Search

Background: Selective steroid injections of the lumbar spine carry a risk of paraplegia of sudden onset. Seven cases have been reported in the English literature since 2002.Materials and Methods: Five new cases have been analyzed, all coming from Paris area centers. Injections were performed between 2003 and 2008. The following items were searched for: location of a previous lumbar spine surgery if any, symptoms indicating the procedure, route of injection, imaging technique used for needle guidance, injection of a contrast medium, type of steroid, other drugs injected if any, paraplegia level, post-procedure MR findings. The current and reported cases were compared.Results: MR findings were consistent with spinal cord ischemia of arterial origin. The high rate of patients who had been operated on in these cases does not correspond to that of patients undergoing injections. The presence of epidural scar might increase the risk. The foraminal route was the only one involved in nonoperated patients. Foraminal, interlaminar, or juxta-zygoapophyseal routes were used in operated-on patients.Conclusion: The high rate of French cases when compared to the literature might arise from the almost exclusive use of prednisolone acetate, a molecule with a high tendency to coalesce in macro-aggregates, putting the spinal cord at risk of arterial supply embolization. [ABSTRACT FROM AUTHOR]

To evaluate the efficiency and complication rate of two percutaneous treatments of osteoid osteomas, percutaneous trephine resection (PR) and interstitial laser ablation (ILA). Ethical review board was obtained for the retrospective study. One hundred and 26 patients were treated by PR (n = 26) or ILA (n = 100) under CT, with a median follow-up of 113 months for the PR group and 47 months for the ILA group. In the group treated by PR, the clinical success rate was 96% at 6-month and 95% at 24-month follow-up, with 12% (3/26) transient complications (one meralgia, two skin burns). One patient experienced immediate failure, and none had delayed failure. In the group treated by ILA, the clinical success rate was 96% at 6-month and 94% at 24-month follow-up, with 4% (4/100) transient complications (one common fibular nerve contusion, one hematoma, one infection and one tendinitis). Four ILA procedures were repeated, one because of initial failure and three because of recurrence (at 6.5, 15 and 32 months). Two were successful and two failed again. Failure was more frequent (p = 0.0094) in patients less than 18 years old, and in lesions with a nidus size of 12 mm or larger (p = 0.0022). [ABSTRACT FROM AUTHOR]

Objective: To compare magnetic resonance (MR)-arthrography and multidetector-spiral-computed-tomography (MDSCT)-arthrography in cartilage-thickness measurement, in hips without cartilage loss, with coronal anatomic slices as gold standard.Method: Institutional review board permission to study cadavers of individuals who willed their bodies to science was obtained. Two independent observers measured femoral and acetabular cartilage thicknesses of 12 radiographically normal hips (six women, five men; age range, 52-98 years; mean age, 76.5 years), on MDSCT-arthrographic and MR-arthrographic reformations, and on coronal anatomic slices, excluding regions of cartilage loss. Inter- and intraobserver reproducibilities were determined. Analysis of variance (ANOVA) was used to test differences between MR-arthrographic and MDSCT-arthrographic measurement errors compared to anatomy.Results: By MR-arthrography, cartilage was not measurable at approximately 50% of points on sagittal and transverse sections, compared to 0-6% of the points by MDSCT-arthrography. In the coronal plane, the difference between MDSCT-arthrographic and MR-arthrographic measurement errors was not significant (P=0.93).Conclusion: In the coronal plane, MR-arthrography and MDSCT-arthrography were similarly accurate for measuring hip cartilage thickness. [ABSTRACT FROM AUTHOR]

Percutaneous local ablation of osteoid osteoma has largely replaced surgery, except in the small bones of the hands and feet. The objective of this study was to describe the technical specificities and results of computed tomography (CT)-guided percutaneous laser photocoagulation in 15 patients with osteoid osteomas of the hands and feet. We retrospectively examined the medical charts of the 15 patients who were treated with CT-guided percutaneous laser photocoagulation therapy at our institution between 1994 and 2004. The 15 patients had a mean age of 24.33 years. None of them had received any prior surgical or percutaneous treatment for the osteoid osteoma. The follow-up period was 24 to 96 months (mean, 49.93). The pain resolved completely within 1 week. Fourteen patients remained symptom-free throughout the follow-up period; the remaining patient experienced a recurrence of pain after 24 months, underwent a second laser photocoagulation procedure, and was symptom-free at last follow-up 45 months later. No adverse events related to the procedure or to the location of the tumor in the hand or the foot were recorded. CT-guided percutaneous laser photocoagulation is an alternative to surgery for the treatment of osteoid osteomas of the hands and feet. [ABSTRACT FROM AUTHOR]

Background: Precise lower limb measurements are crucial for assessing musculoskeletal health; fully automated solutions have the potential to enhance standardization and reproducibility of these measurements. This study compared the measurements performed by BoneMetrics (Gleamer, Paris, France), a commercial artificial intelligence (AI)-based software, to expert manual measurements on anteroposterior full-leg standing radiographs., Methods: A retrospective analysis was conducted on a dataset comprising consecutive anteroposterior full-leg standing radiographs obtained from four imaging institutions. Key anatomical landmarks to define the hip-knee-ankle angle, pelvic obliquity, leg length, femoral length, and tibial length were annotated independently by two expert musculoskeletal radiologists and served as the ground truth. The performance of the AI was compared against these reference measurements using the mean absolute error, Bland-Altman analyses, and intraclass correlation coefficients., Results: A total of 175 anteroposterior full-leg standing radiographs from 167 patients were included in the final dataset (mean age = 49.9 ± 23.6 years old; 103 women and 64 men). Mean absolute error values were 0.30° (95% confidence interval [CI] [0.28, 0.32]) for the hip-knee-ankle angle, 0.75 mm (95% CI [0.60, 0.88]) for pelvic obliquity, 1.03 mm (95% CI [0.91,1.14]) for leg length from the top of the femoral head, 1.45 mm (95% CI [1.33, 1.60]) for leg length from the center of the femoral head, 0.95 mm (95% CI [0.85, 1.04]) for femoral length from the top of the femoral head, 1.23 mm (95% CI [1.12, 1.32]) for femoral length from the center of the femoral head, and 1.38 mm (95% CI [1.21, 1.52]) for tibial length. The Bland-Altman analyses revealed no systematic bias across all measurements. Additionally, the software exhibited excellent agreement with the gold-standard measurements with intraclass correlation coefficient (ICC) values above 0.97 for all parameters., Conclusions: Automated measurements on anteroposterior full-leg standing radiographs offer a reliable alternative to manual assessments. The use of AI in musculoskeletal radiology has the potential to support physicians in their daily practice without compromising patient care standards., Competing Interests: Declarations. Ethics approval and consent to participate: The study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki. The ethics committee of the Collège des Enseignants en Radiologie de France (CERF), the Centre d’Éthique de la Recherche en Imagerie Médicale (CERIM), approved the study (Institutional Review Board approval number CRM-2209-306). Consent for publication: Consent forms were not required for patients, as the images used in this study were completely unidentifiable and there were no specific details on individuals reported within the manuscript. Furthermore, all patients had been informed about the use of their anonymized data for research purposes, which included clear instructions on how to opt out if they chose to do so. Competing interests: L.L., M.D., J.V., V.M., L.C., Z.Z., N.N., and J.D.L. are employees of Gleamer; N.E.R. is a co-founder and chief medical officer of Gleamer. A.D. is a co-founder and chief technical officer of Gleamer. A.G. is a shareholder of BICL, LLC, and consultant to Pfizer, Novartis, TrialSpark, Coval, ICM, Medipost, and TissueGene., (© 2024. The Author(s).)

