468 KCR 2015conplus.co.kr/~kcr2015/down/abstract_book/Scientific...468 KCR 2015 Musculoskeletal Musculoskeletal-Informal Scientific Presentation Presenting Final Abstract Presenting

468 KCR 2015

Musculoskeletal

Musculoskeletal-Informal Scientific Presentation

Presenting Final Abstract Presenting Page No. No.

TitleAuthor No.

Therapeutic effect and complication of one ISP 01_MS 01 SE 07 MS-21 transforaminal injection along with caudal Junghan Hwang 469

epidural injection

Influence of degree of neural foraminal stenosis ISP 01_MS 02 SE 07 MS-29 on injectate spread in transforaminal lumbar Cheol Mog Hwang 469

epidural steroid injections

The classification of thoracolumbar spine injury ISP 01_MS 03 SE 07 MS-33 based on the Thoracolumbar Injury Classification Soohyun Lee 470

and Severity Scale (TLICS)

ISP 03_MS 01 SE 07 MS-04Pictorial Review: Magnetic resonance imaging for

Ka Hei Tse 470ulnar sided wrist pain

ISP 03_MS 02 SE 07 MS-32 Uncommon normal variants on the knee MRI Dong joo Kang 470

Spectrum of atlantoaxial ankylosis (AAA) in the ankylosing spondylitis (AS): Is it really

ISP 03_MS 03 SE 07 MS-34 chronological changes that occur with disease Jeong hoon Lee 471progression or are there two completely different pathways?

ISP 04_MS 01 SE 07 MS-23Three-dimensional Reformatted PET/CT

Seoung Oh Yang 471Application in Musculoskeletal Tumors

Subcutaneous intravascular papillary endothelial ISP 04_MS 02 SE 07 MS-24 hyperplasia: ultrasonographic features and Ok Hwa Kim 472

pathological correlation

ISP 04_MS 03 SE 07 MS-31Tumor or tumor-like lesions in skeletal muscles

In Soo Moon 472mimicking myositis

ISP 06_OT 01 SE 07 MS-38Imaging findings of various skin lesions in

Yoogi Cha 472dermatologic disorders

Musculoskeletal-Informal Scientific Presentation15:40-15:55 B2 Hall

Chairperson(s)Hyun-joo Kim Soonchunhyang University Hospital

Seoul, Korea

ISP 01_MS 01 15:40Therapeutic effect and complication of onetransforaminal injection along with caudalepidural injectionJunghan Hwang, Cheol Mog Hwang, Young Jun Cho, Keum Won Kim, Young Joong Kim,Jae Young Seo Konyang University Hospital, Korea. [email protected]

PURPOSE: To retrospectively evaluate therapeutic effectdifference and complication rate in 3 groups of two leveltransforaminal injection, one level transforaminal injectionalong with caudal epidural injection and only one leveltransforaminal epidural injection for lumbosacral radicu-lopathy.MATERIALS AND METHODS: Transforaminal lumbarepidural steroid injections were performed in 1327patients from January 2012 to January 2015. Amongthese patients, 1135 consecutive lumbar epidural steroidinjections in 685 patients were reviewed. Therapeuticeffects and complication rate were analyzed 1month afterinjection in above 3 groups. Therapeutic effects weremeasured by using a NRS and FPRS scale. Statisticalanalysis was performed using Fisher’s exact test andmultiple logistic regression analysis.RESULTS: 685 lumbar epidural steroid injections (M:F =315:370; mean, 61.9 years), were used for final analysis.274 (40.0%) of 685 patients were treated by one trans-foraminal along with caudal epidural injections; 218(31.8%) were treated by two level transforaminal injec-tions; 193 (29.2%) were treated by only one level trans-foraminal epidural steroid injection. 219 (79.9%) of the274 patients achieved a satisfactory result after onetransforaminal along with caudal epidural injections, and152 (69.7%) of the 218 patients achieved a satisfactoryresult after two level transforaminal epidural injec-tions.125 (64.7%) of the 193 patients achieved a satisfac-tory result after one transforaminal epidural steroid injec-tion. Statistical difference was significant (p < 0.05).Multiple regression analysis showed that two level injec-tions or one transforaminal along with caudal epiduralinjections group had a better treatment effect than onelevel injections only group. The complication rate wasless than 1% of total patients. Complications are mainlyconsisted of skin rash, post postural headache, sorenessat the puncture site after the procedure and had no rela-tionship of steroid dose.CONCLUSION: One transforaminal injection along withcaudal epidural injection is more effective tool for lum-bosacral radiculopathy than two level transforaminalinjections or only one level transforaminal epidural steroidinjection.

ISP 01_MS 02 15:45Influence of degree of neural foraminal stenosison injectate spread in transforaminal lumbarepidural steroid injectionsCheol Mog Hwang, Young jun Cho, Keum Won Kim,Young Joong Kim, Jae Young Seo, Seong Joo Lim,Dae Ho Kim College of Medicine, Konyang University, Korea. [email protected]

PURPOSE: 1. To evaluate spread patterns of injectate intransforaminal epidural steroid injection according todegree of neural foraminal stenosis and needle tip posi-tion. 2. To evaluate of therapeutic effect of epiduralsteroid injection according to spread pattern of injectate.MATERIALS AND METHODS: All procedures were per-formed under ASIPP guidelines. Fluoroscopic imagesfrom 487 consecutive lumbar epidural steroid injections in285 patients were reviewed. Before transforaminalepidural injection, MR images were reviewed and deter-mined degree of neural foraminal stenosis. In advance,needle epidural placement was confirmed by test contrastinjection that opacified epidural space at under targetedvertebral pedicle. Fluoroscopic monitoring and adminis-tration of contrast material mixed with medication, allow-ing visualization of the full extent of medication flow, wereessential to ensure adequate coverage of the target area.Needle placement, and injectate spread patterns weredetermined from procedural images. History of previousspinal operations was determined from proceduralrecords. Patterns in the data were evaluated with 2 testsand t tests.RESULTS: Images from 487 lumbar transforaminalepidural steroid injections, one per patient (M:F =189:298; mean age, 56.7 years), were used for finalanalysis. Patients with mild neural foraminal stenosiswere 285; with severe stenosis were 202. In patients withmild neural foraminal stenosis, injectate spread patternwas mainly intraspinal (51%), both intraspinal andextraspinal (29%) and extraspinal (20%) location. Inpatients with severe neural foraminal stenosis, injectatespread pattern was mainly extraspinal (65%), bothintraspinal and extraspinal (22%) and intraspinal (13%)location. The greater the amount of intraspinal injectate,the extent and duration of symptom’s relief was increased(p < 0.001). The location of needle tip was no correlationwith spread pattern of injectate (p > 0.001).CONCLUSION: Transforaminal epidural steroid injectionis useful treatment method for radiculopathy. In patientswith mild neural foraminal stenosis, intraspinal injectate islarger than extraspinal. The greater the amount ofintraspinal injectate, the extent and duration of symptom’srelief is increased.

Scientific Exhibitions 469M

usculoskeletal

ISP 01_MS 03 15:50The classification of thoracolumbar spine injurybased on the thoracolumbar injury classificationand severity scale (TLICS)Soohyun Lee, Woo Young Kang, Kill Sun Park, Sung Jin Kim, Sang-Hoon Cha, Bum Sang Cho, Min Ho Kang, Kyung Sik Yi, Ji Sun Lee Chungbuk National University Hospital, Korea. [email protected]

The radiological assessment to facilitate communicationwith physicians and serve as a guideline for treatment iscrucial for the evaluation of thoracolumbar spine injury.The Thoracolumbar Injury Classification and SeverityScale (TLICS) is the comprehensive and objective scor-ing and classification system to combine injury morpholo-gy, assessment of mechanical stability, and neurologicstatus. The major teaching points of this exhibit are: 1. Tounderstand the basic thoracolumbar spine anatomy. 2. Tofamiliarize the readers with the classification of thora-columbar spine injury on the base of image findings. Thisarticle is organized by the following contents: 1. Review ofthoracolumbar spine anatomy; motion segment (two adja-cent vertebrae, intervertebral disc, connecting ligaments,two facet joints and capsule) and three column theory(anterior, middle and posterior). 2. Demonstration ofimage interpretation based on four types of major injurymechanism such as compression, burst, flexion-distrac-tion and flexion-dislocation. 3. Display of examples aboutthe clinical application of TLICS and discussion about lim-itation. 4. Summary and Take-home message.


Chairperson(s)Sun Joo Lee Inje University Busan Paik Hospital, Korea

ISP 03_MS 01 11:10Pictorial review: MRI for ulnar sided wrist painKa Hei Tse, Mau Chu Lam, Shing Shun LoUnited Christian Hospital, Hong Kong, China. [email protected]

Ulnar-sided wrist pain can cause significant morbidity anddistress. It is a common presenting complaint in orthope-dic consultation. However, it has been a diagnostic chal-lenge to both radiologists and surgeons because of thecomplex anatomy, biomechanics and pathology. This pic-torial review will include discussion of important wristanatomy and differential diagnosis of ulnar sided wristpain with emphasis on magnetic resonance imaging(MRI) to demonstrate pathologies and classification sys-tems. Triangular fibrocartilage complex (TFCC) is animportant structure at distal ulnar. It serves as a loadabsorber and supports the ulnar sided carpal bones.These components can be demonstrated beautifully onMRI. Injury of the TFCC is considered to be one of themost frequent causes of wrist pain. The commonlyencountered conditions include triangular fibrocartilagedisc injury, extensor carpi ulnaris dislocation and distal

radioulnar ligament injury. The integrity of intrinsic liga-ment of the carpal bones is essential for stability.However, intrinsic ligaments injuries are difficult to pre-cisely diagnose clinically. MRI can diagnose ligamentousinjuries precisely. Carpal bone fracture is another com-monly encountered wrist injury. Not only does MRI diag-nose fracture accurately, but also helps stage and assessrisk of avascular necrosis. Certain congenital conditionsalso predispose painful wrist. Individuals with ulnar posi-tive variance are prone to developing ulnar impaction,whereas lunate avascular necrosis is associated in indi-viduals with ulnar negative variance. Careful assessmentis mandatory when soft tissue masses are encountered.Ganglion, vascular malformation, nerve sheath tumors,soft tissue sarcomas are some examples that will be dis-cussed in this review. Arthritis is seen commonly amongpatient with chronic wrist pain. Rheumatoid arthritis tendsto affect the wrist joints. The ulnar styloid is the earliestsites to be affected. However, early plain film diagnosis isdifficult. MRI is superior in accurate detection of synovialinflammation and bone marrow edema. This confirmsdiagnosis early and allows monitoring of disease activity.Ulnar nerve entrapment in Guyon canal is not uncom-mon. It can be diagnosed clinically. MRI is able to delin-eate anatomy and assess the underlying etiology. Afterreading this review, the reader will be familiar with theanatomy, common conditions and pitfalls encountered inulnar sided wrist pain.

