e-Posters 2025
All the e-poster pdf files are avalaible below. Click on the icon to view the abstract.

Purpose :
Clinical history

Materials and Methods :
Background

Results :
Clinical perspective

Conclusions :
Outcome

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Purpose :

1. Introduce radiologists to the fundamental concepts of prompt engineering in large language models (LLMs) for musculoskeletal (MSK)-based tasks.
2. Explain key prompt techniques, including zero-shot, few-shot, chain-of-thought (CoT), tree-of-thought (ToT), and retrieval-augmented generation (RAG), with examples relevant to MSK radiology.
3. Highlight potential applications of prompt engineering in decision support, reporting automation, and clinical education for MSK radiologists.

Materials and Methods :
The integration of LLMs into radiology has led to increased interest in optimizing their outputs through prompt engineering. Prompt design can significantly influence model performance, particularly in MSK radiology, where nuanced interpretation of findings and structured reporting are essential. Various prompting techniques have been developed to enhance context awareness, reasoning ability, and accuracy of AI-generated responses. However, the optimal approach for different clinical tasks remains unclear. Understanding zero-shot, few-shot, CoT, ToT, and RAG prompting is crucial for radiologists looking to leverage AI effectively in MSK imaging.

Results :
Each prompting technique has distinct advantages and limitations in MSK radiology applications:

• Zero-shot prompting: LLMs generate responses without prior examples. While useful for broad queries, it may lack specificity for MSK radiology. Example: "Describe the MRI features of Achilles tendinopathy."
• Few-shot prompting: Provides the model with a few labeled examples to improve accuracy. Example: "Given these cases of osteoid osteoma, classify the next case."
• CoT prompting: Encourages stepwise reasoning, improving complex tasks. Example: "What is the best MRI protocol for knee imaging? Let’s think step by step."
• ToT prompting: Extends CoT by considering multiple branching possibilities, useful for differential diagnosis generation.
• RAG: LLMs access external databases or guidelines to enhance responses. Example: "Using the provided context, summarize the ESSR guidelines on MRI reporting of stress fractures.

Conclusions :
Prompt engineering offers a practical and scalable approach to optimize LLMs for MSK radiology. Techniques such as few-shot and CoT prompting may enhance clinical reasoning, while RAG-based approaches can help reduce falsified information by grounding responses in verified sources. Radiologists should tailor prompting strategies based on the specific clinical, educational, or research task. As AI continues to evolve, prompt engineering will be a key competency for MSK radiologists integrating LLMs into their workflow.

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Purpose :
Many studies show that the application of advanced AI-based technologies shortens MRI scans and improves image quality.  This study analyses “deep-resolve” AI-technology quantitatively and qualitatively.

Materials and Methods :
32 MR examinations AI-technology based were retrospectively compared with the same examination performed the year before without AI-technology. The images were qualitatively analysed with Likert-scale by two radiologists with 10 and 20 years of experience in MRI. Furthermore, the impact of AI on scan-time reduction, image quality improvement and economic feasibility was evaluated. 

Results :
AI-based noise reduction algorithms improve image clarity, leading to increased radiologist confidence, so images evaluation showed not inferiority in the quality of AI-based MRI sequences compared to no-AI sequences with similar diagnostic accuracy. It was estimated a 35% reduction in scan time. The subsequent economic analysis showed cost savings of EUR 150,000 per year per MRI machine due to increased efficiency. 

Conclusions :
AI-technology improves the efficiency of MRI examinations by reducing the scan time while maintaining the same level of diagnostic quality.  

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Purpose :
To identify the imaging characteristics associated with various types of ulnar-sided wrist impingement syndromes.
 

Materials and Methods :
Ulnar-sided wrist impingement syndromes frequently contribute to chronic wrist pain, often resulting from degenerative changes, anatomical predispositions, or repetitive microtrauma. In this review, we will examine the most common ulnar-sided wrist impingement syndromes: ulnar impaction syndrome, ulnar impingement syndrome, ulnar styloid impaction syndrome.  Imaging studies are essential for evaluating the pathological findings and correlation with patient’s history.

Results :
Ulnar Impaction Syndrome
Symptoms: Patients typically experience ulnar-sided wrist pain, which is often exacerbated by forearm pronation and ulnar deviation of the wrist.
Cause: The condition results from excessive axial loading due to ulnar positive variance, leading to degenerative perforation of the triangular fibrocartilage complex (TFCC), fraying of the lunotriquetral ligament, and deterioration of the cartilage surfaces of the lunate, triquetrum, and ulnar head.
Imaging: Ulnar positive variance is usually identified radiographically and is best assessed using a fully pronated grip view. MRI can effectively reveal impaction or bone contusions in the proximal-ulnar region of the lunate and triquetrum.

Ulnar Impingement Syndrome
Symptoms: This syndrome is characterized by a painful, clicking sensation in the wrist and diminished grip strength.
Cause: It occurs when a shortened ulna impinges on the distal radius, resulting in a painful and disabling pseudarthrosis.
Imaging: Imaging findings may include evidence of ulnar shortening (often requiring surgical intervention), subchondral sclerosis or localized bone edema at the site of impaction, and erosive "scalloping" of the distal radius in advanced stages of the condition.
 
Ulnar Styloid Impaction Syndrome
Symptoms: Patients experience ulnar-sided wrist pain due to an elongated ulnar styloid process that impacts the triquetral bone.
Cause: This condition arises when an oversized ulnar styloid tip improperly contacts the triquetrum.
Imaging: An ulnar styloid measuring greater than 6 mm in length is typically considered elongated. This impaction can lead to chondromalacia of the opposing articular surfaces, specifically at the proximal pole of the triquetrum and the tip of the ulnar styloid.
 
 

Conclusions :
Radiographs, CT, and MRI are useful for identifying ulnar-sided wrist impingement syndromes and assessing the anatomical factors contributing to the symptoms.
 

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Purpose :
Bone marrow edema syndrome (BMES) of the foot and ankle is a self-limiting condition characterized by inflammatory responses that lead to either an acute or insidious onset of lower extremity pain, which may not respond to basic analgesia. This syndrome predominantly affects middle-aged men and women in the later stages of pregnancy, typically around the third trimester.

Materials and Methods :
Accurate diagnosis of BMES relies on distinguishing it from both traumatic and non-traumatic causes of bone marrow edema, which may include conditions such as complex regional pain syndrome, transient migratory edema syndrome, avascular necrosis, subchondral insufficiency fractures, arthropathies, ankle impingement syndromes, infections, and malignancies.

Results :
Radiological investigations for BMES include plain radiography, computed tomography, scintigraphy and MR imaging. An understanding of the trauma mechanisms and specific imaging signs for non-traumatic pathologies provides essential guidance for a systematic and accurate interpretation of underlying causes, enhancing the precision of radiological assessment.

Conclusions :
This review aims to enhance the understanding of BMES among radiologists by highlighting its types, patterns, and common imaging features. Despite the condition's significant impact on patients' functional abilities and quality of life, BMES remains under-represented in existing literature and often goes unrecognized in clinical practice. This article aims to bridge this gap by fostering greater awareness and promoting accurate diagnosis in clinical settings.

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Purpose :
Morton’s neuroma (MN) and intermetatarsal bursitis (IB) are common causes of forefoot pain, often presenting with overlapping clinical symptoms. This presentation aims to:

1.Differentiate these two conditions using MRI and ultrasound.

2.Highlight key imaging features of each with special focus on US technique and guided injections.

3.Discuss management options, including conservative and interventional approaches.

Using case examples from our institute, we aim to provide a framework for accurate diagnosis and highlight image guided techniques for management of MIB.




 

Materials and Methods :

MN, a compressive neuropathy of the common plantar digital nerve, is most frequently located between the third and fourth metatarsal heads. IB is often associated with nerve thickening and perineural fibrosis, which comprise the MN-bursa complex in this condition. Accurate differentiation between these entities is necessary for effective patient care.

Results :

A distinct, hypoechoic lump between the metatarsal heads is visible on ultrasound (US). A positive Mulder's sign, which is characterized by a tactile click upon compression, may be discovered during dynamic examination. A lesion with low signal intensity on T1-weighted images and varying intensity on T2-weighted images can be seen using magnetic resonance imaging (MRI). Associated IB may manifest as fluid accumulation and contrast enhancement. Differential Diagnosis includes Stress fracture, ganglion cysts, synovial

Conclusions :
The care of Morton's neuroma and the intermetatarsal bursa complex depends on an accurate imaging evaluation. Effective treatment options can be guided using US and MRI to distinguish MN and IB.

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Purpose :

• To learn and to review the anatomy and biomechanics of glenohumeral joint.
• To establish a pre-surgical radiological evaluation protocol for reverse shoulder arthroplasty.
• To review the components, indications and complications of reverse shoulder arthroplasty.

Materials and Methods :
Although not as common, reverse shoulder arthroplasty is an increasingly common procedure, so it's important to understand its indications and normal and pathological radiological findings.

Results :
The glenohumeral joint has the greatest range of motion in the body thanks to its ball-and-socket morphology. The rotator cuff's function is essential in stabilizing this joint, so its injury causes an imbalance that leads to cranial migration of the humeral head due to the upward force of the deltoid.
Due to the arrangement of the prosthetic components, the reverse shoulder prosthesis moves the center of rotation of the glenohumeral joint more distally and medially, while simultaneously utilizing and attempting to balance the force generated by the deltoid.
Imaging techniques are essential for the pre and postoperative evaluation of the reverse shoulder prosthesis, as they aid in surgical planning and in the subsequent evaluation of the location of the prosthetic components, as well as their potential complications.
Many of the complications are related to the biomechanics of the prosthesis, and it is essential to understand and to detect them when clinically suspected. The use of metal-suppressed MRI sequences could be helpful in assessing these conditions.

Conclusions :

• Reverse shoulder arthroplasty offers an effective solution for stabilizing the glenohumeral joint in cases of rotator cuff injury.
• Proper pre and postoperative evaluation using imaging techniques is essential to ensure the success of the procedure and the early detection of potential complications.

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Purpose :
 
* Describe the normal anatomy of the glenohumeral joint.
* Illustrate the different labro-capsulo-ligamentous injuries in cases of shoulder instability.

Materials and Methods :
The glenohumeral joint is the most mobile joint in the human body, which makes it inherently unstable.
Its stabilization relies on a complex interaction between static stabilizers (glenoid labrum, joint capsule, glenohumeral ligaments) and dynamic stabilizers (rotator cuff muscles).
The biomechanical complexity of this joint makes it a challenging diagnostic subject for young radiologists.

Results :

Glenohumeral instability refers to a partial or complete  loss of contact between the humeral head and the glenoid cavity.
The Thomas and Matsen  classification, later modified by Snyder and Castagna, distinguishes four distinct types of shoulder instability (SI):
*TUBS (Traumatic Unidirectional Bankart Surgery)
*AMBRII (Atraumatic Multidirectional Bilateral Rehabilitation Inferior capsular tightening Interval reconstruction)
*AMSI (Atraumatic Minor Shoulder Instability)
*AIOS (Acquired Instability Overstressed Shoulder):.
The diagnostic approach begins with radiography, which serves as the first-line imaging modality. Standard projections are performed, and additional views may be obtained if necessary to provide a comprehensive assessment of shoulder anatomy and to rule out traumatic bony lesions.

Computed Tomography (CT) is primarily indicated in post-traumatic settings to evaluate fractures that are either not visible or suspected on radiographs, as well as to assess the extent and severity of already detected fractures.CT also allows for a detailed study of the glenohumeral joint anatomy using 3D/VR reconstructions, which are particularly valuable for surgical planning.

MRI and MR arthrography (MRA) are considered the gold standard for evaluating shoulder instability, providing high-resolution imaging of soft tissue structures such as the labrum, capsule, and ligaments.

Conclusions :
The role of the radiologist in evaluating shoulder instability is to provide the surgeon with an accurate description of all injuries affecting the shoulder stabilizers, specifying their location, extent, and chronicity.
A thorough understanding of the anatomy of the structures involved in shoulder stabilization is therefore essential.

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Purpose :
To describe a novel, simple technique, the Sandwich Technique (ST), aimed at increasing the diagnostic accuracy of computed tomography (CT) guided bone biopsy, ensuring adequate histopathological specimens and avoiding suboptimal samples

Materials and Methods :
The technique essentially involves "sandwiching" the lesion between two "loaves" or slabs of bone, or, in a modified approach, using only the distal normal bone plug to retain the lesional tissue sample, giving a lesion-normal component in the sample. 
This technique was evaluated through an audit of practice of bone biopsies of cystic or necrotic musculoskeletal lesions performed over 2 years at a tertiary orthopedic oncology center.
Additionally, a survey of members of the British Society of Skeletal Radiologists and Orthopedic Surgeons was conducted to assess current biopsy practices.

Results :
The ST demonstrated near 100% diagnostic yield (DY) in an audit of 61 bone biopsy cases.
A survey of 71 clinicians, predominantly from tertiary care or teaching hospitals, revealed varied needle preferences, with the 11-gauge needle most commonly used. For sclerotic, cystic, or necrotic lesions, majortiy (74%) of respondents preferred placing the needle tip within the lesion and avoiding beyond insertion.

Conclusions :
The Sandwich Technique (ST) is a simple, yet effective, and cost-efficient method to enhance the diagnostic accuracy of bone biopsy specimens. Given our 97% diagnostic yield, which is higher than reported in the literature, we advocate for its use to prevent inadequate or insufficient histological specimens.

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Purpose :
To review the evidence basis behind spine cementoplasty and role of consolidation techniques in the spine
 
To discuss the technical considerations, benefits and limitations of treatment
 
Understand the role consolidation plays as adjunct therapy in pain management

Materials and Methods :
To present highlights of key papers outlining the basis of vertebroplasty.
 
To highlight a step by step guide for trainees through case demonstration

Results :
We will review the current literature and evidence basis.
 
We will highlight our current practice in the application of bone consolidation (vertebroplasty).
 
A series of cases to serve as an educational aid to trainees learning vertebroplasty.

Conclusions :
Viewers will achieve a good introduction and understanding to application of musculoskeletal bone consolidation vertebroplasty.

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Purpose :
To review the anatomy of the spine and sacrum and the role treatment
 
To discuss the technical considerations, benefits and limitations of treatment done under fluoroscopy and/or CT
 
Understand the role of treatment.

Materials and Methods :
To highlight a step by step guide for trainees through case demonstration

To review and/or introduce caudal epidural as an alternative option

Results :
We will highlight current practice and the role of musculoskeletal radiologist led basic spinal procedures.
 
A series of cases will serve as an educational aid to trainees for learning.  

Conclusions :
Viewers will achieve a good understanding of how to perform procedures as nerve root blocks and caudal epidurals to offer adjunct pain relief in conjunction to conventional oral medications.

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Purpose :
To highlight the role of CT in Treating Temporomandibular Joint Dysfunction by CT guided Arthrocentesis

Materials and Methods :
59 year old female presented with localised right temporomandibular joint pain for 3 months duration. She was seen by the oral maxillofacial team and an orthopantomogram was performed which was noted to be unremarkable. She was then managed conservatively initially with jaw exercise and laser therapy with mixed response. Upon referral to the interventional radiology team, she was then subjected to a Dynamic MRI of the Temporomandibular Joint which revealed an anteriorly displaced right disc  with absence of disc recapture on close mouth view in keeping with a temporomandibular joint dysfunction and  minimal joint effusion.
59 year old female presented with localised right temporomandibular joint pain for 3 months duration. She was seen by the oral maxillofacial team and an orthopantomogram was performed which was noted to be unremarkable. She was then managed conservatively initially with jaw exercise and laser therapy with mixed response. Upon referral to the interventional radiology team, she was then subjected to a Dynamic MRI of the Temporomandibular Joint which revealed an anteriorly displaced right disc  with absence of disc recapture on close mouth view in keeping with a temporomandibular joint dysfunction and  minimal joint effusion.

Results :
Patient was then counselled for a CT guided arthrocenthesis procedure which was performed under sedation and under sterile conditions. A 23G needle was inserted into the antero-superior aspect and another 21G needle was positioned into the infero-posterior  aspect of the  temporomandibular joint followed by infusion of local anesthesia (Lignocaine 2%),  followed by 5ml of Hartmann Solution and finally and Triamcenolone 40mg into the joint space. Post review 2 weeks after procedure and patient was noted to be pain free with no residual dysfunction. 

Conclusions :
Current standard of practise of temporomandibular joint arthrocenthesis is to perform the procedure without imaging or in some instances under fluoroscopic guidance. Utilising a CT guided technique has the advantage of being  less traumatatic, more precise and provides better clinical outcomes for patients.

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Purpose :
Dupuytren’s disease (DD) is a progressive fibrotic disorder of the palm and fingers, leading to irreversible flexion contracture. Treatment options include surgical fasciectomy, percutaneous needle fasciotomy (PNF), and collagenase Clostridium histolyticum (CCH) injection.
Traditionally, PNF is performed using a 25G needle. However, for over 25 years, we have been using an 18G needle supported by a needle holder, a technique detailed in this study.

Materials and Methods :
Materials:
25G needle, 18G needle
10 cc syringe
1% lidocaine, corticosteroids
Sterile compresses, antiseptic
Zimmer splint, sterile gloves
High-frequency ultrasound probe.
The 18G PNF is performed on an outpatient basis under ultrasound guidance. A preoperative clinical and ultrasound assessment identifies the retracted cord and neurovascular structures. The patient is seated facing the operator, and a precise ultrasound mapping is conducted.
After rigorous asepsis and local anesthesia using a stepwise infiltration technique, the 18G needle (secured by a needle holder) is inserted perpendicularly into the retracted cord. Its bevel (like a scalpel) allows for longitudinal, transverse, and sagittal microdissection. Once adequate dissection is achieved, passive finger extension is applied until cord rupture. A delayed-release steroid is injected into the dissected areas. Finally, a dry dressing and a Zimmer splint maintaining finger extension for one week are applied.

Results :
Flexion contracture resolution in over 90-95% of cases.
In severe cases (>10 years of progression), residual contracture remains <10%.
Surgical fasciectomy, although considered the gold standard, has a high complication rate (4% to 39%), including delayed healing, infection, and neurovascular injuries (Penseur, 2010).
Minimally invasive alternatives such as PNF and CCH, offer better tolerance profiles. The 18G with needle holder PNF appears significantly superior to CCH in terms of flexion reduction and recurrence decrease. Under ultrasound guidance, complications with this technique are exceptional.
No publications describe our technique. The use of a needle holder provides enhanced precision and enables true microdissection of the retracted cord.
 

Conclusions :
The 18G PNF assisted by a needle holder and performed under ultrasound guidance, appears to be more precise, reliable, and safer than CCH, with fewer side effects than surgery. Comparative studies with 25G PNF are needed to validate these results and optimize patient care

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Purpose :
How we do it - the Princess Alexandra Hospital is a tertiary hospital in Brisbane, Australia. We have developed an interdisciplinary approach to diagnosing and treating peripheral neuropathic pain. 

Materials and Methods :

• Multidisciplinary meetings allow the experiences and symptoms of patients with typical peripheral nerve sounding pain and problems to be discussed.
• Patients with peripheral neuropathic pain from traumatic and surgical causes are most represented in our popultaion, although not exclusively. 
• We have a series of case studies illustrating the diagnostic to treatment pathway with documented patient outcomes. 
• Once neuropathic type pain is described it must be determined if there is a central or peripheral cause. Then the level or individual peripheral nerve needs to be identified clinically and anatomically. 
• Appropriate imaging, usually an MRI, is ordered and reviewed considering the patients history and symptoms. 
• Accurate MRI interpretation requires detailed pathoanatomical knowledge to determine chronicity and predict potential outcomes for various treatment options. 
• High frequency US is typically the next step - to further evaluate nerves that may have appeared normal on MRI but are clinically indicated for examination. US is also used to determine if there is an appropriate image guided treatment option.
• The type of nerve damage and impact the damage has had will determine if any or both surgical or US guided intervention is appropriate and what might work best. US can be used in conjunction with surgery - to guide surgical planning. 

Results :
Three case studies will be used to highlight our approach. 
1) 38F post breast cancer surgery and radiotherapy with radial nerve neuropathy. MRI, US and intervention will be presented with patient outcomes at 6 months. 
2) 37M post traumatic injury to the forearm with symptoms in the distribution of the lateral cutaneous nerve - US and intervention will be presented with patient outcomes at 9 months. 
3) 39F with iatrogenic damage to the posterior trunk of the brachial plexus and neuropathic pain - MRI, US and image guided examination and treatment will be presented. 

Conclusions :
Combining MRI, US, clinical expertise, anatomical knowledge and patient insight can lead to innnovative and effective solutions to peripheral neuropathies with minimal harm. 

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Purpose :
To describe procedure of botulinum toxin type A (BTA) injection into the abdominal muscles prior incisional hernia repair, explaining or experience and results at our institution.

Materials and Methods :
Broad incisional and primary hernias of the anterior abdominal wall often associate relevant retraction of the lateral abdominal musculature (external oblique, internal oblique and transverse muscles), therefore resulting in the inability of conventional reparation techniques to reconstruct the physiological fascial structure. 10-15% morbidity and 1.2% mortality are associated with this procedures.
It has been recently described an alternative approach consisting of TBA injection into the mentioned muscles to induce relaxation, therefore allowing primary abdominal wall reconstruction in 95%-100% of cases.
This procedure is indicated in defects broader than 10 cm or patients with Tanaka index >20%. 300 total units of BTA are applied on 6 chosen locations 4-6 weeks prior to surgery, when its effect on the musculature is more intense.
The technique for ultrasound-guided procedure is described, instillating BTA it into each of the three abdominal wall muscles bilaterally along selected injection points, backing the tip of the needle from deep to superficial, thus avoiding gas interposition due to the injection causing artefact, starting with the transverse muscle, then the internal oblique and last, the external oblique.
23G needles are used with a transverse view in the plane of the ultrasound probe. We recommend the application of anesthetic cream 15 minutes prior to the procedure for achieving a less painful procedure for the patient.
CT scans were made prior and one month after BTA injection to analyze feasibility and effect of the procedure, respectively.

Results :
All of the surgical procedures performed at our institution resulted in satisfactory outcome, achieving primary defect closure with no complications associated to TBA injection or during the surgery one month later.

Conclusions :
Ultrasound guided BTA injection proved to be an effective and safe procedure which avoids incisional hernia recurrence and complications associated to surgery. The safety of the installation and the evident effectiveness of this treatment in worldwide publications makes it a valid alternative for patients with broad incisional and primary hernias of the anterior abdominal wall

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Purpose :
Provide a guide on the use of ultrasound for the removal of foreign bodies. We will discuss the visualization of foreign bodies, the necessary skills for extraction, and the pre- and post-procedural recommendations, supported by practical examples from our clinical experience.

Materials and Methods :
Ultrasound is a key tool for identifying and guiding the removal of foreign bodies, offering real-time imaging that provides precision and safety to the procedure. Successful extraction relies on a solid understanding of anatomy, imaging skills, and the appropriate tools. Pre-procedural ultrasound helps pinpoint the foreign body's location and its relationship with surrounding structures, while post-procedural evaluation ensures complete removal and detects complications. Due to the complexity of these procedures, many physicians are hesitant to perform them, making the radiologist's expertise essential for effective and safe removal.

Results :
Through clinical case examples, we demonstrate how ultrasound can be adapted to various scenarios based on the location and nature of the foreign body, whether plastic, glass, splinters, fish bones, or metal. We detail the materials and tools used for each case, offering key technical recommendations to optimize procedural success and minimize complications. The approach is customized according to the foreign body’s characteristics and location, requiring adjustments in both imaging techniques and extraction methods. Additionally, we discuss techniques such as digital ischemia to reduce bleeding and nerve blocks to facilitate extraction and improve patient tolerance. By providing practical insights and case-based examples, we present a comprehensive framework for effectively integrating ultrasound into foreign body removal procedures.

Conclusions :
In conclusion, ultrasound-guided foreign body removal is a safe and effective method, with the radiologist's expertise essential for precise and successful outcomes.

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Purpose :
This case report details a rare occurrence of iatrogenic entrapment of a femoropopliteal bypass graft, emphasizing the use of MRI of the knee and MR angiography in establishing the diagnosis and guiding subsequent management.

Materials and Methods :
A 60-year-old male patient with a history of right femoropopliteal bypass surgery presented with recurrent claudication and pain in the right lower limb in extended position of the knee. Initial evaluation included a dedicated MRI of the knee to assess the graft’s course and its relationship with adjacent soft tissue structures. This was followed by MR angiography to confirm vascular flow and focal narrowing along the graft’s path.

