Recent Advances in Bone and Joint Imaging—2nd Edition

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: 31 March 2025 | Viewed by 12798

Special Issue Editors


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Guest Editor
Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan
Interests: orthopaedic surgery; computer-assisted surgery; computer vision; biomechanics; hand surgery
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Guest Editor
Department of Medical Imaging, National Cheng Kung University Hospital, Tainan, Taiwan
Interests: musculoskeletal radiology; spine imaging; computer-aided diagnosis; interventional radiology
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Special Issue Information

Dear Colleagues,

Diagnostic imaging that visualizes the functions of bones and joints are highly anticipated in daily clinical practice. The diagnostic accuracy of musculoskeletal diseases has improved with the development of new imaging equipment, image processing technologies, and image analysis methods. Recently, various image analysis techniques, such as AI diagnosis, 2D-3D reconstruction, functional imaging, and fusion imaging have also been developed.

The first Special Issue entitled "Recent Advances in Bone and Joint Imaging" was so well received that it was decided to call for papers for the second edition. The purpose of this Special Issue, like the first, is to discuss the diagnosis and treatment of various musculoskeletal disorders using the latest bone-joint imaging technologies. This Special Issue will focus on current topics related to advances in bone and joint imaging, including computer-aided assessment, artificial intelligence, morphological analysis, functional imaging, and combined modalities.

Dr. Yuichi Yoshii
Dr. Chien-Kuo Wang
Guest Editors

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Published Papers (10 papers)