ISP 03_MS 02 11:15Uncommon normal variants on the knee MRIDong joo Kang1, Sun Joo Lee1, Yeong-Mi Park1,Yoon Nae Seo1, Hae Woong Jeong1, Sung-Moon Lee2, Kil Ho Cho3, Chaekyung Lee4

1Inje University Busan Paik Hospital, 2KeimyungUniversity Dongsan Medical Center, 3YeungnamUniversity Medical Center, 4Pohang St. Mary’sHospital, Korea. [email protected]

PURPOSE: To describe uncommon normal variants onthe knee MRI. To correlate the MR imaging of uncommonnormal variants of the knee with arthroscopic findings.CONTENT ORGANIZATION: Diverse uncommon normalvariants are visible on the knee MRI. 1. Ligament

- Aplasia or hypoplasia of the posterior cruciate liga-ment with thickening of Wrisberg ligament

- Aplasia of the anterior cruciate ligament- Oblique meniscomeniscal ligament- Unilateral medial or lateral meniscomeniscal ligament- Anomalous distal insertion of the anterior cruciate lig-

ament2. Meniscus

- Abnormal band of the lateral meniscus- Anomalous insertion of the medial meniscus into the

anterior cruciate ligament3. Muscle

- Anomalous relationship of the gastrocnemius muscleand the popliteal artery

- Accessory slip of the lateral head of gatrocnemius4. Bone

- Sesamoid bone in popliteus tendon (cyamella) or

470 KCR 2015

Musculoskeletal

patellar tendon- Dorsal defect of the patella

SUMMARY: Due to excellent soft tissue contrast andease of acquisition of multiple imaging planes, MRI hasbecome the standard imaging tool for the evaluation ofthe knee. Diverse uncommon normal variants are visibleon the knee MRI. Awareness of imaging appearances ofanatomic variants would be helpful for the accurate diag-nosis and avoiding unnecessary management.

ISP 03_MS 03 11:20Spectrum of atlantoaxial ankylosis (AAA) in theankylosing spondylitis (AS): is it reallychronological changes that occur with diseaseprogression or are there two completelydifferent pathways?Jeong hoon Lee1, Seunghun Lee2, Young Bin Joo2,Yoonah Song2, Tae-Hwan Kim2

1Hanyang University Hospital, 2Hanyang UniversityMedical Center, Korea. [email protected]

PURPOSE: To evaluate morphologic characteristics ofAAA in AS patient and classify them into categories whichreflects the end-stage manifestations of two different dis-ease pathways.MATERIALS AND METHODS: Plain radiographs of cer-vical spine in 62 AS patients with AAA were reviewed.We classified AAA in AS patients into three subtypes:loss of atlantodental interval (type I), ankylosis of facetjoint (type II) and ankylosis of anterior longitudinal liga-ment or anterior atlantooccipital membrane with cervicalspine (type III). And then, we categorized 62 AS patientswith AAA into two subgroups: group A (21 patients) withonly synovial joint involvement of AS (type I or type II orboth) and group B (41 patients) with enthesis involvementof AS with additional synovial joint involvement (type IIIplus type I or type II or both). We compared the results ofmSASSS and disease duration between group A and B.RESULTS: The mean cervical mSASSS of patients ingroup A and B were 27.3 and 16.0 each (p value, 0.196).The mean duration of AS patients in group A and B were23.7 and 23.6 years each. There was no significant differ-ences in cervical, lumbar and total mSASSS or diseaseduration between the two groups.CONCLUSION: We propose that atlantoaxial jointinvolvement in the AS patients is not chronologicalchanges that occur with disease progression, but rather itis end-stage manifestation of two different pathways: oneonly involving synovial joint and the other one involvingboth synovial joint and enthesis.CLINICAL RELEVANCE/APPLICATION: This studyshows the morphologic characteristics of AAA in ASpatient and suggests different pathways of involvementresulting in AAA in AS patients.


Chairperson(s)Jee Young Lee Dankook University Hospital, Korea

ISP 04_MS 01 13:403D reformatted PET/CT application inmusculoskeletal tumorsSeoung Oh Yang, Hong Jae Lee, Sang Ho Lee,Yong In ChoDongnam Inst. of Radiological & Medical Sciences,Korea. [email protected]

Three-dimensional (3D) displays for medical imaging isnow emerging field and very promising tools for diagno-sis, therapy response and detection of tumor recurrence.Morphological criteria for therapy response (CR, PR, SD,PD) have been established with RECIST (Responseevaluation criteria in solid tumors). With adoption of meta-bolic imaging with PET/CT, particularly with F-18-FDG ininitial staging and follow up of tumors, there appears to bea need to modify these criteria not only on morphologicalimaging modalities like CT, but also on tumor metabolismparameters, like SUV (standardized uptake value) asmeasured by PET. Furthermore, 3D imaging taken fromPET/CT can be an excellent approach to assess thetumor response after appropriate therapy. In this posterpresentation, we will discuss the TrueD (Siemens) appli-cation of F-18-FDG PET/CT for both initial staging andpost-therapeutic follow-up in patients with musculoskele-tal tumors. One-hundred eighty-three patients with mus-culoskeletal tumors were enrolled in this study. Seventy-two osteosarcoma, 16 liposarcoma, 16 chondrosarcoma,10 fibrosarcoma, 10 malignant fibrous histiocytoma(MFH), 8 soft tissue sarcoma, 8 melanoma, 6 leiomyosar-coma, 6 synovial sarcoma, 5 Ewing sarcoma and 16other tumors are included. Two technologists performedlaborious job using TrueD software in patients with morethan two PET/CT scans under the supervision of NuclearMedicine Physician. Among many galleries, the mostoptimal palette applied according to anatomic location ofthe tumors (muscle or bone) and other characteristics.Monitoring of tumor response to therapy is very easy toassess using these TrueD PET/CT images. The recentdevelopment of three- and four-dimensional image pro-cessing will lead medical imaging to full definition volu-metric display for clinician as well as patients themselves.VOIs (volume of interests) of 2 or 3 time points displaycan be saved and exported as a powerful and compre-hensive images through the any PACS systems.


usculoskeletal

ISP 04_MS 02 13:45Subcutaneous intravascular papillaryendothelial hyperplasia: US features andpathological correlationOk Hwa Kim1, Hyeong Joo Bae1, Hye Jung Choo2,Sun Joo Lee2, Yeong Mi Kim3, Tae Eun Kim4, Jae Hyuck Yi5, Yeong Hwan Lee6, Yeon Mee Kim1

1Inje University Haeundae Paik Hospital, 2InjeUniversity Busan Paik Hospital, 3Samsung ChangwonHospital, 4Daegu Fatima Hospital, 5Kyungpook NationalUniversity Hospital, 6Daegu Catholic University MedicalCenter, Korea. [email protected]

PURPOSE: To describe gray scale and color Dopplerultrasound features of subcutaneous intravascular papil-lary endothelial hyperplasia (IPEH).MATERIALS AND METHODS: The sonographic appear-ances of ten histologically proven subcutaneous IPEH inten patients (age range, 15-69 years; mean age, 38.2years; F:M = 6:4) were reviewed retrospectively by twomusculoskeletal radiologists. Color Doppler examinationand surgical excision were performed in all cases. Thecorrelations between the ultrasound and pathological fea-tures of the lesions were done.RESULTS: All ten cases were pathologically diagnosedas pure forms of IPEH. The mean size of the lesions was1.3 cm. The margins of the lesions were circumscribed inseven of ten patients. Three had the lobular margins. Thedistinct internal septum-like structures were seen in sevenof ten cases (70%). The vascular density was high in two(20%), moderate in five (50%), low in three of ten cases(30%). The most common vascular pattern was one ormore vessels that were peripherally located. Thedetectable affected vessel was noted in four of ten (40%).CONCLUSION: Although the ultrasound features of sub-cutaneous IPEH are non-specific, it should be included inthe differential diagnosis of a small, circumscribed, oval orelliptical, heterogeneous, hypoechoic subcutaneous softtissue mass in gray scale imaging, showing vascular pat-tern of one or more vessels that were peripherally locatedand varying degree of vascular density on color Dopplerimage. The presence of the intralesional septum-likestructures and detectable affected vessel may be help todistinguish the lesion from the other soft tissue mass.

ISP 04_MS 03 13:50Tumor or tumor-like lesions in skeletal musclesmimicking myositisIn Soo Moon1, Sun Joo Lee1, Young Mi Park1, Yoon Nae Seo1, Ok Hwa Kim2, Tae Eun Kim3, Young Mi Kim4, Kyung Jin Suh5

1Inje University Busan Paik Hospital, 2Inje UniversityHaeundae Paik Hospital, 3Daegu Fatima Hospital,4Samsung Changwon Hospital, 5Dongguk UniversityGyeongju Hospital, Korea. [email protected]

PURPOSE: 1. To review the disease entity of tumor ortumor-like lesions in the skeletal muscles mimickingmyositis. 2. To provide a broad overview of the imagingfindings of these lesions. 3. To correlate the imaging fea-tures of these lesions with pathologic findings.

