Publications by authors named "Asif Saifuddin"

183 Publications

Answer To Test Yourself Question: A 19-year-old male presents with progressive distal lower limb pain.

Skeletal Radiol 2021 Jul 12. Epub 2021 Jul 12.

Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK.

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http://dx.doi.org/10.1007/s00256-021-03855-zDOI Listing
July 2021

Soft tissue masses of the epitrochlear region.

Br J Radiol 2021 Jul 8:20210236. Epub 2021 Jul 8.

Department of Radiology, The Royal National Orthopaedic Hospital, Stanmore, UK.

The epitrochlear lymph nodes (ELN) are rarely examined clinically and are difficult to identify radiologically in healthy patients. They are, therefore, generally under appreciated as a source of significant pathology. Despite this, enlargement of an ELN is almost always secondary to a pathological process, the differential for which is relatively narrow. The following pictorial review illustrates the spectrum of infectious, inflammatory and malignant conditions affecting the ELN, some of which are quite specific to this location. We also emphasise the importance of distinguishing enlarged ELNs from benign and malignant non-nodal soft tissue masses, which can have very similar clinical presentation and imaging appearances.
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http://dx.doi.org/10.1259/bjr.20210236DOI Listing
July 2021

Test yourself question: a 19-year-old male presents with progressive distal lower limb pain.

Skeletal Radiol 2021 Jul 5. Epub 2021 Jul 5.

Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK.

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http://dx.doi.org/10.1007/s00256-021-03854-0DOI Listing
July 2021

Is It Time to Call Time on Bone Marrow Biopsy for Staging Ewing Sarcoma (ES)?

Cancers (Basel) 2021 Jun 29;13(13). Epub 2021 Jun 29.

The London Sarcoma Service, University College London Hospitals Foundation Trusts, London NW1 2BU, UK.

Primary malignant bone sarcomas are rare and Ewing sarcoma (ES), along with osteosarcoma, predominates in teenagers and young adults. The well-established multimodality treatment incorporates systemic chemotherapy with local control in the form of surgery, with or without radiation. The presence and extent of metastases at diagnosis remains the most important prognostic factor in determining patient outcome; patients with skeletal metastases or bone marrow infiltration having a significantly worse outcome than those with lung metastases alone. There is, however, no accepted staging algorithm for ES. Large cooperative groups and national guidelines continue to advocate bone marrow biopsy (BMB) for staging but functional imaging techniques, such as 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) with computerised tomography (CT) have been increasingly used for staging cancers and whole-body magnetic resonance imaging (WB-MRI) for staging skeletal metastases. This review outlines the current literature, from which we conclude that BMB is no longer required for the staging of ES as it does not influence the standard of care management. BMB may, however, provide prognostic information and insights into the biology of ES in selected patients on prospective clinical trials.
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http://dx.doi.org/10.3390/cancers13133261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267963PMC
June 2021

Telangiectatic soft tissue sarcoma and chronic expanding haematoma: a comparative review of MRI features.

Skeletal Radiol 2021 Jun 29. Epub 2021 Jun 29.

Department of Radiology, The Royal National Orthopaedic Hospital, Brockley Hill, HA7 4LP, Stanmore, UK.

Soft tissue sarcomas containing a dominant component of haemorrhage are known to be aggressive tumours associated with a poor prognosis. Importantly, the clinical behaviour and imaging characteristics of extensively haemorrhagic soft tissue sarcomas (also termed telangiectatic soft tissue sarcomas) can resemble those of benign haematomas, particularly those that continue to expand over a prolonged period, so-called chronic expanding haematomas (CEH). The following review evaluates the current literature to identify the clinical, imaging and pathological characteristics of telangiectatic soft tissue sarcomas and to determine features that may help distinguish them from CEH. Ultimately, we suggest that lesions with sizeable regions of internal haemorrhage should be regarded with a high degree of suspicion for underlying malignancy and require referral to a tertiary sarcoma centre, where a carefully planned approach to biopsy and follow-up is needed to avoid errors in diagnosis.
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http://dx.doi.org/10.1007/s00256-021-03853-1DOI Listing
June 2021

MRI differentiation of low-grade and high-grade chondrosarcoma of the shoulder girdle, chest wall and pelvis: a pictorial review based on 111 consecutive cases.

Br J Radiol 2021 Jun 16:20201404. Epub 2021 Jun 16.

Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK.

Approximately 40% of conventional chondrosarcomas arise from the shoulder girdle, chest wall and pelvis. This pictorial review describes the MRI features which may aid in the differentiation of Grade 1 chondrosarcoma (Gd1-CS) from high-grade chondrosarcoma (HG-CS) and dedifferentiated chondrosarcoma (DD-CS) in these locations, based on literature review and assessment of 111 consecutive cases presenting to the senior authors institution over a 13-year period. Of the 111 patients reviewed (71 males and 40 females; mean age 54.3 years; range 17-92 years), 27 were Gd1-CS, 72 were HG-CS and 12 were DD-CS. Tumours arising from the scapula, acetabulum, pubis/ischium and sacrum were more likely to be HG-CS, as were intramedullary tumours. MRI features associated with HG-CS and DD-CS included cortical destruction, bone oedema, soft tissue oedema, tumour necrosis, intermediate T2W SI and joint invasion. The presence of a soft tissue mass became a significant differentiating feature for tumours arising within the medullary cavity, but this was location-specific and did not differentiate between Gd1-CS and HG-CS/DD-CS arising from the sternum or clavicle.
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http://dx.doi.org/10.1259/bjr.20201404DOI Listing
June 2021

An accessory iliotibial band insertion: a unique anatomical variant.

Skeletal Radiol 2021 Jun 1. Epub 2021 Jun 1.

Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK.

The iliotibial band (ITB) is considered an important anterolateral knee joint stabiliser. Its exact anatomy remains unclear with inconsistency owing to relative paucity of detailed cadaveric studies. Multiple ITB distal insertional sites have been reported, the most common and well known being a direct attachment onto Gerdy's tubercle of the anterolateral tibia. We report a rare distal insertional site not previously documented. A 50-year-old man presented with anterior knee pain. MRI showed an accessory band deep to the ITB, partially blending in with its superficial fibres. It inserted onto the anterolateral tibial tuberosity, deep to the patellar tendon insertion and inferomedial to Gerdy's tubercle. This was asymptomatic but the patient did have an underlying median patella ridge osteochondral defect successfully treated with stem cell grafting, completely unrelated to the mentioned variant. This case highlights the importance of detecting rare anatomical variants which can potentially be a source of lateral knee pain.
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http://dx.doi.org/10.1007/s00256-021-03827-3DOI Listing
June 2021

Natural history of the cervical high-intensity intramedullary lesion in achondroplasia.

Spinal Cord Ser Cases 2021 May 27;7(1):46. Epub 2021 May 27.

Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK.

Study Design: Retrospective cohort study.

Objective: The cervical high-intensity intramedullary (CHII) lesion is a recognised finding in achondroplasia, manifesting as a focal area of increased T2W signal intensity in the upper cervical cord in the absence of cervical cord compression. The aim of this study is to determine the natural history of this abnormality.

Setting: Tertiary referral spinal and orthopaedic hospital, UK.

Methods: A retrospective review was undertaken of all patients with achondroplasia who had undergone at least one MRI study which included the cervical spine. Patient age at presentation was recorded and presence of the CHII lesion was determined on the sagittal T2W FSE sequence. For patients who had follow-up studies, presence of the CHII lesion was assessed for any change in morphology (resolution, partial resolution or enlargement). The development of new CHII lesions and presence of associated cord atrophy was also recorded.

Results: The study group consisted of 40 patients (20 males, 20 females: mean age at first MRI of 32.6 years (range 7-66 years). The CHII lesion was identified in 19 (47.5%) cases and was associated with focal cord atrophy in 17 (85%) cases. There was no change or resolution of these lesions nor any associated cord compression. No new CHII lesions developed but progressive cord atrophy was evident.

Conclusion: The CHII lesion is seen in 47.5% of cases of achondroplasia. It appears to be a stable abnormality which does not progress or change its morphology. However, it does appear to be associated with progressive cord atrophy.
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http://dx.doi.org/10.1038/s41394-021-00411-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160127PMC
May 2021

Multimodality imaging of the paediatric flatfoot.

Skeletal Radiol 2021 May 17. Epub 2021 May 17.

Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK.

