Cortical Erosion Research Articles

Prognostic Impact of Pattern of Mandibular Involvement in Gingivo-Buccal Complex Squamous Cell Carcinomas: Marrow and Mandibular Canal Staging System.

PurposeTo study the pattern of mandibular involvement and its impact on oncologic outcomes in patients with gingivo-buccal complex squamous cell carcinoma (GBC-SCC) and propose a staging system based on the pattern of bone involvement (MMC: Marrow and mandibular canal staging system) and compare its performance with the 8th edition of the American Joint Committee on Cancer (AJCC8).MethodsThis retrospective observational study included treatment-naïve GBC-SCC patients who underwent preoperative computed tomography (CT) imaging between January 1, 2012, and March 31, 2016, at a tertiary care cancer center. Patients with T4b disease with high infratemporal fossa involvement, maxillary erosion, and follow-up of less than a year were excluded. The chi-square or Fisher’s exact test was used for descriptive analysis. Kaplan–Meier estimate and log-rank test were performed for survival analysis. Multivariate analysis was done using Cox regression analysis after making adjustments for other prognostic factors. p-Value <0.05 was considered as significant. Based upon the survival analysis with different patterns of bone invasion, a new staging system was proposed “MMC: Marrow and mandibular canal staging system”. “Akaike information criterion” (AIC) was used to study the relative fitted model of the various staging (TNM staging—AJCC8) with respect to survival parameters.ResultsA total of 1,200 patients were screened; 303 patients were included in the study. On radiology review, mandibular bone was involved in 62% of patients. The pattern of bone involvement was as follows: deep cortical bone erosion (DCBE) in 23%, marrow in 34%, and marrow with the mandibular canal in 43% of patients. Patients with DCBE and no bone involvement (including superficial cortical) had similar survival [disease-free survival (DFS) and locoregional recurrence-free survival (LRRFS)], and this was significantly better than those with marrow with or without mandibular canal involvement (for both DFS and LRRFS). Patients with DCBE were staged using the MMC, and when compared with the AJCC8, the MMC system was better for the prediction of survival outcomes, as AIC values were lower compared with those of the AJCC8. There was a significant association (p = 0.013) between the type of bone involvement and the pattern of recurrence.ConclusionsFor GBC-SCC, only marrow with or without mandibular canal involvement is associated with poorer survival outcomes. As compared with the AJCC8, the proposed Mahajan et al. MMC staging system downstages DCBE correlates better with survival outcomes.

Radiological features of oral and maxillofacial plasmablastic lymphomas.

The purpose of the current study was to report on the clinical presentation and radiological features of 72 cases of oral and maxillofacial plasmablastic lymphomas (PBL). Histologically confirmed cases of PBL were retrospectively reviewed over a 10-year period. Demographic and clinical data were retrieved from the patient's records. Radiological information was obtained from the available radiographic examinations. The prevalence of PBL was 0.6% of diagnosed head and neck lesions. PBL presented at a mean age of 39years, demonstrating a strong male predominance. All patients with a known retroviral disease (RVD) status were HIV-positive. PBL had a maxillary predilection (78%), with posterior regions of both jawbones most commonly affected (76%). Most cases had bony involvement (95%), with poorly demarcated bony borders seen in the majority of cases (93%). PBL had a tendency to cause a loss of cortical integrity (96%), either via cortical erosion or destruction, rather than cortical expansion (2%). Most of the current literature on PBL focuses on demographics, anatomical location, and histopathological profile, with radiological features only reported in isolated case reports. This study is the first of its kind to report on the clinicoradiological appearance of PBL in a large sample. These findings may assist clinicians in the clinical diagnostic work-up of patients, including the acquisition and assessment of appropriate advanced radiographic imaging.