CONTENT ORGANIZATION: Variable tumor or tumor-like lesions in the skeletal muscles can be defined aslesions mistaken as myositis.

- Proliferative myositis- Heterotopic ossification- Nodular fasciitis- Diabetic myonecrosis- Pseudotumor- Hemangioma- Lymphoma- Metastasis

SUMMARY: There is a wide variety of tumor or tumor-likelesions in the skeletal muscles mimicking myositis.Usually, they have the imaging feature that maintains theinternal architecture without destruction of the musclefibers. Therefore, this finding can be suspected myositis.In establishing the differential diagnosis for intramuscularlesions mimicking myositis, location, internal mineraliza-tion, MR signal intensity, adjacent soft tissue change,multiplicity, and vascularity should be carefully analyzed.The correlation of the clinical, radiologic, and pathologicfindings can help to make a specific diagnosis of intra-muscular lesions and provide treatment strategy for thesepatients.


Chairperson(s)Jang Gyu Cha Soonchunhyang University Hospital

Bucheon, Korea

ISP 06_OT 01 09:40Imaging findings of various skin lesions indermatologic disordersYoogi Cha, Seon Kwan Juhng, Jung hun Lee, Nam Kyu Chang, Hye Won Kim, Young-Hwan Lee Wonkwang University Hospital, Korea. [email protected]

PURPOSE: The purpose of this presentation is to illus-trate imaging findings of various skin lesions evaluated bymultiple modalities.MATERIALS AND METHODS: We reviewed multipleimaging studies (CT, MR and US) of patients who visitedour hospital to evaluate skin lesions during the lastdecade.RESULTS: Skin lesions are commonly encountered inclinical practice and multiple benign and malignant der-matologic disorders may manifest as noticeable or palpa-ble lesions. Gross findings of many benign lesions canoverlap with those of malignant ones and imaging find-ings can help differentiating the skin lesions in combina-tion of the patient’s clinical history. We classified multipleskin lesions into benign focal lesions (cystic, solid andvascular lesions), premalignant and malignant lesionsand inflammatory lesions.CONCLUSION: We showed multiple imaging findings ofvarious skin lesions in dermatologic disorders. Knowingthe typical imaging characteristics of various dermatologicdisorders can help making differential diagnosis, especial-

472 KCR 2015

Musculoskeletal

ly sonographic findings due to superficial location oflesions.

SE 07 MS-01Calcium hydroxyapatite deposition disease(CHADD) Hyun Soo Kim1, So Young Park2, Wook Jin2, Hye Soo Koo2, Ji Seon Park1, Kyung Nam Ryu1

1Kyung Hee University Medical Center, 2Kyung HeeUniversity Hospital at Gangdong, Korea. [email protected]

LEARNING OBJECTIVE: 1. To review imaging findings of calcium hydroxyapatite

deposition disease (CHADD) in various anatomicallocations on various imaging modalities such as radi-ograph, ultrasonography (US), CT, and MR imaging.

2. To review briefly the differential diagnosis of periarticu-lar and intraarticular calcium deposits.

SUMMARY: 1. Craniovertebral junction and atlantoaxial joint

- Case mimicking infectious arthritis of C0-C1 on ini-tial nonenhanced MR imaging

2. Longus colli3. Shoulder

- Supraspinatus, infraspinatus, teres minor, and sub-scapularis

- Biceps tendon4. Arm

- Pectoralis major insertion5. Elbow

- Bicipitoradial bursa/biceps tendon insertion- Common extensor tendon, common flexor tendon

6. Wrist- Radiocarpal and distal radioulnar joints- Flexor carpi ulnaris

7. Hand- Periarticular (metacarpophalangeal joint)

8. Hip- Gluteus medius origin (iliac crest)- Rectus femoris origin- Hip joint- Greater trochanter

9. Thigh- Gluteus maximus insertion- Adductor magnus insertion

10. Knee- Medial femoral condyle- Lateral femoral condyle

11. Ankle and foot12. Differential diagnosis

- Calcium pyrophosphate deposition disease- Gouty arthritis- Metastatic calcification- Renal osteodystrophy- Heterotopic ossification- Bizarre parosteal osteochondromatous proliferation

CONCLUSION: CHADD include calcific tendinitis, periar-ticular hydroxyapatite deposition, and hydroxyapatite-

induced arthritis and occurs at various anatomical loca-tions in the human body. In symptomatic patients withCHADD, surrounding soft tissue edema or inflammationas well as calcifications are seen. Radiograph, CT, andUS are helpful to diagnose CHADD. CHADD may be mis-diagnosed as infection only on MR imaging because ofinsensitivity to calcifications.

Musculoskeletal


usculoskeletal

SE 07 MS-02US-guided injection of the subacromial bursa:does direction of approach affect patientcomfort?Chrismin Tan1, Matthew J Sampson2

1Royal Adelaide Hospital, 2Flinders University,Australia. [email protected]

Ultrasound (US)-guided corticosteroid injection into thesubacromial-subdeltoid (SASD) bursa is one of the mostcommon outpatient procedures performed by the generalradiologist. There are several described techniques forgaining access into the SASD-bursa posterior, anteriorand lateral. When performed by palpation rather than USguidance, current literature suggests that injection into thebursal space is more accurately achieved with the anteri-or and lateral approaches. When performed by a radiolo-gist under US guidance, intrabursal localization of theinjection is easily ensured regardless of approach.Therefore, a radiologist’s favored technique is more likelyto be influenced by their training, experience and person-al preference. Anecdotal reports are frequently encoun-tered suggesting improved patient comfort with a particu-lar technique. This study presents the results of a retro-spective survey and comparison of subjective patientcomfort during SASD bursal injection performed by expe-rienced radiologists using their favored technique witheither a posterior or lateral approach.

SE 07 MS-03Prognostic significance of focal lesions anddiffuse infiltration on MRI for multiple myeloma:a meta-analysisSo-Yeon Lee1, Hyun-Jung Kim2, Yu Ri Shin3, Hee Jin Park1, Heon Ju Kwon1, Yun Gyoo Lee1, Suk Joong Oh1, Myong Ho Rho1

1Kangbuk Samsung Hospital, 2Korea University Collegeof Medicine, 3The Catholic University of Korea, IncheonSt. Mary’s Hospital, Korea. [email protected]

PURPOSE: The impact of diffuse infiltration or focallesions on MRI for determining progression-free survival(PFS) and overall survival (OS) is not yet clear. The pur-pose of this study was to evaluate impact of diffuse infil-tration or focal lesions on MRI for determining PFS andOS in patients with multiple myelomaMATERIALS AND METHODS: We performed a meta-analysis of research on the prognostic significance of MRIpatterns for OS and PFS using a random effects model.Databases searched without language restriction wereMEDLINE, EMBASE, and the Cochrane Library (January1976 to April 2014). Manual searches were also conduct-ed.RESULTS: Of 10,953 citations identified in the originalsearch, 10 cohort studies for a total of 2015 patients metthe inclusion criteria. Pooled hazard ratios were 1.80(95% confidence interval [CI] 1.32-2.46; p < 0.001) forOS and 2.30 (95% CI 1.65-3.20; p < 0.001) for PFS forfocal lesions; and 1.70 (95% CI 1.30-2.21; p < 0.001) forOS and 1.74 (95% CI 1.07-2.85; p < 0.001) for PFS fordiffuse infiltration. No significant heterogeneity wasobserved among studies.CONCLUSION: This meta-analysis demonstrated anassociation between focal lesions and diffuse infiltrationand poor prognosis in this population.

474 KCR 2015

Musculoskeletal

SE 07 MS-05The effectiveness of fat suppression of IDEALT2-weighted sequence for patients with metallichardware comparing with STIRKyoung-tae Kim, Yeo Ju Kim, Ha Young Lee, Youn Jeong Kim, Young Hye Kang, Soon Gu Cho Inha University Hospital, Korea. [email protected]

PURPOSE: To evaluate the effectiveness of fat suppres-sion of initiative decomposition of water and fat with echoasymmetry and least-squares estimation (IDEAL)sequence for patients with metallic artifact comparing withshort-TI inversion recovery (STIR).MATERIALS AND METHODS: From November 2014 toApril 2015, 14 postoperative patients (M:F = 4:10; age,43-82 years; mean, 65.29 years) with metallic hardwarewere underwent MRI using IDEAL T2-weighted imageand STIR image. The locations of metallic hardwarewere: spine (n = 10), knee (n = 2), and hip (n = 1).Qualitative imaging analyses were done for following find-ings: the signal void size, geometric distortion, pile-up arti-fact, and failure of fat suppression around the metallichardware.RESULTS: In qualitative analyses, IDEAL T2-weightedimages enabled significantly improved pile-up artifact (p <0.05), compared with STIR. However, no significantimprovements were found in the signal void size, geomet-ric distortion, and homogeneity of fat suppression.CONCLUSION: Comparing with STIR, IDEAL T2-weight-ed imaging shows comparable effectiveness of fat sup-pression with reducing pile-up artifacts.

