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AMS2017inTokyoAMS 2017 in Tokyo“RadiologyandPathology:APairof“Radiology and Pathology :WheelsofMSK”
A Pairof Wheels of MSK”
January20and21,2017
January 20 and 21, 201719㼠㼔th㻭㼟㼕㼍㼚㻌㻹㼡㼟㼏㼡㼘㼛㼟㼗㼑㼘㼑㼠㼍㼘㻌㻿㼛㼏㼕㼑㼠㼥
Asian Musculoskeletal Society㻝㻥
Annual Meeting㻭㼚㼚㼡㼍㼘㻌㻹㼑㼑㼠㼕㼚㼓㻼㼞㼑㼟㼕㼐㼑㼚㼠㻌㻷㼡㼚㼕㼔㼕㼗㼛㻌㻲㼡㼗㼡㼐㼍
President Kunihiko Fukuda㻰㼑㼜㼍㼞㼠㼙㼑㼚㼠㻌㼛㼒㻌㻾㼍㼐㼕㼛㼘㼛㼓㼥㻌
Department of Radiology㼀㼔㼑㻌㻶㼕㼗㼑㼕㻌㼁㼚㼕㼢㼑㼞㼟㼕㼠㼥㻌㻿㼏㼔㼛㼛㼘㻌㼛㼒㻌㻹㼑㼐㼕㼏㼕㼚㼑The Jikei University School of Medicine➨㻞㻤ᅇ᪥ᮏ㦵㌾㒊ᨺᑕ⥺◊✲఍
第28 回日本骨軟部放射線研究会
第57回 ᪥ᮏ⑓⌮Ꮫ఍
日本病理学会 ᪥ᮏ㦵㌾㒊⭘⒆◊✲఍
日本骨軟部腫瘍研究会
➨57ᅇ
ྜྠ㛤ദ
合同開催

఍ᮇ䠖 㻞㻜㻝㻣ᖺ㻝᭶㻞㻜᪥䠄㔠䠅䞉㻞㻝᪥䠄ᅵ䠅
会期：2017
年 1 月 20 日
（金）
・21 日
（土）
఍ሙ䠖 ᮾிឿᜨ఍་⛉኱Ꮫ ኱Ꮫ㻝ྕ㤋
会場：東京慈恵会医科大学
大学 1 号館ͱ㻝㻜㻡㻙㻤㻠㻢㻝 ᮾி㒔༊す᪂ᶫ㻟㻙㻞㻡㻙㻤〒105-8461
東京都港区西新橋
3-25-8

Welcome address
Dear colleagues,
We are delighted to have the 19th Annual Meeting and Refresher Course of the Asian
Musculoskeletal Society (AMS) 2017 in Tokyo on 20 and 21 January, 2017. It will be a
Joint Meeting of AMS, Japanese Society of Musculoskeletal Radiology (JSMR) and Bone
& Soft Tissue Tumour Club of Japanese pathologists (BTC). On behalf of the Local
Organizing Committee, I would like to express my gratitude to all who participate inthis meeting.
The theme of the AMS 2017 is “Pathology and Radiology: A Pair of Wheels of MSK”.
The Venue is The Jikei University School of Medicine, Tokyo. During the 2-day session,
joint AMS-JSMR-BTC sessions are scheduled in addition to the AMS sessions. We
welcome submissions of e-poster presentation. Case report and scientific research arewelcome.
We hope this meeting will be a unique opportunity to exchange ideas and knowledge
among AMS and JSMSR members. All the members of Local Organizing Committee arelooking forward to meeting all of you in Tokyo.

⚟⏣ඛ⏕෗┿

Kunihiko Fukuda, M.D.
Chair of Local Organizing Committee
Professor of Radiology
The Jikei University School of Medicine
January, 2017-1-

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Conference Information

Registra

Name of the conference:
The 19th Annual Meeting and Refresher Course of the Asian Musculoskeletal Society(AMS) 2017 joint with the 28th Japanese Society of Musculoskeletal Radiology (JSMR)
and the 57th Bone & Soft Tissue Tumor Club (BTC) of JapanFee :Theme :
“Radiology and Pathology : A Pair of Wheels of MSK”

Date :
January 20 and 21, 2016

Venue :The Jikei University School of Medicine, Tokyo

Name baCommittee
Faculty of AMS

AMS 2017 Organizing Committee

President

Kunihiko Fukuda, Japan: Kunihiko Fukuda, Japan

Vice President : Cheng Xiao Guang, China

Wilfred CG Peh, Singapore

Immediate Past President: Yang Seoung Oh, South Korea

Sri Andreani Utomo, Indonesia

Treasurer: Lisa Wong, Hong Kong

Secretary: Sri Andreani Utomo, Indonesia

Dinner f

Languag

Local Organizing Committee

Assistant Secretary: Chou Hong, Singapore

Jun Aoki, Gunma
Takatoshi Aoki, Fukuoka

Committee members:

Masataka Uetani, Nagasaki

Khalid Al-Ismail, Saudi Arabia

Shigeru Ehara, Iwate

Nuttaya Pattamapaspong, Thailand

Tamotsu Kamishima, Sapporo

Prabhakar Reddy, India

Hideharu Sugimoto, Tochigi

Tamotsu Kamishima, Japan

Hajime Fujimoto, Shizuoka

Smoking

Cellular

Yuko Kobashi, TokyoAMS 2017 Conference Secretariat
Department of Radiology, The Jikei University School of Medicine
3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
TEL: +81-3-3433-1111(EXT. 3360)
E-mail: ams2017@jikei.ac.jp
Co-sponsored by :FUJIFILM Medical Co., Ltd.
Bayer Yakuhin, Ltd.

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Registration :The registration desk will be located on the 3rd floor of the venue in following hours.
January 20 (Fri.) 8:00-17:30
January 21 (Sat.) 8:00-17:00
Fee :All participants will be required to pay the fee of JPY15,000.- for participation.
(Japanese yen is only accepted.)
This amount enables you to access to all scientific sessions of 19th AMS, 28th JSMR, 57th
BTC and every social programs. (Abstract book is also included)
Name badge, bill of receipt and certificate of attendance :Name badge will be handed at the registration desk in exchange of payment. You arekindly requested to wear the badge during all congress sessions and events.
Bill of receipt and certificate of attendance is also handed at the registration desk.

g Committee

mmitteeDinner for all the participants :Dinner for all the participants will be held in “Yomeiden” (Chinese cuisine) , The Prince
Park Tower Tokyo at 19:00 pm on Friday, January 20th.
Language :The official language for AMS is English. There will be no interpretation provided.
Smoking policy :Smoking is prohibited at any time in the meeting halls, reception party room or any
other places in the building except Smoking Area. Your kind understanding is highly
appreciated.
Cellular Phones :Please be sure to turn off or set to silent-mode while attending sessions.

-3-

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Presentation guidelines
Official Language :English in AMS (Japanese in JSMR and BTC but all slides are in English)‫ ۼ‬There will be no interpretations
Equipment for presentation:
The following will be prepared by the Previewing Desk staff:‫ ۼ‬Windows PC‫ ۼ‬TFT monitor and connecting cable (Mini D-Sub15 pin)
Attention:‫ ۼ‬Speakers are required to bring their own PC.
‫ ۼ‬The Previewing Desk will be located at the lobby of the AMS Venue, 3rd floor, whichis available from 8:00 a.m. on January 20-21.
‫ ۼ‬Speakers are required to check-in at the previewing desk to verify that your PC
works properly at least 30 min. prior to the session starts.
‫ ۼ‬Please be sure to complete everything including Q&A̓s within the set period ofsession time. Session time is as follow:- Awards Papers : 9min. (7min+2min)- Refresher Course: 20min.
‫ ۼ‬Slideshow shall be clicked by each speaker. For technical assistance, please find an
AV operator in the hall.