Flatfoot is commonly encountered in the paediatric population and describes a spectrum of clinical and radiological presentations which encompass both normally developing and pathological feet. Flatfoot can be categorised as flexible or rigid, a distinction which has important implications when considering the potential underlying aetiology and treatment options, and therefore imaging is an important component of the diagnostic workup. Weight-bearing plain radiographs are established initial investigations, although the significance of a number of the commonly derived quantitative parameters in children remains unclear. CT and MRI are important additional imaging modalities reserved for the investigation of symptomatic cases or those in which an underlying structural abnormality is suspected, rigid flatfoot commonly falling into one of these two categories. We review and illustrate the multimodality imaging of the paediatric flatfoot, with reference to both qualitative and quantitative radiographic assessment and cross-sectional imaging appearances.
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http://dx.doi.org/10.1007/s00256-021-03806-8DOI Listing
May 2021

Skip metastases in high-grade intramedullary appendicular osteosarcoma: an indicator of more aggressive disease?

Skeletal Radiol 2021 May 14. Epub 2021 May 14.

Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill Stanmore, HA7 4LP, Middlesex, UK.

Objective: To determine whether skip metastases (SM) in high-grade appendicular osteosarcoma (HG-OS) are an indicator of more aggressive disease.

Materials And Method: Retrospective review of patients with histologically confirmed diagnosis HG-OS of the long bones from 2007 to 2020, who had whole-bone MRI to identify SM. Data collected included patient age/gender, bone involved, the presence of SM, the presence of lung metastases from chest CT, the presence of distant bone metastases from whole-body bone scintigraphy or whole-body MRI, and chemotherapy response from resection specimen histology. The presence of lung or bone metastases and chemotherapy response were compared between patients without and with SM.

Results: The study included 241 patients (146 males; 95 females: mean age 18.2 years; range 4-73 years). Based on whole-bone MRI, 202 (83.8%) patients had no SM and 39 (16.2%) patients had a SM. Of patients without a SM, lung metastases were identified in 44 (22%) and distant bone metastases in 6 (3%) cases, while 80 (43%) had a good chemotherapy response and 105 (57%) had a poor chemotherapy response. Of patients with a SM, lung metastases were identified in 22 (58%) and distant bone metastases in 8 (21%) cases, while 11 (32%) had a good chemotherapy response and 23 (68%) had a poor chemotherapy response. The presence of SM was significantly associated with both lung metastases (p < 0.001) and skeletal metastases (p < 0.001), but not with chemotherapy response (p = 0.24). Patients with SM also had poorer survival (p < 0.001).

Conclusions: The presence of SM in appendicular HG-OS suggests more aggressive disease.
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http://dx.doi.org/10.1007/s00256-021-03814-8DOI Listing
May 2021

The diagnosis of pulmonary metastases on chest computed tomography in primary bone sarcoma and musculoskeletal soft tissue sarcoma.

Br J Radiol 2021 Jul 21;94(1123):20210088. Epub 2021 May 21.

UCL Cancer Institute, 72 Huntley St, WC1E 6DD, London, UK.

The lungs are the commonest site of metastasis for primary high-grade bone and soft tissue sarcoma, but current guidelines on the management of pulmonary nodules do not specifically cater for this group of patients. The current article reviews the literature from the past 20 years that has reported the CT features of pulmonary metastases in the setting of known primary bone and soft tissue sarcoma, with emphasis on osteosarcoma, chondrosarcoma, and trunk and extremity soft tissue sarcoma, the aim being to aid radiologists who report chest CT of musculoskeletal sarcoma patients in deciding which lesions should be considered metastatic, which lesions are indeterminate and require follow-up, and which lesions are of no concern.
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http://dx.doi.org/10.1259/bjr.20210088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248210PMC
July 2021

Pictorial review: imaging of the spinal manifestations of achondroplasia.

Br J Radiol 2021 Jul 29;94(1123):20210223. Epub 2021 Apr 29.

Royal National Orthopaedic Hospital NHS Trust, London, UK.

