Soft Tissue Pathology Research Articles

Radiographic and Advanced Imaging Evaluation of Posterior Shoulder Instability.

Posterior shoulder instability is an uncommon but important cause of shoulder dysfunction and pain which may occur as the result of seizure, high energy trauma, or repetitive stress related to occupational or sport-specific activities. This current review details the imaging approach to the patient with posterior shoulder instability and describes commonly associated soft tissue and bony pathologies identified by radiographs, CT, and MR imaging. Advances in MR imaging technology and techniques allow for more accurate evaluation of bone and soft tissue pathology associated with posterior shoulder instability while sparing patients exposure to radiation. Imaging can contribute significantly to the clinical management of patients with posterior shoulder instability by demonstrating the extent of associated injuries and identifying predisposing anatomic conditions. Radiologic evaluation should be guided by clinical history and physical examination, beginning with radiographs followed by CT and/or MRI for assessment of osseous and soft tissue pathology. Synthesis of a patient's clinical history, physical exam findings, and radiologic examinations should guide clinical management.

Glenohumeral internal rotation deficit: insights into pathologic, clinical, diagnostic, and therapeutic characteristics.

Overhead athletes undergo significant biomechanical adaptations due to repetitive overhead movements, primarily affecting the glenohumeral joint. These adaptations can lead to glenohumeral internal rotation deficit (GIRD), which is characterized by posterior capsule stiffness that results in glenohumeral joint translation and a shift in the center of gravity. The severity of GIRD is dependent upon the presence of asymmetry between gained external and lost internal rotation, which is defined clinically as an asymmetry exceeding 20º; this reduces the total range of motion compared to the unaffected limb or baseline measurements. Diagnosis is challenging, as it can be mistaken for chronic scapular adaptations. To mitigate misdiagnosis, a high clinical suspicion is crucial in overhead athletes, especially those who began performing forceful overhead movements before closure of growth plates. Periodic physical examinations should establish baseline values for glenohumeral rotation and track changes in glenohumeral motion to aid in diagnosis. Symptoms of GIRD include shoulder pain, stiffness, and decreased force exertion. Magnetic resonance imaging is the preferred imaging method for evaluating GIRD and assessing concomitant soft tissue pathologies. Untreated GIRD can lead to rotator cuff strength imbalances. Treatment mainly involves conservative measures, such as physical therapy, to improve internal rotation and alleviate posterior tightness. Surgical interventions are considered when symptoms persist despite conservative treatment with physical therapy or in the presence of concomitant pathologies.

Multiple Myeloma

The second most common hematologic malignancy is the clonal proliferation of neoplastic plasma cells within the bone marrow. There is the presence of monoclonal immunoglobulins in the serum and/or urine. This results in anemia, myelosuppression, bone destruction, and clinical consequences of para-proteinemia on kidney function and other organ systems. The disease manifests through the acronym CRAB (hypercalcemia, renal impairment, anemia, and bone lesions). Less frequent manifestations of multiple myeloma are of extramedullary localizations. Myeloma cells can become independent of the bone marrow microenvironment, circulate freely in the blood, and infiltrate organs. This results in a high-risk state characterized by increased proliferation, evasion of apoptosis, and treatment resistance. It can affect any area of tissue. Most commonly it involves the pleura, lymph nodes, chest wall, liver, skin/soft tissue, lungs, CNS, genitourinary system, breast and pancreas. In patients with confirmed multiple myeloma, the diagnosis of extramedullary involvement is typically established by the presence of pathological soft tissue masses using radiological methods such as computed tomography (CT) scan, positron emission tomography/CT (PET/CT), magnetic resonance imaging (MRI), or ultrasound, along with biopsy or physical examination. The molecular mechanisms underlying the development of extramedullary multiple myeloma (EMM) have not been fully defined. Various cytogenetic abnormalities are observed, and some studies have generated genomic sequencing profiles that distinguish EMM from classic multiple myeloma. While plasma cell leukemia (PCL) and central nervous system (CNS) EMM indicate a poor prognosis, outcomes for other manifestations can be highly heterogeneous. Sensitive imaging modalities including PET/CT and MRI (Fig.1) are integral components of diagnosis and response assessment. Patients with extramedullary multiple myeloma (EMM) have a clear survival disadvantage.