Results :
The MRI examination demonstrated narrowing of the bypass graft between the semimembranosus tendon and medial head of gastrocnemius muscle at the level of the posterior medial tibial plateau.  of the bypass graft near the popliteal fossa, accompanied by localized soft tissue edema and fluid. MR angiography corroborated these findings by revealing dynamic compression of the bypass graft in the popliteal fossa with poor flow visible in the graft and popliteal artery filling via profunda collaterals. DSA was done and the patient underwent angioplasty subsequently.

Conclusions :
This case highlights the critical role of MRI in diagnosing and managing iatrogenic complications following femoropopliteal bypass surgery. The complementary insights from MRI knee and MR angiography not only confirmed the diagnosis of graft entrapment but also informed the surgical revision approach. Early and accurate detection of such complications is essential to optimize patient outcomes and prevent further vascular compromise.

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Purpose :

1. Identify common technical errors.
2. Understand interpretation errors.
3. Recognize the impact of errors.
4. Interpret the TBS Score as an added value.
5. Develop strategies for error reduction

Materials and Methods :
A retrospective review was conducted on DEXA exams performed in our radiology department to identify and categorize common errors in both technique and interpretation. This educational case-based study illustrates real examples of the most frequent and significant mistakes observed in clinical practice.
Technical Errors: These were assessed by reviewing patient positioning, scan quality, region of interest selection, and machine calibration. Frequent mistakes included poor patient alignment, failure to exclude artifacts, incorrect selection or exclusion of vertebrae, and improper scan acquisition, all of which can compromise the accuracy of bone mineral density measurements.
Interpretation Errors: These were identified by analyzing the reports generated from each scan. Common mistakes included the incorrect use of T-score versus Z-score based on patient age, comparing scans performed on different machines without same calibration, failure to account for serial BMD changes, and improper application of the TBS Score, which is essential for assessing bone quality.Case examples of both technical and interpretation errors were documented to provide practical insights into improving DEXA accuracy. Based on these findings, recommendations were developed to enhance scan quality, improve report accuracy, and minimize diagnostic discrepancies.
 

Results :
Technical mistakes, such as improper patient positioning, failure to exclude artifacts, and incorrect selection of vertebrae, were among the most frequent issues. Additionally, interpretation errors, including the incorrect use of T-score versus Z-score, misclassification of bone mineral density, and improper application of the TBS, further contributed to diagnostic inconsistencies. A key finding was the lack of proper training among both radiologists and technologists. 

Conclusions :
With the growing aging population and the rising prevalence of osteoporosis, the demand for DEXA scans will continue to increase in the coming years. As a result, radiologists interpreting these exams must receive proper training and be well-versed in the most common technical and interpretation errors to ensure accurate diagnoses and optimal patient care. 
We hope that this illustrative educational paper will enhance awareness and knowledge among radiologists and technologists, leading to more reliable interpretations.

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Purpose :
This educational review seeks to delve into the complexities surrounding bone marrow oedema syndromes using the latest literature, shedding light on their potential causative factors, diagnostic approaches radiologically and highlighting imaging findings that help differentiate the various entities.

Materials and Methods :
Hyperaemia is likely the primary cause of extracellular bone marrow oedema. Various clinical conditions can lead to localised bone marrow oedema, including trauma (bone contusions, stress fractures, and insufficiency fractures), transient hip osteoporosis, regional migratory osteoporosis, complex regional pain syndrome (reflex sympathetic dystrophy), early-stage osteonecrosis, tumours, and joint disorders such as cartilage abrasion in degenerative joint disease.

Results :
Transient osteoporosis (TO) presents with bone marrow oedema on MRI, predominantly affecting weight-bearing joints like the hip. It resolves spontaneously in 7–8 months. Regional migratory osteoporosis shares similar imaging features but shifts between joints over time, differentiating it from TO. Subchondral insufficiency fractures (SIF) present with marrow oedema and subchondral fractures, often progressing to osteonecrosis if vascular compromise occurs. Rapidly progressive osteoarthritis (RPOA) leads to severe joint destruction with rapid space loss, marrow oedema, and femoral head deformation, including the "hatchet-like" deformity. A higher initial Tönnis angle was observed in RPOA patients compared to other conditions. In AVN, maximal depth on mid-coronal MRI aids prognosis, while the Kerboul angle quantifies lesion severity. MRI is the gold standard for CRMO, detecting marrow oedema. Whole-body MRI identifies multifocal lesions. Phenotypic patterns guide prognosis, and isotope bone scans detect active inflammation. In CRPS, MRI should be utilised to exclude other conditions rather than for diagnosis however three-phase bone scintigraphy and osteoprotegerin levels may aid diagnosis, but specificity and sensitivity vary. MRI plays a key role in diagnosing and distinguishing these conditions for optimal management.

Conclusions :
BMOS should be considered in patients with musculoskeletal pain of unknown origin, particularly when MRI reveals characteristic fluid-sensitive signal intensity increase. Early diagnosis can help avoid unnecessary investigations and invasive treatments while also preventing the progression of certain disease processes.

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Purpose :
Transient osteoporosis of pregnancy (TOP) is an uncommon skeletal condition with unknown etiology seen mainly affecting young, healthy, pregnant women in their third trimester. It is a self-limiting disease that appears to resolve gradually during the postpartum period. In most reported cases, TOP is usually found affecting the hip joints followed by the knee joints, and is less likely to involve the ankle joints. Herein, we present a unique case of bilateral ankle joints TOP. 

Materials and Methods :
A 35-year-old female with an unremarkable past medical history was admitted for induction of labor. During her stay, she reported a history of progressive, bilateral ankle joint pain with severe movement limitation that started suddenly in her last month of pregnancy. The patient denies any related history of trauma. A proper clinical evaluation with full laboratory and radiological investigations was carried out by a team of orthopedics and endocrinologists. 

Results :
Magnetic resonance imaging (MRI) was obtained and showed almost bilateral symmetrical changes with a diffused bone marrow edema involving the distal tibia epiphysis not crossing the physeal line with an irregular T1 WI low signal intensity line likely representing an insufficiency fracture that is more evident on the left. This was associated with a smooth periosteal reaction on the medial side of the distal tibia. A mild ankle joint effusion with generalized subcutaneous soft tissue edema surrounding the ankle joint was also noted on both sides. The evaluated ankle joint ligaments and tendons appeared intact with no definite traumatic injury. These findings give the characteristic appearance of TOP in an uncommon location.

Conclusions :
Unfortunately, musculoskeletal pain during the antenatal period is a common issue, thus, TOP is likely unrecognized and not appropriately managed, which subsequently leads to serious complications such as insufficiency fractures and avascular necrosis. This case addresses the importance of considering TOP in the differential diagnosis in the assessment of a pregnant female with joint pain, as early diagnosis and treatment are essential in short and long-term prognostic outcomes.

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Purpose :
Interpreting a diabetic foot case can be challenging, particularly when differentiating between active neuropathic osteoarthropathy (Charcot foot) and osteomyelitis, as well as identifying when a Charcot foot is complicated by superimposed infection. To address these complexities, we propose a step-by-step approach to improve diagnostic accuracy.

Materials and Methods :
Diabetes mellitus is a growing global health concern, contributing to foot complications through a combination of microvascular and macrovascular disease and peripheral neuropathy. These factors often result in deformities, altered weight-bearing, neuropathic osteoarthropathy, calluses, ulcers, infections, and, in many cases, amputations.
Differentiating between active neuropathic osteoarthropathy (Charcot foot) and soft tissue or bone infections is crucial, as these conditions require different treatment strategies. 

Results :
The following steps are recommended for an effective diagnostic approach:

1. Ulcer Assessment

• Yes: presence of an ulcer suggests osteomyelitis.
• No: less likely to be osteomyelitis. If significant edema or joint effusion is present, consider active Charcot foot.

2. Location of Bone Marrow Abonormalities

• Forefoot or Hindfoot (calcaneus): more likely to indicate osteomyelitis.
• Midfoot: more likely to indicate active Charcot foot.

3. Signal Features

• Osteomyelitis: bone marrow hyperintensity on T2-weighted images, marked hypointensity on T1-weighted images, and contrast enhancement.
• Edema: bone marrow hyperintensity on T2-weighted images, mild hypointensity on T1-weighted images, and no contrast enhancement.
• Osteitis (reactive changes from adjacent soft tissue infection or cortical infection): bone marrow hyperintensity on T2-weighted images, contrast enhancement, and only mild hypointensity on T1-weighted images.

4. Secondary Signs of Osteomyelitis
Look for associated features such as:

• Skin callus
• Sinus tract
• Cellulitis
• Phlegmon
• Abscess
• Myositis
• Septic tenosynovitis. 
• Septic arthritis 

5. Look for Charcot Foot with Superimposed Osteomyelitis
Careful evaluation for signs of both conditions coexisting. 

6. Consider including CT-like Sequences

• In late-stage Charcot foot: Useful for visualizing bony proliferations, consolidation, and for surgical planning.
• In osteomyelitis: Helps assess bone erosions, pneumatosis, and visualize the sinus tract.

Conclusions :
Differentiating between Charcot foot and osteomyelitis is essential for appropriate treatment. A systematic approach, focusing on ulcer assessment, location, signal characteristics, and secondary signs, can significantly improve diagnostic accuracy.

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Purpose :
Review imaging pattern and associated causes of denervation in the foot.

 

Materials and Methods :
Early denervation changes present as muscle oedema whilst late findings correspond with muscle atrophy associated with fat infiltration.  When fat infiltration occurs in conjunction with muscle atrophy, the condition becomes irreversible. 
As radiologist, it is pertinent we recognise the early imaging findings whilst it is reversible with prompt management. 

 

Results :
To formulate a checklist when reporting denervation patterns in the foot to ensure optimal management. 

Identify group muscle compartments affected. For example, abductor digiti minimi(ADM) is linked to Baxter's neuropathy whilst intrinsic muscle atrophy is most commonly associated with diabetic neuropathy. 

To recognise common structural conditions such as marginal osteophytes, thickened plantar fascia and perineural fibrosis of the medial plantar nerve predisposes to conditions such as Joplin's neuroma. 

To recognise associated conditions such as toe deformities:mallet, hammer and clawed toes are often linked to loss intrinsic muscle. 

To use an algorithm in excluding conditions such as neuroma, metabolic conditions such as myositis, injury and common nerve entrapment conditions such as tarsal tunnel syndrome, Baxter's, joggers and Joplin's  neuroma. 











 

Conclusions :
MRI has become the gold standard imaging in denervation of the foot. Early recognition of imaging findings in denervation is crucial to ensure optimal management whilst the condition is reversible. Using a methodical approach in reporting would increase reporting accuracy. 

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Purpose :
This review aims to present the imaging findings of skeletal tuberculosis in children, emphasizing key diagnostic features across different modalities.

Materials and Methods :
With the rising incidence of tuberculosis, skeletal involvement constitutes 10–20% of extra-pulmonary cases. The most common pediatric manifestations include tuberculous spondylitis, arthritis, and osteomyelitis. Tuberculous spondylitis initially spares the intervertebral disc, with subligamentous spread potentially affecting multiple vertebral levels in a continuous or skipped pattern. Disease extension into the paravertebral or epidural spaces may occur. Tuberculous arthritis often results from metaphyseal spread into the joint, while tuberculous osteomyelitis presents variably as cystic, well-defined lesions, infiltrative forms, or spina ventosa—a distinctive pattern of diaphyseal expansion with periosteal reaction and cyst-like cavities.

Results :
Radiographs remain the primary imaging tool for assessing bony lesions. Ultrasonography aids in detecting soft tissue extension and guiding biopsy or drainage. Computed tomography (CT) is valuable for evaluating bony sclerosis and destruction, particularly in areas challenging to visualize on radiographs, such as the posterior vertebral elements. Magnetic resonance imaging (MRI) is the modality of choice for early marrow involvement and soft tissue extension, offering superior sensitivity in detecting disease progression.

Conclusions :
Early and accurate imaging diagnosis of skeletal tuberculosis in children is crucial for prompt intervention, reducing morbidity, and preventing long-term deformities or functional impairment.

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Purpose :
Periosteal reactions involving the paediatric population are frequently attributed to trauma. However, various non-traumatic conditions can present with similar imaging features. This poster aims to illustrate diverse aetiologies of lateral malleolus periosteal reactions in children and emphasise the importance of considering non-traumatic causes in differential diagnosis.

Materials and Methods :
Periosteal reactions can occur as a response to numerous insults, commonly fractures or repetitive stress injuries. In children, the lateral malleolus is a site often exposed to trauma, leading to misattribution of periosteal changes solely to injury. However, inflammatory, infectious, and neoplastic conditions can also elicit periosteal reactions. Osteoid osteoma, a benign osteoblastic tumour, can manifest as cortical thickening and periosteal reaction, often misinterpreted as stress-related. Chronic recurrent multifocal osteomyelitis (CRMO), an autoinflammatory bone disorder, may involve the lateral malleolus, mimicking infection or malignancy. Chronic osteomyelitis, resulting from persistent bacterial infection, can also present with periosteal reactions, posing diagnostic challenges.

Results :
We present a series of paediatric cases illustrating periosteal reactions of the lateral malleolus due to non-traumatic causes, including:

Osteoid osteoma: A 10-year-old girl with persistent ankle pain and radiographic evidence of periosteal thickening, previously attributed to trauma from twisting injury. After progressively worsening periosteal reaction, a CT confirmed a central lucent nidus within the fibula which was treated by radiofrequency ablation.

CRMO: An 8-year-old girl with intermittent ankle pain and swelling for several weeks with subtle fibular periosteal reaction on plain radiograph in the absence of clear trauma. MRI revealed bone marrow oedema, periostitis and soft tissue oedema confirmed as CRMO after exclusion of infection and concomitant lesion in the foot on whole body MRI.

Chronic osteomyelitis: A 10-year-old boy with a history of prior significant trauma presenting with lateral malleolus swelling and pain. Imaging demonstrated chronic solid periosteal reaction and cloaca extending into soft tissues in keeping with chronic osteomyelitis.

Conclusions :
While trauma remains a common cause of lateral malleolus periosteal reactions in children, non-traumatic aetiologies such as osteoid osteoma, CRMO and chronic osteomyelitis must be considered. Awareness of these differential diagnoses, along with clinical correlation and imaging, is essential to ensure accurate diagnosis and timely management.

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Purpose :
The purpose of this educational exhibit is to demonstrate how to perform accurate radiographic assessment of paediatric foot alignment in patients with congenital foot anomalies.

Materials and Methods :
Accurate diagnosis and assessment of the severity of paediatric foot deformities by physical examination can be challenging. Radiographs are a useful adjunct for assessing alignment disorders of the foot. Radiographic evaluation of the paediatric foot differs significantly from the adult population. The paediatric foot provides less radiographic information; fewer bones are visible radiographically at birth and there is considerable variation in ossification during childhood. Additionally, normal radiographic values for adults are not necessarily applicable to the paediatric population. When malalignment is present, the radiologist plays a key role in accurate diagnosis.

Results :
Clinical cases will include a variety of conditions with a focus on talipes equinovarus (congenital clubfoot), planovalgus, metatarsus adductus and vertical talus. Correct radiographic technique will be highlighted and the effects of optimising patient positioning in order to focus the x-ray beam on the area of interest will be discussed. The importance of weight-bearing views or (in infants or patients unable to stand) simulated weight bearing to demonstrate the functional positions of the foot will be shown. We will also discuss cases where incorrect radiographic technique can potentially lead to misdiagnosis. Radiographic images will include measurements of angles which enhance diagnostic accuracy. This will include on the standing anteroposterior view: talocalcaneal and talus-first metatarsal angles and on the standing lateral view: talocalcaneal, tibiocalcaneal, tibiotalar and talus-first metatarsal angles. The additional benefit of dorsiflexion and plantar flexion views in select cases is shown. The alignment of the components of the foot (the hindfoot, midfoot, and forefoot) will be depicted in each of the clinical cases, and in some cases the progression of the foot deformity with the patient’s age on radiographic imaging will also be shown.

Conclusions :
Radiographs are a critical tool in the evaluation of paediatric foot abnormalities. Angular measurements can define the boundaries of normal and assist in the diagnosis as well as quantify the degree of the paediatric foot deformity. 

 

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Purpose :


Materials and Methods :


Results :


Conclusions :
Especially when clinically paucisymptomatic imaging plays a key role in differential diagnosis and follow-up of two similar C2 anomalies with different prognostic implications in the pediatric patient.

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Purpose :
To analyse the typical radiological signs to recognize chronic recurrent multifocal osteomyelitis.

Materials and Methods :
CRMO is in an idiopatic autoinflammatory disorder, first described in 1972, affecting children with an average age of 10 years and a female/male ratio of 5:1 causing recurrent episodes of pain and swelling of the affected bones, mostly metaphysis of the long bones with a typical clavicular involvement. It can be related to IBD or skin disorders, such as psoriasis, and there aren’t specific laboratory tests, but imaging is essential for a definitive diagnosis in fact Bristol criteria are based on the presence of typical clinical findings (bone pain with or without significant local or systemic features of inflammation or infection), typical radiological findings (with STIR sequence showing bone marrow oedema with or without bone expansion, lytic areas and periosteal reaction), and one of these two criteria: >1 bone (or clavicle alone) affected without significant raised CRP (<30 mg/l) or bony biopsy demonstrating inflammatory changes with no bacterial growth whilst not on antibiotic therapy.

Results :
A 14-year-old boy with recurrent episodes of thoracic pain underwent an emergency plain radiograph that was negative for fractures followed by chest MRI that revealed bone marrow edema at the body of the sternum near the ossification centers and at the level of the sternoclavicular joint. Subsequently spine and pelvis MRI were useful to detect bone marrow edema at the somatic edges of many vertebras, at the transverse process of the first vertebral soma, costovertebral joints and iliac crest; it also showed enthesitis of the quadratus lumborum and paraspinal muscles: all these findings led to a diagnosis of chronic recurrent multifocal osteomyelitis (CRMO) according to Bristol criteria. The STIR sequence was found to be the primary sequence for the evaluation of the involved bone sites.

Conclusions :
Radiography in the early stages of CRMO doesn’t allow identification of bone alterations that may suggest the diagnosis of CRMO but young patients with recurrent pain in the sternoclavicular area should undergo a whole-body MRI, with the STIR sequence which represents gold standard for the diagnosis and subsequent follow-up of the syndrome.

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Purpose :
Ultrasound is commonly used as the initial assessment for soft tissue tumours in children. It helps confirm the presence and location of a mass, determine its nature, and assess the likelihood of malignancy. Our objective is to highlight key imaging features essential for lesion characterisation and diagnosis. 

Materials and Methods :
Paediatric soft tissue masses encompass a wide spectrum of benign and malignant entities, often presenting diagnostic challenges due to overlapping clinical and imaging features. Ultrasound plays a pivotal role in characterising these lesions, providing detailed anatomical and tissue-specific information without ionising radiation. Accurate diagnosis is essential to guide appropriate management and to avoid unnecessary interventions. Ultrasound is usually the first imaging modality performed to evaluate palpable or visible superficial soft tissue lesions, which are common in children. While clinical factors such as age at presentation, clinical course, and overlying skin discoloration are important for differentiating paediatric soft tissue lesions, ultrasound provides valuable insights for specific diagnosis, particularly for typical benign lesions. It also aids in guiding further investigations by offering detailed information on the lesion's location, characteristics (including solid vs. cystic), vascularity, and compressibility. Knowledge of the normal anatomy, proper ultrasound technique, and the imaging findings of common and uncommon soft tissue lesions in children are crucial for accurate assessment and management of patients. 

Results :
This pictorial review provides a concise overview of ultrasound features of common paediatric soft tissue masses, along with key differentials to consider, based on a search conducted over the past 15 years at our institution. The case examples include haemangioma, venous malformation, lymphatic malformation, lipomatous lesion (typical vs atypical), plexiform neurofibroma, haematoma, subcutaneous fat necrosis of the newborn, epidermal inclusion cyst, pilomatricoma and rhabdomyosarcoma. The cases presented illustrate key imaging characteristics, and correlation is made with clinical findings to enhance diagnostic confidence and improve understanding of these conditions. 

Conclusions :
This exhibit serves as an educational tool to aid radiologists in recognising ultrasound patterns of paediatric soft tissue masses, which will facilitate accurate differential diagnosis to guide optimal patient referral.  

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Purpose :
- To review and illustrate typical and unusual fracture patterns in the paediatric foot and ankle and to understand the mechanism of injury.  
- To demonstrate the type of injuries in different paediatric age groups and their relationship with skeletal maturation.   
- To illustrate normal variants and pitfalls when reporting imaging of the paediatric foot and ankle.  

Materials and Methods :
The ankle is the second most common site of physeal fracture, second to the distal radius.  Foot fractures in children often pose a diagnostic challenge. Clinical examination, judicious use of imaging techniques and knowledge of review areas are needed to establish a diagnosis. 
Distinct characteristics of the paediatric skeleton lead to fracture patterns and complications that differ from those in adults. In children, increasing participation in competitive sports has led to an increased incidence of foot and ankle injuries. It is vital that radiologists are aware of key imaging features in the emergency setting to prevent post-traumatic complications. This includes premature physeal arrest and articular incongruity.  

Results :
We reviewed the imaging and clinical findings of paediatric patients presenting with foot and ankle injuries to a tertiary centre emergency department for the past 15 years. Based on this, we will provide a comprehensive educational pictorial review of paediatric ankle and foot fracture patterns and findings that guide appropriate management.  
Anatomy and the significance of accessory bones in the growing skeleton will be outlined. Examples illustrating the complexity of the anatomy and the effect of deforming forces at the time of injury will be shown, with emphasis on the mechanism of injury and stage of physeal fusion.  
We will also review transitional ankle fractures, specific to adolescents, that occur during asymmetrical fusion of the growth plate and include Tillaux and triplane fractures. 

Conclusions :
Paediatric foot and ankle fracture patterns differ based on age and regional skeletal maturation. Given the complex anatomy, these injuries pose a diagnostic challenge and differentiation from normal variants is vital. The radiologist should be familiar with these common paediatric injuries and be able to recognise patterns such as physeal involvement, multiple fractures, fracture displacement, and articular involvement that will require timely orthopaedic input.

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Purpose :
This article equips trainees with the essential knowledge and skills needed for out-of-hours MRI spine reporting.

Materials and Methods :
Urgent out-of-hours MRI spine studies are crucial for conditions like cauda equina compression, metastatic spinal cord compression, and unstable spinal trauma, requiring immediate intervention. While many studies may not confirm clinical suspicion, occult pathologies can go unnoticed unless specifically searched for. MRI spine reports are often first completed by radiology registrars at major neurosurgical centers, with consultant review within 24 hours. Trainee competency in MRI interpretation varies, creating challenges in diagnostic accuracy under time constraints. A systematic approach to image review is essential for accurate reporting and optimal patient outcomes.

Results :
This poster highlights critical spinal pathologies, including cauda equina compression, metastatic spinal cord compression, spondylodiscitis, insufficiency fractures, and unstable fractures. Schematic illustrations emphasize key review areas to aid pattern recognition and diagnostic accuracy. A proposed checklist will help registrars reduce errors and build confidence in MRI spine reporting.

Conclusions :
A solid understanding of relevant anatomy and potential pathologies is essential for pattern recognition and accurate reporting, ensuring timely patient management when needed.

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Purpose :
Dorsal arachnoid cysts (DAC)/webs(W) and spinal cord herniation (SCH) are uncommon thoracic spinal cord abnormalities. These can lead to significant neurological morbidity, if left untreated. Distinguishing between these conditions based on clinical and radiological features remains challenging. This presentation aims to:
1. Recognize key radiological features of SCH and DAC.
2. Describe clinical presentations.
3. Understand the role of imaging in diagnosis and surgical planning.
4. Evaluate imaging utility in disease progression, monitoring and post-surgical assessment.

Materials and Methods :
Spinal cord herniation (SCH) results from the protrusion of the spinal cord through a dural defect into the epidural space, causing tethering and displacement of the cord. It may be congenital or secondary to trauma, infection, or surgery. DAC can also be congenital or acquired due to adhesions and are often incidental findings. We retrospectively reviewed cases of SCH and DAC/W from radiology information system (RIS) in a tertiary spinal and Major Trauma Centre.
SCH demonstrates a female predominance, typically between ages 21–78 (mean: 51 years). Most patients of SCH present with Brown-Séquard syndrome. In contrast, most DAC are asymptomatic and incidentally detected.

Results :
On retrospective review over 3 years, a total of 111 cases were reported as either/or DAC, webs or SCH. Majority of the cases were reported as DAC or webs. SCH was reported in only 9 cases with imaging differential of DAC/web.
MRI is the primary imaging modality for SCH, showing anterior displacement of the spinal cord, a characteristic “C-sign” deformity, chronic compression signal changes in the cord. SCH is most common between T4–T7. CT myelography confirms ventral dural defects and altered CSF dynamics.
Arachnoid cysts appear as non-enhancing, extramedullary CSF collections displacing the spinal cord or nerve roots. Myelography reveals contrast filling defects and subarachnoid space effacement. The “scalpel sign” has been described in DAW (dorsal arachnoid web).
Imaging findings differentiating these entities are illustrated using examples in this study.

