RPS 2010 - Imaging of injuries and instabilities of the peripheral joints

Author Block: N. M. I. Obeidat¹, R. Khasawneh¹, S. Bani Essa¹, M. Alkhatatba¹, A. Abdel Kareem¹, M. Al-Na'Asan¹, Y. Alshgerat¹, M. Aljarrah¹, L. Sawalha²; ¹Irbid/JO, ²Amman/JO
Purpose: To investigate the MRI findings of patients presenting with SIRVA after COVID-19 vaccination and to assess the associations between these findings and patient demographics, clinical symptoms, and vaccine-related factors.
Methods or Background: A retrospective cross-sectional study involved patients who reported shoulder disorders following COVID-19 vaccination between 1 May 2021 and 1 May 2022. Data collected included demographics, clinical symptoms, vaccination details, and MRI findings. Statistical analyses assessed associations between MRI findings and patient demographics, clinical symptoms, and vaccine-related factors. Chi-square tests and t-tests were utilized, with statistical significance set at p < 0.05 and trends noted at p < 0.1.
Results or Findings: 35 patients were diagnosed with SIRVA (3 had bilateral involvement; mean age 53.6 ± 9.0 years; 54.3% females). The majority developed symptoms within 24 hours post-vaccination (88%), most of them resolved within a week (84%). Pain was the predominant symptom (51.4%). MRI findings were subacromial bursitis (89.5%), enthesial erosions (63.2%), tendinopathy (47.4%), rotator cuff tears and changes of adhesive capsulitis (each 36.8%), effusion (23.7%), as well as muscle and bone marrow edema (10.5% and 7.9%, respectively). Statistically significant associations were found between tendinopathy and both, older age (p=0.024) and AstraZeneca vaccine (p=0.033), subacromial bursitis with both female gender (p=0.013) and higher BMI (p=0.023), and between changes of adhesive capsulitis and Sinopharm vaccine (p=0.029). Non-diabetics, females, and patients with tendinopathy, were more likely to have persistent symptoms after 3 years following vaccination.
Conclusion: SIRVA following COVID-19 vaccination results in different shoulder pathologies apparent on MRI, many of which are strongly related to patient demographics and type of vaccine administered. Awareness of SIRVA changes among radiologists is paramount, especially in seasons of vaccination campaigns such as in early winter (flu-vaccines).
Limitations: Retrospective study and small patient sample.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Retrospective study.

Author Block: I. Blom¹, N. Mathijssen², G. Kraan²; ¹Delft/NL, ²Zoetermeer/NL
Purpose: To assess the ability to lower the radiation dose in four-dimensional computed tomography (4DCT) for assessment of scapholunate (SL) instability without compromising diagnostic quality.
Methods or Background: Scapholunate (SL) instability can be diagnosed using 4DCT. However, CT comes with increased radiation exposure compared to other diagnostic imaging tools. Therefore, six randomly chosen cadaveric human hand specimens were scanned using an automatic device simulating radial-ulnar deviation. Parameters affecting radiation dose—scanning time, scan range, tube current (mAs), and tube voltage (kVp)—were varied and compared to clinical settings. Effective dose (ED) and image noise were assessed for all performed scans. Image noise was measured in soft tissue and cortical bone, since cortical bone was used for segmentation. Three medical specialists analyzed image quality and diagnostic value using a 5-point Likert scale.
Results or Findings: The ED was 0.081 mSv under standard clinical settings. Reducing the scan range to 80 mm (including all carpal bones) decreased the ED to 0.038 mSv. Further reduction to 0.004 mSv was achieved by shortening the scanning time and lowering the tube current. Lowering tube current increased image noise in soft tissue, but reduced noise in cortical bone. Adjusting scanning time and scan range did not affect image noise. Image quality was deemed diagnostically acceptable for low dose 4DCT by all observers, even 22 percent of the scans were deemed as excellent image quality.
Conclusion: A low-dose 4DCT protocol for SL instability seems feasible without compromising diagnostic image quality compared to other imaging tools. Further research is needed to explore low-dose 4DCT for other indications.
Limitations: The limitations of the study are a human cadaveric study and a questionaire based on 1 question.
Funding for this study: No fundings were received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: None.