Evaluation of the Efficiency and Effectiveness of MRI in the Diagnosis of Chronic Shoulder Pain

Objective: This study aimed to evaluate MRI efficiency in diagnosing chronic shoulder pain causes. Chronic shoulder pain accounts for 5% of musculoskeletal consultations. Method: Thirty-four chronic shoulder pain patients (18-65 years) underwent shoulder MRI. Sequences included T1-weighted, T2-weighted, proton density, and STIR for comprehensive analysis. All patients were clinically diagnosed with chronic shoulder pain prior to imaging. Finding: One patient (1.96%) had normal MRI findings. Thirty-three patients (98.04%) had abnormalities. Rotator cuff injuries were most prevalent, especially partial supraspinatus tears (18.63%). Other findings included bursitis, joint effusion, AC arthropathy, Hill Sachs deformity, AC joint impingement, rotator cuff fatty atrophy, and biceps tendinopathy. Conclusion: MRI provided excellent visualization of soft tissue pathologies causing chronic shoulder pain, noninvasively without ionizing radiation. Combining MRI sequences accurately diagnosed various shoulder conditions. Fat suppression sequences were key for identifying rotator cuff tears. MRI is the gold standard for diagnosing rotator cuff injuries, the most common chronic shoulder pain cause. Novelty: This study demonstrates MRI's utility for evaluating chronic shoulder pain causes. While no single sequence visualizes all shoulder pathologies, using T1-weighted, T2-weighted, proton density, and STIR sequences together provides a comprehensive analysis to guide appropriate patient treatment. Keywords MRI, Chronic shoulder pain, Rotator cuff, Joint effusion, frozen shoulder

Cervicofacial Pediatric Tissue Expansion: Aesthetic Unit-Based Algorithm.

Tissue expansion is a powerful tool for reconstruction of pediatric soft-tissue pathologies, but complication rates for children have been reported as high as 40%. Infection and implant extrusion lead to premature removal and delays in reconstruction. Expanding the head and neck is uniquely challenging because the confluence of facial aesthetic units must be respected. These challenges have prompted the senior author's creation of an aesthetic-unit based algorithm. A retrospective study of pediatric patients who underwent cervicofacial tissue expander placement by the senior author (R.J.R) was performed over a 17-year period. Predictor variables included age, sex, race, indication, number of expanders placed at each operation, serial expansion, expander type, expander size, home versus clinic inflation, and prophylactic antibiotics. Univariate and multivariate analyses were performed to identify risk factors for complications. An aesthetic-unit based reconstructive algorithm is proposed. Forty-eight pediatric patients had 111 cervicofacial tissue expanders placed. Twenty expanders were associated with complications (18%) for surgical site-infection (12.6%), extrusion (4.5%), and expander deflation (6.3%). Expanders placed for congenital nevi (p=0.042) and use of textured expander (p=0.027) were significantly associated with decreased complications. When controlling for covariates, serial expansion of the same site was associated with increased rates of readmission (p=0.027) after having just one prior expander. Iatrogenic ectropion occurred in 13.5% of the study population; expanders with at least one complication during tissue expansion were significantly associated with incidence of iatrogenic ectropion (p=0.026). By using an aesthetic-unit based algorithm, reconstructive outcomes can be optimized for pediatric cervicofacial tissue expansion.

Pediatric orbital lesions: bony and traumatic lesions.

Orbital pathologies can be broadly classified as ocular lesions, extraocular soft-tissue pathologies (non-neoplastic and neoplastic), and bony and traumatic lesions. In this paper, we discuss the key imaging features and differential diagnoses of bony and traumatic lesions of the pediatric orbit and globe, emphasizing the role of CT and MRI as the primary imaging modalities. In addition, we highlight the adjunctive role of ocular sonography in the diagnosis of intraocular foreign bodies and discuss the primary role of sonography in the diagnosis of traumatic retinal detachment.