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Research

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10 pages, 2890 KiB  
Article
A Novel Method to Represent the Three-Dimensional Inclination of the Distal Radius Joint Surface
by Akira Ikumi, Reo Asai, Yusuke Eda, Tooru Uchida, Sho Kohyama, Takeshi Ogawa and Yuichi Yoshii
Diagnostics 2025, 15(3), 345; https://doi.org/10.3390/diagnostics15030345 - 1 Feb 2025
Viewed by 245
Abstract
Objectives: This study aims to define three-dimensional (3D) parameters for the inclination of the distal radius joint surface. The goal is to develop standardized parameters for fracture reduction through comprehensive 3D evaluations of the joint surfaces. Methods: We analyzed 112 CT scans of [...] Read more.
Objectives: This study aims to define three-dimensional (3D) parameters for the inclination of the distal radius joint surface. The goal is to develop standardized parameters for fracture reduction through comprehensive 3D evaluations of the joint surfaces. Methods: We analyzed 112 CT scans of unaffected wrists (56 males and 56 females) to construct 3D models of the distal radius. Using 3D coordinates, the normal vectors and angles were calculated based on three reference points on the distal radius joint surface. These normal vector components were then converted into unit vector components A, B, and C for the x, y, and z axes, respectively. Additionally, the angles of these unit vectors were assessed in the xy, yz, and xz planes. The 3D measurements were compared between males and females and against traditional two-dimensional (2D) parameters such as palmar tilt and radial inclination. Results: For males, the unit vector components were as follows: A: −0.14 ± 0.09, B: −0.92 ± 0.02, and C: −0.36 ± 0.07; for females, A: −0.21 ± 0.08, B: −0.90 ± 0.03, and C: −0.36 ± 0.05. Significant differences were found between males and females for the A and B vector components (representing the palmar–dorsal and proximal–distal axes, p < 0.01). The angles of the unit vectors in the xy, yz, and xz planes were 8.9 ± 5.4°/12.9 ± 5.0°, 21.3 ± 4.1°/22.1 ± 3.2°, and 22.2 ± 14.8°/28.8 ± 10.1° for males and females, respectively. There were significant differences between males and females in the angles of the xy and xz planes (sagittal and axial planes, p < 0.01). Strong correlations were observed between the xy-plane vectors and palmar tilt (r = 0.96), as well as between the yz-plane vectors and radial inclination (r = 0.88). Conclusions: This study evaluated the 3D inclination of the distal radius joint surface, revealing significant gender differences. This method, which also allows for the assessment of rotational alignment—difficult with conventional techniques—is expected to be a key 3D parameter in treating distal radius fractures. Full article
(This article belongs to the Special Issue Recent Advances in Bone and Joint Imaging—2nd Edition)
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11 pages, 5859 KiB  
Article
AI-Based Noise-Reduction Filter for Whole-Body Planar Bone Scintigraphy Reliably Improves Low-Count Images
by Csaba Csikos, Sándor Barna, Ákos Kovács, Péter Czina, Ádám Budai, Melinda Szoliková, Iván Gábor Nagy, Borbála Husztik, Gábor Kiszler and Ildikó Garai
Diagnostics 2024, 14(23), 2686; https://doi.org/10.3390/diagnostics14232686 - 28 Nov 2024
Viewed by 630
Abstract
Background/Objectives: Artificial intelligence (AI) is a promising tool for the enhancement of physician workflow and serves to further improve the efficiency of their diagnostic evaluations. This study aimed to assess the performance of an AI-based bone scan noise-reduction filter on noisy, low-count [...] Read more.
Background/Objectives: Artificial intelligence (AI) is a promising tool for the enhancement of physician workflow and serves to further improve the efficiency of their diagnostic evaluations. This study aimed to assess the performance of an AI-based bone scan noise-reduction filter on noisy, low-count images in a routine clinical environment. Methods: The performance of the AI bone-scan filter (BS-AI filter) in question was retrospectively evaluated on 47 different patients’ 99mTc-MDP bone scintigraphy image pairs (anterior- and posterior-view images), which were obtained in such a manner as to represent the diverse characteristics of the general patient population. The BS-AI filter was tested on artificially degraded noisy images—75, 50, and 25% of total counts—which were generated by binominal sampling. The AI-filtered and unfiltered images were concurrently appraised for image quality and contrast by three nuclear medicine physicians. It was also determined whether there was any difference between the lesions seen on the unfiltered and filtered images. For quantitative analysis, an automatic lesion detector (BS-AI annotator) was utilized as a segmentation algorithm. The total number of lesions and their locations as detected by the BS-AI annotator in the BS-AI-filtered low-count images was compared to the total-count filtered images. The total number of pixels labeled as lesions in the filtered low-count images in relation to the number of pixels in the total-count filtered images was also compared to ensure the filtering process did not change lesion sizes significantly. The comparison of pixel numbers was performed using the reduced-count filtered images that contained only those lesions that were detected in the total-count images. Results: Based on visual assessment, observers agreed that image contrast and quality were better in the BS-AI-filtered images, increasing their diagnostic confidence. Similarities in lesion numbers and sites detected by the BS-AI annotator compared to filtered total-count images were 89%, 83%, and 75% for images degraded to counts of 75%, 50%, and 25%, respectively. No significant difference was found in the number of annotated pixels between filtered images with different counts (p > 0.05). Conclusions: Our findings indicate that the BS-AI noise-reduction filter enhances image quality and contrast without loss of vital information. The implementation of this filter in routine diagnostic procedures reliably improves diagnostic confidence in low-count images and elicits a reduction in the administered dose or acquisition time by a minimum of 50% relative to the original dose or acquisition time. Full article
(This article belongs to the Special Issue Recent Advances in Bone and Joint Imaging—2nd Edition)
