilage nodules in the subsynovial tissue of a joint, tendon sheath, or bursa. The nodules may enlarge and detach from the synovium. The knee, followed by the hip, in male adults are the most commonly involved sites and patient population. The pathologic appearance may simulate chondrosarcoma because of significant histologic atypia, and radiologic correlation to localize the process as synovially based is vital for correct diagnosis. Radiologic findings are frequently pathognomonic. Radiographs reveal multiple intraarticular calcifications (70%-95% of cases) of similar size and shape, distributed throughout the joint, with typical \"ring-and-arc\" chondroid mineralization. Extrinsic erosion of bone is seen in 20%-50% of cases. Computed tomography (CT) optimally depicts the calcified intraarticular fragments and extrinsic bone erosion. Magnetic resonance (MR) imaging findings are more variable, depending on the degree of mineralization, although the most common pattern (77% of cases) reveals low to intermediate signal intensity with T1-weighting and very high signal intensity with T2-weighting with hypointense calcifications. These signal intensity characteristics on MR images and low attenuation of the nonmineralized regions on CT scans reflect the high water content of the cartilaginous lesions. CT and MR imaging depict the extent of the synovial disease (particularly surrounding soft-tissue involvement) and lobular growth. Secondary synovial chondromatosis can be distinguished from primary disease both radiologically (underlying articular disease and fewer chondral bodies of variable size and shape) and pathologically (concentric rings of growth). Treatment of primary disease is surgical synovectomy with removal of chondral fragments; recurrence rates range from 3% to 23%. Malignant transformation to chondrosarcoma is unusual (5% of cases) and, although difficult to distinguish from benign disease, is suggested by multiple recurrences and marrow invasion. Recognizing the appearances of primary synovial chondromatosis, which reflect their underlying pathologic characteristics, improves radiologic assessment and is important to optimize patient management.","author":[{"dropping-particle":"","family":"Murphey","given":"Mark D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vidal","given":"Jorge A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fanburg-Smith","given":"Julie C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gajewski","given":"Donald A","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiographics","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2007","1"]]},"page":"1465-88","title":"Imaging of synovial chondromatosis with radiologic-pathologic correlation.","type":"article-journal","volume":"27"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁷","plainTextFormattedCitation":"17","previouslyFormattedCitation":"¹⁷"},"properties":{"noteIndex":0},"schema":""}17. The joint space is narrowed. Milgram proposed the following staging system ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0009-921X","PMID":"3180568","abstract":"Synovial osteochondromatosis may occur within an otherwise normal synovial joint (primary disease), within a diseased joint (secondary disease), within tendon sheaths, and within extraarticular bursal cavities. Each of these four types of disease can present in one of three progressive morphologic stages in which the intrasynovial proliferations of cartilage and bone break free to form loose bodies. A 61-year-old man presented with loose bodies about his right shoulder. This case report demonstrates that the disease was a true example of bursal osteochondromatosis of the subacromial bursa, Stage III, rather than synovial osteochondromatosis of the shoulder joint. Well-documented cases of bursal osteochondromatosis are rare.","author":[{"dropping-particle":"","family":"Milgram","given":"J W","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hadesman","given":"W M","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Clinical orthopaedics and related research","id":"ITEM-1","issue":"236","issued":{"date-parts":[["1988","11"]]},"page":"154-9","title":"Synovial osteochondromatosis in the subacromial bursa.","type":"article-journal"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁰","plainTextFormattedCitation":"20","previouslyFormattedCitation":"²⁰"},"properties":{"noteIndex":0},"schema":""}20. In the initial stage, there is active synovial disease without loose bodies. The transitional stage is characterized by persistent synovial disease and formation of loose bodies, whereas in the third stage, detached intra-articular nodules are present, with burned-out intrasynovial disease. Approximately two-thirds of them calcify or ossify.Plain radiographs are normal in the initial stage, whereas MRI shows increased amount of joint fluid and nonspecific synovitis (Fig. 9 A-B). Uncalcified nodules are also invisible on plain radiographs in the transitional stage, and are isointense to muscle on T1-weighted images and hypointense to synovial fluid on T2-weighted images (Fig. 9 C-D). Calcified lesions are seen as small, round signal voids. Finally, ossified nodules may demonstrate signal intensities of fatty bone marrow. Plain radiography and CT demonstrate calcified or ossified nodules (Fig. 10) (Table 2). Myositis ossificansMyositis ossificans is a benign, solitary, frequently self-limiting, ossifying soft-tissue mass encountered often in young patients and related to trauma in more than half of the cases ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1249/JSR.0000000000000515","ISSN":"1537-890X","PMID":"30204632","abstract":"Myositis ossificans is a benign, solitary, frequently self-limiting, ossifying soft-tissue mass encountered often in the active sporting population. Typically occurring within skeletal muscle - most often the brachialis, quadriceps and adductor muscle groups - lesions may arise with or without a traumatic history. The exact pathophysiology of these ossifying lesions is still poorly understood. Patients present with localized pain and swelling with loss of range of motion. Plain radiographs may not be able to detect early lesions, which allows for an expanded role of ultrasonography as an early screening modality, despite magnetic resonance imaging remaining the gold standard for imaging of soft tissue masses. Conservative treatment is implemented for most patients with excellent outcomes, with surgical excision being an option for persistent symptoms or progressive disease. Typically, athletes are able to progress to light activity at 2 to 3 months, full activity by 6 months, and back to their preinjury level by 1 year.","author":[{"dropping-particle":"","family":"Devilbiss","given":"Zachary","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hess","given":"Matthew","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ho","given":"Garry W.K.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Current Sports Medicine Reports","id":"ITEM-1","issue":"9","issued":{"date-parts":[["2018","9"]]},"page":"290-295","title":"Myositis Ossificans in Sport","type":"article-journal","volume":"17"},"uris":[""]}],"mendeley":{"formattedCitation":"²²","plainTextFormattedCitation":"22","previouslyFormattedCitation":"²³"},"properties":{"noteIndex":0},"schema":""}22.The lesion has a typical zonal organization on histology and imaging.Three time-dependent stages have been described: early, intermediate and mature. There may be some overlap between these stages ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.5435/JAAOS-D-14-00269","ISSN":"1067-151X","PMID":"26320160","abstract":"Myositis ossificans is a self-limiting, benign ossifying lesion that can affect any type of soft tissue, including subcutaneous fat, tendons, and nerves. It is most commonly found in muscle as a solitary lesion. Ossifying soft-tissue lesions historically have been inconsistently classified. Fundamentally, myositis ossificans can be categorized into nonhereditary and hereditary types, with the latter being a distinct entity with a separate pathophysiology and treatment approach. The etiology of myositis ossificans is variable; however, clinical presentation generally is characterized by an ossifying soft-tissue mass. Advanced cross-sectional imaging alone can be nonspecific and may appear to be similar to more sinister etiologies. Therefore, the evaluation of a suspicious soft-tissue mass often necessitates multiple imaging modalities for accurate diagnosis. When imaging is indeterminate, biopsy may be required for a histologic diagnosis. However, histopathology varies based on stage of evolution. The treatment of myositis ossificans is complex and is often made in a multidisciplinary fashion because accurate diagnosis is fundamental to a successful outcome.","author":[{"dropping-particle":"","family":"Walczak","given":"Brian E.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Johnson","given":"Christopher N.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Howe","given":"B. Matthew","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of the American Academy of Orthopaedic Surgeons","id":"ITEM-1","issue":"10","issued":{"date-parts":[["2015","10"]]},"page":"612-622","title":"Myositis Ossificans","type":"article-journal","volume":"23"},"uris":[""]}],"mendeley":{"formattedCitation":"²³","plainTextFormattedCitation":"23","previouslyFormattedCitation":"²⁴"},"properties":{"noteIndex":0},"schema":""}23. In the early stage (up to 4 weeks), faint peripheral calcifications may appear at earliest 2 weeks of presentation on ultrasound or CT and very soon after on plain radiographs. The signal intensity on MRI is nonspecific and the lesion may enhance, simulating a soft tissue sarcoma. Biopsy should be avoided in this stage as histologic findings may show a high mitotic activity, hyperchromatic myofibroblastic cells and osteoid matrix, simulating an extraskeletal osteosarcoma (ESO). After 4 weeks to 8 weeks (intermediate stage), a well-defined peripheral calcification with central lucency or hypodensity becomes more apparent on plain radiographs and CT respectively. MRI shows a rim of low SI on all pulse sequences, corresponding to calcifications but generally calcifications are less conspicuous on MRI. There is perilesional oedema which gradually disappears after 4 weeks. In the mature stage starting at 8 weeks until 6 to 12 months, calcifications are gradually replaced by ossification, with no residual central lucency on plain radiographs. The calcification-ossification front further develops following a centripetal pattern, with lamellar bone at the periphery proceeding towards the center (Figs. 11-12) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1055/s-0030-1253161","ISSN":"1089-7860","PMID":"20486028","abstract":"Myositis ossificans (MO) is characterized by abnormal heterotopic bone formation involving striated muscle, tendons, ligaments, fasciae, and aponeuroses. Myocardium, the diaphragm, tongue, larynx, smooth muscle, and sphincters are all spared. Several subtypes of myositis ossificans exist: posttraumatic myositis ossificans (PTMO), nontraumatic/pseudomalignant myositis ossificans, and myositis ossificans progressiva (MOP). This article reviews the clinical features and differential diagnoses of each subtype of MO and illustrates the typical imaging features demonstrated by plain radiography, ultrasound, radionuclide bone scans, computed tomography, and magnetic resonance imaging.","author":[{"dropping-particle":"","family":"Tyler","given":"Philippa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saifuddin","given":"Asif","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Seminars in Musculoskeletal Radiology","id":"ITEM-1","issue":"02","issued":{"date-parts":[["2010","6","18"]]},"page":"201-216","title":"The Imaging of Myositis Ossificans","type":"article-journal","volume":"14"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁴","plainTextFormattedCitation":"24","previouslyFormattedCitation":"²⁵"},"properties":{"noteIndex":0},"schema":""}24 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"00217646","abstract":"Myositis ossificans circumscripta (MOC) is a localized, non-neoplastic, heterotopic ossification within the muscle. Despite advances in medical imaging, it remains difficult to distinguish it from other disorders. As a consequence, a biopsy is frequently performed. We illustrate some common findings and non-specific imaging features of MOC with respect to radiography, computed tomography, bone scintigraphy, ultrasonography, and magnetic resonance imaging. The differentiation among MOC and its mimics is also presented in order to help the radiologists to make an appropriate diagnostic decision.","author":[{"dropping-particle":"","family":"Wang","given":"X.L.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Malghem","given":"J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parizel","given":"P.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gielen","given":"J.L.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"F.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schepper","given":"A.M.A.","non-dropping-particle":"De","parse-names":false,"suffix":""}],"container-title":"Journal Belge de Radiologie","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2003"]]},"page":"278-285","title":"Myositis ossificans circumscripta","type":"article-journal","volume":"86"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁵","plainTextFormattedCitation":"25","previouslyFormattedCitation":"²⁶"},"properties":{"noteIndex":0},"schema":""}25. This centripetal pattern is important in the differential diagnosis with ESO in which the lesion calcifies from the center to the periphery. MRI demonstrates low signal intensity on all sequences in mature lamellar bone with hyperintense areas on T1-WI, corresponding to fatty bone marrow formation between the bone trabeculae. The perilesional edema is absent in this stage ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.5435/JAAOS-D-14-00269","ISSN":"1067-151X","PMID":"26320160","abstract":"Myositis ossificans is a self-limiting, benign ossifying lesion that can affect any type of soft tissue, including subcutaneous fat, tendons, and nerves. It is most commonly found in muscle as a solitary lesion. Ossifying soft-tissue lesions historically have been inconsistently classified. Fundamentally, myositis ossificans can be categorized into nonhereditary and hereditary types, with the latter being a distinct entity with a separate pathophysiology and treatment approach. The etiology of myositis ossificans is variable; however, clinical presentation generally is characterized by an ossifying soft-tissue mass. Advanced cross-sectional imaging alone can be nonspecific and may appear to be similar to more sinister etiologies. Therefore, the evaluation of a suspicious soft-tissue mass often necessitates multiple imaging modalities for accurate diagnosis. When imaging is indeterminate, biopsy may be required for a histologic diagnosis. However, histopathology varies based on stage of evolution. The treatment of myositis ossificans is complex and is often made in a multidisciplinary fashion because accurate diagnosis is fundamental to a successful outcome.","author":[{"dropping-particle":"","family":"Walczak","given":"Brian E.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Johnson","given":"Christopher N.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Howe","given":"B. Matthew","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of the American Academy of Orthopaedic Surgeons","id":"ITEM-1","issue":"10","issued":{"date-parts":[["2015","10"]]},"page":"612-622","title":"Myositis Ossificans","type":"article-journal","volume":"23"},"uris":[""]}],"mendeley":{"formattedCitation":"²³","plainTextFormattedCitation":"23","previouslyFormattedCitation":"²⁴"},"properties":{"noteIndex":0},"schema":""}23 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1055/s-0030-1253161","ISSN":"1089-7860","PMID":"20486028","abstract":"Myositis ossificans (MO) is characterized by abnormal heterotopic bone formation involving striated muscle, tendons, ligaments, fasciae, and aponeuroses. Myocardium, the diaphragm, tongue, larynx, smooth muscle, and sphincters are all spared. Several subtypes of myositis ossificans exist: posttraumatic myositis ossificans (PTMO), nontraumatic/pseudomalignant myositis ossificans, and myositis ossificans progressiva (MOP). This article reviews the clinical features and differential diagnoses of each subtype of MO and illustrates the typical imaging features demonstrated by plain radiography, ultrasound, radionuclide bone scans, computed tomography, and magnetic resonance imaging.","author":[{"dropping-particle":"","family":"Tyler","given":"Philippa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saifuddin","given":"Asif","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Seminars in Musculoskeletal Radiology","id":"ITEM-1","issue":"02","issued":{"date-parts":[["2010","6","18"]]},"page":"201-216","title":"The Imaging of Myositis Ossificans","type":"article-journal","volume":"14"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁴","plainTextFormattedCitation":"24","previouslyFormattedCitation":"²⁵"},"properties":{"noteIndex":0},"schema":""}24 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"00217646","abstract":"Myositis ossificans circumscripta (MOC) is a localized, non-neoplastic, heterotopic ossification within the muscle. Despite advances in medical imaging, it remains difficult to distinguish it from other disorders. As a consequence, a biopsy is frequently performed. We illustrate some common findings and non-specific imaging features of MOC with respect to radiography, computed tomography, bone scintigraphy, ultrasonography, and magnetic resonance imaging. The differentiation among MOC and its mimics is also presented in order to help the radiologists to make an appropriate diagnostic decision.","author":[{"dropping-particle":"","family":"Wang","given":"X.L.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Malghem","given":"J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parizel","given":"P.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gielen","given":"J.L.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"F.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schepper","given":"A.M.A.","non-dropping-particle":"De","parse-names":false,"suffix":""}],"container-title":"Journal Belge de Radiologie","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2003"]]},"page":"278-285","title":"Myositis ossificans circumscripta","type":"article-journal","volume":"86"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁵","plainTextFormattedCitation":"25","previouslyFormattedCitation":"²⁶"},"properties":{"noteIndex":0},"schema":""}25. Between months 6 and 12, the lesion may spontaneously regress slightly or completely and appear smaller on repeated radiographs (Fig. 11) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.5435/JAAOS-D-14-00269","ISSN":"1067-151X","PMID":"26320160","abstract":"Myositis ossificans is a self-limiting, benign ossifying lesion that can affect any type of soft tissue, including subcutaneous fat, tendons, and nerves. It is most commonly found in muscle as a solitary lesion. Ossifying soft-tissue lesions historically have been inconsistently classified. Fundamentally, myositis ossificans can be categorized into nonhereditary and hereditary types, with the latter being a distinct entity with a separate pathophysiology and treatment approach. The etiology of myositis ossificans is variable; however, clinical presentation generally is characterized by an ossifying soft-tissue mass. Advanced cross-sectional imaging alone can be nonspecific and may appear to be similar to more sinister etiologies. Therefore, the evaluation of a suspicious soft-tissue mass often necessitates multiple imaging modalities for accurate diagnosis. When imaging is indeterminate, biopsy may be required for a histologic diagnosis. However, histopathology varies based on stage of evolution. The treatment of myositis ossificans is complex and is often made in a multidisciplinary fashion because accurate diagnosis is fundamental to a successful outcome.","author":[{"dropping-particle":"","family":"Walczak","given":"Brian E.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Johnson","given":"Christopher N.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Howe","given":"B. Matthew","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of the American Academy of Orthopaedic Surgeons","id":"ITEM-1","issue":"10","issued":{"date-parts":[["2015","10"]]},"page":"612-622","title":"Myositis Ossificans","type":"article-journal","volume":"23"},"uris":[""]}],"mendeley":{"formattedCitation":"²³","plainTextFormattedCitation":"23","previouslyFormattedCitation":"²⁴"},"properties":{"noteIndex":0},"schema":""}23.Florid reactive periostitis and soft tissue aneurysmal bone cyst are closely related lesions to myositis ossificans ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.path.2015.05.004","ISBN":"9780323402743","ISSN":"18759157","PMID":"26297064","abstract":"Soft tissue lesions can contain bone or cartilage matrix as an incidental, often metaplastic, phenomenon or as a diagnostic feature. The latter category includes a diverse group ranging from self-limited proliferations to benign neoplasms to aggressive malignancies. Correlating imaging findings with pathology is mandatory to confirm that a tumor producing bone or cartilage, in fact, originates from soft tissue rather than from the skeleton. The distinction can have dramatic diagnostic and therapeutic implications. This content focuses on the gross, histologic, radiographic, and clinical features of bone or cartilage-producing soft tissue lesions. Recent discoveries regarding tumor-specific genetics are discussed.","author":[{"dropping-particle":"","family":"Cho","given":"Soo Jin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Horvai","given":"Andrew","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Surgical Pathology Clinics","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2015"]]},"page":"419-444","publisher":"Elsevier Inc","title":"Chondro-Osseous Lesions of Soft Tissue","type":"article-journal","volume":"8"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁶","plainTextFormattedCitation":"26","previouslyFormattedCitation":"²⁷"},"properties":{"noteIndex":0},"schema":""}26. Florid reactive periostitis is attached to the underlying cortex, whereas myositis is usually separated from the cortex. Soft tissue ABC contains fluid-fluid levels on MRI ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.path.2015.05.004","ISBN":"9780323402743","ISSN":"18759157","PMID":"26297064","abstract":"Soft tissue lesions can contain bone or cartilage matrix as an incidental, often metaplastic, phenomenon or as a diagnostic feature. The latter category includes a diverse group ranging from self-limited proliferations to benign neoplasms to aggressive malignancies. Correlating imaging findings with pathology is mandatory to confirm that a tumor producing bone or cartilage, in fact, originates from soft tissue rather than from the skeleton. The distinction can have dramatic diagnostic and therapeutic implications. This content focuses on the gross, histologic, radiographic, and clinical features of bone or cartilage-producing soft tissue lesions. Recent discoveries regarding tumor-specific genetics are discussed.","author":[{"dropping-particle":"","family":"Cho","given":"Soo Jin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Horvai","given":"Andrew","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Surgical Pathology Clinics","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2015"]]},"page":"419-444","publisher":"Elsevier Inc","title":"Chondro-Osseous Lesions of Soft Tissue","type":"article-journal","volume":"8"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁶","plainTextFormattedCitation":"26","previouslyFormattedCitation":"²⁷"},"properties":{"noteIndex":0},"schema":""}26.Calcific myonecrosisCalcific myonecrosis is an uncommon late sequela of trauma, with a reported delay ranging from 10 to 64 years after an initial traumatic event ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s00256-002-0549-1","ISBN":"0364-2348 (Print)\\r0364-2348 (Linking)","ISSN":"0364-2348","PMID":"12525942","abstract":"Calcific myonecrosis is a rare, late sequela of trauma occurring almost exclusively in the lower extremity which may be confused with an aggressive primary neoplasm. The platelike mineralization pattern seen on radiographs is characteristic but not widely recognized by clinicians. Three cases of calcific myonecrosis are reported, unique in that two presented for care following infection and that one had extended to involve the muscle compartments of the foot, a previously unreported site.","author":[{"dropping-particle":"","family":"Holobinko","given":"J Newt","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Damron","given":"Timothy a","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Scerpella","given":"Patrick R","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hojnowski","given":"Leonard","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Skeletal radiology","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2003"]]},"page":"35-40","title":"Calcific myonecrosis: keys to early recognition.","type":"article-journal","volume":"32"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁷","plainTextFormattedCitation":"27","previouslyFormattedCitation":"²⁸"},"properties":{"noteIndex":0},"schema":""}27 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0341-2695","PMID":"10192025","abstract":"Calcific myonecrosis is a rare and late sequela of compartment syndrome, which becomes symptomatic years after the initial trauma. We diagnosed this condition in a 64-year old man, 42 years after he sustained a shot-gun wound to the right lower leg. Total excision of a peripherally calcified, cystic mass, continuous with the anterior tibial muscle belly resulted in complete resolution of symptoms. Consideration of the diagnosis is warranted in patients with a history of major injury who develop a soft tissue mass in the traumatized compartment. The treatment of choice is marginal excision.","author":[{"dropping-particle":"","family":"Tuncay","given":"I C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Demir?rs","given":"H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Isiklar","given":"Z U","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Agildere","given":"M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Demirhan","given":"B","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tandogan","given":"R N","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"International orthopaedics","id":"ITEM-1","issue":"1","issued":{"date-parts":[["1999","1"]]},"page":"68-70","title":"Calcific myonecrosis.","type":"article-journal","volume":"23"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁸","plainTextFormattedCitation":"28","previouslyFormattedCitation":"²⁹"},"properties":{"noteIndex":0},"schema":""}28 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"17802393","author":[{"dropping-particle":"","family":"Peeters","given":"J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"F.