Background: There are several therapeutic options for the management of shoulder adhesive capsulitis (AC). The superiority of arthro-distension over intra-articular steroid injection (ISI) for AC remains controversial., Objectives: To evaluate the efficacy of a single arthro-distension procedure combined with early and intensive mobilization (ADM) and physiotherapy, versus ISI and physiotherapy, in people with AC lasting ≥3 months., Methods: This was a prospective, 2 parallel-group, 2-center, observer-blind randomized controlled trial conducted in tertiary care settings. Adults with AC were randomly assigned to the treatment or control group. Efficacy was assessed using the self-administered Shoulder Pain and Disability Index (SPADI). Total, pain and disability SPADI scores 15 days, 6 weeks, and 3, 6 and 12 months after the procedure (total SPADI at 15 days: primary outcome; other outcomes were secondary) were compared between groups using analysis of covariance (ANCOVA). A post hoc analysis stratified on the initial range of passive glenohumeral abduction, which had not been pre-specified, was conducted., Results: There were 33 participants in each group. Both groups improved over time. Mean (SD) total SPADI score at 15 days was 33.8 (19.6) in the treatment group and 32.8 (17.5) in the control group, p = 0.393. There were no significant differences for any variables in the overall sample. The post hoc analysis found ADM to be associated with a significant decrease in total SPADI score at 15 days compared with ISI (p = 0.049) in individuals with initial passive glenohumeral abduction >45°., Conclusions: The effects of ADM on pain and function were not statistically different from those of ISI. However, ADM may be useful in individuals with initial passive glenohumeral abduction >45°., Database Registration: NCT00724113., Competing Interests: Declaration of competing interest Prof. Christelle Nguyen has the following conflicts of interest: grants or contracts from the French Ministry of Health; consulting fees from Thuasne and Merz; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Thuasne, Novartis, Pfizer, and Lilly; support for attending meetings and/or travel from Grünenthal; and participation on a Data Safety Monitoring Board or Advisory Board from Thuasne. The other authors do not have any conflict of interest., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Purpose: The purpose of this study was to evaluate the safety and efficacy of transient genicular artery embolization (GAE) using an ethiodized oil-based emulsion for the treatment of knee osteoarthritis (KOA)., Materials and Methods: This prospective, single-arm, open-label, multicenter, first-in-human cohort trial was registered on ClinicalTrials.gov (NCT04733092). The main inclusion criterion was diagnosis of KOA according to a visual analogue scale (VAS) pain score ≥ 40 mm (score range: 0-100 mm), despite conservative treatment for at least three months. Treatment efficacy was assessed using changes in VAS pain score, Mean Western Ontario & McMaster Universities osteoarthritis (WOMAC) function score (normalized to 100; score ranging from 0 to100) and outcome measures in rheumatoid arthritis clinical trials (OMERACT)-Osteoarthritis Research Society (OARSI) set of responder criteria., Results: Twenty-two consecutive participants (13 women; mean age, 66 ± 9 [standard deviation (SD)]) were included and underwent GAE. Emulsion consisted in a mixture of ioversol and ethiodized oil (ratio 1:3, respectively) prepared extemporaneously. The rate of serious adverse events attributed to GAE within one month was 5% (1/22), corresponding to reversible worsening of renal function. Immediate technical success rate was 100%. Mean VAS pain score dropped from 74.4 ± 16.5 (SD) mm at baseline to 37.2 ± 26.7 (SD) mm at three months (P < 0.001). Mean WOMAC function score (normalized to 100: score ranging from 0 to 100) decreased from 57.3 ± 17.1 (SD) at baseline to 33.5 ± 25.9 (SD) at three months (P < 0.001). At three months, 16 out of 22 participants (73%) were considered responders according to the OMERACT-OARSI set of responder criteria, including high improvement in either pain or WOMAC function, or improvement in both pain and WOMAC function., Conclusion: GAE using an ethiodized oil-based emulsion is safe and improves pain and function in participants with KOA for at least three months., Competing Interests: Declaration of Competing Interest MS reports consulting fees from Guerbet France and to be a co-inventor of the patented emulsion. OP and CD are also co-inventors of the patented emulsion. The other authors have no conflicts of interest related to this work to declare., (Copyright © 2023 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Mechanism of neurologic complications after epidural spinal injections (ESI) of particulate steroids at the cervical spine include intrathecal injection, epidural hematoma, direct spinal cord injury, and brain stem or cord infarction due to an arterial spasm or inadvertent intra-arterial injection of particulate steroids. At the lumbar spine, there is evidence that a spinal cord infarction secondary to an inadvertent intra-arterial injection of particulate steroids through a transforaminal approach is the leading mechanism.Variations in the arterial supply of the spinal cord help to understand how a lumbar ESI may lead to a spinal cord infarction at the thoracic level. A radiculomedullary artery arising from the lumbar or sacral spine may participate to the supply of the spinal cord. All radicular and radiculomedullary arteries penetrate the spinal canal through the intervertebral foramen. Therefore, its catheterization carries a risk of inadvertent intraarterial injection. An ex vivo animal study has shown that particulate steroids injected in the blood stream produce an immediate and unexpected change of red blood cells into spiculated cells which aggregate and cause arterioles obstruction, while no particulate steroid macroaggregates or vascular spasm were observed. Rare instances of neurologic complications also occurred after ESI performed through a posterior approach. All occurred in previously operated on patients suggesting a pathologic role for the epidural scar., (© 2023. The Author(s), under exclusive licence to International Skeletal Society (ISS).)