Accuracy of Wrist MRI in Detecting Synovitis and Correlation with Arthroscopy

Abstract Hypothesis Wrist magnetic resonance imaging (MRI) has shown excellent diagnostic accuracy in evaluating soft-tissue pathology of the wrist including ganglion cysts, ligament tears, and triangular fibrocartilage complex (TFCC) pathology. However, it is unclear how often MRI detects synovitis that is subsequently encountered during wrist arthroscopy and may be a source of pain for patients with symptoms unresponsive to conservative treatment. The aim of this study is to assess the diagnostic accuracy of conventional MRI in the detection of wrist synovitis observed intraoperatively with wrist arthroscopy. Materials and Methods A retrospective chart review was performed on 51 patients who underwent arthroscopy for chronic wrist pain and MRI confirmed wrist pathology that did not resolve with nonoperative treatment. Wrist arthroscopy was performed by three fellowship-trained hand surgeons. While the primary pathology like TFCC or scapholunate ligament tear was identified and treated arthroscopically, it was noted that many of the patients had concomitant synovitis observed arthroscopically that was not identified preoperatively on MRI. Therefore, the diagnosis of wrist synovitis on MRI scan was compared with the observed presence of synovitis at the time of wrist arthroscopy. Results of preoperative MRI without contrast were categorized as true positive, false positive, true negative, and false negative, based upon intraoperative arthroscopic findings. Results In total, 45/51 patients were confirmed to have dorsal and ulnar synovitis on wrist arthroscopy. MRI identified 16/51 patients as having synovitis. Of those 16 patients, 2 were false positives. Conclusion The results demonstrate that conventional MRI without contrast has poor diagnostic accuracy in detecting wrist synovitis. Patients with ligament or chondral pathology or no clearly identifiable pathology on MRI whose clinical symptoms persist despite conservative treatment may have underlying dorsal and ulnar wrist synovitis that is not detected on MRI. Wrist arthroscopy facilitates the identification and treatment of synovitis in patients with concomitant wrist pathology and pain refractory to nonoperative treatment. This study suggests that MRI may have a low sensitivity for identifying wrist synovitis when compared with wrist arthroscopy during the evaluation of patients presenting with wrist pain.

Quality of life of patients with rheumatic diseases

ObjectiveHealth-related quality of life (HRQoL) is an important indicator of population health and can measure the impact of medical actions. The main objective of this study was to determine the HRQoL of patients with rheumatic diseases (RD) and compare it with that of the general population. MethodsObservational, cross-sectional, single-center study, with consecutive inclusion of outpatients over 18 years of age seen at a Rheumatology hospital-based outpatient clinic in Madrid. Sociodemographic, clinical variables and HRQoL were recorded. HRQoL was measured with the 5-dimension, 5-level EuroQoL (EQ-5D-5L), which includes the EQ-Index (0–1 scale) and a visual analog scale (VAS, 0–100 scale). A descriptive analysis and a comparison with the HRQoL of the Spanish general population were performed. Results1144 patients were included, 820 (71.68%) women, with a mean age of 56.1 years (range 18–95), of whom 241 (25.44%) were new patients. In patients with RD, the HRQoL measured with the EQ-Index and with the VAS, was 0.186 and 12 points lower, respectively, than in the general population. The decrease in HRQoL affected the 5 health dimensions, especially “pain/discomfort”, followed by “daily activities” and “mobility”. This reduction in HRQoL was observed in both men and women, and in all age ranges, although it was greater between 18 and 65 years of age. The reduction in HRQoL affected all RD subtypes, especially the “peripheral and axial mechanical pathology” and the “soft tissue pathology” group. ConclusionsPatients with rheumatic diseases report worse HRQoL when compared to the general population in all dimensions of HRQoL.

Quality of life of patients with rheumatic diseases

ObjectiveHealth-related quality of life (HRQoL) is an important indicator of population health and can measure the impact of medical actions. The main objective of this study was to determine the HRQoL of patients with rheumatic diseases (RD) and compare it with that of the general population. MethodsObservational, cross-sectional, single-center study, with consecutive inclusion of outpatients over 18 years of age seen at a Rheumatology hospital-based outpatient clinic in Madrid. Sociodemographic, clinical variables and HRQoL were recorded. HRQoL was measured with the 5-dimension, 5-level EuroQoL (EQ-5D-5L), which includes the EQ-Index (0–1 scale) and a visual analog scale (VAS, 0–100 scale). A descriptive analysis and a comparison with the HRQoL of the Spanish general population were performed. Results1144 patients were included, 820 (71.68%) women, with a mean age of 56.1 years (range 18–95), of whom 241 (25.44%) were new patients. In patients with RD, the HRQoL measured with the EQ-Index and with the VAS, was 0.186 and 12 points lower, respectively, than in the general population. The decrease in HRQoL affected the 5 health dimensions, especially “pain/discomfort”, followed by “daily activities” and “mobility”. This reduction in HRQoL was observed in both men and women, and in all age ranges, although it was greater between 18 and 65 years of age. The reduction in HRQoL affected all RD subtypes, especially the “peripheral and axial mechanical pathology” and the “soft tissue pathology” group. ConclusionsPatients with rheumatic diseases report worse HRQoL when compared to the general population in all dimensions of HRQoL.