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9 pages, 1065 KiB  
Article
Assessing Femoral Head Medialization in Developmental Hip Dysplasia Type 1 and Type 2 Hip Separation
by Sonay Aydin, Onder Durmaz, Erdem Fatihoglu, Ozlem Kadirhan and Erdal Karavas
Diagnostics 2024, 14(20), 2317; https://doi.org/10.3390/diagnostics14202317 - 18 Oct 2024
Viewed by 688
Abstract
Background/Objectives: The prevalence of developmental hip dysplasia is estimated to be 0.1–2 per 1000 infants. Hip imaging by ultrasonography is considered to be the gold standard method for screening and detecting developmental dysplasia of the hip (DDH), as per the Graf categorization. The [...] Read more.
Background/Objectives: The prevalence of developmental hip dysplasia is estimated to be 0.1–2 per 1000 infants. Hip imaging by ultrasonography is considered to be the gold standard method for screening and detecting developmental dysplasia of the hip (DDH), as per the Graf categorization. The classification of hip differentiation into type 1 and type 2 is determined by the alpha angle, as assessed by the Graf classification. Type 1 hips are defined as those with an alpha angle exceeding 60 degrees, whilst type 2 hips are defined as those with measurements falling within the range of 50 to 59 degrees. Methods: The computerized patient card in our institution had a compilation of 208 hip photographs taken from 110 patients, with 98 of them being bilateral. The acquisition of these photos occurred from January 2020 to December 2020. A retrospective review was conducted on the ultrasound (US) scans, with a specific emphasis on the outcomes related to type 1 and type 2 hips. Results: There were 108 high-resolution US photos in the type 1 hip group and 100 high-resolution US images in the type 2 hip group. In terms of unilateral or bilateral cases, gender, or age, no statistically significant differences were seen between the two groups (p > 0.05). The FMD model exhibited a sensitivity of 86% and specificity of 70% in effectively predicting the presence of type 1 mature hips when the values surpassed 2.9 mm. The AUC (area under the curve) value achieved was 0.628. Conclusions: The process of diagnostic categorization may occasionally encounter challenges in accurately differentiating between type 1 and type 2 hip separation subsequent to a hip ultrasound examination. The findings of our analysis indicate that the assessment of the FMD is a highly successful method, demonstrating both high specificity and sensitivity in differentiating between various scenarios. Full article
(This article belongs to the Special Issue Recent Advances in Bone and Joint Imaging—2nd Edition)
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10 pages, 1804 KiB  
Article
The Development of a Yolov8-Based Model for the Measurement of Critical Shoulder Angle (CSA), Lateral Acromion Angle (LAA), and Acromion Index (AI) from Shoulder X-ray Images
by Turab Selçuk
Diagnostics 2024, 14(18), 2092; https://doi.org/10.3390/diagnostics14182092 - 22 Sep 2024
Viewed by 721
Abstract
Background: The accurate and effective evaluation of parameters such as critical shoulder angle, lateral acromion angle, and acromion index from shoulder X-ray images is crucial for identifying pathological changes and assessing disease risk in the shoulder joint. Methods: In this study, a YOLOv8-based [...] Read more.
Background: The accurate and effective evaluation of parameters such as critical shoulder angle, lateral acromion angle, and acromion index from shoulder X-ray images is crucial for identifying pathological changes and assessing disease risk in the shoulder joint. Methods: In this study, a YOLOv8-based model was developed to automatically measure these three parameters together, contributing to the existing literature. Initially, YOLOv8 was used to segment the acromion, glenoid, and humerus regions, after which the CSA, LAA angles, and AI between these regions were calculated. The MURA dataset was employed in this study. Results: Segmentation performance was evaluated with the Dice and Jaccard similarity indices, both exceeding 0.9. Statistical analyses of the measurement performance, including Pearson correlation coefficient, RMSE, and ICC values demonstrated that the proposed model exhibits high consistency and similarity with manual measurements. Conclusions: The results indicate that automatic measurement methods align with manual measurements with high accuracy and offer an effective alternative for clinical applications. This study provides valuable insights for the early diagnosis and management of shoulder diseases and makes a significant contribution to existing measurement methods. Full article
(This article belongs to the Special Issue Recent Advances in Bone and Joint Imaging—2nd Edition)
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18 pages, 2634 KiB  
Article
Preoperative Assessment of Medication-Related Osteonecrosis of the Jaw Using [18F]fluoride Positron Emission Tomography (PET)/CT and [18F]fluorodeoxyglucose PET/MRI in Correlation with Histomorphometry and Micro-CT—A Prospective Comparative Study
by Christian Philipp Reinert, Christina Pfannenberg, Brigitte Gückel, Helmut Dittmann, Christian la Fougère, Konstantin Nikolaou, Siegmar Reinert, Rouven Schönhof and Sebastian Hoefert
Diagnostics 2024, 14(4), 428; https://doi.org/10.3390/diagnostics14040428 - 15 Feb 2024
Viewed by 1512
Abstract
Objectives: The purpose of this study was to investigate the imaging characteristics of medication-related osteonecrosis of the jaw (MRONJ) using [18F]fluoride positron emission tomography/computed tomography (PET/CT) and [18F]fluorodeoxyglucose (FDG) PET/magnetic resonance imaging (MRI) for preoperative assessment and to correlate them with microarchitectural and [...] Read more.