Background: Magnetic resonance imaging (MRI) is the dominant 3D imaging modality to quantify muscle properties in skeletal muscle disorders, in inherited and acquired muscle diseases, and in sarcopenia, in cachexia and frailty., Methods: This review covers T1 weighted and Dixon sequences, introduces T2 mapping, diffusion tensor imaging (DTI) and non-proton MRI. Technical concepts, strengths, limitations and translational aspects of these techniques are discussed in detail. Examples of clinical applications are outlined. For comparison 31 P-and 13 C-MR Spectroscopy are also addressed., Results: MRI technology provides a rich toolset to assess muscle deterioration. In addition to classical measures such as muscle atrophy using T1 weighted imaging and fat infiltration using Dixon sequences, parameters characterizing inflammation from T2 maps, tissue sodium using non-proton MRI techniques or concentration or fiber architecture using diffusion tensor imaging may be useful for an even earlier diagnosis of the impairment of muscle quality., Conclusion: Quantitative MRI provides new options for muscle research and clinical applications. Current limitations that also impair its more widespread use in clinical trials are lack of standardization, ambiguity of image segmentation and analysis approaches, a multitude of outcome parameters without a clear strategy which ones to use and the lack of normal data., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. KE is a part time and MABE a full time employee of Clario, Inc., (© 2023 The Authors.)

Objective: To explore the diagnostic performance of routine magnetic resonance imaging (MRI) for the cross-sectional assessment of osteophytes (OPs) in all three knee compartments using computed tomography (CT) as a reference standard., Methods: The Strontium Ranelate Efficacy in Knee Osteoarthritis (SEKOIA) trial explored the effect of 3 years of treatment with strontium ranelate in patients with primary knee OA. OPs were scored for the baseline visit only using a modified MRI Osteoarthritis Knee Score (MOAKS) scoring system in the patellofemoral (PFJ), the medial tibiofemoral (TFJ) and the lateral TFJ. Size was assessed from 0 to 3 in 18 locations. Descriptive statistics were used to describe differences in ordinal grading between CT and MRI. In addition, weighted-kappa statistics were employed to assess agreement between scoring using the two methods. Sensitivity, specificity, positive predictive value and negative predictive value as well as area under the curve (AUC) measures of diagnostic performance were employed using CT as the reference standard., Results: Included were 74 patients with available MRI and CT data. Mean age was 62.9 ± 7.5 years. Altogether 1,332 locations were evaluated. For the PFJ, MRI detected 141 (72%) of 197 CT-defined OPs with a w-kappa of 0.58 (95% CI [0.52-0.65]). In the medial TFJ, MRI detected 178 (81%) of 219 CT-OPs with a w-kappa of 0.58 (95% CI [0.51-0.64]). For the lateral compartment these numbers were 84 (70%) of 120 CT-OPs with a w-kappa of 0.58 (95% CI [0.50-0.66])., Conclusion: MRI underestimates presence of osteophytes in all three knee compartments. CT may be helpful particularly regarding assessment of small osteophytes particularly in early disease., (Copyright © 2023 Osteoarthritis Research Society International. All rights reserved.)

Objective: To develop definitions for imaging features being considered as potential classification criteria for calcium pyrophosphate deposition (CPPD) disease, additional to clinical and laboratory criteria, and to compile example images of CPPD on different imaging modalities., Methods: The American College of Rheumatology and European Alliance of Associations for Rheumatology CPPD classification criteria Imaging Advisory Group (IAG) and Steering Committee drafted definitions of imaging features that are characteristic of CPPD on conventional radiography (CR), conventional computed tomography (CT), dual-energy CT (DECT), and magnetic resonance imaging (MRI). An anonymous expert survey was undertaken by a 35-member Combined Expert Committee, including all IAG members. The IAG and 5 external musculoskeletal radiologists with expertise in CPPD convened virtually to further refine item definitions and voted on example images illustrating CR, CT, and DECT item definitions, with ≥90% agreement required to deem them acceptable., Results: The Combined Expert Committee survey indicated consensus on all CR definitions. The IAG and external radiologists reached consensus on CT and DECT item definitions, which specify that calcium pyrophosphate deposits appear less dense than cortical bone. The group developed an MRI definition and acknowledged limitations of this modality for CPPD. Ten example images for CPPD were voted acceptable (4 CR, 4 CT, and 2 DECT), and 3 images of basic calcium phosphate deposition were voted acceptable to serve as contrast against imaging features of CPPD., Conclusion: An international group of rheumatologists and musculoskeletal radiologists defined imaging features characteristic of CPPD on CR, CT, and DECT and assembled a set of example images as a reference for future clinical research studies., (© 2022 American College of Rheumatology.)