Single-sided magnetic resonance-based sensor for point-of-care evaluation of muscle

Magnetic resonance imaging is a widespread clinical tool for the detection of soft tissue morphology and pathology. However, the clinical deployment of magnetic resonance imaging scanners is ultimately limited by size, cost, and space constraints. Here, we discuss the design and performance of a low-field single-sided magnetic resonance sensor intended for point-of-care evaluation of skeletal muscle in vivo. The 11 kg sensor has a penetration depth of >8 mm, which allows for an accurate analysis of muscle tissue and can avoid signal from more proximal layers, including subcutaneous adipose tissue. Low operational power and shielding requirements are achieved through the design of a permanent magnet array and surface transceiver coil. The sensor can acquire high signal-to-noise measurements in minutes, making it practical as a point-of-care tool for many quantitative diagnostic measurements, including T2 relaxometry. In this work, we present the in vitro and human in vivo performance of the device for muscle tissue evaluation.

Ultrasound Applications in Pediatric Orthopedics.

Imaging techniques have significantly impacted physicians' capability for diagnosis and differential diagnosis for decades. The aim of this review is to update our knowledge regarding the use of US in orthopedic pediatric patients for diagnostic purposes or procedural/therapeutic purposes. This review demonstrates the application of US in trauma (long bone fractures, radial neck fractures, etc.), developmental anomalies such as developmental dysplasia of the hip and congenital dislocation of the patella, soft tissue pathologies (ganglion cyst, popliteal cyst, hemangioma, lipoma, etc.), tumors, apophysitis, joint effusion, and femoral acetabular impingement. US aid in musculoskeletal procedures has also been reported; US-guided procedures such as aspiration, injection, biopsy, foreign body removal, and peripheral nerve block reduce complications, thus making the procedures safer for the patient. Sonography is a fast, low-cost, mobile, non-invasive, and radiation-free diagnostic tool. Even though US requires a skilled operator and has a long learning curve, in experienced hands is the "orthopedic surgeon's stethoscope".

Posterior Ankle Impingement: It's Not Only About the Os Trigonum.

Os trigonum and Stieda process are common etiologies for posterior ankle impingement syndrome (PAIS), and diagnosis is typically made by radiographs, computed tomographic, or magnetic resonance imaging. However, these static tests may not detect associated soft tissue and bony pathologies. Posterior ankle and hindfoot arthroscopy (PAHA) is dynamic, providing at least ×8 magnification with full anatomical visualization. The primary aim of this study was to report the prevalence of associated conditions seen with trigonal impingement treated with PAHA. In this retrospective comparative study, patients who underwent PAHA for PAIS due to trigonal impingement, from January 2011 to September 2016, were reviewed. Concomitant open posterior procedures and other indications for PAHA were excluded. Demographic data were collected with pre- and postoperative diagnosis, arthroscopic findings, type of impingement, location, associated procedures, and anatomical etiologies. Trigonal impingements were divided in os trigonal or Stieda and subgrouped as isolated, with flexor hallucis longus (FHL) disorders, with FHL plus other impingement, and with other impingement lesions. A total of 111 ankles were studied-74 os trigonum and 37 Stieda. Isolated trigonal disorders accounted for 15.3% of PAIS (n = 17). Cases having associated conditions had a mode of 3 additional pathologies. FHL disorders were found in 69.4%, subtalar impingement in 32.4%, posteromedial ankle synovitis in 25.2%, posterolateral ankle synovitis in 22.5%, and posterior inferior tibiofibular ligament impingement in 19.8% of cases. Associated pathologies were observed in 58.6% of cases when FHL was not considered. Significant differences were noted comparing os and Stieda (isolated: 20.3% to 5.4%, P = .040; FHL plus others: 35.1% to 59.5%, P = .015). Trigonal bone (os trigonum or Stieda) was found to cause impingement in isolation in a small proportion of cases even when the FHL was considered part of the same disease spectrum. This should alert surgeons when considering removing trigonal impingement. Open approaches may limit the visualization and assessment of associated posterior ankle and subtalar pathoanatomy, thus possibly overlooking concomitant causes of PAIS. Level III, retrospective comparative study.