Achondroplasia is the commonest hereditary skeletal dysplasia exhibiting dwarfism with characteristic rhizomelic (proximal) shortening of the limbs. It is predominantly linked with an autosomal dominant inheritance, but sporadic mutations can occur which are associated with advanced maternal age. Approximately 1 in every 25 000-30 000 live births are affected, and the overall life expectancy is marginally reduced by ~10 years. Mutations in the fibroblast growth factor receptor causes a decrease in endochondral ossification, which results in stunted growth of cartilaginous bones. A resultant narrowed foramen magnum and a short clivus are seen which predisposes to craniocervical spinal canal stenosis. Apnoeic events arising from the compression of the vertebral arteries at the level of the craniocervical junction lead to fatality in the young, with a death rate as high as 7.5%. Decrease in the caudal inter-pedicular distance is characteristic and a contributory factor for cervical, thoracic and lumbar spinal canal stenosis, most pronounced in the lumbar spine with patients often requiring surgical intervention to ease symptoms. Thoracolumbar kyphoscoliosis and sacral manifestations such as small sacro-sciatic notches and a horizontal pelvis are seen. The aim of this pictorial review is to demonstrate the imaging findings of the spinal and pelvic manifestations of achondroplasia.
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http://dx.doi.org/10.1259/bjr.20210223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248197PMC
July 2021

The incidence and relevance of non-fatty components in trunk and extremity lipomatous soft tissue masses.

Br J Radiol 2021 Jun 20;94(1122):20201403. Epub 2021 May 20.

Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK.

Objectives: To determine the incidence and diagnostic relevance of non-fatty 'solid appearing' components within lipomatous tumours of the trunk and extremity.

Methods And Materials: Retrospective review of patients referred to a specialist musculoskeletal oncology service over a 12-month period with a lipomatous trunk or extremity soft tissue tumour. The presence and morphology (solitary/multifocal; homogeneous/heterogeneous; well-defined/poorly defined) of non-fatty components was recorded based on MRI and compared with the final histological diagnosis.

Results: 213 patients with 217 lipomatous tumours were included, 119 (55.9%) males and 94 (44.1%) females with mean age of 54.6 years (range 7-93 years). Seventy-seven (35.5%) lesions arose superficial to the fascia and 139 (64.1%) deep, while a single case involved both compartments. Mean maximal tumour dimension was 94.9 mm (range 12-288 mm). Non-fatty 'solid appearing' components were identified in 28 (12.9%) cases, of which eight were solitary and 20 were multifocal, six had homogeneous SI and 22 had heterogeneous SI, and eight had well-defined margins, while 20 had poorly defined margins. Histological diagnosis was available in 20 of the tumours containing non-fatty components, 16 of which were benign, two intermediate grade and two malignant (a dedifferentiated liposarcoma and a myxoid liposarcoma). The commonest diagnosis was spindle cell lipoma, which accounted for 10 of 20 (50%) cases with confirmed histology.

Conclusions: Non-fatty components are identified in ~13% of trunk and extremity lipomatous tumours. The majority of such lesions are benign lipoma variants, most commonly spindle cell lipoma.

Advances In Knowledge: Solid non-fatty components are identified in approximately 13% of lipomatous tumours referred to a specialist sarcoma service. Despite the concern that these may represent dedifferentiated liposarcomas, high-grade tumours were seen in only two cases, the commonest diagnosis being a spindle cell lipoma.
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http://dx.doi.org/10.1259/bjr.20201403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173682PMC
June 2021

Magnetic resonance imaging of trunk and extremity myxoid liposarcoma: diagnosis, staging, and response to treatment.

Skeletal Radiol 2021 Apr 1. Epub 2021 Apr 1.

Department of Clinical Oncology, University College London Hospital, 250 Euston Road, London, NW1 2PG, UK.

Myxoid liposarcoma (MLS) accounts for approximately 30% of all liposarcomas. The majority are intermediate-grade tumours, but the presence of >5% round cell component renders it a high-grade sarcoma with subsequent poorer outcome. MLS most commonly arises in the lower extremities, has a predilection for extra-pulmonary sites of metastatic disease, and is recognized to be radiosensitive. The purpose of the current article is to review the role of MRI in the management of MLS, including the characteristic features of the primary tumour, features which help to identify a round cell component and thus determine prognosis, the role of whole-body MRI for evaluation of extra-pulmonary metastatic disease, and the utility of MRI for assessing treatment response. The MRI differential diagnosis of MLS is also considered.
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http://dx.doi.org/10.1007/s00256-021-03769-wDOI Listing
April 2021

An update on the imaging of diaphyseal aclasis.

Skeletal Radiol 2021 Apr 1. Epub 2021 Apr 1.

Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK.