Objective: Osteoarthritis (OA) is a highly prevalent chronic condition. The subchondral bone plays an important role in onset and progression of OA making it a potential treatment target for disease-modifying therapeutic approaches. However, little is known about changes of periarticular bone mineral density (BMD) in OA and its relation to meniscal coverage and meniscal extrusion at the knee. Thus, the aim of this study was to describe periarticular BMD in the Applied Public-Private Research enabling OsteoArthritis Clinical Headway (APPROACH) cohort at the knee and to analyze the association with structural disease severity, meniscal coverage and meniscal extrusion., Design: Quantitative CT (QCT), MRI and radiographic examinations were acquired in 275 patients with knee osteoarthritis (OA). QCT was used to assess BMD at the femur and tibia, at the cortical bone plate (Cort) and at the epiphysis at three locations: subchondral (Sub), mid-epiphysis (Mid) and adjacent to the physis (Juxta). BMD was evaluated for the medial and lateral compartment separately and for subregions covered and not covered by the meniscus. Radiographs were used to determine the femorotibial angle and were evaluated according to the Kellgren and Lawrence (KL) system. Meniscal extrusion was assessed from 0 to 3., Results: Mean BMD differed significantly between each anatomic location at both the femur and tibia (p < 0.001) in patients with KL0. Tibial regions assumed to be covered with meniscus in patients with KL0 showed lower BMD at Sub (p < 0.001), equivalent BMD at Mid (p = 0.07) and higher BMD at Juxta (p < 0.001) subregions compared to regions not covered with meniscus. Knees with KL2-4 showed lower Sub (p = 0.03), Mid (p = 0.01) and Juxta (p < 0.05) BMD at the medial femur compared to KL0/1. Meniscal extrusion grade 2 and 3 was associated with greater BMD at the tibial Cort (p < 0.001, p = 0.007). Varus malalignment is associated with significant greater BMD at the medial femur and at the medial tibia at all anatomic locations., Conclusion: BMD within the epiphyses of the tibia and femur decreases with increasing distance from the articular surface. Knees with structural OA (KL2-4) exhibit greater cortical BMD values at the tibia and lower BMD at the femur at the subchondral level and levels beneath compared to KL0/1. BMD at the tibial cortical bone plate is greater in patients with meniscal extrusion grade 2/3., Competing Interests: Declaration of competing interest FWR is shareholder of Boston Imaging Core Lab. (BICL), LLC. He is consultant to Calibr and Grünenthal; RH is a member of the speakers bureau and a consultant of Siemens Healthineers, outside the submitted work. MK reports grants from IMI-APPROACH, during the conduct of the study; consulting fees from GlaxoSmithKline, Pfizer, Merck-Serono, Kiniksa, Abbvie, Flexion, Galapagos, Jansen, CHDR, UCB, Novartis outside the submitted work and all paid to institution; FJB funding from Gedeon Richter Plc., Bristol-Myers Squibb International Corporation (BMSIC), Sun Pharma Global FZE, Celgene Corporation, Janssen Cilag International N·V, Janssen Research & Development, Viela Bio, Inc., Astrazeneca AB, UCB BIOSCIENCES GMBH, UCB BIOPHARMA SPRL, AbbVie Deutschland GmbH & Co.KG, Merck KGaA, Amgen, Inc., Novartis Farmacéutica, S.A., Boehringer Ingelheim España, S.A, CSL Behring, LLC, Glaxosmithkline Research & Development Limited, Pfizer Inc., Lilly S.A., Corbus Pharmaceuticals Inc., Biohope Scientific Solutions for Human Health S.L., Centrexion Therapeutics Corp., Sanofi, MEIJI FARMA S.A., Kiniksa Pharmaceuticals, Ltd. Grunenthal, Asofarma Mexico, Gebro Pharma, Roche, Galapagos, Regeneron; FB is shareholder of 4Moving Biotech and 4P,Pharma, reports personal fees from Boehringer, Bone Therapeutics, Expanscience, Galapagos, Gilead, GSK, Merck Sereno, MSD, Novartis, Pfizer, Roche, Sanofi, Servier, Peptinov, TRB Chemedica, Viatris. WW is employee and shareholder of Chondrometrics GmbH. AL is employee of Servier. The other authors declare no competing interests., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Information is lacking on the natural history of early stages of degenerative rotator cuff disease. Such information can be obtained by using clinical and imaging assessment after conservative treatment in affected patients., Hypothesis: Subacromial impingement syndrome is a clinical presentation that can be associated with early stages of the disease. We aimed to describe the natural history of degenerative rotator cuff disease from the early stages by studying clinical and imaging outcomes in non-operated patients with subacromial impingement syndrome., Patients and Methods: Patients with subacromial impingement syndrome were prospectively included. They had conservative treatment and were assessed before treatment and during at least 12-month follow-up. Assessment included clinical evaluation on a 0- to 100-point Constant scale and subscales as well as MRI of the rotator cuff. Clinical results were compared to baseline MRI findings and according to lesional progression., Results: We included 26 patients with mean age 59.1 (SD 9.6), mean pain duration 23.1 (31.3) months; mean total Constant score 39.1 (12.1). Overall, 9 patients had no tear, 9 had a partial tear and 8 had a full-thickness tear. Mean follow-up was 21 (SD 10) months. Total Constant score and subscores improved at follow-up in the overall sample. Patients without tear and those with partial or full-thickness tear at baseline showed clinical improvement. MRI of the rotator cuff at follow-up indicated lesional worsening in 7 patients. However, clinical improvement did not differ by lesional progression or not., Conclusion: We report on 21-month clinical and MRI assessments of degenerative rotator cuff disorders including early stages of the disease. Clinical improvement was not related to MRI changes over time. Further investigations are needed to verify our findings in larger study populations.

X-linked hypophosphatemia (XLH) is the most common form of inheritable rickets. The disease is caused principally by PHEX mutations leading to increased concentrations of circulating intact FGF23, hence renal phosphate wasting, hypophosphatemia, and decreased circulating levels of 1,25(OH) 2 vitamin D. The chronic hypophosphatemia leads to rickets and osteomalacia through a combination of mechanisms, including a lack of endochondral ossification and impaired mineralization. Imaging has a major role in determining the diagnosis of rickets and its cause, detecting complications as early as possible, and helping in treatment monitoring., (Copyright © 2021. Published by Elsevier Masson SAS.)