Radiographic Ischial Enthesopathy in Patients with Psoriatic Arthritis

AbstractBackground To investigate the prevalence of radiographic ischial entheseal lesions in patients with psoriatic arthritis (PsA) compared to patients with rheumatoid arthritis (RA).Patients and Methods Thirty-eight patients with PsA and 46 patients with RA were included. Anteroposterior radiographs of the pelvis and lateral foot were evaluated for entheseal lesions. The following entheseal sites were reviewed: os ischium, bilateral Achilles tendon and inferior calcaneus. Abnormalities such as cortical erosions and enthesophytes (irregular bony proliferation) were recorded.Results The frequency of enthesopathic changes in the ischial region was found to be statistically significantly higher in PsA patients compared with RA patients (50 and 28.3%, respectively, p=0.04). Enthesopathic changes of the calcaneus and Achilles tendon also occurred more frequently in PsA patients than in RA patients.Conclusion Radiographic entheseal lesions in the ischial region are more prevalent in PsA patients compared with RA patients with symptoms in that region. Furthermore, such enthesopathic changes in the ischium are observed as frequently as changes in the Achilles tendon. These findings regarding structural entheseal lesions in the pelvic region contribute to the knowledge of entheseal involvement in PsA.

Open-Source Image Analysis Tool for the Identification and Quantification of Cortical Interruptions and Bone Erosions in High-Resolution Peripheral Quantitative Computed Tomography Images of Patients with Rheumatoid Arthritis

Open-Source Image Analysis Tool for the Identification and Quantification of Cortical Interruptions and Bone Erosions in High-Resolution Peripheral Quantitative Computed Tomography Images of Patients with Rheumatoid Arthritis

Dactylitis is an indicator of a more severe phenotype independently associated with greater SJC, CRP, ultrasound synovitis and erosive damage in DMARD-naive early psoriatic arthritis

ObjectiveTo characterise the impact of dactylitis in disease-modifying antirheumatic drug (DMARD)-naive early psoriatic arthritis (PsA).MethodsPatients with early PsA meeting the classification criteria for PsA (CASPAR) were recruited. Clinical outcomes were...

Taux d’usure et ostéolyse avec deux types de polyéthylène recuit hautement réticulé de deuxième génération en arthroplastie totale de la hanche : étude comparative rétrospective au recul minimum de cinq ans

BackgroundAs no previous study has directly compared the linear wear rate in two types of second-generation annealed highly cross-linked polyethylene, we performed a retrospective study with a minimum of 5-year follow-up to assess primary arthroplasties in the: (1) wear rates; and (2) incidence of osteolysis of the two types of HXLPE. HypothesisThere was no significant difference in the linear wear rate and the incidence of osteolysis between the two types of second-generation annealed highly cross-linked polyethylene. Patients and methodsIn this single-center study, we reviewed 257 cases of primary cementless total hip arthroplasties between 2011 and 2015, which were performed with 32mm delta ceramic on second-generation annealed highly cross-linked polyethylene (X3 and E1 were used in 105 and 103 cases, respectively). The mean wear rate was evaluated using a computer-assisted method, and the incidence of osteolysis was evaluated based on the appearance of a localized area with loss of trabecular bone or cortical erosion adjacent to the implants during the latest follow-up. ResultsIn total, we evaluated 208 cases, followed postoperatively for over 5 years (mean, 6.1 years, range: 5.0–8.0). There were no significant differences between the two groups with respect to age (list in order of group X, group E, p-value) (61.2±12.3, 62.7±12.1, p=0.36), sex (ratio of male: 17.1 %, 14.6 %, p=0.61), body mass index (22.9±3.7, 22.8±4.0, p=0.91), pre- (49.9±14.8, 48.5±13.8, p=0.49) and postoperative (91.3±9.1, 92.7±7.0, p=0.23) Japanese Orthopaedic Association Hip Score, cup size (50.8±3.0, 50.9±2.2, p=0.70), cup inclination (38.7±4.8, 37.6±4.8, p=0.10), and cup anteversion (18.7±6.9, 18.5±7.6, p=0.80). The mean linear wear rates of the X3 and E1 groups were 0.057±0.039 (range: 0–0.16) and 0.054±0.037mm/year (range: 0–0.15), respectively (p=0.61). No osteolysis was found on the final plain radiographs in both groups. DiscussionThis study revealed that both types of highly cross-linked polyethylene have excellent linear wear rates and were equally safe to use. However, the difference between the two materials in terms of the long-term wear rate should be further validated. Level of evidenceIII; retrospective case control study.

Developing a grading scale for the evaluation of degenerative changes in uncovertebral (Luschka) joints.