Conclusions :
Both SCH and DAC/webs cause focal spinal cord deformities but require distinct management approaches. Improved awareness and early recognition by radiologists can facilitate accurate diagnosis and timely intervention, reducing the risk of delayed treatment  and neurological morbidity.

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Purpose :
To elucidate the pathophysiology of Pott’s disease.

To assess the role of imaging in the diagnosis of Pott’s disease.

To describe the most common radiological findings and highlighting diagnostic pitfalls that must be avoided to ensure reliable interpretation.

Materials and Methods :
Tuberculous spondylitis is a severe and increasingly prevalent spinal infection. With the increasing of multidrug-resistant mycobacteria, the incidence of Pott’s disease has been on the rise.

This review aims to examine the typical and atypical imaging findings of spinal tuberculosis, emphasizing key diagnostic features and potential pitfalls for accurate interpretation.

Results :
Tuberculous spondylitis, also know as Pott's disease, is an infection of the vertebrae and intervertebral discs caused by Mycobacterium tuberculosis. It remains a major public health hazard, especially in developing countries.

Furthermore, the clinical and radiologic features of tuberculosis may mimic those of many other diseases, such as pyogenic spondylitis . although in many cases biopsy or culture specimens are required to make the definitive diagnosis, It is crucial to have a thorough understanding of the typical imaging features of tuberculosis as their treatments are notably different.

Although radiographs may appear normal in the early stages of the disease, it remains the initial screening tool when infectious spondylitis is suspected because radiographic changes are often detectable at the time of the initial examination, Furthermore, other entities can be excluded by X-rays.

CT provides superior evaluation of radiographic findings and lesion extent. it offers a multiplanar reconstruction imaging, which is crucial for assessing both bone and soft tissue infections, especially in presurgical planning.

MRI is considered the method of choice in spinal infection with its high sensitivity and specificity.
Signal changes occur early in the development of the disease, when no other image modality shows lesions. It provides detailed anatomical localization, facilitates early detection of disk and bone destruction, and is essential for guiding surgical decisions.

Conclusions :
Early and accurate imaging, especially MRI and CT, is crucial for diagnosing tuberculous spondylitis. These modalities help assess the disease's extent and guide treatment decisions. Young residents must be familiar with these imaging techniques to ensure timely diagnosis and effective management of this severe infection.

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Purpose :
There are numerous classification systems for spinal trauma with a multitude of injury subtypes, which can be challenging to consistently define and utilise in clinical practice.  We aim to compare some of these classification systems, with a focus on spinal biomechanics, injury mechanisms and typical imaging appearances to provide a useful educational review and aid with classification understanding. 

Materials and Methods :
We compare the Arbeitsgemeinschaft für Osteosynthesefragen (AO), Thoracolumbar Injury Classification and Severity Score (TLICS) and Denis’ classification systems for spinal trauma with emphasis on the mechanism of injury. We include correlative radiographs and cross-sectional images, highlighting the strengths of each modality, to aid with understanding the similarities and differences between these injury classifications. 

Results :
A unified classification system integrates overlapping elements of the AO, Denis and TLICS systems. The injury morphology is the first concept to be incorporated, with compression and burst-type, distraction-type and translation/rotation-type injuries. Next the integrity of the posterior ligamentous complex needs to be defined as either, intact, indeterminate or disrupted. The neurological status of the patient is a component present in both the AO and TLICS classifications, with the neurology measured as either: intact, transient deficit, radicular symptoms, incomplete spinal cord injury, or complete spinal cord injury. Axial compression, rotational and shear instability are the main determinants of the injuries. Each imaging modality has its benefit; the availability of radiographs, CT for more sensitive fracture assessment and MRI for evaluation of soft tissue integrity. 

Conclusions :
Integrating spinal biomechanics with a unified classification system enhances clinical applicability and more relevant approach to assessment of spinal trauma.  While CT is the best option for initial fracture classification, MRI is most useful in evaluating stability and the aetiology of neurological compromise. The best approach in clinical practice would be utilising multiple imaging modalities for appropriate clinical queries, to acquire a high diagnostic accuracy and aid future treatment planning. 

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Purpose :
To review the layered anatomy of the medial collateral ligament (MCL) and apply this to MRI injury patterns.

Materials and Methods :
The MCL is a flat ligament with three layers:

1. Superficial (layer I): The deep crural fascia, continuous with the fascia of the vastus medialis and sartorius.

2. Intermediate (layer II): The tibial collateral ligament (TCL) proper, the primary valgus stabilizer, particularly during knee flexion, and a secondary stabiliser against external rotation.

3. Deep (layer III): The deep meniscofemoral and meniscotibial capsular ligaments, which provide secondary rotational stability and limit excessive valgus.

Posteriorly, the intermediate and deep layers fuse to form the posterior oblique ligament (POL), the primary restraint against excessive internal rotation.

MCL injuries typically result from direct valgus forces or sudden directional changes, and often coexist with other injuries, particularly of the anterior cruciate ligament. The two main mechanisms are straight valgus instability and anteromedial rotary instability.

Results :
MCL injuries present with medial knee pain, localised tenderness, joint effusion, and valgus laxity. MRI is essential for grading:

· Grade 1: High signal medial to TCL, indicating deep crural fascia injury (layer I) .

· Grade 2: High signal within the TCL with or without focal thinning and/or high signal deep to TCL due to injury to the meniscofemoral or meniscotibial capsular ligaments (layer II).

· Grade 3: Complete MCL disruption.

Secondary signs of injury include medial femoral condyle marrow oedema, increased laxity or 'wavy' MCL appearance especially with distal injury, and lateral compartment bone bruising in cases of direct valgus forces. Chronic injuries may show a Pellegrini-Stieda lesion.

MCL injury mimics include pes anserine/MCL bursitis, medial meniscal tears, osteoarthritis, cellulitis and trauma. Hydroxyapatite deposition disease can mimic a Pellegrini-Stieda lesion.

Conclusions :
Grade 1 and 2 MCL injuries typically heal with conservative management with early mobilisation and a hinged knee brace. Grade 3 injuries may require surgery, particularly with severe valgus alignment, a Stener-like lesion with interposition of the pes anserinus fibres between the distal MCL attachment and the tibia, or additional bony avulsion or ligamentous injuries.

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Purpose :
Anterior cruciate ligament (ACL) reconstruction is commonly performed to restore knee stability and enabling athletes to return to play. Despite advancements in surgical techniques and fixation methods, postoperative complications remain a concern, potentially affecting rehabilitation and long-term function. Imaging plays a critical role in the early identification of these complications, guiding clinical decisions, and optimizing patient outcomes.

Materials and Methods :
We reviewed post-ACL reconstruction MRI knee examinations performed at our institution and compiled a series of cases demonstrating the spectrum of potential complications. Imaging modalities primarily included MRI and radiographs. Cases were categorized into early, intermediate, and late postoperative complications.

Results :
A pictorial review highlights key complications encountered after ACL reconstruction, including:

1. Graft-related complications: Graft rupture, stretching, loosening and impingement.
2. Tunnel abnormalities: Malposition, widening, and hardware loosening.
3. Intra-articular complications: Cyclops lesion, arthrofibrosis, and synovitis.
4. Infectious and inflammatory complications: Septic arthritis and prosthetic joint infection.

MRI is the preferred modality for assessing graft integrity, tunnel positioning, and secondary intra-articular pathology, while radiographs are valuable for evaluating hardware and tunnel expansion. Early recognition of these imaging findings can prevent treatment delays, optimize rehabilitation strategies, and ultimately influence return-to-play timelines for athletes.

Conclusions :
ACL reconstruction is a common procedure in the physically active population, with complications that may impact recovery and return to play. Radiologists play a vital role in postoperative assessment, as accurate identification of complications can influence clinical and surgical decision-making. Familiarity with the imaging spectrum of these complications enhances collaboration with orthopedic surgeons, leading to improved patient outcomes.

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Purpose :
What Is Sinding-Larsen-Johansson Syndrome?
Sinding Larsen Johansson Syndrome is a juvenile osteochondrosis and traction epiphysitis affecting the extensor mechanism of the knee which disturbs the patella tendon attachment to the inferior pole of the patella. The tenderness of the inferior pole of the patella is usually accompanied by MRI or X-ray evidence of splintering of that pole. 

Materials and Methods :
The syndrome is caused by traction on the patellar ligament, which causes inflammation at the insertion of the proximal tendon into the inferior pole of the patella. SLJS is commonly seen in active adolescents between 10 and 14 years of age.  
 An MRI will show a complete picture of knee, including the area around it. This will show if the patellar tendon has thickened as a result of their injury. Radiographic features include thickening of the proximal patellar tendon (potentially followed by dystrophic calcification and/or ossification) and fragmentation of the inferior pole of the patella.

Results :
Patellar sleeve avulsion fractures occur usually with jumping and a full circumference of cartilaginous tissue and often a bony fragment is avulsed from the lower pole of the patella.  
The mechanism is believed to be due to forceful contraction of the quadriceps against resistance, particularly in adolescent male athletes. SLJS can be distinguished from patellar tendinopathy by the presence of bone marrow edema over the patella.  A patellar sleeve fracture is a traumatic separation of the distal articular cartilage with or without a bony fragment of the patellar body that is characterized by sudden pain and follows a single injury and normally affects one side.Various pathogenic mechanisms have been proposed: apophysitis, periostitis, chronic tendinitis and osteochondrosis. In fact, this syndrome is similar to that of Osgood-Schlatter and both can be present in the same patient

Conclusions :
In summary, Sinding-Larsen-Johansson syndrome is caused by traction on the patellar ligament, causing inflammation at the insertion of the proximal ligament into the inferior pole of the patella.  It is technically an osteochondrosis and should be differentiated from a patellar sleeve fracture and patellar tendinopathy.  Treatment is largely nonsurgical and conservative measure with relative rest and possibly immobilization and therapy are common treatments.

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Purpose :
Bone stress injuries (BSIs) are common in athletes and physically active individuals, often resulting in significant downtime and affecting performance. Accurate diagnosis and classification are essential to guide management, prevent progression, and optimize rehabilitation strategies. Imaging plays a critical role in assessing injury severity, estimating healing time, and determining safe return to activity. Early recognition of high-risk stress injuries is particularly crucial in preventing long-term complications.

Materials and Methods :
We reviewed bone stress injuries diagnosed at our institution using multiple imaging modalities, including MRI, radiographs, and bone scintigraphy. A pictorial case series was compiled to illustrate the imaging spectrum of BSIs, ranging from early marrow edema to fracture. Cases were classified using established grading systems, including the Fredericson grading system for tibial stress injuries and the Arendt and Griffiths classification for femoral neck stress fractures.

Results :
Our findings highlight the importance of imaging-based classification in predicting recovery times and guiding clinical management:

• Low-risk stress injuries: Characterized by periosteal or bone marrow edema without fracture. These typically responded well to conservative treatment, including modified activity and load management, with a shorter recovery timeline.
• High-risk stress injuries: These involved critical weight-bearing regions (such as the femoral neck) and were associated with cortical disruption or fracture lines. They required extended rehabilitation, non-weight-bearing protocols, and, in selected cases, surgical intervention.
• Imaging modalities and prognostic value: MRI was the most sensitive modality for early detection, enabling prompt intervention, while radiographs were valuable for tracking healing progression and chronic changes. Bone scintigraphy played a supplementary role in cases with ambiguous symptoms or multifocal involvement.

Conclusions :
A structured imaging approach is essential for early detection, risk stratification, and treatment planning in BSIs, ultimately improving outcomes and ensuring a safe return to activity. Recognizing high-risk stress injuries and understanding imaging-based predictive indicators are key to optimizing recovery and minimizing reinjury risk. Radiologists play a pivotal role in guiding clinicians by providing detailed imaging assessments that shape individualized management plans for athletes and active individuals.

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Purpose :
Ganglion cysts are possible causes of medial ankle entrapment. It is caused by compression of the posterior tibial nerve and its branches in the non-distendable tarsal tunnel. Tarsal tunnel is formed between the calcaneus, flexor retinaculum and below the medial malleolus.
The origin of peri-articular ganglion cysts has been long debated. Common discussions include displaced synovial tissue during embryogenesis, pluripotential mesenchymal cell proliferation, traumatic connective tissue degeneration and formation of the cyst by migration of synovial fluid in joint. Complications such as neurovascular compromise leading to denervation syndrome may occur as well.

Materials and Methods :
60 year old lady with underlying diabetes mellitus presented to orthopaedic clinic with complaint of left ankle and foot pain with swelling for over 1 year. On clinical examination, there was tenderness at anterior talofibular ligament, as well as cuboid and talar bones. MRI was performed for further assessment.
 

Results :
Tubular cystic lesion suggestive of an elongated ganglion cyst seen in tarsal tunnel, its superior margin from just above the tibiotalar joint, coursing inferiorly within the tarsal tunnel , causing compression of the adjacent posterior tibial nerve as well as its medial plantar branch. Diffuse high signal intensity observed at its inferior margin, particularly of the quadratus plantar muscle which is suggestive of acute denervation.

Conclusions :
It is stressed that we perform preoperative imaging to look for cause of entrapment neuropathy such as ganglion cyst and presence of any communication of this to the joint; as it is important to predict outcome of therapy. At the same time, it is vital to search for possible complications to adjacent structures that may contribute to patients' symptoms.

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Purpose :
To provide a comprehensive pictorial review of stress fractures in young athletes, emphasizing imaging findings, common anatomical locations, risk factors, and diagnostic challenges trough case presentations.

Materials and Methods :
Stress fractures are overuse injuries brought on by mechanical strain that is too great for the bone to remodel.
Young athletes frequently experience them as a result of skeletal immaturity, highimpact exercise, and inadequate recuperation time. 
In order to avoid problems like full fractures, delayed healing, or chronic pain, an early and precise diagnosis is essential.
 Early stress fractures could not be seen on radiographs, which are frequently the first imaging modality used. 
While nuclear medicine investigations and CT scans can help with diagnosis and therapy planning, MRI is the most sensitive modality for early detection 

Results :
The femoral neck, anterior tibia, tarsal navicular, and metatarsals are among the high-risk areas. Because they have the potential to develop into full fractures, these need to be diagnosed and treated as away. 
The posteromedial tibia, fibula, and calcaneus are examples of lowrisk locations that typically mend with conservative treatment. 
Periosteal edema, marrow signal abnormalities, and cortical disruption are among the MRI findings that help in early diagnosis before radiographic changes manifest. Radiographic findings may demonstrate cortical sclerosis, periosteal response, or fracture lines in later stages after initially seeming normal 

Conclusions :
Stress fractures in young athletes are a serious issue that needs to be identified early and treated appropriately. By increasing diagnosis accuracy, a multimodal imaging strategy enables prompt intervention to avoid problems and guarantee the best possible recovery

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Purpose :
A retrospective analysis of trampoline-related injuries over five years, presenting to the emergency department of a busy teaching hospital in the UK.

Materials and Methods :
Trampoline-related injuries are a common presentation in UK emergency departments, particularly among the paediatric population. A study by Chambers et al. found an increase in these injuries due to the rising popularity of personal trampolines and recreational trampoline parks. These injuries can place a significant strain on healthcare systems, especially during school holidays. In response to this surge, both the Canadian Paediatric Society and the American Academy of Pediatrics have discouraged trampoline use at home. A retrospective search of the local Radiology Information System (RIS) for emergency department (ED) imaging requests was conducted over a five-year period. Imaging modalities included plain film radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Radiological reports were reviewed and categorized as positive or negative for injury.

Results :
The RIS search yielded 41 cases that included the word ‘trampoline’ in the clinical history, of which 25 (61%) were positive for an injury. A wide range of injuries was observed, including high-grade injuries requiring operative management, such as complete ACL rupture, fracture-dislocation of the elbow, Achilles tendon rupture, and tibial plateau fracture. The knee joint was the most commonly injured area (64%), consistent with previous studies.

Conclusions :
This study highlights a broad spectrum of injuries, including high-grade injuries requiring surgical intervention. Therefore, it is crucial for radiologists to be familiar with the full range of potential injuries associated with trampoline use.

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Purpose :
This educational pictorial essay aims to emphasize the indispensable role of Computed Tomography (CT) in timely and accurate diagnosis, offering unique advantages in managing sports injuries.

Materials and Methods :
CT scans offer definitive, high resolution precise 3D mapping – integrating fine element modelling – revolutionizes the understanding of bony injuries, stress reactions, and fracture healing providing a scaffold for surgical planning, analysing biomechanical load and individualized rehabilitation protocols. The high resolution and speed of CT make it ideal for acute trauma, providing quick and accurate information that aids in rapid decision-making. Three-dimensional reconstructions illustrates complex injury patterns clearly, aiding surgical planning and permitting accurate orthopaedic hardware follow-up. Dual-energy computed tomography (DECT) combines the advantages of conventional CT with the ability to detect bone marrow oedema which was previously limited to magnetic resonance imaging (MRI). CT is often performed first due to its increased availability, especially in the emergency setting, shorter imaging duration, and possible patient contraindications to MRI.

Results :
In this pictorial essay, there is summarization and display of CT findings using examples from musculoskeletal trauma, to illustrate how CT can be of great help in sports imaging and management.
Detection of subtle and occult fractures which could change the management.
Helpful in regions of complex anatomy and areas difficult to assess on X-ray such as the spine, pelvis, and small bones i.e. investigating trabecular bone predominant regions (e.g., vertebral bodies, pelvis, hip, and long bone metaphyses) for stress (i.e., fatigue or insufficiency) and fragility fractures.
Injuries such as shin splints or tibial stress fractures are readily identified on CT.
Detection of spondylolysis without listhesis.
Detection of dislocation and its cause for optimal management and further prevention.

Conclusions :
CT is unmatchable in diagnosing minor occult fractures particularly in areas of complex anatomy especially in emergency settings, ensuring accurate diagnosis and treatment, , preventing long-term consequences of sports-related injuries and allowing for safe and timely return to play.

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Purpose :
To provide an in-depth case-based overview of the imaging appearances of rugby-related injuries, highlighting sport-specific injury patterns, diagnostic challenges, and the critical role of radiology in diagnostics and guiding return-to-play decisions.

Materials and Methods :
A series of illustrative cases from professional and amateur rugby players was selected to represent key injury types across anatomical regions. Imaging modalities including MRI, CT, and ultrasound were evaluated for their diagnostic advantages, with emphasis on modality selection, protocol optimisation, and imaging features influencing clinical management. Each case was correlated with clinical findings, treatment pathways, and return-to-play outcomes.

Results :
Rugby is a highly athletic team sport, which provides players many physical and psychosocial health benefits. Like any full-contact sport, injuries are common. These injuries encompass a spectrum of osseous, ligamentous and musculotendinous trauma, as well as chronic conditions and degenerative impairments. The type of injury suffered often reflects the player's position, as this influences the nature of biomechanics involved in various situations, such as rucks, mauls, scrums, and tackles. The knee (multi-ligamentous injury) followed by ankle (ligament and syndesmotic injury) and shoulder (GHJ instability) represent the highest burden of time-loss injuries. Front-row forwards, being exposed to high-risk collisions, exhibit a greater prevalence of spinal pathology, including acute fractures, dislocations, cord injury and chronic debility. Meanwhile, backs are more exposed to open-field running and tackling injuries, with muscle strains and ligament ruptures being more frequent. Advanced MRI protocols have shown value, such as 3D VIBE with STIR for detecting subtle stress injuries and differentiating active healing from chronic fractures. High-resolution ultrasound provides dynamic assessment of soft tissue injuries and ultrasound-guidance is considered the gold standard for percutaneous intervention. CT plays a role in fracture evaluation and surgical planning.

Conclusions :
Playing rugby is a life-enhancing physical activity. However, the sport has a diverse injury profile where radiology is central to diagnosis, grading, and return-to-play decision-making. This case-based presentation enhances understanding of common injury patterns and their imaging correlates, improves diagnostic confidence, and supports evidence-based player management.

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Purpose :

- Brief clinical overview of the common muscle denervation syndromes around the shoulder in sports injuries  
- The role of MRI in characterizing the muscle denervation syndromes and important tips  
 

Materials and Methods :
Muscle denervation around the shoulder is a rare but important cause of shoulder pain secondary to sport injuries.Other causes including trauma, compressive lesions and neuropathy. The diagnosis is traditionally based on multiple parameters including clinical history, examination and nerve conduction studies.  

MRI has an important role because it can identify exactly which nerve is affected depending on the muscle groups involved. It can also often depict the cause of the denervation. Common muscle denervation syndromes around the shoulder include Parsonage turner syndrome, Quadrilateral space syndrome and spinal accessory denervation.  

Results :
Muscle denervation is characterised on MRI by muscle oedema (high T2/STIR signal within the muscle body) and fat atrophy/reduction in the muscle bulk. This can be subtle and easily missed.  

Parsonage turner syndrome is a self-limiting brachial neuritis that most commonly affects the suprascapular nerve. Most frequently the muscles affected are the supraspinatus and infraspinatus.  

Quadrilateral space syndrome is a compressive neuropathy of the axillary nerve within the quadrilateral space. This usually affects the deltoid and teres minor muscles.  

Spinal accessory neuropathy commonly affects the trapezius muscle however may also affected the sternocleidomastoid muscle body.  

Rarer muscles affected include the latissmus dorsi with the thoracodorsal nerve involved. 

Conclusions :
MRI can play a crucial role in diagnosing muscle denervation and the possible causes of this. It is important for radiologists to be aware of these uncommon causes of shoulder pain. When looking for muscle denervation on MRI, features including muscle oedema and fat atrophy are important as well as any underlying cause. 

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Purpose :
Traumatic musculo-aponeurotic injuries of the pelvis are not uncommon, particularly among athletes, and present a diagnostic challenge in radiology. The radiologist plays a crucial role in diagnosing and staging these injuries, primarily using ultrasound and MRI, to optimize therapeutic management. The objective of this work is to describe and illustrate both common and less common traumatic musculo-aponeurotic injuries of the pelvis.

Materials and Methods :
We retrospectively analyzed imaging examinations performed at our center, University Hospital of Angers, in the context of trauma, both in the general population and in elite athletes. 

Results :
The high-level athletic population was primarily composed of ice hockey players and footballers. The main imaging modalities used were ultrasound and MRI. Injuries were classified according to the location of the affected muscle : anterior, lateral, posterior, and pelvi-trochanteric, and their severity was assessed based on the French National Institute of Sports (INSEP) classification system of acute muscle injuries.

Conclusions :
Traumatic musculo-aponeurotic injuries of the pelvis are not uncommon in athletes population, with a sometimes challenging diagnostic approach. Accurate imaging assessment is essential for optimal management, allowing for treatment adaptation and reducing the risk of complications and recurrences.

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Purpose :
Amateur runners frequently experience overuse injuries due to improper training, inadequate footwear, or biomechanical imbalances. Multimodal imaging—including radiography, MRI, CT, and ultrasound—plays a crucial role in diagnosing and managing these injuries. A thorough understanding of common injury patterns and their imaging characteristics is essential for accurate assessment and appropriate treatment.
 

Materials and Methods :
This exhibit will:
1. Identify common lower extremity injuries in amateur runners.
2. Explore key imaging findings across radiography, MRI, CT, and ultrasound.
3. Recognize imaging pitfalls and differential diagnoses.
4. Correlate radiologic findings with clinical management strategies.

Results :
- Common Injury Patterns
   a. Stress fractures & bone stress injuries
   b. Tendinopathies & enthesopathies
   c. Ligamentous & joint injuries
   d. Other overuse-related conditions

- Radiologic Findings & Case-Based Review
   a. Multimodal imaging approach
   b. Representative cases with imaging correlations
   c. Key diagnostic challenges & differential diagnoses

Conclusions :
Understanding characteristic imaging features, recognizing pitfalls, and correlating findings with clinical presentation are essential for optimizing patient care.

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Purpose :
The objective of this review is to evaluate the diagnostic accuracy and clinical relevance of magnetic resonance arthrography (MR arthrography) in detecting labral pathology, particularly in the hip and shoulder joints. We aim to discuss its advantages over conventional MRI and its role in guiding clinical management.

Materials and Methods :
Labral tears are a common cause of joint pain and dysfunction, particularly in active individuals and athletes. Accurate diagnosis is crucial for treatment planning and prevention of further joint deterioration. MR arthrography, which involves intra-articular injection of contrast medium, has been increasingly utilized for detailed assessment of labral integrity. This review will cover common anatomical variants of the labrum, variants, pitfalls and main pathological findings.