Competing Interests: L’auteur déclare organiser et participer à des conférences pour Pfizer, Lilly, Novartis, UCB, Genevrier, et être employé de Gleamer : start-up intelligence artificielle

Objective: Despite its prevalence, there are few worldwide hand osteoarthritis (HOA) cohorts. The main objective of DIGItal COhort Design (DIGICOD) cohort is to investigate prognostic clinical, biological, genetic and imaging factors of clinical worsening after 6years follow-up., Methods: DIGICOD is a hospital-based prospective cohort including patients>35years-old with symptomatic HOA fulfilling: (i) ACR criteria for HOA with≥2 symptomatic joints among proximal/distal interphalangeal joints or 1st interphalangeal joint with Kellgren-Lawrence (KL)≥2; or (ii) symptomatic thumb base OA with KL≥2. Main exclusion criteria were inflammatory arthritis and crystal arthropathies. Annual clinical evaluations were scheduled with imaging (X-rays of the hands and of other OA symptomatic joints) and biological sampling every 3years. Hand radiographs are scored using KL and anatomical Verbruggen-Veys scores. Follow-up visits are ongoing. Cohort methodology and baseline characteristics are presented., Results: Between April 2013 and June 2017, from the 436 HOA included patients, 426 have been analysed of whom 357 (84%) are women. Mean age±standard deviation was 66.7±7.3years and mean disease duration was 12.6±9.6years. Metabolic syndrome affected 151 (36.5%) patients. Mean Visual Analog Scale (VAS) hand pain (0-100mm) was 44.4±26.7mm at activity. Mean FIHOA (0-100) was 19.9±18.6. Elevated serum CRP level (≥5mg/L) involved 10% patients. Mean KL score (0-128) was 46.7±18 and the mean number of joint with KL≥2 was 15.1±6.3. Erosive HOA (defined as≥1 Erosive or Remodeling phase joint according to Verbruggen-Veys score) involved 195/426 (45.8%) patients and the median number (interquartile range) of erosive joints in erosive patients was 3.0 (1.0-5.0)., Conclusion: DIGICOD is a unique prospective HOA cohort with a long-term 6years standardized assessment and has included severe radiologically HOA patients with a high prevalence of erosive disease., (Copyright © 2021 Société française de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.)

Background: Ceramic-on-ceramic (COC) total hip replacements (THR) have exhibited less instability and late dislocation. Hip capsule plays an important role in hip stability. Different surrounding soft tissue reactions have been observed according to the bearing material used but no study compared these data using MRI investigation. Therefore, we performed a retrospective case control study to compare hip capsule thicknesses according to the bearing materials in THR and in native hips., Hypothesis: Hip capsule is thicker after COC THR compared to ceramic- or metal-on-polyethylene (PE) bearings, or native hips., Materials and Method: Magnetic resonance imaging (MRI) images, combined with a multi acquisition variable resonance image combination (MAVRIC) sequence, was used to measure the hip capsule thickness in 16 patients (29 hips) who had either COC (13 hips, median age at surgery: 64.8 years old, median follow-up at imaging: 2482 days), PE bearings (11 hips, median age at surgery: 48.4 years old (significantly different from COC THR), median follow-up at imaging: 1860 days (NS)), or a native hip with no implant (5 hips). Two independent radiologists measured capsular thicknesses in 4 different zones and were blinded regarding the bearing components. The imaged hips were classified into three groups: native, COC and PE., Results: The COC THR group had the thickest capsules (median 7.0mm, range 2.9-15.5mm). This result was statistically significant (p<0.0001) when compared to PE THR (median 4.9mm, range 2.2-10.5mm), and to native hips (median 4.1mm, range 2.7-6.9mm) measurements, respectively. Furthermore, painful hips had thinner capsules (4.6mm, range 2-10.5) compared to not painful hips (6.8mm, range 2.3-15.5) (p=0.0006)., Discussion: This is the first in-vivo study measuring capsular thickness in THR with the objective of measuring variations according to the hip implant materials used. The results revealed a significantly thicker capsule for the COC bearing compared to either PE or native hips, and a thinner capsule in painful hips., Level of Evidence: III, retrospective non-consecutive cohort study., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objective: The coexistence of calcium pyrophosphate dihydrate (CPPD) and monosodium urate monohydrate crystals in gouty tophi has rarely been reported. We undertook this study to investigate CPPD crystal deposits in a series of surgically removed gouty tophi and to identify factors associated with these deposits., Methods: Twenty-five tophi from 22 gout patients were analyzed using polarized light microscopy, field emission scanning electron microscopy (FESEM), and μ Fourier transform infrared (μFTIR) spectroscopy., Results: Tophi consisted of multiple lobules separated by fibrous septa and surrounded by a foreign-body giant cell reaction. CPPD crystal aggregates were identified in 9 of 25 tophi from 6 patients. CPPD crystals were dispersed or highly compacted, localized at the edge or inside the tophus lobules, with some lobules completely filled with crystals. Both monoclinic and triclinic CPPD crystal phases were identified using FESEM and μFTIR. Compared to patients without CPPD, those with CPPD-containing tophi were older (mean 60.5 years versus 47.2 years; P = 0.009), and had longer-term gout duration (mean 17.0 years versus mean 9.0 years; P < 0.05) and tophi duration (mean 10.0 years versus mean 4.6 years; P < 0.01). None of the patients had radiographic chondrocalcinosis of the knee or wrist., Conclusion: CPPD crystal formation seems to be a late and frequent event of tophus maturation, occurring more frequently with aging, and could contribute to the speed of tophus dissolution and the apparent persistence of tophus sometimes observed even after effective, long-lasting urate-lowering therapy., (© 2020, American College of Rheumatology.)

Background: The diagnosis of adhesive capsulitis is currently based on restricted range of motion (ROM) but its diagnostic value has only been rarely investigated., Aim: The aim of this study is to assess the diagnostic value of active global and passive gleno-humeral ROM to diagnose shoulder adhesive capsulitis., Design: Cross-sectional descriptive study., Setting: One French center for Rehabilitation Medicine., Population: Patients referred for treatment of shoulder adhesive capsulitis in our center were included. Inclusion criteria were: shoulder pain; limitation of active global ROM (abduction or flexion <180°); limitation of passive gleno-humeral ROM (abduction or flexion <90° or 25% reduction at less of lateral rotation versus the opposite shoulder); no gleno-humeral arthropathy on radiography., Methods: The volume of the gleno-humeral capsule was assessed during a procedure of arthro-distension. The reference criterion for adhesive capsulitis was a volume <12 mL. We analyzed the correlation between the parameters of mobility and the volume of the gleno-humeral capsule; and the positive predictive value (PPV) of inclusion criteria, with the reference criterion for the diagnosis of adhesive capsulitis., Results: We included 38 patients. Passive gleno-humeral ROM in abduction only was correlated with volume of the gleno-humeral capsule: r=0.33, P=0.043. The PPV of inclusion criteria was 82% for the diagnosis of shoulder adhesive capsulitis. Rather than 90°, when we considered 80°, 60° and 40° as the threshold of passive gleno-humeral ROM in abduction, the PPV increased from 83% to 100%., Conclusions: Passive gleno-humeral ROM in abduction is correlated with volume of the gleno-humeral capsule. The PPV is high for active global and passive gleno-humeral ROM for diagnosis of shoulder adhesive capsulitis., Clinical Rehabilitation Impact: Limitation of active and passive shoulder ROM, especially passive abduction gleno-humeral, is a good criterion to diagnose shoulder adhesive capsulitis, in patients with shoulder pain and no gleno-humeral arthropathy on radiography.