-4-

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㼠㼔㼑㻌㻝㻥㼠㼔㻌㻭㼚㼚㼡㼍㼘㻌㻹㼑㼑㼠㼕㼚㼓㻌㼍㼚㼐㻌㻾㼑㼒㼞㼑㼟㼔㼑㼞㻌㻯㼛㼡㼞㼟㼑㻌㼛㼒㻌㼠㼔㼑㻌㻭㼟㼕㼍㼚㻌㻹㼡㼟㼏㼡㼘㼛㼟㼗㼑㼘㼑㼠㼍㼘㻌㻿㼛㼏㼕㼑㼠㼥㻌㻔㻭㻹㻿㻕㻌㻞㻜㻝㻣

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㻻㼜㼑㼚㼕㼚㼓㻌㻸㼑㼏㼠㼡㼞㼑1-1. Quantitative imaging and radiomics- impact on MSK- radiology
Maximilian F. Reiser(Germany)
Department of Clinical Radiology, Ludwig Maximilians- University

Imaging modalities provide data and these data can be used to extract substantial information about diseases
beyond morphological and functional alterations. This allows achieving higher precision in characterizing disease
in individual patients and in the assessment of prognosis. Eventually, quantitative imaging and radiomics are
expected to improve outcome by selecting the most appropriate therapy and to detect risk factors.
Quantitative imaging stands for the translation of imaging findings in imaging biomarkers. Biomarkers havemultiple applications, including: 1) Prediction: use as a tool to predict patients at risk of disease. Bonedensitometry is has been established as an indicator of the risk to experience osteoporotic fractures and is an
example of predictive biomarker. 2) Detection: use as a diagnostic tool for the identification of patients withdisease. For example, measurement of the synovial enhancement can be used as a biomarker of inflammatory joint
diseases. 3) Staging: use as a tool for classification of the extent of disease. PET-CT with measurements ofspecific uptake values (SUV) is increasingly used as staging biomarker of various malignant tumors. 4) Grading:use as an indicator of disease aggressiveness and prognosis. Several studies with variable results have assessed thecorrelation between MRI perfusion and diffusion parameters and tumor aggressiveness or prognosis, and 5)
Assessment of response to treatment: use as a tool for evaluating the disease response to treatment.
MSK radiology has pioneered the development of biomarkers and greatly contributed to the implementation ofimaging biomarkers and defining the requirements for their effective use which are in addition to technology
stability (robustness), noninvasiveness, and broad availability, with two main prerequisites- standardization andvalidation. Compared with biochemical and histological biomarkers, imaging biomarkers have the advantage ofremaining noninvasive and being spatially and temporally resolved.
Radiomics is an emerging field that converts imaging data into a high dimensional minable feature space using alarge number of automatically extracted data-characterization algorithms. It explores the association between
single or multiple morphologic and functional imaging features or between voxel- based morphometry and genetic
information (candidate genes, genome- wide sequencing or gene expression profiles). Novel IT-methods are
employed in order to extract substantial information from imaging data.
Radiomic analysis includes several steps: 1) preprocessing (normalization, segmentation), 2) feature extraction(shape, volume, roundness, signal intensities, texture) and 3) classification (machine learning, supervised
learning). The extracted features are employed as diagnostic vectors which are correlated with clinical andpathologic data. For machine learning various algorithms are available, such as random forest, support vector
machines and logistic regression. The results are evaluated by training and testing cycle.
Publications in radiomics are increasing at a high pace. Breast, prostate and lung cancer have been exploredextensively whereas musculoskeletal disorders have not been widely examined yet.
It is anticipated that radiomics will further enhance the value of medical imaging by making the maximum of
information available. Radiologist should partner with associated disciplines to embrace this new technology anddiligently assess its clinical usefulness.

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㻷㼍㼠㼍㼥㼍㼙㼍㻌㻹㼑㼙㼛㼞㼕㼍㼘㻌㻸㼑㼏㼠㼡㼞㼑
1-2. Imaging in osteoarthritis: state of the art
Ali Guermazi(USA)
Boston University School of Medicine

Osteoarthritis (OA) has major implications for healthcare worldwide, without effective pharmacological treatment
available at present. The field of joint imaging, and particularly magnetic resonance (MR) imaging, has evolved
significantly thanks to technical advances and the application of these to clinical research. In particular, cartilage
imaging is at the forefront of these developments. In this presentation, different aspects of OA imaging andcartilage assessment, with an emphasis on recent advances, will be discussed. Multiple imaging tools areavailable. Radiography is still most widely used imaging modality despite known limitations, and it is used formaking clinical diagnosis and for inclusion/stratification in OA epidemiological studies. Ultrasound can be used
for clinical diagnosis of synovitis, although it is less frequently used than MRI due to lack of ability to image
deeper structures. Today, MRI is the most important imaging tool for OA research. Associations between MRI
findings and symptoms/progression of OA have increasingly become available in the literature. There aresemiquantitative MRI scoring systems that are reliable and validated for use in clinical and epidemiologicalstudies. Emerging advanced imaging techniques such as compositional MRI enable us to capture
pre-morphologic, physiological status of tissue such as cartilage and meniscus.

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㻸㼡㼚㼏㼔㼠㼕㼙㼑㻌㻸㼑㼏㼠㼡㼞㼑2-1. Pathology of non-neoplastic diseases
Edward F DiCarlo(USA)- 15 -

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㻸㼡㼚㼏㼔㼠㼕㼙㼑㻌㻸㼑㼏㼠㼡㼞㼑2-2. MSK intervention under US guidance
Otto Chan(United Kingdom)
The London Independent Hospital and Royal Free and Whittington Hospitals

The author will concentrate on describing in detail the treatment of the 10 commonest interventions that heperforms in general MSK interventions, using a new concept of HVIGI (High volume image guided injections).
This will include common conditions such as osteoarthritis (including knees and 1st MTPJ), Achilles and Patellatendinopathy, subacromial impingement, greater trochanteric bursitis, lateral epicondylitis, plantar fasciitis,
chronic MCL syndrome, small tendon tendinopathy (including De Quervain's tenosynovitis and ankles), Morton's
neuroma and Sinus tarsi syndrome.

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㻿㼣㼑㼑㼠㼟㻌㼟㼑㼙㼕㼚㼍㼞㻌㻝
2-3. MR Spectroscopy in Evaluating Fat Composition of Femoral Head and as Biomarker ofDeveloping Avascular Necrosis
Tiffany Ting-Fang Shih(National Taiwan University)
Department of Radiology and Medical Imaging, National Taiwan University Medical College and Hospital.

Introduction
The etiology of femoral head avascular necrosis remained unclear. Most research mentioned about ischemicchanges. However, the fat content and lipogenesis of epiphysis in femoral head may have some contribution ofincreased intraosseous pressure of femoral head. Thus, we aimed to evaluate the intraosseous fat component invivo by using the non-invasive MR spectroscope.
Objectives
To evaluate the femoral head lipid composition by proton MR spectroscopy (MRS) and investigate its relationshipwith the development of avascular necrosis (AVN) in a longitudinal follow up study
Material and methods
Thirty-eight patients with unilateral femoral head AVN were prospectively enrolled. Proton MRS was conductedon their contralateral, intact side of femoral head during the initial MR examination. All patients were followed atorthopedic clinics to evaluate the possibility of newly developed AVN. The initial MRS variables included
amplitude (AM), integration (I) and line width (LW) of different peaks and lipid/water ratio. Logistic regression
and CART analysis were used for statistical analysis.
Results
The follow up duration of these patients ranged from 738-5578 days (2575 ± 1214 days). Five patients among
them developed new AVN during the follow-up. Lipid spectrum of initial MRS variables showed significant
difference among those who developed AVN (n=5) or not (n=33; p < 0.05). One of the cutoff point of integrationof lipid peak at 2.1 ppm was significant at 347.92 (P=0.007).
Conclusion
Alteration of lipid component of bone marrow depicted by proton MRS may be a biomarker for new AVN
development in a normal-looking femoral head. Proton MRS could serve as a non-invasive image tool ofsubclinical AVN.