Results :
Studies indicate that MR arthrography provides superior visualization of labral tears compared to conventional MRI, with reported sensitivity ranging from 85% to 95% and specificity from 80% to 98%. The technique enables better differentiation between normal anatomical variants and pathological findings. In addition, MR arthrography aids in the evaluation of associated intra-articular abnormalities, including cartilage lesions and ligamentous injuries, which can influence treatment decisions.

Conclusions :
MR arthrography is a highly effective imaging modality for detecting labral pathology, offering improved diagnostic confidence and influencing therapeutic approaches. Its enhanced accuracy compared to conventional MRI justifies its use in cases where labral injury is suspected, particularly in patients with persistent joint pain and functional limitations. Further advancements in imaging protocols and contrast agents may continue to refine its clinical utility.

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Purpose :
case report

Materials and Methods :
track and field athlete

Results :
conflictual plica

Conclusions :
case report

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Purpose :
Through an anatomical review of the knee joint with special emphasis on the fat pads and adjacent soft tissues, explain the different types of knee friction syndromes with MRI cases seen in our centre.

Materials and Methods :
In the knee joint, several fat pads are located between the joint capsule and the synovial membrane, providing support and cushioning to the bones and joint surfaces and facilitating lubrication and joint stability.
Fat impingement syndromes causes are varied and depend on the location of the fat pad, including friction between structures, acute trauma, altered joint mechanics, repeated microtrauma and patellofemoral instability.

Results :
Depending on their anatomical location, we can classify knee friction syndromes as follows:
- Infrapatellar fat pad impingement syndrome: resulting from compression of the superolateral aspect of Hoffa's fat pad between the posterior aspect of the patella tendon and the lateral femoral condyle.
- Suprapatellar quadricipital fat pad impingement syndrome: located above the patella, between the suprapatellar synovial recess and the quadricipital tendon.
- Prefemoral fat pad impingement syndrome: it is thought to be caused by a prominent suprapatellar osteophyte or friction of the patellar tendon with the lateral femoral condyle.
- Iliotibial band friction syndrome: common cause of lateral knee pain related to intense physical activity resulting in chronic inflammation of the fat adjacent to the iliotibial band.
- Cruciate ligament fat pad impingement syndrome: it occurs in people with intense physical activity and presents with pain in the posterior aspect of the knee that limits sports practice.
- Posteromedial knee friction syndrome: it is thought to be due to narrowing of the space between the posteromedial femoral condyle and the sartorius and/or gracilis tendons.
 

Conclusions :
Knee friction syndromes are often underdiagnosed because the imaging findings are often subtle, but MRI is a very effective diagnostic method that allows an accurate assessment of the anatomical structures involved.
It is very important to correlate the radiological findings with the patient's clinical history by also looking for chondral, meniscal, ligamentous or synovial pathology before attributing the cause of knee pain to friction syndrome.

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Purpose :
To explore the anatomical & functional connection between the pyramidalis muscle and the thigh adductor group, shedding light on their roles in core stability and lower limb movement.
To highlight their impact on movement, injury prevention, and rehabilitation, emphasizing their importance in overall body mechanics. 
The awareness of its location helps radiologists identify subtle injuries or abnormalities in the abdominal wall, ensuring accurate diagnosis and assessment 
 

Materials and Methods :
The pyramidalis muscle is a small triangular structure located in front of the lower rectus abdominis, present in about 90% of individuals. It attaches to the pubis and pubic symphysis by tendinous and ligamentous fibers, tapering upwards to attach to the linea alba. It is innervated by the subcostal nerve and supplied by branches of the inferior epigastric artery. 
The pyramidalis muscle and adductor longus tendon are connected via the anterior pubic ligament, forming the pyramidalis–anterior pubic ligament–adductor longus complex. 
This muscle helps tense the linea alba and is associated with penile erection and upright posture. It is also being investigated for stem cell therapy in treating post-prostatectomy stress urinary incontinence. Understanding its function and anatomical presence is vital for accurate radiology and clinical practice. 
In surgery, particularly for infra-umbilical incisions, knowing the pyramidalis muscle and linea alba biomechanics is crucial. Identifying its termination point ensures precise incision placement, improving surgical outcomes. 

Results :
The pyramidalis muscle and adductor longus tendon are anatomically connected via the anterior pubic ligament, forming the pyramidalis–anterior pubic ligament–adductor longus complex (PLAC). Insufficient anatomical awareness can lead to missed injuries, particularly in cases of proximal adductor avulsions where multiple injuries may go undetected. MRI is crucial for evaluating PLAC integrity, ensuring accurate diagnosis and treatment planning.

Conclusions :
Radiologists must be familiar with the pyramidalis muscle and its connection to the adductor group to effectively identify proximal adductor injuries. Understanding this anatomical relationship is vital for accurate detection of subtle injuries on imaging, ensuring precise diagnosis and optimal treatment strategies.

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Purpose :
To delineate the radiological anatomy and biomechanical significance of the pyramidalis–anterior pubic ligament–adductor longus complex (PLAC).  
To characterize the radiological patterns of PLAC-related injuries and available classification systems.  
To analyze the role of imaging in guiding treatment decisions and return-to-play outcomes.

Materials and Methods :
The pyramidalis is the only abdominal muscle located in front of the pubic bone. It originates from the pubic crest and anterior pubic ligament, inserting into the linea alba.. 
Injuries to the adductor longus are seldom isolated and are typically part of a broader injury involving the PLAC. 
The injury mechanism generally involves a noncontact eccentric force that pushes the hip into abduction and extension.
 Groin pain is prevalent among athletes in sports that demand rapid cutting, pivoting, or kicking—such as soccer and ice hockey—and athletic pubalgia is increasingly recognized as a common source of chronic groin and adductor discomfort.
 

Results :
PLAC injuries are classified into six subtypes, all involving fibrocartilaginous avulsion. Further subdivisions are based on the relationship between the pyramidalis and adductor longus. Various examples will be presented to highlight the crucial role of MRI in accurate diagnosis and effective patient management. 
Other groin injury classifications exist, such as the Doha classification, which does not fully encompass the PLAC complex in detail.  
Accurately identifying and diagnosing this intricate injury is essential for guiding patient treatment and expediting a return to play. 

Conclusions :
The proximal adductor longus is an integral part of the PLAC and is rarely injured in isolation. Referring to these injuries as PLAC injuries better captures their complexity. A thorough understanding of the anatomy and its related findings is crucial for accurately diagnosing and treating these multifaceted injuries.   

 

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Purpose :
To review the imaging findings associated with proximal patellar tendinosis/tendinopathy (jumper’s knee) on various imaging modalities.

Materials and Methods :
Patellar tendinopathy is a relatively frequently observed entity, affecting mostly young active individuals and athletes, with a slight male predominance. It is common in sports requiring frequent jumping movements, like volleyball or basketball. This condition is an overuse injury caused by accumulating stress on the patellar tendon by the extensor mechanism, resulting in microtearing and mucoid degeneration and later macroscopic tearing. Inflammation doesn’t have a role in patomechanism, according to past histologic studies, so tendinosis, rather than tendinitis, should be the accepted terminology.

Results :
6 patients with knee pain were evaluated by radiographs, ultrasound, or conventional MRI. X-rays could demonstrate soft tissue swelling or enthesophyte in the region of the inferior patellar pole. Ultrasound is a great first-line modality, with the possibility of comparing the normal to the affected side. Ultrasound can show thickening, hypoechogenicity and increased vascularity of the tendon, with possible infiltration or edema of Hoffa’s fat pad. MRI is the best modality, depicting anteroposterior tendon thickening of more than 7 mm, hyperintensity, or partial tearing of the patellar tendon, commonly beginning at the proximal end, posterior medial to central fibers. Associated findings are edema and cystic areas in the inferior patellar pole, enthesophyte, surrounding soft tissue edema, and Hoffa’s fat pad edema.

Conclusions :
Jumpers’ knee is a relatively frequently encountered condition of the patellar tendon. Radiologists should be familiar with the typical imaging findings. Radiographs have a limited role in the diagnosis. Ultrasound and MRI can accurately depict and characterize patellar tendinosis. MRI is the best modality able to depict the whole knee joint and has the ability to detect other pathologies in the differential of anterior knee pain.

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Purpose :
To highlight that ankle pain following a twisting injury is not always due to lateral collateral ligament sprains — particularly of the anterior talofibular ligament, which is by far the most common injury — but may also result from injuries at the midtarsal (Chopart) joint level.

Materials and Methods :
A 50y - old female presented with ankle pain following a twisting injury. Radiographs of the foot were unremarkable, and due to persistent clinical symptoms, the patient underwent an 0.5 T open MRI, due to the fact that she was claustrophobic, with T1- TSE, T2 T1- TSE and STIR sequences.

Results :
Sagittal MRI images through the talar neck revealed diffuse thickening and an edematous appearance of the dorsal talonavicular ligament, which was intact. Subtle bone marrow edema was also noted at the inferior aspect of the talus, consistent with a compression fracture. In sagittal images at a more lateral level, approximately at the anterior process of the calcaneus, marked edema was observed within the anatomic territory of the bifurcate ligament, involving both its calcaneonavicular and calcaneocuboid bands. The ligament fibers appeared discontinuous and indistinct, suggestive of a tear. In axial images, at the level of the calcaneocuboid joint, the dorsal calcaneocuboid ligament appeared edematous and thickened, although the ligament fibers remained intact.

Conclusions :
Chopart injuries are not always associated with fractures at the joint level, with or without subluxation. Often, this injury pattern involves only ligamentous structures and may clinically mimic a lateral collateral ligament injury. Radiologists should be familiar with this type of injury to guide appropriate clinical management, as inadequate treatment may lead to chronic foot pain due to cuboid instability.

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Purpose :
Purpose: Comprehensive review of relevant anatomy, injury mechanisms and spectrum of injuries observed in elite sports people.
 

Materials and Methods :
Retrospective review of cased mined from a sports imaging database over the last 10 years using keyword searches. Cases were selected based on clinical diagnosis of ACJ injuries which were confirmed by imaging findings. Imaging modalities included radiographs, computed tomography (CT), and magnetic resonance imaging (MRI). Key clinical details, including patient demographics, presenting symptoms were reviewed. When available, mechanisms of injury, and outcomes and peri- and post-procedural imaging were also analysed.
 
 

Results :
Cases were reviewed  based on pathomechanism of injury (direct versus indirect trauma) and severity of injuries. Mild injuries included cases of joint effusion and/or periligamentous and capsular edema; moderate injuries which included partial ligamentous sprains with and without clavicular displacement and severe injuries which encompassed complete ligamentous sprains/ruptures; clavicular dislocation and associated fractures. Cases with subacute on chronic and chronic findings were also reviewed such as ligamentous and capsular scarring, distal clavicular osteolysis, and secondary osteoarthritis. This review presents the role of imaging in guiding decision and rehabilitation including prognostic findings that may predict prolonged recovery or recurrent instability.
 

Conclusions :
This comprehensive case series review emphasizes the value of imaging in evaluating AC joint injuries in elite sports people. By integrating anatomical knowledge, pathomechanical insights, and imaging findings, this review provides a practical framework for diagnosing and managing these injuries. Improved awareness of subtle imaging findings in ACJ injuries can potentially guide effective injury management and improved outcomes. 

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Purpose :
The primary objective of this educational poster is to highlight common pitfalls encountered in the interpretation of X-rays for sports-related injuries. While X-ray remains the first-line imaging modality for many acute musculoskeletal injuries, certain fractures, dislocations, and soft tissue abnormalities can be easily overlooked or misdiagnosed. By identifying these pitfalls, radiologists and physicians can enhance patient care, avoid overlooked injuries, and increase diagnostic precision.

Materials and Methods :
Sports injuries frequently present with pain and limited function, often prompting an initial X-ray examination. However, the sensitivity of X-rays for detecting subtle fractures, stress injuries, and soft tissue abnormalities is limited. Common challenges include occult fractures (e.g., scaphoid, Lisfranc, and tibial plateau fractures), growth plate injuries in paediatric athletes, and the misinterpretation of normal anatomical variants as pathology. This poster reviews case-based examples that illustrate typical X-ray pitfalls and, where relevant, correlates them to advanced imaging (e.g. CT and MRI).

Results :
A systematic approach to interpreting X-rays in the context of sports injuries can significantly reduce misdiagnoses.
Key findings include:
- Occult fractures: Scaphoid waist fractures, femoral neck stress fractures, and subtle tibial plateau fractures often require additional views or advanced imaging for confirmation.
- Dislocations and ligamentous injuries: Perilunate dislocation and Lisfranc injuries may be overlooked without careful scrutiny of alignment.
- Normal variants mimicking pathology: Bipartite patella and os trigonum may be mistaken for fractures.
- Growth plate injuries: Salter-Harris fractures in young athletes require careful assessment to avoid long-term complications.
- Soft tissue considerations: Joint effusions, fat pad signs, and subtle periosteal reactions may be the only radiographic clues to underlying pathology.

Conclusions :
While X-rays remain an essential tool in sports imaging, certain injuries may be prone to misinterpretation. Awareness of common pitfalls, combined with a structured review approach and appropriate use of adjunct imaging, enhances diagnostic confidence and patient outcomes. This poster aims to reinforce the best practices and improve radiographic interpretation of sports-related injuries.

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Purpose :
- To learn the procedure for obtaining appropriate MRI images in order to evaluate chronic exertional compartment syndrome in the forearm effectively.
-To understand the radiological manifestations of this pathology and how to differentiate it from mimics.
-To review the anatomy of the forearm and clinical presentation of this disease.

Materials and Methods :
We performed a retrospective evaluation of patients suspected of having chronic exertional compartment syndrome (CECS) in the forearm and selected representative MRI images of positive cases, negative cases and mimics.
We documented the process for preparing patients prior to image acquisition.
We conducted an updated bibliographic review.

Results :
Chronic exertional compartment syndrome (CECS) is marked by transient pressure increases in confined muscle compartments that occur during exercise.

CECS is frequently missed as the source of muscle pain in the limbs because it can exhibit a wide range of symptoms, mimic other conditions, lack clear physical exam findings, and manifest intermittently or transiently.

Magnetic resonance imaging is an effective imaging method for evaluating this condition due to its sensitivity in detecting muscle edema. However, we must perform a pre-exercise acquisition and a post-exercise acquisition to screen for mimicking pathologies. We present a series of cases showing this manifestations and some mimic cases.

Knowledge of clinical manifestations is essential as it allows us to properly define the imaging protocol and guide the diagnosis.

Conclusions :
· The pre-exercise acquisition helps us detect mimics or associated pathologies in the forearm.
· We must be aware of the manifestations of exertional compartment syndrome in the forearm for an adequate evaluation of athletes in sports that require repeated use of this muscle group such as professional motorcycle riders, climbing, weightlifting, rowing, baseball, tennis, windsurfing and water-skiing athletes.
· Although intramuscular pressure measurement is the most established method for diagnosis, MRI plays a fundamental role as a non-invasive method and provides information about all the compartments of the forearm.

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Purpose :
Ischiofemoral impingement (IFI) is a clinical condition characterized by abnormal contact between the ischium and the femoral neck, which can lead to hip pain, limited range of motion, and eventual joint degeneration. The aim of this poster is to raise awareness and demonstrate the radiological signs of IFI to allow for more confident diagnosis.

Materials and Methods :
It is often underdiagnosed due to its subtle presentation and the similarity of symptoms with other hip pathologies. Radiological imaging plays a critical role in diagnosing IFI, with magnetic resonance imaging (MRI) being the gold standard for evaluation. On MRI, key findings include narrowing of the space between the ischium and femoral neck, abnormally increased contact between the two structures, and soft tissue/muscle oedema and muscle atrophy, particularly in the quadratus femoris. The use of cross-sectional imaging, such as MRI with coronal or axial views, provides a detailed visualization of the anatomical relationships, allowing for assessment of the degree of impingement. Additionally, radiographs may reveal signs of bony changes, such as femoral neck deformities or acetabular dysplasia, that can predispose to IFI. Computed tomography (CT) may also be helpful for evaluating bony morphology and detecting subtle changes in the hip joint. 

Results :
-

Conclusions :
Early detection of IFI through radiological means is essential for guiding appropriate treatment, ranging from conservative management to surgical interventions. Although the radiological features of IFI can be subtle, with careful analysis, imaging modalities can provide invaluable insights into the diagnosis and prognosis of the condition, enabling better management strategies and reducing associated morbidity.

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Purpose :
With a focus on current discoveries in both conservative and surgical management, this review attempts to offer a thorough examination of anterolateral ankle impingement (ALAIS), including its clinical presentation, imaging methods, and available treatments by presenting cases from our radiology departemnt.

Materials and Methods :
Previous ankle sprain could cause Anterior talo-fibular ligament injury which is a major factor in the development of anterolateral ankle impingement syndrome (ALAIS). It is characterised by pain and swelling, especially on the anterolateral side of the ankle. MRI and arthroscopy are essential to diagnosis. For detecting bone abnormalities and soft tissue injury, MRI is especially helpful. Arthroscopy is frequently utilised for both diagnosis and treatment because it offers a direct and dynamic picture of the impingement . The first line of treatment is usually non-operative, such as physical therapy and corticosteroid injections; if symptoms continue, surgical intervention, like as an arthroscopic synovectomy, may be necessary.

Results :
Imaging methods, especially magnetic resonance imaging (MRI), are essential for detecting ALAIS because they enable the detection of bone anomalies, synovitis, and soft tissue lesions . In addition to helping with diagnosis, arthroscopy makes it easier to perform successful treatments like antero-lateral synovectomy, which has been demonstrated to have positive results. Ankle micro-instability can occasionally occur without visible laxity, necessitating further ligamentous therapy to address the underlying instability. In many cases, conservative therapies work well, but when symptoms are not improving, surgery is advised.

Conclusions :
An important clinical point is that a previous ankle injury, especially sprains, can cause anterolateral ankle impingement. The diagnosis of the ailment depends on precise imaging, such as arthroscopy and MRI. Different persons respond well to conservative treatment methods, while those who experience chronic symptoms benefit from surgical techniques, especially arthroscopic procedures. Positive results and function restoration can result from early diagnosis and individualised treatment.

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Purpose :
To understand the key grading systems for muscle injuries in athletes and their clinical relevance, differentiate between commonly used grading systems and evaluate the advantages and limitations of each classification, particularly their role in predicting recovery timelines and guiding treatment strategies.

Materials and Methods :
Muscle injuries can greatly affect an athlete’s performance and career. A standardised approach ensures that all team members, from sports physicians to physiotherapists, use a common language when discussing injury severity. Several grading systems exist, each with unique merits. Among the most commonly used systems are the British Athletics Classification, the Munich Consensus Classification and various MRI-based grading systems. The integration of these methodologies supports a more comprehensive assessment of muscle injuries, leading to improved treatment planning and safer return-to-play decisions.

Results :
The British Athletics Classification is a simple three-grade system based on the extent of muscle fiber disruption observed on MRI.

• Grade 1 involve minimal fiber disruption and mild edema.
• Grade 2 show partial fiber tearing with more extensive edema and possible fascial involvement.
• Grade 3 are complete muscle tears with retraction.

This system is widely used because of its simplicity and strong correlation with return-to-play timelines. However, it does not differentiate functional injuries from structural injuries and may overlook subtle variations that affect recovery.

The Munich Consensus Classification differentiates injuries as functional (no fiber disruption) versus structural (with fiber disruption), further subdivides structural injuries into minor and major tears or complete ruptures, thereby providing a more refined approach for rehabilitation planning despite its greater complexity.

MRI-based grading systems, such as the Askling Classification for hamstring injuries, assess details like edema and hemorrhage, consider the mechanism of injury, offering high diagnostic accuracy. However, their reliance on advanced imaging limits practicality in some clinical settings.

Conclusions :
Optimizing muscle injury management involves selecting the grading system that best suits the clinical context. An approach that integrates the simplicity of the British Athletics Classification with the detailed analysis of the Munich Consensus and MRI-based systems can lead to better patient outcomes. This integrated strategy enhances clinical decision-making, supports interdisciplinary collaboration, and ultimately accelerates the safe return of athletes to competitive play.

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Purpose :
- Review the anatomy of the menisci and common anatomical variants
- Common pathologies visualized during an MRI study - spectrum of meniscal tears, grading systems and associated findings, most common pitfalls, illustrated using examples from our practice. 

Materials and Methods :
The knee MRI protocol most commonly used in our institution involves: proton density weighted in the sagittal plane, fat-saturated proton-density in all planes, and T1- weighted in the coronal plane. 
The menisci absorb shock, redistribution of the axial load, facilitate nutrient distribution and aid in joint lubrication. 
The menisci are wedge-shaped fibrocartilaginous structures, having a C-shaped configuration (symmetrical in the case of the LM and more crescentic in the case of the MM.
They can be divided in thirds: anterior horn, body, and posterior horn and roots.

Results :
Anatomical variants:
Discoid meniscus: enlargement of the meniscus (body of the meniscus measures ≥15 mm on a midline coronal image)
More prone to mucoid degeneration and tearing
Menisco-femoral ligaments: Humphrey and Wrisberg 
Meniscal Flounce: rippled appearance of the medial meniscus, typically caused by knee flexion, which may mimic a tear 
Meniscal Ossicle: often found in the posterior horn of the medial meniscus, may mimic a loose body or tear
Chondrocalcinosis: can increase meniscal signal intensity, reducing the sensitivity and specificity for detecting tears

Meniscal tears:
- Horizontal tears
- Longitudinal tears
- Radial tears
- Roots tears
- Complex tears
-Bucket-handle tears

Indirect Signs of Meniscal tear (Parameniscal cyst, meniscal extrusion, subchondral marrow oedema)

Conclusions :
Recognizing the normal anatomy and anatomic variants of the meniscus and deep understanding of the different tear patterns ensures an accurate diagnosis of meniscal lesions and guides optimal treatment planning.

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Purpose :
Bone marrow edema and soft-tissue injuries are a useful tool to extrapolate the biomechanics beyond a traumatic injury of the knee. In case of trauma there is always a side of the joint where the traumatic force is applied, resulting in bone marrow impaction, and a corresponding countercoup side where the soft-tissues and ligamentous structures are involved resulting in ligament distraction, reactive bone marrow edema at insertions or bone avulsion. In literature several different mechanisms of knee trauma are described and among the most frequent we considered the following patterns: pivot-shift, valgus stress, varus stress, anteroposterior translation, hyperextension and patellar dislocation.

Materials and Methods :
For each injury mechanisms we selected specific inclusion criteria considering the distribution of ligamentous strains/tears/avulsions and of bone marrow edema in the femoral condyles and in the tibial plateau. If the criteria were only partially met the injury pattern was labelled as “uncertain”. Finally, the involvement of the posteromedial and posterolateral corner structures has been considered as an additional finding but not as injury category. From this assumption we  selected from the PACS archive of the IRCCS San Martino hospital a cohort of 50 knee MRI of patients who accessed the hospital in 2024 for traumatic knee injury and we categorized every exam according to the inclusion criteria in 7 different patterns.

Results :
The results show that in this cohort 27 (54%) MRI studies met the criteria for the pivot-shift mechanism category, 6 (12%) for patellar dislocation, 3 (6%) for varus stress, 2 (4%) for valgus stress, 1 (<1%) for AP translation (dashboard injury) and none for the pure hyperextension category. In the pivot-shift category 6 patients had PMC or PLC involvement while 11 (22%) patients presented an “uncertain” pattern.

Conclusions :
This study reveals a predominance of pivot-shift mechanism with 54% of cases. The involvement of posteromedial and posterolateral corner structures highlights the complexity of such injuries. Notably 22% of patients presented “uncertain” patterns, indicating a need for improved diagnostic criteria. Limited representation of hyperextension and anteroposterior translation appears in agreement with their epidemiology. Overall, these findings emphasize the importance of a systematic approach to knee injury evaluation and management.

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Purpose :
- Review the anatomy of the metacarpophalangeal (MCP) joint of the thumb and identify the ligaments responsible for stabilizing it.
- Illustrate MRI and ultrasound findings in ulnar collateral ligament (UCL) injuries, including Stener lesion (complete tear and interposition of the adductor pollicis between the proximal phalanx and a retracted UCL).
- Present some of the surgical procedures used for treatment of these lesions and postoperative imaging findings.

Materials and Methods :
The thumb is different from the other fingers in its anatomy and grasping function.
The ulnar collateral ligament is a primary stabilizer of the metacarpophalangeal joint during valgus stress. Acute injuries occur due to sudden forced abduction or hyperextension of the thumb, and are common in sports and occupational injuries, known as skier´s thumb or gamekeeper’s thumb, the latter first described as a chronic overuse injury. 
A complete tear of the UCL and retraction lying superficial to the adductor pollicis aponeurosis (Stener lesion) leads to instability and often require operative management. Prompt and accurate imaging identification of the injury helps choose proper surgical treatment to prevent progression to chronic instability and early osteoarthritis.