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Camerlinck","given":"M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parizel","given":"P.M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"JBR-BTR","id":"ITEM-1","issue":"2","issued":{"date-parts":[["2010"]]},"page":"111","title":"Calcific myonecrosis","type":"article-journal","volume":"93"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁹","plainTextFormattedCitation":"29","previouslyFormattedCitation":"³⁰"},"properties":{"noteIndex":0},"schema":""}29 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"17802393","author":[{"dropping-particle":"","family":"Peeters","given":"J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"F.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Camerlinck","given":"M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parizel","given":"P.M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"JBR-BTR","id":"ITEM-1","issue":"2","issued":{"date-parts":[["2010"]]},"page":"111","title":"Calcific myonecrosis","type":"article-journal","volume":"93"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁹","plainTextFormattedCitation":"29","previouslyFormattedCitation":"³⁰"},"properties":{"noteIndex":0},"schema":""}29. It typically affects the lower extremities in the anterior and lateral compartments of the leg ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"author":[{"dropping-particle":"","family":"Eyselbergs","given":"M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Catry","given":"F","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Scharpé","given":"P","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"F.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Eurorad","id":"ITEM-1","issued":{"date-parts":[["2011"]]},"title":"Case 9086 Calcific myonecrosis","type":"article-journal"},"uris":[""]}],"mendeley":{"formattedCitation":"³⁰","plainTextFormattedCitation":"30","previouslyFormattedCitation":"³¹"},"properties":{"noteIndex":0},"schema":""}30. More rarely, the foot ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s00256-002-0549-1","ISBN":"0364-2348 (Print)\\r0364-2348 (Linking)","ISSN":"0364-2348","PMID":"12525942","abstract":"Calcific myonecrosis is a rare, late sequela of trauma occurring almost exclusively in the lower extremity which may be confused with an aggressive primary neoplasm. The platelike mineralization pattern seen on radiographs is characteristic but not widely recognized by clinicians. Three cases of calcific myonecrosis are reported, unique in that two presented for care following infection and that one had extended to involve the muscle compartments of the foot, a previously unreported site.","author":[{"dropping-particle":"","family":"Holobinko","given":"J Newt","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Damron","given":"Timothy a","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Scerpella","given":"Patrick R","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hojnowski","given":"Leonard","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Skeletal radiology","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2003"]]},"page":"35-40","title":"Calcific myonecrosis: keys to early recognition.","type":"article-journal","volume":"32"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁷","plainTextFormattedCitation":"27","previouslyFormattedCitation":"²⁸"},"properties":{"noteIndex":0},"schema":""}27 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0001-6462","PMID":"20306980","abstract":"Calcific myonecrosis is a rare, late complication of compartment syndrome in the lower extremity. In this condition an entire single muscle of the leg is replaced by a fusiform mass with central liquefaction and peripheral calcification. Calcific myonecrosis presents a diagnostic dilemma to the clinician; it has to be considered in the differential diagnosis of a calcifying soft tissue tumour in the lower extremity. The purpose of this report is to highlight the importance of recognition of the lesion and its key clinico-pathological presenting features leading to appropriate management. We describe the unique presentation, diagnosis and surgical management of calcific myonecrosis involving only the flexor hallucis longus muscle of the leg in a middle-age adult. We found MRI Scan as the most useful method of investigation. Diagnosis can be confirmed by yellow-brown paste like material within the lesion intra-operatively or by aspiration and further by histology. We recommend complete excision of the lesion and closure of the wound with compression dressing, to avoid secondary infection.","author":[{"dropping-particle":"","family":"Papanna","given":"Madhavan Chikkapapanna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Monga","given":"Puneeth","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wilkes","given":"Richard Allen","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Acta orthopaedica Belgica","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2010","2"]]},"page":"137-41","title":"Post-traumatic calcific myonecrosis of flexor hallucis longus. A case report and literature review.","type":"article-journal","volume":"76"},"uris":[""]}],"mendeley":{"formattedCitation":"³¹","plainTextFormattedCitation":"31","previouslyFormattedCitation":"³²"},"properties":{"noteIndex":0},"schema":""}31 and upper extremities are involved ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s00256-003-0740-z","ISSN":"0364-2348","PMID":"14991247","abstract":"Calcific myonecrosis is a rare and latent condition characterized by a dystrophic calcified lesion that can present 10-64 years following initial trauma. Of the 25 cases documented in English world literature, all have occurred in the lower extremity exclusively. We report a case of a 60-year-old man with a painless enlarging left forearm mass that was subsequently diagnosed as calcific myonecrosis. Awareness of this lesion arising outside of the lower extremity is important to avoid unnecessary surgical intervention and patient reassurance.","author":[{"dropping-particle":"","family":"Larson","given":"R C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sierra","given":"R J","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sundaram","given":"M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Inwards","given":"C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Scully","given":"S P","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Skeletal radiology","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2004","5"]]},"page":"306-9","title":"Calcific myonecrosis: a unique presentation in the upper extremity.","type":"article-journal","volume":"33"},"uris":[""]}],"mendeley":{"formattedCitation":"³²","plainTextFormattedCitation":"32","previouslyFormattedCitation":"³³"},"properties":{"noteIndex":0},"schema":""}32.Plain radiographs show a fusiform mass along with the long axis of the muscles with peripheral calcifications with a typical linear plate- or plaque-like configuration.On MRI the periphery of the lesion is of low intensity on T1-WI, corresponding to abundant calcification (Fig. 13). T1- and T2-WI may demonstrate lesion heterogeneity caused by repeated intralesional hemorrhage with accumulation of blood products, liquefaction necrosis and calcified areas. The lesion does not enhance, unless there is superimposed inflammation often due to mobilization of plaque and penetration through the muscle fascia ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"author":[{"dropping-particle":"","family":"Eyselbergs","given":"M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Catry","given":"F","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Scharpé","given":"P","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"F.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Eurorad","id":"ITEM-1","issued":{"date-parts":[["2011"]]},"title":"Case 9086 Calcific myonecrosis","type":"article-journal"},"uris":[""]}],"mendeley":{"formattedCitation":"³⁰","plainTextFormattedCitation":"30","previouslyFormattedCitation":"³¹"},"properties":{"noteIndex":0},"schema":""}30 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s00256-007-0436-x","ISSN":"0364-2348","PMID":"18274743","author":[{"dropping-particle":"","family":"Gielen","given":"J L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Blom","given":"R M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"F M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schepper","given":"A M A","non-dropping-particle":"De","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vijver","given":"K","non-dropping-particle":"Van de","parse-names":false,"suffix":""}],"container-title":"Skeletal radiology","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2008","4"]]},"page":"335, 337-8","title":"An elderly man with a slowly growing painless mass in the soft tissues of the lower leg: presentation.","type":"article-journal","volume":"37"},"uris":[""]}],"mendeley":{"formattedCitation":"³³","plainTextFormattedCitation":"33","previouslyFormattedCitation":"³⁴"},"properties":{"noteIndex":0},"schema":""}33.Vascular calcificationsArterial and venous calcifications are frequently seen in older patients and readily detected on plain radiographs but are usually not visible on MRI. Extensive venous calcifications may sometimes cause areas of low signal on both pulse sequences (Fig. 14). Tumoral CalcinosisIdiopathic tumoral calcinosis is characterized by the presence of progressively enlarging juxta-articular calcified soft tissue masses. These deposits contain a mixture of amorphous calcium carbonate, calcium phosphate and hydroxyapatite crystals ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"PMID":"12727056","abstract":"Tumor calcinosis is uncommon, typically manifesting as paraarticular, extracapsular soft tissue deposits containing amorphous calcium phosphate and calcium carbonate, with associated hydroxyapatite crystal. CT and MRI are the primary diagnostic radiological tools evaluating these lesions. Primary treatment is early surgical excision with wide margins, as there is a high recurrence rate. We describe the angiographic findings in tumoral calcinosis, demonstrating hypervascularity beyond the calcified mass periphery. Exact margin definition with angiography may influence management and surgical approach.","author":[{"dropping-particle":"","family":"Neeman","given":"Ziv","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wood","given":"Bradford J","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Clinical imaging","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2003"]]},"page":"184-6","title":"Angiographic findings in tumoral calcinosis.","type":"article-journal","volume":"27"},"uris":[""]}],"mendeley":{"formattedCitation":"³⁴","plainTextFormattedCitation":"34","previouslyFormattedCitation":"³⁵"},"properties":{"noteIndex":0},"schema":""}34 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s00402-004-0715-0","ISSN":"0936-8051","PMID":"15340747","abstract":"BACKGROUND: Tumoral calcinosis occurs in two distinct clinical forms. The sporadic form is secondary to chronic renal failure, hyperparathyroidism, milky-alkali syndrome, hypervitaminosis D and other systemic disorders. The familial form is extremely rare (around 100 cases worldwide) and affects patients in the first or second decade of life. It is believed to be transmitted in a dominant autosomal manner with variable clinical expressivity and is manifested as hyperphosphatemia, elevated serum 1,25-dihydroxyvitamin D with juxta-articular tumorous calcifications. Moreover, the theory of a unique dental malformation serving as a screening marker for clinically non-apparent affected individuals is revisited and reconfirmed.\n\nCASE REPORT: We present a case of a Caucasian male newborn, as well as a review of the literature with differential diagnostic considerations and their therapeutical implications.","author":[{"dropping-particle":"","family":"Polykandriotis","given":"Elias P","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Beutel","given":"Florenz K","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Horch","given":"Raymund E","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Grünert","given":"J?rg","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Archives of orthopaedic and trauma surgery","id":"ITEM-1","issue":"8","issued":{"date-parts":[["2004","10"]]},"page":"563-7","title":"A case of familial tumoral calcinosis in a neonate and review of the literature.","type":"article-journal","volume":"124"},"uris":[""]}],"mendeley":{"formattedCitation":"³⁵","plainTextFormattedCitation":"35","previouslyFormattedCitation":"³⁶"},"properties":{"noteIndex":0},"schema":""}35. The exact pathogenesis is not known. An inborn error of phosphorus and vitamin D metabolism is suggested. Hyperphosphatemia are observed in only one third of cases ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0028-3940","PMID":"10379593","abstract":"Two siblings with histologically and radiologically proven tumoral calcinosis presented with cerebral and peripheral aneurysms. The brother died of a ruptured subclavian artery aneurysm after surgical repair of brachial, iliofemoral and coeliac axis aneurysms. Magnetic resonance and catheter angiography in the sister demonstrated marked carotid dysplasia and a left ophthalmic segment aneurysm, not amenable to treatment. We believe this is the first reported case of familial aneurysms in association with tumoral calcinosis.","author":[{"dropping-particle":"","family":"Adams","given":"W M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Laitt","given":"R D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Davies","given":"M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"O'Donovan","given":"D G","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Neuroradiology","id":"ITEM-1","issue":"5","issued":{"date-parts":[["1999","5"]]},"page":"351-5","title":"Familial tumoral calcinosis: association with cerebral and peripheral aneurysm formation.","type":"article-journal","volume":"41"},"uris":[""]}],"mendeley":{"formattedCitation":"³⁶","plainTextFormattedCitation":"36","previouslyFormattedCitation":"³⁷"},"properties":{"noteIndex":0},"schema":""}36 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1053/jars.2003.50018","ISSN":"1526-3231","PMID":"12522393","abstract":"An unusual case of symptomatic, solitary, intra-articular tumoral calcinosis of the knee in a 39-year-old man is presented. This is the first reported case of intra-articular tumoral calcinosis with no associated underlying systemic diseases. Magnetic resonance imaging was helpful in delineating the lesion. Surgical excision resulted in resolution of symptoms and was not followed by recurrence of the lesion.","author":[{"dropping-particle":"","family":"Fujii","given":"Tsuyoshi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Matsui","given":"Nobuzo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yamamoto","given":"Tetsuji","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yoshiya","given":"Shinichi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kurosaka","given":"Masahiro","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2003","1"]]},"page":"E1","title":"Solitary intra-articular tumoral calcinosis of the knee.","type":"article-journal","volume":"19"},"uris":[""]}],"mendeley":{"formattedCitation":"³⁷","plainTextFormattedCitation":"37","previouslyFormattedCitation":"³⁸"},"properties":{"noteIndex":0},"schema":""}37 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0364-2348","PMID":"7747184","abstract":"A patient with tumoral calcinosis involving the buttock and ischial bone is presented. Bone marrow involvement and a pattern of septal enhancement on MR imaging after intravenous administration of Gd-DTPA were very suggestive of a diagnosis of a chondro(sarco) matous musculoskeletal tumor. The absence of an underlying metabolic disorder, the appreciation of fluid-calcium levels within the lesion and knowledge of the macroscopic and microscopic appearance of this disorder have led to the correct diagnosis in this case.","author":[{"dropping-particle":"","family":"Geirnaerdt","given":"M J","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kroon","given":"H M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Heul","given":"R O","non-dropping-particle":"van der","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Herfkens","given":"H F","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Skeletal radiology","id":"ITEM-1","issue":"2","issued":{"date-parts":[["1995","2"]]},"page":"148-51","title":"Tumoral calcinosis.","type":"article-journal","volume":"24"},"uris":[""]}],"mendeley":{"formattedCitation":"³⁸","plainTextFormattedCitation":"38","previouslyFormattedCitation":"³⁹"},"properties":{"noteIndex":0},"schema":""}38 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"8756-3282","PMID":"7626311","abstract":"We describe a patient with tumoral calcinosis, in which acetazolamide (ACZ) was, for the first time, tested for its therapeutic efficacy. The 19-year-old Japanese man had been suffering from multiple recurrent calcific masses with tenderness around the finger, knee, and toe joints since 10 months of age. Radiographs revealed several calcific subcutaneous masses around the finger joints, and calcific myelitis around the right knee joint and in the calvarium. The patient had hyperphosphatemia with elevated maximal threshold of renal phosphate excretion in the presence of normal kidney function and normocalcemia, suggesting a reduced ability to excrete phosphorus in the urine. A delay of disappearance of orally administered phosphate from the blood stream was found. A serum parathyroid hormone (PTH) level was normal, and responses to PTH and ACZ were also normal regarding the induction of phosphaturia. Since the masses tended to recur easily despite repeated surgical resections, we started medical treatment with phosphorus deprivation by oral aluminum hydroxide. However, the drug alone had no effect on hyperphosphatemia or calcific lesions, and ACZ was added in expectation of making the patient's phosphorus balance negative by its phosphaturic effect. Fourteen years of administration of the two drugs apparently improved the patient's symptoms, the biochemical findings, and the calcific lesions on radiographs. Thus, ACZ appeared to be useful for tumoral calcinosis resistant to phosphorus deprivation by aluminum hydroxide alone.","author":[{"dropping-particle":"","family":"Yamaguchi","given":"T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sugimoto","given":"T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Imai","given":"Y","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fukase","given":"M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fujita","given":"T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chihara","given":"K","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Bone","id":"ITEM-1","issue":"4 Suppl","issued":{"date-parts":[["1995","4"]]},"page":"247S-250S","title":"Successful treatment of hyperphosphatemic tumoral calcinosis with long-term acetazolamide.","type":"article-journal","volume":"16"},"uris":[""]}],"mendeley":{"formattedCitation":"³⁹","plainTextFormattedCitation":"39","previouslyFormattedCitation":"⁴⁰"},"properties":{"noteIndex":0},"schema":""}39. The hip joint being the most common site ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0001-6462","PMID":"8237339","abstract":"Clinical observations of 11 new cases of tumoral calcinosis are reported. The condition is characterized by calcified masses of varying size in the region of major joints. Surgical excision is recommended in selected cases determined by the size of the lesion, the deformity present and functional complaints. In this series surgical excision was done in 6 patients, and the diagnosis was confirmed histopathologically. After a complete excision of the tumor, no recurrences were seen in 5 cases with a mean follow-up time of 25 months. Incomplete excision led to multiple recurrences in one patient.","author":[{"dropping-particle":"","family":"Noyez","given":"J F","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Murphree","given":"S M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chen","given":"K","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Acta orthopaedica Belgica","id":"ITEM-1","issue":"3","issued":{"date-parts":[["1993","1"]]},"page":"249-54","title":"Tumoral calcinosis, a clinical report of eleven cases.","type":"article-journal","volume":"59"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴⁰","plainTextFormattedCitation":"40","previouslyFormattedCitation":"⁴¹"},"properties":{"noteIndex":0},"schema":""}40. The disease may be multifocal ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1053/jars.2003.50018","ISSN":"1526-3231","PMID":"12522393","abstract":"An unusual case of symptomatic, solitary, intra-articular tumoral calcinosis of the knee in a 39-year-old man is presented. This is the first reported case of intra-articular tumoral calcinosis with no associated underlying systemic diseases. Magnetic resonance imaging was helpful in delineating the lesion. Surgical excision resulted in resolution of symptoms and was not followed by recurrence of the lesion.","author":[{"dropping-particle":"","family":"Fujii","given":"Tsuyoshi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Matsui","given":"Nobuzo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yamamoto","given":"Tetsuji","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yoshiya","given":"Shinichi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kurosaka","given":"Masahiro","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2003","1"]]},"page":"E1","title":"Solitary intra-articular tumoral calcinosis of the knee.","type":"article-journal","volume":"19"},"uris":[""]}],"mendeley":{"formattedCitation":"³⁷","plainTextFormattedCitation":"37","previouslyFormattedCitation":"³⁸"},"properties":{"noteIndex":0},"schema":""}37. A secondary form may be due to chronic renal failure ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"17802393","author":[{"dropping-particle":"","family":"Muylder","given":"L.","non-dropping-particle":"Van","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Declercq","given":"H.