SE 07 MS-06Usefulness of diffusion-weighted MR imaging fordifferentiating between benign and malignantsuperficial soft tissue tumors and tumor-likelesionsJi young Jeon, Hye Won Chung, Sang Hoon Lee,Myung Jin Shin, Min Hee Lee Asan Medical Center, Korea. [email protected]

PURPOSE: To evaluate the usefulness of adding diffu-sion-weighted imaging with apparent diffusion coefficient(ADC) mapping to conventional 3.0T magnetic resonanceimaging (MRI) to differentiate between benign and malig-nant superficial soft tissue tumor and tumor-like lesion.MATERIALS AND METHODS: The Institutional ReviewBoard approved this retrospective study, and informedconsent was waived. The authors retrospectively ana-lyzed conventional MRI including DW images (DWI) (bvalues: 0, 400, 800 sec/mm2) with ADC mapping in 60histologically proven superficial soft tissue lesions (SSTL)(25 malignant; 35 benign), excluding lipomas. Two radiol-ogists with different experience independently evaluatedconventional MRI alone and additional DWI to differenti-ate between malignant and non-malignant lesions.Diagnostic performances were compared between thesetwo sets of images. The mean ADC values obtained fromentire mass and enhancing solid portion were comparedbetween benign and malignant SSTL. Diagnostic perfor-mance based on each ADC value was compared by

using the area under the receiver operating characteristiccurve (AUC).RESULTS: For inexperienced reader, with conventionalMRI alone, sensitivity, specificity and accuracy were80.77%, 79.44% and 80%. With combining conventionaland DWI, sensitivity, specificity and accuracy were92.31%, 85.29% and 88.33%. Additional DWI influencedto improve the rate of correct diagnosis by 8.33% (5/60).For experienced reader, additional DWI revealed thesame accuracy of 85% without added value on correctdiagnosis. The mean ADCs from entire mass (ADCav) ofbenign and malignant SSTLs were 1555 ± 606 and 1014± 333 μm2/sec, respectively. Also, the mean ADCs fromenhancing solid portion (ADCsolid) of benign and malig-nant SSTL were 1386 ± 510 and 865 ± 363 μm2/sec,respectively. The mean ADCs of malignant SSTL were allsignificantly lower than that of benign SSTL (p < 0.001).The AUCs using the value of ADCav was 0.794 (0.681-0.907) and that of ADCsolid was 0.794 (0.682-0.906). Thetwo ROC curves are not significantly different (p ≥ 1.00).CONCLUSION: The combination of conventional MRand DWI contributed to differential diagnosis of benignand malignant SSTLs, and measuring ADCs of the SSTLhad a diagnostic value in challenging cases.

F/56 Follicular B-cell Lymphoma

SE 07 MS-07Incidence of vertebral hemangioma as detectedat 1.5T MRIAriunbold Gankhuyag1, Tuvshinjargal Dashjamts2,Norjmaa Sereenendorj3, Solongo Erdenesaikhan4

1National Cancer Center, 2Mongolian NationalUniversity of Medical Sciences, 3National Center forTrauma and Orthopedics, 4Central Hospital for SpecialCivil-servant, Mongolia. [email protected]

PURPOSE: The incidence of vertebral hemangiomas asthe most common benign spinal neoplasms has been dif-ferently reported from 10 to 27% based on autopsyseries, plain X-rays and MRI reviews. In Mongolia, pro-longed life expectancy leads to increased number ofspine MRI examinations in older patients, in whom the ini-tial detection of hemangiomas in advanced age awakessuspicion for various conditions beginning from benignage-related fatty bone marrow conversion to malignan-cies, metastases. Therefore, we aimed to study the fea-tures of MRI findings in hemangioma to provide evidence.


usculoskeletal

MATERIALS AND METHODS: Till September 2012, UBSongDo Hospital was the only 1.5Tesla MRI facility inMongolia. We retrospectively reviewed using PACS andOSCE systems the clinical and imaging data of patients,who underwent the spine MRI in 2012. Spine MRI proto-col included standard 3 mm thick slabs for sagittal andaxial T1WI, T2WI scans, coronal Proton Density, andsagittal STIR or TRIM sequences. The images werereviewed for age, sex, location, imaging characteristics,size and margins. We conducted statistical evaluationusing Microsoft Excel and SPSS 21.RESULTS: From total 7587 spine MRI cases, 223patients with total 324 hemangiomas were detected. Theaverage age was 48.3. Average of highest diameter ofhemangiomas was 9.2 mm. The results of this study aresimilar to the international reports based on MRI findings,but slightly differ by highest incidence of thoracic spines.From total 324 hemangiomas, it was found in cervicalspine in 10 (3%), in thoracic spine in 152 (47%), in lumbarspine in 147 (45.5%), and in sacrum in 15 (4.5%) cases.Hemangiomas appear hyperintense on T2WI scans in320 (98.8%), hyperintense on T1WI scan in 309 (95.4%),and hyperintense on STIR in 84 (26%). The majority ofhemangiomas -65.1% -showed rounded or ovoid shape,with clear and regular margins.CONCLUSION: In our study population, the incidence ofhemangioma was 2.93. We detected it more frequently infemales than males (M:F = 1:1.4), in older age group. Themajority of the lesions were located in thoracic and lum-bar spine. The majority of the lesions were relativelysmall, with maximum diameter less than 10mm. Ourresults are similar those of the previously publishedinternational studies, although we report relatively higherincidence of hemangioma-likely lesions in the thoracicspine than the comparable international studies.

SE 07 MS-08Imaging review of hind foot painCheolyoung KimLee Chun Tek Hospital, Korea. [email protected]

PURPOSE: 1. To know the anatomy and various cause of hindfoot

pain.2. To review imagings causing hindfoot pain and provide

accurate diagnosis and proper treatment.CONTENTS AND ORGANIZATION: 1. Achillles tendon pathology2. Plantar fascia pathology3. Stress fracture of calcaneusCONCLUSION: Clinically posterior foot pain is commonand sometimes differential diagnosis between plantarpain and achilles tendinopathy is very difficult.Combination of clinical finding, physical examination, radi-ologic imagings are helpful for differential diagnosis andfamiliarity with these multimodality imagings result inaccurate diagnosis of plantar and posterior foot pain.

SE 07 MS-09Anatomical variants of Lister’s tubercle on MRimagingWan Ying Chan, Le Roy Chong Changi General Hospital, Singapore. [email protected]

PURPOSE: Lister’s tubercle has been used as a stan-dard anatomical landmark in hand surgery andarthroscopy procedures. While many studies havedescribed the anatomy of the wrist on MR imaging, therehas been no literature describing anatomical variations ofLister’s tubercle. This study aims to evaluate MR wristdatasets to determine the incidence and describeanatomical variants of Lister’s tubercle, as well as therelationship of these variants with the dorsal extensor ten-dons of the wrist.MATERIALS AND METHODS: A retrospective, singleinstitution study was performed of 380 patients to evalu-ate the prevalence of anatomical variants of Lister’stubercle. Structural characteristics of the anatomical vari-ants were identified and classified. The relationship ofthese anatomical variations with respect to the adjacentdorsal extensor tendons was assessed.RESULTS: Analysis of the studies shows severalanatomical variants of the Lister’s tubercle, including aninteresting variant where the course of the extensor polli-cus longus tendon lies along the radial aspect of Lister’stubercle. Other anatomical variants of Lister’s tuberclemay be also be classified based on its shape and config-uration.CONCLUSION: There are several anatomical variationsin the configuration of Lister’s tubercle amongst the popu-lation studied. Recognition and an understanding of theseanatomical variations may have clinical implications forsurgical planning.

SE 07 MS-10CT-guided percutaneous bone biopsy in patientswith bone lesion of unknown etiology: analysisof 178 casesRajesh JawaleWockhardt Hospitals, Nasik, India. [email protected]

INTRODUCTION: In spite of the great progress in imag-ing techniques such as CT or MRI, the specific diagnosisof various pathological bone conditions often remains dif-ficult. CT guided core needle biopsy is a well-establishedand effective technique for evaluation of bone lesions ofunknown etiology.PURPOSE: Purpose of this study is to present our resultsof CT guided bone biopsy and assessment of diagnosticeffectiveness of the technique.MATERIALS AND METHODS: We retrospectivelyreviewed results of 178 consecutive CT guided percuta-neous biopsies of bone lesions in 177 patient (mean age,60.8; range, 13-81 years old; M:F = 62:38) performed atour hospital from November 2008 to October 2014. Mostof the biopsies were performed as day care procedureand patients were observed for at least 6 hours after thebiopsy. Eight patients who lost to follow-up were excludedfrom the study. MRI and CT findings were evaluated and

476 KCR 2015

Musculoskeletal

the results of additional work-up studies were conductedto achieve a differential diagnosis. Final diagnosis wasestablished by histopathology, immunohistochemistry andcultureRESULTS: The biopsies were performed in the followingregions: Spine (56.2%), pelvic bones (26.8%), long bones(13.4%), sternum, ribs and scapula (3.6%).The mostcommonly biopsied region was spine and the level ofspinal biopsy was cervical in 1 (1%), thoracic in 29 (29%),lumbar in 51 (51%), and sacral in 19 (19%). 169 out of178 of our biopsies (94.94%) were diagnostic. The diag-nosis was infective lesion in 52, inflammatory lesion in 10,primary /systemic malignant tumors (Sarcoma, PNET,plasmacytoma, lymphoma, multiple myeloma) in 36, andmetastatic tumors in 60, benign tumors in 3 and others in8 cases. In spondylodiscitis, the most common isolatedmicroorganism was Mycobacterium tuberculosis. Thelumbar spine was the most common location of infection(25 of 52) and also of metastatic tumors (34 of 60). In 9(5%) cases the procedure was not diagnostic and theobtained tissue revealed sclerotic bone, remodeled bone,intramedullary fibrosis, increased cellularity or blood clots,but did not lead to a specific pathology diagnosis. Therewere no post procedure complications in our series.CONCLUSION: CT-guided bone biopsy is safe, minimal-ly invasive, extremely effective procedures and offer highdiagnostic results with a very low complication rate. Itplays a pivotal role in patient work up and management,and should be considered as the preferred technique inevaluation of bone lesions.