Results :
MRI is the primary imaging modality used to evaluate the bony and soft tissue anatomy of the MCP joint, obtaining the appropriate image of the thumb along its axis.
Ultrasound is a more accessible and readily available tool in acute injuries and allows for dynamic examination to evaluate articular instability.
We will also review some of the surgical procedures used for UCL repair, such as bony reattachment, reconstruction, tendon grafting, and MCP joint arthrodesis, and postoperative imaging findings.

Conclusions :
MRI and ultrasound studies are extremely useful for assessment of UCL injuries of the first MCP joint. Knowledge and clear understanding of these lesions are essential to help determine the appropriate treatment to restore prehensile function and prevent chronic instability.

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Purpose :
The primary objective of this study is to investigate the mechanism, diagnosis, and impact of lumbar stress injuries in Indian cricketers, particularly fast bowlers. By identifying key risk factors, biomechanical influences, and diagnostic advancements, the study aims to contribute to more effective prevention and rehabilitation strategies, ultimately reducing injury incidence and improving player longevity.

Materials and Methods :


Results :


Conclusions :


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Purpose :
Anterior cruciate ligament reconstruction imaging is key in assessing postoperative outcomes and complications. This poster aims to provide an overview of postoperative anterior cruciate ligament (ACL) graft imaging, highlighting normal postoperative appearances of ACL repairs and exploring various cases of complications that can arise. It is key for radiologists to be able to identify normal post-operative apperances and be able to report accurately on the various potential complications that can occur to guide the surgical team and improve patient outcomes.

Materials and Methods :
ACL reconstruction is a common procedure with aims to restore knee stability following ligamental tears. Surgical techniques vary with the vast majority involving autologous graft reconstruction - namely the bony-patella tendon-bone graft and hamstring graft. Post-operative imaging is essential for monitoring graft integrity and assessing for complications. Various modalities including CT, MR and plain film imaging is often utilised to assess the position of the formed femoral and tibial tunnels. Although MRI is the primary modality for evaluating ACL graft complications to assess signal characteristics and local soft tissue structures. A clear understanding of normal and abnormal post-operative findings is crucial for radiologists to differentiate expected post-surgical changes from pathology requiring intervention.

Results :
We present a range of cases highlighting normal post-operative ACL imaging findings and ranging complications categorised as motion-related or postoperative laxity.
Normal post-operative ACL graft appearance:

• Assessing femoral/tibial tunnel position and alignment
• Expected MR signal characteristics with graft evolution. 

Graft motion-related complications:

• Impingement
• Arthrofibrosis
• Intra-articular loose bodies
• Ganglion cysts

Complications associated with post-operative laxity:

• Graft stretching
• Complete and partial graft tears.

Conclusions :
Recognising the normal appearances of ACL grafts and identifying complications early can enable the radiologist to provide clinically relevant and accurate reports, which are impactful to patient functional outcomes.  
 

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Purpose :
Recently, ligament injuries resembling Stener's injury have been identified in other areas of the body, yet they remain underreported in the literature. Our objective is to analyze the imaging characteristics of these injuries using X-ray, ultrasound or MRI. Additionally, we aim to highlight the importance of early diagnosis, as these injuries require surgical management.

Materials and Methods :
Stener lesion has an underdiagnosis rate of up to 64%. If classic Stener lesion is already a diagnostic challenge, can you imagine how many Stener-like lesions are we missing?

Results :
We did a pictorial review of the following Stener-like lesions: radial collateral ligament of metacarpo-phalangeal joint of the thumb and medial collateral ligament of the knee. For each injury type, we provide detailed imaging findings from X-ray, ultrasound or MRI, highlighting key anatomical features crucial for accurate diagnosis.

Conclusions :
Underdiagnosis of Stener-like injuries prevents from healing and causes secondary potential instability of the joint. Therefore, recognizing the characteristic imaging patterns of these injuries is essential for musculoskeletal radiologists to ensure timely and effective treatment. After all, only what is known can be diagnosed.

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Purpose :
This is a pictorial review of various sporting injuries affecting the lower leg including the tibia, fibula, surrounding muscles nerves and vessels. The learning objective is to enhance the readers understanding of the mechanisms of these injuries with multimodality imaging. This review aims to bridge the gap between clinical presentation and radiological findings, equipping healthcare professionals with the knowledge to improve patient outcomes in sports medicine.

Materials and Methods :
This review is based on a retrospective analysis of imaging studies from athletes across various sports. Cases were selected from a tertiary musculoskeletal center, focusing on injuries such as stress-related fractures, muscle injuries, tendon rupture and overuse. Imaging modalities including radiography, ultrasound, MRI and CT, were utilised to illustrate the spectrum of injuries encountered. Clinical histories and mechanisms of injury were correlated with imaging findings to provide context and improve diagnostic accuracy.

Results :
The review highlights key imaging features of lower leg injuries, such as the "dreaded black line" of tibial stress fractures, medial tibial stress syndrome, the "high ankle sprain" pattern of syndesmotic ankle injuries, and the characteristic appearances of various myofascial and myotendinous injuries. Uncommon injuries, such as Maisonneuve fractures and compartment syndrome, are also discussed. The pictorial examples demonstrate the importance of advanced imaging in diagnosing subtle or complex injuries that may be missed on initial assessment. Additionally, the review emphasises the role of imaging in guiding treatment decisions, from conservative management to surgical intervention.

 

Conclusions :
This pictorial review underscores the critical role of imaging in the diagnosis and management of lower leg injuries in athletes. By improving the awareness of various patterns of injury and correlating clinical scenarios with radiological findings; radiologists, orthopedic surgeons and sports medicine practitioners can improve assessment and outcomes for those wanting to return to play.

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Purpose :


Materials and Methods :


Results :


Conclusions :


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Purpose :
To highlight the importance of recognizing distal adductor magnus injuries as a potential cause of medial knee pain and to emphasize the role of Magnetic Resonance Imaging (MRI) in accurate diagnosis.

Materials and Methods :
The adductor magnus is the largest medial thigh muscle, playing a key role in hip adduction and stabilization. While hamstring injuries are more common, adductor strains can occur due to rapid, uncoordinated movements, especially in athletes. Distal adductor magnus injuries are extremely rare, with only one prior case reported.

Results :
A 30-year-old professional luge competition sustained a high-velocity crash, leading to medial knee pain. X-ray results indicated the absence of fractures, however Computed Tomography  (CT)  demonstrated the obliteration of the adipose planes posterior to the vastus medialis muscle. MRI results revealed a Grade 2 strain of the distal adductor magnus, bone contusion at the adductor tubercle, rupture of the medial patellar retinaculum at its femoral connection, and hemarthrosis in the patellofemoral recesses. 

Conclusions :
These findings highlight the complex nature of medial knee injuries in high-impact sports and the critical importance of MRI in obtaining an accurate diagnosis. Adductor magnus injuries are a rare cause of medial knee pain in athletes. Although proximal injuries are more common, adductor magnus injuries should be considered in cases of medial knee pain.

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Purpose :


Materials and Methods :


Results :
We focus on the MRI findings of following key abnormalities:

• Patellar osteochondral defects – focal areas of chondral damage with injury of adjacent subchondral bone, often secondary to trauma.  
• Chondromalacia patella – degradation of the articular hyaline cartilage of the patella, frequently causing anterior knee pain.
• Patellar tendinosis and tears – spectrum of tendinopathy ranging from chronic degenerative thickening to full thickness tendon tear.  
• Quadriceps tendon tear – usually secondary to trauma or a forced knee flexion.  
• Transient patellar dislocation – a characteristic bone contusions pattern with associated injuries to the medial patella retinaculum.   
• Osgood-Schlatter disease – apophysitis of the tibial tubercle with characteristic soft tissue swelling.   
• Prepatellar and infrapatellar bursitis – Inflammation and fluid accumulation often secondary to repetitive trauma.
• Suprapatellar and Hoffa’s Fat pad impingement – common cause of anterior knee pain manifesting as characteristic locations of impingement and oedema.

Conclusions :


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Purpose :
To provide a pictorial review of pulley injuries, detailing their anatomy, imaging characteristics, classification, and management strategies, with a focus on rock climbers and athletes prone to flexor 
tendon pulley injuries trough presenting cases from our radiology department including a case of multiple pulleys injury in one finger of a climber.

Materials and Methods :
Due to the flexor tendons' constant exposure to high loads, rock climbers commonly suffer pulley injuries, particularly to their fingers. A 2 pulleys in particular are among the annular (A) pulleys that are most frequently affected. From moderate strains to complete ruptures, these injuries result in flexor tendon bowstringing and loss of function

Results :
Ultrasound is the best modality for detecting pulley thickening, flexor tendon bowstringing, and fibre discontinuity because of its dynamic assessment potential and being cost effective . 
Magnetic resonance imaging (MRI) using T2-weighted and proton density sequences are used to find out secondary tendon displacement and fluid-filled gaps in the pulley system that are two obvious signs of soft tissue injuries.
X-ray: Usually used to rule out associated fractures or avulsions, particularly in severe cases .

Classification:

The Schweitzer system is used to classify pulley injuries, with Grade I (moderate strain) leading to Grade IV (multiple pulley ruptures with substantial tendon bowstringing).

Management:

conservative Treatment: Splinting, activity moderation, and physical therapy are effective treatments for mild to moderate injuries (Grades III). Taping methods that assist reinforce the pulley and lessen tendon tension include circumferential taping and H-taping. In severe situations (Grades III_V) with total pulley rupture or ongoing malfunction, surgery is recommended. Normal biomechanics can be restored with surgical restoration with tendon grafts, especially in elite athletes.
 

Conclusions :
Early and accurate MRI diagnosis is crucial for treating pulley injuries and preventing long-term issues. In order to restore hand function, large ruptures require surgery, even though the majority of cases can be treated conservatively. Sports medicine doctors, radiologists, and hand surgeons must all work together to optimise patient results.

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Purpose :
To provide a pictorial overview of varying causes of ASIS pain across different imaging modalities.

Materials and Methods :
Anterior Superior Iliac Spine (ASIS) pain encompasses a wide patient demographic and is a common site for both acute and chronic injury. Plain film radiography is usually the first, and often, the only imaging modality performed in the acute setting. Sonography, MRI and CT are often utilised in evaluation of chronic ASIS pain. We aim to provide a pictorial review of common causes of ASIS pain and their radiological evaluation and appearance across different imaging modalities.

Results :
Acute, traumatic ASIS injury is most commonly associated with apophyseal injuries in the paediatric population and professional athletes. Chronic ASIS pain, however, can present a diagnostic challenge due to a wide spectrum of causative aetiologies, relatively complex regional anatomy and inadequate choice of imaging by the referring clinicians. This review will provide a synopsis of a number of pathologic findings across a range of imaging modalities, to encompass the following: Repetitive strain injuries, proximal iliotibial band tendinopathy and tears, tumours, referred or neurogenic pain from the lumbar spine or lateral femoral cutaneous nerve entrapment.

Conclusions :
This educational poster will provide a pictorial overview of a range of pathologies contributing to ASIS pain and the relevant imaging findings and interpretation.

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Purpose :


Materials and Methods :


Results :


Conclusions :


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Purpose :
To describe the biomechanics and imaging features of common injuries in competitive swimming, focusing on the shoulder, spine, and knee.
 

Materials and Methods :
Swimming involves repetitive overhead arm movements and intense lower-limb propulsion, leading to a high prevalence of overuse injuries. The most common conditions include swimmer’s shoulder, lumbar hyperextension injuries, and breaststroker’s knee. Imaging plays a key role in diagnosing these conditions, particularly MRI, which provides detailed soft tissue evaluation.

Results :
Shoulder injuries, seen in up to 91% of elite swimmers, include subacromial impingement, rotator cuff tendinopathy, and labral tears. MRI frequently reveals supraspinatus tendinopathy, biceps tendon pathology, and glenohumeral instability. Lumbar hyperextension, common in butterfly and breaststroke, contributes to facet joint stress injuries, spondylolysis, and early disc degeneration, with MRI showing marrow edema and pars defects. Breaststroker’s knee results from valgus stress during the whip kick, leading to medial collateral ligament sprains and patellar tendinopathy, with MRI demonstrating tendon thickening and peripatellar edema.

Conclusions :
Overuse injuries are prevalent in swimmers, requiring imaging for accurate diagnosis and management. MRI is essential for evaluating soft tissue damage and guiding treatment. Understanding swimming biomechanics aids in injury prevention and rehabilitation.
 

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Purpose :
To analyze the biomechanics of water polo-related injuries and their imaging features, particularly in the shoulder, hip, and spine.

Materials and Methods :
Water polo requires repetitive overhead throwing, treading water, and explosive movements, leading to a spectrum of injuries. The shoulder is the most affected site, followed by the hip and lumbar spine. Imaging, particularly MRI, plays a crucial role in assessing soft tissue and bone pathologies.

Results :
Shoulder injuries, including rotator cuff tendinopathy, SLAP tears, and instability, are frequently observed in water polo players. MRI findings include labral tears, infraspinatus tendinopathy, and glenohumeral joint effusions. The eggbeater kick contributes to femoroacetabular impingement and adductor-related groin pain, with MRI revealing labral damage and marrow edema. Lumbar spine injuries, including stress reactions and spondylolysis, are common due to rotational forces during throwing and defensive movements, with MRI showing pars defects and facet joint arthropathy.

Conclusions :
Water polo injuries primarily affect the shoulder, hip, and spine due to repetitive strain and contact forces. MRI is the imaging modality of choice for diagnosing soft tissue injuries and guiding management strategies.

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Purpose :
To discuss the biomechanics, injury patterns, and imaging findings associated with competitive diving, with a focus on the spine, wrist, and shoulder.

Materials and Methods :
Diving involves complex aerial maneuvers, high-speed water entry, and significant joint loading. Common injuries include lumbar stress reactions, wrist impaction syndromes, and shoulder instability. Imaging, particularly MRI, aids in the evaluation of these conditions

Results :
Lumbar spine injuries, including spondylolysis and early disc degeneration, are prevalent among divers due to repeated hyperextension and high-impact landings. MRI commonly reveals pars defects, facet joint edema, and Schmorl’s nodes. Wrist injuries, particularly scaphoid impaction and triangular fibrocartilage complex tears, result from forceful water entry, with MRI demonstrating bone marrow edema and ligament disruptions. Shoulder injuries, including rotator cuff tendinopathy and labral tears, arise from repetitive overhead movements, with MRI showing supraspinatus tendinosis and posterior labral injuries.

Conclusions :
Competitive diving subjects athletes to high-impact forces, predisposing them to chronic spine, wrist, and shoulder injuries. MRI plays a key role in diagnosing these conditions, aiding in treatment planning and prevention strategies.

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Purpose :
To highlight common errors in the classification and imaging interpretation of groin pain, focusing on adductor- and pubic-related groin injuries in athletes.

Materials and Methods :
Groin pain is a frequent complaint among athletes, particularly in multidirectional sports such as soccer and ice hockey. The anatomical complexity of the pubic region, including the pubic symphysis, pre-pubic aponeurotic complex (P-PAC), and pyramidalis-anterior pubic ligament-adductor longus complex (PLAC), often leads to misdiagnoses. The 2015 Doha Agreement introduced a standardized classification system, dividing groin pain into adductor-, iliopsoas-, inguinal-, and pubic-related categories. Despite this framework, diagnostic errors persist, especially in differentiating adductor-related injuries from pubic apophysitis. Magnetic resonance imaging (MRI) is the preferred modality for evaluating these conditions, but its interpretation is prone to misclassification.

Results :
Misinterpretation of MRI findings often leads to incorrect diagnoses and inappropriate management strategies. Bone marrow edema in the pubic symphysis is frequently misattributed to "osteitis pubis," a nonspecific term that does not differentiate between pubic-related and adductor-related pathologies. Adductor longus injuries, including enthesopathy and fibrocartilage avulsions, are commonly overlooked or confused with rectus abdominis injuries due to the complex anatomical overlap. Additionally, superior and secondary cleft signs on MRI can be mistaken for chronic apophysitis sequelae, leading to unnecessary interventions. In adolescent athletes, the delayed maturation of the pubic apophysis is often misdiagnosed as an acute injury rather than a normal developmental variant. Understanding the specific imaging characteristics of these conditions is crucial for accurate diagnosis and treatment planning.

Conclusions :
Accurate classification of groin pain relies on a comprehensive understanding of anatomical structures and proper MRI interpretation. Standardized terminology, such as the Doha Agreement classification, improves diagnostic consistency and facilitates communication between radiologists and clinicians. Recognizing common imaging pitfalls, particularly in distinguishing adductor injuries from pubic-related conditions, is essential for optimizing patient management and reducing unnecessary interventions.

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Purpose :
To examine the MRI characteristics of osteochondral lesions in the knee and distinguish osteochondritis dissecans (OCD) from normal ossification variants and post-traumatic lesions. Additionally, to discuss the role of MRI in both pre- and post-surgical evaluations.

Materials and Methods :
We analyzed knee MRIs at 1.5 Tesla in both adolescents and adults presenting with osteochondral lesions, some with a history of prior trauma and others without.
Osteochondral lesions of the knee can present a diagnostic challenge due to overlapping imaging features from various causes. MRI plays a crucial role in differentiating OCD from other conditions. Features such as bone fragmentation, classic locations on the femoral condyles, instability or disruption of the overlying cartilage, as well as signs of acute injury (including bone marrow edema, fracture lines and associated soft tissue damage), all contribute to an accurate diagnosis.

Results :
MR imaging, both at initial presentation and during follow-up, provides critical information on lesion size, depth, stability, and cartilage involvement. These factors guide treatment decisions, such as whether conservative management or surgical intervention is necessary. For cases requiring surgery, postoperative MRI is vital for assessing graft integration, cartilage repair, and detecting potential complications like graft failure or subchondral cyst formation.

Conclusions :
This presentation highlights key MRI features that differentiate osteochondral lesions of the knee, aiding in the decision-making process for both conservative and surgical management, ultimately improving long-term joint health and function.

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Purpose :
To report two rare cases of Jersey finger with complete rupture of the flexor digitorum profundus (FDP) tendon in zone III of the palm, confirmed by ultrasound and surgical findings, and to underline the role of imaging in diagnosing and managing these injuries

Materials and Methods :
Two male patients presented with an inability to flex the distal interphalangeal joint (DIP) of the fifth finger following closed traction injuries. The first was a 30-year-old bricklayer who sustained the injury during a DIY accident, and the second was a 63-year-old retired man who experienced the injury while doing home repairs. Both had normal initial radiographs. Ultrasound was performed 3 days post-trauma in the first case and 2 weeks post-trauma in the second case, using a Toshiba Aplio i800. Surgical repair was performed 7 days and 1 month after trauma, respectively.

Results :
In both cases, ultrasound revealed a complete rupture of the FDP tendon of the fifth ray in zone III, likely at the level of the hamate hook, with retraction of approximately 3–4 cm. The distal tendon stump was visualized 2–3 cm proximal to the M5 head, while the proximal stump was poorly visualized, likely retracted into the carpal tunnel. The FDP proximal to the carpal tunnel and the digital flexor tendons were normal, though effusion was noted within the tendon sheath. Surgical exploration confirmed the ultrasound findings. The first patient underwent direct tendon repair with a double Kessler suture technique, while the second patient underwent an intercalary tendon transfer of the flexor digitorum superficialis from the fourth ray.

Conclusions :
These cases highlight a previously undescribed cause of Jersey finger of the fifth ray, involving a rupture in zone III at the level of the hamate hook. Accurate diagnosis of this specific localization via ultrasound avoids unnecessary surgical exploration of the digital canal, reducing the risk of long-term fibrosis. Early imaging plays a crucial role in guiding appropriate surgical planning and improving outcomes.

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Purpose :
Magnetic resonance imaging (MRI) is a crucial imaging modality for the diagnosis of musculoskeletal (MSK) tumors, offering both qualitative and quantitative analysis of tissue composition. We aimed to descript how to determine the key tissue components of musculoskeletal tumors.

Materials and Methods :
Key tissue components of MSK tumor identifiable on MRI include mature fat and fluid. However, hyperintense mimickers, such as hematomas on T1-weighted images (T1WI) and pseudocystic lesions on T2-weighted images (T2WI), can complicate MRI interpretation. Masses with non-specific MRI features, such as iso signal intensity (SI) on T1WI and high SI on T2WI, require differential diagnosis, focusing on patterns like low SI on both sequences and signs suggestive of malignancy, with biopsy indicated for uncertain cases. Advanced MRI techniques enhance diagnostic precision: DIXON quantifies fat content, diffusion-weighted imaging assesses cellularity with tumor heterogeneity, and dynamic contrast-enhanced MRI quantifies perfusion. 

Results :
Ultimately, integrating conventional and functional MRI analyses is essential for accurately characterizing the diverse and complex nature of MSK tumors.

Conclusions :

•MSK tumors are a complex and heterogeneous group of tumors.
•Narrowing the differential diagnosis by tissue composition
•Addition of functional sequences to the conventional MRI protocols increases the diagnostic accuracy of interpretations for MSK tumors

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Purpose :

1. Understand the basic science and classification of clonal plasma cell disorders with their respective clinical implications.
2. Become familiar with epidemiology, risk factors, diagnostic criteria, characteristic clinical symptoms, disease course (including repeated patterns of remission and relapse), and common treatments.
3. Discuss the variety of bone marrow infiltration patterns on imaging.
4. Evaluate the evolving role of advanced imaging techniques such as whole body MRI including the role of diffusion weighted imaging, whole body CT and PET CT (FDG and other newer tracers in research)
5. Recommendations from the International Myeloma Working Group and MY-RADS reporting guidelines.

Materials and Methods :
​Clonal plasma cell disorders represent a spectrum of conditions, from benign to malignant, that affect the bone marrow. This spectrum includes monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM) and full-blown multiple myeloma (MM). The presence of monoclonal gammopathy is a relatively common finding in adults over the age of 50, upto 4% of the population. Yet, these conditions are known for their insidious progression, often leading to skeletal destruction. The nuances of imaging are essential for diagnosis and monitoring disease progression. Advances in imaging techniques have shed light on the structural consequences of these disorders, allowing for earlier detection and more refined prognostication.

Results :

1. Introduction to Clonal Plasma Cell Disorders: From MGUS to MM.
2. Bone Health & Risk Factors: What population is at increased riks? 
3. Diagnostic criteria, characteristic clinical symptoms & common current treatments.
4. Case Studies: Key radiologic findings from MGUS, SMM, and MM.
5. Imaging Modalities and Techniques: The role of X-ray, CT, MRI, and PET/CT in detection and monitoring. 
6. Future Directions in Imaging: What’s next in skeletal radiology for clonal plasma cell disorders?

Conclusions :

1. Clonal plasma cell disorders represent a continuum, and early imaging is crucial for patient management.
2. Advanced imaging techniques such as whole body CT, MRI or FDG-PET CT offer improved sensitivity in detecting skeletal changes, even before clinical symptoms.
3. These conditions often co-exist with osteoporosis making accurate imaging diagnosis vital for patient management and preventing debilitating skeletal damage.

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Purpose :
To review the role of thermal ablation as a minimally invasive treatment for osteoid osteoma.

Materials and Methods :


Results :


Conclusions :


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Purpose :
To identify and describe key imaging features of cartilage tumors that aid in distinguishing benign from malignant lesions.

Materials and Methods :


Results :


Conclusions :
Recognizing worrisome imaging features in cartilage tumors is crucial for accurate diagnosis and timely intervention.

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Purpose :
Scapulothoracic bursitis might be a cause of discomfort and limited mobility of the shoulder girdle region. It can be clinically present in patients who have aggravated pain of the scapula upon motion, occasionally with grinding or snapping sound (crepitus).
On an imaging perspective, ultrasound is usually the modality of choice for evaluation of patients with mass in the scapular region, whilst MRI should be modality of choice for further characterization of the lesion. MRI is particularly helpful to identify size and location of inflamed bursa.

Materials and Methods :
Here we present a case of a 76 year old lady with underlying pulmonary tuberculosis infection, who had complained of right upper back swelling that was gradually increasing in size. Upon examination, upper back crepitus was noted at the right shoulder girdle.

Results :
There is a fairly well defined rim-enhancing encapsulated collection within the right infraserratus muscle region. Presence of scattered hypointense foci within likely to represent ‘rice bodies’. This lesion is confined within the right infrascapular bursa. Anteriorly there is a solid enhancing soft tissue lesion seen traversing the adjacent intercostal muscles and posterior ribs with no clear plane in between. No intrathoracic extension. Posteriorly, it compresses onto the right teres minor muscle with no infiltration. Scapula is preserved with normal signal intensity and no bony erosion. Medially, no extension to the right trapezius muscle. Laterally, clear plane seen with the right axillary neurovascular bundles.