Investigation of the Effect of Virtual Microscopy on Pathology Education in a Medical Faculty

Aim: Virtual microscopy technology has been widely used in histopathological diagnosis and pathology education, replacing the traditional light microscope, which is considered an important visual tool in pathology education. Slides scanned and stored online for use in virtual microscopy were first described in 1985 and have experienced significant developments since 2000. In this study. The aim of this study was to determine how virtual microscopy affected medical school students' pathology education. Methods: The study included the 3rd year students of Izmir Democracy University Faculty of Medicine. The study was conducted prior to the end-of-year pathology practice exam. As a result of the scanning performed by company received support, 102 slides were selected from the training archive and virtualized. Among them, forty slides representing lesions and organs from ten different systems, were chosen. The students were divided into two groups (group 1 and 2.) and the selected slides were used as educational material. Each student was given the opportunity to study both 20 virtual and 20 microscope slides. The students in the first group (G1) examined 20 slides (M1) of the ten systems with the light microscope and the other 20 slides on the virtual microscope (S1). On the other hand, the students in the second group (G2) examined with a light microscope (M2) the slides which shown to the first group in the virtual microscope (V1); and they examined with the virtual microscope (V2) the slides which shown to the first group in the light microscope (M1). This training course was completed in approximately eight hours. For the end-of-year pathology practice exam held the next day, the students were randomly divided into 4 groups and each group was asked questions about 10 slides from 10 different systems. These questions were about the descriptive characteristics of the organs and lesions that are examined. All slides were shown to the examinees one day later. Results: Eighty-nine students in total [n:52 (58.4%) men, n:37 (41.6%) women] took part in the survey. The study found no significant difference in overall exam scores between students using traditional light microscopy and those using virtual microscopy, with average scores being 17.2±7 on a scale of 5 to 40 points. Students who examined slides using light microscopy had an average score of 8.7±4.6, while those who used virtual microscopy had an average score of 8.6±4.1. It was found that the success rates were similar regardless of whether the students used traditional microscopy or virtual reality. Yet when the results were grouped by gender, female students had higher overall (p=0.05) and light microscopy scores (p=0.001). When the groups were investigated separately, the exam scores attained were comparable in terms of from the exam content related to major system disorders did not differ between the groups. based on learning method without any statistical significance between groups. However, while group 1 students who participated in studying with light microscopy training before the exam had higher exam scores in the exam content related to bone and soft tissue pathology compared to group 2 students studying with virtual microscopy (in bone and soft tissue pathology had a mean score of 3±1.5 vs 1.2±1.7) points, virtual learners had a mean score of 1.2±1.7 points, with a statistically significant intergroup difference according to the Mann- Whitney U test (p=0.027). Conclusions: Virtual microscopy is a crucial component of medical students' pathology training in undergraduate medical education in terms of providing opportunities for medical students to see the rare cases and standardization of the training in different institutions. Particularly in undergraduate education, it is crucial for the understanding of rare cases and standardization of the pathology education. But as our study's findings on the pathology of bone and soft tissues showed, conventional light microscopy is still essential for understanding the pathology of some systems. Moreover, one's gender may affect student's capacity for virtual learning. Understanding the distinction between genders in terms of learning capacity may aid in providing students a better education.