SE 07 MS-11Various factors contribute to graft extrusion inlateral meniscus allograft transplantation: MRIevaluation of 87 kneesSang Yub Lee, Jaegu Yoon, Hyeon-Kyeong Lee The Armed Forces Capital Hospital, Korea. [email protected]

PURPOSE: Lateral meniscus allograft transplantation(LMAT) is a feasible surgical option for young meniscus-deficient patients. Although several studies have exploredthe factors that contribute to graft extrusion, they have notbeen fully elucidated. The aim of this study was to deter-mine the various factors that contribute to graft extrusion.MATERIALS AND METHODS: Patients with knees thathad received LMAT using a keyhole technique (n=87knees in 82 patients) were reviewed. The mean age ofthese patients was 26.9 years (range, 19-54 years), andthe mean postprocedural follow-up interval was 13?days(range, 1-136 days). Twelve magnetic resonance imag-ing (MRI) measurement parameters (axial and coronallocation of the bone block) that could potentially influencegraft extrusion were evaluated, along with absolute graftextrusion and relative percentage of extrusion (RPE).RESULTS: A significant correlation was found between10 of the 12 MRI measurement parameters and bothabsolute extrusion and RPE (r = 0.241-0.438, p < 0.05).The absolute middle distance and depth of the boneblock were independent predictors of absolute extrusion(b = 0.394 and 0.213, respectively; p < 0.05), and the rel-ative middle distance and relative bone block elevationwere found to be predictors of RPE (b = 0.409 and 0.211,

respectively; p < 0.05).CONCLUSION: The results of this study show that boththe coronal and axial locations of the bone block influencegraft extrusion in LMAT. Therefore, correct positioning ofthe bone block, including both the axial and coronalplanes, is essential to minimize graft extrusion.

SE 07 MS-12MRI findings of chronic anterior cruciateligament tearYoung Wook JeonAsan Medical Center, Korea. [email protected]

PURPOSE: Chronic ACL (anterior cruciate ligament) tearnot infrequently showed minute changes of the bundle onmagnetic resonance imaging (MRI) that confused thediagnosis of tear. The purpose of in this study was toevaluate the MRI findings of chronic ACL tear.MATERIALS AND METHODS: Institutional ReviewBoard approval was obtained and informed consentrequirement was waived. One hundred nine patient (93men and 16 women) who had confirmed ACL tear byarthroscopy after 3.0T MRI study of the knee were evalu-ated according to the time from the injury to the imageacquisition, into four groups: acute (within 6 weeks), sub-acute (6 weeks to 3 months), intermediate (3 months to 1year) and chronic (more than 1 year). ACL morphology(loss of striation and signal change), ACL angle, PCLangle, anterior translation of the femur on the tibia, jointeffusion, and Lachman test were evaluated for eachgroup. Sagittal intermediate-weighted images wereassessed for MRI findings.RESULTS: Twenty-six acute tears, fifteen subacutetears, thirty-four intermediate tears, and thirty-four chronictears were included in this study. Loss of striation anddecreased signal change showed strong correlation withtime interval from injury (p < 0.001). Also PCL angle andjoint effusion decreased gradually with time (p < 0.001).Other findings including ACL angle, anterior translation,and Lachman test showed no correlation with chronicity.CONCLUSION: Loss of striation and decreased signalchange of ACL could help the diagnosis of chronic tear.CLINICAL RELEVANCE/APPLICATION: In clinical prac-tice, MRI findings will occasionally be difficult to distin-guish chronic ACL tear from an intact ligament. Loss ofstriation and decreased signal intensity of ACL help thediagnosis of chronic tear.

SE 07 MS-13The use of osteochondral and bony allograft inankle surgery: imaging perspectiveHyojeong Mulcahy, Jack Porrino, Felix Chew University of Washington, USA. [email protected]

TEACHING POINTS: Indications for the use of bony andsoft tissue allografts for orthopedic surgical applicationsare increasing with improved surgical techniques andadvancing experience. Large osteochondral lesions of thetalar dome, advanced osteoarthritis of the ankle in youngpatients, and end-stage osteoarthritis of the ankle with a


usculoskeletal

large bony defect, present significant challenges to anklesurgeons. Osteochondral and bony allograft can offernumerous advantages in those challenging situations byallowing defective tissue to be anatomically matched andreconstructed through transplantation.This educational exhibit will: 1. Review the current concepts of bony and osteochon-

dral allograft in ankle surgery.2. Explain and illustrate normal and abnormal imaging

features related to these procedures and surgical tech-niques.

TABLE OF CONTENTS AND OUTLINE: 1. Current concepts of bony and osteochondral allograft

in ankle surgery2. Indications of bony and osteochondral allograft in ankle

surgery3. Normal and abnormal post-operative imaging findings

of1) Osteochondral allograft transplantation for talar

osteochondral injury2) Resurfacing hemiarthroplasty3) Bipolar total osteochondral allograft (BFTOA) trans-

plantation4) Tibiotalocalcaneal arthrodesis with intercalary struc-

tural allograft5) Tibiotalocalcaneal arthrodesis with femoral head

allograft

SE 07 MS-14A pictorial review of coccygeal mass in adultJisook Yi1, Jang Gyu Cha1, Hyun-Joo Kim2, Sung-Moon Lee3, Sun Joo Lee4

1Soonchunhyang University Bucheon Hospital,2Soonchunhyang University Seoul Hospital, 3KeimyungUniversity Dongsan Medical Center, 4Inje UniversityBusan Paik Hospital, Korea. [email protected]

TEACHING POINTS: To illustrate the various imagingfeature of the common and unusual coccygeal masseswhich include congenital lesions, infectious lesions andneoplastic lesions in adult with pathologic correlation. Toreview the pathogenesis of coccygeal mass in adult.

SUMMARY: Various pathologic masses which includecongenital, infectious and neoplastic condition can occurin coccygeal area. But coccygeal mass in adult is uncom-mon and not well known to radiologists. Knowledge of the

normal anatomy and familiarity with the imaging featuresand clinical manifestations of these lesions are importantfor determining the type of mass or narrowing the differ-ential diagnosis.

SE 07 MS-15Immediate postoperative MR imaging aftersuccessful lumber microdiscectomyKyung Ah ChunCatholic Kwandong University International St. Mary’sHospital, Korea. [email protected]

PURPOSE: Immediate changes of postoperative discwith anterior epidural mass after mimicking postoperativecomplication can be seen in patients with a successfuloutcome. The purpose of this study was to evaluateimmediate postoperative findings of MR imaging within 2weeks after successful lumbar microdiscectomy.MATERIALS AND METHODS: We retrospectivelyreviewed patients with a successful outcome after lumbarmicrodiscectomy on one side and at a single level. Thirty-six patients underwent MR imaging within 2 weeks aftersurgery on a 3 T unit, including sagittal and axial turbospine-echo T2-weighted images as well as sagittal T1-weighted images. Postoperative MR images were ana-lyzed and compared with preoperative images using thefollowing parameters: (1) Posterior margin and signalintensity of disc; (2) size and signal intensity of anteriorepidural soft tissue mass; (3) nerve root involvement; (4)paraspinal soft tissues and posterolateral epiduralchange.RESULTS: Posterior margin of postoperative disc wasconcave in 20 patients (56%), convex in 9 (25%), andunchanged in 7 (19%). Deformation of dural sac with

478 KCR 2015

Musculoskeletal

increased size of anterior epidural soft tissue was seen in17 patients (47%), decreased in 15 (42%), andunchanged in 4 (11%). The signal intensity of all anteriorepidural masses was increased on T2-weighted image.Postoperative discs of 27 patients (75%) were increasedT2 signal intensity. All patients had nerve root involve-ment, and soft tissue edema or fluid collection of high T2signal along the surgical tract in the paraspinal soft tissuelateral to the spinous process and in the posterolateralepidural space.CONCLUSION: Concave posterior margin of immediatepostoperative disc is common after successful lumbarmicrodiscectomy. Postoperative epidural mass showsincreased T2 signal intensity, compared with low signal ofpreoperative herniated disc. Interpretation of immediatepostoperative imaging should be carefully made, with clin-ical correlation

SE 07 MS-16Imaging findings of desmoplastic fibromainvolving tubular bones and flat bonesBora Yoon1, Ji Seon Park1, Kyung Nam Ryu1, Wook Jin2, So Young Park2


BACKGROUND: Desmoplastic fibroma is a rare benignprimary bone tumor with local aggressiveness. Mostdesmoplastic fibromas involve mandible, and other flatbones and tubular bones can be rarely involved. Due tothe rarity, there have been few reports of the radiologicfindings of desmoplastic fibroma involving other flat bonesand tubular bones.PURPOSE: 1. To illustrate radiographic, CT, or MR findings of five

surgically proven desmoplastic fibromas involving tubu-lar bones or other flat bones except mandible

2. To describe its differential diagnosisCONTENTS ORGANIZATION :1. General reviews of desmoplastic fibroma (epidemiolog-

ic, clinical, radiological, histological)2. Case presentation

- Case 1. F/18, tibia- Case 2. M/23, humerus- Case 3. F/47, femur- Case 4. M/46, clavicle- Case 5. M/33, pubic bone

1) Radiography: destructive pattern, margin, periostealreaction, pseudotrabeculation

2) CT: same as those of radiography in detail3) MRI: signal intensity on T1/T2-weighted images,

enhancement pattern, secondary cystic change,adjacent marrow edema, associated soft tissuelesions

4) Differential diagnosis: giant cell tumor, fibrous dys-plasia, aneurysmal bone cyst, malignant bonetumor, etc.

SUMMARY: Desmoplastic fibromas rarely involving tubu-lar bones or flat bones except mandible show variousradiological findings with or without aggressiveness, anda wide spectrum of bone tumors even including malignantbone tumors can be listed as differential diagnosis.

However, the awareness of these radiologic features inour presentation can contribute to make a differentialdiagnosis of desmoplastic fibroma.