Author Block: X. Liu; Zhengzhou, Henan Province, China/CN
Purpose: To explore the potential of combining the iterative metal artifact reduction (iMAR) algorithm with cinematic volume rendering technique (cVRT) in photon-counting CT for assessing hip replacements.
Methods or Background: A retrospective study was conducted on 120 patients who underwent hip arthroplasty exams using the photon-counting CT scanner (NAEOTOM Alpha). Reconstruction of CT images employing conventional methods, volume rendering (VR), and cVRT, both with and without iMAR. Measurements of CT numbers and standard deviations (SDs) in regions of interest (ROIs) were obtained. Objective image quality and subjective scores were assessed using established scales. Statistical analyses included paired T tests, Mann-Whitney U tests, and Kappa tests.
Results or Findings: Compared with the non-iMAR group, the iMAR group showed significantly decreased and increased CT numbers in hyperattenuating and hypoattenuating areas, respectively, as well as lowered artifact and image noise (p<.001). Qualitatively, the iMAR group showed superiority to the non-iMAR group in both image quality and diagnostic confidence, with scores increases of 2.70 and 2.88 points, respectively (p<0.05). iMAR combined with cVRT received the highest subjective score (p<0.05) among the four series of post-processing images, followed by iMAR with VR images(P<0.05), cVRT and VR images in the non-iMAR group both received the lowest scores.
Conclusion: The iMAR algorithm in photon-counting CT effectively reduces artifacts and image noise, enhancing both image quality and diagnostic confidence in post-hip metal replacement assessments. When combined with cVRT, it provides a more intuitive visualization of metal implant stability and the relationship between implants and adjacent tissues.
Limitations: Not applicable.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The ethics committee notification can be found under the number 2021-KS-HNSR115

Author Block: S. L. Chung¹, M. S. Sait²; ¹Oxford/UK, ²Kings University Hospital/UK
Purpose: To familiarise the different types of hip prostheses.
To be able to interpret normal imaging findings post surgery in mainstay modalities such as radiograph, ultrasound, CT and MRI.
To understand the limitations of each imaging modalities and when to consider further imaging such as SPECT-CT scans or PET/CT.
To be aware of the possible false positive findings such as positive tracer uptake in nuclear scans within 1 year post operation is still within normal physiological limits.
To increase awareness the numerous types of complications from most common to least and the time intervals it occurs.
Methods or Background: Review of current literature of optimisation of imaging modalities to reduce artefact caused by hip prostheses enabling better assessment of the joint.
Results or Findings: Slice-encoding for metal artefact correction (SEMAC)-is a relatively new MRI sequence particularly STIR and T1-weighted SEMAC sequences help reduce artefacts caused by hip prosthesis best and can help exclude aseptic loosening.
Understand the scopes of SPECT-CT, PET/CT and MRI including when to use adjunct imaging to diagnose.
Conclusion: MRI is the best imaging modality for reviewing hip prosthesis but accessibility is dependent on institution. MR SEMAC protocol should be routinely applied to reduce artefacts and increasing diagnostic assessment.
Limitations: Limited articles on updated nuclear studies/protocols.
Funding for this study: Nil
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not Applicable

Author Block: A. Jonkergouw, P. Tukker, W. De Monye; Haarlem/NL
Purpose: This study aims to evaluate the clinical consequences of radiographs performed routinely on the first day after arthroplasty or internal fixation of the hip and knee.
Methods or Background: We conducted a retrospective search of our imaging database for day-one post-operative radiographs after total hip arthroplasty, hip hemi-arthroplasty, dynamic hip screw fixation, gamma nail fixation, total knee arthroplasty, and unicompartmental knee arthroplasty, starting from 1 January 2023 until 500 radiographs for hip surgeries and 500 for knee surgeries were included.