The Efficacy of Punch Biopsies in Diagnosing Intra-Oral Lesions in OMFS

Intraoral biopsies are used, as an adjunct to clinical examination, to confirm the diagnosis of unknown pathology. Traditional biopsy techniques involved the sole use of a scalpel to obtain samples to determine histopathological diagnoses. This paper explores the efficacy of punch biopsies when sampling soft tissue pathologies. A punch biopsy is a tool that is available in varying sizes that allows us to take accurate samples of intra-oral lesions to obtain histopathological diagnoses. Punch biopsies have an array of benefits; smaller sample sizes required, simple and quick procedures and leser operators sensitive. 66 punch biopsies of varying sizes and intra-oral sites were reviewed to assess their diagnostic quality. We reviewed the histopathology reports, noting any evidence of artifact as well as samples that were not diagnostically acceptable thus requiring a second biopsy. Our findings showed that 98.5% of the punch biopsies taken were diagnostic, with only 1 out of the 66 samples reviewed requiring re-biopsy. We noted this was a 2mm biopsy, the smallest punch used in our sample size. This audit shows the benefit of appropriately sized punch biopsies when sampling intraoral lesions. Clinicians are encouraged to use punch biopsies more often when sampling intraoral soft tissue lesions. Limitations of the initial cycle of this audit include the modest sample size. Successive cycles will look at more extensive data sets as well as compare traditional elliptical biopsies to punch biopsy techniques. This second cycle will allow us to discern the efficacy of modern punch biopsy techniques over traditional methods for sampling intraoral soft tissue lesions.

Do Dynamic Plantar Pressures Differ Based on Sonographic Evidence of Metatarsophalangeal Joint Synovitis in People With Rheumatoid Arthritis?

The metatarsophalangeal joints (MTPJs) are the most common location for synovitis in people with rheumatoid arthritis (RA), yet their association with plantar foot pressures has received very little attention. This study aimed to determine whether plantar pressures differed based on sonographic evidence of MTPJ synovitis in people with RA. Ultrasound was used to assess synovitis (grey scale synovial hypertrophy and power Doppler signal) in MTPJs 1 to 5 using the combined EULAR/Outcome Measures in Rheumatology scoring system. Peak pressure (PP) and pressure time integrals (PTIs) were assessed during barefoot walking for seven plantar foot regions (heel, midfoot, first metatarsal, second metatarsal, third to fifth metatarsals, hallux, lesser toes). Mixed-effects linear regression was used to determine the difference in PP and PTI between MTPJs with none/minimal synovitis and MTPJs with moderate/severe synovitis. Thirty-five participants with RA were included. Mean age was 66.3 years and mean disease duration was 22.2 years. Participants with sonographic evidence of moderate/severe synovitis at the first MTPJ had reduced PTI at the hallux compared with those with none/minimal synovitis at this joint (P = 0.039). Participants with moderate/severe synovitis at the second MTPJ and fourth MTPJ had reduced PP and reduced PTI at lesser toes compared with those with none/minimal synovitis in these joints (all P ≤ 0.048). No significant differences were observed for synovitis in other joints. These findings may be suggestive of an inverse relationship between plantar pressure and soft tissue pathology, which is consistent with an offloading strategy and reduced use of the toes during propulsion.

Shear wave elastography assessment of buccinator stiffness in patients of different age groups

Objective: to assess the capabilities of lower face muscles stiffness measurement with shear wave elastography in female patients of various age groups.Material and methods. Ultrasound examination with buccinator muscle stiffness measurement in shear wave elastography was performed in 45 healthy female patients divided into three equal groups by the age (20–30, 31–40 and 41–50 years old) with the use of Epiq 5 (Phillips, the Netherlands) with a linear probe (4–18 MHz). Exclusion criteria were: a history of facial soft tissue pathology, neuromuscular disorders, invasive or minimally invasive facial cosmetology, long-term activity with an active use of facial muscles and articulation. The values of Young's modulus (kPa) were measured in the central and lateral parts of the buccinator muscle in the standing and supine positions of the patients.Results. There was no significant differences of Young's modulus in the central and lateral parts measured standing compared to supine position in all age groups (except the lateral part in group 1). A signifi cant progressive decrease of the buccinator muscle stiffness obtained in three age groups with minimal values of Young’s modulus in the age group of 41–50 years: median – from 5.8 to 9.1 kPa (minimum–maximum values – from 4.1 to 11.3 kPa ) depending on the area of measurements and the position of the patient. In patients of the age group 20–30 years – 8.6–13.8 kPa (7.6–16.5 kPa), 31–40 years – 8.0–11.8 kPa (6.0–13.7 kPa ), respectively.Conclusion. Shear wave elastography allows the assessment of age-related changes in soft tissue, as demonstrated by the decrease of buccinator muscle stiffness

Magnetic resonance imaging shows spinal curvature in Chinook salmon (Oncorhynchus tshawytscha) is associated with chronic inflammation of peri-vertebral soft tissues.