Conclusions :
Typical clinical and imaging findings are featured in case of scapulothoracic bursitis. It could closely mimic a cystic mass without a solid portion, situated in the subscapular region. MRI is useful to differentiate between a distended  and inflamed bursa from a tumor.

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Purpose :
To review the imaging features of atypical lipomatous tumour (ALT)/ well differentiated liposarcoma (WDL) and the significance of this lesion with a focus on its location. 

Materials and Methods :
ALT and WDL represent the same lesion with the term ALT used to describe lesions located in anatomical sites in which complete surgical resection is curative. The term WDL is largely reserved for lesions arising in anatomical sites such as the retroperitoneum and mediastinum, where there is greater potential for recurrence and disease progression. ALT/WDL does not metastasize but has the potential to dedifferentiate into a dedifferentiated liposarcoma highlighting the importance of recognising these lesions.  

Results :
The main differential of these fatty lesions are simple lipomas. Imaging features which can be used to help differentiate an ALT/WDL from a simple lipoma include location, size and the imaging characteristics of the lesion. ALT/WDL most commonly occurs in the retroperitoneum and the deep subfascial tissues of the extremities such as the thigh, although it can also occur in the subcutaneous tissues, head/neck and mediastinum. ALT/WDL tends to be larger than simple lipomas with a size over 10cm often used as a discriminator. The presence of nodules, masses and thickened septa all favour the diagnosis of an ALT/WDL over a lipoma. The risk of dedifferentiation is highly dependent on the location of the lesion with those in the retroperitoneum most at risk. Conversely, dedifferentiation of a subcutaneous ALT is an extremely rare entity.

Conclusions :
The radiologist should be aware of the imaging features which suggest an ALT/WDL as opposed to a simple lipoma to identify lesions in which biopsy or excision is necessary. The radiologist should also be aware of the variable natural history of these lesions dependant on their location.  

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Purpose :
To review the imaging findings of Ollier disease, a rare non-hereditary skeletal disorder characterized by multiple enchondromas, and highlight its potential for malignant transformation. This case illustrates the radiologic features, clinical presentation, and management of enchondromatosis complicated by chondrosarcoma.

Materials and Methods :
Ollier disease is a subtype of enchondromatosis characterized by multiple enchondromas with a unilateral or asymmetric distribution, primarily affecting the long bones, hands, and feet. The disorder is associated with somatic mutations in IDH1 or IDH2 and typically presents in childhood. While enchondromas are benign, the increased lesion burden in Ollier disease results in a significantly elevated risk of malignant transformation, with up to 30-50% of cases developing chondrosarcoma. Early radiographic recognition and longitudinal monitoring are crucial for diagnosis, risk stratification, and timely intervention.

Results :
We present a case of a 38-year-old male with a history of leg length discrepancy, scoliosis, and recent persistent left knee pain following mild trauma. Initial radiographs demonstrated multiple expansile lytic lesions with chondroid matrix calcifications involving the left femur and tibia, consistent with enchondromatosis. MRI revealed a large, lobulated T2 hyperintense lesion with heterogeneous enhancement in the left proximal tibia, raising suspicion for malignant transformation. Subsequent CT confirmed cortical erosion and endosteal scalloping, further supporting a diagnosis of secondary chondrosarcoma. The patient underwent biopsy, which confirmed grade II chondrosarcoma arising from pre-existing enchondromas. Surgical resection with total knee arthroplasty was performed.

Conclusions :
This case highlights the imaging spectrum of Ollier disease and its potential for malignant transformation. Recognizing early radiographic indicators of chondrosarcoma, such as cortical breakthrough, aggressive periosteal reaction, and soft tissue extension, is essential for prompt diagnosis and management. Long-term surveillance of patients with Ollier disease is critical for optimizing outcomes and preventing delays in treatment.

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Purpose :
To review the imaging characteristics of Gorham-Stout Disease (GSD), a rare disorder characterized by progressive osteolysis, and to highlight its diagnostic challenges, particularly in spinal and pelvic involvement. This case underscores the importance of recognizing key radiologic findings for early diagnosis and appropriate management.

Materials and Methods :
Gorham-Stout Disease, also known as vanishing bone disease, is a rare idiopathic condition marked by progressive osteolysis and replacement of bone with angiomatous or lymphatic tissue. The disease can affect any part of the skeleton but commonly involves the axial skeleton, ribs, and pelvis. The exact pathogenesis remains unclear, though it is thought to be associated with abnormal lymphangiogenesis. Clinical manifestations vary depending on the site of involvement and can include pain, fractures, and skeletal deformity. Given its rarity and nonspecific symptoms, GSD is often misdiagnosed, making imaging a critical tool for early identification and differentiation from other osteolytic conditions.

Results :
We present a case of a 20-year-old female with progressive lumbar and pelvic pain and an evolving pelvic deformity. MRI of the thoracic and lumbosacral spine demonstrated extensive vertebral bone resorption with fatty infiltration of the thoracolumbar spine, sacrum, and pelvis, while maintaining vertebral body height and alignment. Unlike more advanced cases, there was no evidence of severe kyphotic or lordotic deformity. CT imaging confirmed progressive osteolysis with cortical thinning, and subsequent biopsy of pelvic tissue revealed cystic angiomatosis/lymphangiomatosis, confirming the diagnosis. The patient’s condition worsened over time, illustrating the progressive nature of GSD.

Conclusions :
Gorham-Stout Disease presents substantial diagnostic challenges due to its rarity and variable radiologic presentation. Early recognition of imaging hallmarks—progressive osteolysis, cortical thinning, and fatty infiltration—is crucial for diagnosis and differentiation from other osteolytic disorders. This case highlights the need for heightened clinical awareness, timely imaging evaluation, and continued research to improve management strategies for this rare disease.

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Purpose :
To provide a comprehensive visual overview of benign cortical bone tumors emphasizing key imaging characteristics that aid in differential diagnosis and help distinguish them from aggressive lesions through case presentations.
 

Materials and Methods :


Results :
Osteoid Osteoma: Best detected on CT, this condition is characterized by a tiny, radiolucent nidus surrounded by reactive sclerosis.
 It usually manifests in young boys who have NSAIDrelieved nocturnal discomfort.
Osteoblastoma: Larger (>2 cm) and less reactive sclerosis than osteoid osteoma. The posterior components of the spine are often affected.
Non-ossifying fibroma (NOF): A well defined, eccentric, multilocular lytic lesion with a sclerotic border, frequently observed in children's long bone metaphysis.
A less severe form of NOF, fibrous cortical defects are typically accidental and self-limiting.
Cortical desmoid: an uneven, sclerotic lesion in the posterior femoral cortex that is frequently caused by muscular traction or long-term tension.
 

Conclusions :
Radiographic and crosssectional imaging characteristics are essential for distinguishing benign cortical bone cancers. 
It is easier to direct proper therapy and prevent needless interventions when one is aware of their characteristic sites, age distribution, and imaging presentations. 
CT and MRI are examples of advanced imaging techniques that help with diagnosis and treatment planning.

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Purpose :
Pictorial review to demonstrate the varied pathognomonic appearances of rare benign parosteal lipoma that could help obviate the requirement for percutaneous needle.

Review of the differential diagnosis and their imaging features.

Materials and Methods :
Parosteal lipomas are rare, benign adipocytic tumours that arise in close proximity /adhere to the periosteum representing 0.3% of all lipomas. They typically present as enlarging, non-tender masses in middle-aged patients. The femur is the commonest site of involvement but their imaging features at atypical sites including thumb and ribs are presented in this case series. The imaging features correspond to their histological features that include; intrinsic adipose tissue with varying spicules cancellous bone, thin peripheral fibrous capsule, broad periosteal attachment containing mature hyaline cartilage with endochondral ossification.

Results :
The pathognomonic imaging features can include;

· well defined intrinsic adipose tissue with varying spicules cancellous bone ranging from complete homogenous hyperintense T1/T2 fat signal through to larger percentage of radiating bone spicules

· thin peripheral fibrous capsule of hypointense T2 signal

· broad periosteal attachment containing mature hyaline cartilage with endochondral ossification. This includes pedunculated and sessile ossified excrescences. There can be varying degrees of cortical thickening/periostitis near their base

· other imaging features that can be associated with these lesions include extrinsic pressure related phenomenon including muscle atrophy potentially caused by nerve impingement.

The main differential diagnosis due to its osseous components is an osteochondroma. Unlike osteochondroma, they lack medullary continuity or a cartilage cap. Parosteal chondroma can have similar broad parosteal attachment but would have varying degrees of intrinsic mineralised/un-mineralised cartilaginous signal. The lack of definite ossified parosteal excrescence at its base would suggest a diagnosis of overlying soft tissue well differentiated/atypical lipomatous tumour.

Surgical excision could be offered for local pressure effects etc but is not normally required for histological confirmation (none of our presented cases went on to have surgical pathological correlation).

Conclusions :
Recognising pathognomonic imaging features of parosteal lipomas is crucial given that they involve ossified excrescences, potentially mass effect on adjacent structures, and diagnostic overlap with other parosteal lesions. Awareness of these key-imaging characteristics can prevent unnecessary biopsy.

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Purpose :
Mesenchymal chondrosarcoma, first described by Lichtenstein and Bernstein in 1959, is a rare high-grade malignant tumor with mesenchymal and cartilaginous components. It typically arises from neural crest derivatives in bone or soft tissue and accounts for less than 0.4% of all sarcomas and around 1% of chondrosarcomas(1). Unlike conventional chondrosarcoma, it primarily affects individuals in their third decade of life, has a poorer prognosis, and exhibits a higher metastasis rate(2). This article presents a case of extraskeletal mesenchymal chondrosarcoma (EMC), a rare variant occurring in an atypical age group.

Materials and Methods :
A 60-year-old female presented with swelling and pain in the distal thigh, persistent for 8 months. A contrast-enhanced Magnetic Resonance Imaging(MRI) was performed after a soft tissue lesion, without bony involvement, was noted on radiographs. The MRI showed a lobulated, well-defined mass extending from the distal thigh to the proximal calf, isointense on T1WI, with a heterogeneous hyperintense signal on T2WI and heterogeneous enhancement after contrast administration. The mass was in close contact with the posterior femur, but no cortical destruction was observed. A trucut biopsy confirmed the diagnosis of EMC. Preoperative lower extremity CT angiography ruled out invasion of nearby blood vessels or bone. The patient underwent surgery followed by chemotherapy.

Results :
EMC occurs in soft tissue, most commonly in the thigh when involving the lower extremity, as seen in our case(3). In the largest clinicopathological study of 117 EMC cases, this tumor was found to be more aggressive than other chondrosarcomas and had a high incidence of distant metastasis(4). However, no metastasis was detected in our patient at diagnosis. Radiological imaging is essential for assessing soft tissue involvement, guiding differential diagnosis, determining biopsy need, and staging. T1WI and T2WI MRI characteristics are nonspecific, but T2WI hyperintense lobules with peripheral T2WI hypointensity and T2WI hypointense chondroid-type calcifications have been reported as potentially specific findings(5). In our case, T2WI hyperintense lobules were observed, though no chondroid-type calcifications were present. 

Conclusions :
Although EMC is a rare condition, specific MRI findings can facilitate its differential diagnosis. Early diagnosis is crucial, enabling prompt intervention and significantly improving the disease's prognosis.

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Purpose :
The purpose of this case report is to present a rare occurrence of a hydatid cyst involving the sacroiliac joint with extension into the spinal canal, highlighting its diagnostic challenges. Given its atypical presentation and the potential for misdiagnosis, this report aims to emphasize the importance of considering hydatid disease in the differential diagnosis of lytic expensile bone lesions with extension, especially in endemic regions. Additionally, we discuss the imaging characteristics, differential diagnosis, and the role of radiologists in early detection and management to prevent severe neurological complications.

Materials and Methods :
we describe the clinical presentation, imaging findings, and diagnostic approach for a patient with a hydatid cyst involving the sacroiliac joint and extending into the spinal canal. The following methods were used:

1. Clinical Assessment.
2. Imaging Studies.
3. Lab investigation.
4. Management options.

Results :
extension of the hydatid cyst from the sacroiliac joint into the spinal canal is a rare phenomenon. In most cases of musculoskeletal hydatid disease, cysts are localized to the bone or joint without spreading to adjacent soft tissues spinal canal. The pathogenesis of this extension remains unclear, though it is likely related to the anatomical proximity and the potential for cysts to breach normal tissue boundaries via pressure or local invasion. In our case, the involvement of the spinal canal added a layer of complexity to the diagnosis.

Conclusions :
In conclusion, this case highlights the importance of considering hydatid cysts in the differential diagnosis of cystic lesions in the sacroiliac joint and spine, particularly in endemic regions. Radiological imaging, particularly MRI, plays a crucial role in identifying these rare lesions and guiding the diagnosis. Early recognition of hydatid cysts can prevent complications and enable appropriate management, even in cases where surgery is not immediately pursued.

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Purpose :
To illustrate imaging characteristics of both frequent and rare osteochondroma complications, including interpretation pearls and diagnostic challenges, through case studies from a national sarcoma centre.

Materials and Methods :
Osteochondromas are amongst the most common benign bone tumours, typically presenting in childhood or adolescence. While often asymptomatic and incidental, they can lead to various complications due to their location, size, and potential for malignant transformation. Recognizing these complications promptly on imaging is crucial for effective patient management. This educational poster reviews characteristic imaging findings across different modalities, emphasizing radiographs, CT, and MRI, in diagnosing osteochondroma-related complications. Complications discussed include malignant transformation to chondrosarcoma, fracture, vascular impingement or pseudoaneurysm formation, nerve compression, bursa formation, growth abnormalities or deformities, and infarction of osteochondromas.

Results :
Imaging examples are presented for each discussed complication:

Malignant Transformation to Chondrosarcoma: Demonstrated by increased cartilage cap thickness (>1.5-2 cm), irregular margins, and rapid lesion enlargement.

Fracture: Evident as cortical disruption, lucent fracture lines, and associated soft tissue swelling.

Vascular Impingement/Pseudoaneurysm: In the example case provided, a osteochodroma was complicated by pseudoaneurym. Initially the pseuoaneurysm was thought to be a as a soft tissue sarcoma on CT.

Nerve Compression: Characterized by adjacent nerve displacement and signal alteration on MRI.

Bursa: Seen as fluid collections with synovial enhancement on MRI, typically overlying the osteochondroma.

Growth Abnormalities/Deformities: Including limb length discrepancies. angular deformities and osseous fusion.

Infarction: Demonstrated by areas of sclerosis, mixed density, or irregular margins within the lesion.

Conclusions :
Radiologists play a pivotal role in diagnosing complications of osteochondromas through accurate interpretation of imaging findings, directly influencing management decisions and patient outcomes. Familiarity with these complications ensures timely diagnosis and appropriate intervention.

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Purpose :
Pacinian corpuscular hyperplasia (PCH) is a rare condition characterised by benign hyperplasia of the Pacinian bodies, usually localised to the fingers and toes. Pacinian bodies, also known as Vater-Pacini bodies or lamellar bodies, are pressure-sensitive nerve endings in the skin. PCH usually presents as painless or mildly painful subcutaneous masses and is often detected incidentally. However, in symptomatic cases, patients may present with localised discomfort, tenderness, or mild neuropathic complaints. This rare pathology may be confused with neurogenic tumors or other soft tissue lesions when not well known clinically and radiologically.
This study aimed to describe the radiological imaging findings of PCH, to contribute to the clinical differential diagnosis, and to reduce the need for surgery or intervention.

Materials and Methods :
A 58-year-old male patient was admitted to the orthopaedic department of our hospital with a complaint of pain radiating to the entire left hand for 3 months. His medical history, physical examination, and laboratory findings were unremarkable. Coronal T1 ,STIR, Axial T1, PD FS, and Sagittal PD FS plan images with 3 mm slice thickness, Axial T1, PD FS, and Sagittal PD FS plan images with 4 mm slice thickness were obtained in our clinic with 1.5T SIGNA Explorer device without contrast material.
 

Results :
On MRI, diffuse multiple nodular images were observed in the subcutaneous soft tissue of the left hand with a millimetric-sized hypointense signal in T1-WI and a hyperintense signal in T2-WI. Contrast-enhanced images were not obtained.
 

Conclusions :
Pacinian corpuscular hyperplasia is a rare lesion that should be recognised. Unnecessary biopsy and surgical interventions can be avoided, especially when its characteristic features are evaluated by non-invasive methods such as MRI and USG. The differential diagnosis of PCH should be made with lesions originating from peripheral nerves, especially schwannomas, neurofibromas, and glomus tumors, and other soft tissue tumors such as lipomas and fibromas. Since PCH is a benign pathology, surgical excision may be required only in symptomatic cases. A good knowledge of the characteristics of this lesion by radiologists during the diagnostic process can help patients avoid unnecessary interventions by making the correct differential diagnosis.
 

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Purpose :
Spinal tumours represent a significant diagnostic challenge, particularly when benign or non-neoplastic conditions mimic malignant pathology. Misinterpretation may result in multiple untoward outcomes not limited to, unnecessary biopsies, treatment delay, and increased patient anxiety. In this exhibit, we aim to highlight key imaging features of common tumour mimics—such as aggressive haemangiomas, bone islands, acute Schmorl’s nodes, inflammatory anterior corner lesions, and focal nodular marrow hyperplasia. 

Materials and Methods :
Benign spinal lesions can often resemble primary or metastatic neoplasms on imaging. For example, aggressive haemangiomas may demonstrate enhancement and bony expansion, mimicking metastases. Bone islands can be mistaken for osteoblastic metastases, while acute Schmorl’s nodes and inflammatory anterior corner lesions may be misidentified as neoplastic vertebral body involvement. Focal nodular marrow hyperplasia can simulate marrow-infiltrative disease. Distinguishing these conditions is crucial for appropriate patient management.

Results :
Key imaging features of tumour mimics across multiple modalities include:

• Aggressive Haemangiomas: High T2 signal, contrast enhancement, and preservation of trabecular architecture on MRI; classic polka-dot and corduroy appearance on CT.
• Bone Islands: Sclerotic, well-defined lesions with no enhancement on MRI or CT; unchanged on follow-up imaging.
• Acute Schmorl’s Nodes: Focal endplate defect with surrounding marrow oedema on STIR sequences; no soft tissue component.
• Inflammatory Anterior Corner Lesions: High T2 signal at vertebral corners with associated ligamentous changes, commonly seen in inflammatory spondyloarthropathies.
• Focal Nodular Marrow Hyperplasia: Small, hyperintense T1 foci with signal drop-out on opposed-phase imaging, confirming fat content.

Conclusions :
A multimodality imaging approach is essential for differentiating tumour mimics from true spinal neoplasms. MRI is particularly valuable for assessing marrow signal changes, while CT provides crucial information on bone architecture. Recognizing these imaging patterns can prevent misdiagnosis, guide appropriate management, and reduce unnecessary interventions.

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Purpose :
We present the oldest epithelioid osteoblastoma (EO) case reported to date in the literature at 67 years old. We discuss the epidemiologic, clinical, radiologic and histopathologic features of EO, conventional osteoblastoma (CO), low-grade osteoblastoma-like osteosarcoma (LGOBLOS) and other relevant differential diagnoses (DDx). We present the DDx of bone tumours with fluid-fluid levels (FFL) in young and old patients.

Materials and Methods :
Much is known about CO, a rare tumour that accounts for less than 1% of primary bone tumours, mostly occurring in males and 10–20 year olds. However, there is a paucity in the literature relating to these rarer and more aggressive osteoblastoma subtypes, including EO and LGOBLOS, which occur in slightly older patients.
 

Results :
A 67-year?old male presented with worsening right shoulder pain and restricted range of motion.
Radiograph, CT and MRI demonstrate a large lytic mass in the proximal right humerus with internal mineralisation, bubbly appearances, FFL, sclerotic borders, cortical destruction and post-contrast enhancement. There was surrounding bone marrow and soft tissue oedema, with subacromial bursitis and a glenohumeral joint effusion.
Prior to referral to our specialist orthopaedic oncology referral centre, DDx by the time of multidisciplinary team (MDT) discussion had included: metastasis, plasmacytoma / multiple myeloma, primary bone sarcoma (especially chondrosarcoma), giant cell tumour with aneurysmal bone cyst-like features.
CT thorax, abdomen and pelvis was negative for primary malignancy, while a serum protein electrophoresis was negative for plasmacytoma / multiple myeloma.
An aggressive benign primary bone tumour, such as EO, was favoured at MDT. However, a malignant primary bone tumour, most notably LGOBLOS, could not be excluded.
Following CT-guided biopsy and subsequent surgery, histopathologic analysis confirmed an EO.
 

Conclusions :
This case proves that osteoblastoma, and its more aggressive subtypes, should be included in the DDx of a lesion with FFL, even in an older than expected patient.
The distinction between malignant differentials is crucial, such as LGOBLOS that generally requires adjuvant radiotherapy or chemotherapy, which are contraindicated in EO. En bloc resection is often favoured in EO due to lesion aggression, location and associated higher recurrence rates.
Due to a paucity of literature, more research is warranted related to EO and LGOBLOS.
 

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Purpose :
We present the case of a 38-year-old male with a three-year history of indolent and progressive unilateral right foot swelling and pain with primary intraarticular SC (PISC) of right calcaneocuboid joint (CCJ) and review the literature.

Materials and Methods :
Synovial chondromatosis (SC) is a rare, benign neoplastic process involving multiple hyaline cartilaginous nodules in the subsynovial tissue of a joint, tendon sheath or bursa. PISC is an idiopathic and largely monoarticular, involving large joints. Most cases occur at the knee, then the hip, elbow, shoulder and ankle. PISC is rare in the foot.

Results :
A literature review revealed one case of PISC of the CCJ that did not describe radiological features and one case of PISC of the subtalar joint that extended into CCJ.

Conclusions :
Primary intraarticular synovial chondromatosis (PISC) is rare in the foot and extremely rare at the CCJ (CCJ). This is the first described instance in existing literature. Our review highlights the radiologic features of SC that can be pathognomonic, differential diagnosis and management. We have emphasized the importance of considering PISC as a differential for calcification and soft tissue swelling at the CCJ. We highlight methods to distinguish from other differential diagnoses, especially chondrosarcoma, to prevent mistreatment.
 

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Purpose :
Illustrate Ewing Sarcoma's imaging aspect from typical to atypical on imaging including plain radiography, CT and MRI.
Describe the differential diagnosis of Ewing’s Sarcoma, including osteomyelitis and osteosarcoma, highlighting the pearls and pitfalls to make the right diagnosis.
Review the imaging features in posttreatment imaging.

Materials and Methods :
A retrospective analysis of 30 patients, performed in the years 2022-2024, at the pediatric radiological department. All the patients benefited from plain radiography of the involved bone, 10 had a CT scan, and 15 had an MRI for further assessment of medullary invasion. MRI was performed in a 1.5 Tesla machine with a standardized protocol. 15 patients benefited from a post-therapeutic MRI. All patients were later confirmed histologically for Ewing Sarcoma. Tumor location, extension of the tumor, periosteal reaction, soft tissue invasion and articular extension, were all evaluated and reported to the surgeon.

Results :
The mean age of the patient was 7 years old, with extremes from 2 years old to 17 years old. 8 cases were incidentally discovered in a traumatic context, while all the others had symptoms ranging from pain in the involved site, local swelling, or palpable tumor. Loss of body mass and weakness were noted in 10 cases. The most frequent tumor site was the femur with 15 cases followed by the tibia in 10 cases. Agressive features were found in all cases as bone destruction, moth-eaten to permeative pattern, cortical destruction. Periostal reaction was frequently seen in 75% of patients, either lamellated or spiculated, sclerotic component in 35% of cases, and other aspects were studied in order to approach the diagnosis. medullary involvement were found in all the cases. 

Conclusions :
Ewing sarcoma is a highly malignant primary bone tumor that is derived from red bone marrow and accounts for approximately 33% of primary bone tumors. Even though plain radiography can detect the malignant aspect of a bone lesion orienting toward an Ewing sarcoma, MRI remains superior owing to its superior contrast resolution with a better evaluation of bone marrow and soft tissue.

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Purpose :
To review the role that new imaging techniques equipped in modern ultrasound machines may play in the study of soft tissue tumours (STT).

Materials and Methods :
Ultrasound is considered one of the first techniques to be performed when studying a STT, alongside clinical examination. In recent years, in addition to the classical characteristics of an STT that can be assessed (such as its size, location, echostructure, Doppler flow, or even the study of vascularisation using contrast), more modern techniques like elastography, both qualitative (strain elastography) and quantitative (shear wave elastography), and the study of microvascularisation, have begun to be employed. These are now available on more advanced ultrasound systems.