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"F.M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"JBR-BTR","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2013"]]},"page":"50","title":"Secondary tumoral calcinosis with intra-osseous extension","type":"article-journal","volume":"96"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴¹","plainTextFormattedCitation":"41","previouslyFormattedCitation":"⁴²"},"properties":{"noteIndex":0},"schema":""}41. On radiographs, the characteristic appearance of tumoral calcinosis is a well-demarcated lobulated calcified mass located in the periarticular soft tissue, commonly at the extensor side. The lobules are separated by radiolucent lines, histologically corresponding to fibrous septa. This may cause a “chicken wire” appearance of plain radiographs. Fluid-calcium levels may be seen on upright radiographs ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0001-6462","PMID":"8237339","abstract":"Clinical observations of 11 new cases of tumoral calcinosis are reported. The condition is characterized by calcified masses of varying size in the region of major joints. Surgical excision is recommended in selected cases determined by the size of the lesion, the deformity present and functional complaints. In this series surgical excision was done in 6 patients, and the diagnosis was confirmed histopathologically. After a complete excision of the tumor, no recurrences were seen in 5 cases with a mean follow-up time of 25 months. Incomplete excision led to multiple recurrences in one patient.","author":[{"dropping-particle":"","family":"Noyez","given":"J F","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Murphree","given":"S M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chen","given":"K","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Acta orthopaedica Belgica","id":"ITEM-1","issue":"3","issued":{"date-parts":[["1993","1"]]},"page":"249-54","title":"Tumoral calcinosis, a clinical report of eleven cases.","type":"article-journal","volume":"59"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴⁰","plainTextFormattedCitation":"40","previouslyFormattedCitation":"⁴¹"},"properties":{"noteIndex":0},"schema":""}40 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"1531-5037","PMID":"12891514","abstract":"Tumoral calcinosis is a distinct clinical and histologic entity that is characterized by a large deposition of calcium that resembles a neoplasm and is found predominantly in adolescents and young adults in the periarticular tissues of large joints. The authors describe the clinical presentation of a 15-year-old boy admitted at our pediatric day-surgery center for surgical management of tumoral calcinosis of the left gluteal region. Complete surgical excision is the treatment of choice.","author":[{"dropping-particle":"","family":"Bittmann","given":"S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Günther","given":"M W","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ulus","given":"H","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of pediatric surgery","id":"ITEM-1","issue":"8","issued":{"date-parts":[["2003","8"]]},"page":"E4-7","title":"Tumoral calcinosis of the gluteal region in a child: case report with overview of different soft-tissue calcifications.","type":"article-journal","volume":"38"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴²","plainTextFormattedCitation":"42","previouslyFormattedCitation":"⁴³"},"properties":{"noteIndex":0},"schema":""}42 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0364-2348","PMID":"8614855","abstract":"OBJECTIVE: Tumoral calcinosis is a frequently misdiagnosed disorder. This study details the radiologic and pathologic characteristics of tumoral calcinosis that distinguish it from most other entities.\n\nDESIGN: Radiologic and pathologic findings, and medical records of 12 patients with tumoral calcinosis were reviewed and compared with equivalent information about 5 patients with other calcified lesions.\n\nPATIENTS: The 12 patients ranged in age from 15 months to 62 years. Six had idiopathic tumoral calcinosis and 6 had secondary tumoral calcinosis.\n\nRESULTS AND CONCLUSIONS: A consistent radiologic finding for tumoral calcinosis was a dense calcified mass that was homogeneous except for a \"chicken wire\" pattern of lucencies, which correlated histologically with thin fibrous septae. Other characteristics of tumoral calcinosis included fluid-calcium levels, demonstrated in four patients, and smooth osseous erosions adjacent to the mass, demonstrated in three patients. Five cases of tumoral calcinosis were originally confused with other calcified lesions; however, the radiologic findings were characteristic of tumoral calcinosis in retrospect.","author":[{"dropping-particle":"","family":"Steinbach","given":"L S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Johnston","given":"J O","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tepper","given":"E F","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Honda","given":"G D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Martel","given":"W","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Skeletal radiology","id":"ITEM-1","issue":"8","issued":{"date-parts":[["1995","11"]]},"page":"573-8","title":"Tumoral calcinosis: radiologic-pathologic correlation.","type":"article-journal","volume":"24"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴³","plainTextFormattedCitation":"43","previouslyFormattedCitation":"⁴⁴"},"properties":{"noteIndex":0},"schema":""}43. Cortical destruction and intramedullary extension may occur due to chronic pressure erosion (Fig. 15) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"17802393","author":[{"dropping-particle":"","family":"Muylder","given":"L.","non-dropping-particle":"Van","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Declercq","given":"H.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"F.M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"JBR-BTR","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2013"]]},"page":"50","title":"Secondary tumoral calcinosis with intra-osseous extension","type":"article-journal","volume":"96"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴¹","plainTextFormattedCitation":"41","previouslyFormattedCitation":"⁴²"},"properties":{"noteIndex":0},"schema":""}41. On MRI, tumoral calcinosis has a well-circumscribed multicystic mass. On T1-WI, the mass appears inhomogeneous and is of intermediate to low signal. The lesion is heterogeneous and may contain areas of low ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0364-2348","PMID":"8738007","abstract":"We report a case of a 12-year-old girl with idiopathic tumoral calcinosis of the neck. There are calcium deposits in the paraspinal soft tissue with bony involvement in the cervical spine. CT and MR images are presented along with clinical and pathological features. Bony involvement in this disease has not been recognized before.","author":[{"dropping-particle":"","family":"Ohashi","given":"K","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yamada","given":"T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ishikawa","given":"T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yamaguchi","given":"S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nakajima","given":"H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takagi","given":"M","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Skeletal radiology","id":"ITEM-1","issue":"4","issued":{"date-parts":[["1996","5"]]},"page":"388-90","title":"Idiopathic tumoral calcinosis involving the cervical spine.","type":"article-journal","volume":"25"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴⁴","plainTextFormattedCitation":"44","previouslyFormattedCitation":"⁴⁵"},"properties":{"noteIndex":0},"schema":""}44 and relatively high signal on T2-WI. This hyperintense T2 signal may be attributed to the granulomatous foreign body reaction ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1148/radiology.174.1.2294551","ISSN":"0033-8419","PMID":"2294551","abstract":"Five patients with tumoral calcinosis were evaluated with radiography, bone scintigraphy, computed tomography (CT), and magnetic resonance (MR) imaging. The arthropathy of calcium pyrophosphate dihydrate deposition disease was seen in two of the patients and pseudoxanthoma elasticum-like syndrome in three. Identification of calcific particular masses on radiographs is characteristic of tumoral calcinosis. Marrow lesions could be identified as patchy areas of calcification (calcific myelitis) in long bones and the calvarium. Bone scintigraphy appears to be the best modality for detection of the masses and marrow lesions and for monitoring therapy. At CT the masses demonstrated a varied appearance, from small and solid to large and cystic. The marrow abnormality appears as an area of increased attenuation and spotty calcification that in the skull may be associated with dural and vascular calcifications. MR imaging of the particular masses was remarkable in that the masses displayed high signal intensity on T2-weighted images despite a large calcific component. Marrow lesions also showed increased signal intensity on T2-weighted images. When calcified particular masses are present the diagnosis is rarely in question. The diagnosis may be overlooked, however, when calcific myelitis is the only manifestation.","author":[{"dropping-particle":"","family":"Martinez","given":"S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vogler","given":"J B","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Harrelson","given":"J M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lyles","given":"K W","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiology","id":"ITEM-1","issue":"1","issued":{"date-parts":[["1990","1"]]},"page":"215-22","title":"Imaging of tumoral calcinosis: new observations.","type":"article-journal","volume":"174"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴⁵","plainTextFormattedCitation":"45","previouslyFormattedCitation":"⁴⁶"},"properties":{"noteIndex":0},"schema":""}45 or to the hypervascularity of the lesion ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"PMID":"12727056","abstract":"Tumor calcinosis is uncommon, typically manifesting as paraarticular, extracapsular soft tissue deposits containing amorphous calcium phosphate and calcium carbonate, with associated hydroxyapatite crystal. CT and MRI are the primary diagnostic radiological tools evaluating these lesions. Primary treatment is early surgical excision with wide margins, as there is a high recurrence rate. We describe the angiographic findings in tumoral calcinosis, demonstrating hypervascularity beyond the calcified mass periphery. Exact margin definition with angiography may influence management and surgical approach.","author":[{"dropping-particle":"","family":"Neeman","given":"Ziv","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wood","given":"Bradford J","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Clinical imaging","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2003"]]},"page":"184-6","title":"Angiographic findings in tumoral calcinosis.","type":"article-journal","volume":"27"},"uris":[""]}],"mendeley":{"formattedCitation":"³⁴","plainTextFormattedCitation":"34","previouslyFormattedCitation":"³⁵"},"properties":{"noteIndex":0},"schema":""}34 or to the partial fluid nature of the calcium material (“milk of calcium”) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0001-6462","PMID":"19205333","abstract":"Idiopathic tumoral calcinosis is an unusual benign condition characterized by the presence of calcified soft tissue masses of varying size around the joints. In this retrospective study,clinical data and radiological features of nine cases of idiopathic tumoral calcinosis are reviewed. Imaging features, particularly magnetic resonance imaging findings are detailed.","author":[{"dropping-particle":"","family":"Chaabane","given":"Skander","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chelli-Bouaziz","given":"Mouna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Jelassi","given":"Helmi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mrad","given":"Karima","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Smida","given":"Mahmoud","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ladeb","given":"Mohamed Fethi","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Acta orthopaedica Belgica","id":"ITEM-1","issue":"6","issued":{"date-parts":[["2008","12"]]},"page":"837-45","title":"Idiopathic tumoral calcinosis.","type":"article-journal","volume":"74"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴⁶","plainTextFormattedCitation":"46","previouslyFormattedCitation":"⁴⁷"},"properties":{"noteIndex":0},"schema":""}46. Multiple fluid-fluid or fluid-calcium levels may be seen ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0364-2348","PMID":"8614855","abstract":"OBJECTIVE: Tumoral calcinosis is a frequently misdiagnosed disorder. This study details the radiologic and pathologic characteristics of tumoral calcinosis that distinguish it from most other entities.\n\nDESIGN: Radiologic and pathologic findings, and medical records of 12 patients with tumoral calcinosis were reviewed and compared with equivalent information about 5 patients with other calcified lesions.\n\nPATIENTS: The 12 patients ranged in age from 15 months to 62 years. Six had idiopathic tumoral calcinosis and 6 had secondary tumoral calcinosis.\n\nRESULTS AND CONCLUSIONS: A consistent radiologic finding for tumoral calcinosis was a dense calcified mass that was homogeneous except for a \"chicken wire\" pattern of lucencies, which correlated histologically with thin fibrous septae. Other characteristics of tumoral calcinosis included fluid-calcium levels, demonstrated in four patients, and smooth osseous erosions adjacent to the mass, demonstrated in three patients. Five cases of tumoral calcinosis were originally confused with other calcified lesions; however, the radiologic findings were characteristic of tumoral calcinosis in retrospect.","author":[{"dropping-particle":"","family":"Steinbach","given":"L S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Johnston","given":"J O","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tepper","given":"E F","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Honda","given":"G D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Martel","given":"W","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Skeletal radiology","id":"ITEM-1","issue":"8","issued":{"date-parts":[["1995","11"]]},"page":"573-8","title":"Tumoral calcinosis: radiologic-pathologic correlation.","type":"article-journal","volume":"24"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴³","plainTextFormattedCitation":"43","previouslyFormattedCitation":"⁴⁴"},"properties":{"noteIndex":0},"schema":""}43. The calcified areas are of low intensity on T1- and T2-WI ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s10067-006-0269-3","ISSN":"0770-3198","PMID":"16565889","author":[{"dropping-particle":"","family":"Ovali","given":"Gulgun Yilmaz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tarhan","given":"Serdar","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Serter","given":"Selim","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bayindir","given":"Petek","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okcu","given":"Guvenir","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Demireli","given":"Peyker","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pabuscu","given":"Yuksel","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Clinical rheumatology","id":"ITEM-1","issue":"7","issued":{"date-parts":[["2007","7"]]},"page":"1142-4","title":"A rare disorder: idiopathic tumoral calcinosis.","type":"article-journal","volume":"26"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴⁷","plainTextFormattedCitation":"47","previouslyFormattedCitation":"⁴⁸"},"properties":{"noteIndex":0},"schema":""}47. The septa separating the cysts are of low signal on T1-weighted images and variable signal on T2-weighted images and enhance after gadolinium contrast injection ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0001-6462","PMID":"19205333","abstract":"Idiopathic tumoral calcinosis is an unusual benign condition characterized by the presence of calcified soft tissue masses of varying size around the joints. In this retrospective study,clinical data and radiological features of nine cases of idiopathic tumoral calcinosis are reviewed. Imaging features, particularly magnetic resonance imaging findings are detailed.","author":[{"dropping-particle":"","family":"Chaabane","given":"Skander","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chelli-Bouaziz","given":"Mouna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Jelassi","given":"Helmi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mrad","given":"Karima","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Smida","given":"Mahmoud","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ladeb","given":"Mohamed Fethi","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Acta orthopaedica Belgica","id":"ITEM-1","issue":"6","issued":{"date-parts":[["2008","12"]]},"page":"837-45","title":"Idiopathic tumoral calcinosis.","type":"article-journal","volume":"74"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴⁶","plainTextFormattedCitation":"46","previouslyFormattedCitation":"⁴⁷"},"properties":{"noteIndex":0},"schema":""}46. Soft tissue tumors containing intralesional mineralizationMRI is the preferred modality for evaluation of soft tissue tumors. A variety of benign and malignant soft tissue tumors may contain intralesional calcifications or ossifications. Table 3 summarizes the most common ones. Based on the analysis of the distribution and pattern of mineralized foci, tissue specific diagnosis may be suggested.Phleboliths are circular foci with a lucent center are characteristic for soft tissue haemangioma (slow flow vascular malformation) (Fig. 16). Ring-and-arc calcification in soft tissue lesions reveal the chondroid nature of the lesions and may be seen in a number of benign or malignant cartilage tumors or other soft tissue lesions containing chondroid foci ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.path.2015.05.004","ISBN":"9780323402743","ISSN":"18759157","PMID":"26297064","abstract":"Soft tissue lesions can contain bone or cartilage matrix as an incidental, often metaplastic, phenomenon or as a diagnostic feature. The latter category includes a diverse group ranging from self-limited proliferations to benign neoplasms to aggressive malignancies. Correlating imaging findings with pathology is mandatory to confirm that a tumor producing bone or cartilage, in fact, originates from soft tissue rather than from the skeleton. The distinction can have dramatic diagnostic and therapeutic implications. This content focuses on the gross, histologic, radiographic, and clinical features of bone or cartilage-producing soft tissue lesions. Recent discoveries regarding tumor-specific genetics are discussed.","author":[{"dropping-particle":"","family":"Cho","given":"Soo Jin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Horvai","given":"Andrew","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Surgical Pathology Clinics","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2015"]]},"page":"419-444","publisher":"Elsevier Inc","title":"Chondro-Osseous Lesions of Soft Tissue","type":"article-journal","volume":"8"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁶","plainTextFormattedCitation":"26","previouslyFormattedCitation":"²⁷"},"properties":{"noteIndex":0},"schema":""}26.Soft tissue chondroma most commonly involves the hands (Fig. 17) and feet ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.path.2015.05.004","ISBN":"9780323402743","ISSN":"18759157","PMID":"26297064","abstract":"Soft tissue lesions can contain bone or cartilage matrix as an incidental, often metaplastic, phenomenon or as a diagnostic feature. The latter category includes a diverse group ranging from self-limited proliferations to benign neoplasms to aggressive malignancies. Correlating imaging findings with pathology is mandatory to confirm that a tumor producing bone or cartilage, in fact, originates from soft tissue rather than from the skeleton. The distinction can have dramatic diagnostic and therapeutic implications. This content focuses on the gross, histologic, radiographic, and clinical features of bone or cartilage-producing soft tissue lesions. Recent discoveries regarding tumor-specific genetics are discussed.","author":[{"dropping-particle":"","family":"Cho","given":"Soo Jin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Horvai","given":"Andrew","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Surgical Pathology Clinics","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2015"]]},"page":"419-444","publisher":"Elsevier Inc","title":"Chondro-Osseous Lesions of Soft Tissue","type":"article-journal","volume":"8"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁶","plainTextFormattedCitation":"26","previouslyFormattedCitation":"²⁷"},"properties":{"noteIndex":0},"schema":""}26 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0001-6462","PMID":"17939475","abstract":"Soft tissue chondromas are rare slowly-progressing benign tumours. We report 5 new cases of soft-tissue chondromas of the hand. The median age at the time of diagnosis was 38 years. The evolution ranged from one month to 5 years. Standard radiographs showed variable images depending on the degree of calcification. An excision biopsy was performed in all patients. A well encapsulated and limited tumour was found at surgery. Positive diagnosis was provided by the pathology examination. Simple excision-biopsy should suffice to treat the condition but care should be taken to make the excision complete in order to avoid recurrence.","author":[{"dropping-particle":"","family":"Khedhaier","given":"Abdelkarim","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Maalla","given":"Riadh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ennouri","given":"Khelil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Regaya","given":"Nizar","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Acta orthopaedica Belgica","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2007","8"]]},"page":"458-61","title":"Soft tissues chondromas of the hand: a report of five cases.","type":"article-journal","volume":"73"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴⁸","plainTextFormattedCitation":"48","previouslyFormattedCitation":"⁴⁹"},"properties":{"noteIndex":0},"schema":""}48 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0147-5185","PMID":"12960811","abstract":"Tenosynovial chondromatosis is a multinodular cartilaginous proliferation that arises from the tenosynovial membranes. This report describes the clinical, radiologic, and histopathologic findings in 37 cases of this uncommon entity. There were 17 males and 20 females, ranging in age from 20 to 86 years (mean and median age, 46 years). The process involved tenosynovium of the fingers (n = 19), feet (n = 8), wrists (n = 4), ankles (n = 2), hand, not otherwise specified, or palm (n = 2), knee (n = 1), and forearm (n = 1). Signs of disease or symptoms were present for 5 weeks to 18 years (median duration, approximately 2 years) before surgical excision. The two most common complaints were a painless mass and a mass that was mildly tender with pressure. None of the tumors had clinical, radiologic, or histopathologic evidence of articular or bone involvement. Histologically, all tumors consisted of a multinodular cartilaginous proliferation involving tenosynovium and/or subsynovial connective tissue. Mild or moderate atypia, as encountered in chondroma of soft parts and synovial chondromatosis, was a frequent finding. Follow-up information was available for 16 patients (43%). Only two patients with follow-up information remained disease free after their initial surgical procedure. Seven patients had one recurrence and seven patients had two or more recurrences. Tenosynovial chondromatosis appears to be an extraarticular counterpart of synovial (intraarticular) chondromatosis. Our review indicates this process is often confused with chondroma of soft parts, in part, because both entities have a predilection for the hands and feet. Diagnosis of this underrecognized entity is of clinical importance because of the high local recurrence rate.","author":[{"dropping-particle":"","family":"Fetsch","given":"John F","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vinh","given":"Tuyethoa N","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Remotti","given":"Fabrizio","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Walker","given":"Eric A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Murphey","given":"Mark D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sweet","given":"Donald E","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The American journal of surgical pathology","id":"ITEM-1","issue":"9","issued":{"date-parts":[["2003","9"]]},"page":"1260-8","title":"Tenosynovial (extraarticular) chondromatosis: an analysis of 37 cases of an underrecognized clinicopathologic entity with a strong predilection for the hands and feet and a high local recurrence rate.","type":"article-journal","volume":"27"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴⁹","plainTextFormattedCitation":"49","previouslyFormattedCitation":"⁵⁰"},"properties":{"noteIndex":0},"schema":""}49. In addition to intralesional curvilinear calcifications, the lesion may cause pressure erosion of the underlying bone. MRI is very useful to demonstrate the cartilaginous matrix, which is hyperintense on T2-WI and has a lobular appearance ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1155/2014/763480","ISSN":"2090-6749","PMID":"24778891","abstract":"Periosteal chondroma is a rare benign hyaline cartilage neoplasm that occurs most commonly in the metaphases of long tubular bones. We present a unique case of periosteal chondroma arising in the proximal phalanx of the left index finger in a 12-year-old boy. Physical examination revealed a slightly protuberant, subcutaneous mass. Plain radiographs and computed tomography scans showed a periosteal lesion producing saucerization of the cortex and subjacent cortical sclerosis, without internal matrix calcification. On magnetic resonance imaging, the lesion exhibited intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Contrast-enhanced fat-suppressed T1-weighted images demonstrated peripheral and septal enhancement. The patient underwent a marginal excision with curettage of the underlying bone cortex. Histological examination confirmed the diagnosis of periosteal chondroma. There has been no evidence of local recurrence eight months after surgery. Periosteal chondroma can protrude into the subcutaneous soft tissue causing a palpable mass. Recognition of the typical radiological features can lead to an accurate diagnosis of this rare condition.","author":[{"dropping-particle":"","family":"Kosaka","given":"Hidetomo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nishio","given":"Jun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Matsunaga","given":"Taiki","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Aoki","given":"Mikiko","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Iwasaki","given":"Hiroshi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Naito","given":"Masatoshi","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Case reports in orthopedics","id":"ITEM-1","issued":{"date-parts":[["2014","1"]]},"page":"763480","title":"Imaging features of periosteal chondroma manifesting as a subcutaneous mass in the index finger.","type":"article-journal","volume":"2014"},"uris":[""]}],"mendeley":{"formattedCitation":"⁵⁰","plainTextFormattedCitation":"50","previouslyFormattedCitation":"⁵¹"},"properties":{"noteIndex":0},"schema":""}50. Poorly defined, amorphous calcifications are seen in up to 30% of synovial sarcomas ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0009-9260","PMID":"4378123","author":[{"dropping-particle":"","family":"Horowitz","given":"A L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Resnick","given":"D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Watson","given":"R C","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Clinical radiology","id":"ITEM-1","issue":"4","issued":{"date-parts":[["1973","10"]]},"page":"481-4","title":"The roentgen features of synovial sarcomas.","type":"article-journal","volume":"24"},"uris":[""]}],"mendeley":{"formattedCitation":"⁵¹","plainTextFormattedCitation":"51","previouslyFormattedCitation":"⁵²"},"properties":{"noteIndex":0},"schema":""}51 and approximately 50% of extraskeletal osteosarcomas ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/978-3-319-46679-8_2","ISBN":"978-3-319-46677-4","author":[{"dropping-particle":"","family":"Botchu","given":"R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"James","given":"S. L.