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㻿㼣㼑㼑㼠㼟㻌㼟㼑㼙㼕㼚㼍㼞㻌㻞
2-4. Subchondral (insufficiency) fracture and its related disorders
Takehiko Yamaguchi(Japan)
Koshigaya Hospital, Dokkyo Medical University

Subchondral (insufficiency) fracture (SIF) of femoral head is one of the common fractures in elderly patients witha background of osteoporosis or obesity, like femoral neck fracture and vertebral compression fracture. SIF is
recently recognized bone and joint disorders and should be distinguished from avascular osteonecrosis of thefemoral head (AVN). SIF was first introduced in 1996 and then Yamamoto and Bullough had examinedenergetically and contributed to establish this entity. SIF tends to occur in elderly women. SIF often produces
sudden onset of severe hip pain and gait disturbance with or without a history of minor trauma. The clinical courseof SIF is variable: some spontaneously improve and some finally lead to collapse of femoral head. In the earlystage, X-ray fails to demonstrate any abnormality except decreased bone density.
Then,irregularity of articular surface and crescent sign gradually appear. In the advanced stage, the narrow joint spaceand collapsed femoral head are recognized. Imaging findings of SIF sometimes mimic those of AVN. More than
70% of patients suffering from AVN have a history of steroid intake or alcohol abuse. AVN develops bilaterally
in about half of the patients. X-ray reveals subchondral crescent sign and band-like osteosclerosis at the interface
between necrotic and viable bone. Bone scan shows cold in hot appearance. On MRI, T1-weighted image reveals
low-signal band which is very characteristic of AVN, following diffuse bone edema pattern. Nowadays, rapidly
destructive arthrosis of the hip (RDA), transient osteoporosis of the hip, and spontaneous osteonecrosis of theknee are considered to be related to SIF.

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㻿㼣㼑㼑㼠㼟㻌㼟㼑㼙㼕㼚㼍㼞㻌㻟2-5. Correlation between microcirculation of supraspinatus tendon and shoulder externalrotation strength in overhead athletesChao-Yu Hsu, M.D.(Taipei Hospital)
Department of Radiology, Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan;
Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan
It has been suggested that tendon adaptation mechanisms to loading vary the morphological compositions of thetendon according to the regional functions in ways that affect the tendon proper, including its blood vessels. The
distribution of the blood vessels within the anterior supraspinatus tendon is different than that in the posterior
tendon. These differences may become significant in the dominant arms of overhead athletes playing sports
involving smashing, such as badminton.
The objective of this study was to measure and compare the features of regional microcirculation within the
supraspinatus tendon, and to investigate the correlations between those features and shoulder external rotation
strength in overhead athletes.
Seventeen badminton athletes were recruited. DCE-MRI was conducted on the tendons in each athlete’ s
dominant arm, including measures for the volume transfer constant (Ktrans), reverse reflux rate constant (Kep),
extravascular extracellular space volume (Ve) and blood plasma volume (Vp). Isokinetic tests were used tomeasure the acceleration time and the relative fatigue ratio of the shoulder external rotation of the arm.
The DCE-MRI measures for the anterior, posterior, and entirety of the tendon showed regional differences in the
Ktrans and Kep values, and correlations between the Kep values for the whole supraspinatus tendon and theacceleration time (r = -0.663, p= 0.005) and between the Vp value of the whole tendon and the relative fatigue
ratio (r =- 0.605, p= 0.01).
We conclude that DCE-MRI demonstrated differences between the microcirculatory features of the anterior andposterior portions of the supraspinatus tendon. In addition, microcirculation at the supraspinatus tendon andshoulder external rotation explosive strength and fatigue are correlated. Our results regarding microcirculatory
profiles suggest that DCE-MRI provides a feasible means of explaining the regional features of microvascular
adaptations in the tendons and for validating clinical observations of tendon tears.

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㻿㼣㼑㼑㼠㼟㻌㼟㼑㼙㼕㼚㼍㼞㻌㻠
2-6. Diagnostic pitfalls in MR imaging of musculoskeletal tumors
Masataka Uetani(Japan)
Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences

A wide range of musculoskeletal tumors and tumor-like conditions may be encountered when patients undergo
radiologic examinations. Although MR imaging is a powerful imaging method that has been used extensively inthe evaluation of musculoskeletal tumors, nontumoral or tumorlike lesions may have similar imaging findings.
The imaging features of certain normal, reactive, benign neoplastic, inflammatory, traumatic, or degenerative
processes in the musculoskeletal system may mimic malignant tumors. Misinterpretation of the imaging findings
can lead to inappropriate clinical management of the patient. We review and describe the MR imaging
characteristics of nontumoral bone lesions that are located in the marrow cavity, cortical bone, or in both, and soft
tissue lesions that may be misinterpreted as sarcoma.

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㻾㼑㼒㼞㼑㼟㼔㼑㼞㻌㻯㼛㼡㼞㼟㼑㻾㻝㻚㻌㻮㼛㼚㼑㻌㼀㼡㼙㼛㼞㼟㻌㻝
R1-1. Conventional radiography in the diagnosis of bone tumors
Shalini Agarwal(India)
Pandit Bhagwat Dayal Sharma, PGIMS, Rohtak

The term bone tumor is a broad category, encompassing benign and malignant neoplasms and miscellaneous’tumor like’ conditions. These occur predominantly in children. These are however, relatively rare and form only
0.2% of total human burden. The frequency is possibly underestimated because the benign variety is often
asymptomatic. Radiographs, even today are the single most helpful imaging modality when establishing the initialdifferential diagnosis of primary bone tumors. These reveal the site of the lesion, borders /zone of transition, typeof bone destruction, periosteal reaction, matrix of the lesion and nature and extent of soft tissue involvement. Outof these the zone of transition is the single most important criteria differentiating benign from malignant lesions.
Size of the lesion can differentiate osteoid osteoma from an osteoblastoma, an enchondroma from achondrosarcoma, and so on. Number and characteristic appearance of lesions can further help in making adiagnosis as in the case of multiple myeloma. Some lesions like non ossifying fibroma, osteochondroma,
enostosis, etc, have a characteristic appearance and can be diagnosed on radiographs without further imaging.
Lastly radiographs can also diagnose pathologic fractures which are seen more often in benign lesions rather thanmalignant. These can confuse the clinical as well as the radiological picture and are best diagnosed onradiographs. Radiographs are limited in determining the extra-osseous tumor volume and the extent of disease in
the intact bone marrow. These are also limited in cases of anatomic overlap and complex bony anatomy. Also
nearly 50% of the bone has to be lost for a lesion to become radiographically visible. Hence, they should beinterpreted with caution It is important to remember the strengths and weaknesses of radiographs and interpret thefindings in the light of clinical picture and other imaging modalities.

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R1-2. MRI of tumor like lesions of bone
Mahesh Prakash(India)
PGIMER,Chandigarh

Tumor like lesions of bone are commonly encountered in clinical practice.They usually grow slowly, but cangrow with rapid rate. Many of them can be diagnosed by plain films however cross sectional imaging may berequired for diagnosis and management of various lesions.The MRI is useful when lesion is faintly visualized onplain radiography or when the lesion is indeterminate in nature.The MRI can also done to characterize the lesion
and may be required for the surgical management of the lesion.This lecture will give glimpse of indication andusefulness of MRI in various tumor like lesions of bone.