The study aimed to develop a grading scale for evaluating degenerative changes in uncovertebral joints (UVJs) found on computed tomography (CT) scans, and assess the intra- and inter-rater reliability of this scale. The study included 50 subjects (average age 55.12 ± 13.76 years) referred for CT examinations due to cervical complaints. Three researchers developed a reading protocol using a semiquantitative grading scale of UVJ degenerative changes. CTs were read and reread several times to refine the protocol. Subsequently, the reader read and reread 20 CTs (C3-C7 bilateral, altogether 200 UVJs) 2 weeks apart in order to assess the intra-rater reliability. The second reader, after the training, read the same 20 CTs (yet, C4-C6 bilateral, altogether 120 UVJs) in order to assess the inter-rater reliability. The additional 30 CTs were evaluated to analyze the prevalence and associations between the studied parameters. The final grading scale included joint space narrowing, osteophyte, subchondral sclerosis, subchondral cyst, hypertrophy, cortical erosion, and vacuum phenomenon. The intra-rater agreement ranged from very good in joint space narrowing (k= 0.757), osteophyte grade (k= 0.748), subchondral cyst (k= 0.716), hypertrophy (k= 0.728), vacuum phenomenon (k= 0.712) to good (k= 0.544) in subchondral sclerosis, and fair in cortical erosion (k= 0.36). For the overall UVJ degeneration grade, the intra-rater agreement was very good (k= 0.616) and the inter-rater reliability was good (k= 0.468). 77.6% of the evaluated UVJs exhibited some degenerative changes. Our grading scale is the first to evaluate UVJs presenting good-very good intra-rater and inter-rater reliability which can be utilized in further clinical studies and assess degenerative changes in UVJs.

Wear rate and osteolysis in two types of second-generation annealed highly cross-linked polyethylene in total hip arthroplasty: A retrospective comparative study with a minimum of five years

BackgroundAs no previous study has directly compared the linear wear rate in two types of second-generation annealed highly cross-linked polyethylene, we performed a retrospective study with a minimum of 5-year follow-up to assess primary arthroplasties in the (1) wear rates and (2) incidence of osteolysis of the two types of HXLPE. HypothesisThere was no significant difference in the linear wear rate and the incidence of osteolysis between the two types of second-generation annealed highly cross-linked polyethylene. Patients and methodsIn this single-center study, we reviewed 257 cases of primary cementless total hip arthroplasties between 2011 and 2015, which were performed with 32mm delta ceramic on second-generation annealed highly cross-linked polyethylene (X3 and E1 were used in 105 and 103 cases, respectively.). The mean wear rate was evaluated using a computer-assisted method, and the incidence of osteolysis was evaluated based on the appearance of a localized area with loss of trabecular bone or cortical erosion adjacent to the implants during the latest follow-up. ResultsIn total, we evaluated 208 cases, followed postoperatively for over 5 years (mean, 6.1 years, range: 5.0-8.0). There were no significant differences between the two groups with respect to age (list in order of Group X, Group E, p value) (61.2±12.3, 62.7±12.1, p=0.36), sex (ratio of male: 17.1%, 14.6%, p=0.61), body mass index (22.9±3.7, 22.8±4.0, p=0.91), pre- (49.9±14.8, 48.5±13.8, p=0.49) and post-operative (91.3±9.1, 92.7±7.0, p=0.23) Japanese Orthopaedic Association Hip Score, cup size (50.8±3.0, 50.9±2.2, p=0.70), cup inclination (38.7±4.8, 37.6±4.8, p=0.10), and cup anteversion (18.7±6.9, 18.5±7.6, p=0.80). The mean linear wear rates of the X3 and E1 groups were 0.057±0.039 (range: 0–0.16) and 0.054±0.037mm/year (range: 0–0.15), respectively (p=0.61). No osteolysis was found on the final plain radiographs in both groups. DiscussionThis study revealed that both types of highly cross-linked polyethylene have excellent linear wear rates and were equally safe to use. However, the difference between the two materials in terms of the long-term wear rate should be further validated. Level of evidenceIII; retrospective case control study.