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Davies","given":"A. M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Imaging of Soft Tissue Tumors","edition":"4th","editor":[{"dropping-particle":"","family":"Vanhoenacker","given":"F.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parizel","given":"P.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gielen","given":"J.L.","non-dropping-particle":"","parse-names":false,"suffix":""}],"id":"ITEM-1","issued":{"date-parts":[["2017"]]},"page":"41-57","publisher":"Springer International Publishing","publisher-place":"Cham","title":"Radiography and Computed Tomography","type":"chapter"},"uris":[""]}],"mendeley":{"formattedCitation":"¹","plainTextFormattedCitation":"1","previouslyFormattedCitation":"¹"},"properties":{"noteIndex":0},"schema":""}1 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.path.2015.05.004","ISBN":"9780323402743","ISSN":"18759157","PMID":"26297064","abstract":"Soft tissue lesions can contain bone or cartilage matrix as an incidental, often metaplastic, phenomenon or as a diagnostic feature. The latter category includes a diverse group ranging from self-limited proliferations to benign neoplasms to aggressive malignancies. Correlating imaging findings with pathology is mandatory to confirm that a tumor producing bone or cartilage, in fact, originates from soft tissue rather than from the skeleton. The distinction can have dramatic diagnostic and therapeutic implications. This content focuses on the gross, histologic, radiographic, and clinical features of bone or cartilage-producing soft tissue lesions. Recent discoveries regarding tumor-specific genetics are discussed.","author":[{"dropping-particle":"","family":"Cho","given":"Soo Jin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Horvai","given":"Andrew","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Surgical Pathology Clinics","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2015"]]},"page":"419-444","publisher":"Elsevier Inc","title":"Chondro-Osseous Lesions of Soft Tissue","type":"article-journal","volume":"8"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁶","plainTextFormattedCitation":"26","previouslyFormattedCitation":"²⁷"},"properties":{"noteIndex":0},"schema":""}26.METAL AND OTHER FOREIGN BODIESForeign bodies such as plastic, wood, glass, and silica may penetrate the soft tissues. Most foreign bodies are of slightly higher density than the surrounding soft tissue except for metal or a postoperative textiloma which are radiopaque.Although US is the modality of choice for further evaluation of foreign bodies, MRI may sometimes inadvertently detect foreign bodies ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.ajoc.2017.06.010","ISSN":"24519936","author":[{"dropping-particle":"","family":"Platt","given":"Alexander S.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wajda","given":"Benjamin G.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ingram","given":"April D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei","given":"Xing-Chang","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ells","given":"Anna L.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"American Journal of Ophthalmology Case Reports","id":"ITEM-1","issued":{"date-parts":[["2017","9"]]},"page":"76-79","title":"Metallic intraocular foreign body as detected by magnetic resonance imaging without complications– A case report","type":"article-journal","volume":"7"},"uris":[""]}],"mendeley":{"formattedCitation":"⁵²","plainTextFormattedCitation":"52","previouslyFormattedCitation":"⁵³"},"properties":{"noteIndex":0},"schema":""}52.Foreign bodies are usually low on all MR pulse sequences, due to the presence of few mobile protons ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"1064-9689","PMID":"8564692","abstract":"The MR appearance of soft-tissue masses that simulate neoplasms has been described. In some cases, radiographs may demonstrate characteristic findings in association with MR imaging that may be diagnostic, such as an ossific rim seen in myositis ossificans, periosteal reaction seen in fibro-osseous pseudotumor, and retained foreign bodies present in a foreign body reaction or abscess. In other cases, the characteristic lesion location, age of the patient, and clinical presentation may be suggestive of the diagnosis, as in elastofibroma and nodular fasciitis.","author":[{"dropping-particle":"","family":"Jelinek","given":"J","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kransdorf","given":"M J","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Magnetic resonance imaging clinics of North America","id":"ITEM-1","issue":"4","issued":{"date-parts":[["1995","11"]]},"page":"727-41","title":"MR imaging of soft-tissue masses. Mass-like lesions that simulate neoplasms.","type":"article-journal","volume":"3"},"uris":[""]}],"mendeley":{"formattedCitation":"⁵³","plainTextFormattedCitation":"53","previouslyFormattedCitation":"⁵⁴"},"properties":{"noteIndex":0},"schema":""}53 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s002470050678","ISSN":"0301-0449","PMID":"10460333","abstract":"Foreign bodies within soft tissues are common in children. They may cause a chronic inflammatory reaction that can result in abnormal findings on radiographs, including lytic or blastic osseous changes. These radiographic findings can mimic both benign and malignant processes. In cases where the history is uncertain and the foreign body is not recognized, magnetic resonance (MR) imaging can make a specific diagnosis and direct appropriate therapy.","author":[{"dropping-particle":"","family":"Laor","given":"T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Barnewolt","given":"C E","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Pediatric radiology","id":"ITEM-1","issue":"9","issued":{"date-parts":[["1999","9"]]},"page":"702-4","title":"Nonradiopaque penetrating foreign body: \"a sticky situation\".","type":"article-journal","volume":"29"},"uris":[""]}],"mendeley":{"formattedCitation":"⁵⁴","plainTextFormattedCitation":"54","previouslyFormattedCitation":"⁵⁵"},"properties":{"noteIndex":0},"schema":""}54 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2214/ajr.165.2.7618565","ISSN":"0361-803X","PMID":"7618565","author":[{"dropping-particle":"","family":"Monu","given":"J U","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McManus","given":"C M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ward","given":"W G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haygood","given":"T M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pope","given":"T L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bohrer","given":"S P","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"AJR. American journal of roentgenology","id":"ITEM-1","issue":"2","issued":{"date-parts":[["1995","8"]]},"page":"395-7","title":"Soft-tissue masses caused by long-standing foreign bodies in the extremities: MR imaging findings.","type":"article-journal","volume":"165"},"uris":[""]}],"mendeley":{"formattedCitation":"⁵⁵","plainTextFormattedCitation":"55","previouslyFormattedCitation":"⁵⁶"},"properties":{"noteIndex":0},"schema":""}55 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s13244-011-0076-5","ISSN":"1869-4101","PMID":"22347956","abstract":"Mimickers of soft tissue tumours in the hand and wrist are more frequent than true neoplastic lesions. Pseudotumours belong to a large and heterogeneous group of disorders, varying from normal anatomical variants, cystic lesions, post-traumatic lesions, skin lesions, inflammatory and infectious lesions, non-neoplastic vascular lesions, metabolic disorders (crystal deposition disease and amyloidosis) and miscellaneous disorders. Although the imaging approach to pseudotumoural lesions is often very similar to the approach to \"true\" soft tissue tumoral counterparts, further management of these lesions is different. Biopsy should be performed only in doubtful cases, when the diagnosis is unclear. Therefore, the radiologist plays a pivotal role in the diagnosis of these lesions. Awareness of the normal anatomy and existence and common imaging presentation of these diseases, in combination with relevant clinical findings (clinical history, age, location and skin changes), enables the radiologist to make the correct diagnosis in most cases, thereby limiting the need for invasive procedures.","author":[{"dropping-particle":"","family":"Vanhoenacker","given":"Filip M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Eyselbergs","given":"Michiel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hul","given":"Erik","non-dropping-particle":"Van","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dyck","given":"Pieter","non-dropping-particle":"Van","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schepper","given":"Arthur M","non-dropping-particle":"De","parse-names":false,"suffix":""}],"container-title":"Insights into imaging","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2011","6"]]},"page":"319-333","title":"Pseudotumoural soft tissue lesions of the hand and wrist: a pictorial review.","type":"article-journal","volume":"2"},"uris":[""]}],"mendeley":{"formattedCitation":"⁵⁶","plainTextFormattedCitation":"56","previouslyFormattedCitation":"⁵⁷"},"properties":{"noteIndex":0},"schema":""}56. Adjacent edema may be seen due to inflammatory reaction. Even small metal fragments (Fig. 18), e.g. in metal workers may cause marked magnetic susceptibility artifacts, which are most pronounced on gradient echo imaging ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.21037/qims.2016.12.19","ISSN":"2223-4292","PMID":"28275567","author":[{"dropping-particle":"","family":"Senol","given":"Serkan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gumus","given":"Kazim","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Quantitative imaging in medicine and surgery","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2017","2"]]},"page":"142-143","publisher":"AME Publications","title":"A rare incidence of metal artifact on MRI.","type":"article-journal","volume":"7"},"uris":[""]}],"mendeley":{"formattedCitation":"⁵⁷","plainTextFormattedCitation":"57","previouslyFormattedCitation":"⁵⁸"},"properties":{"noteIndex":0},"schema":""}57. As intra-ocular metal fragments, bullets and shrapnel are a risk factor for retinal detachment in MRI, patients who have worked with sheet metal or ammunition, intra-ocular metal fragments should be ruled out by radiographs prior to the MR examination. Plain radiography may-however- fail to detect very tiny intraocular metallic foreign bodies ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.radi.2016.09.006","ISSN":"10788174","PMID":"28290341","abstract":"PURPOSE The aim of this study is to determine the accuracy of orbital X-rays, when using computed radiography (CR), in detecting ferromagnetic intra-ocular foreign bodies (IOFBs) prior to magnetic resonance imaging (MRI). METHODS A total of 64 orbital X-rays of an anthropomorphic head phantom were acquired using CR. For each image 1, 2, 3, or 4, large, medium, or small IOFBs were fixed to the anterior surface of the left or right orbit. Each of the acquired images with an IOFB was duplicated in order to increase the sample size. A further 16 normal images (no IOFB) were also included in the sample. Observers were invited to review the images and were permitted to manually magnify and window the images to detect any IOFBs present on each image. RESULTS 10 observers (4 radiographers; 4 reporting radiographers; 2 consultant radiologists) independently reviewed the images. The mean (SD) sensitivity and specificity were 72.1% (7.3%) and 99.2% (0.8%) for all observers, respectively. According to size the sensitivity in detecting small, medium and large IOFB were 46%, 76% and 93%, respectively. According to location, the lower lateral quadrants had the lowest sensitivity (53%) whereas the upper medial had the greatest (88%). CONCLUSION Findings from this study using CR support previous conclusions that conventional X-rays fail to detect metallic IOFBs in all cases. Diagnostic performance is governed by IOFB size and location.","author":[{"dropping-particle":"","family":"Momoniat","given":"H.T.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"England","given":"A.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiography","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2017","2"]]},"page":"55-59","title":"An investigation into the accuracy of orbital X-rays, when using CR, in detecting ferromagnetic intraocular foreign bodies","type":"article-journal","volume":"23"},"uris":[""]}],"mendeley":{"formattedCitation":"⁵⁸","plainTextFormattedCitation":"58","previouslyFormattedCitation":"⁵⁹"},"properties":{"noteIndex":0},"schema":""}58. Based on a report of 2 cases, Zhang et al. suggested that tiny ferromagnetic fragments with a diameter below 0.5 mm are too small to be visualized by radiographs or CT, but are not likely to cause MR-induced damage of magnetic field strengths below 1.0 T ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.radi.2016.09.006","ISSN":"10788174","PMID":"28290341","abstract":"PURPOSE The aim of this study is to determine the accuracy of orbital X-rays, when using computed radiography (CR), in detecting ferromagnetic intra-ocular foreign bodies (IOFBs) prior to magnetic resonance imaging (MRI). METHODS A total of 64 orbital X-rays of an anthropomorphic head phantom were acquired using CR. For each image 1, 2, 3, or 4, large, medium, or small IOFBs were fixed to the anterior surface of the left or right orbit. Each of the acquired images with an IOFB was duplicated in order to increase the sample size. A further 16 normal images (no IOFB) were also included in the sample. Observers were invited to review the images and were permitted to manually magnify and window the images to detect any IOFBs present on each image. RESULTS 10 observers (4 radiographers; 4 reporting radiographers; 2 consultant radiologists) independently reviewed the images. The mean (SD) sensitivity and specificity were 72.1% (7.3%) and 99.2% (0.8%) for all observers, respectively. According to size the sensitivity in detecting small, medium and large IOFB were 46%, 76% and 93%, respectively. According to location, the lower lateral quadrants had the lowest sensitivity (53%) whereas the upper medial had the greatest (88%). CONCLUSION Findings from this study using CR support previous conclusions that conventional X-rays fail to detect metallic IOFBs in all cases. Diagnostic performance is governed by IOFB size and location.","author":[{"dropping-particle":"","family":"Momoniat","given":"H.T.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"England","given":"A.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiography","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2017","2"]]},"page":"55-59","title":"An investigation into the accuracy of orbital X-rays, when using CR, in detecting ferromagnetic intraocular foreign bodies","type":"article-journal","volume":"23"},"uris":[""]}],"mendeley":{"formattedCitation":"⁵⁸","plainTextFormattedCitation":"58","previouslyFormattedCitation":"⁵⁹"},"properties":{"noteIndex":0},"schema":""}58. Platt et al. reported a 3.5-mm intraocular metallic foreign body that was detected by MRI in a 10-year-old patient without causing any damage to the ocular tissues ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.ajoc.2017.06.010","ISSN":"24519936","author":[{"dropping-particle":"","family":"Platt","given":"Alexander S.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wajda","given":"Benjamin G.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ingram","given":"April D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei","given":"Xing-Chang","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ells","given":"Anna L.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"American Journal of Ophthalmology Case Reports","id":"ITEM-1","issued":{"date-parts":[["2017","9"]]},"page":"76-79","title":"Metallic intraocular foreign body as detected by magnetic resonance imaging without complications– A case report","type":"article-journal","volume":"7"},"uris":[""]}],"mendeley":{"formattedCitation":"⁵²","plainTextFormattedCitation":"52","previouslyFormattedCitation":"⁵³"},"properties":{"noteIndex":0},"schema":""}52. Further evaluation in vitro and in vivo animals studies to evaluate the movement and MR safety of tiny intraocular ferromagnetic particles at 1.5 and 3.0T MR is -however- warranted ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.radi.2016.09.006","ISSN":"10788174","PMID":"28290341","abstract":"PURPOSE The aim of this study is to determine the accuracy of orbital X-rays, when using computed radiography (CR), in detecting ferromagnetic intra-ocular foreign bodies (IOFBs) prior to magnetic resonance imaging (MRI). METHODS A total of 64 orbital X-rays of an anthropomorphic head phantom were acquired using CR. For each image 1, 2, 3, or 4, large, medium, or small IOFBs were fixed to the anterior surface of the left or right orbit. Each of the acquired images with an IOFB was duplicated in order to increase the sample size. A further 16 normal images (no IOFB) were also included in the sample. Observers were invited to review the images and were permitted to manually magnify and window the images to detect any IOFBs present on each image. RESULTS 10 observers (4 radiographers; 4 reporting radiographers; 2 consultant radiologists) independently reviewed the images. The mean (SD) sensitivity and specificity were 72.1% (7.3%) and 99.2% (0.8%) for all observers, respectively. According to size the sensitivity in detecting small, medium and large IOFB were 46%, 76% and 93%, respectively. According to location, the lower lateral quadrants had the lowest sensitivity (53%) whereas the upper medial had the greatest (88%). CONCLUSION Findings from this study using CR support previous conclusions that conventional X-rays fail to detect metallic IOFBs in all cases. Diagnostic performance is governed by IOFB size and location.","author":[{"dropping-particle":"","family":"Momoniat","given":"H.T.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"England","given":"A.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiography","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2017","2"]]},"page":"55-59","title":"An investigation into the accuracy of orbital X-rays, when using CR, in detecting ferromagnetic intraocular foreign bodies","type":"article-journal","volume":"23"},"uris":[""]}],"mendeley":{"formattedCitation":"⁵⁸","plainTextFormattedCitation":"58","previouslyFormattedCitation":"⁵⁹"},"properties":{"noteIndex":0},"schema":""}58. Injection granulomas arising from injection of oil-based corticosteroids in bodybuilders contain foci of high signal on T1-WI ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2214/ajr.182.4.1821090","ISSN":"0361-803X","PMID":"15039199","author":[{"dropping-particle":"","family":"Lee","given":"Sang Yong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Nae Ho","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chung","given":"Myong Ja","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chung","given":"Gyung Ho","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"AJR. American journal of roentgenology","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2004","4"]]},"page":"1090-1","title":"Foreign-body granuloma caused by dispersed oil droplets simulating subcutaneous fat tissue on MR images.","type":"article-journal","volume":"182"},"uris":[""]}],"mendeley":{"formattedCitation":"⁵⁹","plainTextFormattedCitation":"59","previouslyFormattedCitation":"⁶⁰"},"properties":{"noteIndex":0},"schema":""}59. An intralesional fat-fluid level may be seen at the interface of fatty and necrotic components. The combination of the clinical history and location at typical injection sites, such as the shoulder and gluteus muscles are the clues to the correct diagnosis of these pseudotumoral soft tissue masses ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"17802393","author":[{"dropping-particle":"","family":"Ardies","given":"L.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Beule","given":"T.","non-dropping-particle":"De","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Degroote","given":"T.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"F.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"P.K.