Objectives: The purpose of this study was to investigate the imaging characteristics of medication-related osteonecrosis of the jaw (MRONJ) using [18F]fluoride positron emission tomography/computed tomography (PET/CT) and [18F]fluorodeoxyglucose (FDG) PET/magnetic resonance imaging (MRI) for preoperative assessment and to correlate them with microarchitectural and histomorphometric data with respect to clinical findings. Methods: Twelve patients (five female; mean age 75 ± 7.6 yr) with symptomatic MRONJ underwent both scans on the same day, and imaging findings were used to plan surgical interventions for seven patients. Bone tracer uptake was classified as high, medium, or low, and surgical samples were evaluated using Micro-CT and histomorphometric analysis. Results: CT showed medullary sclerosis in all patients, and MRI revealed gadolinium enhancement in four patients. PET imaging revealed remarkably elevated [18F]fluoride uptake and moderately increased [18F]FDG uptake in MRONJ compared to healthy jawbones, with both differences being statistically significant. [18F]fluoride uptake was associated with necrosis, bacteria, and inflammatory tissue. Micro-CT data did not show significant differences, but histomorphometric analysis revealed higher osteocyte and lacunae densities in the high [18F]fluoride uptake group, and more necrotic bone in the medium [18F]fluoride uptake group. Bacteria were observed in all areas. Conclusions: In summary, [18F]fluoride PET accurately identified MRONJ extent, revealing functional changes in jawbone remodeling not visible on CT. [18F]FDG PET showed differences in bone and soft tissue, though less pronounced. This method aids in evaluating disease activity and guiding treatment planning, requiring further research for optimal surgical approaches based on tracer uptake. Full article
(This article belongs to the Special Issue Recent Advances in Bone and Joint Imaging—2nd Edition)
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11 pages, 2309 KiB  
Article
Detection of Factors Related to the Development of Osteochondritis Dissecans in Youth Baseball Players Screening
by Shotaro Teruya, Takeshi Ogawa, Hiroki Yamada, Hiromitsu Tsuge, Ryuhei Michinobu, Kazuhiro Ikeda, Yuki Hara, Hiroshi Kamada, Masashi Yamazaki and Yuichi Yoshii
Diagnostics 2023, 13(23), 3589; https://doi.org/10.3390/diagnostics13233589 - 3 Dec 2023
Viewed by 1342
Abstract
On-field screening for ‘elbow injury in baseball’, a condition commonly seen in youth baseball players, was conducted over two years on 160 elementary school students in Ibaraki Prefecture, Japan. This on-field screening was conducted in collaboration with the Ibaraki Prefecture High School Baseball [...] Read more.
On-field screening for ‘elbow injury in baseball’, a condition commonly seen in youth baseball players, was conducted over two years on 160 elementary school students in Ibaraki Prefecture, Japan. This on-field screening was conducted in collaboration with the Ibaraki Prefecture High School Baseball Federation. Pitchers, catchers, symptomatic players, and players who had previously experienced elbow pain were given a comprehensive evaluation that included a physical exam and ultrasound. Out of the 135 students who were successfully screened, 10 were diagnosed with osteochondritis dissecans of the humeral capitellum (OCD). Notably, seven among these were asymptomatic. This assessment identified limited range of motion and pain when extending their elbow as significant risk factors for OCD. An attempt at on-field screening for baseball elbow injuries in collaboration with the local baseball federation was introduced. The risk factors for OCD were identified. Considering these factors, more efficient screening will be possible in the next attempt. Full article
(This article belongs to the Special Issue Recent Advances in Bone and Joint Imaging—2nd Edition)
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12 pages, 1329 KiB  
Article
Coexistence of Vertebral and Intervertebral Disc Changes in Low Back Pain Patients—In Depth Characterization with Same Day MRI and CT Discography
by Hanna Hebelka, Alfred Erkmar, Helena Brisby and Kerstin Lagerstrand
Diagnostics 2023, 13(23), 3528; https://doi.org/10.3390/diagnostics13233528 - 24 Nov 2023
Cited by 2 | Viewed by 1182
Abstract
The aim of this study was to investigate to what extent annular fissures, vertebral and endplate changes, and Modic changes (MCs), coexist in low back pain (LBP) patients by using multiple imaging modalities. Sixty-two LBP patients (mean age 45 years, range 24–63, 53% [...] Read more.
The aim of this study was to investigate to what extent annular fissures, vertebral and endplate changes, and Modic changes (MCs), coexist in low back pain (LBP) patients by using multiple imaging modalities. Sixty-two LBP patients (mean age 45 years, range 24–63, 53% men) were examined with same-day CT-discography and MRI. Intervertebral discs punctured for discography (n = 204) were evaluated on MRI [Pfirrmann grade, High-Intensity Zone (HIZ)] and on CT-discograms [Modified Dallas Discogram Score (DDS)]. DDS≥ 1, i.e., disc fissures involving the outer annulus were further digitomized into delimitable fissuring (<50% of annulus affected) or non-delimitable annular fissuring. Using both MRI and CT, adjacent vertebrae and endplates were assessed for MC, vertebral sclerosis, and a modified endplate defect score (EPS). In 194 discs the contrast agent was adequately injected during discography, of which 160 (83%) displayed outer annular fissures, with 91 (47%) of the latter being delimitable fissures. Most discs with delimitable fissures were moderately degenerated; 68% Pfirrmann grade ≤3, 71% EPS ≤ 2, and 12% displayed MC. The majority (76%) of MCs were associated with advanced adjacent disc degeneration; 84% Pfirrmann grade ≥4, 76% with non-delimitable annular fissuring, 59% EPS≥ 4, and 34% EPS of 3. A total 95 HIZ (47%) were found, of which 54 had delimitable fissuring, while the remainder displayed non-delimitable fissuring. Vertebral sclerosis was commonly observed (26%), both with MCs (73%) and without MCs (27%), and not specifically linked to MC type 3. A total of 97% of segments with vertebral sclerosis displayed outer annular fissures. These findings were significant (0.046 > p > 0.0001), except between HIZ and adjacent sclerosis (p = 0.303). To conclude, the present study confirmed a close interplay between the disc and adjacent vertebra and endplates. The fact that a majority of discs with delimitable annular fissures did not coexist with pronounced endplate changes and/or MCs, however, supports the theory that disc fissuring is an early event in the degenerative cascade. This was further supported by the fact that MCs were strongly linked to extensive disc fissuring and to advanced endplate damage. Further, vertebral sclerosis was common also in vertebra without MCs and strongly associated to annular fissuring, indicating that sclerosis is a previously underestimated feature of a general degenerative process. Full article
(This article belongs to the Special Issue Recent Advances in Bone and Joint Imaging—2nd Edition)
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Review