Results :
The study of elastography in STTs is technically challenging, as it can be influenced by multiple factors: the depth of the lesion (greater apparent stiffness the deeper it is), its location (if it is located over a bony structure, it will appear less elastic), or even the angle/position at which the study is performed (some studies recommend acquiring images with the prove in the short axis of the lesion) have all been correlated with results. There are works that support the usefulness of elastographic techniques, although many results remain preliminary and occasionally even contradictory.
Microvascular studies are performed by assessing the vascular ratio (percentage of vascular tissue), which is higher when there are more vessels within the STT. Similar to Doppler and contrast-enhanced studies (though more uncertain in the case of power Doppler), it is logical to assume that a vascularised lesion has higher metabolic activity and is therefore more likely to be aggressive when referring to STTs. Initial published studies seem to support this hypothesis.

Conclusions :
The study of elastography and microvascularisation could enhance the diagnostic capability of ultrasound in differentiating the aggressiveness of soft tissue tumours.

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Purpose :
Recognize the imaging features of Intravascular Papillary Endothelial Hyperplasia (IPEH) and its potential to mimic nerve sheath tumors.

Understand the importance of MRI and ultrasound in differentiating IPEH from aggressive peripheral nerve tumors.
 

Materials and Methods :
Intravascular Papillary Endothelial Hyperplasia (IPEH), also known as Masson’s tumor, is a benign intravascular lesion characterized by papillary endothelial hyperplasia within a thrombus. It commonly affects the head, neck, and extremities, with a predilection for women aged 30-50 years. Due to its imaging appearance, IPEH can be misdiagnosed as a soft tissue or nerve sheath tumor.

Results :
A 45-year-old patient with bilateral sciatica, more pronounced on the right side for three months, underwent imaging that revealed bilateral peri-ischiatic masses. MRI suggested neurofibromas, while ultrasound indicated perineural cysts. A previous ultrasound-guided biopsy of the right gluteal lesion was inconclusive, leading to surgical excision due to suspicion of a nerve sheath tumor.

 

Eight months later, MRI of the left sciatic nerve confirmed an expansile lesion extending from the endo-pelvic region to the gluteal muscles, with low signal intensity on T2/STIR, high signal intensity on T1, and diffusion restriction. Nodular thickenings were also noted along the distal thigh and popliteal fossa of the right side. Ultrasound confirmed an oval, hypoechoic, avascular lesion along the left sciatic nerve, with no enhancement on Doppler or contrast-enhanced ultrasound (CEUS).
Histological examination revealed IPEH, confirming its benign nature despite the atypical location and aggressive imaging features.

Conclusions :
This case highlights the importance of considering IPEH in the differential diagnosis of nerve-related soft tissue lesions. The diffuse nerve involvement and imaging findings initially suggested a malignant pathology, reinforcing the role of MRI and ultrasound in lesion characterization. Including IPEH in the differential diagnosis can aid pathologists in reaching an accurate conclusion.

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Purpose :
The primary objective of this case presentation is to highlight the diagnostic challenges associated with a rare case of intramuscular Alveolar Soft Part Sarcoma (ASPS) in a lady of older age group. The aim is to improve understanding of ASPS, focusing on their clinical and radiological features, and to emphasize the significance of a multidisciplinary approach in both diagnosis and treatment.
 

Materials and Methods :
Alveolar soft part sarcoma (ASPS) is a rare and malignant soft tissue tumor that primarily affects the extremities, pelvis, or retroperitoneum. ASPS is most commonly diagnosed in adolescents and young adults, with a median age of onset around 20 years. However, it has been documented in patients older than 50, though these cases are exceptionally rare. This report discusses a case of a 61-year-old female patient, presented to the orthopaedic oncology clinic with large painless mass in her left gluteal region for the past 20 years. The mass showed rapid increase in size for the past 1 year. The patient had no significant medical history or history of malignancy.
 

Results :
Ultrasound left gluteal region was performed, showing a large hypoechoic intramuscular mass with internal vascularity. MRI was done showing a well-defined soft tissue mass within the gluteus maximus muscle. This mass appears predominantly isointense with muscle on T1 and heterogeneously hyperintense on T2 with enhancement in post contrast sequences.  There were no signs of bony involvement. An ultrasound guided biopsy of the mass was performed, revealing tumour cells arranged in sheets and nests surrounded by fibrovascular septa, characteristic of ASPS. Immunohistochemical staining was positive for TFE3, a transcription factor that is frequently associated with ASPS, confirming the diagnosis. The patient is scheduled for CT scan to stage the disease prior to surgical resection of the mass.
 

Conclusions :
ASPS is a rare and aggressive sarcoma that can occur in older adults with less favorable outcomes due to the increased likelihood of metastatic disease at the time of diagnosis. This case report underscores the importance of considering rare malignancies like ASPS in the differential diagnosis of soft tissue masses, even in older patients.
 

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Purpose :
This narrative review aimed to critically summarize available literature on positron emission tomography (PET) imaging's utility in the management of primary bone tumours including osteosarcoma, chondrosarcoma, and Ewing sarcoma.

Materials and Methods :
Primary malignant bone tumours can pose significant diagnostic and therapeutic challenges due to inter-tumour heterogeneity. While traditional imaging modalities such as radiography, MRI (Magnetic resonance imaging), and CT (Computed tomography) remain essential for initial evaluation and staging, emerging evidence underscores the evolving role of PET, particularly PET/CT with Fluoro-deoxyglucose (18F-FDG), in the comprehensive management of bone sarcomas.

Results :
We highlight the potential of PET/CT as a powerful, non-invasive tool for early response assessment in osteosarcoma, which could inform timely treatment adjustments and optimize patient outcomes.
PET scanning, especially in combination with conventional anatomical imaging, has emerged as a useful tool in diagnosing, staging, and monitoring chondrosarcomas.
Central analysis of Ewing sarcoma demonstrated that PET/CT outperformed bone marrow biopsy in detecting bone marrow involvement with diffuse FDG uptake, accurately capturing age-related changes in bone marrow, and identified further bone metastases with focal FDG uptake and cortical destruction undetected by biopsy.

Conclusions :
Despite limitations like inconsistencies in Standard Uptake Value (SUV) cutoffs and reduced pulmonary resolution, PET/CT is valuable for staging, assessing response to neoadjuvant chemotherapy, predicting histological outcomes, detecting recurrence, and guiding biopsy in metabolically active tumour sites.
Further large scale, prospective studies are warranted to standardize protocols and establish PET's definitive role in sarcoma management.

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Purpose :


Materials and Methods :


Results :


Conclusions :
From the search it was observed that pain education achieved positive results in decreasing pain perception. However, the true impact on the quality of life of oncologic patients is still a matter of discussion, with varying results among published studies.

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Purpose :
Haematolymphoid malignancies and other bone marrow disorders pose significant diagnostic challenges due to their complex and variable imaging appearances. This study aims to review the role of various imaging modalities and their contribution to the precise diagnosis, staging, and follow-up of these complex disorders, highlighting their ability to detect disease extent and monitor treatment response.
 

Materials and Methods :
A comprehensive analysis of current imaging modalities was conducted. Traditional radiography and ultrasound were assessed for their roles in detecting bony changes and guiding biopsy procedures, respectively. Advanced imaging techniques, including computed tomography (CT) for detailed anatomical evaluation, magnetic resonance imaging (MRI) with Whole body diffusion-weighted imaging (WB MRI) for superior soft tissue contrast, and positron emission tomography (PET) when combined with CT or MRI, were reviewed.

Results :
The findings indicate that each imaging modality offers distinct advantages in assessing haematolymphoid malignancies. While radiography identifies osteolytic or sclerotic lesions, ultrasound is particularly useful in the evaluation of superficial lymphadenopathy and in biopsy guidance. CT remains crucial for mapping nodal and extranodal disease due to its high anatomical resolution. MRI, recognized as the gold standard for marrow assessment, enables differentiation of malignant infiltration, marrow reconversion, and edema. The use of DWI increases the sensitivity of MRI in detecting subtle changes and specificity to detect malignancy over other confusion or overlapping marrow infiltrative pathologies. PET combined with CT or MRI adds a functional dimension, enabling better discrimination between benign and malignant processes.

Conclusions :
The radiological assessment of haematolymphoid malignancies is not without its challenges. Variability in imaging appearances, particularly in indolent lymphomas, can complicate interpretation. As a result, radiologists must integrate imaging findings to reach a definitive diagnosis. Multidisciplinary collaboration with clinical, laboratory, and histopathological data is essential to refine diagnostic strategies, optimize treatment planning, and ultimately improve patient prognoses in haematolymphoid malignancies.

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Purpose :
Fast bowlers play an important role in cricket and are more prone to injury. Due to injuries, many fast bowlers lose significant on-field time and some may even have to retire prematurely. As there is a lacuna in current medical literature on ultrasound imaging in fast bowlers, this presentation aims to address the same.
Additionally, ultrasound and dynamic ultrasound offer real-time insights into soft tissue function, aiding in targeted treatment and rehabilitation plans.

Materials and Methods :
Cricket is the oldest and among the most popular sport in the world. The fast bowler plays a key role in cricket and are more prone to injury. Due to this, a fast bowler’s career is usually shorter and even in a short career, fast bowlers have to recover from multiple injuries, leading to a significant loss of on-field time.[3] Injuries can range from a musculotendinous sprain to fractures, depending on the severity of the mechanism. Most commonly reported injuries in fast bowlers are extremity injuries.The Hamstring strain is cited as the most common injury associated. USG-guided interventions are the mainstay of non-surgical interventions in athletes and can be used to treat several injuries. Ultrasound is also useful in guiding the precise placement of therapeutic injections, such as corticosteroids or platelet-rich plasma (PRP), for accelerated healing.

Results :
A minimum of twenty cases of sports injury were studied.
In upper extremity, shoulder ultrasound imaging of the cases with Rotator cuff and P. Major tear, ultrasound diagnosis of Epicondylitis, Thrower’s elbow and Ulnar neuritis are discussed.
USG imaging of hand diagnosing De Quervain synovitis and its ultrasound guided management.
In lower extremity, cases with various muscular and tendon injuries such as Hamstring and Semimembranosus partial or full thickness tears are discussed with special focus on ultrasound imaging tips.
In ankle ultrasound imaging, cases with TendoAchillis tendinopathy or rupture, ligament tear and plantar fasciitis.

Conclusions :
USG plays a vital role in ensuring optimal recovery, allowing for safe and timely returns to physical activity. The high resolution and dynamicity make it ideal for impingement, and accurate information that aids in rapid decision-making and intervention.

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Purpose :
Demonstrate a sonographic approach to visualising the subscapularis muscle belly. 
Highlight the safety profile of interventions through a trans-axillary approach.
Discuss therapeutic options for pain and spasticity involving the upper girdle musculature.

Materials and Methods :
Shoulder ultrasound is a key tool used by musculoskeletal practitioners to diagnose and treat a variety of upper girdle diseases. While magnetic resonance imaging is the cornerstone of shoulder imaging, sonography is readily available, practical and superior in its ability for dynamic assessment of musculoskeletal pathologies. The subscapularis muscle is commonly involved in a myriad of pathology including myofascial pain and spasticity. Interestingly, there is scarce literature on the assessment of the subscapularis muscle itself for diagnostic and therapeutic purposes. Partly, conventional approaches to shoulder ultrasound have not included the assessment of the subscapularis muscle due to it’s inherent anatomical location deep to the scapular which is averse to sound wave penetration. 

Results :
We describe an approach to visualising the subscapularis muscle as a short addition to the established shoulder sonography format. The patient is imaged in a semi-recumbent position with the arms elevated above and behind the head in the ABER (ABduction and External Rotation) position. This position naturally abducts and externally rotates the shoulder joint bringing subscapularis to a superficial position for assessment and intervention.

Conclusions :
To our knowledge, the trans-axillary sonography in the ABER position for the assessment of the subscapularis muscle belly is neither well established in practise nor extensively published in literature. The relative ease of positioning and sonographic access to the musculature coupled with the potential for assessment and intervention makes this approach extremely desirable to the musculoskeletal practitioner. 

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Purpose :
Delayed-onset muscle soreness (DOMS) is an indirect subacute muscular injury caused from unaccustomed intense exercise. Symptoms occur as early as 8 to 24 hours after exercise and are characterized by soreness, stiffness, pain, swelling, reduced range of motion, and decreased strength. Symptoms peak at 24-72 hours and resolve by 5-10 days.

DOMS is usually caused from eccentric contractions in which the muscle forcibly lengthens while attempting to shorten resulting in microtrauma to the muscle cells and inflammation. The severity of DOMS correlates with creatine kinase which is released into the blood from muscle membrane damage.

Although there is little clinical indication for imaging delayed-onset muscle soreness, ultrasound can be a valuable modality to identify more severe injuries. One should be familiar with the findings of DOMS to avoid over-calling pathology.
 

Materials and Methods :
We present a case of a 19-year-old male who presented with left upper extremity pain and stiffness centered about the elbow two days following intense weight training. His pain was 5/10. He was unable to flex or extend his arm around his elbow. A swollen bulge was noted in the antecubital space with some swelling of his forearm. No loss of sensation. He denied numbness, tingling, and anabolic steroid use.

An ultrasound (US) of his left elbow was ordered to evaluate for muscle-tendon pathology including a tear.

Results :
On day 3, US of the left upper extremity demonstrated increased echogenicity of the biceps brachii, preferentially the short head, and brachioradialis with mild overall enlargement and preservation of the muscle architecture. Little to no associated hyperemia. Similar but milder findings involving the brachialis and contralateral brachioradialis. The combined sonographic findings and clinical history were most compatible with delayed onset muscle soreness.

Conclusions :
Ultrasound imaging features of DOMS include increased hyperechogenicity of the affected muscles, preservation of the muscle architecture, and in many cases an overall increase in muscle size with minimal hyperemia.

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Purpose :
Ulnar nerve injuries are a complication of upper extremity fractures and surgical interventions. Delayed neuropathic symptoms, such as numbness and motor deficits, may indicate persistent nerve compression or fibrosis, necessitating further surgical evaluation.

Materials and Methods :
N. J., a 15-year-old male, sustained a fracture of the medial epicondyle of the humerus in June 2024, which required open reduction and fixation with pins. During surgery, the operating team noted a suspected ulnar nerve injury, which was addressed intraoperatively. However, in September 2024, the patient presented with persistent numbness in the fourth and fifth fingers and restricted elbow joint mobility.

Results :
An ultrasound examination revealed ulnar nerve swelling at the cubital tunnel, surrounded by fibrotic tissue, suggesting post-traumatic neuropathy with secondary fibrosis. The patient underwent surgical decompression and excision of the fibrotic tissue around the ulnar nerve. The goal of the procedure was to relieve nerve compression and restore function. Postoperatively, the patient was enrolled in a rehabilitation program aimed at restoring motor function and sensory recovery. Early postoperative follow-up demonstrated gradual improvement in sensation and mobility.

Conclusions :
This case highlights the importance of early recognition of post-traumatic ulnar neuropathy, particularly following fractures involving the elbow region. Ultrasound imaging plays a crucial role in identifying nerve compression, and surgical decompression remains an effective treatment option when conservative management fails.

Acknowledgements: We extend our gratitude to Dr. Anna Toplaghaltsyan for her expert surgical intervention at the Wigmore Clinic in Armenia.

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Purpose :
Post-amputation neuromas and peroneal nerve neuropathy can significantly impact a patient’s quality of life. This case report presents the successful surgical management of N.G., a patient who developed a peroneal nerve neuroma and neuropathy following an amputation of the proximal third of the leg.

Materials and Methods :
N.G., a male patient, was involved in a mine explosion in May 2024 and subsequently underwent an amputation of the proximal third of the leg. Persistent phantom pain and discomfort led to further evaluation, which revealed bone overgrowth. In January 2025, he underwent a second resection of the bone overgrowth. Despite the procedure, he continued to experience persistent numbness and severe pain. In February 2025, an ultrasound was performed, revealing peroneal neuropathy and a neuroma.

Results :
Ultrasound examination identified peroneal nerve enlargement in the popliteal fossa and fibular head level, with nerve discontinuity. A hypoechoic, well-defined lesion measuring 4.5 × 9.0 mm without vascularization confirmed the presence of a stump neuroma. Additionally, atrophy of the lateral head of the gastrocnemius muscle was observed, characterized by hyperechoic texture and loss of normal muscle fiber architecture. Surgical excision of the neuroma was performed to alleviate neuropathic pain. The peroneal nerve was carefully resected to remove the pathological segment. Postoperatively, the patient reported significant pain relief.

Conclusions :
This case highlights the importance of timely surgical intervention in post-amputation patients experiencing neuroma-related neuropathic pain. Proper diagnosis and targeted surgical treatment can enhance quality of life.

Acknowledgements: The author would like to acknowledge Dr. Harutyunyan Daniel, a microsurgeon at the Military Hospital of Yerevan, for performing the final surgical intervention.

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Purpose :
To underline that vascular malformations can also be found in muscles, even if in less of 1% of cases, and masseter muscle is the most common site.

Materials and Methods :
Intramuscular vascular malformations can be divided in capillary, venous, arterial, lymphatic and combined and intramasseter venous malformations can be mistaken for a cellulitis or for a parotid swelling. IMVM can be found in the same percentage in both males and females usually in the third decade Plain radiograph and CT can be useful to detect phleboliths but only ultrasound and MRI can give soft tissue definition and vascularity of the lesion. 

Results :
A 67-year-old female patient comes to our attention for left swollen cheek with changes in dimension depending on the temperature and the months of the year without ever having carried out any tests and without reporting pain but only a feeling of tension due to the swelling. She underwent and ultrasound of the left cheek that showed normal appearance of the parotid gland and there weren’t lymphadenopathies or signs of subcutaneous edema, the only relevant finding was a hypoechoic mass in the left masseter muscle. Color Doppler integration helped to detect vascularity of the lesion and Power Doppler showed slow flow velocity, moreover the lesion was compressible in keeping with the diagnosis of left intramasseter venous malformation.

Conclusions :
Ultrasound plays a primary role in detecting slow flow intramuscular malformations thanks to the integration of Color and Power Doppler and MRI can be useful in doubtful cases to make a certain diagnosis.

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Purpose :
To demonstrate the approach and technqiue of sural nerve ultrasound.
To describe normal ultrasound anatomy and pathologies of sural nerve.

Materials and Methods :
Sural nerve is a pure sensory cutaneous nerve also known as small saphenous nerve extending from the posterior distal calf coursing along the small saphenous vein posterolateral ankle and dorsal lateral foot. The nerve is superficial in course and hence can be easily seen using high resolution ultrasound.

Results :
Ultrasound is a readily available imaging modality for imaging peripheral nerves. Sural nerve pathologies can be broadly classified into primary and secondary (iatrogenic, traumatic, compression, etc,). In this exhibit we have demonstrated the approach and examination techniques for ultrasound imaging of sural nerve, its normal anatomy, variants and common pathologies.

Conclusions :
This exhibit demonstrates the technique, approach, normal anatomy and pathologies of sural nerve on ultrasound.

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Purpose :
To describe the role of ultrasound in evaluation of  hand and finger tendon injuries.
To describe ultrasound imaging features of tendon injuries of hand and fingers.

Materials and Methods :
Ultrasonography(US) is a readily available imaging modality in case of acute injuries. High resolution ultrasound using high frequency probes has drasticallly imporved over the past few years especially in evaluating the superficial structures. US has been proposed as the gold standard in assessing the tendons. Role of US in musculoskletal imaging is indispensable as its accuracy is equivalent to MRI. Dynamic US is commonly used in closed tendon injuries to assess the status of injured tendons, degree of injury and level of retraction. US provides a pre-operative insight for the surgeons and helps in choosing the right intervention and surgical technique.  

Results :
US has proven high sensitivity and specificity in diagnosing tendon injuries especially of the hand and fingers. Currently US imaging is part of a standard protocol in suspected and diagnosed cases of  tendon injuries. In this exhibit we have demonstrated the ultrasound technique, approach and evaluation of tendon injuries of hand and fingers.   

Conclusions :
A knowledge of common tendon injuries and their patterns in US imaging has become essential. We have presented a pictorial review of US imaging features of common tendon injuries.

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Purpose :
To review and describe the key magnetic resonance imaging (MRI) features of distinct ankle and foot entrapment neuropathies.
To provide an overview of the impact of these conditions on patients and the role of the radiologist in diagnosis and prognosis.

Materials and Methods :
Peripheral compressive neuropathies (entrapment neuropathies) involve acute or chronic nerve injury in anatomically constrained spaces, such as fibromuscular or fibro-osseous tunnels or areas where nerves course through muscles (mechanical causes). Although less common, they can also arise from specific limb positioning (dynamic causes).
These conditions are a significant cause of pain and functional impairment, significantly affecting quality of life of patients and often remaining underrecognized. The variability in symptoms and anatomy frequently leads to ambiguous clinical presentations, making traditional diagnostic methods (clinical and electrophysiological evaluation) less reliable. Additionally, delayed diagnosis severely hinders neuronal and functional recovery.
Radiologists play a crucial role in early diagnosis through MRI. Unlike conventional methods, MRI provides essential diagnostic insights, allowing for the identification of underlying causes and differentiation between treatable and non-treatable cases. Moreover, it supports in anatomical visualization of nerve pathways and surrounding structures, and also provides guidance for selective nerve block procedures

Results :
MRI provides both direct and indirect signals of nerve injury. Direct signals include increased peripheral fascicular and endoneural intensity on T2-weighted images, nerve enlargement, loss of the normal fascicular pattern and blurring of perifascicular fat. Indirect signals indicate muscle denervation, leading to atrophy and fatty involution (increased intensity on T1) as well as edema (increased intensity on fluid-sensitive T2/PD sequences).
The medical records of patients with ankle and foot entrapment neuropathies at our hospital were reviewed, and some imaging examples of the following conditions were analysed:

• Deep peroneal nerve entrapment;
• Tarsal tunnel syndrome;
• Medial plantar nerve entrapment;
• Lateral plantar neuropathy/Baxter neuropathy;
• Morton neuroma (including Heuter’s and Iselin’s subtypes).

Conclusions :
Entrapment neuropathies are linked to debilitating motor (weakness and paralysis) and sensory (pain and paresthesias) symptoms, which significantly impact quality of life of patients. Early and accurate diagnosis, primarily through MRI, allows for timely management of these conditions, positively influencing the functional recovery of injured nerves.

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Purpose :
To review the pathophysiology of femoroacetabular impingement (FAI).
To discuss the role of imaging in the assessment of FAI.

Materials and Methods :


Results :


Conclusions :


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Purpose :

1. Understand pelvic neuroanatomy and adjacent soft tissue involved in pelvic pain.
2. Describe the role of high-resolution MR neurography in assessing pelvic nerve pathways and neuropathic pain causes.
3. Identify causes of pudendal neuralgia and neuropathies affecting the iliohypogastric, ilioinguinal, genitofemoral, and posterior femoral cutaneous nerves.

Materials and Methods :
Pelvic pain syndromes are common and often involve neuropathic components, with pudendal neuralgia being the most recognized. However, other nerves from the sacral and lumbar plexus, including the iliohypogastric, ilioinguinal, genitofemoral, and branches of the posterior femoral cutaneous nerve, may also contribute to neuropathic pelvic and genital pain. Diagnosis is challenging due to complex neuroanatomy and overlapping etiologies. MR neurography helps assess affected nerves and musculoskeletal structures, with emerging sequences improving vascular suppression and nerve visualization.
 

Results :
Pudendal Neuralgia: Neuropathic perineal pain (burning, numbness, allodynia), worsened by sitting on soft surfaces.

• Neuroanatomy: Pudendal nerve (S2–S4) through Alcock’s canal, innervating the perineum and pelvic floor.
• Entrapment & Causes: Compression at Alcock’s canal or sacrospinous/sacrotuberous ligaments (Nantes Criteria) due to trauma, surgery, or chronic pressure.
• MR Findings: Nerve thickening, signal changes, and muscle denervation.

Inferior Cluneal Neuralgia: Neuropathic pain in the inferolateral buttock and lateral perineal region, worsened by sitting on hard surfaces.

• Neuroanatomy: Perineal branches and inferior cluneal nerve from the posterior femoral cutaneous nerve (S1-S3).
• Entrapment & Causes: Deep subgluteal syndrome, hamstring injuries, peri-ischial pathology.
• MR Findings: Nerve thickening, edema, or fibrosis.

Border Nerve Pain Syndrome: Neuropathic pain in the lower abdomen, groin, or proximal thigh extending to the anterior genital area.

• Neuroanatomy: iliohypogastric, ilioinguinal and genitofemoral nerves from the lumbar plexus.
• Entrapment & Causes: Compression from spinal pathology, surgery (hernia repair, gynecologic procedures), or scarring.
• MR Findings: Nerve signal changes, fibrosis.

Conclusions :
MR neurography, with specialized morphological and functional sequences, is a valuable tool for diagnosing neuropathic pelvic pain. However, accurate interpretation requires thorough understanding of pelvic neuroanatomy, entrapment sites, and underlying causes.
 