Solitary osteochondromas are common, benign hyaline cartilage-capped exostoses that primarily arise from the metaphyses of long and flat bones. Diaphyseal aclasis is an autosomal dominant condition resulting from EXT1 or EXT2 gene mutations and is characterized by multifocal osteochondromas. These can result in a wide spectrum of complications, such as skeletal deformity, neurological and vascular complications, adventitial bursa formation, fracture, and rarely malignant transformation to peripheral chondrosarcoma. In this review, we outline in detail the multimodality imaging features of DA and its associated complications.
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http://dx.doi.org/10.1007/s00256-021-03770-3DOI Listing
April 2021

Musculoskeletal imaging features of non-Langerhans cell histiocytoses.

Skeletal Radiol 2021 Mar 31. Epub 2021 Mar 31.

Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.

The non-Langerhans cell histiocytoses (N-LCH) represent a group of rare diseases with different clinical presentations and imaging features to classical LCH. While there is a long list of entities, only few present with musculoskeletal soft tissue and osseous manifestations alongside the more commonly reported systemic findings. Erdheim-Chester disease (ECD) is typically seen in adults as bilateral and symmetrical long bone osteosclerosis. Rosai-Dorfman disease (RDD) is more commonly seen in children and young adults with bone involvement usually being a manifestation of extra-nodal disease. Primary osseous RDD is very rare, with both displaying rather non-specific imaging features of an expansile lucent lesion with or without an extra-osseous component. Juvenile xanthogranuloma (JXG) is a benign disorder typically seen in very young children. The most common imaging manifestation is a dermal or sub-dermal soft tissue mass. This article reviews the musculoskeletal imaging appearances of the commoner N-LCH.
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http://dx.doi.org/10.1007/s00256-021-03765-0DOI Listing
March 2021

Test yourself question: multiple firm soft tissue masses.

Skeletal Radiol 2021 Mar 29. Epub 2021 Mar 29.

Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.

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http://dx.doi.org/10.1007/s00256-021-03761-4DOI Listing
March 2021

Test yourself answer: multiple firm soft tissue masses.

Skeletal Radiol 2021 Mar 26. Epub 2021 Mar 26.

Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.

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http://dx.doi.org/10.1007/s00256-021-03762-3DOI Listing
March 2021

The differential diagnosis of trunk and extremity dermal and sub-dermal lesions referred to a musculoskeletal oncology service.

Clin Imaging 2021 Feb 24;78:51-59. Epub 2021 Feb 24.

Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK. Electronic address:

Objectives: To determine the differential diagnosis of dermal and sub-dermal soft tissue masses which do not extend to the deep fascia that are referred to a specialist musculoskeletal oncology service.

Materials And Methods: Review of all patients referred to a specialist musculoskeletal oncology service over a 13-month period with a dermal or sub-dermal soft tissue mass which did not extend to the deep fascia based on MRI appearances. Data collected included age, gender, site and maximal lesion size, and final histological diagnosis for biopsied and/or excised lesions.

Results: 56 patients were included, 21 (37.5%) males and 35 (62.5%) females with mean age 49.75 years (range 5-86 years). 3 patients had 2 lesions making a total of 59 lesions, 11 (18.6%) dermal and 48 (81.4%) sub-dermal. Histological diagnosis was available in 44 (74.6%) cases, of which 11 (25%) were non-neoplastic, 23 (52.3%) were benign neoplasms, and 10 (22.7%) were malignant neoplasms. Although older age at presentation and greater mean maximal tumour dimension were seen with malignant lesions, these did not reach statistical significance (p = 0.154 and 0.102 respectively). There was also no relationship between skin involvement from sub-dermal lesions and malignancy, but 5 of 6 dermal lesions which showed an exophytic growth pattern were malignant.

Conclusions: The differential diagnosis of dermal and sub-dermal lesions which do not reach the deep fascia is wide with a malignant lesion being the cause in almost one-quarter of cases.
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http://dx.doi.org/10.1016/j.clinimag.2021.02.030DOI Listing
February 2021

A 29-year-old male with a long history of atraumatic wrist pain.

Skeletal Radiol 2021 Mar 12. Epub 2021 Mar 12.

The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.

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http://dx.doi.org/10.1007/s00256-021-03743-6DOI Listing
March 2021

Comparison of lumbar degenerative disc disease using conventional fast spin echo W MRI and fast spin echo dixon sequences.