Mandibular cortical bone structure as risk indicator in fractured and non-fractured 80-year-old men and women

ObjectiveTo investigate the association between mandibular cortex parameters and fracture in a group of 286 men and women, 79–80 years of age.Study designIn a cross-sectional study, the mandibular cortex was evaluated with Klemetti’s index for cortical erosion. The cortical thickness was measured with a ruler adjusting for the magnification factor. The odds ratio (OR) for fracture when having a severely eroded cortex or a cortex thickness < 3 mm was calculated.ResultsA normal cortex was found in 65% of men, whereas only 7% had a severely eroded cortex. The OR for severely eroded cortex as fracture risk predictor was significant (2.32; 95% CI 1.3–4.2), also when the female group was evaluated separately. A significant difference was found between the mean thickness for men (3.96 mm) and women (2.92 mm), respectively. The OR for cortical thickness < 3 mm was significant (2.00; 95% CI 1.1–3.6) in the total group, but not when men and women were evaluated separately.ConclusionsAmong old women, the cortical parameters were significantly associated with prevalent fracture. In old men, other circumstances may be more important.

Ultrasound feature variants of the adductor longus tendon in asymptomatic sportive subjects: Management implications

ObjectivesThe potential contribution of ultrasound (US) to diagnose adductor longus (AL) tendinopathy in athletic pubalgia requires clarification. We investigate US findings from AL tendons of asymptomatic participants to identify the range and prevalence of common US features not associated with groin pain. MethodsWe consecutively enrolled 45 volunteers physically active participants with no history of groin pain. US features of bilateral AL tendons were investigated and recorded by two experienced musculoskeletal radiologists (MSKR) in accordance with a defined ultrasound protocol. Two other MSKRs retrospectively and independently analyzed all US images. ResultsNinety AL tendons from 45 participants (4/45 women) were imaged (average age: 35 years ±14.6; dominant side: 37/45 (82.2%) right, 8/45 (17.8%) left). Abnormalities on US were found in all 45 (100%) AL tendons, including: abnormal echogenicity (98.9%/100% respectively according to reader), loss of fibrillar structure (92.2%/97.8%), irregularities of the superficial paratendon (23.3%/30%), calcifications (22.2%/25.5%), and cortical erosion (52%/55.5%), with excellent inter-observer assessment. No AL tears or hyperemia at color Doppler were detectable. ConclusionsAL tendon abnormalities were identified via US in 100% of our asymptomatic athletes. The significance of these US findings should be interpreted cautiously with respect to clinical presentation. On the other hand, there is a need for supplemental investigation into the clinical relevance of US AL tendon tears not present in the present asymptomatic athlete population.

Evaluation of condylar changes in relation to various malocclusions

Introduction: Variability in the size and shape of mandibular condyles among individuals of different sexes and ages may appear as a remodeling process to accommodate malocclusion. Hence, the aim of this study was to assess whether or not associations exist between different types of malocclusions and morphological modifications of the mandibular condyle. Materials and Methods: A systematic literature search was conducted on the Medline database via PubMed interface and supplemented by a manual search via Google Scholar to identify more articles reporting the subject of the review. A combination of controlled vocabulary was used in the search strategy and the final update was stopped on January 2021. The risk of bias was assessed based on the Newcastle–Ottawa Scale. Results and Discussion: Considering the preestablished inclusion and exclusion criteria, 20 articles were retained with 2607 human subjects (967 males/1299 females and 341 not specified, age: 4–60 years). Eighty percent of the selected articles reported associations between malocclusion and morphological changes of the condylar head. Sagittal plane malocclusions produce more changes to the temporomandibular joint components (head of condyle and joint space) (71.93%), while vertical malocclusions lead to the most severe manifestations. Conclusions: Cone-beam computed tomography is the most useful tool for the assessment of osseous morphology of mandibular head condyles and detection of cortical erosion (21.7%). Associations between morphological changes of the condylar head and specific types of malocclusions were proven. However, there is still a need for more clinical studies.