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"JBR-BTR","id":"ITEM-1","issue":"2","issued":{"date-parts":[["2012"]]},"page":"108","title":"Bilateral intramuscular pseudotumor in a bodybuilder","type":"article-journal","volume":"95"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶⁰","plainTextFormattedCitation":"60","previouslyFormattedCitation":"⁶¹"},"properties":{"noteIndex":0},"schema":""}60 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1055/s-0035-1549322","ISSN":"1098-898X","PMID":"26021589","abstract":"Soft tissue tumors (STTs) are not infrequent about the shoulder girdle. This article provides a short overview of useful parameters in grading and characterization of those lesions. The most frequent histologic types of STT about the shoulder girdle are also discussed. Benign STTs and mimickers of STTs are emphasized because precise imaging characterization of aggressive STTs is much more difficult than of their benign counterparts. Besides evaluation of the lesion's extent, a major role for imaging is to select those lesions that should undergo biopsy. MRI is the preferred imaging technique.","author":[{"dropping-particle":"","family":"Vanhoenacker","given":"Filip M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verstraete","given":"Koenraad L","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Seminars in musculoskeletal radiology","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2015","7"]]},"page":"284-99","title":"Soft Tissue Tumors about the Shoulder.","type":"article-journal","volume":"19"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶¹","plainTextFormattedCitation":"61","previouslyFormattedCitation":"⁶²"},"properties":{"noteIndex":0},"schema":""}61.LESIONS WITH A SLIGHTLY INCREASED DENSITY THAN SURROUNDING SOFT TISSUEGoutGout is a metabolic disorder characterized by hyperuricemia and deposits of uric acid crystals in joints and periarticular soft tissues. The first metatarsophalangeal joint is most commonly involved, followed by the ankle, knee, wrist, fingers and elbow. Clinical and radiographic findings of articular manifestations are usually diagnostic ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.rcl.2017.04.004","ISSN":"1557-8275","PMID":"28774457","abstract":"This article reviews the main radiographic features of crystal deposition diseases. Gout is linked to monosodium urate crystals. Classic radiographic features include subcutaneous tophi, large and well-circumscribed paraarticular bone erosions, and exuberant bone hyperostosis. Calcium pyrophosphate deposition (CPPD) can involve numerous structures, such as hyaline cartilages, fibrocartilages, or tendons. CPPD arthropathy involves joints usually spared by osteoarthritis. Basic calcium phosphate deposits are periarticular or intraarticular. Periarticular calcifications are amorphous, dense, and round or oval with well-limited borders, and most are asymptomatic. When resorbing, they become cloudy and less dense with an ill-defined shape and can migrate into adjacent structures.","author":[{"dropping-particle":"","family":"Jacques","given":"Thibaut","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Michelin","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Badr","given":"Sammy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nasuto","given":"Michelangelo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lefebvre","given":"Guillaume","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Larkman","given":"Neal","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cotten","given":"Anne","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiologic clinics of North America","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2017","9"]]},"page":"967-984","title":"Conventional Radiology in Crystal Arthritis: Gout, Calcium Pyrophosphate Deposition, and Basic Calcium Phosphate Crystals.","type":"article-journal","volume":"55"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴","plainTextFormattedCitation":"4","previouslyFormattedCitation":"⁴"},"properties":{"noteIndex":0},"schema":""}4. Soft tissue deposition of uric acid crystals is designated as tophaceous gout ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0364-2348","PMID":"9361362","abstract":"Gouty arthritis is the most frequent rheumatological complication among cyclosporine-treated organ transplant recipients. We report one case of pseudotumoral intramuscular tophaceous deposit of the forearm, in a heart transplant patient with a history of traumatic wound to the same area 17 years previously, and with no known arthritis.","author":[{"dropping-particle":"","family":"Chaoui","given":"A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Garcia","given":"J","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kurt","given":"A M","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Skeletal radiology","id":"ITEM-1","issue":"10","issued":{"date-parts":[["1997","10"]]},"page":"626-8","title":"Gouty tophus simulating soft tissue tumor in a heart transplant recipient.","type":"article-journal","volume":"26"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶²","plainTextFormattedCitation":"62","previouslyFormattedCitation":"⁶³"},"properties":{"noteIndex":0},"schema":""}62. Uric acid crystals deposits are slightly denser than the surrounding soft tissues. They are currently often characterized dual energy CT ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0392-856X","PMID":"30296979","abstract":"In this systematic literature review, we update imaging modalities in gout, with a focus on newer technologies, particularly Dual-energy computed tomography (DECT). Conventional radiography (CR), ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT) and dual-energy CT (DECT) have been used to evaluate different stages and clinical manifestations of gout and hyperuricaemia. We compare and contrast these modalities across the spectrum of this disease and of clinical scenarios and objectives (1).","author":[{"dropping-particle":"","family":"Bayat","given":"Sara","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Baraf","given":"Herbert S B","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rech","given":"Juergen","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Clinical and experimental rheumatology","id":"ITEM-1","issue":"5","issued":{"date-parts":[["0"]]},"page":"53-60","title":"Update on imaging in gout: contrasting and comparing the role of dual-energy computed tomography to traditional diagnostic and monitoring techniques.","type":"article-journal","volume":"36 Suppl 1"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶³","plainTextFormattedCitation":"63","previouslyFormattedCitation":"⁶⁴"},"properties":{"noteIndex":0},"schema":""}63, whereas ultrasound is useful to identify crystals on the surface of the articular cartilage ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1097/MD.0000000000012834","ISSN":"1536-5964","PMID":"30334984","abstract":"The aim of our study was to compare the performance of ultrasonography (US) and dual-energy computed tomography (DECT) in detecting the crystal deposition at lower extremity joints in patients with gout. The correlation of imaging findings with microscopic findings was further assessed whenever aspiration is available.We recruited consecutive patients who were presented with arthritis of lower extremity from January 2012 to December 2014. All the patients underwent DECT and US scan of bilateral knees, ankles, and feet. Synovial fluid was obtained by aspiration from an acute inflammatory joint if possible.Finally, 60 patients fulfilling the 1977 gout classification criteria were included in our study. We found that US can detect significantly more patients with crystal deposition than DECT (81.7% vs 56.7%, by US and DECT, respectively, P?<?.001). The frequency of urate crystal deposition detected by US at MTP1, knee, and ankle joints regions was 56.7%, 63.3%, and 51.7%, respectively. The percentage of positivity of double contour sign on US was 33.3%, 48.3%, and 41.7% at the joints mentioned above, respectively. There was a good correlation between ultrasound and synovial fluid analysis in detecting crystal deposition (κ?=?0.87, P?=?.001), while the agreement between DECT and synovial fluid analysis was just fair (κ?=?0.28, P?=?.02).The sensitivity of US in detecting urate crystal deposition in lower extremity joints was higher than DECT. The superiority was more obvious in knee and MTP1 joints. US should be considered as the first choice of image examinations when diagnosing gout.","author":[{"dropping-particle":"","family":"Wang","given":"Yu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Deng","given":"Xuerong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Xu","given":"Yufeng","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ji","given":"Lanlan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Zhuoli","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Medicine","id":"ITEM-1","issue":"42","issued":{"date-parts":[["2018","10"]]},"page":"e12834","publisher":"Wolters Kluwer Health","title":"Detection of uric acid crystal deposition by ultrasonography and dual-energy computed tomography: A cross-sectional study in patients with clinically diagnosed gout.","type":"article-journal","volume":"97"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶⁴","plainTextFormattedCitation":"64","previouslyFormattedCitation":"⁶⁵"},"properties":{"noteIndex":0},"schema":""}64, rather than within cartilage, as observed with CPPD ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s13244-018-0619-0","ISSN":"1869-4101","PMID":"29882050","abstract":"Musculoskeletal calcifications are frequent on radiographs and sometimes problematic. The goal of this article is to help radiologists to make the correct diagnosis when faced with an extraosseous musculoskeletal calcification. One should first differentiate a calcification from an ossification or a foreign body and then locate the calcification correctly. Each location has a specific short differential diagnosis, with minimal further investigation necessary. Intra-tendon calcifications are most frequently associated with hydroxyapatite deposition disease (HADD). In most cases, intra-articular calcifications are caused by calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. Soft tissue calcification can be caused by secondary tumoural calcinosis from renal insufficiency, or collagen vascular diseases and by vascular calcifications, either arterial or venous (phlebolith). TEACHING POINTS ? Calcifications have to be differentiated form ossification and foreign body. ? A musculoskeletal MRI study must always be correlated with a radiograph. ? The clinical manifestations of calcifications may sometimes mimic septic arthritis or sarcoma. ? HADD and CPPD crystal deposition have a distinct appearance on radiograph. ? Calcinosis is more frequently caused by chronic renal failure and scleroderma.","author":[{"dropping-particle":"","family":"Freire","given":"Véronique","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moser","given":"Thomas P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lepage-Saucier","given":"Marianne","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Insights into Imaging","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2018","8","7"]]},"page":"477-492","title":"Radiological identification and analysis of soft tissue musculoskeletal calcifications","type":"article-journal","volume":"9"},"uris":[""]}],"mendeley":{"formattedCitation":"³","plainTextFormattedCitation":"3","previouslyFormattedCitation":"³"},"properties":{"noteIndex":0},"schema":""}3. The MR imaging features of gouty arthritis include synovial thickening and joint effusion. Tophaceous gout is of low to intermediate signal intensity is seen on T1-WI ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"1064-9689","PMID":"8564688","abstract":"The exquisite soft-tissue contrast and multi-planar imaging capabilities of MR imaging uniquely qualify this modality for the evaluation of periarticular pathology. MR evaluation can be diagnostic by signal characterization, as in a lipoma, or by anatomic location, as seen in meniscal and synovial cysts. In other less diagnostic pathology, MR imaging can focus a differential diagnosis, guide percutaneous or surgical biopsy, provide local staging, and serve as a surgical map.","author":[{"dropping-particle":"","family":"Slyke","given":"M A","non-dropping-particle":"Van","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moser","given":"R P","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Madewell","given":"J E","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Magnetic resonance imaging clinics of North America","id":"ITEM-1","issue":"4","issued":{"date-parts":[["1995","11"]]},"page":"651-67","title":"MR imaging of periarticular soft-tissue lesions.","type":"article-journal","volume":"3"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶⁵","plainTextFormattedCitation":"65","previouslyFormattedCitation":"⁶⁶"},"properties":{"noteIndex":0},"schema":""}65. T2-WI characteristics vary from a heterogeneously hypointense to hyperintense mass on T2-weighted images (Fig. 19) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0364-2348","PMID":"9361362","abstract":"Gouty arthritis is the most frequent rheumatological complication among cyclosporine-treated organ transplant recipients. We report one case of pseudotumoral intramuscular tophaceous deposit of the forearm, in a heart transplant patient with a history of traumatic wound to the same area 17 years previously, and with no known arthritis.","author":[{"dropping-particle":"","family":"Chaoui","given":"A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Garcia","given":"J","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kurt","given":"A M","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Skeletal radiology","id":"ITEM-1","issue":"10","issued":{"date-parts":[["1997","10"]]},"page":"626-8","title":"Gouty tophus simulating soft tissue tumor in a heart transplant recipient.","type":"article-journal","volume":"26"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶²","plainTextFormattedCitation":"62","previouslyFormattedCitation":"⁶³"},"properties":{"noteIndex":0},"schema":""}62, depending on the degree of inflammation ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0392-856X","PMID":"30296979","abstract":"In this systematic literature review, we update imaging modalities in gout, with a focus on newer technologies, particularly Dual-energy computed tomography (DECT). Conventional radiography (CR), ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT) and dual-energy CT (DECT) have been used to evaluate different stages and clinical manifestations of gout and hyperuricaemia. We compare and contrast these modalities across the spectrum of this disease and of clinical scenarios and objectives (1).","author":[{"dropping-particle":"","family":"Bayat","given":"Sara","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Baraf","given":"Herbert S B","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rech","given":"Juergen","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Clinical and experimental rheumatology","id":"ITEM-1","issue":"5","issued":{"date-parts":[["0"]]},"page":"53-60","title":"Update on imaging in gout: contrasting and comparing the role of dual-energy computed tomography to traditional diagnostic and monitoring techniques.","type":"article-journal","volume":"36 Suppl 1"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶³","plainTextFormattedCitation":"63","previouslyFormattedCitation":"⁶⁴"},"properties":{"noteIndex":0},"schema":""}63. Enhancement may be seen ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0364-2348","PMID":"10197451","abstract":"OBJECTIVE: To define the imaging characteristics of intra-articular tophi of the knee.\n\nDESIGN AND PATIENTS: Twelve patients with intra-articular tophi in the knee were studied with routine MR imaging, gadolinium (Gd)-enhanced MR imaging, and CT over a 4-year period. There were 11 men and one woman, 25-82 years of age (mean age 48 years). Four patients did not have a documented history of gout at the time of the MR examination. The diagnosis of intra-articular tophi was provided by arthroscopy and histological examination (5 patients), by microscopic study of joint fluid (5 patients), or by characteristic clinical, laboratory and imaging findings (2 patients).\n\nRESULTS: In 15 MR examinations the tophi were located purely intra-articularly in 10 knees. In the remaining five MR studies, periarticular soft tissues or bone, or both, were involved. All the intra-articular tophi manifested low to intermediate signal intensity on both T1- and T2-weighted images. All five Gd-enhanced MR examinations demonstrated a heterogeneous peripheral enhancement. All 10 CT scans showed varying degrees of stippled calcifications within the tophi. The nature of the calcifications was confirmed on histological examination in three patients.\n\nCONCLUSION: Presenting clinical manifestations of gout may relate to intra-articular tophaceous deposits. Such deposits present as masses on MR images with low to intermediate signal intensity on both T1- and T2-weighted images and a characteristic enhancement pattern following intravenous Gd administration. These features relate primarily to internal calcifications, which are most evident on CT images. MR evaluation (including Gd administration) supplemented, in some cases, with CT scanning allows accurate diagnosis of intra-articular tophaceous deposits.","author":[{"dropping-particle":"","family":"Chen","given":"C K","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yeh","given":"L R","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pan","given":"H B","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yang","given":"C F","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lu","given":"Y C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"J S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Resnick","given":"D","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Skeletal radiology","id":"ITEM-1","issue":"2","issued":{"date-parts":[["1999","3"]]},"page":"75-80","title":"Intra-articular gouty tophi of the knee: CT and MR imaging in 12 patients.","type":"article-journal","volume":"28"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶⁶","plainTextFormattedCitation":"66","previouslyFormattedCitation":"⁶⁷"},"properties":{"noteIndex":0},"schema":""}66.Pigmented Villonodular Synovitis and Tenosynovial Giant Cell Tumor PVNS represents a diffuse benign fibrohistiocytic tumor arising from the synovium of joints, characterized by the formation of nodular synovial masses consisting of hemosiderin deposits. The predominantly affected joint of diffuse PVNS is the knee, followed by the ankle and in rare cases the wrist, hip, shoulder and elbow. Localised intra-articular forms are designated as Localised Nodular Synovitis (LNS) and most commonly affects Hoffa’s fat pad. It may also involve the tendon sheath (Tenosynovial Giant Cell tumors) and bursae (Pigmented Villonodular Bursitis) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/978-3-319-46679-8_14","ISBN":"978-3-319-46677-4","author":[{"dropping-particle":"","family":"Shah","given":"A.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Botchu","given":"R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Davies","given":"A. M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"James","given":"S. L.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Imaging of Soft Tissue Tumors","edition":"4","editor":[{"dropping-particle":"","family":"Vanhoenacker F.M., Parizel P.M.","given":"Gielen J.L.","non-dropping-particle":"","parse-names":false,"suffix":""}],"id":"ITEM-1","issued":{"date-parts":[["2017"]]},"page":"311-337","publisher":"Springer International Publishing","publisher-place":"Cham","title":"So-Called Fibrohistiocytic Tumours","type":"chapter"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶⁷","plainTextFormattedCitation":"67","previouslyFormattedCitation":"⁶⁸"},"properties":{"noteIndex":0},"schema":""}67. Standard radiographs may be normal in an early stage, or may demonstrate well-defined dense soft tissue masses due to hemosiderin deposition. Calcifications are typically not seen. Later, proliferation of the synovium may cause erosions and marginal sclerosis in the adjacent bone. Erosions occur in a more early stage in joints with a limited capacity to expand, such as the wrist and hip joints.For early detection and for imaging characterization, MRI is the preferred imaging technique and is currently referred as the gold standard ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.5334/jbr-btr.167","ISBN":"0302-7430 (Print) 0302-7430","ISSN":"17802393","PMID":"22764668","abstract":"A 38-year-old woman was referred to our department with persisting pain and swelling of the right ankle, 10 months following an inversion trauma. Initial standard radiographs were unremarkable. Conservative treatment with physiotherapy and local infiltration was unsuccessful. Three month later, repeated plain radiographs revealed a slightly radiodense mass at the anterior aspect of the talocrural joint (Fig. A, white arrow). An MRI was performed for further characterization. These images show an intra-articular nodular mass within the anterior ankle joint recess. The lesion was of intermediate to low signal intensity on axial T1-weighted (WI) images (Fig. B, star). On sagittal fatsuppressed T2-WI, the lesion contained multiple intralesional areas of low signal intensity interspersed with areas of high signal (Fig. C, star). A peripheral low signal intensity rim was seen, in keeping with hemosiderin deposition within the synovium (Fig. C, black arrow). Blooming artefact was seen on gradient echo imaging (not shown). Based on the imaging findings, the diagnosis of Pigmented VilloNodular Synovitis (PVNS) was made, which was confirmed on surgery (Fig. D, surgical view showing a lesion with black pigment within the synovium) and subsequent histological examination. The postoperative course was uneventful.","author":[{"dropping-particle":"","family":"Verlinden","given":"C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"F M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boone","given":"P","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"JBR-BTR","id":"ITEM-1","issue":"2","issued":{"date-parts":[["2012","3","1"]]},"page":"101","publisher":"Ubiquity Press","title":"Pigmented villonodular synovitis of the ankle presenting as a persisting ankle effusion","type":"article","volume":"95"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶⁸","plainTextFormattedCitation":"68","previouslyFormattedCitation":"⁶⁹"},"properties":{"noteIndex":0},"schema":""}68.Both T1-and T2-WI images reveal hypointense intra-articular masses, indicative of hemosiderin deposition. Fatsuppressed T2-WI images may show areas of interspersed fluid entrapped within the thickened and hemosiderin-laden synovium.Gradient echo imaging is very useful to demonstrate characteristic “blooming” artefacts caused by hemosiderin deposits. The lesion usually enhances vividly (Fig. 20) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/978-3-319-46679-8_14","ISBN":"978-3-319-46677-4","author":[{"dropping-particle":"","family":"Shah","given":"A.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Botchu","given":"R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Davies","given":"A. M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"James","given":"S. L.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Imaging of Soft Tissue Tumors","edition":"4","editor":[{"dropping-particle":"","family":"Vanhoenacker F.M., Parizel P.M.","given":"Gielen J.L.","non-dropping-particle":"","parse-names":false,"suffix":""}],"id":"ITEM-1","issued":{"date-parts":[["2017"]]},"page":"311-337","publisher":"Springer International Publishing","publisher-place":"Cham","title":"So-Called Fibrohistiocytic Tumours","type":"chapter"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶⁷","plainTextFormattedCitation":"67","previouslyFormattedCitation":"⁶⁸"},"properties":{"noteIndex":0},"schema":""}67. Ganglion cysts and enlarged bursae Ganglion cysts, synovial cysts and enlarged bursae are easy to characterize on ultrasound and MRI due to their fluid contents and to define the exact location and their relationship to the joint and surrounding structures ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/978-3-319-46679-8_20","ISBN":"9783319466798","abstract":"This chapter will focus on imaging of those soft tissue lesions originating from the synovium or arising within the joint that are not included in the WHO Classification of Soft Tissue Tumors (2013). These lesions clinically present as a soft tissue mass and are often referred to the radiologist for further work-up of a “soft tissue tumor.” They are most often of nonneoplastic origin and have in most scenarios characteristic imaging features. Typical examples comprise of synovial cyst, ganglion cyst, and lipoma arborescens. ? Springer International Publishing AG 2017.","author":[{"dropping-particle":"","family":"Nikodinovska","given":"V. Vasilevska","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"Filip M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Imaging of Soft Tissue Tumors","edition":"4th","editor":[{"dropping-particle":"","family":"Vanhoenacker","given":"F.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parizel","given":"P.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gielen","given":"J. L.","non-dropping-particle":"","parse-names":false,"suffix":""}],"id":"ITEM-1","issued":{"date-parts":[["2017"]]},"page":"495-522","publisher-place":"Cham","title":"Synovial lesions","type":"chapter"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶⁹","plainTextFormattedCitation":"69","previouslyFormattedCitation":"⁷⁰"},"properties":{"noteIndex":0},"schema":""}69. The lesions are hyperintense on T2-WI and there is subtle peripheral enhancement.If large enough, they may be suspected on plain films if a nonspecific soft tissue swelling is seen adjacent to the joint (Fig. 21).Peritrochanteric, subacromial-subdeltoid, ischiogluteal, pes anserine, iliopsoas, pre- and infrapatellar, retrocalcaneal and olecranon bursae are most commonly involved ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.4103/0971-3026.95400","ISSN":"1998-3808","PMID":"22623812","abstract":"A bursa is a fluid-filled structure that is present between the skin and tendon or tendon and bone. The main function of a bursa is to reduce friction between adjacent moving structures. Bursae around the knee can be classified as those around the patella and those that occur elsewhere. In this pictorial essay we describe the most commonly encountered lesions and their MRI appearance.","author":[{"dropping-particle":"","family":"Chatra","given":"Priyank S","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Indian journal of radiology & imaging","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2012","1"]]},"page":"27-30","title":"Bursae around the knee joints.","type":"article-journal","volume":"22"},"uris":[""]}],"mendeley":{"formattedCitation":"⁷⁰","plainTextFormattedCitation":"70","previouslyFormattedCitation":"⁷¹"},"properties":{"noteIndex":0},"schema":""}70 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.rcl.2012.10.005","ISSN":"00338389","PMID":"23622093","abstract":"Cystic lesions are common around the knee and are often encountered as an incidental finding on routine magnetic resonance imaging examinations. The clinical presentation of cysts and other fluid collections is variable, depending on their size, location, and relationship to adjacent anatomic structures. This article reviews the anatomy, etiology, clinical presentation, and imaging features of commonly occurring cystic lesions around the knee and discusses some of the potential pitfalls that may be encountered in clinical practice.","author":[{"dropping-particle":"","family":"Steinbach","given":"Lynne S.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Stevens","given":"Kathryn J.