Br J Radiol 2021 May 8;94(1121):20201438. Epub 2021 Mar 8.

Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK.

Objectives: To compare the grading of lumbar degenerative disc disease (DDD), Modic end-plate changes (MEPC) and identification of high intensity zones (HIZ) on a combination of sagittal weighted turbo spin echo (W TSE), weighted fast spin echo (W FSE) and short tau inversion recovery (STIR) sequences (routine protocol) with a single sagittal W FSE Dixon MRI sequence which provides in-phase, opposed-phase, water only and fat only images in a single acquisition (Dixon protocol).

Methods: 50 patients underwent lumbar spine MRI using the routine protocol with the addition of a W FSE Dixon sequence. DDD grade, MEPC and HIZ for each disc level were assessed on the routine and Dixon protocols. Each protocol was reviewed independently by three readers (consultant musculoskeletal radiologists with 26-, 8- and 4 years' experience), allowing assessment of inter-reader agreement and inter protocol agreement for each assessed variable.

Results: The study included 17 males and 33 females (mean age 51 years; range 8-82 years). Inter-reader agreement for DDD grade on the routine protocol was 0.57 and for the Dixon protocol was 0.63 ( = 0.08). Inter-reader agreement for MEPC on the routine protocol was 0.45 and for the Dixon protocol was 0.53 ( = 0.02), and inter-reader agreement for identification of the HIZ on the routine protocol was 0.52 and for the Dixon protocol was 0.46 ( = 0.27). Intersequence agreement for DDD grade ranged from 0.61 to 0.97, for MEPC 0.46-0.62 and for HIZ 0.39-0.5.

Conclusion: A single sagittal W FSE Dixon MRI sequence could potentially replace the routine three sagittal sequence protocol for assessment of lumbar DDD, MEPC and HIZ resulting in ~60% time saving.

Advances In Knowledge: Grading of lumbar DDD, presence of Modic changes and high intensity zones were compared on sagittal W TSE, W FSE and STIR sequences with a W FSE Dixon sequence, with fair-to-good correlation suggesting that three conventional sequences could be replaced by a single Dixon sequence.
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http://dx.doi.org/10.1259/bjr.20201438DOI Listing
May 2021

A 29-year-old male with a long history of atraumatic wrist pain.

Skeletal Radiol 2021 Feb 26. Epub 2021 Feb 26.

The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.

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http://dx.doi.org/10.1007/s00256-021-03742-7DOI Listing
February 2021

Tumours and tumour-like lesions of joints: Differential diagnoses in a paediatric population compared to adults.

Br J Radiol 2021 Apr 22;94(1120):20201389. Epub 2021 Feb 22.

Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK.

Objective: To determine the differential diagnosis of intra-articular tumours and tumour-like lesions in a paediatric population compared to adults.

Methods: Retrospective review of children up to the age of 18 years with suspected intra-articular tumours and tumour-like lesions referred to a specialist musculoskeletal oncology service from January 2019 to August 2020. Data recorded included patient age and gender, lesion location and morphology (based on the classification system of Adams et al.), and the final diagnosis made either by image-guided biopsy/resection or by clinical and imaging features. Comparison was then made with a group of adults presenting during the same period.

Results: 28 paediatric patients were included (12 males and 16 females with mean age 11.2 years, range 3-18 years). Joints involved were the knee ( = 22; 78.6%), ankle ( = 4; 14.3%), hip ( = 1; 3.6%) and elbow ( = 1; 3.6%). Lesion morphology was Type 1 ( = 18; 64.3%), Type 2 ( = 3; 10.7%), Type 3 ( = 1; 3.6%) and Type 4 ( = 5; 17.9%). Final diagnosis was made by image-guided biopsy/resection in 18 (64.3%) patients. The commonest neoplastic lesion was tenosynovial giant cell tumour ( = 11; 39.3%), followed by synovial haemangioma ( = 5; 17.9%). There was only a single malignant lesion, a case of synovial sarcoma. Of eight (28.6%) non-neoplastic lesions, three were diagnosed as juvenile idiopathic arthritis and three as non-specific synovitis. There was no difference compared to adults regarding gender, joint involved or lesion morphology, but there was a significant difference in final diagnoses ( < 0.001). The range of intra-articular tumours and tumour-like lesions in children differs from that in adults, although tenosynovial giant cell tumour is the commonest diagnosis in both groups and malignant lesions are rare.