Association of Pattern of Mandibular Invasion in MDCT with Recurrence in Oral Cancers

Background: Mandibular invasion has been a long-debated criterion for predicting prognosis in oral cancers. Though the American Joint Committee on Cancer (AJCC) marks cortical erosion in oral lesions as T4 disease, it is often challenged that mere superficial bony erosion should not be used to demark T4 disease. Aim: This study aimed to evaluate the association of pattern of mandibular erosion in preoperative Multi-Detector CT (MDCT) of oral cancers with the presence of recurrent loco-regional malignant disease. Materials and Methods: A retrospective study was done in the Department of Radio-Diagnosis of a tertiary center in Western India. MDCT Neck findings in 56 consecutive postoperative patients clinically suspected for recurrent oral carcinoma over a period of 1 year were assessed. Preoperative MDCT of all patients was evaluated for presence and pattern of mandibular involvement by primary malignancy. These patterns were compared with the presence of recurrent disease in the postoperative scan. Association between two findings was tested by Fisher's exact test. Results: Forty-eight patients showed features of recurrent malignancy on MDCT confirmed by biopsy; of which 10 patients had shown no bony invasion in the preoperative scan, 14 had shown cortical erosion and 24 showed medullary invasion. P value for association of recurrence and bony invasion pattern was found to be 0.6705 (insignificant) for cortical erosive lesions and 0.0469 (significant) for medullary infiltrative lesions. Conclusion: Only medullary infiltrative lesions of the mandible have a statistically significant association with recurrent disease and may be used as a prognostic factor. Cortical erosions are statistically insignificant in predicting recurrence similar to no bone invasions.

Specific Magnetic Resonance Imaging Findings as Predictors of Osteomyelitis in Routine Clinical Practice

Background: The gold standard for the diagnosis of osteomyelitis is histopathology combined with positive bone cultures. Magnetic Resonance Imaging (MRI) is often used to aide diagnosis and guide treatment decisions. The purpose of the study was to examine the association of MRI findings with, and their sensitivity and specificity in identifying osteomyelitis as proven by bone histopathology and bone culture in routine clinical practice. Materials and Methods: A retrospective analysis of patients with bone specimens obtained by biopsy or at resection for suspected osteomyelitis during 2010-2014 at an academic medical center in New York City. We used bivariate analysis to compare findings of patients who did or did not have osteomyelitis confirmed on histopathology (Analysis 1) and those who had either bone histopathology demonstrating osteomyelitis, positive bone cultures or both or who had neither (Analysis 2). Results: We identified 103 patients with an MRI in the week prior to bone biopsy or bone resection. In Analysis 1, 52 (50.5%) of 103 patients had osteomyelitis confirmed on histopathology. In Analysis 2, 72 (70%) patients had proven osteomyelitis. These groups with and without osteomyelitis did not differ significantly with respect to the frequency of marrow edema, cortical erosions, decreased T1 signal or increased T2 signal in either analysis and the sensitivity and specificity of MRI findings for detecting osteomyelitis was lower than reported in prior studies. Conclusions: Based on the above results, clinicians should be aware that the sensitivity and specificity of MRI findings for histologic and microbiologic osteomyelitis may be less in real world practice than is reported in formal studies.

Mid-term outcomes after reverse total shoulder arthroplasty with latissimus dorsi transfer.

Reverse total shoulder arthroplasty is a common treatment for patients with rotator cuff arthropathy who have failed a prior rotator cuff repair. Latissimus dorsi transfer can be performed simultaneously to reverse total shoulder arthroplasty for patients with preoperative external rotation deficiency. Current literature is limited with several studies providing functional and pain improvements at short-term follow-up; however, there is a deficit in data regarding mid-term outcomes. The purpose of this study was to evaluate the clinical and radiographic outcomes following reverse total shoulder arthroplasty with latissimus dorsi transfer with mid-term follow-up. We hypothesized significant improvement in external rotation and shoulder functionality for patients with preoperative external rotation lag. We retrospectively reviewed patients who underwent reverse total shoulder arthroplasty with latissimus dorsi transfer. Preoperative and postoperative changes in range of motion were assessed. American Shoulder and Elbow Surgeon Score and the Simple Shoulder Test were used to evaluate changes in shoulder function while pain scores were assessed using the Visual Analog Scale (VAS). Radiographs were reviewed for rotator cuff arthropathy, fatty infiltration, scapular notching, baseplate loosening, and osteolysis. We reported frequency and mean ± standard deviation for categorical and continuous variables, respectively. Means were compared using the paired Student's t-test and proportions using the Chi-square test. Fifteen patients met the inclusion criteria. The mean age of the cohort was 71.7 ± 8.4 years (range 51.2-87.8 years) with a mean follow-up of 6.3 ± 4.1 years (range 1.0-14.5 years). Reverse total shoulder arthroplasty with latissimus dorsi transfer improved external rotation (-7 ± 21.3° to 38 ± 15.8°; p value = 0.001). There was no statistically significant difference regarding forward flexion (116.3 ± 45.4° to 133.7 ± 14.7°; p value = 0.17) and internal rotation (T12 to L2; p value = 0.57). The procedure led to an increase in American Shoulder and Elbow Surgeon Score scores (37 ± 19 to 62 ± 22; p = 0.005) and Simple Shoulder Test scores (2 ± 2 to 6 ± 3; p value = 0.001) with a significant reduction in Visual Analog Scale scores (5 ± 3 to 2 ± 3; p value = 0.022). The procedure corrected external rotation lag in 10 patients. Radiographically, rotator cuff arthropathy was found to be grade 3 in two patients, grade 4 A in four patients, grade 4B in eight patients, and grade 5 in one patient. On postoperative imaging, scapular notching was found in six patients (40%). Twelve patients had cortical humeral erosion at the site of the latissimus dorsi transfer. Only one patient experienced a shoulder-related complication which was aseptic baseplate loosening and required a revision reverse total shoulder arthroplasty with allograft. In this study, patients undergoing reverse total shoulder arthroplasty with latissimus dorsi transfer experienced improvements in range of motion, functional scores, and pain at mid-term follow-up. The shoulder-related complication rate was low.Level of evidence: IV; Case series.