Objective: To verify earlier data in cadavers that in female subjects with OA meniscal coverage is associated with lowered bone mineral density of the underlying subchondral bone in the proximal tibia by investigating the local bone mineral density (BMD) distribution within the epiphysis., Methods: BMD of the subchondral bone of the tibia was measured by QCT in 67 elderly females diagnosed with OA (Kellgren-Lawrence grades 2-3). The epiphysis was subdivided along the axis of the tibia into a subchondral-epiphyseal VOI covering the first 5-6 mm below the subchondral bone plate, a mid-epiphyseal VOI covering the adjacent 7-8 and a juxtaphyseal VOI of another 7-8 mm that bordered the growth plate. These VIOs were further divided into lateral and medial and then into anterior, mid and posterior sub-VOIs. Finally, all subVOIs were divided in one subVOI covered by the menisci (CM) and another not covered by the menisci (nCM). BMD ratios of these two subVOIs were compared., Results: In the subchondral epiphysis BMD was significantly lower (Medial: mean BMD diff  = 125 mg/cm 3 , p<0.001; Lateral: mean BMD diff  = 56 mg/cm 3 p < 0.001) in subVOIs covered by the meniscus compared to subVOIs not covered by the meniscus. The BMD difference was no longer significant in the mid epiphysis (Medial: mean BMD diff  = 10 mg/cm 3 , p>0.82; Lateral: mean BMD diff  = 7 mg/cm 3 , p=0.99) and was reversed in the juxtaphysis. With a few exceptions these BMD differences were independent of the lateral-medial and the anterior-mid-posterior position. BMD significantly (p<0.05) decreased with age independent on whether the location was covered or uncovered by the meniscus, however the BMD ratio of the corresponding nCM and CM subVOIs did not significantly (p>0.1) change with age., Conclusion: In-vivo QCT measurements of the BMD distribution in the proximal tibia indicate a protective effect of the menisci in the subchondral bone close to the joint. This protective effect is age independent despite the overall age-related decrease of BMD., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

In achondroplasia, lumbar spinal stenosis arises from congenital dysplasia and acquired degenerative changes. We here aimed to describe the changes of the lumbar spinal canal and intervertebral disc in adults. We included 18 adults (age ≥ 18 years) with achondroplasia and lumbar spinal stenosis. Radiographs were used to analyze spinal-pelvic angles. Antero-posterior diameter of the spinal canal and the grade of disc degeneration were measured by MRI. Antero-posterior diameters of the spinal canal differed by spinal level (P < 0.05), with lower values observed at T12-L1, L1-2 and L2-3. Degrees of disc degeneration differed by intervertebral level, with higher degrees observed at L1-2, L2-3 and L3-4. A significant correlation was found between disc degeneration and thoraco-lumbar kyphosis at L2-3, between antero-posterior diameter of the spinal canal and lumbar lordosis at T12-L1 and L2-3, and between antero-posterior diameter of the spinal canal and thoraco-lumbar kyphosis at L1-2. Unlike the general population, spinal stenosis and disc degeneration involve the upper part of the lumbar spine in adults with achondroplasia, associated with thoraco-lumbar kyphosis and loss of lumbar lordosis.

Adventitious bursitis of the plantar fat pad is a common cause of forefoot pain. It may develop at sites where subcutaneous tissue is exposed to friction and high pressure. In the forefoot, adventitious bursitis is usually adjacent to bony prominences of the metatarsal heads. Diagnosis and management of adventitious bursitis usually do not require imaging studies. However, the condition occasionally presents as a solid pseudotumoral mass requiring imaging. Magnetic resonance imaging (MRI) may demonstrate a heterogeneous mass with a solid component exhibiting intermediate to high signal intensity on T2-weighted images and thick nodular enhancement suggesting a neoplastic lesion. We report three cases of adventitious bursitis in patients who complained of a painful palpable mass on the forefoot, with a partially solid and enhancing component seen on MRI. In the first case, a biopsy was performed for the diagnosis of adventitious bursitis. The two other cases exhibited a solid component on MRI. However, a diagnosis of adventitious bursitis was suspected, and it was felt that a biopsy could be postponed. The spontaneous regression of the mass with relative discharge of the forefoot pressure confirmed the diagnosis. With these three cases, we illustrate the MR findings that could suggest adventitious bursitis despite the presence of a solid component and that may obviate the need for pathologic proof., (Copyright Journal of Radiology Case Reports.)