Chinook salmon (Oncorhynchus tshawytscha) farmed in New Zealand are known to develop abnormal spinal curvature late in seawater production. Its cause is presently unknown, but there is evidence to suggest a neuromuscular pathology. Using magnetic resonance imaging (MRI), we evaluated the relationship between soft tissue pathology and spinal curvature in farmed Chinook salmon. Regions of interest (ROIs) presenting as pathologic MRI signal hyper-intensity were identified from scans of 24 harvest-sized individuals: 13 with radiographically-detectable spinal curvature and 11 without. ROIs were excised from individuals using anatomical landmarks as reference points and histologically analysed. Pathologic MRI signal was observed more frequently in individuals with radiographic curvature (92%, n = 12) than those without (18%, n = 2), was localized to the peri-vertebral connective tissues and musculature, and presented as three forms: inflammation, fibrosis, or both. These pathologies are consistent with a chronic inflammatory process, such as that observed during recovery from a soft tissue injury, and suggest spinal curvature in farmed Chinook salmon may be associated with damage to and/or compromised integrity of the peri-vertebral soft tissues. Future research to ascertain the contributing factors is required.

Textural Analysis of Magnetic Resonance Images as an Additional Evaluation Tool of Parotid Glands in Sjögren-Primarily Findings.

Magnetic Resonance Imaging (MRI) plays a leading role in diagnosing soft tissue pathologies, especially in the head and neck. It is increasingly popular for evaluating salivary gland issues like neoplasms and Sjogren's Syndrome. Advanced MRI methods, including MRI sialography and texture analysis, offer non-invasive alternatives, enhancing MRI's role. This study focused on the relationship between the apparent diffusion coefficient (ADC) and T2-weighted MRI sialography and texture analysis (TA) of parotid glands in children with and without Sjogren's Syndrome (SS). Using 3.0 Tesla MRI with DWI and T2-weighted imaging, expended texture analysis, first-order statistics (FSOs), second-order, and higher-order statistics were conducted. The results showed significant differences in parotid ADC values, with lower values in the SS group, particularly in cases of higher disease activity. Lower kurtosis values were associated with more severe Tonami Scale grades. FSO parameters correlated well with the texture analysis from T2-weighted images, indicating promise in grading parotid gland inflammation. However, further research is needed to understand the impact of variables like binning and region of interest (ROI) size. This study highlights the potential of texture analysis for assessing parotid gland inflammation and emphasizes the need for more investigations in this area.

A review of oral pathology in orthodontics. Part 1: Soft-tissue pathology

Orthodontists are well placed to detect soft-tissue disease of the oral cavity and associated structures because of the frequent repeat examinations of their patients. This review describes the clinical manifestations, pathologic features, and treatment of the soft-tissue pathology most likely to be encountered by the orthodontist and uncommon soft-tissue disease with significant implications for the patient. The recognition of soft-tissue disease will allow reassurance, referral, and early intervention when required.

SPINAL TUMORS-04 SOLITARY FIBROUS TUMOUR, A DIAGNOSTIC CONUNDRUM (A CASE REPORT)

Abstract A 33-year-old male presented with neck pain and early signs of cervical myelopathy. He had a circumferential enhancing C4 tumour with bone demineralization. He had previously had an ACDF and a biopsy of the affected region with variable histology results. Imaging revealed a circumferential C4 tumour with bilateral vertebral encasement and cord compression. He had an extensive tumour debulking , corpectomy and posterior fusion. His neck pain resolved and myelopathy is stable at Nurick grade I. Histology Sections showed cellular tumor composed of spindle cells with little intervening stroma CD34 positive, progesterone receptor negative and EMA. STAT6 was positive confirming a solitary fibrous tumour. Patient has commenced adjuvant radiotherapy. Solitary tumours, formerly classified hemangiopericytoma are rare. In this case, the patient had had three previous inconclusive histological evaluations. Utilization of immunohistochemistry tests enabled the establishment of a conclusive diagnosis and treatment planning. Previously solitary fibrous tumors were classified as hemangiopericytomas with the option of three grades. However, in the current 2021 WHO 5th edition, the term hemangiopericytomas has been dropped to align these tumors fully with the soft tissue pathology nomenclature. These tumors have the characteristic alteration of the NAB2-STAT6 gene/molecular profile.