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22 pages, 14276 KiB  
Review
Superscan Pattern on Bone Scintigraphy: A Comprehensive Review
by Emran Askari, Sara Shakeri, Hessamoddin Roustaei, Maryam Fotouhi, Ramin Sadeghi, Sara Harsini and Reza Vali
Diagnostics 2024, 14(19), 2229; https://doi.org/10.3390/diagnostics14192229 - 6 Oct 2024
Viewed by 2682
Abstract
Background/Objectives: The superscan pattern is a characteristic finding on bone scintigraphy, associated with a variety of metabolic bone diseases, malignancies, and other conditions. This pattern is characterized by a diffuse and intense uptake of radiotracer throughout the entire skeleton. Despite being a relatively [...] Read more.
Background/Objectives: The superscan pattern is a characteristic finding on bone scintigraphy, associated with a variety of metabolic bone diseases, malignancies, and other conditions. This pattern is characterized by a diffuse and intense uptake of radiotracer throughout the entire skeleton. Despite being a relatively rare finding, the superscan pattern can have significant clinical implications. Methods: This comprehensive review summarizes the available literature on the superscan pattern, focusing on its pathophysiology, clinical significance, and differential diagnoses. Relevant studies and case reports were analyzed to outline the diagnostic challenges associated with the interpretation of bone scintigraphy featuring the superscan pattern. Results: The literature highlights the clinical significance of the superscan pattern in various metabolic and oncologic conditions. Misinterpretation of this pattern can lead to diagnostic challenges, especially in distinguishing it from other pathologic conditions. Differential diagnosis remains crucial in the accurate interpretation and subsequent management of patients with this finding. Conclusions: This review provides a comprehensive overview of the superscan pattern on bone scintigraphy, aiming to assist clinicians in recognizing and managing this rare yet clinically important finding. Full article
(This article belongs to the Special Issue Recent Advances in Bone and Joint Imaging—2nd Edition)
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22 pages, 1654 KiB  
Review
Osteochondritis Dissecans of the Elbow in Overhead Athletes: A Comprehensive Narrative Review
by Andro Matković, Thomas Ferenc, Damjan Dimnjaković, Nikolina Jurjević, Vinko Vidjak and Branka R. Matković
Diagnostics 2024, 14(9), 916; https://doi.org/10.3390/diagnostics14090916 - 28 Apr 2024
Viewed by 1328
Abstract
Osteochondritis dissecans (OCD) of the elbow mainly occurs in overhead athletes (OHAs). This narrative review aimed to comprehensively analyze the epidemiological data, etiological factors, clinical and imaging features, treatment options, and outcomes of OHAs with the diagnosis of elbow OCD. A literature search [...] Read more.
Osteochondritis dissecans (OCD) of the elbow mainly occurs in overhead athletes (OHAs). This narrative review aimed to comprehensively analyze the epidemiological data, etiological factors, clinical and imaging features, treatment options, and outcomes of OHAs with the diagnosis of elbow OCD. A literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science. Individuals with elbow OCD were usually 10–17 years of age with incidence and prevalence varying between studies, depending on the sport activity of the patients. The etiology of OCD lesions is multifactorial, and the main causes are believed to be repetitive trauma, the biomechanical disproportion of the articular surfaces, poor capitellar vascular supply, and inflammatory and genetic factors. Athletes usually presented with elbow pain and mechanical symptoms. The mainstay for the diagnosis of elbow OCD is MRI. The treatment of elbow OCD lesions should be conservative in cases of stable lesions, while various types of surgical treatment are suggested in unstable lesions, depending mainly on the size and localization of the lesion. The awareness of medical practitioners and the timely diagnosis of OCD lesions in OHAs are key to favorable outcomes. Full article
(This article belongs to the Special Issue Recent Advances in Bone and Joint Imaging—2nd Edition)
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Other