Objective: Assessment of enthesitis, a key feature in spondyloarthritis (SpA) and psoriatic arthritis (PsA), using objective and sensitive methods is pivotal in clinical trials. MRI allows detection of both soft tissue and intra-osseous changes of enthesitis. This article presents an atlas for the Outcome Measures in Rheumatology (OMERACT) Heel Enthesitis Magnetic Resonance ImagingMRI Scoring System (HEMRIS)., Methods: Following a preliminary selection of potential examples of each grade, as per HEMRIS definitions, the images along with detailed definitions and reader rules were discussed at web-based, interactive meetings between the members of the OMERACT MRI in Arthritis Working Group., Results: Reference images of each grade of the MRI features to be assessed using HEMRIS, along with reader rules and recommended MRI sequences are depicted., Conclusion: The presented reference images can be used to guide scoring Achilles tendon and plantar fascia (plantar aponeurosis) enthesitis according to the OMERACT HEMRIS in clinical trials and cohorts in which MRI enthesitis is used as an outcome., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The microbiological diagnosis of bone and joint infections (BJI) currently relies on cultures, and the relevance of molecular methods is still debated. The aim of this study was to determine whether polymerase chain reaction (PCR) could improve the etiological diagnosis of BJI., Methods: A prospective study was conducted during a 4-year period at Lariboisiere University Hospital (Paris, France), including patients with suspicion of infectious spondylodiscitis, septic arthritis, prosthetic joint infections, and respective noninfected groups. Clinical and radiological data were collected at inclusion and during follow-up. All samples were analyzed by conventional cultures and 16S ribosomal deoxyribonucleic acid (rDNA) gene (16S-PCR). Specific cultures and PCR targeting Mycobacterium tuberculosis were also performed for spondylodiscitis samples. Case records were subsequently analyzed by an independent expert committee to confirm or invalidate the suspicion of infection and definitively classify the patients in a case or control group. The sensitivity of the combination of culture and PCR was compared with culture alone., Results: After expert committee analysis, 105 cases of BJI cases and 111 control patients were analyzed. The most common pathogens of BJI were staphylococci (30%), M tuberculosis (19%), and streptococci (14%). Adding PCR enhanced the sensitivity compared with culture alone (1) for the diagnosis of M tuberculosis spondylodiscitis (64.4% vs 42.2%; P < .01) and (2) for nonstaphylococci BJI (81.6% vs 71.3%; P < .01). It is interesting to note that 16S-PCR could detect BJI due to uncommon bacteria such as Mycoplasma and fastidious bacteria., Conclusions: Our study showed the benefit of 16S-PCR and PCR targeting M tuberculosis as add-on tests in cases of suspected BJI., (© The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Objective: To develop and validate an enthesitis magnetic resonance imaging (MRI) scoring system for spondyloarthritis/psoriatic arthritis, using the heel as model., Methods: Consensus definitions of key pathologies and 3 heel enthesitis multireader scoring exercises were done, separated by discussion, training, and calibration., Results: Definitions for bone and soft tissue pathologies were agreed. In the final exercise, median pairwise single-measures intraclass correlation coefficients (ICC; patient-level) for entheseal inflammation status/change scores were 0.83/0.82 for all readers. For radiologists and selected rheumatologists, ICC were 0.91/0.84 and quadratic-weighted κ (lesion-level) 0.57-0.91/0.45-0.81., Conclusion: The proposed definitions and Heel Enthesitis Scoring System (HEMRIS) are reliable among trained readers and promising for clinical trials.

Background: Calcium pyrophosphate dihydrate deposition disease (CPPD) has been reported to involve the spine, but few systematic studies have been published., Objective: To further characterize the spinal involvement with CPPD by a review of CPPD patients hospitalized in a rheumatology department., Methods: We retrospectively reviewed data for patients consecutively admitted with a diagnosis of CPPD in the rheumatology department of Lariboisière hospital in Paris, France over 5 years by using a standardized protocol and electronic case report forms. Imaging studies were also reviewed., Results: Spinal CPPD was diagnosed in 37/152 (24.3%) CPPD patients. Patient with spinal involvement had more widespread peripheral CC. The cervical (n = 21) and lumbar (n = 19) segments were most involved. CT-scan was more sensitive than plain radiographs for detecting spinal calcifications. Crown dens syndrome was a prominent feature of cervical involvement. Inflammatory sterile spondylo-discitis was observed in 6 patients. Lesions were frequently multiple and were classified into 4 types. Ruling out septic discitis required image-guided biopsies in 3 patients. Sacroiliac involvement included calcification in 5 patients and severe sterile destructive arthropathy and joint fusion in one patient each. Degenerative changes were common, and CPPD could not be implicated because of the patients 'age and lack of a control population. In 12 patients, severe clinical features requiring hospitalization were related to such degenerative changes., Conclusion: Symptomatic involvement of the spine was observed in 24% of this series of hospitalized CPPD patients. Specific entities were the cause of hospitalisation in 25 of the 37 patients with spinal calcification and included inflammatory pain related to crystal deposits and destructive arthropathy of the spine and sacroiliac joints. Discitis exhibited a wide range of MRI features and biopsies were needed to rule out infection in 3 of the 6 discitis., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: Osteoarthritis (OA) is a disease of the whole joint characterized by cartilage loss and subchondral bone remodeling. The role of microcracks in cartilage integrity and subchondral bone homeostasis is not fully understood. The main goal of this work was to evaluate microcrack density in both calcified cartilage and subchondral bone plate in relation to cartilage damage in humans and to better define the association of microcracks and osteocyte density in subchondral bone., Methods: We investigated 18 bone cores from cadaveric human knees that were stained with En-Bloc Basic Fuchsin. We quantified microcrack density, osteocyte density, cartilage surfaces and cartilage damage. The presence of microcracks was confirmed for each bone core by scanning electron microscopy. Finally, trabecular subchondral bone parameters were measured by micro-CT., Results: Microcracks were detected in both calcified cartilage and subchondral bone plate. The density of microcracks in both calcified cartilage (CC) and subchondral bone plate (SBP) was negatively correlated with cartilage damage (r = -0.45, p < 0.05). The presence of microcracks in SBP was associated with a lower histological OA score. Osteocytes formed a dendrite network that abruptly stopped at the border of calcified cartilage. Osteocyte density in subchondral bone plate was increased in the presence of microcracks in calcified cartilage., Conclusions: Subchondral bone plate microcracks might be required for maintaining cartilage homeostasis. Microcracks in calcified cartilage may trigger osteocyte density in subchondral bone plate with subsequent regulation of subchondral bone remodeling to prevent cartilage damage., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To evaluate the prevalence and performance as axial Spondyloarthritis (axSpA) diagnostic feature of radiographic and MRI lesions 'typical' of axSpA of the sacroiliac joint (SIJ) and spine in a mechanical chronic back pain (CBP) population and in an axSpA cohort., Methods: Cross-sectional multicentre study. Patients: (1) recent onset axSpA (DESIR cohort) and (2) mechanical non-axSpA CBP matched for age and gender (ILOS study). Imaging: radiographs and MR scans were performed identically in both groups. All images were centrally read, blinded for diagnosis and for other imaging findings in the same patient. Statistical analysis: prevalence of lesions 'typical of axSpA' were compared in both groups. Sensitivity, specificity and positive likelihood ratios (LR+) of each lesion (and combination of lesions) were calculated., Results: A total of 98 patients with CBP were included, and compared with 100 patients with recent onset axSpA. SIJ lesions were consistently more frequent in the axSpA group (35.0% vs 11.8% p<0.001, 35.0% vs 8.4% p<0.001% and 32.0% vs 10.0%. p<0.001 for modified New York criteria, MRI sacroiliitis and ≥3 erosions of the SIJ on MRI, respectively), and performed well (LR+ for ≥3 erosions 3.0 (95% CI 1.6 to 5.8)). Spine lesions were comparable across groups: radiographic lesions were rare, while all MRI lesions were frequent., Conclusion: Our study confirms that 'typical' lesions can also be observed in patients with non-axSpA CBP but that SIJ lesions by all modalities remain the most valuable for diagnosis, including structural lesions of the SIJ. This suggests the potential interest of adding MRI SIJ structural lesions in the definition of MRI abnormalities for axSpA classification., Competing Interests: Competing interests: AM received an ASAS (Assessment of SpondyloArthritis International Society) research grant and an unrestricted grant from Pfizer (Passerelle) to conduct this study. There are no other benefits from commercial sources for the work reported on in the manuscript, and no other financial interests that any of the authors may have, which could create a potential conflict of interest or the appearance of a conflict of interest with regard to the work.