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiologic Clinics of North America","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2013","5"]]},"page":"433-454","title":"Imaging of Cysts and Bursae About the Knee","type":"article-journal","volume":"51"},"uris":[""]}],"mendeley":{"formattedCitation":"⁷¹","plainTextFormattedCitation":"71","previouslyFormattedCitation":"⁷²"},"properties":{"noteIndex":0},"schema":""}71 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.rcl.2007.08.005","ISSN":"0033-8389","PMID":"17981178","abstract":"Cystic lesions around the knee comprise a diverse group of entities, ranging from benign cysts to complications of underlying diseases such as infection, arthritis, and malignancy. Their diverse causes result in varied prognoses and therapeutic options. Although the presentation of cystic masses may be similar, their management may differ, thus highlighting the importance of appropriate categorization. MR aids in the characterization of lesions by first localizing them, and then defining their relationship with adjacent structures and identifying any additional abnormalities. For the purpose of this article, the authors limit the scope of their discussion to benign cysts, ganglia, and bursae about the knee.","author":[{"dropping-particle":"","family":"Beaman","given":"Francesca D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Peterson","given":"Jeffrey J","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiologic clinics of North America","id":"ITEM-1","issue":"6","issued":{"date-parts":[["2007","11"]]},"page":"969-82, vi","title":"MR imaging of cysts, ganglia, and bursae about the knee.","type":"article-journal","volume":"45"},"uris":[""]}],"mendeley":{"formattedCitation":"⁷²","plainTextFormattedCitation":"72","previouslyFormattedCitation":"⁷³"},"properties":{"noteIndex":0},"schema":""}72 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s00256-003-0741-y","ISSN":"0364-2348","PMID":"14991250","abstract":"This review presents a comprehensive illustrated overview of the wide variety of cystic lesions around the knee. The aetiology, clinical presentation, MRI appearances and differential diagnosis are discussed. Bursae include those related to the patella as well as pes anserine, tibial collateral ligament, semimembranosus-tibial collateral ligament, iliotibial and fibular collateral ligament-biceps femoris. The anatomical extension, imaging features and clinical significance of meniscal cysts are illustrated. Review of ganglia includes intra-articular, extra-articular, intraosseous and periosteal ganglia, highlighting imaging findings and differential diagnoses. The relationship between proximal tibiofibular joint cysts and intraneural peroneal nerve ganglia is discussed. Intraosseous cystic lesions, including insertional and degenerative cysts, as well as lesions mimicking cysts of the knee are described and illustrated. Knowledge of the location, characteristic appearance and distinguishing features of cystic masses around the knee as well as potential imaging pitfalls such as normal anatomical recesses and atypical cyst contents on MR imaging aids in allowing a specific diagnosis to be made. This will prevent unnecessary additional investigations and determine whether intra-articular surgery or conservative management is appropriate.","author":[{"dropping-particle":"","family":"McCarthy","given":"Catherine L.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McNally","given":"Eugene G.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Skeletal Radiology","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2004","4","1"]]},"page":"187-209","title":"The MRI appearance of cystic lesions around the knee","type":"article-journal","volume":"33"},"uris":[""]}],"mendeley":{"formattedCitation":"⁷³","plainTextFormattedCitation":"73","previouslyFormattedCitation":"⁷⁴"},"properties":{"noteIndex":0},"schema":""}73 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s40477-015-0167-0","ISSN":"1876-7931","PMID":"26191110","abstract":"PURPOSE The presence of the subacromial-subdeltoid (SASD) bursa inflammation has recently been proposed as a primary radiologic factor predicting persistent limitation and pain in operated patients. The aim of the study was to verify the hypothesis that pain, or increased shoulder pain, could be associated with SASD bursitis not only in operated patients but also in general population. METHODS A consecutive series of 1940 shoulder ultrasound examinations were performed by our Department over a 5-year period using linear multi-frequency probes. All reports of examination executed for shoulder pain were reviewed. The video clips were independently reviewed by two radiologists: effusion in the SASD bursa and the presence of other pathological conditions were evaluated and confirmed. RESULTS A total of 1147 shoulder video clips were re-evaluated, and 1587 pathologies were detected; 65.5?% of patients had only one pathology, 30.4?% had two and 4.1?% presented three pathologies. The difference between the group with and without effusion is statistically significant for acromioclavicular joint arthritis, supraspinatus tendon calcific tendinopathy, full-thickness and superficial tear of the supraspinatus, traumas and rheumatoid arthritis with a p value <0.01. CONCLUSIONS Our study shows that the effusion in the SASD bursa is frequently associated with shoulder pain often independently from the underlying pathology; further studies are needed to confirm the statistical significance of this relationship by clarifying possible confounding factors. SCOPO DEL LAVORO La presenza di alterazioni flogistiche a livello della borsa subacromiondeltoidea (BSAD) è stata recentemente proposta come fattore principale per predire la comparsa di dolore e limitazione funzionale nei Pazienti operati a livello della spalla. Lo scopo del nostro studio è di verificare l’ipotesi che il dolore, o l’incremento dello stesso, sia associato con la flogosi della BSAD non solo nei Pazienti operati ma anche nella popolazione generale. MATERIALI E METODI In 5 anni nel nostro dipartimento sono state eseguite, utilizzando esclusivamente sonde lineari multifrequenza, 1940 ecografie della spalla. Tutti gli esami aventi come indicazione il dolore sono stati selezionati. I videoclip degli esami selezionati sono stati rivalutati da due radiologi indipendentemente: è stata in tal modo confermata la presenza di versamento nella BSAD e di altri reperti patologici. RISULTATI Sono stati rivalutati i video…","author":[{"dropping-particle":"","family":"Draghi","given":"Ferdinando","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Scudeller","given":"Luigia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Draghi","given":"Anna Guja","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bortolotto","given":"Chandra","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Ultrasound","id":"ITEM-1","issue":"2","issued":{"date-parts":[["2015","6","2"]]},"page":"151-158","title":"Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study","type":"article-journal","volume":"18"},"uris":[""]}],"mendeley":{"formattedCitation":"⁷⁴","plainTextFormattedCitation":"74","previouslyFormattedCitation":"⁷⁵"},"properties":{"noteIndex":0},"schema":""}74 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.5312/wjo.v6.i9.688","ISSN":"2218-5836","PMID":"26495246","abstract":"This article presents a narrative review of cystic lesions around the hip and primarily consists of 5 sections: Radiological examination, prevalence, pathogenesis, symptoms, and treatment. Cystic lesions around the hip are usually asymptomatic but may be observed incidentally on imaging examinations, such as computed tomography and magnetic resonance imaging. Some cysts may enlarge because of various pathological factors, such as trauma, osteoarthritis, rheumatoid arthritis, or total hip arthroplasty (THA), and may become symptomatic because of compression of surrounding structures, including the femoral, obturator, or sciatic nerves, external iliac or common femoral artery, femoral or external iliac vein, sigmoid colon, cecum, small bowel, ureters, and bladder. Treatment for symptomatic cystic lesions around the hip joint includes rest, nonsteroidal anti-inflammatory drug administration, needle aspiration, and surgical excision. Furthermore, when these cysts are associated with osteoarthritis, rheumatoid arthritis, and THA, primary or revision THA surgery will be necessary concurrent with cyst excision. Knowledge of the characteristic clinical appearance of cystic masses around the hip will be useful for determining specific diagnoses and treatments.","author":[{"dropping-particle":"","family":"Yukata","given":"Kiminori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nakai","given":"Sho","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Goto","given":"Tomohiro","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ikeda","given":"Yuichi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shimaoka","given":"Yasunori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yamanaka","given":"Issei","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sairyo","given":"Koichi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hamawaki","given":"Jun-Ichi","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"World Journal of Orthopedics","id":"ITEM-1","issue":"9","issued":{"date-parts":[["2015","10","18"]]},"page":"688","title":"Cystic lesion around the hip joint","type":"article-journal","volume":"6"},"uris":[""]}],"mendeley":{"formattedCitation":"⁷⁵","plainTextFormattedCitation":"75","previouslyFormattedCitation":"⁷⁶"},"properties":{"noteIndex":0},"schema":""}75 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"1532-0650","PMID":"28290630","abstract":"Superficial bursitis most often occurs in the olecranon and prepatellar bursae. Less common locations are the superficial infrapatellar and subcutaneous (superficial) calcaneal bursae. Chronic microtrauma (e.g., kneeling on the prepatellar bursa) is the most common cause of superficial bursitis. Other causes include acute trauma/hemorrhage, inflammatory disorders such as gout or rheumatoid arthritis, and infection (septic bursitis). Diagnosis is usually based on clinical presentation, with a particular focus on signs of septic bursitis. Ultrasonography can help distinguish bursitis from cellulitis. Blood testing (white blood cell count, inflammatory markers) and magnetic resonance imaging can help distinguish infectious from noninfectious causes. If infection is suspected, bursal aspiration should be performed and fluid examined using Gram stain, crystal analysis, glucose measurement, blood cell count, and culture. Management depends on the type of bursitis. Acute traumatic/hemorrhagic bursitis is treated conservatively with ice, elevation, rest, and analgesics; aspiration may shorten the duration of symptoms. Chronic microtraumatic bursitis should be treated conservatively, and the underlying cause addressed. Bursal aspiration of microtraumatic bursitis is generally not recommended because of the risk of iatrogenic septic bursitis. Although intrabursal corticosteroid injections are sometimes used to treat microtraumatic bursitis, high-quality evidence demonstrating any benefit is unavailable. Chronic inflammatory bursitis (e.g., gout, rheumatoid arthritis) is treated by addressing the underlying condition, and intrabursal corticosteroid injections are often used. For septic bursitis, antibiotics effective against Staphylococcus aureus are generally the initial treatment, with surgery reserved for bursitis not responsive to antibiotics or for recurrent cases. Outpatient antibiotics may be considered in those who are not acutely ill; patients who are acutely ill should be hospitalized and treated with intravenous antibiotics.","author":[{"dropping-particle":"","family":"Khodaee","given":"Morteza","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"American family physician","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2017","2","15"]]},"page":"224-231","title":"Common Superficial Bursitis.","type":"article-journal","volume":"95"},"uris":[""]}],"mendeley":{"formattedCitation":"⁷⁶","plainTextFormattedCitation":"76","previouslyFormattedCitation":"⁷⁷"},"properties":{"noteIndex":0},"schema":""}76. An adventitious bursa results from inflammation and fibrinoid necrosis of connective tissue in areas subject to chronic frictional irritation. It is most commonly located at the first metatarsophalangeal joint, due to chronic friction over a hallux valgus but it may be seen in other locations (Fig. 22)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/978-3-319-46679-8_20","ISBN":"9783319466798","abstract":"This chapter will focus on imaging of those soft tissue lesions originating from the synovium or arising within the joint that are not included in the WHO Classification of Soft Tissue Tumors (2013). These lesions clinically present as a soft tissue mass and are often referred to the radiologist for further work-up of a “soft tissue tumor.” They are most often of nonneoplastic origin and have in most scenarios characteristic imaging features. Typical examples comprise of synovial cyst, ganglion cyst, and lipoma arborescens. ? Springer International Publishing AG 2017.","author":[{"dropping-particle":"","family":"Nikodinovska","given":"V. Vasilevska","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vanhoenacker","given":"Filip M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Imaging of Soft Tissue Tumors","edition":"4th","editor":[{"dropping-particle":"","family":"Vanhoenacker","given":"F.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parizel","given":"P.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gielen","given":"J. L.","non-dropping-particle":"","parse-names":false,"suffix":""}],"id":"ITEM-1","issued":{"date-parts":[["2017"]]},"page":"495-522","publisher-place":"Cham","title":"Synovial lesions","type":"chapter"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶⁹","plainTextFormattedCitation":"69","previouslyFormattedCitation":"⁷⁰"},"properties":{"noteIndex":0},"schema":""}69.LESIONS CAUSING DISPLACEMENT OF SURROUNDING FAT PADSA variety of soft tissue lesions of different etiology may cause displacement and distortion of surrounding fat pads. Most lesions cannot be further characterized on radiographs alone. This paragraph will be restricted to accessory muscles. Accessory muscles are variations in muscular anatomy differing from the musculature described in anatomy textbooks ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1055/s-0030-1253155","ISSN":"10897860","PMID":"20486022","abstract":"Several accessory muscles in the upper and lower limb have been described in the medical literature. Most are asymptomatic and represent incidental findings at imaging. In some instances, however, these muscles may become clinically relevant producing palpable swelling, entrapment of neurovascular structures, or exercise-related pain. The diagnosis of accessory muscles is based on recognition of their typical location and on cross-sectional imaging features. Familiarity with their most common location and knowledge of the possible clinical syndromes caused by these supernumerary structures may aid in diagnosis and treatment.","author":[{"dropping-particle":"","family":"Martinoli","given":"Carlo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Perez","given":"Maribel Miguel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Padua","given":"Luca","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Valle","given":"Maura","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Capaccio","given":"Enrico","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Altafini","given":"Luisa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Michaud","given":"Johan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tagliafico","given":"Alberto","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Seminars in Musculoskeletal Radiology","id":"ITEM-1","issue":"2","issued":{"date-parts":[["2010"]]},"page":"106-121","title":"Muscle variants of the upper and lower limb (with anatomical correlation)","type":"article-journal","volume":"14"},"uris":[""]}],"mendeley":{"formattedCitation":"⁷⁷","plainTextFormattedCitation":"77","previouslyFormattedCitation":"⁷⁸"},"properties":{"noteIndex":0},"schema":""}77. Most accessory muscles are incidental findings on imaging. They may become symptomatic because they present as a soft tissue mass or may cause compression or displacement of adjacent neurovascular structures and tendons. They also may cause exercise-related pain due to a focal compartment syndrome or inadequate blood supply ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1055/s-0030-1253155","ISSN":"10897860","PMID":"20486022","abstract":"Several accessory muscles in the upper and lower limb have been described in the medical literature. Most are asymptomatic and represent incidental findings at imaging. In some instances, however, these muscles may become clinically relevant producing palpable swelling, entrapment of neurovascular structures, or exercise-related pain. The diagnosis of accessory muscles is based on recognition of their typical location and on cross-sectional imaging features. Familiarity with their most common location and knowledge of the possible clinical syndromes caused by these supernumerary structures may aid in diagnosis and treatment.","author":[{"dropping-particle":"","family":"Martinoli","given":"Carlo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Perez","given":"Maribel Miguel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Padua","given":"Luca","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Valle","given":"Maura","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Capaccio","given":"Enrico","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Altafini","given":"Luisa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Michaud","given":"Johan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tagliafico","given":"Alberto","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Seminars in Musculoskeletal Radiology","id":"ITEM-1","issue":"2","issued":{"date-parts":[["2010"]]},"page":"106-121","title":"Muscle variants of the upper and lower limb (with anatomical correlation)","type":"article-journal","volume":"14"},"uris":[""]}],"mendeley":{"formattedCitation":"⁷⁷","plainTextFormattedCitation":"77","previouslyFormattedCitation":"⁷⁸"},"properties":{"noteIndex":0},"schema":""}77 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1148/rg.282075064","ISBN":"1527-1323","ISSN":"0271-5333","PMID":"18349452","abstract":"A wide array of supernumerary and accessory musculature has been described in the anatomic, surgical, and radiology literature. In the vast majority of cases, accessory muscles are asymptomatic and represent incidental findings at surgery or imaging. In some cases, however, accessory muscles may produce clinical symptoms. These symptoms may be related to a palpable swelling or may be the result of mass effect on neurovascular structures, typically in fibro-osseous tunnels. In cases in which an obvious cause for such symptoms is not evident, recognition and careful evaluation of accessory muscles may aid in diagnosis and treatment.","author":[{"dropping-particle":"","family":"Sookur","given":"Paul a","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Naraghi","given":"Ali M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bleakney","given":"Robert R","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Jalan","given":"Rosy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Otto","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"White","given":"Lawrence M","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiographics : a review publication of the Radiological Society of North America, Inc","id":"ITEM-1","issue":"2","issued":{"date-parts":[["2008"]]},"page":"481-499","title":"Accessory muscles: anatomy, symptoms, and radiologic evaluation.","type":"article-journal","volume":"28"},"uris":[""]}],"mendeley":{"formattedCitation":"⁷⁸","plainTextFormattedCitation":"78","previouslyFormattedCitation":"⁷⁹"},"properties":{"noteIndex":0},"schema":""}78.On plain radiography, accessory muscles may cause displacement of fat planes, but they are rarely diagnostic because of its low soft tissue contrast. The prototype is an accessory soleus muscle, causing obliteration of Kager’s fat pad ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1055/s-0038-1641575","ISSN":"1098898X","PMID":"29791956","abstract":"Accessory muscles and variations are not uncommon at the upper and lower extremity. They are often overlooked because they are asymptomatic and present as incidental findings on imaging. However, they may present as a soft tissue swelling, thereby mimicking soft tissue tumors. Other symptoms are attributed to impingement on neurovascular structures and to exercise-related pain. Thorough knowledge of the anatomy, systematic imaging analysis, and the awareness of it are the clues to correct identification. On ultrasound, accessory muscles have a similar echotexture as other muscles, whereas the signal intensity on magnetic resonance imaging (MRI) is similar to muscle. Because of the intrinsic contrast with the adjacent intermuscular fat, accessory muscles are best depicted on MRI without fat suppression. This article provides a short overview of the anatomy of most prevalent accessory muscles of the upper and lower limb and its potential pathogenic nature.","author":[{"dropping-particle":"","family":"Vanhoenacker","given":"Filip M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Desimpel","given":"Julie","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mespreuve","given":"Marc","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tagliafico","given":"Alberto","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Seminars in Musculoskeletal Radiology","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2018","7","23"]]},"page":"275-285","title":"Accessory Muscles of the Extremities","type":"article-journal","volume":"22"},"uris":[""]}],"mendeley":{"formattedCitation":"⁷⁹","plainTextFormattedCitation":"79","previouslyFormattedCitation":"⁸⁰"},"properties":{"noteIndex":0},"schema":""}79. US and MRI are the preferred imaging modalities for direct identification of accessory muscles. The clues to differentiate accessory muscles from true soft tissue neoplasms are the knowledge of the variant anatomy, their specific location and their similar echotexture and signal to other muscles on US and MRI respectively.When fat suppression (FS) is used, accessory muscles are barely distinguishable from the surrounding structures. Therefore, because of their intrinsic contrast with the adjacent intermuscular fat, accessory muscles are best identified on T1-WI without FS (Fig. 23) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1055/s-0038-1641575","ISSN":"1098898X","PMID":"29791956","abstract":"Accessory muscles and variations are not uncommon at the upper and lower extremity. They are often overlooked because they are asymptomatic and present as incidental findings on imaging. However, they may present as a soft tissue swelling, thereby mimicking soft tissue tumors. Other symptoms are attributed to impingement on neurovascular structures and to exercise-related pain. Thorough knowledge of the anatomy, systematic imaging analysis, and the awareness of it are the clues to correct identification. On ultrasound, accessory muscles have a similar echotexture as other muscles, whereas the signal intensity on magnetic resonance imaging (MRI) is similar to muscle. Because of the intrinsic contrast with the adjacent intermuscular fat, accessory muscles are best depicted on MRI without fat suppression. This article provides a short overview of the anatomy of most prevalent accessory muscles of the upper and lower limb and its potential pathogenic nature.","author":[{"dropping-particle":"","family":"Vanhoenacker","given":"Filip M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Desimpel","given":"Julie","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mespreuve","given":"Marc","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tagliafico","given":"Alberto","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Seminars in Musculoskeletal Radiology","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2018","7","23"]]},"page":"275-285","title":"Accessory Muscles of the Extremities","type":"article-journal","volume":"22"},"uris":[""]}],"mendeley":{"formattedCitation":"⁷⁹","plainTextFormattedCitation":"79","previouslyFormattedCitation":"⁸⁰"},"properties":{"noteIndex":0},"schema":""}79.FATCONTAINING LESIONSMRI is the imaging technique of choice for characterization of adipocytic tumors. CR is rarely diagnostic but may occasionally demonstrate a radiolucent soft tissue mass and/or osseous deformity caused by mass effect (Fig. 24).AIRCONTAINING LESIONSDegenerative disc and joint disease An intervertebral vacuumphenomenon is defined as the presence of gas in the intervertebral disk spaces ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1148/radiology.139.2.7220878","ISSN":"0033-8419","PMID":"7220878","abstract":"\"Vacuum\" phenomena relate to the accumulation of gas, principally nitrogen, in crevices within the intervertebral disk or vertebra. Their appearance does not uniformly indicate \"degenerative\" disk disease (primary intervertebral osteochondrosis), as gaseous collections may accompany other processes (vertebral osteomyelitis, Schmorl node formation, spondylosis deformans, vertebral collapse with osteonecrosis) affecting the disk and adjacent vertebral bodies. The location and appearance of the \"vacuum\" phenomena are helpful indicators as to the precise nature of the spinal disorder.","author":[{"dropping-particle":"","family":"Resnick","given":"D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Niwayama","given":"G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Guerra","given":"J","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vint","given":"V","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Usselman","given":"J","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiology","id":"ITEM-1","issue":"2","issued":{"date-parts":[["1981","5"]]},"page":"341-8","title":"Spinal vacuum phenomena: anatomical study and review.","type":"article-journal","volume":"139"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸⁰","plainTextFormattedCitation":"80","previouslyFormattedCitation":"⁸¹"},"properties":{"noteIndex":0},"schema":""}80. It is a common manifestation of degenerative disc disease ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2214/AJR.10.6359","ISSN":"0361-803X","author":[{"dropping-particle":"","family":"D’Anastasi","given":"Melvin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Birkenmaier","given":"Christof","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schmidt","given":"Gerwin P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wegener","given":"Bernd","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Reiser","given":"Maximilian F.