Direct Assessment of Rabbit Cortical Bone Basic Multicellular Unit Longitudinal Erosion Rate: A 4D Synchrotron-Based Approach.

Cortical bone remodeling is carried out by basic multicellular units (BMUs), which couple resorption to formation. Although fluorochrome labeling has facilitated study of BMU formative parameters since the 1960s, some resorptive parameters, including the longitudinal erosion rate (LER), have remained beyond reach of direct measurement. Indeed, our only insights into this spatiotemporal parameter of BMU behavior come from classical studies that indirectly inferred LER. Here, we demonstrate a 4D in vivo method to directly measure LER through in-line phase contrast synchrotron imaging. The tibias of rabbits (n=15) dosed daily with parathyroid hormone were first imaged in vivo (synchrotron micro-CT; day 15) and then ex vivo 14 days later (conventional micro-CT; day 29). Mean LER assessed by landmarking the co-registered scans was 23.69 ± 1.73 μm/d. This novel approach holds great promise for the direct study of the spatiotemporal coordination of bone remodeling, its role in diseases such as osteoporosis, as well as related treatments. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Effect of radiographic disease severity in high-resolution quantitative computed tomography assessment of metacarpophalangeal joint erosion and cysts.

Bone erosions are the hallmark of rheumatoid arthritis (RA). High-resolution peripheral quantitative computed tomography (HR-pQCT) enables 3-dimensional visualization of arthritic bone erosions at a high resolution. However, the degree of erosive disease could influence the reliability of HR-pQCT evaluation. We aim to assess the intra- and inter-reader variability of identification of erosions in the metacarpophalangeal (MCP) joints using HR-pQCT in healthy controls and patients with RA, stratified according to van der Heijde-modified Sharp Score (HSS) of radiographic erosions. We analyzed HR-pQCT images from 78 patients with RA and 25 healthy controls. Patients were allocated to one of three groups of mild, moderate or severe disease according to HSS of MCP joints 2 and 3. Total HR-pQCT scans were analyzed twice in random order by three experienced readers, blinded to group distribution. The number of cortical interruptions and their classification as either erosions or cysts according to predefined criteria were recorded. Intraclass correlation coefficients (ICC) for cortical interruptions, erosions and cysts were calculated for each group using a 2-way random-effects model for inter-reader ICC and a 2-way mixed-effects model for intra-reader ICC. The intra- and inter-reader ICC were good to moderate for cortical interruptions and moderate for erosions throughout disease severity groups. The ICCs for the identification of cysts decreased with increasing degree of erosive disease. The detection of cortical interruptions is only minimally affected by the degree of erosive damage, whereas the distinction between erosions and cysts is more complex in patients with extensive erosive disease.

Role of intralesional polidocanol in management of Aneurysmal bone cyst.