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R1-3. Benign mimics of malignancy
Swee Tian Quek(Singapore)
National University of Singapore

Focal lesions in bone and soft-tissue are common and may mimic malignancies. They may be due to normal
anatomic variants, trauma or stress-related conditions, physiological response/processes, infective/inflammatory
conditions as well as other non-neoplastic processes.
Some of these tumor mimickers can be left alone, while others may be associated with a significant disease
process. It is important for the radiologist and clinician to be aware of these mimickers of malignancy andunderstand some of the characteristic features which allow discrimination between them and true neoplasms inorder to avoid unnecessary additional workup.
This talk is not an exhaustive review of these conditions but illustrates through examples some of the benign
mimics of malignancy and tries to show some of the similarities, and more importantly, highlights some of thedifferences from true neoplasms. In the process, it also underlines the theme of the conference by showing how
often, in many of these conditions, the clinicians require pathology and radiology to work together as ‘a pair ofwheels’ to provide them with meaningful information for the proper management of their patients.

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R1-4. Primary bone lymphomas
Rakhee Kumar Paruchuri(India)
School of Medical Sciences & Research, Sharda University, Greater Noida

Primary bone lymphoma (PBL) is an uncommon malignancy that accounts for less than 5% of all primary bonetumors and are defined as extranodal lymphomas arising from the medullary cavity without evidence of distal
nodal or extra nodal soft tissue involvement. Groups 1 & 2 as per the WHO classification of “Lymphoma
involving bone” are traditionally accepted as PBL. NHL variety is more common than Hodgkin’s lymphoma The
most common sites are the femur and pelvis. Although the radiographic appearances of primary bone lymphoma
are varied and nonspecific, of the various patterns described on conventional radiographs, the “lytic destructive”
pattern is most common with a permeative and moth eaten pattern of bone destruction. Periosteal reaction, soft
tissue masses, cortical breakthrough and pathological fractures are other findings. As the lesion can appear nearnormal on plain radiographs, a second modality such as bone scintigraphy or magnetic resonance (MR) imaging
should be used. The marrow involvement is striking on T1W scans as hypointense with the soft tissue mass
showing T2/STIR heterogenous signal intensities. Role of DWI and ADC maps is still evolving. Despite thevariability, the presence of a solitary, permeative, metadiaphyseal lesion with a layered periosteal reaction on
plain radiographs and a soft-tissue mass on MR images, especially in a patient older than 30 years, is highlysuggestive of lymphoma. The case for a diagnosis of primary bone lymphoma is further strengthened if the soft
tissue mass and marrow changes are associated with little cortical destruction. Both MRI and FDG-PET are used
to evaluate the lesion pre and post treatment effectively. CT is used to stage the disease prior to start of treatment.
Histopathology is essential to establish the diagnosis. PBL has a better prognosis than many other malignant bonetumors; therefore, early identification allows for appropriate treatment.

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R1-5. Imaging of chondrosarcoma
Elysanti Dwi Martadiani(Indonesia)
Faculty of Medicine, Udayana University-Sanglah Hospital, Denpasar, Bali

Chondrosarcoma is a malignant tumor that produces cartilage matrix, and it becomes the commonest primary
sarcoma of bone in adults. Based on its location, chondrosarcoma is divided as central and peripheralchondrosarcoma. Based on its origin, this tumor is classified as primary chondrosarcoma which is arising de novo,
and secondary chondrosarcoma that develops from pre-existing tumor. Subtypes of primary chondrosarcoma
include conventional, clear cell, juxtacortical, myxoid, mesenchymal, extraskeletal and dedifferentiatedchondrosarcoma. This topic is describing about the imaging characteristic of each subtype of primarychondrosarcoma, and the signs of malignant transformation from benign cartilaginous tumor to secondary
chondrosarcoma.

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㻾㼑㼒㼞㼑㼟㼔㼑㼞㻌㻯㼛㼡㼞㼟㼑㻾㻞㻚㻌㻮㼛㼚㼑㻌㼀㼡㼙㼛㼞㼟㻌㻞
R2-1. High grade Surface Osteosarcoma
Bambang Budyatmoko(Indonesia)
Premier hospital jatinegara,jakarta

High grade surface osteosarkoma
Is the rarest of three type of surface osteosarkoma
High grade periosteal osteosarkoma( also known as high grade surface osteosarkoma) account of lesi than
1-percent
The difference between convensional osteosarcoma is the location on surface of bone
X ray finding appears as bergulat cortical destruction as well as iregular periosteal reaction
We would like to report our caseand difficulties in pathology diagnose- 26 -

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R2-2. Clinico-radiologico-pathological correlation of cases of giant cell tumor treated by Denosumab
Tony W.H. SHEK(Hong Kong)
University of Hong Kong, Queen Mary Hospital

Giant cell tumor of bone is one of the commonest bone tumors, particularly among Asians. GCT is characterizedhistologically by the presence of an evenly distributed population of multinuclear osteoclast-like giant cells in a
background of mononuclear tumor cells as well as a third component of macrophages. The osteoclast-like giant
cells are not the neoplastic cell population. They are in fact recruited into the lesion by chemotactic substances(RANKL) produced by the mononuclear tumor cells. These osteoclast-like giant cells possess osteolytic activity
on the bone which causes the characteristic lytic radiological appearance of GCT. While GCT can be treated bysurgical resection, a proportion of them are unresectable because of their anatomical location or involvement ofother vital organs. There is therefore an unmet need to develop non-surgical treatment options for GCT.
Denosumab is a monoclonal antibody against RANKL (Receptor Activator of NF-kB Ligand). It has been used in
the treatment of osteoporosis and metastatic bone disease. Through the blockade of the RANKL pathway, theosteolytic activity of the osteoclasts and hence bone resorption is inhibited. Recently, denosumab has been
approved in the treatment of surgically unresectable giant cell tumor of bone.
At Queen Mary Hospital, we have treated 12 cases of giant cell tumor of bone with denosumab for the past three
years. The denosumab was given by monthly injection, with additional doses on 2nd and 3rd weeks.
There was good symptomatic improvement in all 12 cases. Ten cases showed radiological response withcalcification. Histologically there was complete absence of osteoclast-like giant cells with evidence of boneformation in all 12 cases. The bone formation in a background of tumor cells could lead the inexperienced
pathologists to erroneously diagnose the case as osteosarcoma.

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R2-3. SPINAL BONE HEMANGIOMA, INCIDENTAL OR IMPORTANT IMAGING FINDING
Sri Andreani Utomo(Indonesia)
Department of Radiology, Dr. Soetomo Hospital, Faculty of Medicine, Airlangga University, Surabaya

Spinal hemangioma is the most common benign vertebral vascular tumor. It is usually asymptomatic andincidentally detected due to their characteristic features on imaging for other reasons.Spinal hemangiomaclassified into typical hemangioma and atypical hemangioma
Atypical spinal hemangioma can rarely be aggressive with epidural involvement and cord compression,
aggressive hemangioma represent less than one percent of all hemangiomas, and are more common in womenthan in men. If left untreated, aggressive hemangiomas can cause serious neurological effects.
Plain X ray shows prominent trabecular pattern, sclerotic vertebra with vertical trabeculae, most commonly seenin the mid-back (thoracic) and lower back (lumbar).
CT scan shows a polka dot appearance in axial slices and “corduroy cloth” appearance in coronal and sagitalreconstruction
MRI will show whether the tumor has expanded into the spinal column or spinal canal, or encroached on the
spinal cord. MRI can also show the extent of nerve damage in the spine and can assist in planning surgicaltreatment.
MRI shows extraosseous components better and depicts the haemangioma components as fat and water.
Thickened trabeculae appear as low signal areas in both T1 and T2 images. T1 high intensity signal due to its fat
component, T2 bright/high intensity signal, usually greater than on T1, due to its high water content, depending on
the balance of fat and vascular components, they may or may not be hyperintense on STIR images.
T1 with contrast, significant enhancement seen due to high vascularity
Differential diagnosis includes bone marrow fatty changes, fatty endplate degeneration, herniated disks, synovial
cysts, granulomatous infections, neurogenic tumors, lymphomas, meningiomas, metastasis, pure epidural
hematomaRadiologist should be aware the various imaging features of the aggressive spinal hemangioma that can simulate
many pathologies like a primary bone malignancy or metastasis
As aggressive hemangiomas often mimic other aggressive spinal lesions, additional imaging modalities such as
CT, angiography, and radiography are usually needed to make a definitive diagnosis- 28 -