Advances In Knowledgeart: In our series, ~16% of tumours and tumour-like lesions of joints occur in the paediatric population. Tenosynovial giant cell tumour remains the commonest diagnosis in children as in adults. Synovial haemangioma and juvenile idiopathic arthritis were the next commonest diagnoses in children, while primary synovial chondromatosis and reactive synovitis were the next commonest diagnoses in adults. Malignant lesions are rare in both groups.
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http://dx.doi.org/10.1259/bjr.20201389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010541PMC
April 2021

The role of imaging in differentiating low-grade and high-grade central chondral tumours.

Eur J Radiol 2021 Apr 5;137:109579. Epub 2021 Feb 5.

Imaging Department, Royal National Orthopaedic Hospital, United Kingdom.

Chondrosarcoma is a malignant cartilage matrix-producing tumour. Those arising de novo are called primary chondrosarcomas and are the second commonest primary malignant bone tumours. Numerous types of primary chondrosarcoma exist, namely conventional central (intramedullary), periosteal (juxta-cortical), clear cell, mesenchymal, and dedifferentiated. The biologic aggressiveness, prognosis and thus management of chondrosarcoma are dependent on the histological sub-type and grade. Accurate pre-operative diagnosis is therefore essential in determining management and outcome which requires a multidisciplinary approach taking into account clinical features, imaging findings and histopathology. In this review, we present the pertinent multimodality imaging features which aid in the differentiation of low-grade and high-grade conventional central chondrosarcoma.
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http://dx.doi.org/10.1016/j.ejrad.2021.109579DOI Listing
April 2021

Role of in-phase and out-of-phase chemical shift MRI in differentiation of non-neoplastic versus neoplastic benign and malignant marrow lesions.

Br J Radiol 2021 Mar 17;94(1119):20200710. Epub 2021 Feb 17.

Department of Medical Imaging, Royal National Orthopaedic Hospital, Stanmore, UK.

Objective: To determine its ability of in-phase (IP) and out-of-phase (OOP) chemical shift imaging (CSI) to distinguish non-neoplastic marrow lesions, benign bone tumours and malignant bone tumours.

Methods: CSI was introduced into our musculoskeletal tumour protocol in May 2018 to aid in characterisation of suspected bone tumours. The % signal intensity (SI) drop between IP and OOP sequences was calculated and compared to the final lesion diagnosis, which was classified as non-neoplastic (NN), benign neoplastic (BN) or malignant neoplastic (MN).

Results: The study included 174 patients (84 males; 90 females: mean age 44.2 years, range 2-87 years). Based on either imaging features ( = 105) or histology ( = 69), 44 lesions (25.3%) were classified as NN, 66 (37.9%) as BN and 64 (36.8%) as MN. Mean % SI drop on OOP for NN lesions was 36.6%, for BN 3.19% and for MN 3.24% ( < 0.001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of CSI for differentiating NN from neoplastic lesions were 65.9%, 94.6%, 80.6%, 89.1%% and 87.4% respectively, and for differentiating BN from MN were 9.1%, 98.4%, 85.7%, 51.2 and 53.1% respectively.

Conclusion: CSI is accurate for differentiating non-neoplastic and neoplastic marrow lesions, but is of no value in differentiating malignant bone tumours from non-fat containing benign bone tumours.

Advances In Knowledge: CSI is of value for differentiating non-neoplastic marrow lesions from neoplastic lesions, but not for differentiating benign bone tumours from malignant bone tumours as has been previously reported.
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http://dx.doi.org/10.1259/bjr.20200710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011264PMC
March 2021

Paediatric bone lesions: diagnostic accuracy of imaging correlation and CT-guided needle biopsy for differentiating benign from malignant lesions.

Br J Radiol 2021 Apr 10;94(1120):20201234. Epub 2021 Feb 10.

Musculoskeletal Radiology Department, Royal National Orthopaedic Hospital, Stanmore, UK.

Objective: To determine the sensitivity, specificity and accuracy of CT-guided needle biopsy (CT-NB) for distinguishing benign and malignant lesions in children with suspected primary bone tumours, and to assess the correlation between imaging diagnosis and final diagnosis.