For each case, the radiological report was reviewed to determine if any immediate post-operative abnormalities were detected. Additionally, we recorded the type of prosthesis, the patient’s age and sex, and information on excessive pain from patient records.
Results or Findings: Of the 500 patients who underwent hip surgery, 388 (77.6%) received total hip arthroplasty, 27 (5.4%) hemi-arthroplasty, 34 (6.8%) dynamic hip screw fixation, and 51 (10.2%) gamma nail fixation. Of the 500 patients who underwent knee surgery, 420 (84%) received total knee arthroplasty, and 80 (16%) unicompartmental knee arthroplasty.

Across the entire cohort, post-operative abnormalities were noted in 33 patients (3.3%). Five patients (0.5%) required additional medical care due to a fracture, all of whom had undergone hip surgery. Three (0.3%) underwent revision surgery, and 2 (0.2%) received weight-bearing restrictions. Of the 5 patients with a fracture, 4 (80%) reported significant pain prior to undergoing radiological examination. Gender did not influence the occurrence of post-operative abnormalities.
Conclusion: Given that only 0.5% of all patients required additional medical care after detection of post-operative abnormalities, the necessity for routine post-operative radiographs appears limited.
Limitations: Based on the available data, no definite predictive factor has been identified in relation to radiological abnormalities after hip or knee surgery.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The ACLU gave permission for this study. This committee advises the Board of Directors on new scientific studies at Spaarne Gasthuis.

Author Block: A. Cutaia, R. Faletti, P. Fonio, E. La Paglia; Turin/IT
Purpose: To assess the reliability of LTPS and INS to predict ACL HgI and MD.
Methods or Background: 110 patients (Mean Age 46,1years) with MR evidence of pathological ACL were retrospectively selected.
Three groups: HgI (Mean age 31,58years), Low-grade injury (LgI) (Mean age 45,85years) and MD (Mean age 59,33years).
LTPS was measured on sagittal T1-TSE images: Firstly selecting a slice comprehending tibial attachment of posterior cruciate ligament and intercondylar eminence, tracking the tibial axis with craniocaudal circles method.
Secondly, in a slice immediately medial to the head of the fibula, drawing a line perpendicular to the tibial axis.
Thirdly, measuring the angle between this line and the one parallel to the posterior tibial plateau.
LTPS was reported as increased when greater than 10°.
INS was measured drawing the Blumensaat Line, then evaluating in which section of the tibial plateau it landed: anterior third type 1, middle third type 2, posterior third type 3.
INS was extreme when classified as group 2 or 3.
Statistical significance was measured using Z and T test for quantitative variables and ChiSquare for qualitative variables.
Results or Findings: General Group (GG) mean LTPS was 6,87° +-3,09.
Patients with an increased LTPS (Mean LTPS 10,69° +-0,73) showed significantly higher prevalence (66% vs.36%) of ACL HgI compared to GG (p<0.005).
HgI group’s mean LTPS was 7,83° +-3,02, significantly higher than LgI group (p<0.025).
MD group showed significantly higher prevalence (55% vs.27%) of extreme INS compared to HgI (p<0.025).
Conclusion: Increased LTPS should be added in MR reports as it could highlight a predisposition to ACL HgI.
INS should be assessed as it could play a pivotal role in the onset of ACL MD on the basis of chronic impingement.
Limitations: The study is retrospective and monocentric.
Funding for this study: None.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: None.

Author Block: M. Tunçez¹, I. Akan¹, F. Seyfettinoğlu², H. Çetin Tunçez¹, B. Dirim Mete¹, C. Kazımoğlu¹; ¹Izmir/TR, ²Adana/TR
Purpose: Current classification systems have generally been developed based on the type of fracture patterns. The most commonly used is the Schatzker classification system, which includes six types of tibial plateau fractures. While this classification evaluates the fracture in two dimensions, three-dimensional classifications were introduced after the spread of CT. To our knowledge, the classification system regarding soft tissue injuries based on MRI findings has not been established yet. Therefore, in this study, we aimed to evaluate the usability of a new modified classification by evaluating soft tissue injuries in tibial plateau fractures.
Methods or Background: A total of 36 patients with tibial plateau fractures were included in the study. Patients’ age, gender, and affected sides were recorded. Injuries to the medial meniscus, lateral meniscus, anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament were examined with preoperative magnetic resonance imaging. Soft tissue injuries were arranged according to the novel modified classification based on the Schatzker classification.
Results or Findings: The mean age of the study participants was 45 (19-76) years; 72% of the patients were men and 28% were women. Moreover, 44% and 56% of the patients had broken the right and left tibial plateaus, respectively. At least one soft tissue injury was detected in 29 (81%) patients. In 14 (39%) patients, two or more soft tissue injuries were observed. All patients were arranged according to the novel modified classification regarding ligament and meniscus injuries.
Conclusion: With this novel modified classification system, we think that having better information about the preoperative condition of the soft tissue injuries can change the surgical strategy in patients with tibial plateau fractures.
Limitations: Patients with minimal displacement and those requiring conservative treatment were excluded.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This retrospective study was approved by the Institutional Review Board of our hospital.