SE 07 MS-17Characteristic MR signal intensity pattern ofexercise-induced rhabdomyolysis: differentialpoint from other causes and its clinicalsignificanceEungkoo Yeon, So Young Park, Ji Seon Park, Wook Jin, Kyung Nam Ryu Kyung Hee University Medical Center, Korea. [email protected]

BACKGROUND: Rhabdomyolysis occurs in various con-ditions such as extreme muscle strain, medication, crushinjury or metabolism and generally demonstratesincreased T2 signal intensities with edema in the involvedmuscles on MRI. We experienced a few cases of exer-cise-induced rhabdomyolysis in which showed diffuselyincreased T2 signal intensity of both anterior thigh mus-cles sparing rectus femoris.PURPOSE: 1. To illustrate MR findings of overuse or exercise-

induced rhabdomyolysis involving thigh and to com-pare with those of other rhabdomyolysis with other eti-ology.

2. To consider clinical significance of distinguishable MRfeatures of overuse or exercise-induced rhabdomyoly-sis.

CONTENT ORGANIZATION: 1. Overview and pathophysiology of rhabdomyolysis2. MR findings of rhabdomyolysis3. Review of four cases of rhabdomyolysis developed

after vigorous physical training1) Clinical factors

- history- symptom, physical examination- laboratory findings

2) MRI findings (Fig. 1)

- involvement of thigh muscles- MR signal intensity- in one case, temporal evolution of MR signal inten-

sities on serial follow-up MRI4. Correlation with functional anatomy of thigh muscles5. Discussion about the reason why rectus femoris is pre-

served in rhabdomyolysisCONCLUSION: Preservation of rectus femoris muscle onMRI in overuse or exercise-induced rhabdomyolysis can


usculoskeletal

be a differential point from rhabdomyolysis with other eti-ology. This MR finding is thought to visualize functionalanatomy of thigh muscles with repetitive physical move-ment.

SE 07 MS-18Benign musculoskeletal tumorous lesionsmanifesting multiple lesions: what radiologistshould know or concern?Hye Young Choi1, Ji Seon Park1, Kyung Nam Ryu1,Wook Jin2, So Young Park2


BACKGROUND: Musculoskeletal tumorous lesions withmultiplicity suggest malignancy such as metastasis orhematopoietic malignancy rather than benign lesions,however, some benign musculoskeletal tumorous lesionsalso manifest as multiple lesions. These lesions occasion-ally present atypical or different imaging findings com-pared with those of the same solitary lesion. Besides, oneof these multiple lesions could be a malignant lesion, andit is important to recognize the clinical and imaging fea-tures suggesting malignant transformation.PURPOSE:1. To organize benign musculoskeletal tumorous lesions

manifesting multiple lesions.2. To review their each radiologic findings including typi-

cal, atypical, and suggesting malignant transformation.CONTENT ORGANIZATION: 1. Introduction2. Classification

1) Osseous- Osteochondromatosis: Hereditary multiple exos-

toses- Enchondromatosis: Ollier’s syndrome- Hemangiomatosis- Polyostotic fibrous dysplasia: Albright’s disease- Histiocytosis X: Langerhans cell histiocytosis- Giant cell tumor- Adamantinoma- Osteofibrous dysplasia

2) Soft tissue- Hemangiomatosis- Neurofibromatosis- Fibromatosis- Lipomatosis or angiolipomatosis

3. Imaging findings1) Typical2) Atypical3) Malignant transformation: including clinical features

SUMMARY: Benign musculoskeletal tumorous lesionswith multiplicity have somewhat different and variousimaging features compared with those of the samelesions as solitary manifestation. With clinical correlation,an awareness of the spectrum of radiologic features(atypical findings or malignant transformation) can con-tribute to correct diagnosis and proper treatment plan-ning.

SE 07 MS-19Calcific tendinitis in unusual locationsJaehyung Lee, Sung Hye Koh, Sun-Young Park,Hye Jeong Kim, In Jae Lee, Kwanseop Lee Hallym University Sacred Heart Hospital, Korea. [email protected]

Calcific tendinitis usually occurs in shoulder involvingrotator cuff. It makes acute severe pain mimicking septicarthritis during absorptive stage of the crystal deposition.Identification of the crystal deposition in the lesion onimaging studies is essential to correct diagnosis and man-agement. In case of calcific tendinitis occurs in unusuallocation, it is not easy to diagnose it on imaging studieswithout high suspicion of it. We present radiographicimaging findings of calcific tendinitis occurs in variousunusual locations: 1. Upper arm - pectoralis major. 2.Elbow - common flexor, common extensor, triceps,biceps 3. Wrist - flexor carpi ulnaris 4. Hip - rectusfemoris, gluteus medius, gluteus maximus, hamstring 5.Knee and lower leg - quadriceps, gastrocnemius medialhead, biceps femoris, pes anserinus, soleus 6. Ankle andfoot - Achilles tendon, tibialis posterior, peroneus longus,flexor hallucis longus, flexor hallucis brevis 7. Neck -longus colli

SE 07 MS-20Practical guideline for US-guided core needlebiopsy of soft tissue tumors: transformationfrom beginner to specialistTack Sun Oh, Hye Won Chung, Jong-Seok Lee, Min Hee Lee, Sang Hoon Lee, Myung Jin Shin Asan Medical Center, Korea. [email protected]

TEACHING POINT:1. US-guided core needle biopsy of soft tissue tumors is

very important for differentiating malignancy frombenignancy. But there is no practical guideline for inex-perienced radiologist using detailed images anddescriptions.

2. By using this practical guideline with several specificcases, radiologists could perform core needle biopsiesof soft tissue tumors successfully without complication.

TABLE OF CONTENTS/OUTLINE: Our exhibition will becomposed of 4 parts: 1. Selection of the biopsy target for accurate biopsy result

1) Correlation between US findings and various imag-ing findings on MR and PET-CT to find solid andrepresentative region or malignant component oftumor

2. Selection of the biopsy route for avoiding unintendedwide excision or local tumor recurrence1) Understanding of the orthopedic surgeon’s perspec-

tive2) Watch out for critical anatomic structures

3. Principles and tips of biopsy technique1) Selection of proper biopsy needle and adequate

number of specimen2) Tips for difficult biopsy cases such as movable or

very painful mass4. Discrepancy between radiological diagnosis and biop-

sy result

480 KCR 2015

Musculoskeletal

SE 07 MS-22The pictorial gallery of extraneural cysticercosisAnupam Lal, Priyanka Naranje, Santosh kumar P,Karthik Rayasam, Mahesh Prakash, Niranjan KhandelwalPGIMER, India. [email protected]

BACKGROUND: Cysticercosis, a parasitic infestationcaused by larval stage of Taenia solium is a major healthproblem in the developing countries. It is a diagnostic andtherapeutic dilemma for the clinicians.PURPOSE: With the objective of demonstrating typicalimaging findings of involvement of soft tissues by cys-ticercus cellulosae, we present the pictorial essay oftwenty three patients who were diagnosed with the condi-tion.MATERIALS AND METHODS: The imaging data of 23patients with cysticercus cellulosae encountered duringthe last 6 years were reviewed. Imaging modalities includ-ed ultrasonography (USG), computed tomography (CT)and Magnetic resonance imaging (MRI) of variousregions.RESULTS: Twenty three cases (14 male and 9 femalepatients) of cysticercosis in the soft tissues and glandswere observed. Mean age was 21.3 years. Fine needleaspiration cytology (FNAC) was performed to diagnosethe lesion in six cases. The pattern of distribution was stri-ated muscles in 21, parotid gland in 2 and subcutaneoustissues in 2 patients. Imaging findings on USG, CT andMRI of cysticercosis (solitary and multiple) involving theseregions are described which were diagnostic of the entity.Four different sonographic patterns of muscular cysticer-cosis were also observed including cysticercus cyst withan inflammatory mass around it, an irregular cyst withvery minimal adjacent fluid, large irregular collection ofexudative fluid with the typical cysticercus cyst containingthe scolex and calcified cysticercosis.CONCLUSION: Wide spectrum of radiological appear-ance of cysticercosis as described in this pictorial essaysignifies the importance of different imaging modalitiessuch as USG, CT and MRI in conclusively and noninva-sively diagnosing this clinically dilemmatic condition.


usculoskeletal

SE 07 MS-25C1 and C2 lesion: what radiologist should knowJi Sung Han1, Seun Ah Lee1, Baek Hyun Kim1, Suk-Joo Hong2, Chang Ho Kang3, Kung-Sik Ahn3,Min A Yoon2

1Korea University Ansan Hospital, 2Korea UniversityGuro Hospital, 3Korea University Anam Hospital,Korea. [email protected]

TABLE OF CONTENTS: Our exhibit will be divided into 2sections and present relevant illustrations and cases:1. Anatomy of the atlanto-axial joint - plain radiograph,

CT, MR1) Bony anatomy2) Ligament anatomy

2. Diseases involving the atlanto-axial joint1) Trauma-related lesions : trauma mechanism and

classification(1) Atlas fracture - including Jefferson’s fracture(2) Axial fracture - including odontoid process frac-

ture, hangman’s fracture(3) Atlanto-axial dislocation

2) Degeneration or inflammation - related lesion(1) Degenerative arthritis - including a synovial cyst

arising from the transverse ligament related osodontoideum.

(2) Rheumatoid arthritis(3) Crystal deposition disease - including crowned

dens syndrome, longus colli tendonitis(4) Ossification of the ligament

3) Infection- related lesion(1) Viral-atlanto-axial rotatory fixation(2) Pyogenic lesion

4) Tumors

SE 07 MS-26Comparison of US findings of subcutaneousangiolipoma with lipomaYoon Sang Shin, Yeo Ju Kim, Youn Jeong Kim, Ha Young Lee, Kyung Hee Lee, Tong Joo Lee Inha University Hospital, Korea. [email protected]

PURPOSE: To compare and describe the ultrasonogra-phy (US) findings of subcutaneous angiolipoma and sim-ple lipomas in pathology proven cases.MATERIALS AND METHODS: We retrospectivelyreviewed US findings pathology-proven angiolipoma andsimple lipoma of subcutaneous fat layer from September2011 to September 2013 using database of our institu-tion. Total pathology proved angiolipoma was found in 13patients and simple lipoma was found in 33 patients. In13 patients of angiolipoma, there was total 19 separatetumor and one patient had pathologically confirmed oneangiolipoma and one lipoma on different body sites sototal patient’s number is 45. The US findings of eachmass were analyzed for location, echotexture andechogenicity, internal fat stranding sign which indicatesfibrous septa structure, long and short diameter and itsratio, tumor shape and multiplicity. For the evaluation ofinternal vascularity, color Doppler image was alsoobtained.