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Purpose :
Hydatid disease (HD), caused by species of Echinococcus, is a zoonotic infection primarily affecting areas where livestock farming is prevalent, such as Turkey. The liver and lungs are the most commonly involved organs; however, HD can affect various other systems within the body(1-3). Intramuscular localization of HD is exceedingly rare. This article discusses the imaging findings of intramuscular HD through a clinical case.

Materials and Methods :
A 61-year-old male, with a background in cattle farming, presented to the orthopedic clinic with complaints of leg pain and swelling. Physical examination revealed a painful mass in the left thigh. Laboratory tests indicated a positive indirect hemagglutination result. Magnetic Resonance Imaging (MRI) demonstrated a multilocular cystic mass located within the adductor muscle planes. The mass showed hypointensity on T1WI and hyperintensity on proton density images, with peripheral contrast enhancement. Combining the patient's clinical history, laboratory results, and imaging findings, the mass was identified as a mother hydatid cyst containing daughter vesicles. Surgical excision of the mass was performed, and the patient was treated with albendazole pre/postoperatively. Pathological examination confirmed the diagnosis of a HD, validating the radiological findings.

Results :
Intramuscular HD accounts for only 1-4% of all cases, as the elevated lactic acid levels in muscles create an unfavorable environment for the growth of hydatid larvae( 4). Biopsy and aspiration are discouraged due to the risk of cyst rupture, dissemination, and severe allergic reactions, which can be life-threatening(4,5). Therefore, imaging plays a critical role in the diagnosis of HD.
Ultrasonography aids in evaluating the internal structure of the cyst, while CT provides insight into cyst wall calcification and the cystic structure. However, MRI is considered the most sensitive and specific modality for diagnosis. In this case, the MRI revealed a multilocular lesion with daughter vesicles, characteristic of HD, although not pathognomonic. MRI can also identify other patterns of intramuscular hydatidosis, such as peripheral rim, internal cyst membranes, peripheral edema, and peripheral enhancement, reflecting pericyst vascularization(4,6).

Conclusions :
Therefore, HD should always be included in the differential diagnosis of soft tissue masses, particularly in endemic regions, where radiological findings are crucial for diagnosis, even when laboratory tests mayn’t indicate abnormalities.

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Purpose :
Psoas abscess in patients with diabetes, tuberculosis infection or with immunocompromised state can happen, however getting a bilateral, symmetrical disease are rare. It is also important to note that often the clinical symptom for psoas abscess are non-specific, to prompt the necessary investigation. The actual diagnosis often being delayed as well as challenging as it could easily be missed on the initial ultrasound. This is a unique case report of bilateral, symmetrical psoas abscess, whom first presented with wet gangrene of right first toe.  

Materials and Methods :
A 50-years-old male patient with underlying diabetes and ischemic heart disease, presented initially for wet gangrene of  right first toe. He undergone wound debridement and Ray’s amputation. However, he deteriorated within the first week post-operation with persistent raised CRP, although clinically the amputated toe site was not infected. He also complains of a slight epigastric pain. His total white count (TWC) rosed to 21, CRP became 98 from 61mg/L, with increasing urea trends (urea 14.5 to 21.3mmol/L, Creatinine 147 to 353umol/L). His hemoglobin levels are borderline at 10-10.5g/dl. UFEME done negative findings. No sacral sore detected.  
OGDS done showed Type II gastric ulcer. USG was ordered to rule out any abdominal collection, and followed with CT abdomen. 

Results :
The ultrasound incidentally revealed thickened bilateral psoas with heterogenous hypoechoeic lesion. No intraabdominal collection. CT scan done confirms bilateral, symmetrical psoas abscess measuring 5.5cm x 4.7cm x 11.8cm on the right and 4.3cm x 3.3cm x 11.3cm (AP x W x CC) on the left, some of which not yet liquified. The adjacent vertebral bone appears normal.
The patient was successfully treated with 6 weeks course of antibiotic and follow-up ultrasound. He refused for percutaneous drainage.  

Conclusions :
Bilateral psoas abscess is a rare findings and challenging to be diagnosed because it’s clinical symptom are often non-specific. Bilateral psoas should be evaluated thoroughly and routinely during ultrasound, or otherwise an abscess within it may easily be missed leading to unnecessary investigation and health deterioration for the patient.

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Purpose :
Raise awareness of Cuboid-Navicular Coalition, an extremely rare type of tarsal coalition which can lead to chronic midfoot/hindfoot pain. To illustrate—using our case series as examples—the role of different imaging modalities in its diagnosis and management.

Materials and Methods :
Tarsal coalition is a congenital abnormality due to failure of segmentation of tarsal bones. Although most coalitions involve the calcaneonavicular or talocalcaneal joints, cuboid–navicular coalition is exceptionally rare. Patients typically present as adolescents or adults with midfoot or hindfoot pain, stiffness, and abnormalities from altered biomechanics. Conventional radiographs are frequently inconclusive because findings can be subtle and tarsal bones typically overlap on conventional views. MRI is often required to confirm diagnosis, characterise the type of coalition, and identify associated abnormalities. CT can add value by in surgical planning. 

Results :
In our series of three cases (ages 14–44):

Case 1: 28 year old female
Lateral foot pain following ankle injury.
MRI: T2 and PD images demonstrate a fibrocartilaginous cuboid-navicular coalition.
Management was conservative. 

Case 2: 14 year old female
Sustained Salter-Harris III fracture of the right ankle.
MRI: PDFS and T1 images demonstrate a fibrocartilaginous cuboid-navicular coalition with increased signal, in keeping with stress reaction. Additionally, there is surrounding osseous hypertrophy of the cuboid. 
Discharged following physiotherapy.

Case 3: 44 year old female
Sustained stress fracture.
Oblique radiograph showing irregular joint lines, osteophytes, and subchondral sclerosis at the cuboid-navicular interface.
MRI: Fibrocartilaginous coalition with bone marrow oedema. Irregular joint line and subchondral sclerosis reflect degenerative change.
Managed conservatively.

These imaging features, in conjunction with a clinical history of nonspecific foot pain and stiffness, support the diagnosis. 

Conclusions :
Cuboid–navicular coalition, though rare, should be considered in the differential for chronic midfoot pain. Cross-sectional imaging—particularly MRI—is important for diagnosis as it demonstrates acute and chronic change, as well as surrounding abnormalities resulting from altered biomechanics. The possibility of bilateral involvement mandates consideration of imaging the contralateral foot. Management ranges from conservative therapy to surgical resection. CT adds value in surgical planning for cases with refractory pain. 

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Purpose :
The objective of this analysis is to assess the efficacy of Dual-Energy Computed Tomography (DECT) in the detection of occult fractures in the pelvic and hip region, with a particular focus on sacral, femoral neck, and intertrochanteric fractures. This poster illustrates, through examples, the advantages DECT in fracture detection and visualization of fracture extent using bone marrow edema maps, and how this can influence treatment options.

Materials and Methods :
Radiography and computed tomography (CT) are the primary imaging modalities used in trauma setting for the detection of hip and pelvic fractures. While these techniques are generally effective, they can sometimes be less reliable in detecting fractures resulting from low-energy trauma. DECT, with its capacity to detect bone marrow edema, is already known to offer a significant advantage in the detection and assessment of pelvic fractures. Accurately identifying the presence and extent of fractures can impact clinical management, including decisions regarding the necessity of surgical intervention.

Results :
DECT has demonstrated superior capabilities in identifying occult fractures, particularly in the context of pelvic fragility fractures. It effectively visualizes the extent of these fractures, which can change the fracture classification and urge the need for surgical pelvic stabilization. In cases initially diagnosed as isolated greater trochanteric fractures, DECT frequently reveals an extension of bone marrow edema into the intertrochanteric region, suggesting a more extensive fracture than initially suspected. Additionally, DECT can detect occult femoral neck fractures, which, similar to the extent of insufficiency fractures in the femoral neck, can influence the type of treatment required.

Conclusions :
DECT provides crucial diagnostic information that standard CT may not reveal, particularly in detecting the true extent of fractures. This added diagnostic capability can impact clinical decision-making, including the management and potential surgical treatment of fractures. As such, DECT offers a valuable tool for the comprehensive assessment of pelvic and hip fractures in trauma patients.

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Purpose :
To describe the key anatomical features and biomechanics involved with the development of patellofemoral instability.
To discuss the risk factors associated with patellofemoral instability and propose a comprehensive approach to its imaging assessment.
To depict the most relevant imaging findings of patellar dislocation as well as its current treatment options.

Materials and Methods :
Patellar instability occurs when the patella does not properly align with the trochlea during the initial stages of knee flexion and can be caused by any anatomical factor that interferes with this alignment. The most important predisposing factors of patellar instability include: trochlear dysplasia, patella alta (high position of the patella), and excessive lateral distance between the tibial tubercle and the trochlear groove (lateralization of the tibial tuberosity). Secondary factors include excessive femoral anteversion, excessive external rotation of the tibia, and genu valgum.

Results :
The main role of imaging in patellar instability is to depict the anatomical factors leading to patellar instability, identify features of a previous lateral dislocation, and demonstrate additional lesions that may influence treatment. Several imaging modalities have previously been used in the assessment of patellar instability and currently, cross-sectional imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) play a fundamental role, providing a more comprehensive evaluation that includes precise three-dimensional measurements, greater soft tissue detail, and reliable detection of associated injuries. 

Conclusions :
The utilization of cross-sectional imaging techniques such as CT and MRI have not only had an impact on the time and precision of the diagnosis of patellar instability but has even influenced treatment options. MRI has shown to be a highly sensitive imaging modality for detecting risk factors for chronic patellar instability and assessing associate knee joint damage such as:  bone, capsular, ligamentous and cartilaginous injuries. MRI can provide pivotal information to orthopedic surgeons to facilitate the selection of a tailored treatment for each individual case. 

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Purpose :
The brachial plexus is susceptible to a variety of injuries and diseases, making its detailed evaluation vital for patient care. This study aims to demonstrate how MRI can effectively reveal both normal anatomy and the characteristic features of lesions—whether traumatic, neoplastic, or otherwise—thereby helping to differentiate their nature.

Materials and Methods :
In this retrospective review, we examined MRI scans from patients with suspected brachial plexus pathology. Standard imaging protocols—including T1-weighted, T2-weighted, STIR, and contrast-enhanced sequences—were used to capture detailed images of the nerve structures. These images were then compared with clinical findings and, when available, surgical data to validate the observations.

Results :
The MRI studies consistently depicted the normal components of the brachial plexus, such as nerve roots, trunks, divisions, and cords. In cases of trauma, signs like nerve edema, disruptions, and subsequent fibrosis were observed. Neoplastic lesions, including benign nerve sheath tumors and metastatic involvements, presented with varied signal intensities and contrast uptake patterns. Moreover, inflammatory and other non-traumatic lesions manifested as areas of increased signal on STIR images with irregular contrast enhancement, aiding in their differentiation from traumatic or tumoral conditions.

Conclusions :
MRI stands out as an essential tool in assessing brachial plexus disorders, offering high-resolution insight into both anatomy and pathology. Recognizing the MRI patterns associated with traumatic injuries, tumours, and other conditions enhances diagnostic accuracy and informs clinical decision-making.

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Purpose :

• To emphasize why is important to report neurovascular and soft tissue injuries in high energy fractures, beyond fracture lines.
• To review neurovascular injuries associated with high energy fractures such as arterial dissection, arterial amputation, braquial plexus injury or sciatic nerve injury.
• To review soft tissue injuries associated with fractures such as muscle and tendinous injuries, tendon entrapment and subcutaneous tissue injuries (open and closed degloving lesions).
• To make a brief comment on how to report neurovascular and soft tissue lesions in mangled/threatened extremities.

Materials and Methods :
Polytrauma is a leading cause of death and disability in young patients. It has been described that near 60% of high energy polytrauma patients present muskuloeskeletal injuries. Complex fractures benefit from early and accurate management and the radiologist should report adequately bone fractures as well as neurovascular and soft tissue injuries. Different neurovascular and soft tissue injury will be described througout a pictorial review and peculiarities of mangled/threatened limbs will be discussed.

Results :
- BONES: Polytrauma often present complex fractures: long bones, intraarticular, displaced, open, multifragmentary...
- NEUROVASCULAR: Direct and indirect vascular injuries may happen in this patients. Indirect lessions are more frequent in axillary and popliteal arteries. An hematoma surrounding the axillary artery represents and indirect sign of brachial plexus injury. Ciatic nerve is nicely seen in CT images and may be damaged in femoral fractures.
- SOFT TISSUES: Muscle and tendon injuries secondary to sharp bone fragments. Tendon entrapment in wrist and ankle fractures. Soft tissue open and closed degloving injuries, with high risk of skin necrosis.
- MANGLED/THREATENED LIMBS: Whether to amputate or attemp limb salvage is a very difficult decision. Radiology gives crucial information to help determine the best option.

Conclusions :
High energy polytrauma patients often present with muskuloeskeletal injuries that may hinder recovery and determine future disabilites. Some of these injuries benefit from early and accurate management and radiologist should report adequately not only fracture lines but also neurovascular bundle and soft tissue injuries.

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Purpose :
To present a variety of pathologies of the painful hand/wrist, either post-traumatic, mass-forming, inflammatory or degenerative.

Materials and Methods :
During a period of 4 months we examined 21 patients presenting with pain around the wrist and 17 complaining for finger soreness. Ten of them recalled an injury in the recent past. In those presenting with mass-forming lesions a complementary scan after IVC injection was performed.

Results :
We recorded four cases of inflammatory arthropathy, with findings of synovial thickening, inflammatory tenosynovitis of the flexor/extensor tendons, juxtaarticular erosions, as well as bone edema and cartilage loss. One of the cases was complicated with secondary osteochondromatosis of the carpometacarpal joint. In a patient with SLE, we witnessed changes in both hands, affecting the synovial and ligamentous stuctures, with preservation of joint space and cartilage. 
In the post-traumatic context, we recorded two patients with intercarpal ligament injuries, one of whom also led to carpal instability (DISI). Two patients suffered from bone bruises in the carpal bones of the radial aspect of the wrist, along with tendinous injuries. One patient was diagnosed with metacarpal bone injury and two others with injuries of the finger phalanges. In three patients we recognized ligamentous injuries of the collateral ligaments and the extensor hood. One patient presented with traumatic tear of the ECU tendon.
In two patients with palpable lesions of the fingers, enhancing lesions compatible with GCT of the tendon sheath were identified. In a patient with persistent pain of the finger, we found an enhancing lesion of the distal phalanx, arising from the subungal region, attributed to glomangioma. A patient with progressive numbness of the 5th finger, we found a complete tear of the superficial flexor tendon, distal to an unfused hook of the hamate, associated with compression of the ulnar nerve. One patient, recalling trauma over a year ago, was complaining for a mass lesion of the finger, partially ossified, compatible with Nora's lesion. Another young patient was found to have an accessory tendon of the 1st extensor compartment.

Conclusions :
We display traumatic, mass-forming and inflammatory/degenerative causes of pain in the hand/wrist region that every radiologist should be familiar with.

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Purpose :

• To define the key clinical and anatomical characteristics of Deep Gluteal Syndrome (DGS) and its role in sciatic nerve entrapment.
• To establish the main differential diagnoses of DGS and highlight distinguishing features to avoid misdiagnosis.
• To emphasize the importance of imaging techniques in the accurate identification and assessment of DGS-related pathologies

Materials and Methods :
Deep gluteal syndrome (DGS) is a non-discogenic cause of sciatic nerve entrapment within the subgluteal space, often leading to chronic posterior hip pain and radiating symptoms. Despite being a relatively common condition, it remains underdiagnosed due to its overlapping clinical presentation with other musculoskeletal disorders. The complexity of its etiology makes accurate diagnosis challenging, requiring a thorough assessment. Magnetic resonance imaging (MRI) is essential in identifying the underlying causes and distinguishing DGS from other potential sources of sciatic nerve-related pain.

Results :
MRI was crucial in identifying sciatic nerve entrapment, perineural edema, muscle asymmetry, and inflammation. The most frequent etiologies included piriformis syndrome, ischiofemoral impingement, fibrous bands, gluteal tendon pathology, and postsurgical scarring. MRI effectively distinguished DGS from other causes of gluteal pain, such as lumbar radiculopathy, hamstring tendinopathy, sacroiliac joint dysfunction, and ischiofemoral bursitis.

Conclusions :
Deep gluteal syndrome is a relevant and often underdiagnosed cause of peripelvic pain and non-discogenic sciatica. Due to its multifactorial origin, an integrated diagnostic approach combining clinical evaluation with advanced imaging techniques, such as MRI, is essential. A detailed understanding of the subgluteal space anatomy and the various causes of nerve entrapment is crucial for proper diagnosis and effective treatment.
 

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Purpose :
This case report aims to highlight an unusual presentation of systemic mastocytosis that radiologically mimicked lymphoma. The objective was to demonstrate the role of multimodality imaging and histopathological evaluation in establishing the correct diagnosis when conventional imaging findings are ambiguous.

Materials and Methods :
A 70 year-old patient presented with nonspecific complaints including fatigue, weight loss, and intermittent abdominal pain. Clinical examination revealed mild hepatosplenomegaly. Initial CT Chest abdomen and pelvis revealed hepatosplenomegaly with nodal disease, predominently below diaphragm. Widespread bone sclerosis was noted. Given the imaging findings that raised suspicion for a lymphomatous process, a whole-body PET/CT scan was performed, which revealed paraaortic lymph nodes showing mild FDG uptake (max SUV ~2). Hepatosplenomegaly was noted with uptake in spleen greater then in liver. Additionally, diffuse skeletal sclerosis was noted with no focal metabolically active osseous lesion. An excisional biopsy of an enlarged axillary lymph node was subsequently performed which confirmed Systemic Mastocytosis with associated clonal haematological mast cell lineage disease.

Results :
Imaging studies initially suggested a diagnosis of lymphoma due to the hepatosplenomegaly, lymphadenopathy and unusual skeletal findings. However, the detailed evaluation using PET/CT provided essential clues that prompted further investigation. The definitive diagnosis was established by tissue analysis, which revealed dense aggregates of atypical mast cells. The above findings indicated complexity of the case and the need for careful correlation between radiological and histopathological findings.

Conclusions :
This report emphasizes that systemic mastocytosis can present with imaging features closely resembling those of lymphoma, including hepatosplenomegaly, multiple FDG-avid lymph nodes and diffuse skeletal sclerosis. The case underscores the importance of a multimodality approach combining advanced imaging techniques with confirmatory tissue diagnosis. Awareness of such atypical presentations is crucial for clinicians and radiologists to avoid misdiagnosis and ensure that patients receive appropriate and timely management. 

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Purpose :
This is a pictorial review of multiple hindfoot fractures gathered at our department which aims to serve as an educational article as well as raising awareness about possible missed fractures in the hindfoot, focusing on their clinical and medicolegal importance. It is intended to help radiologists, emergency department (ED) physicians, and practitioners, recognize subtle fractures of the hindfoot, thus reducing misdiagnosis rates, and mitigating the associated medicolegal risks.

Materials and Methods :
Injuries related to the foot and ankle continue to be amongst the common presentations to ED departments. Here, we discuss the high frequency of foot and ankle injuries in ED settings, citing statistics that show a large number of cases related to sprains and fractures. Despite the reliance on plain radiographs as the first line of imaging, fractures are still commonly missed due to various pitfalls such as overlapping bones and difficulty in interpreting radiographs. We highlight the growing concerns over the financial implications of missed diagnoses, citing increased legal claims, damages, and the burden placed on the NHS. Using a case based, pictorial approach, we summarise the relevant anatomy, a variety of hindfoot injuries, and the relevant mechanisms and implications of each.

Results :
Commonly missed fractures include those of the posterior and lateral processes of the talus, anterior process of the calcaneum, and other ossicle fractures. This case based article outlines the relevant anatomy, the relevant mechanisms, and implications of these fractures with a variety of examples. In addition to the serious consequences for patients, including prolonged recovery times and complications, missed hindfoot fractures present a significant financial cost to the healthcare system. 

Conclusions :
Missed hindfoot fractures present both clinical and financial challenges, with significant implications for patient care and healthcare resources. Advanced imaging techniques such as CT and MRI play a critical role in diagnosing these subtle fractures. The article underscores the importance of raising awareness among healthcare providers, especially trainees and less experienced staff, as well as providing examples and learning points to reduce the risk of missed diagnoses and mitigate the clinical and medicolegal consequences associated with delayed treatment.

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Purpose :
-Mastering radiological MRI anatomy of the knee .
-Emphasize all the mistakes encountered by less experienced radiologists.

Materials and Methods :
- Magnetic resonance imaging (MRI) is the imaging modality of choice for evaluation of different knee pathologies.
- Mastering the radiological anatomy of the knee helps to prevent the majority of errors commonly made by junior radiologists.

Results :
- Magnetic resonance imaging (MRI) of the knee joint is among the most frequently requested exams in general radiology and is a staple in MRI units, alongside spinal and brain MRI studies.
-While interpreting knee MRI may appear straightforward in many cases, certain pitfalls include areas of anatomic variants, normal anatomy, and technique-related artifacts masquerading as abnormalities as well as commonly overlooked abnormalities.
- This pictorial review aims to provide an overview of these common misinterpretations and challenges in knee MRI, with a particular focus on those that young residents and less experienced radiologists often encounter

Conclusions :
MRI of the knee joint is a routine exam that every general radiologist have tomaster. However, a variety of potential pitfalls in interpretation of abnormalities related to the knee have been identified, particularly in evaluation of the menisci, ligaments, and articular cartilage.We hereby present a short review of the most common pitfalls

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Purpose :
Current methods of determining sarcopenia and assessing muscle volume involve indirect measurements, such as BMI and grip strength. Imaging however, provides direct quantification of muscle volume. Many patients increasingly undergo CT scans as part of their initial evaluation which can then opportunistically provide further information about body composition with no additional cost. However, muscle volume measurements on imaging has been limited by its labour intensiveness.
 
We developed a Deep Learning (DL) model which can automate the measurement of total psoas volume on CT scans. The CT derived psoas muscle volume provides a reproducible estimate of frailty/functional status.

Materials and Methods :
Segmentation of the total psoas volume was performed on CT abdomen & pelvis studies by two Radiologists. A total of 650 axial CT images with radiologist segmented psoas were used to build a deep learning model based on Ultralytics YOLOv8.
 
The deep learning (DL) model was used to segment the psoas of 123 patients from a lymphoma cohort. The volume of the psoas muscle was calculated using the pixel area and slice thickness contained within the metadata of the CT images.
 
Total psoas muscle volumes were correlated with patient age, height, weight, body mass index (BMI), lean body weight (LBW) and body surface area (BSA). Correlation was determined using Pearson’s correlation coefficient.

Results :
The median DL generated total psoas volume (PV) was 158.27ml (IQR 105.10 –190.71).
There were positive correlations between PV and all physical measures including height (r = 0.60, p < 0.001), weight (r = 0.47, p < 0.001), BMI (r = 0.28, p 0.002), LBW (r = 0.66, p < 0.001), and BSA (r = 0.55, p = <0.001), and a negative correlation between PV and age (r = -0.22, p = 0.015).

Conclusions :
DL radiology model provides total psoas volume as a reproducible biomarker of frailty/sarcopenia.

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Purpose :
The aim of our systematic work was to investigate an artificial
intelligence (AI) -based prediction of relevant internal injuries of the paediatric knee
joint based on initial radiographs and to develop a corresponding AI model.

Materials and Methods :
We queried the hospital information systems of two independent sites
for pediatric and adolescent patients up to the age of 19 years with a history of
recent trauma, who had undergone a radiograph and Magnetic Resonance Imag-
ing (MRI) of the same knee joint within 48 hours at ap and lateral projections.
After exclusion of patients due to postoperative situations, tumorous or infectious
diseases, missing and invalid radiographs, 873 patients with 1,746 total images
were included. Each model was assessed for precision, recall, accuracy and the
F1 score, revealing variation between model versions in performance metrics.

Results :
The averaged performance across all EfficientNet models achieved a
precision of 0.7340, recall of 0.7181, accuracy of 0.7131, and 0.7260. The best per-
forming model, EfficientNet-B5, achieved an average precision of 0.7445, recall for
0.7890, and accuracy for 0.7450, respectively. The heat maps revealed significant
concentrations of pathologies detected by AI primarily in the femoral and tibial
condyles. AI also identified fractures and microtrabecular fractures, suggesting
their effectiveness in identifying relevant injuries on (pediatric) knee radiograph.

Conclusions :
AI showed promising approaches to correctly assess and classify initial X-ray images for
the presence of relevant or non-relevant pathologies in our pilot study and AI models could be trained and optimized in the future so that
a relevant injury can be ruled out or expected with a high degree of certainty, solely
based on a standard knee radiograph.

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