Author Block: D. Deppe¹, M. Gabriele¹, E. K. Simşek², A. Ordas-Bayon³, M. Leskovar¹, A. Trepczynski¹, S. Zachow¹, G. Duda¹, M. Heyland¹; ¹Berlin/DE, ²Ankara/TR, ³Madrid/ES
Purpose: Determining the best treatment for lower limb fractures is challenging due to multiple factors affecting bone healing, requiring precise monitoring for optimal care. A radiographic assessment of the end point of bone healing is difficult, prompting the use of scores such as the modified Radiographic Union Score for Tibial fractures (mRUST) that represents one of the most used scores to evaluate radiographic fracture healing. However, the use of mRUST across different locations and treatment options has not yet been thoroughly demonstrated. The objective of this study is to validate the robustness of mRUST as a reliable measure during follow-up in lower limb fractures using various treatment modalities.
Methods or Background: Six international investigators (five orthopaedic surgeons and one radiologist) independently assessed the mRUST in 166 patients with extra-articular lower-limb fractures for different follow-up timepoints. Inter-rater reliability was assessed for location (femur/ tibia), treatment option (plate fixation/ nail fixation) and for different treatment options in different fracture locations using intraclass correlation coefficients (ICC).
Results or Findings: 166 patients (63 femur fractures, 103 tibia fractures; 32.52% female) with a total of 1136 follow up time points were included. Overall inter-rater reliability for mRUST was good (0.77), regardless of fixation method (0.79, for both nail and plate fixation) or anatomical location (0.78 in tibia fractures, 0.81 in femur fractures). On cortex level, reliability varied for different location within in the bone with highest inter-rater agreement for the medial cortex (0.70-0.74) and lowest for the posterior cortex (0.65-0.74)
Conclusion: The mRUST-Score proves to be a robust scoring tool for healing monitoring in lower-limb fractures treated with different fixation methods in different parts of the bone.
Limitations: Images were presented in chronological order, which limited the results of this study.
Funding for this study: None.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Local ethics committee approval was granted for this retrospective study (EA4/099/22).

Author Block: S. Rajan, J. S. Chatha, H. Mahajan; New Delhi/IN
Purpose: Osteochondral lesions of the talar dome (OLT) can result from recurrent ankle microinstability, traumatic events, or anatomical abnormalities. This study aims to evaluate the correlation between OLT and single, double, or triple ligament tears within the lateral collateral ligament complex.
Methods or Background: A retrospective review was conducted on 212 consecutive ankle MRIs performed for pain or instability, sourced from the PACS server. Examination under anesthesia and arthroscopic confirmation were obtained in 23 cases. The data were anonymized and analyzed by two radiologists with extensive experience. The status of the superior and inferior ATFL bands, the calcaneofibular ligament (CFL), and the superficial and deep deltoid ligaments were assessed. Osteochondral lesions were classified using the Anderson classification. Statistical significance was evaluated using the Chi-square test to assess the relationship between ligament tears and OLT.
Results or Findings: OLT was identified in 74 patients (36.6%), while 126 patients (62.4%) had no OLT. Among those with OLT, 72 had lateral collateral ligament pathology, with only 2 cases showing no definitive tears. Of the 74 patients with OLT, 26 had tears of the superior ATFL with inferior band scarring, 36 had tears of both ATFL bands, and 19 had tears of both ATFL bands and the CFL. Statistical analysis revealed a significant correlation (p < 0.01) between the presence of ligament tears and the occurrence of OLT.
Conclusion: This study highlights a significant correlation between osteochondral lesions of the talar dome and lateral ligament tears, emphasizing the need for comprehensive assessment of ligament integrity in patients with OLT.
Limitations: Arthroscopic proof of ligament tears was not present in all cases
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Retrospective study