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7 pages, 1782 KiB  
Interesting Images
A Case Showing a New Diagnostic Aspect of the Application of Radiofrequency Echographic Multi-Spectrometry (REMS)
by Nikola Kirilov, Fabian Bischoff, Stoyanka Vladeva and Elena Bischoff
Diagnostics 2023, 13(20), 3224; https://doi.org/10.3390/diagnostics13203224 - 17 Oct 2023
Cited by 3 | Viewed by 1333
Abstract
Radiofrequency echographic multi-spectrometry (REMS) is an ultrasound technique that has been recently introduced in the medical field to detect osteoporosis and fracture risk at axial sites. The use of sonography to visualize the region of interest (ROI) of the hip neck provides the [...] Read more.
Radiofrequency echographic multi-spectrometry (REMS) is an ultrasound technique that has been recently introduced in the medical field to detect osteoporosis and fracture risk at axial sites. The use of sonography to visualize the region of interest (ROI) of the hip neck provides the opportunity to identify occult fractures. A 91-year-old woman with persistent right leg pain was referred to rheumatologist due to a known history of arthritis and osteoporosis. She was able to walk using a crutch, although experiencing an antalgic gait. The patient had recently fallen on her right side from standing height. During the visualization of the ROI of the right femoral neck using REMS, an abrupt break of the femoral cortex suspected to be a fracture was seen; therefore, the measurement of the femoral neck was performed on the left side. The T-score had value of −2.9 SD and the fragility score was 86.7. Due to unclear signs of a fracture after an X-ray of the hip, a computed tomography (CT) exam of the hip was performed, which revealed a femoral neck fracture. Occult fractures of the femoral neck are challenging to diagnose and require numerous radiologic exams. The use of ultrasound as a method to measure bone density allows the simultaneous diagnosis of osteoporosis and detection of fractures. Full article
(This article belongs to the Special Issue Recent Advances in Bone and Joint Imaging—2nd Edition)
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