RESULTS: Most of angiolipoma was located in upperextremity area whereas lipoma mostly founded at trunkarea (p = 0.00). Hyperechogenicity and heterogeneousechotexture of tumor parenchyma was the significantlymore found in angiolipoma than lipoma (p = 0.00).Tumor’s lateral margin was generally ill-defined in angi-olipoma whereas lipoma showed relatively well-definedlateral margin (p = 0.001). Tumor’s shape also demon-strated significant differences between two tumor groups.Angiolipoma showed more oval shaped mass with itsround and smooth lateral margin whereas lipoma gener-ally showed spindle shaped with sharp lateral margin (p =0.006). Angiolipoma had more internal vascularities thanlipoma (p = 0.027). Mean long and short diameter of angi-olipoma was significantly smaller than that of lipoma (p =0.000). Multiplicity of each tumor groups and internalechogenic stranding sign which indicates fibrous septastructure showed no statistical significant difference.CONCLUSION: Tumor’s location, echogenicity and echo-texture, lateral margin, tumor shape, long and short diam-eter, and internal vascularity are useful and meaningfulfindings in case of making differential diagnosis of angi-olipoma and simple lipoma of subcutaneous layer withUS.

SE 07 MS-27Correlation with quantitative analysis of theenhancement of a perfusion MRI andarthroscopic findings in adhesive capsulitis:preliminary studyHee Seok Jeong, Seung jun Lee, Tae Yong Moon,Seung Kug Baik, Jun Woo Lee Pusan National University Yangsan Hospital, Korea. [email protected]

PURPOSE: For a precise diagnosis of adhesive capsuli-tis, to evaluate the quantitative value through an analysisof perfusion MRI enhancement, and investigation relationwith thickening of axillary pouch in the arthroscopic find-ings.MATERIALS AND METHODS: The subjects for thisstudy were chosen from patients visited in a single tertiaryhospital, from January 2015 and April 2015, 24 patients(11 men and 13 women; average age 58.4 years, range39-76 years) who underwent arthroscopy after perfusionMRI, because of shoulder pain. We retrospectivelyreviewed perfusion MRI images and arthroscopic find-ings. Perfusion MRI analysis were administered by 2musculoskeletal radiologists with 28 and 3 years of expe-rience, each. MRI analysis was done using 2-compart-ment modeling of SIEMENS Tissue4D program to getKtrans means value. The paired T-test was used to com-pare the mean values. All statistical tests were performedusing SPSS 18 for Windows (SPSS Inc., Chicago, IL,USA). P < 0.05 was considered statistically significant.RESULTS: Of 24 patients, 5 patients showed adhesivecapsulitis and Ktrans means average value was 0.080(range, 0.094-0.066). 19 patients showed no adhesivecapsulitis and Ktrans means average value was 0.028(range, 0.049-0.013). Two group were significantly differ-ent between Ktrans means average value. 3 patientsshowed thickening of axillary pouch and adhesive cap-sulitis. 9 patients showed thickening of axillary pouch and

482 KCR 2015

Musculoskeletal

no adhesive capsulitis. 2 patients showed normal axillarypouch, but they were diagnosed with adhesive capsulitis.CONCLUSION: In a diagnosis of adhesive capsulitis,thickness of axillary pouch at MRI and arthroscopy arenot good enough, only. Enhanced value in perfusion MRImay be considered as a kind of diagnosis option.

SE 07 MS-28T2* mapping of articular cartilage after ACLreconstructionMin kyoung Lee, Sheen Woo Lee, Yu Mi Jeong, Eu Gene Joe, Chang Rae Kim Gachon University Gil Medical Center, Korea. [email protected]

PURPOSE: To evaluate the T2* value of patients afteranterior cruciate ligament reconstructive surgery withoutmeniscal tear.MATERIALS AND METHODS: Patients after ACL recon-struction were studied, who had surgery for ACL withoutany other knee injury including meniscal tear (5 patients;mean age, 43 ± 9 years). Asymptomatic healthy volun-teers (n = 4; age, 31 ± 2 years) were included as a con-trol group. The protocol consisted multi echo, gradientrecalled echo (ME-GRE) sequence with 3.0T MRI(Siemens Skyra, Erlangen, Germany), using six echoesfor T2* mapping. Geometric acquisition parameters for allsequences were identical (FOV: 166 × 166 mm; matrix:384 × 384; section-thickness: 4.0/0.8 mm, nominal flipangle 60。, TR 931.0 ms, TE 4.4/11.9/19.4/ 27.0/34.5 ms,bandwidth 260.0 Hz/pixel, 22 sections, total acquisitiontime of 3:45 min). The T2* value were derived using aninline processing package (SyngoMapIt; Siemens,Erlangen, Germany). A region of interest (ROI) wasdrawn in the lateral and medial, femoral and tibial com-partments, patellar and trochlear cartilages. Each com-partment was divided into three subregions: anterior, cen-tral and posterior. Mean values for ROI of cartilage wereused for statistical analysis. Quantitative evaluation wasperformed by analysis of variance using independentsample T-Test and multivariate general linear model(SPSS version 20.0). The age of the study group wasalso considered. Differences with a p value less than 0.05were considered statistically significant.RESULTS: The mean T2* values of patients’ lateral tibialanterior, medial tibial anterior, patellar and trochlear carti-lage were higher than controls despite the patients’ meanage being higher (p < 0.05).CONCLUSION: Although limited by a small sample size,this study shows that T2* value of tibial lateral and medialanterior subregions, patellar and trochlear cartilage ishigher in only-ACL reconstruction group compared withthe control.

SE 07 MS-30Traumatic fat effusion in tendon sheaths inpatients with wrist fracturesChorong Seo, Yu Mi Jeong, Sheen Woo Lee,Eugene Joe Gachon University Gil Medical Center, Korea. [email protected]

HYPOTHESIS: There are rare case reports about trau-matic fat effusion in tendon sheaths following wrist frac-tures. The purpose of this study is to investigate theprevalence of traumatic fat effusion in tendon sheathsafter wrist fractures and to find its clinical significance.METHODOLOGY: Consecutive wrist CT scans followingacute trauma from October 2014 to February 2015 in thetertiary care trauma center were retrospectively reviewedby two radiologists including a board-certified muscu-loskeletal radiologist. The presence and location of trau-matic fat effusion in tendon sheaths were investigated byvisual assessment and measurement of Hounsfield Unit.And the fracture patterns were described as intra-articulardistal radius fracture, extra-articular distal radius fracture,simultaneous distal radioulnar fracture or carpal bonefractures.RESULTS: Among the 126 wrist CT scans (M:F = 53:73;mean age, 53 years) included in this study, 25 exams(19.8%) revealed traumatic fat effusion in the tendonsheaths. The location of the traumatic fat effusion in ten-don sheaths were as follows: six (24%) in extensor carpiradialis longus (ECRL)/extensor carpi radialis brevis(ECRB)/extensor pollicis longus (EPL) concurrently, six(24%) in EPL, four (16%) in ECRB, three (12%) in exten-sor digitorum, two (8%) in ECRB/ECRL, two (8%) inECRB/EPL, one (4%) in ECRL/EPL, one (4%) in ECRL.Twenty three cases (92%) had intra-articular distal radiusfractures; eleven (47.8%) of them had distal radius frac-tures with ulnar styloid avulsion, eight (34.8%) of themhad only radius fractures, four (17.4%) of them had con-comitant intra-articular distal radioulnar fracture. Only two(8%) had extra-articular distal radius fractures.CONCLUSION: Traumatic fat effusions in tendonsheaths were unexpectedly common than that have beenreported in the intra-articular distal radius fractures.ECRL, ECRB and EPL were the most frequently involvedsites. More attention should be paid to detect traumaticfat effusions in tendon sheaths not to miss an occult intra-articular distal radius fracture.


usculoskeletal

SE 07 MS-35Dermatofibroma: US findings and pathologiccorrelationSo Young Park1, Kyu Yeon Won1, Wook Jin1, Ji Sun Park2, Kyung Nam Ryu2

1Kyung Hee University Hospital at Gangdong, 2KyungHee University Medical Center, Korea. [email protected]

PURPOSE: To evaluate ultrasonographic (US) findings ofdermatofibroma and to correlate them with pathologicfindings.MATERIALS AND METHODS: 12 dermatofibromas in10 patients (M:F = 2:9; age range, 18-53 years with amean of 35.3 years) were included in this study. US find-ings were analyzed and evaluated by two musculoskele-tal radiologists in consensus for the following characteris-tics: location, size, shape, margin, marginal spiculation,echogenicity change at adjacent dermis and subcuta-neous layer, internal echogenicity, heterogeneousechogenicity, internal hyperechoic dots, and vascularity.US characteristics were correlated with the pathologicfindings by discussion between one radiologist and onepathologist.RESULTS: On US, 75% (9/12) were located in both der-mis and subcutaneous fat layers and 25% (3/12) werelocated only in dermis layer. Mean size was 0.7 cm withrange of 0.4-1 cm. The shapes of the lesions were oval in50% (6/12) and irregular in 50% (6/12). 67% (8/12 had ill-defined margin and 33% (4/12) had well-defined margin.Marginal spiculation was noted in 67% (8/12). 83%(10/12) had echogenicity change at adjacent dermis and58% (7/12) had echogenicity change at adjacent subcuta-neous layer. 75% (9/12) were isoechoic to the subcuta-neous fat, one had hypoechoic relative to the subcuta-neous fat, and one had hyperechoic relative to the subcu-taneous fat. 25% (3/12) had internal heterogeneousechogenicity. Internal hyperechoic dots were noted in33% (4/12). 92% (11/12) showed no vascularity.Pathologically, location, shape, margin, and marginalspiculation were well correlated with US findings.Reactive fibrosis and chronic inflammation were seen inarea of echogenicity change in adjacent dermis and sub-cutaneous layer. Three lesions with heterogeneousechogenicity had blood-filled clefts. Internal hyperechoicdots corresponded to cholesterol granuloma within thedermatofibroma in one of four lesions. Several medium-sized vessels were seen in one lesion with increased vas-cularity on US.CONCLUSION: Dermatofibroma may be suggested forthe dermal lesion with or without extension into subcuta-neous fat layer having ill-defined margin, marginal spicu-lation, surrounding soft tissue echogenicity change, isoe-choic to the subcutaneous fat, and no vascularity.