Author Block: K. Bokwa, D. G. Mocanu, N. Solidakis, P. Szaro; Gothenburg/SE
Purpose: Previous studies indicate that peroneus brevis instability and split tears may be missed in up to half of patients clinically due to unclear clinical signs and on conventional magnetic resonance (MRI) because of its static nature. We hypothesize that dynamic imaging may improve the diagnosis of peroneus brevis instability and split tears. However, no studies have evaluated whether dynamic MRI can visualize peroneus tendon motion. The aim of this study is to assess whether dynamic MRI can be used to evaluate the motion of the peroneal tendons.
Methods or Background: Study design: observational pilot study. We performed dynamic MRI using two small flexible coils in a 3T machine, assessing the axial plane at the lateral malleolus with Dynamic Balanced Fast Field Echo (BFFE). Ten participants received movement training from a radiology nurse before imaging. Two radiologists (raters) evaluated the image quality. We included only examinations with clear tendon outlines, visible motion without artifacts. Raters assessed the position of peroneus brevis relative to peroneus longus in neutral, plantar, and dorsal flexion, reaching a consensus. Radiologists measured the distance between the tendons' central points in each position, reporting the mean values.
Results or Findings: All examinations were included in the analysis. Preliminary analysis revealed that dynamic MRI allows visualisation of peroneus tendons motion in good quality. The mean distance between the tendons was 2.1 mm (SD 0.3 mm) in the neutral position, 4.8 mm (SD 0.3 mm) in dorsal flexion, and 2.0 mm (SD 0.2 mm) in plantar flexion.
Conclusion: Dynamic magnetic resonance allows the evaluation of peroneus tendon motion, offering a novel approach for evaluating stability that may improve the accuracy of peroneus diagnostics.
Limitations: Small sample size, only dorsal and plantar flexion in the ankle.
Funding for this study: The study was founded by Stiftelsen Tornspiran 934: 2023-12-01.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The Swedish Ethical Review Authority approved the study: 2023-07231-01.

Author Block: E. Höhne, I. Yel, A. Gökduman, S. Bernatz, M. Dimitrova, C. Booz, T. Vogl, S. Mahmoudi; Frankfurt/DE
Purpose: In professional soccer extensive musculoskeletal assessments are conducted prior to player transfers to evaluate the current state and future risk of injury. Magnetic resonance imaging (MRI) is essential in this process revealing musculoskeletal findings even in the absence of symptoms. This analysis presents the five most frequent MRI findings in a cohort of professional soccer players and aims to improve understanding of the physical condition of elite athletes.
Methods or Background: This retrospective study included comprehensive musculoskeletal 3T MRI scans obtained during medical checks of professional soccer players from August 2019 to September 2024. Clinical data were extracted from medical records and supplemented with further functional information.
Results or Findings: MRI scans of 44 professional soccer players were analysed. Among the players, five were left-footed, one was two-footed, and the remaining players were right-footed. The average age at the time of examination was 22.8 years (± 4,3). The most common finding was a secondary cleft on the left side, observed in 18 players (40.9%). A bulging or protruding disc at the L5/S1 level was found in 31.8% of the cases. Degenerative changes in the labrum were identified in 27.3% of players on the left side and in another 27.3% on the right side. Chondropathy of the left knee was present in 27.3% of cases.
Conclusion: This retrospective analysis revealed several notable findings, particularly given the young average age of the athletes. The main findings included a secondary cleft and labral degeneration, which may be associated with the common occurence of groin pain in soccer players. A better understanding of these associations could enhance the development of more effective diagnostic and preventive strategies for musculoskeletal injuries.
Limitations: The limited sample size restricts the generalizability of findings.
Funding for this study: None.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The local ethics committee has approved this retrospective study.