Objectives: Beta-2-microglobulin (β2M) dialysis-related amyloidosis (DRA), a disabiliting joint disease, has been initially reported in patients under long-term dialysis. The incidence and prevalence has significantly decreased with the improvement in dialysis techniques. Here, we attempted to clarify the clinical and MRI features to improve the diagnosis., Methods: We retrospectively reviewed the files of 19 patients under dialysis treatment referred for suspicion of β2M DRA. The diagnosis was based on MRI criteria (low signal intensity on both T1- and T2-weighted MR sequences). MRI analysis included a scoring of the several joint lesions. Scores were quantified according to a severity scale (0 to 3)., Results: Patients had a mean age of 66.0 ± 10.5 years and mean dialysis duration of 23.7 ± 10.5 years. DRA affected mainly large joints (shoulder in 73.7%, hip in 47.3%) and spine (36.8%). MRI images for 8 shoulders, 8 hips, and 3 spines were analysed. Amyloid synovitis was present in all cases, with high mean scores in the three sites. In all joints, the most common lesions were tendon thickening (68.4%) and bone erosions (68.4%). The mean tendon thickening score was high, particularly at the shoulders and also at the spine. Bone erosions were most frequent in the shoulder and pelvis., Conclusion: In patients under long-term dialysis, β2M DRA involves large joints but also the spine. Special awareness should be drawn by the thickening of the tendon. MRI is required to characterize the pattern of the lesions and to achieve the diagnosis., (Copyright © 2018 Société française de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.)

Purpose To evaluate determinants of hip fracture by assessing soft-tissue composition of the upper thigh at CT. Materials and Methods In this retrospective analysis of prospectively collected data, CT studies in 55 female control participants (mean age, 73.1 years ± 9.3 [standard deviation]) were compared with those in 40 female patients (mean age, 80.2 years ± 11.0) with acute hip fractures. Eighty-seven descriptors of the soft-tissue composition were determined. A multivariable best subsets analysis was used to extract parameters best associated with hip fracture. Results were adjusted for age, height, and weight. Results of soft-tissue parameters were compared with bone mineral density (BMD) and cortical bone thickness. Areas under the receiver operating characteristic curve (AUCs) adjusted for multiple comparisons were determined to discriminate fracture. Results The hip fracture group was characterized by lower BMD, lower cortical thickness, lower relative adipose tissue volume of the upper thigh, and higher extramyocellular lipid (EML) surface density. The relative volume of adipose tissue combined with EML surface density (model S1) was associated with hip fracture (AUC, 0.85; 95% confidence interval [CI]: 0.78, 0.93), as well as trochanteric trabecular BMD combined with neck cortical thickness (model B2) (AUC, 0.84; 95% CI: 0.75, 0.92). The model including all four parameters provided significantly better (P < .01) discrimination (AUC, 0.92; 95% CI: 0.86, 0.97) than model S1 or B2. Conclusion In addition to bone mineral density and geometry of the proximal femur, the amount of adipose tissue of the upper thigh and the distribution of the adipocytes in the muscles are significantly associated with acute hip fracture at CT. © RSNA, 2018 Online supplemental material is available for this article.

We report the case of a 30-year-old woman with histologically proven monostotic fibrous dysplasia of C2 revealed by a pathological fracture of the odontoid process. Radiological investigations showed a ground-glass mineralization of the vertebral body, a centimetric lytic area with poorly defined margins involving the inferior part of the vertebral body and inferior endplate and a fracture through an osteolytic area in the base of the odontoid process. Owing to the vertebral instability, a surgical procedure combining C0-C5 fixation and posterior bone grafting was performed. The surgical biopsy was inconclusive and pathological confirmation was finally obtained through a percutaneous needle biopsy under fluoroscopic guidance. At 26-month follow-up, the patient still experienced mild persistent cervical posterior neck pain and stiffness possibly related to a C5-6 laxity below the intervertebral fixation. This case combines three radiological findings, which are unusual in fibrous dysplasia: monostotic presentation involving the spine, some aggressive radiographic features, and a pathological fracture., (© The Authors, published by EDP Sciences, 2019.)

We report a case of combined percutaneous screw placement and cementoplasty guided by CT and fluoroscopy in a 66-year-old man with extensive osteolytic destruction of the right iliac bone and sacral wing due to metastasic infiltrative vesical carcinoma. The medical condition was responsible for very limited and painful walking. Two perpendicular screws were inserted into the iliac bone and sacroiliac joint, and bone cement injection was used to anchor the screws and restore the mechanical continuity of the pelvis ring. This minimally invasive procedure allowed for significant and rapid resumption of painless walking., (© The Authors, published by EDP Sciences, 2019.)

Osteoporosis circumscripta is sometimes observed at the skull vault and corresponds to the initial stage of Paget's disease of the bone. Differentiating osteoporosis circumscripta from other reasons for osteolytic images of the vault may be difficult. We report a case of osteoporosis circumscripta of the frontal bone. A lucent rim seen on CT scan, which was enhanced on gadolinium-enhanced MRI, delineated the abnormal bone. The patient was a 50-year-old woman who had CT scans of the skull for chronic sinusitis. Pathology examination showed typical bone changes of Paget's disease. The lucent and enhancing rim sign may help in differentiating Paget's disease from other conditions.