Methods: Retrospective review of children who underwent CT-NB of a suspected primary bone tumour between October 2016 and October 2019. Data collected included anatomical location, imaging diagnosis, type of needle, type of biopsy sample, CT-NB diagnosis, final diagnosis and post-procedural complications. The final diagnosis was established based on surgical histology or clinical/imaging follow-up.

Results: 125 patients met the inclusion criteria (68M, 57F: mean age 11 years; range 10 months-18 years). Biopsy was performed using a 10 cm Jamshidi needle (10G = 96; 13 G = 8); 14G Tru-Cut needle ( = 18); 14G Temno needle ( = 3). The commonest anatomical locations were the femur ( = 40), tibia ( = 25) and humerus ( = 16), while the commonest diagnoses were osteosarcoma ( = 35), CRMO ( = 15) and LCH ( = 14). A benign tumour was correctly identified on imaging in 100% of cases, and a malignant tumour in 95.8%. Sensitivity, specificity and diagnostic accuracy of CT-NB for distinguishing malignant from benign lesions were 98%, 100 and 99%. Of 24 indeterminate biopsy results, all that had a non-aggressive radiological appearance were benign. No immediate complications were recorded.

Conclusion: CT-NB represents a safe and very effective tool for differentiating benign and malignant lesions in children presenting with a suspected primary bone tumour. Suspected radiological diagnosis plays a pivotal role in the management of indeterminate biopsy results.

Advances In Knowledge: Paediatric bone tumours pose a significant diagnostic and therapeutic challenge. The interpretation of the imaging findings is essential for the successful management of indeterminate histological results.
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http://dx.doi.org/10.1259/bjr.20201234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010532PMC
April 2021

MRI features of low-grade and high-grade chondrosarcoma in enchondromatosis.

Skeletal Radiol 2021 Aug 23;50(8):1637-1646. Epub 2021 Jan 23.

Imaging Department, Royal National Orthopaedic Hospital, Stanmore, England.

Objective: To identify magnetic resonance imaging (MRI) features which aid differentiation of low-grade chondral tumours (LGCT-enchondroma and grade 1 chondrosarcoma) from high-grade chondral tumours (HGCT) in patients with enchondromatosis.

Materials And Method: Approval from our local Research and Innovation Centre of The Institute of Orthopaedics was gained. Patients with enchondromatosis who had biopsy and/or resection of chondral lesions over a 13-year period were identified. The pre-biopsy MRI study was assessed by two experienced musculoskeletal radiologists for tumour origin (intramedullary or surface), cortical expansion, cortical destruction, bone marrow oedema, periosteal reaction, soft tissue mass and soft tissue oedema. MRI features were compared with the final histopathological diagnosis.

Results: The study group comprised 25 males and 16 females, with a mean age of 34.9 years (range 6-81 years). Fifty-nine lesions were assessed (12 patients had > 1 tumour treated), including 43 LGCT and 16 HGCT. Significant MRI features suggesting malignant transformation to HGCT for both observers included bone oedema (p = < 0.001 and 0.002), periosteal reaction (p = 0.01) and soft tissue oedema (p = 0.001 and 0.05). Cortical destruction and soft tissue mass were predictors of HGCT in major long bones, but no significant differentiating features were identified in the hands and feet.

Conclusion: The presence of bone oedema, periosteal reaction and soft tissue oedema on MRI may indicate a high-grade malignant transformation of chondral tumours in patients with enchondromatosis.
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http://dx.doi.org/10.1007/s00256-021-03718-7DOI Listing
August 2021

Imaging following surgery for primary appendicular bone tumours.

Skeletal Radiol 2021 Aug 22;50(8):1527-1555. Epub 2021 Jan 22.

Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.

Primary bone tumours are uncommon, with sarcomas accounting for < 0.2% of all malignancies. The survival rate of primary bone sarcomas has significantly improved due to (neo)adjuvant therapy, while improved surgical techniques and development of new prostheses have shifted the surgical focus from amputation to limb preservation in the vast majority of patients. A wide variety of surgical options are available for the treatment of primary bone tumours which depend upon histological diagnosis, their appearance at the time of presentation and response to any (neo)adjuvant therapy as required. This review is intended to help radiologists familiarise themselves with the management of primary appendicular bone tumours and expected normal postoperative appearances for the various surgical techniques, and to recognise potential complications.
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http://dx.doi.org/10.1007/s00256-021-03712-zDOI Listing
August 2021
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