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Baur-Melnyk","given":"Andrea","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"American Journal of Roentgenology","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2011","11"]]},"page":"1182-1189","title":"Correlation Between Vacuum Phenomenon on CT and Fluid on MRI in Degenerative Disks","type":"article-journal","volume":"197"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸¹","plainTextFormattedCitation":"81","previouslyFormattedCitation":"⁸²"},"properties":{"noteIndex":0},"schema":""}81. The gas may be located either at the nucleus pulposus or at the peripheral part of the disc resulting from focal rupture of the annulus fibrosus. MRI is less sensitive than CR or CT to detect vacuum phenomenon ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"PMID":"15055327","abstract":"Although true physical-chemical experimental proofs are lacking in the literature, numerous clinical reports have shown that many radiological manifestations of the so-called vacuum phenomenon (VP) only represent snapshots of a complex dynamic hydropneumatical continuum extending from true vacuum to gas and/or fluid and vice versa. In the great majority of cases, VP remains an incidental accessory or anecdotal finding but, nevertheless, it occasionally represents a useful clinical or radiological sign of critical importance for the understanding, clinical diagnosis, prognosis, and therapeutic implications of several spinal diseases. VP and gas collections have been described in segments of the spine including the disc space, Schmorl nodes and vertebral structures, the epidural and intradural spaces, synovial cysts, and facet joints. In this article the author discusses and illustrates many aspects of VP and gas in the spine through selected examples collected over an 18-month period of time.","author":[{"dropping-particle":"","family":"Coulier","given":"B","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"JBR-BTR ","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2004"]]},"page":"9-16","title":"The spectrum of vacuum phenomenon and gas in spine.","type":"article-journal","volume":"87"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸²","plainTextFormattedCitation":"82","previouslyFormattedCitation":"⁸³"},"properties":{"noteIndex":0},"schema":""}82. Although gas within the disc is usually of low signal intensity on T2-weighted images due to the lack of water protons, a hyperintense signal less than fluid or even fluid-like signal may be seen in patients with a clear intradiscal vacuumphenomenon on plain films or CT ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0361803X","author":[{"dropping-particle":"","family":"D'Anastasi","given":"D'Anastasi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"D'Anastasi","given":"Melvin","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"American Journal of Roentgenology","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2011"]]},"page":"1182-1189","title":"Correlation between vacuum phenomenon on CT and fluid on MRI in degenerative disks","type":"article-journal","volume":"197"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸³","plainTextFormattedCitation":"83","previouslyFormattedCitation":"⁸⁴"},"properties":{"noteIndex":0},"schema":""}83. The presence of fluid or hyperintense signal is correlated to the presence and amount of bone marrow edema and degenerative endplate abnormalities Modic I ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2214/AJR.10.6359","ISSN":"0361-803X","author":[{"dropping-particle":"","family":"D’Anastasi","given":"Melvin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Birkenmaier","given":"Christof","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schmidt","given":"Gerwin P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wegener","given":"Bernd","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Reiser","given":"Maximilian F.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Baur-Melnyk","given":"Andrea","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"American Journal of Roentgenology","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2011","11"]]},"page":"1182-1189","title":"Correlation Between Vacuum Phenomenon on CT and Fluid on MRI in Degenerative Disks","type":"article-journal","volume":"197"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸¹","plainTextFormattedCitation":"81","previouslyFormattedCitation":"⁸²"},"properties":{"noteIndex":0},"schema":""}81. It has been postulated that on MRI in supine position, fluid transudate flows slowly from adjacent edematous endplate into the vacuum cleft. On CT, which takes only a few minutes, the time spent in the supine position is too short for migration of fluid into the vacuum cleft ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2214/AJR.10.6359","ISSN":"0361-803X","author":[{"dropping-particle":"","family":"D’Anastasi","given":"Melvin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Birkenmaier","given":"Christof","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schmidt","given":"Gerwin P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wegener","given":"Bernd","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Reiser","given":"Maximilian F.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Baur-Melnyk","given":"Andrea","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"American Journal of Roentgenology","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2011","11"]]},"page":"1182-1189","title":"Correlation Between Vacuum Phenomenon on CT and Fluid on MRI in Degenerative Disks","type":"article-journal","volume":"197"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸¹","plainTextFormattedCitation":"81","previouslyFormattedCitation":"⁸²"},"properties":{"noteIndex":0},"schema":""}81.This hyperintense signal within the disc in patients with a degenerative vacuum phenomenon should not be confused with early spondylodiscitis.In a similar way, a subtle peripheral vacuumphenomenon in spondylosis deformans may be seen as a hyperintense annular tear on corresponding T2-WI MR images, especially when fluid-sensitive sequences are used.A vacuumphenomenon may also occur in other joints, including the shoulder, wrist, hip, sacroiliac joint, ankle, subtalar joint, and knee ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"1940-5901","PMID":"26064222","abstract":"OBJECTIVES To find the accurate incidence of the vacuum phenomenon in the hip and the best projection position for producing the vacuum phenomenon in plain hip radiographs in children. METHODS All pediatric anteroposterior (AP)-view and frog-leg-position plain hip joint radiographs obtained in our hospital between January 2003 and March 2013 were examined. The subjects' ages ranged between 0 and 14 years (mean, 4.2 years). All of the plain radiographs showing crescent-, linear-, and irregular-shaped lucencies between the femoral head and acetabulum were included in the present study. RESULTS A total of 16,749 cases, including 12,422 cases (5,912 boys and 6,510 girls) with only AP-view plain radiographs and 4,327 cases (1,537 boys and 2,790 girls) with both AP-view and frog-leg-position plain radiographs that were assessed in our hospital between January 2003 and March 2013, were examined. None of the AP-view plain hip radiographs exhibited the vacuum phenomenon. Vacuum phenomenon of the hips was found in only 258 cases (321 hips) in the frog-leg-position plain radiographs of 4,327 cases, resulting in a constituent ratio of 5.96% (258/4327). A total of 1,738 normal children were assessed in the 4,327 frog-leg-position radiographs, and 150 cases of the vacuum phenomenon were found in the normal children; thus, the incidence of the vacuum phenomenon in normal children was 8.63% (150/1,738). In 2,360 children with developmental dysplasia of the hip (DDH) who were assessed in the 4,327 frog-leg-position radiographs, 98 cases of vacuum phenomenon were found, yielding an incidence of 4.15% in children with DDH (98/2,360). Thus, the 258 cases with vacuum phenomenon included 150 normal hips (58.14%), 98 cases with DDH (37.98%), 5 cases with Legg-Calvé-Perthes disease (1.94%), and 1 case each of solitary eosinophilic granuloma in the left ischium (0.39%), polyostotic fibrous dysplasia of the left and right proximal femurs (0.39%), 1 case of hereditary multiple exostoses (0.39%), 1 case of congenital coxa vara (0.39%), and 1 fracture of the femoral neck after surgery (0.39%). The 321 hips in the 258 cases were classified as complete (121 hips, 37.69%) or partial (200 hips, 62.31%) types according to the proportion of the lucency area in the hip joints and as linear (159 hips, 49.53%), crescent (151 hips, 47.04%), or irregular (11 hips, 3.43%) lucencies according to the shape of the lucency area in the hips. CONCLUSIONS The vacuum phenomenon of the hip in children …","author":[{"dropping-particle":"","family":"Liu","given":"Zhenjiang","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Wei","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Lijun","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"International journal of clinical and experimental medicine","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2015"]]},"page":"3325-31","title":"Analysis of the vacuum phenomenon in plain hip radiographs in children.","type":"article-journal","volume":"8"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸⁴","plainTextFormattedCitation":"84","previouslyFormattedCitation":"⁸⁵"},"properties":{"noteIndex":0},"schema":""}84. Its clinical significance is still debated ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1002/ca.22334","ISSN":"08973806","PMID":"24288359","abstract":"Vacuum phenomenon (VP) is an anatomical entity of potential confusion in the diagnosis and evaluation of joint pathology. Observation of this phenomenon has been demonstrated on basic radiographs, computed tomography, and magnetic resonance imaging. Although VP is most often associated with degenerative joint disease, it is observed with other pathologies. Two problematic scenarios can occur: a false-positive diagnosis of serious pathology instead of benign VP and a false-negative diagnosis of benign VP with a more serious underlying process Despite this potential for confusion, criteria for distinguishing VP from other causes of joint pain and for evaluating a suspected case of VP have not been fully established. We reviewed the literature to determine underlying mechanism, symptomology, associated pathologies, and clinical importance of VP. The formation of VP can be explained by gas solubility, pressure-volume relationships, and human physiology. CT, GRE-MRI, and multipositional views are the best imaging studies to view VP. Although most cases of VP are benign, it can be associated with clinical signs and symptoms. VP outside the spine is an underreported finding on imaging studies. VP should be on the differential diagnosis for joint pain, especially in the elderly. We have proposed criteria for diagnosing VP and generated a basic algorithm for its workup. Underreporting of this phenomenon shows a lack of awareness of VP on the part of physicians. By identifying true anatomic VP, we can prevent harm from suboptimal treatment of patients.","author":[{"dropping-particle":"","family":"Gohil","given":"Ishan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vilensky","given":"Joel A.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Weber","given":"Edward C.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Clinical Anatomy","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2014","4"]]},"page":"455-462","title":"Vacuum phenomenon: Clinical relevance","type":"article-journal","volume":"27"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸⁵","plainTextFormattedCitation":"85","previouslyFormattedCitation":"⁸⁶"},"properties":{"noteIndex":0},"schema":""}85.TraumaSoft tissue air may occur in injuries causing leakage of air from a damaged lung or other penetrating (such as open fractures or shotgun wounds), lacerating, or crushing injuries in which the skin is disrupted ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1148/17.6.1158","ISSN":"0033-8419","abstract":"THE absence of radiographic density, or the negative density, of air and gases of all kinds causes them to cast distinctive shadows, familiar to all of us, on X-ray films. In addition to films of parts of the body which normally contain air, on films of any part of the abdomen the shadows of gas or air in the alimentary canal are always present. These vary in size from small bubbles and isolated pockets in the stomach and large intestine to wide inflation of the greater portion of the colon. On films of other parts of the body, however, the presence of shadows cast by air or gas is of rare occurrence. They are always found associated with injuries in which the skin is penetrated, with laceration of the underlying soft tissues, or in injuries which cause leakage of air from a damaged lung. The presence of air in wounds of these kinds is of minor importance, but the detection of gas caused by infections with ana?robic organisms is often of major clinical significance. Except during the World War, the subjec...","author":[{"dropping-particle":"","family":"Rhinehart","given":"D. A.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiology","id":"ITEM-1","issue":"6","issued":{"date-parts":[["1931","12","1"]]},"page":"1158-1170","publisher":" The Radiological Society of North America ","title":"Air and Gas in the Soft Tissues: A Radiologic Study","type":"article-journal","volume":"17"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸⁶","plainTextFormattedCitation":"86","previouslyFormattedCitation":"⁸⁷"},"properties":{"noteIndex":0},"schema":""}86. The latter are always limited to the region of the injury, never extend into uninjured tissue and usually rapidly decrease in size and disappear soon ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1148/17.6.1158","ISSN":"0033-8419","abstract":"THE absence of radiographic density, or the negative density, of air and gases of all kinds causes them to cast distinctive shadows, familiar to all of us, on X-ray films. In addition to films of parts of the body which normally contain air, on films of any part of the abdomen the shadows of gas or air in the alimentary canal are always present. These vary in size from small bubbles and isolated pockets in the stomach and large intestine to wide inflation of the greater portion of the colon. On films of other parts of the body, however, the presence of shadows cast by air or gas is of rare occurrence. They are always found associated with injuries in which the skin is penetrated, with laceration of the underlying soft tissues, or in injuries which cause leakage of air from a damaged lung. The presence of air in wounds of these kinds is of minor importance, but the detection of gas caused by infections with ana?robic organisms is often of major clinical significance. Except during the World War, the subjec...","author":[{"dropping-particle":"","family":"Rhinehart","given":"D. A.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Radiology","id":"ITEM-1","issue":"6","issued":{"date-parts":[["1931","12","1"]]},"page":"1158-1170","publisher":" The Radiological Society of North America ","title":"Air and Gas in the Soft Tissues: A Radiologic Study","type":"article-journal","volume":"17"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸⁶","plainTextFormattedCitation":"86","previouslyFormattedCitation":"⁸⁷"},"properties":{"noteIndex":0},"schema":""}86. The combination of the clinical history and plain films are sufficient for the diagnosis and MRI is not mandatory for this indication.Abscess and necrotizing soft tissue infectionsA soft tissue abscess is a fluid collection surrounded by a well-vascularized fibrous pseudocapsule ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/978-3-319-46679-8_21","ISBN":"9783319466798","abstract":"? Springer International Publishing AG 2017. Mimickers of the soft tissue tumors belong to a large and heterogeneous group of disorders, varying from normal anatomic variants, and other pitfalls such as inflammatory and infectious lesions, reactive lesions that may mimic nerve sheath tumors, posttraumatic lesions, skin lesions, nonneoplastic vascular lesions, metabolic disorders (crystal deposition disease, amyloidosis, and miscellaneous disorders (Geyser phenomenon in long-standing rotator cuff disease, Baker”s cyst, elastofibroma dorsi, pseudohypertrophy of the lower leg due to neurogenic compression, etc.). Classification of these pseudotumors remains still a matter of debate. Many of these lesions are reactive or self-limiting without the need for further investigation or significant intervention. The imaging approach is often very similar to the approach of “true” soft tissue tumoral counterparts Knowledge of the normal anatomy and existence and common presentation of these diseases, in combination with the relevant clinical findings (clinical history, location, skin changes), enables the correct diagnosis in most cases, thereby limiting the need for invasive procedures. Biopsy should be performed in doubtful cases.","author":[{"dropping-particle":"","family":"Vanhoenacker","given":"Filip M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mechri Rekik","given":"Meriem","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Salgado","given":"Rodrigo","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Imaging of Soft Tissue Tumors","edition":"4th","editor":[{"dropping-particle":"","family":"Vanhoenacker","given":"Filip M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parizel","given":"Paul M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gielen","given":"Jan L","non-dropping-particle":"","parse-names":false,"suffix":""}],"id":"ITEM-1","issued":{"date-parts":[["2017"]]},"page":"523-575","publisher":"Springer International Publishing","publisher-place":"Cham","title":"Pseudotumoral lesions","type":"chapter"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸⁷","plainTextFormattedCitation":"87","previouslyFormattedCitation":"⁸⁸"},"properties":{"noteIndex":0},"schema":""}87. On conventional radiography, a soft tissue abscess may cause potential distortion of normal muscle anatomy and fascial planes. This nonspecific sign is of little value, unless there is intralesional gas development in case of gas-forming infection. Therefore, the diagnosis is usually made on ultrasound, CT or MRI. On MR, an abscess is hypointense to isointense relative to muscle tissue on T1-WI. On T2-WI, the central portion of the abscess is usually hyperintense. Central pus collection may cause diffusion restriction. The inflammatory pseudocapsule can have a variable signal intensity compared to skeletal muscle on T1-WI. A thick and irregular enhancing peripheral rim, corresponds to the inflammatory and cellular component of the abscess. Peripheral edema in muscle and subcutaneous tissue is hyperintense on T2-WI ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2214/ajr.144.6.1217","ISSN":"0361-803X","PMID":"3873805","abstract":"Ten patients with percutaneous biopsy or surgically proven abscesses were evaluated with magnetic resonance imaging (MRI) to describe the appearance of abscesses, define the capability of MRI to localize abscesses, and compare the capabilities of MRI and CT for the diagnosis and determination of the extent of an abscess. Comparative CT scans were available in six cases. The most common MRI finding was an abnormal area of low signal intensity, either homogeneous or heterogeneous, on the short repetition rate (500 msec TR) images with a relative increase in signal intensity on the longer repetition rate (1500 or 2000 msec TR) images. MRI demonstrated a more clear delineation of the extent of inflammatory changes than did CT, and MRI demonstrated the abscess as a collection distinct from surrounding structures on at least one repetition rate. Intravenous contrast medium was unnecessary with MRI to evaluate vasculature or to define the capsule around an abscess. With CT, unless an abscess contained air or was of low attenuation, it often blended with the surrounding structures and was difficult to differentiate from them. Surgical clips in the postoperative patient with an abscess did not degrade the MR images as often occurred with CT. This study describes the MRI appearance of abscess and indicates a potential value of the use of MRI to evaluate abscess outside the central nervous system and spine.","author":[{"dropping-particle":"","family":"Wall","given":"S D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fisher","given":"M R","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amparo","given":"E G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hricak","given":"H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Higgins","given":"C B","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"AJR. American journal of roentgenology","id":"ITEM-1","issue":"6","issued":{"date-parts":[["1985","6"]]},"page":"1217-21","title":"Magnetic resonance imaging in the evaluation of abscesses.","type":"article-journal","volume":"144"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸⁸","plainTextFormattedCitation":"88","previouslyFormattedCitation":"⁸⁹"},"properties":{"noteIndex":0},"schema":""}88.Intralesional gas bubbles may cause inhomogeneity on T2-weighted images with intralesional foci of signal void ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2214/ajr.144.6.1217","ISSN":"0361-803X","PMID":"3873805","abstract":"Ten patients with percutaneous biopsy or surgically proven abscesses were evaluated with magnetic resonance imaging (MRI) to describe the appearance of abscesses, define the capability of MRI to localize abscesses, and compare the capabilities of MRI and CT for the diagnosis and determination of the extent of an abscess. Comparative CT scans were available in six cases. The most common MRI finding was an abnormal area of low signal intensity, either homogeneous or heterogeneous, on the short repetition rate (500 msec TR) images with a relative increase in signal intensity on the longer repetition rate (1500 or 2000 msec TR) images. MRI demonstrated a more clear delineation of the extent of inflammatory changes than did CT, and MRI demonstrated the abscess as a collection distinct from surrounding structures on at least one repetition rate. Intravenous contrast medium was unnecessary with MRI to evaluate vasculature or to define the capsule around an abscess. With CT, unless an abscess contained air or was of low attenuation, it often blended with the surrounding structures and was difficult to differentiate from them. Surgical clips in the postoperative patient with an abscess did not degrade the MR images as often occurred with CT. This study describes the MRI appearance of abscess and indicates a potential value of the use of MRI to evaluate abscess outside the central nervous system and spine.","author":[{"dropping-particle":"","family":"Wall","given":"S D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fisher","given":"M R","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amparo","given":"E G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hricak","given":"H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Higgins","given":"C B","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"AJR. American journal of roentgenology","id":"ITEM-1","issue":"6","issued":{"date-parts":[["1985","6"]]},"page":"1217-21","title":"Magnetic resonance imaging in the evaluation of abscesses.","type":"article-journal","volume":"144"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸⁸","plainTextFormattedCitation":"88","previouslyFormattedCitation":"⁸⁹"},"properties":{"noteIndex":0},"schema":""}88 (Fig. 25) . Pedal abscesses in diabetic foot are nearly always due to contiguous spread from an adjacent skin ulcer or sinus tract. The sinus tract and necrotic center of the abscess may show gas and air-fluid levels on plain radiographs. Ulcerations are seen on MRI as defects of skin and/or subcutaneous tissue and may be surrounded by “heaped-up” edges.Sinus tracts appear as thin bands of high signal on T2-WI with a “tram-track” appearance on contrast-enhanced fatsuppresssed T1-WI due to enhancement of the margins of the sinus tract. Associated osteomyelitis is frequently seen ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1259/bjr.20150135","ISSN":"1748-880X","PMID":"26111070","abstract":"Diabetic complications in the lower extremity are associated with significant morbidity and mortality, and impact heavily upon the public health system. Early and accurate recognition of these abnormalities is crucial, enabling the early initiation of treatments and thus avoiding or minimizing deformity, dysfunction and amputation. Following careful clinical assessment, radiological imaging is central to the diagnostic and follow-up process. We aim to provide a comprehensive review of diabetic lower limb complications designed to assist radiologists and to contribute to better outcomes for these patients.","author":[{"dropping-particle":"","family":"Naidoo","given":"P","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Liu","given":"V J","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mautone","given":"M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bergin","given":"S","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The British journal of radiology","id":"ITEM-1","issue":"1053","issued":{"date-parts":[["2015","9"]]},"page":"20150135","publisher":"British Institute of Radiology","title":"Lower limb complications