European journal of radiology
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This review focuses on the occurrence, imaging and differential diagnosis of insufficiency fractures. Prevalence, the most common sites of insufficiency fractures and their clinical implications are discussed. Insufficiency fractures occur with normal stress exerted on weakened bone. ⋯ Bone scintigraphy still plays a role in detecting fractures, with good sensitivity but limited specificity. The most important differential diagnosis is underlying malignant disease leading to pathologic fractures. Bone densitometry and clinical history may also be helpful in confirming the diagnosis of insufficiency fractures.
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In the assessment of osteoporosis, the measurement of bone mineral density (BMD(a)) obtained from dual energy X-ray absorptiometry (DXA; g/cm(2)) is the most widely used parameter. However, bone strength and fracture risk are also influenced by parameters of bone quality such as micro-architecture and tissue properties. This article reviews the radiological techniques currently available for imaging and quantifying bone structure, as well as advanced techniques to image bone quality. ⋯ The quantification of the trabecular architecture included parameters of scale, shape, anisotropy and connectivity. Finite element analyses required highest resolution, but best predicted the biomechanical properties of the bone. MR diffusion and perfusion imaging and MR spectroscopy may provide measures of bone quality beyond trabecular micro-architecture.
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The international consensus on treatment of rheumatoid arthritis (RA) involves early initiation of disease modifying anti-rheumatic drugs (DMARDs) for which a reliable identification of early disease is mandatory. Conventional radiography of the joints is considered the standard method for detecting and quantifying joint damage in RA. ⋯ In order to allow early treatment initiation and optimal guidance of the therapeutic strategy, there is a need for methods which are capable of early detection of inflammatory joint changes. In this review, we will discuss available data, advantages, limitations and potential future of MRI in RA.
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The advent of whole-body MRI (WB-MRI) has introduced tumor imaging with a systemic approach compared to established sequential, multi-modal diagnostic algorithms. Hardware innovations, such as the introduction of multi-receiver channel whole-body scanners at 1.5 T and recently 3T, combined with acquisition acceleration techniques, have made high resolution WB-MRI clinically feasible. Now, a dedicated assessment of individual organs with various soft tissue contrast, spatial resolution and contrast media dynamics can be combined with whole-body anatomic coverage in a multi-planar imaging approach. ⋯ Furthermore, it has been introduced as a whole-body bone marrow screening application. Within this context WB-MRI is highly accurate for the detection of skeletal metastases and staging of hematologic diseases, such as multiple myeloma or lymphoma. This article summarizes recent developments and applications of WB-MRI and highlights its performance within the scope of systemic oncologic staging and surveillance.
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Positron emission tomography (PET) and computed tomography (CT) complement each other's strengths in integrated PET/CT. PET is a highly sensitive modality to depict the whole-body distribution of positron-emitting biomarkers indicating tumour metabolic activity. However, conventional PET imaging is lacking detailed anatomical information to precisely localise pathologic findings. ⋯ The standard whole-body coverage simplifies staging and speeds up decision processes to determine appropriate therapeutic strategies. Further development and implementation of new PET-tracers in clinical routine will continually increase the number of PET/CT indications. This promotes PET/CT as the imaging modality of choice for working-up of the most common tumour entities as well as some of the rare malignancies.