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R2-4. Imaging of chordomas of skeleton: radio-pathological feature correlations
Rammohan Vadapalli (Indonesia)- 29 -

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R2-5. Imaging of primary bone tumors of the spine
Lisa LS Wong(Hong Kong)
Hong Kong Imaging and Diagnostic Centre

Primary spine tumours are uncommon compared to secondary spine tumours. They can be benign or malignant.
The primary bone tumours of the spine can be classified similar to tumours involving the appendicular skeleton
into osseous, cartilaginous or fibrous tumours. There are some primary tumours which do not fit into thesecategories, including haemangioma, chordoma, giant cell tumour, aneursymal bone cyst, lymphoma and myeloma.
Similar to assessment of primary tumours in the appendicular skeleton, the age of the patient and the site oftumour involvement in the spine (level of spinal involvement and vertebral body vs posterior vertebral element
involvement) are important features for differential diagnosis. Some tumours have characteristic imaging
appearances allowing their diagnosis e.g. haemangioma, osteoid osteoma. Biopsy would be needed for thosetumours which are imaging non-specific.
Although plain radiography is usually the initial investigation that may alert one to the presence of tumour in thespine, CT scan is often needed for proper evaluation of the exact location and morphology of the spinal tumour
and to look for cortical extent and matrix mineralization. Small tumours are also better seen on CT scan than plainradiographs e.g. osteoid osteoma. MRI is the modality of choice for determining the extent of tumour involvementin the spinal column and adjacent paraspinal soft tissues as well as any spinal cord or nerve root involvement. Thisis important for surgical planning. The use of contrast can help to determine the best site for obtaining biopsy of
the tumour. However, one may overdiagnose the extent of tumour when there is extensive associated soft tissue
oedema and this may lead to sampling error during biopsy. Thus, correlation with CT is important. Angiography
is sometimes used to delineate vascular involvement and for pre-operative embolization.

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㻾㼑㼒㼞㼑㼟㼔㼑㼞㻌㻯㼛㼡㼞㼟㼑㻾㻟㻚㻌㻿㼛㼒㼠㻌㼀㼕㼟㼟㼡㼑㻌㼀㼡㼙㼛㼞㼟
R3-1. Radiographic evaluation of soft tissue calcifications/ossifications
Sanjeewa Heman Munasinghe RWP RSP USP(Sri Lanka)
Army Hospital, Colombo

Presence of calcifications or ossification in soft tissue gives important clues to narrow down the differential
diagnosis or some times provides definitive diagnosis of soft tissue pathologies. Calcifications in the soft tissues
may result from different etiologies but, they can be broadly grouped into four main categories, dystrophic
calcifications, metastatic calcifications, calcinosis and miscellaneous calcifications.
Though MR imaging has become the imaging technique of choice in the evaluation of soft-tissue lesions,conventional radiography remains vital in the initial assessment of such abnormalities, given its widespread
availability and low cost.
Calcifications and ossifications appear as radiodense masses in radiographs and the differentiation between
calcification and ossification may not be possible in all situations. The presence of trabecular pattern inossification differentiates it from calcification but, this is not possible in all cases. Systematic approach withdetailed evaluation of the morphology and distribution of the soft-tissue calcifications and ossifications together
with a thorough knowledge of the entities that may occur at the site of the noted abnormality, provides significant
interpretive value in reaching a definitive diagnosis, differential diagnosis or accurately recommend the next mosteffective management step.
The lecture will highlight the many of the common soft-tissue calcifications and ossifications encountered inclinical practice while illustrating the subtle, but important information that can be yielded about these lesions
from radiographs.

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R3-2. Imaging of muscle pathologies
Sheikh Adnan(China)- 32 -

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R3-3. The role of ultrasonography in soft tissue masses
Paulus Rahardjo(Indonesia)
School of Medicine, Airlangga University and Dr. Soetomo Hospital Surabaya

The Role of Ultrasonography in Soft Tissue Masses
Introduction
Ultrasonography is a great diagnostic tool. The interaction with the patient and flexibility in performing theexamination, often resulting in greater diagnostic effectiveness, particularly in performing guided interventions.
Spesific tumors in ultrasonography.
Lipomas frequently involve the superficial soft tissues, long axis parallel to the skin surface, and well-defined toill-defined margins. Lipomas are typically homogeneous in echotexture and most commonly slightly hyperechoic
to the adjacent subcutaneous fat.
Hemangiomas have a variable heterogeneous echogenicity with filling vascular channels in Power Doppler
sonography. Hyperechoic foci with distal shadowing representing phleboliths..
Peripheral nerve sheath tumors may have a characteristic appearance of a well-defined hypoechoic fusiform mass
located at the appropriate nerve distribution.. This lesion can be specifically diagnosed when the adjacent nerve isidentified.
A small rounded lesion located beneath the nail suggests a glomus tumor. Cystic lesions around the joint arebursitis, ganglion cyst, or meniscal cyst.
Ultrasonography to detect maligancy soft tissue masses
History of trauma is not a reliable information to exclude malignancy. George A (2012) found that 21% patientwith malignant soft tissue mass or sarcoma reported of previous trauma.
Clinical features for suspicion of soft tissue sarcoma are either or combination of these: a). Bigger than 3-5 cm, 2).
Deep to the fascia, 3). Enlarging mass, 4). Painful, 5.) Recurrent after previous excision.
Miscellanous findings and ultrasound guided intervention
The non-opaque foreign bodies often be easily identified. Cellulitis and abscess formation can all be shown.
Hematomas can be similar in appearance to complex abscesses, but the clinical information helps differentiate
between these lesions.
Ultrasonography is useful for guiding percutaneous needle biopsy or aspiration, avoiding vessels and nerves, helps
determine the viable portion of a lesion (Doppler), and post intervention scanning to evaluate for residual fluid or
detection of complication- 33 -

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R3-4. Imaging of Vascular Malformations
Nuttaya Pattamapaspong(Thailand)
Chiang Mai University

Imaging of Vascular Malformations
Vascular malformations in soft tissue are vascular lesions comprised of dysplastic and tortuous vascular channels
that relate to abnormality in angiogenesis. The clinical presentations are variable including nonspecific limb pain,
limb swelling, a mass, skin discoloration, and clinical symptoms related to high flow arteriole venous shunts. The
signs and symptoms of lesions may be present at birth or childhood but worsen during adulthood. The unclear
nomenclature and classification are a challenge. For instance, the term hemangioma has been applied to these
vascular malformations as well as other vascular tumors which differ in clinical behavior. The classification by
the International Society for the Study of Vascular Anomalies (ISSVA) improves the inconsistent in terminology
and is a guide for treatment planning. Based on ISSVA classification, vascular malformations are divided into
three patterns: low flow, high flow, and combined vascular malformations. The low flow type can be divided bypathological features into capillary, venous, and lymphatic malformations. The high flow vascular malformations
are arteriovenous malformations and arteriovenous fistulas, depending on the presence or absence of aprecapillary vascular nidus. The combined vascular malformations (capillary-venous, capillary-lymphatic, andlymphatic venous) may be a manifestation of syndromes such as Klippel-Trenaunay, Parkes Weber, orBannayan-Riley-Ruvalcaba diseases. The lesion can be treated by surgery or non-surgical treatment such as
endovascular embolization, sclerosing therapy, and compression by pressure garments. The characteristic imaging
features of these lesions when related to clinical presentations can lead to the correct diagnosis and help avoid
unnecessary biopsy. This lecture presents the imaging and clinical patterns of these lesions which provides a guideto the diagnosis.

