0:00

Thank you, uh, Minnie.

0:02

That was, uh, absolutely spectacular.

0:05

And, uh, uh, obviously with, uh, complicated anatomy

0:09

and so many, uh, tendons

0:11

and muscles, uh, to, uh, think about.

0:14

We're gonna move on to, to our first case discussion,

0:18

and I have privilege to introduce Dr.

0:20

Eddie Smit, one of our younger, uh,

0:24

bone radiologist.

0:25

Eddie is, uh, in charge of our fellowship program.

0:30

He's also in charge of our visiting scholar program.

0:34

Uh, so any visitors who might want to consider coming

0:38

to UCSD, Eddie is your man.

0:40

He's a terrific, uh, bone radiologist, good communicator,

0:44

and I really appreciate Eddie, your willingness to, uh,

0:49

showcases during this, uh, first day.

0:51

So it's all yours. Okay, Eddie,

0:54

This comedic relief, sir.

0:55

You forgot that. All right. So, thank you.

1:00

Uh, thank you for, uh, MRI online committee, uh,

1:03

course directors and, and Dr.

1:05

Resnick, of course, for, uh, inviting me to, um, do, uh,

1:09

or share some of these cases.

1:11

Uh, I believe I have two sessions,

1:13

and the first session, I figured, um, we can start with, uh,

1:18

m some MSK tumors.

1:20

I am, uh, my bias, uh, in MSK, uh,

1:24

radiology is towards tumors, trauma and, um, infection.

1:28

So, uh, we'll leave, uh, I guess the more sports related,

1:32

uh, cases

1:34

for my second session later today, if that's all right.

1:37

And we will dive right in into some, uh, a couple of tumor,

1:41

uh, and, uh, tumor like lesions.

1:44

Uh, I also am aware of some of the, uh, questions

1:48

that the audience, um, gave to, uh, this panel, uh,

1:53

earlier today or perhaps even over the weekend,

1:55

regarding some, uh, uh, topics that, uh,

1:58

we would like touched upon, uh,

2:00

during today's case sessions.

2:02

And the major one here is probably, uh, in regards

2:05

to tumors gonna be, um, some diffusion weighted imaging.

2:08

So with that, um, uh,

2:12

will slide into the first case,

2:14

and I believe this was a case, uh, the history

2:17

that we got was, uh, adult with, uh, hip pain.

2:20

Now, here at UCSD, we have the luxury of, uh,

2:23

having a robust

2:24

and, uh, continually growing, uh, burgeoning, if you will,

2:27

uh, uh, orthopedic oncology, uh, um, uh, colleagues

2:32

that, that are growing.

2:34

And they bring us some really interesting cases.

2:36

So we, we get, we, we have the privilege of really, uh,

2:39

helping in the care of some of these complicated cases.

2:42

And so in this first case,

2:44

as we see here in this radiograph, we see, uh, uh,

2:47

jumping right into the saline finding.

2:49

We see this, uh, ossific

2:51

and calcific densities, if you will, in

2:54

and about the, uh, right hip.

2:56

And we can see that these, uh, calcifications on this,

2:59

this cropped and zoomed up images

3:00

of a frog leg lateral view of the right hip.

3:03

We see that these, uh, ossific calcific dens arguably kind

3:07

of look like, uh, popcorn, uh, like an appearance signifying

3:11

or indicating that we're probably dealing

3:13

with some conduit matrix, uh, looking through all the, uh,

3:17

clutter or, or busyness, if you will, on this lateral, uh,

3:21

uh, lateral view, uh,

3:23

or frog leg, uh, lateral view of the right hip.

3:25

We can see there are also some subtle erosions trying

3:28

to squinting our eyes, looking through these, uh, uh,

3:31

bodies, if you will, uh, sort of scalloping

3:34

and causing a chronic osce remodeling of the, uh,

3:37

femoral head, uh, and neck junction,

3:39

particularly sup laterally here.

3:41

Uh, as you can see on my cross hairs, moving right along

3:46

into the patient's, uh, Mr.

3:49

That, uh, we were giving from an outside institution.

3:52

Uh, I like to start with, uh, localizers.

3:54

And sometimes I, I get asked, uh, how I set up

3:57

and look at things, but in general,

3:59

I like my coronals on top and, uh, axials

4:02

and, uh, sagal on the bottom.

4:04

Um, so in this case, we'll hang up the large field of view,

4:08

coronal, along with the small field of view, uh,

4:10

coronal fluid sensitive, and then the axial

4:12

and, um, uh,

4:14

sagal in the bottom right hand corner of our screen.

4:17

So let me just, uh, window

4:18

and level this appropriately, the sagittal.

4:21

So going along with our, uh, radiographic findings,

4:24

we can see again, uh, centered in

4:27

and about that, uh, right hip, okay, um, right hip joint,

4:31

we can see those, uh, bodies again causing, okay,

4:36

that chronic erosion along the anterior aspect

4:39

of the femoral head and neck junction here of the right hip.

4:42

And correlating with our radiographs.

4:44

Obviously, we know that this is probably in the more mature

4:48

or, uh, I wanna say advanced,

4:50

but, uh, more, I guess mature phase of what's likely, uh,

4:54

synovial, uh, osteo chondro mitosis.

4:57

Obviously, if, uh, these weren't dark

5:00

and we didn't have our previous, uh, radiograph showing

5:02

that these, uh, uh, chondrocytes were ossified

5:06

or relatively more mature,

5:08

then we would use just the term synovial con mitosis.

5:12

Now, synovial con mitosis, uh, as most of us know, uh, is a,

5:17

basically a pseudotumor condition of, uh, uh,

5:21

can be divided into, uh, primary and secondary forms.

5:24

Okay? The, the primary forms,

5:26

or primary sc for short is thought to be due to a metaplasia

5:30

that takes place within the synovial lining or that membrane

5:33

and the cartilages.

5:34

These cartilages nodules sort of, uh, flake

5:37

or break off later

5:38

and detach from the synovial,

5:40

forming the loose bodies within the joint cavity,

5:42

and typically with the primary synovial choma ptosis

5:45

or osteo osteo mitosis, these bodies are typically

5:49

what I like to call monotonous and uniform boring, okay?

5:53

Uniform in appearance,

5:55

and typically about a centimeter or so in size.

5:57

Juxtapose that in my, our mind's eye

6:00

with secondary synovial con mitosis

6:02

or osteo caustic osis, that's simply due

6:05

to cartilage nodules that develop in the presence of

6:09

cartilage, uh, loose bodies

6:11

or intraarticular bodies that sort of flake

6:13

and fragment off of the, in this case, the femoral head

6:17

or the acetabular lining, right?

6:19

And that's typically what we're gonna see

6:21

with chronic osteoporosis and what have you.

6:24

It can also happen, as we know, related to, you know, osteo

6:28

stefans or old osteochondral injuries

6:29

or lesions, whatever terms you use, rheumatoid arthritis,

6:33

prior trauma infection, or when it's really bad

6:37

and we start to lose bone, uh, uh,

6:39

bone stock and what have you.

6:41

Uh, the other big thing to think of is a neuropathic joint,

6:44

perhaps in a patient with, uh, prior traumatic brain injury

6:47

or, or spinal cord injury.

6:49

So, in both of these cases, though, as you can imagine,

6:52

these bodies can ultimately lead to further

6:55

or accelerated joint damage,

6:57

and which is what we, what we don't wanna see.

6:59

And, uh, advance primary or secondary,

7:02

or, sorry, uh, secondary degenerative changes

7:04

or osteophytic change.