The Top Ten

This issue of Seminars of Musculoskeletal Radiology addresses some new and some potentially difficult areas in musculoskeletal (MSK) radiology. We have specifically incorporated a top-ten tips format to help readers understand the most important points to consider regarding each of the topics discussed in this issue. Six of the articles deal with new techniques, modalities, or indications in MSK imaging, and the remaining four articles discuss more common images of entities prone to misinterpretation.

Many of us are not familiar with the new imaging technique of magnetic resonance (MR) neurography. The article by Chalian and Chhabra discusses the top-ten tips needed to get started with MR neurography, addressing anatomy, pathophysiology, clinical indications, hardware and software, protocols, interpretation, pitfalls, and reporting. This article will be tremendously helpful to those wishing to set up a successful MR neurography service.

Imaging of groin pain is another perplexing issue in MSK radiology with closely related anatomical structures and overlapping clinical presentations and terminology. In their article on imaging groin injury in athletes, Madani and Robinson clarify this commonly encountered entity, emphasizing the diagnostic interplay between clinical evaluation and imaging assessment, particularly with magnetic resonance imaging (MRI) with a view to providing the correct treatment plan.

Over the last decade, considerable changes have occurred in the evaluation of axial spondylarthritis, with imaging of the sacroiliac joints and the spine playing an important role in early diagnosis. In a review of current imaging protocols for spondyloarthropathy, Reijnierse, Eshed, and van Gaalen provide their tips for the effective imaging of axial spondylarthritis to help radiologists and rheumatologists use imaging appropriately for effective clinical decision making.

Dual-energy computed tomography (DECT) is the new kid on the block in MSK imaging, and we are fortunate to have an overview on the use and benefits of this technology with regard to MSK imaging by Walstra and colleagues. DECT has already shown considerable benefit in the management of gout and in reducing metal artifact. Its ability to detect bone marrow edema as well as helping in collagen analysis, bone marrow lesion detection, and iodine mapping, at no additional radiation dose to the patient, has yet to be fully explored. This article will be of considerable benefit to MSK radiologists who are either purchasing a DECT system or already have a system installed.

Imaging of the brachial plexus is increasingly requested in patients with upper limb pain either following trauma or otherwise. Both MRI and ultrasound have their own merits in evaluation of the brachial plexus, and these relative pros and cons are outlined in the article by Griffith and Lalam.

Fluoroscopy was traditionally used to guide joint injections. Ultrasound is also a very useful and increasingly utilized modality to guide either diagnostic or therapeutic joint injection and will no doubt become even more commonplace in this regard. For readers wishing to increase their knowledge and skill in ultrasound-guided joint injection, the top tips are outlined in the article by Lee and Griffith.

The final four articles in this issue deal with particular areas in MSK imaging that are commonly imaged, although they may still cause difficulties with interpretation. The first of these four articles outline the top-ten pitfalls in rotator cuff ultrasound which is as accurate as MRI in the detection of rotator cuff pathology. This article will be helpful to those less familiar with performing ultrasound examination of the shoulder.

The second of these four articles discusses tips for imaging the triangular fibrocartilaginous complex (TFCC) of the wrist. This article by Ng and Griffith aims to simplify imaging of this anatomically complex area by MRI. Wrist imaging is one of the final bastions of joint imaging for MSK radiologists, and this article will help smooth over the common difficulties encountered when imaging the TFCC.

Injuries to the anterior cruciate ligament (ACL) are common and a frequent indication for MRI examination of the knee. Nevertheless, assessing the ACL injury by MRI is not always straightforward. As such, Griffith and Ng offer tips for effective imaging of the ACL.

Finally, osteoporosis is an entity radiologists encounter almost every day in their clinical practice. The top-ten pitfalls associated with the diagnosis of osteoporosis and osteoporotic fracture are outlined in the article by Cheng, Griffith, and Chan.

We hope you will enjoy reading this issue of Seminars and find the top-ten format useful for delineating the relative importance of the points discussed and also find topics helpful to your clinical practice. I would like to thank the editorial team for their help and all the authors for their willingness, enthusiasm, and hard work in preparing articles for this issue.