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R3-5. Imaging of fat-containing tumor: benign or malignant?
Suphaneewan Jaovisidha(Thailand)
Ramathibodi Hospital, Mahidol University

Fat-containing tumors are the most common soft-tissue tumors encountered in clinical practice, and vast majorityof them are benign. Lipomas are the most common benign fat-containing masses that demonstrate a characteristic
appear¬ance at magnetic resonance (MR) imaging. Less common benign fat-containing soft-tissue masses include
angiolipoma, myolipoma, chondroid lipoma, osteolipoma, lipoblastoma, spindle cell lipoma/pleomorphic
lipoma, , lipo¬matosis of nerve, lipomatosis, hibernoma, and fat necrosis. Well-differentiated liposarcomas(WDLs)/atypical lipomatous tumors (ALTs) are locally aggressive soft-tissue masses that do not metas¬tasize.
Biologically more aggressive liposarcomas include pleomorphic, myxoid, and dedifferentiated subtypes. At MR
imaging, lipomas typically resemble subcutaneous fat but may contain a few thin septae. The presence of thick,irregular, nodular, enhancing septa and nonfatty components suggests liposarcoma rather than lipoma. However,benign lipomatous lesions and WDL/ALT frequently have overlapping MR imaging findings. Distinguishing
WDL/ALT from a benign lipomatous lesion or from fat necrosis at imaging can be confusing and often requires
histologic evalu¬ation. This session will present the spectrum of fat-containing masses following the World
Health Organization (WHO) classification of adipocytic tumors, with an emphasis on commonly encounteredlesions and overlapping MR imaging findings of certain tumors that may require histologic sampling. The role ofmolecular markers in proper characterization and classification of fat-containing soft-tissue masses will be briefly
mentioned.

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㻾㼑㼒㼞㼑㼟㼔㼑㼞㻌㻯㼛㼡㼞㼟㼑㻾㻠㻚㻌㻹㼕㼟㼏㼑㼘㼘㼍㼚㼑㼛㼡㼟㻌㻝
R4-1. Interpreting findings in bone mineral densitometry of patients with Ankylosing Spondylitis
Gervais Khin-Lin Wansaicheong(Singapore)
Tan Tock Seng HospitalObjectives:
To discuss the indications, contraindications, findings, interpretation and artifacts seen when performing bonemineral densitometry analysis in patients with ankylosing spondylitis (AS).
Findings:
AS is a well known disease. The classic clinical and radiographic features have been described in the literature.
However, in recent years, our understanding of the disease has broadened. Early seronegative axial
spondyloarthropathy encompasses AS. The evaluation and treatment choices have also changed with the inclusionof biologics.
The reasons to perform a bone mineral densitometry in patients with AS include the increased risk of osteoporosis
and increasing life span in this group of patients. These reasons are considered valid indications in the ISCD 2015
Position Statement in Adults. The availability of treatment for osteoporosis makes the appropriate diagnosis
important. The criteria used are similar to other patients. A Z score is used when interpreting findings in malepatients less than 50 years of age or pre-menopausal women. A T score is used in postmenopausal women or men
more than 50 years of age.
It should be noted that the presence and pattern of bone disease alters the findings seen in AS. The lumbar spine is
one site that is used in analysis of bone density. However, the occurrence of lumbar syndesmophytes,
enthesopathy, bone anklyosis of the facet joints, ossification of the interspinous ligament and sclerosis of thevertebral bodies can increase the bone density. This can account for the sometimes conflicting reports in theliterature regarding the association between AS and osteoporosis.

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R4-2. Sclerosing Skeletal Dysplasias
Naga Varaprasad Vemuri(India)
Global Superspeciality Hospital, Vijayawada, Andhra Pradesh

Sclerosing Bone Dysplasias are a very interesting group of conditions showing uniform generalised increased
density or sometimes localised patchy density of bones with wide range of clinical, radiological and genetic
features. The conditions have been grouped under hereditary and non-hereditary conditions. Since genetic studies
are not available in many of the centres in our country, the author has made a more simple classification ofsymptomatic and non symptomatic (Incidental) group of conditions and their diagnosis on the basis ofradiological findings. Important entities grouped under Symptomatic category include osteopetrosis,
Pyknodysostosis and Engelmann’ s Disease while asymptomatic group includes Osteopoikilosis, Osteopathia
Striata and Mixed Sclerosing Dysplasia. Melhorestosis can have both symptomatic and asymptomaticpresentation. This presentation will provide a broad idea of all these Dysplasias with a brief description of somenot so common disorders.

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R4-3. RENAL OSTEODISTROPHY: MUSCULOSKELETAL IMAGING FINDINGS
Giuseppe Guglielmi(Italy)
University of Foggia

Kidney disease encompasses a large number of pathologies. Making a preliminary distinguish, it is possible todiscuss, about musculoskeletal (MSK) manifestation and their radiological findings, of two groups of diseases:
those where MSK manifestation are related to chronic kidney disease (CKD) and those no-CKD related.
CKD includes a spectrum of different pathophysiologic processes associated with impaired kidney function, and a
progressive decline in glomerular filtration rate (GFR). Due to its increasing prevalence, CKD and its
complications are considered one of the major public health problem. 1 Among these complications, disorders ofcalcium and phosphate metabolism have a remarkable importance, and can be further classified in the group of
renal osteodystrophy (aka chronic kidney disease-mineral and bone disorder, CKD-MBD). 2 Renal
osteodystrophy is classically subdivided into two metabolic states: those associated with high bone turnover withincreased PTH levels (including osteitis fibrosa cystica, the classic lesion of secondary hyperparathyroidism) andthose associated with low bone turnover with low or normal PTH levels (adynamic bone disease andosteomalacia). 3-5
No-CKD comprises a large number of diseases, but tubular diseases of the kidney are mainly involved in MSK
manifestation. In this setting, conditions listed are pathologic deposition of calcium salts in soft tissues(chondrocalcinosis) and crystal-associated arthropathies, such as calcium pyrophosphate dihydrate (CPPD) andhydroxyapatite (HA) crystal deposition. 6-8
1 Brosnahan G, Fraer M. Chronic kidney disease: whom to screen and how to treat, part 1: definition,
epidemiology, and laboratory testing. South Med J. 2010 Feb;103(2):140-6.
2 Baumgarten M, Gehr T. Chronic kidney disease: detection and evaluation. Am Fam Physician. 2011 Nov 15;84(10):1138-48.
3 Lacativa PG, Franco FM, Pimentel JR, Patrício Filho PJ, Gonçalves MD, Farias ML. Prevalence of radiologicalfindings among cases of severe secondary hyperparathyroidism. Sao Paulo Med J. 2009 May;127(2):71-7.
4 Cannata-Andía JB, Rodriguez García M, Gómez Alonso C.Osteoporosis and adynamic bone in chronic kidneydisease. J Nephrol. 2013 Jan-Feb;26(1):73-80.
5 West SL, Jamal SA. Determination of bone architecture and strength in men and women with stage 5 chronic
kidney disease. Semin Dial. 2012 Jul;25(4):397-402.
6 Gutierrez M, Silveri F, Bertolazzi C, Giacchetti G, Tardella M, Di Geso L, Filippucci E, Grassi W.[Gitelman
syndrome associated with chondrocalcinosis: description of two cases]. Reumatismo. 2010 Jan-Mar;62(1):60-4.
7 Braunstein EM, Menerey K, Martel W, Swartz R, Fox IH. Radiologic features of a pyrophosphate-likearthropathy associated with long-term dialysis. Skeletal Radiol. 1987;16(6):437-41.
8 Su B, Tang Y, Tang Y, Qiu L. Hydroxyapatite crystal deposition forming para-articular multiple large masses: acase report and literature review. Rheumatol Int. 2013 Dec;33(12):3099-102.