SE 07 MS-36Ultrasonoelastographic evaluation at 3-monthfollow-up of plantar fasciitis after collageninjectionMinchul Kim, Yun Sun Choi, Darae Kim, Jin Su Kim,Ki Won Young Eulji Hospital, Eulji University, Korea. [email protected]

PURPOSE: To evaluate sonoelastography in monitoringtreatment response of patients with plantar fasciitis. MATERIALS AND METHODS: Thirteen adult female(mean age, 45.5 years) patients with proximal plantarfasciitis were prospectively enrolled, after unsuccessfulconservative treatment. Individuals graded heel pain witha visual analogue scale, and underwent B-mode ultra-sonography, and real-time static sonoelastography.Collagen injection was applied to the heels of plantarfasciitis patients. Maximum fascial thickness was mea-sured from the anterior edge of the calcaneal border verti-cally to the inferior border of the plantar fascia. For semi-quantitative measurement of plantar fascia stiffness, weselected a circular area, within 1-cm of calcaneal insertionsite of plantar fascia. The calcaneus bone was used asreference for elasticity as 6, and relative stiffness of plan-tar fascia to calcaneus bone was measured. Follow-upsonoelastography and visual analogue scale gradingwere done after 3 months.RESULTS: The stiffness of plantar fascia was significant-ly increased after 3-month follow up (p < 0.01). The plan-tar fascia thickness did not show significant difference inpre and post-treatment evaluation (p = 0.202). The meanVAS values in the plantar fasciitis group decreased signif-icantly 3 month after collagen injection (p < 0.05).Perifascial bursitis was developed in one patient. Nogross fascia disruption was observed.CONCLUSION: Sonoelastography revealed hardening ofthe plantar fascia in subjects with plantar fasciitis, aftercollagen injection. Therefore sonoelastography may be asensitive and comprehensive tool to monitor treatmenteffects.CLINICAL APPLICATION: It has been generally knownthat sonoelastography can well demonstrate plantar fasci-itis, and assist in cases of inconclusive B-mode US.Sonoelastography is also useful for the more sensitivenotice of findings improvement in follow up than B-modeimage, and color scale can demonstrate visible outcomesof plantar fascia treatment.

484 KCR 2015

Musculoskeletal

SE 07 MS-37Imaging manifestation of gout in the fingerJin Kyeong Sung, Jee Young Kim The Catholic University of Korea, St. Vincent’sHospital, Korea. [email protected]

PURPOSE: To present imaging findings of gout in the fin-ger. MATERIALS AND METHODS: Five patients with topha-ceous gout of the finger (three men and two women;mean age, 62.8 years) were included. Plain radiographyand MR images were evaluated.RESULTS: Multiple joints were involved in four cases,and monoarticular involvement was seen in one case. Onplain radiography, all five cases demonstrated soft tissueswelling with cortical erosion and overhanging edge. Jointspace narrowing was present in one case, andintraosseous osteolytic lesion with bone destruction wasnoted in two patients. MR imaging showed nodular syn-ovial thickening and asymmetric soft tissue mass forma-tion in four patients, which were hypointense on T1 andT2-weighted images and showed heterogeneousenhancement. Intraosseous infiltration was present in twocases. Extensor tendon was involved in four cases. Inthree cases with involvement of flexor tendon, the lesionabutted tendon focally in one case, and segmentaltenosynovitis was seen in two cases.CONCLUSION: Imaging findings of gout in finger arevariable.

SE 07 MS-39Clinical value of pointwise encoding timereduction with radial acquisition (PETRA)sequence compared to conventional 2D fastspin-echo (SE) sequence in assessing internalderangement of the kneeDonghyun Kim, Sun Joo Lee, Young Mi Park, Hae Woong Jeong, Seok Jin Choi, Sang Suk Han Inje University Busan Paik Hospital, Korea. [email protected]

PURPOSE: To evaluate the usefulness of PETRAsequence for diagnosis of internal derangement of theknee.MATERIALS AND METHODS: Twenty-six patientsunderwent both PETRA magnetic resonance (MR) imag-ing and 2D fast SE MR imaging of the knee at 3.0T. All ofthese patients received arthroscopic surgery. Multiplanarreformations (MPR) of single-echo fat-saturated (FS)PETRA images and their MPR sequences were com-pared with 2D fast SE MR images. Two musculoskeletalradiologists reviewed the images independently.Statistical analysis was performed to calculate the inter-observer agreement and to compare the diagnostic per-formance of the sequences.RESULTS: Arthroscopy revealed 19 MM tears, 8 LMtears, 7 ACL tears, 3 PCL tears and 50 cartilaginouslesions. For meniscal tears, the diagnostic accuracieswere greater on the PETRA images, compared with the2D fast SE MR images. Medial meniscal tear showedsensitivity of 84.21%, specificity of 92.86%, and accuracyof 86.54% on PETRA imaging, where the 2D fast SE MR

imaging showed sensitivity of 94.74%, specificity of50.00%, and accuracy of 82.69% (the area under thereceiver-operating characteristic [AUC] = 0.885 versus0.724, p < 0.05). Lateral meniscal tear showed sensitivityof 87.50%, specificity of 97.22%, and accuracy of 94.23%on the PETRA images, where the 2D fast SE MR imagesshowed sensitivity of 87.50%, specificity of 72.22%, andaccuracy of 76.92% (AUC = 0.924 versus 0.799, p <0.05). Cartilaginous defect showed sensitivity of 58.00%,specificity of 95.37%, and accuracy of 77.40% on thePETRA imaging, where the 2D fast SE MR imagingshowed sensitivity of 70.00%, specificity of 91.67%, andaccuracy of 81.25% (AUC = 0.767 versus 0.808, p <0.05). There was no statistically significant difference inthe diagnostic accuracy of ligament tears on PETRAimaging compared with the 2D fast SE MR imaging.There were excellent inter-observer agreements for bothPETRA and 2D imaging (k > 0.82).CONCLUSION: The diagnostic performance of PETRAimaging is superior to that of the 2D fast SE MR imagingin evaluation of the meniscal tears. The cartilaginousdefects are more accurately seen on the 2D fast SE MRimages rather than the PETRA images. There is no sig-nificant difference in diagnostic ability between thePETRA imaging and the 2D fast SE MR imaging in evalu-ating the ligament tears.

SE 07 MS-40The A to Z of ankle USYeonah Kang, Yusuhn Kang, Joongmo Ahn Seoul National University Bundang Hospital, Korea. [email protected]

TEACHING POINTS: 1. Understand normal anatomy of ankle joint; bony struc-

ture, ligament, and tendon.2. Ankle ultrasound is a useful tool in prompt diagnosis of

diverse diseases.3. Learn systematic scanning technique based on clinical

finding.TABLE OF CONTENTS/OUTLINE:1. Overview of ankle anatomy2. Understand systematic scanning technique

1) anterior scan- anterior talofibular ligament- anterior tibiofibular ligament- calcaneofibular ligament

2) lateral scan- peroneal tendons

3) medial scan- tibialis posterior tendon- flexor digitorum longus tendon- flexor hallucis longus tendon- deltoid ligament- tarsal tunnel and tibial nerve

4) posterior scan- achilles tendon

5) plantar fascia3. US and MRI correlation of various diseases4. References


usculoskeletal

SE 07 MS-41 MRI brachial plexus: Review of normal anatomyand common pathological findingsSiew Kune Wong1, Lee Lian Chew2

1Singapore General Hospital, 2Tan Tock Seng Hospital,[email protected]

OBJECTIVES: To describe the normal anatomy andimaging techniques. To illustrate the common traumaticand non traumatic injuries to the brachial plexus.BACKGROUND: The brachial plexus is a network ofnerves formed by the anterior rami of the lower four cervi-cal nerves and the first thoracic nerve. It is divided intoroots, trunks, divisions, cords and branches as it passesfrom the neck to the axilla innervating the upper extremi-ty. Magnetic resonance imaging (MRI) because of its

superior soft tissue resolution and multiplanar capabilitiesis the imaging modality of choice to depict normal anato-my and evaluation of traumatic and non-traumatic pathol-ogy of the brachial plexus. Traumatic brachial plexusinjury can be divided into pre- and postganglionic lesionswhile non-traumatic plexopathy can be due to localizednerve involvement, mass effect or widespread inflamma-tory process.IMAGE FINDINGS: This poster will review the normalanatomy of the brachial plexus as well as the imagingfindings of the commonly encountered traumatic and non-traumatic pathology of the brachial plexus.CONCLUSION: The use of MRI which is the imagingmodality of choice, has greatly aided in the managementof brachial plexus plexopathies. Familiarity with the imag-ing appearances of normal anatomy and pathology willimpact on the management of the patient.

486 KCR 2015

Musculoskeletal

Documents

468 KCR 2015conplus.co.kr/~kcr2015/down/abstract_book/Scientific...468 KCR 2015 Musculoskeletal Musculoskeletal-Informal Scientific Presentation Presenting Final Abstract Presenting