of diabetes mellitus: a comprehensive review with clinicopathological insights from a dedicated high-risk diabetic foot multidisciplinary team.","type":"article-journal","volume":"88"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸⁹","plainTextFormattedCitation":"89","previouslyFormattedCitation":"⁹⁰"},"properties":{"noteIndex":0},"schema":""}89. Necrotizing soft tissue infections (NSTIs) are rapidly progressive and lead to sepsis, multi-system organ failure, and sometimes death ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.suc.2018.05.001","ISSN":"00396109","PMID":"30243450","abstract":"Necrotizing soft tissue infections (NSTI) are characterized by rapidly progressive infection that causes tissue necrosis with associated sepsis and multisystem organ failure. A rapid diagnosis is essential to decreasing the morbidity and mortality of NSTIs. There must be a high index of suspicion based on history and physical examination. There are no adjunct laboratory values or imaging that have high sensitivity and specificity in the diagnosis of NSTI. The treatment involves emergent, radical surgical debridement of involved tissues and broad spectrum antibiotics. Follow-up should include close monitoring of the wound and repeat debridements in the operating room.","author":[{"dropping-particle":"","family":"Garcia","given":"Nicole M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cai","given":"Jenny","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Surgical Clinics of North America","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","10"]]},"page":"1097-1108","title":"Aggressive Soft Tissue Infections","type":"article-journal","volume":"98"},"uris":[""]}],"mendeley":{"formattedCitation":"⁹⁰","plainTextFormattedCitation":"90","previouslyFormattedCitation":"⁹¹"},"properties":{"noteIndex":0},"schema":""}90. Air tracking on plain films or CT along the soft tissue can also indicate aggressive NSTIs that need urgent surgical debridement ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.11604/pamj.2017.26.149.11393","ISSN":"1937-8688","PMID":"28533872","author":[{"dropping-particle":"","family":"Gomes","given":"Diogo Carrola","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Quaresma","given":"Luísa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Pan African medical journal","id":"ITEM-1","issued":{"date-parts":[["2017"]]},"page":"149","publisher":"African Field Epidemiology Network","title":"Plain x-ray films in soft tissue infections.","type":"article-journal","volume":"26"},"uris":[""]}],"mendeley":{"formattedCitation":"⁹¹","plainTextFormattedCitation":"91","previouslyFormattedCitation":"⁹²"},"properties":{"noteIndex":0},"schema":""}91. Identifying gas on radiographs or CT images has a high specificity but low sensitivity for NSTI (2) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2214/ajr.144.6.1217","ISSN":"0361-803X","PMID":"3873805","abstract":"Ten patients with percutaneous biopsy or surgically proven abscesses were evaluated with magnetic resonance imaging (MRI) to describe the appearance of abscesses, define the capability of MRI to localize abscesses, and compare the capabilities of MRI and CT for the diagnosis and determination of the extent of an abscess. Comparative CT scans were available in six cases. The most common MRI finding was an abnormal area of low signal intensity, either homogeneous or heterogeneous, on the short repetition rate (500 msec TR) images with a relative increase in signal intensity on the longer repetition rate (1500 or 2000 msec TR) images. MRI demonstrated a more clear delineation of the extent of inflammatory changes than did CT, and MRI demonstrated the abscess as a collection distinct from surrounding structures on at least one repetition rate. Intravenous contrast medium was unnecessary with MRI to evaluate vasculature or to define the capsule around an abscess. With CT, unless an abscess contained air or was of low attenuation, it often blended with the surrounding structures and was difficult to differentiate from them. Surgical clips in the postoperative patient with an abscess did not degrade the MR images as often occurred with CT. This study describes the MRI appearance of abscess and indicates a potential value of the use of MRI to evaluate abscess outside the central nervous system and spine.","author":[{"dropping-particle":"","family":"Wall","given":"S D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fisher","given":"M R","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amparo","given":"E G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hricak","given":"H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Higgins","given":"C B","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"AJR. American journal of roentgenology","id":"ITEM-1","issue":"6","issued":{"date-parts":[["1985","6"]]},"page":"1217-21","title":"Magnetic resonance imaging in the evaluation of abscesses.","type":"article-journal","volume":"144"},"uris":[""]}],"mendeley":{"formattedCitation":"⁸⁸","plainTextFormattedCitation":"88","previouslyFormattedCitation":"⁸⁹"},"properties":{"noteIndex":0},"schema":""}88.The overall role of MRI in the diagnosis of NSTI is very limited ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.suc.2018.05.001","ISSN":"00396109","PMID":"30243450","abstract":"Necrotizing soft tissue infections (NSTI) are characterized by rapidly progressive infection that causes tissue necrosis with associated sepsis and multisystem organ failure. A rapid diagnosis is essential to decreasing the morbidity and mortality of NSTIs. There must be a high index of suspicion based on history and physical examination. There are no adjunct laboratory values or imaging that have high sensitivity and specificity in the diagnosis of NSTI. The treatment involves emergent, radical surgical debridement of involved tissues and broad spectrum antibiotics. Follow-up should include close monitoring of the wound and repeat debridements in the operating room.","author":[{"dropping-particle":"","family":"Garcia","given":"Nicole M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cai","given":"Jenny","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Surgical Clinics of North America","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","10"]]},"page":"1097-1108","title":"Aggressive Soft Tissue Infections","type":"article-journal","volume":"98"},"uris":[""]}],"mendeley":{"formattedCitation":"⁹⁰","plainTextFormattedCitation":"90","previouslyFormattedCitation":"⁹¹"},"properties":{"noteIndex":0},"schema":""}90. ConclusionsAlthough MRI is nowadays the preferred imaging modality for evaluation of soft tissue lesions, knowledge and meticulous analysis of often subtle soft tissue signs on conventional radiography may be helpful to select patients that need to be referred for subsequent MRI. In addition, certain plain film findings, such as intralesional calcification or gas may allow to make to a more specific tissue diagnosis and may obviate the need for invasive diagnostic procedures and potential harmful treatment.Key points, Pearls, Pitfalls, VariantsPlain films have a low sensitivity is the diagnosis of soft tissue tumors or tumor-like conditions, but the presence of intralesional soft tissue calcification may be useful for tissue specific diagnosis e.g. in case of myositis ossificans or slow flow vascular malformations (hemangiomas).Mineralization in myositis ossificans follows a time-dependent centripetal pattern from the periphery towards the center. The mineralization pattern in extraskeletal osteosarcoma (ESO) is more amorphous and occurs from the center to the periphery. The clinical history of trauma is not also present in myositis ossificans. Calcific myonecrosis may present several year after trauma.MRI and histology may simulate ESO in the early stage of myositis ossificans. Biopsy should be avoided in the early stage of myositis ossificans.The use of fatsuppression may decrease conspicuity of accessory muscles.Although plain films have a low sensitivity in the diagnosis of soft tissue infections, the presence of intralesional air may enhance the specificity of gas forming infection and of necrotizing soft tissue infections.What the referring physician needs to knowMRI is the preferred imaging modality for evaluation of most soft tissue lesions, due to its high soft tissue contrast.Although plain radiography is not very sensitive, identification of certain macroscopic components within the lesion, may allow a more specific diagnosis. The presence of intralesional calcifications and air yield the greatest diagnostic value. In this regard, plain radiographs may be complementary to MRI for characterization of certain soft tissue lesions such as myositis ossificans, calcifying myonecrosis, calcified soft tissue tumors and gas forming infection. MRI and histology may simulate ESO in early myositis. In any case of suspected myositis ossificans, biopsy should be avoided and repeated evaluation by serial radiography or US is mandatory. As intra-ocular metal fragments, bullets and shrapnel may cause the risk of retinal detachment in MRI, patients who have worked with sheet metal or ammunition, intra-ocular metal fragments should be ruled out by radiographs prior to the MR examination.ReferencesADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY 1. Botchu R, James SL, Davies AM. Radiography and Computed Tomography. In: Vanhoenacker FM, Parizel PM, Gielen JL, eds. Imaging of Soft Tissue Tumors. 4th ed. Cham: Springer International Publishing; 2017:41-57. doi:10.1007/978-3-319-46679-8_2.2. Cho S-J, Horvai A. Chondro-Osseous Lesions of Soft Tissue. Surg Pathol Clin. 2015;8(3):419-444. doi:10.1016/j.path.2015.05.004.3. Freire V, Moser TP, Lepage-Saucier M. 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Cystic lesion around the hip joint. World J Orthop. 2015;6(9):688. doi:10.5312/wjo.v6.i9.688.76. Khodaee M. Common Superficial Bursitis. Am Fam Physician. 2017;95(4):224-231.77. Martinoli C, Perez MM, Padua L, et al. Muscle variants of the upper and lower limb (with anatomical correlation). Semin Musculoskelet Radiol. 2010;14(2):106-121. doi:10.1055/s-0030-1253155.78. Sookur P a, Naraghi AM, Bleakney RR, Jalan R, Chan O, White LM. Accessory muscles: anatomy, symptoms, and radiologic evaluation. Radiographics. 2008;28(2):481-499. doi:10.1148/rg.282075064.79. Vanhoenacker FM, Desimpel J, Mespreuve M, Tagliafico A. Accessory Muscles of the Extremities. Semin Musculoskelet Radiol. 2018;22(3):275-285. doi:10.1055/s-0038-1641575.80. Resnick D, Niwayama G, Guerra J, Vint V, Usselman J. Spinal vacuum phenomena: anatomical study and review. Radiology. 1981;139(2):341-348. doi:10.1148/radiology.139.2.7220878.81. D’Anastasi M, Birkenmaier C, Schmidt GP, Wegener B, Reiser MF, Baur-Melnyk A. Correlation Between Vacuum Phenomenon on CT and Fluid on MRI in Degenerative Disks. Am J Roentgenol. 2011;197(5):1182-1189. doi:10.2214/AJR.10.6359.82. Coulier B. The spectrum of vacuum phenomenon and gas in spine. JBR-BTR . 2004;87(1):9-16.83. D’Anastasi D, D’Anastasi M. Correlation between vacuum phenomenon on CT and fluid on MRI in degenerative disks. Am J Roentgenol. 2011;197(5):1182-1189.84. Liu Z, Yan W, Zhang L. Analysis of the vacuum phenomenon in plain hip radiographs in children. Int J Clin Exp Med. 2015;8(3):3325-3331.85. Gohil I, Vilensky JA, Weber EC. Vacuum phenomenon: Clinical relevance. Clin Anat. 2014;27(3):455-462. doi:10.1002/ca.22334.86. Rhinehart DA. Air and Gas in the Soft Tissues: A Radiologic Study. Radiology. 1931;17(6):1158-1170. doi:10.1148/17.6.1158.87. Vanhoenacker FM, Mechri Rekik M, Salgado R. Pseudotumoral lesions. In: Vanhoenacker FM, Parizel PM, Gielen JL, eds. Imaging of Soft Tissue Tumors. 4th ed. Cham: Springer International Publishing; 2017:523-575. doi:10.1007/978-3-319-46679-8_21.88. Wall SD, Fisher MR, Amparo EG, Hricak H, Higgins CB. Magnetic resonance imaging in the evaluation of abscesses. AJR Am J Roentgenol. 1985;144(6):1217-1221. doi:10.2214/ajr.144.6.1217.89. Naidoo P, Liu VJ, Mautone M, Bergin S. Lower limb complications of diabetes mellitus: a comprehensive review with clinicopathological insights from a dedicated high-risk diabetic foot multidisciplinary team. Br J Radiol. 2015;88(1053):20150135. doi:10.1259/bjr.20150135.90. Garcia NM, Cai J. Aggressive Soft Tissue Infections. Surg Clin North Am. 2018;98(5):1097-1108. doi:10.1016/j.suc.2018.05.001.91. Gomes DC, Quaresma L. Plain x-ray films in soft tissue infections. Pan Afr Med J. 2017;26:149. doi:10.11604/pamj.2017.26.149.11393.Table 1: Radiographic grayscale of macroscopic components occurring in soft tissue lesions.GrayscaleSoft tissue componentBlackAirDark grayFatLight grayWater and most other soft tissueWhite (moderate)Calcification, ossificationWhite (marked)Metal, IronTable 2: Radiographic-MR correlation of synovial chondromatosis StageRadiographsT1-WIT2-WIEarlyNormalHypointense joint fluidHyperintense increased joint fluidIntermediateNormalNodules isointense with muscleNodules of high signalLate stage calcified nodulesCalcified nodulesLow signal nodulesLow signal nodulesLate stage ossified nodulesOssified nodules with concentric ringsRinglike nodules containing central fatRinglike nodules containing alternating fat and cartilageTable 3: Most common soft tissue tumors with intralesional mineralization. Benign tumorsLipoma (chondrolipoma variant)HemangiomaExtraskeletal chondromaTumors of intermediate malignancyOssifying fibromyxoid tumorMalignant tumorsMetastasis of carcinomaLiposarcomaLeiomyosarcomaLow grade fibromyxoid sarcomaExtraskeletal osteosarcomaMesenchymal chondrosarcomaExtraskeletal myxoid chondrosarcomaCaptions to figuresFig. 1. Chronic calcified infrapatellar bursitis. Lateral radiograph of the right knee (A) shows multiple amorphous calcifications in a prepatellar soft tissue mass (white arrow). Sagittal T1-WI (B) and sagittal fatsuppressed T2-WI (C). The calcifications are hypointense on both pulse sequences, but the number and extent of the calcifications is less conspicuous on MRI?than on plain films. Fig. 2. Calcifying tendinopathy of the gluteus maximus in a patient presenting with pain at the right upper leg. A metastasis at the right femur was suspected on bone scintigraphy. AP radiograph of the right upper leg (A) showing calcification adjacent to the posterolateral cortex of the right femoral diaphysis (white arrow). Axial CT image (B) of the right femur confirms calcifications (long white arrow) with heterogeneous density at the distal insertion of the gluteus maximus at the linea aspera. Note a small intracortical lucency (short black arrow). Axial fatsuppressed T1-WI after administration of gadolinium contrast (C). There is thickening and heterogenous enhancement of the tendon (long white arrow) and a subtle intracortical focus of enhancement in the posterior femoral cortex (short white arrow). Fig. 3. BCP deposition in the medial collateral ligament of the knee with surrounding inflammation. AP radiograph of the left knee (A) showing irregular delineated calcifications adjacent to the medial femoral condyle (white arrow). Coronal fatsuppressed T2-WI (B). Foci of low signal anterior to the femoral insertion of the medial collateral ligament with surrounding strands of high signal indicating inflammatory reaction (white arrow).Fig. 4. Calcifying tendinopathy of the longus colli in a 37-year-old patient presenting with marked neck pain. Axial CT (soft tissue window) image (A) showing a retropharyngeal collection tissue mass (white arrow). Axial (B) and sagittal reformatted CT (bone window) (C) shows amorphous calcifications underneath the anterior arc of C1 at the attachment of the right m. longus colli. The calcification is ill-defined, which indicates an acute inflammatory reaction (white arrows). Fig. 5. Chondrocalcinosis mimicking a meniscus tear. AP radiograph of the left knee (A) showing chondrocalcinosis in the medial and lateral meniscus (white arrows) and the articular cartilage of the lateral femoral condyle (white arrowhead). Coronal fatsuppressed T2-WI (B). High signal intensity band extending to the inferior border of the medial meniscus simulating a meniscus tear (white arrow).Fig. 6. Fibro-osteosis at the distal quadriceps tendon insertion. Lateral radiograph of the left knee (A). Sagittal T1-WI (B). Sagittal fatsuppressed T2-WI (C). Note a focal bony excrescence best seen on plain films (white arrow). On T1-WI, the lesion contains yellow bone marrow (white arrow), whereas on FS T2-WI, the lesion is barely visible due to the lack of contrast of the fibro-osteosis with the fibers of the quadriceps tendon (white arrow).Fig. 7. Mixed connective tissue disease. Plain radiograph of the right lower leg (A). Extensive soft tissue calcification in the anterior and posterior compartment. Note also postsurgical arthrodesis of the right knee. Axial T1-WI of the right lower leg (B) shows hypointense areas adjacent to the fascia cruris anteriorly (white long arrow) and at the intermuscular fascia between the soleus and lateral gastrocnemius muscle (white arrowheads). Axial FS T2-WI of both lower legs shows bilateral hypointense areas adjacent to the fascia cruris (white long arrow) and in the calf muscles (white arrowheads). Fig. 8. Primary osteochondromatosis of the right hip in a 51-year-old patients presenting with a decreased range of motion of the right hip. Initial plain radiograph (A) shows no abnormalities. Coronal fatsuppressed T2-WI (B) 5 weeks later shows a subtle increase of fluid in the right hip (white long arrow) compared to the left hip. Coronal fatsuppressed T2-WI (C) 4 years later showing persisting joint effusion at the right hip and multiple intra-articular nodules (white long arrow). Note also an erosion at the lateral femoral neck. Plain radiograph at that moment (D) shows sclerotic delineated erosions at the anterolateral aspect of the femoral neck (white long arrow), although the intra-articular nodules are not calcified.Fig. 9. Secondary osteochondroma mimicking a displaced meniscus fragment on MRI. Coronal fatsuppressed T2-WI (A) shows a hypointense fragment underneath the medial collateral ligament mimicking a displaced meniscus fragment (white long arrow). The medial meniscus is shortened due to previous partial meniscectomy (white arrowhead). Correlation with plain radiographs (B) shows an ossified fragment adjacent to the medial femoral condyle (white long arrow). Note also narrowing of the joint space due to cartilage loss (white arrowhead).Fig. 10. Secondary synovial osteochondromatosis of the elbow. Plain radiographs (A) show multiple intra-articular ossified nodules (white long arrow). There is osteophyte formation at the radial neck (black arrowhead). On sagittal fatsuppressed T2-WI, these nodules have a mixed signal consisting of central high signal and a peripheral rim of low signal. The central core of high signal correlates with cartilage, whereas the peripheral rim consists of ossification (B). Note also increased joint fluid.Fig. 11. Myositis ossificans in a soccer player 4 weeks after a blunt trauma. Lateral plain film of the right femur (A) shows a prefemoral shell-like calcification perpendicular to the femoral diaphysis (white long arrow). Sagittal T1-WI (B) and sagittal fatsuppressed T2-WI (C) 1 week later. The lesion is heterogeneous on both pulse sequences and has a nonspecific signal intensity (white long arrow). Intralesional calcifications are difficult to appreciate. The lesion is surrounded by edema. Lateral plain film or the right femur (D) 6 weeks after the first radiograph show further maturation and ossification (white long arrow). Lateral plain films or the right femur (E) 12 month later shows marked decrease of the ossification and fusion with the underlying cortex of the femur (white long arrow). Fig. 12. Myositis ossificans in 27-year-old male. Radiograph of the pelvis 2 months after a blunt trauma at the right gluteus region (A) shows a subtle radiodensity with faint calcifications (white long arrow). Coronal T1-WI (B) and coronal fatsuppressed T2-WI (C) 5 weeks later. The lesion is heterogeneous on both sequences and contains foci of low signal in keeping with calcifications (white long arrow). There is some perilesional oedema on the T2-WI. Axial CT (D) at the same moment shows mature ossification in the right gluteus minimus (white long arrow). ?Fig. 13. Calcifying myonecrosis. Anteroposterior (A) and lateral radiograph of the right lower leg (B) showing typical plate-like calcifications along with longitudinal axis of the muscle in the anterior compartment of the right lower leg (white arrows). FS T2-WI (C) of another patient shows a low signal in the anterior and lateral compartment of the right lower leg white arrow). The central part is of intermediate signal, which is more pronounced in the lateral compared tto the anterior compartment. Fig. 14. Venous calcifications due to previous venous thrombosis. Sagittal T1-WI (A) and fatsuppressed T2-WI (A) shows a focus of low signal on both pulse sequences within the gastrocnemius muscles (white arrow), which is difficult to characterize on MRI. Correlation with plain radiographs (C) shows bilateral serpiginous calcification in keeping with old calcified thrombi (white arrows).Fig. 15. Secondary tumoral calcinosis due to chronic renal failure. Plain radiograph of the left hip shows a large lobulated calcified mass adjacent to the greater trochanter (white arrow) (A). Coronal reformatted CT (B) shows cortical destruction of the greater trochanter with extension of calcifications within the adjacent medullary cavity (white arrow).Used with permission from Van Muylder L, Declercq H, Vanhoenacker FM.Secondary tumoral calcinosis with intraosseous extension.JBR-BTR. 2013 Jan-Feb;96(1):50. Fig. 16. Soft tissue hemangioma. Lateral radiograph of the right lower leg (A) showing multiple phleboliths within the posterior compartment of the lower leg (white arrows). The lesion contains also some interspersed fat. Sagittal fatsuppressed T2-WI (B) and axial T1-WI (C). The mass has a multilobular appearance (white arrow), has a high signal on T2-WI and is interspersed with fat (white arrowheads). Phleboliths are more conspicuous on CR.Fig. 17. Soft tissue chondroma. Lateral radiograph of the right third finger (A) showing a nodular soft tissue lesion at the extensor side of first phalanx with intralesional ring-and-arc calcifications. Sagittal fatsuppressed T2-WI (B). The lesion is of low signal at its central part, whereas it is of high signal at the periphery. Fig. 18. Tiny metal particles within the soft tissues due to previous surgery at the ankle. Sagittal T1-WI (A) and fatsuppressed T2-WI (A) shows metal artefacts within Kager’s fad pad (white arrows). Correlation with plain radiographs of the right ankle (C) shows multiple tiny metal particles (white arrow).Fig. 19. Tophaceous gout. Radiograph of the left foot (A). Note extensive erosions with overhanging edges at the first metatarsophalangeal joint (white arrow). The adjacent soft tissue swelling has an increased density compared to the surrounding soft tissues. Sagittal T1-WI (B). Sagittal fatsuppressed T2-WI (C). Subtraction image of sagittal fatsuppressed T1-WI before and after administration of gadolinium contrast (D). Tophi are of heterogeneous signal intensity on both pulse sequences (white arrows) and there is heterogenous contrast enhancement (white arrows). Fig. 20. Localized Nodular Synovitis of Hoffa’s fad pad. Lateral radiograph of the right knee (A). Sagittal T1-WI (B). Sagittal fatsuppressed T2-WI (C). Sagittal gradientecho imaging (D). Sagittal FS T1-WI after gadolinium contrast (E). Nodular mass within Hoffa’s fad pad (white arrows). The lesion is isointense to muscle on T1-WI, heterogeneous on T2-WI and there is marked blooming artefact on gradient echo imaging. Note marked enhancement after gadolinium contrast.Fig. 21. Arthrosynovial cyst of left wrist. Lateral radiograph of the left wrist (A) showing a nonspecific soft tissue swelling at the dorsal aspect of the wrist (white arrow). Sagittal T2-WI (B). The lesion is of high signal and there is a connecting stalk to the radiocarpal compartment (white arrow). Fig. 22. Adventitious bursa resulting from chronic friction in a skater. Anteroposterior radiograph of the left ankle (A) showing a nonspecific soft tissue mass at the medial malleolus (white arrow). Coronal fatsuppressed T2-WI (B) reveals a fluid-filled bursa (white arrow). Fig. 23. Accessory soleus. Lateral radiograph of the right ankle (A) shows partial obliteration of Kager’s fad pad (white arrow). Sagittal T1-WI (B) and FS T2-WI (C) reveals an accessory soleus (white arrow) The lesion is most conspicuous on non fatsuppressed images. The lesion has a similar signal intensity to muscle on MRI and has a muscular architecture on ultrasound (white arrow) (D).Fig. 24. Intramuscular abscess. Anteroposterior radiograph of the left lower leg (A) shows soft tissue gas lateral to the fibula (white arrow) Axial contrast-enhanced CT (B) showing intramuscular collections with peripheral rim enhancement in the anterior, lateral and posterior compartments with intralesional gas (white arrow). Corresponding axial T2-WI. The intralesional gas bubbles are of low signal (white arrow), but their identification and correct interpretation is less straightforward on MRI compared to CT.Fig. 25. Intramuscular lipoma. Lateral radiograph of the right upper leg shows a well-defined lesion with similar density of the subcutaneous fat (white arrow). (A). Axial T1-WI (B) and axial FS T1-WI (C) confirms the lipomatous nature of the lesion with a signal intensity similar to subcutaneous fat (white arrows). ................
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