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R4-4. Radiology of tumor induced osteomalacia
Xiaoguang Cheng(China)- 39 -

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2017/01/18 23:14:37

㻾㼑㼒㼞㼑㼟㼔㼑㼞㻌㻯㼛㼡㼞㼟㼑㻾㻡㻚㻌㻹㼕㼟㼏㼑㼘㼘㼍㼚㼑㼛㼡㼟㻌㻞
R5-1. Imaging in Avascular Necrosis of the Femoral Head
Rosy Setiawati MD, PhD.(Indonesia)
Musculoskeletal Division, Department of Radiology,
Airlangga School of Medicine/Dr. Soetomo-Airlangga University Teaching Hospital, Surabaya, Indonesia
Avascular necrosis (AVN) or osteonecrosis is common and represents loss of blood supply to a region of bone.
Frequently affected sites include the femoral head, humeral head, about the knee, femoral/tibial metadiaphysis,
scaphoid, and lu¬nate. There are numerous causes of osteonecrosis most commonly related to trauma,
corticosteroids, and idiopathic etiology of AVN is multifactorial. Radiologic findings correspond to theunderlying pathology of osseous response to osteonecrotic and vascularized granulation tissue at the reactive
interface. In the early stages localized subchondral edema is characteristic. Due to necrosis of the cells of bonemarrow and bone fibrovascular, reactions with hyperemia can be delineated. Imaging of osteonecrosis isfrequently diagnostic with a serpentine rim of sclerosis on radiographs, photopenia in early disease at bone
scintigraphy, and maintained yellow marrow at MR imaging with a serpentine rim of high signal intensity(double-line sign). In later stages calcification as well as new bone formation and microfractures are typicallydemonstrated and visualized best with plain radiograph and CT. Recognizing the appearance of osteonecrosis,
which reflects the underlying pathology, improves radiologic assessment and is important to guide optimal patientmanagement.

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R5-2. MR imaging of sports injuries of the elbow
Bruce B. Forster(Canada)
University of British ColumbiaThis presentation will briefly discuss the technical and procedure-related considerations in performing MRI and
MR arthrograms of the elbow, and will then use a four compartment approach to illustrate the common sports
injuries of this joint. Common flexor/extensor tendinopathy, radial and esp ulnar collateral ligament tears, elbow
plica syndrome, and triceps and distal biceps tendon pathology and their mechanisms and the role of imaging intreatment decisions will be discussed.

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R5-3. Imaging of Spinal Trauma
Richa Arora(India)
Nizams Institute of Medical Sciences, Hyderabad

Learning Objectives of my talk:Introduce evidence-based imaging approach
1. Role of CT- Who, how and why?
2. Anatomy
3. Patterns of injury- Biomechanics
4. Upper cervical spine- craniocervical junction
5. Lower cervical spine
6. Thoracolumbar spine
7. Mimicks of vertebral fractures- Physiologic wedging, Scheurmann’ s disease, Neoplastic collapse.

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R5-4. Imaging less common causes of spinal stenosis
Poh Lye Paul See(Singapore)
Khoo Teck Puat Hospital

Spinal stenosis refers to a range of conditions that decrease the total area of the spinal canal, lateral recesses, orneural foramina. It may occur in any region of the spine resulting in neurological deficits. It can occur anywhere
along the spine, with lumbar and cervical stenosis being the most frequent. While lumbar spinal stenosis is morecommon, cervical spinal stenosis is more dangerous because it involves compression of the spinal cord whereas
the lumbar spinal stenosis involves compression of the cauda equina.
Multifactorial degenerative changes involving bony overgrowth, herniated discs or thickened ligaments tend to be
the most common causes. Other causes include tumours, spinal injuries and Paget's disease, among others.
In this presentation, we share some of the less common causes of spinal canal stenosis encountered in our practice.

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R5-5. Pitfalls and Artifact of PET/CT and PET/MRI in Musculoskeletal System
Seoung‐Oh Yang(South Korea)- 44 -

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R5-6. Lean tissue imaging: present concepts and potential impacts
Wing Chan(Taipei Medical University)- 45 -

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㻾㼑㼒㼞㼑㼟㼔㼑㼞㻌㻯㼛㼡㼞㼟㼑㻾㻢㻚㻌㻹㻿㻷㻌㼁㼘㼠㼞㼍㼟㼛㼡㼚㼐
R6-1. Ultrasonography in calcific tendinopathy
Joban Ashish Babhulkar(India)
Star Imaging and Research centre, Deenanath Mangeshkar Hospital , Pune

Calcific tendinopathy is a disease characterized by deposition of hydroxyapatite crystals within tendons, mostcommonly affecting the rotator cuff tendons and causing significant shoulder pain. It occurs in three stages : precalcific, calcific and post calcific, out of which, the calcific resorptive stage is the most excruciatingly painful.
Ultrasonography using a high resolution linear transducer ( 7 – 11 M Hz) is the investigation of choice fordiagnosing calcific tendinopathy . Sonographically, this disease can be divided into acute calcific tendonitis andchronic calcific tendinopathy. Ultrasonography can demonstrate calcium is its slurry or amorphous state, when it
may be missed on plain radiographs. It cal also demonstrate complications such as intraosseus migration or
calcific bursitis. Ultrasonography is also useful in performing a USG guided barbotage in case of acute calcifictendonitis of the rotator cuff or in case of calcific bursitis. Barbotage followed by instillation of a local steroid
within the subacromial bursa provides significant relief to the patients. Calcific tendinopathy is also known toaffect the Achilles tendon and the patellar tendon as well. USG guided PRP injection has shown to be of value inchronic calcific tendinopathy of the Achilles tendon.

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R6-2. Ultrasound of the Elbow Ligaments
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University of Arizona, Tucson, AZ

Objectives:
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Abstract:
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VRQRJUDSKLFSRVWHURODWHUDOXOQRKXPHUDOOD[LW\RI!PPGXULQJWKHSRVWHURODWHUDOURWDWRU\VWUHVVWHVWLQJVKRXOG
UDLVHVXVSLFLRQRIXQGHUO\LQJLQVWDELOLW\- 47 -

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R6-3. Ultrasound-guided Synovial Biopsy with Pathological Correlation
James F Griffith (Hong Kong)
The Chinese Univeristy of Hong Kong

Background and overview: Ultrasound-guided tru-cut synovial biopsy is a safe and reliable technique with a highdiagnostic yield for diagnosing synovial tumour and most joint infections. Regarding joint infection, synovial
biopsy of native joints has a higher diagnostic yield than that of infected prosthetic joints. Synovial biopsy forjoint infection is indicated when there is clinically suspected joint infection though little or no joint fluid visible on
ultrasound.
Outline of research study: 111 ultrasound-guided synovial biopsies were reviewed and compared with the final
clinicopathological diagnosis established either after synovectomy or clinical/imaging follow-up. 107 (96%) of
the 111 biopsies yielded synovium histologically. Accuracy, sensitivity and specificity of synovial biopsy was
99%, 97% and 100% for synovial tumour; 100%, 100% and 100% for native joint infection, and 78%, 45% and100% for prosthetic joint infection.
Summary: Ultrasound-guided synovial biopsy is highly accurate at diagnosing synovial tumour and at detecting
infection of non-prosthetic joints. For prosthetic joints, the accuracy is moderate, though this yield potentially
may be increased by submitting more (up to 12) biopsy cores for culture and sensitivity. Based on the results ofour study, we encourage the more widespread use of ultrasound-guided synovial biopsy.