Background: Aneurysmal bone cyst is a true benign bone tumor often seen in young children and adolescents. ABCs often present with impending or pathological fracture due its aggressive cortical erosion. Modalities of treatment viz: Curettage with or without graft, Enbloc excision, cryotherapy, argon beam laser, radiotherapy, arterial embolization are often associated high morbidity & high complication rates. Objectives: The aim of this study was to evaluate the clinical & radiological efficacy of polidocanol in the management of Aneurysmal bone cyst. Material & Methods: After radiological and cytological confirmation of ABC, 18 patients meeting the inclusion criteria were included in this study. The patients were treated with intralesional polidocanol under fluoroscopic guidance. Results: The mean age of patients was 8.2 years. Mean number of injections required was 3.2, with three patients showing radiological resolution after single injection. Recurrence was seen in 1 patient after showing initial resolution. There were no cases of anaphylaxis or local inflammatory reactions. Conclusion: Polidocanol is a safe and inexpensive alternative to other modalities of treatment and should always be first line of treatment for the management of the Aneurysmal bone cyst.

CPD article: Radiographic interpretation of the navicular bone: a review

Navicular syndrome (navicular disease) plays a major role in the equine industry as a chronic, degenerative, and often career-limiting disease process, affecting a variety of breeds of horses. In addition to clinical signs and diagnostic analgesia, diagnostic imaging plays a key role in the identification of this disease process; radiography is the most widely used imaging modality. In addition to their clinical utility, foot radiographs are a standard element of most pre-purchase examinations. Good radiographic quality and positioning are necessary for accurate interpretation. Radiographic lesions of the navicular bone, such as sclerosis, enlarged synovial invaginations, distal border fragments and flexor cortical erosions, are important to identify and understand because of their potential role in the disease process. This article reviews an approach to radiological evaluation and interpretation of lesions affecting the navicular bone.

Osteosarcoma of the Jaws: A Literature Review.

Osteosarcoma of the jaws (OSJ) is a relatively rare disease, accounting for between 2% and 10% of all cases of osteosarcoma. It is morphologically and radiologically identical to the trunk and extremity variant, but distinct in several crucial aspects. The lesion is characterized by sarcomatous cells which produce a variable amount of osteoid bone. It arises centrally within the bone and can be subdivided into osteoblastic, chondroblastic and fibroblastic subtype, depending on the predominant cell type. Radiographically, these tumors display a spectrum of bone changes from well-demarcated borders to lytic bone destruction with indefinite margins and variable cortical bone erosion or, in some cases, images of sclerotic bone. Therapeutic options for OSJ include surgery, chemotherapy and radiotherapy, which are employed according to age of the patient, histological classification and localization of the tumor. Today, there is no general consensus in the treatment guidelines for the OSJ though surgery represents the key to the treatment. The main prognostic factor deeply influencing the patient's prognosis remains the complete tumor resection with negative surgical margins. The aim of the present review is to describe state of the art regarding diagnostic and surgical treatment aspects of the primary osteosarcoma of the jaws.

Ultrasound features of the subungual glomus tumor and squamous cell carcinomas.

Nail tumors often pose a significant challenge for the clinician, as they are burdened by a high delay in diagnosis and paucity of clinical signs in the early stage. In most cases, the onset of pain or nail plate dystrophy leads to imaging investigations such as plain radiography, magnetic resonance imaging, and ultrasonography (US) when surgery is pending. A 2-year monocentric study evaluated the histologically confirmed cases of subungual glomus tumor (GT) and squamous cell carcinoma (SCC) with a pre-surgical US assessment, and reviewed their sonography features. A total of 7 digital GTs and 6 SCCs of the nail were collected. GT and SCC are easily distinguishable on US. Compared to SCC, GT was positively associated with an ovoid shape, well-defined borders, bone cup-scalloping without cortical erosion, and a rich intralesional vascular pattern (P < 0.05). Vice versa, SCC was significantly correlated with irregular shape, ill-circumscribed margins, an infiltrative growth pattern with peripheral hypoechoic foci, posterior acoustic shadow, cortical erosion, and a highly vascular multipolar peripheral pattern (P < 0.05). The rapid assessment of GT and SCC sonographic features may contribute to reduce diagnostic delay, expedite management, and decrease the risk of surgical relapse.