Computed Tomography: State-of-the-Art Advancements in Musculoskeletal Imaging

ABSTRACT

Although musculoskeletal magnetic resonance imaging (MRI) plays a dominant role in characterizing abnormalities, novel computed tomography (CT) techniques have found an emerging niche in several scenarios such as trauma, gout, and the characterization of pathologic biomechanical states during motion and weight-bearing. Recent developments and advancements in the field of musculoskeletal CT include 4-dimensional, cone-beam (CB), and dual-energy (DE) CT. Four-dimensional CT has the potential to quantify biomechanical derangements of peripheral joints in different joint positions to diagnose and characterize patellofemoral instability, scapholunate ligamentous injuries, and syndesmotic injuries. Cone-beam CT provides an opportunity to image peripheral joints during weight-bearing, augmenting the diagnosis and characterization of disease processes. Emerging CBCT technologies improved spatial resolution for osseous microstructures in the quantitative analysis of osteoarthritis-related subchondral bone changes, trauma, and fracture healing. Dual-energy CT-based material decomposition visualizes and quantifies monosodium urate crystals in gout, bone marrow edema in traumatic and nontraumatic fractures, and neoplastic disease. Recently, DE techniques have been applied to CBCT, contributing to increased image quality in contrast-enhanced arthrography, bone densitometry, and bone marrow imaging. This review describes 4-dimensional CT, CBCT, and DECT advances, current logistical limitations, and prospects for each technique.

Low-grade ductal carcinoma in situ (DCIS) arising in a fibroadenoma of the breast during 5 years follow-up: A case report

RATIONALE

Fibroadenoma (FA) is a common type of benign breast tumors but ductal carcinoma in situ (DCIS) rarely arises within this tumor type.

PATIENT CONCERNS

This case report presents a non-symptomatic 61-year-old woman with FA that was coincidentally found during a breast cancer screening program performed 5 years ago by her city of residence. She had subsequently been followed-up with mammography and breast ultrasound (US). US showed a slightly enlarged tumor and dynamic magnetic resonance imaging (MRI) indicated malignancy within the FA.

DIAGNOSIS

The pathological examination revealed low-grade DCIS within the FA.

INTERVENTIONS

The patient underwent a core needle biopsy followed by breast-conserving therapy with sentinel lymph node biopsy and then postoperative radiation therapy.

OUTCOMES

Currently, she has been followed-up for 2 years without no signs of recurrence.

LESSONS

Careful observation with US followed by dynamic MRI is essential in the early diagnosis of DCIS originating in a FA.