The primary role of radiological imaging in the diagnosis of rare musculoskeletal diseases. Emphasis on ultrasound

Multidisciplinary analysis of ancient human skeletal remains using computed tomography: A case study from Cumae, Italy

BACKGROUND

Radiology is a pivotal clinical method in anthropology, offering minmally destructive examination of ancient human remains. Archaeologists frequently rely on radiology to analyse anthropological and pathological findings without damaging osteological artifacts from archaeological excavations, including those intended for museum display. Imaging plays a critical role in assessing anthropological and pathological aspects of bones in osteoarchaeological studies, providing insights into sex, age at death, stature, and various pathologies such as infections, and neoplasmas, and trauma. This study, conducted at the University Hospital "Luigi Vanvitelli" in Naples, focuses on analyzing human skeletal remains excavated from the Acropolis of Cumae (Campania, Italy), fostering collaboration among archaeologists, physical and rehabilitation medicine physicians (i.e., physiatrists) with expertise in the management of metabolic bone diseases,and radiologists. The study aims to identify and assess anthropological and pathological features of skeletal remains using advanced imaging techniques. Additionally, it highlights the role of multidisciplinary collaboration for comprehensive analysis of ancient remains, laying the basis for future research to improve knowledge in this field.

MATERIALS AND METHODS

Human remains from the cemetery of the Christian Basilica of Cumae, were catalogued and examined utilizing conventional radiography (CR) and computed tomography (CT). CT scans were conducted on bone fragments to assess integrity, density alterations, fractures, and pathologies. Each bone fragment was analyzed separately, maintaining anatomical orientation. Dual-energy CT (DECT) scans were employed in select cases, enhancing bone lesion detection.

RESULTS

The collaboration between archaeologists and radiologists facilitated the reconstruction and the identification of skeletal fragments. CT analysis revealed diverse findings across cases, including fractures, osteosclerotic areas, and degenerative changes. Detailed observations from CT scans were complemented by X-ray examinations, contributing to comprehensive skeletal analyses.

DISCUSSION

Paleoradiology, coined in 1987, has evolved with CT advancements, enabling minimally invasive examination of ancient remains. CT imaging offers superior resolution and detail compared to conventional radiography, aiding in the identification of subtle pathologies. Multidisciplinary collaboration enhances diagnostic accuracy and ensures comprehensive analyses.

CONCLUSIONS

CT analysis provides detailed insights into bone integrity and pathologies, facilitating comprehensive anthropological examinations. Multidisciplinary collaboration is essential for accurate interpretations of ancient human remains. This study represents a preliminary phase, laying the groundwork for further investigations into morpho-densitometric characteristics.

Utilization of MRI in surgical decision making in the shoulder

Background

The aim of this study is to evaluate both the utility of MRI scans and reports used in the current practice routine of shoulder surgeons and their surgical decision-making process.

Methods

Ninety-three shoulder-specialised orthopaedic surgeons of the Canadian Shoulder and Elbow Society (CSES) Orthopaedic Association were surveyed in 2020 anonymously online to help identify the use of MR-imaging and reports in managing shoulder disorders and surgical decision process.

Results

Thirty out of 93 (32.25%) CSES fellowship-trained orthopaedic surgeons participated. Respondents request MRI scans in about 55% of rotator cuff (RC) pathology and 48% of shoulder instability cases. Fifty percent of patients with potential RC pathology arrive with a completed MRI scan prior first orthopaedic consult. Their surgical decision is primarily based on patient history (45–55%) and physical examination (23–42%) followed by MRI scan review (2.6–18%), reading MRI reports (0–1.6%) or viewing other imaging (3–23%) depending on the shoulder disease. Ninety percent of surgeons would not decide on surgery in ambiguous cases unless the MR-images were personally reviewed. Respondents stated that shoulder MRI scans are ordered too frequently prior specialist visit as identified in more than 50% of cases depending on pathology.

Conclusions

The decision-making process for shoulder surgery depends on the underlying pathology and patient history. The results demonstrate that orthopaedic surgeons are comfortable reviewing shoulder MRI scans without necessarily reading the MRI report prior to a surgical decision. MRI scans are becoming an increasingly important part of surgical management in shoulder pathologies but should not be used without assessment of patient history and or physical examination.