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R6-4. Ultrasound of the wrist and hand tendons
Ian Y Y Tsou(Singapore)
Department of Radiology, Mount Elizabeth Hospital

Imaging of the wrist and hand tendons with ultrasound has always been challenging. Although the hand andfingers are amenable to ultrasound imaging, the difficulty has been with the small size and superficial position ofthese tendons, which places them in the extreme near-field of the ultrasound transducer.
The integrity of the wrist and hand tendons is critical for normal hand function, without which, both movementsof strength and fine motor movements would not be possible. The tendons may be affected by traumatic,
inflammatory or overuse pathologies.
Complete evaluation of the hand and wrist tendons is insufficient with static imaging, as functional assessment
requires dynamic visualization of the tendons on movement. Ultrasound is ideally suited for real-time imaging of
tendon movement.

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㻾㼑㼒㼞㼑㼟㼔㼑㼞㻌㻯㼛㼡㼞㼟㼑㻾㻣㻚㻌㻹㻿㻷㻌㻵㼚㼠㼑㼞㼢㼑㼚㼠㼕㼛㼚㼟㻌
R7-1. Musculoskeletal Ultrasound Interventions
Kambiz Motamedi, MD(USA)
University of California, Los Angeles (UCLA)This review of ultrasound guided musculoskeletal interventions covers indications, technical considerations,patient positioning and a step-by-step guide for performing various procedures. These procedures include joint
injections and aspirations, cyst aspirations and fenestration, tendon sheath injections, soft tissue biopsy, andneedling versus barbotage of calcific tendinopathy.

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R7-2. PNT‐percutaneous needle tenotomy: patellar tendon, Achilles tendon and plantar fascia
Marina Obradov(The Netherlands)
Sint Maartenskliniek,Nijmegen

Insertional tendinosis involves injury of the fibrocartilaginous zone that connects tendon to bone, with oedema,loosening of collagen, cell necrosis, leading to tears, neovascularisation and calcium deposition. It results fromoveruse in individuals with major physical activities and athletes of all levels. Proximal patellar tendinopathy
affects up to 40% of athletes involved in jumping sports. In 10-25% Achilles tendinopathy and plantar fasciitis
conservative treatment fails.
On US affected tendon is enlarged, hypoechoic, heterogeneous, with loss of fibrillary pattern, neovascularisation,
cortical irregularities and calcifications.
Some RCT suggests that percutaneous needle tenotomy in chronic tendinopathy improves outcome.
Certain tendinopathy may be more amenable to needling based on daily use, weight bearing, physical demands
and factors that vary with anatomical location.
After the injection of the anaesthetic at the tendon surface repetitive passing the 18 G needle along the long axis of
the tendon, parallel to the transducer through the area of tendinosis disrupts the chronic degenerative process,causes bleeding and inflammation, locale increase of growth factors that promote healing wherefore patient haveto avoid NASID medication 2 weeks for and after the procedure.
Physical therapy two weeks after PNT is advised.

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R7-3. Role of PRP in MSK diseases.KDOLG$$O,VPDLO0' 6DXGL$UDELD.LQJ)DLVDO6SHFLODLVW+RVSLWDO

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DSURJUHVVLYHVWUHWFKLQJDQGVWUHQJWKHQLQJSURJUDP- 52 -

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R7-4. CT Guided Biopsy for Musculoskeletal Tumors: Experience in A Tertiary Referral Centerin Indonesia〇Thariqah Salamah(Indonesia) Marcel Prasetyo
Department of Radiology Faculty of Medicine Universitas Indonesia / Dr. Cipto Magunkusumo General
Hospital
CT guided biopsy is an excellent technique for musculoskeletal tumor biopsy guidance. CT is useful to determine
optimal biopsy location, avoid important neurovascular structures, and minimizing compartmental tumoral
contamination. Our institution is a tertiary level national referral hospital in Jakarta Indonesia. During 2013-2016,29 musculoskeletal tumor patients were referred for CT guided biopsy. Most common location is pelvis (75,86%).
Tissue specimen obtained from CT guided biopsy mostly could be diagnosed histopathologically, with exceptionof 5 patients. In our institution, CT guided biopsy is done with team-based approach by oncologic orthopaedic
surgeons, musculoskeletal radiologists, and musculoskeletal pathologists. This presentation will also covered
techniques used in our institution and difficulties that we faced in doing CT guided biopsy procedures.

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R7-5. Ultrasound of peripheral nerves: normal anatomy, imaging technique, pathology and US
guided nerve interventions
Hema Choudur, FRCPC(Canada)
McMaster University

The ultrasound technique for visualization of peripheral nerves will be briefly discussed.
The anatomy, pathology and US appearance of various peripheral nerve entities will be detailed.
Advantages and disadvantages of US Imaging of peripheral nerves will be presented and compared with MRI.
A Spectrum of US Guided Peripheral Nerve Interventions will be depicted and tips provided to incorporate thesenewer techniques into clinical US practice.

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㻾㼑㼒㼞㼑㼟㼔㼑㼞㻌㻯㼛㼡㼞㼟㼑㻾㻤㻚㻌㻶㼛㼕㼚㼠㻌㻰㼕㼟㼛㼞㼐㼑㼞㼟
R8-1. Approach to hip pain in children
Kin Sun TSE(Hong Kong)
Department of Radiology and Imaging, Queen Elizabeth Hospital

Hip pain in young children can be caused by various infective (septic arthritis and/or osteomyelitis) andnon-infective causes (transient synovitis, Legg-Calve-Perthes disease, traumatic, and arthropathy). Among older
children and adolescents, common causes of hip pain include slipped capital femoral epiphysis, juvenile idiopathic
arthritis especially enthesitis-related arthritis subtype, and traumatic causes.
Transient synovitis of hip is the most common cause of acute hip pain in young children. It is a self-limiting
benign inflammatory condition affecting the hip. It is important to exclude septic arthritis and/or osteomyelitis,which carry significant morbidities and sequelae. Prior studies had shown that clinical and laboratory information
could help predicting septic arthritis, including history of fever, non-weight bearing, elevated erythrocyte
sedimentation rate (ESR), and elevated serum white cell count. On the other hand, ultrasound examination, both
Grayscale and Power Doppler, cannot reliably distinguish between these two entities. Ultrasound examination has
the roles to detect effusion and soft-tissue collection, detect subperiosteal abscess complicating osteomyelitis, andguide needle aspiration. Radiographic examination is an initial investigation tool in evaluating acute hip pain inyoung children, especially among infants and adolescents when transient synovitis is less common. Septic arthritis
is manifested by soft tissue swelling, widening of joint space, osteopenia; and later joint space narrowing andbony erosions. Osteomyelitis changes include bone erosions, periosteal reaction and physeal plate changes. MR
examination can confirm the diagnosis, delineate the extent of involvement, and look for acute and latecomplications of these conditions.
Referred pain from the spine, pelvis and knees is another important source for acute knee pain in children. It is
important to exclude important causes, e.g. osteomyelitis, diskitis, psoas abscess, and knee pathologies, inappropriate clinical scenarios.
Therefore, systematic approach to paediatric hip pain based on clinical history, physical examination, laboratory
and radiological examinations is essential.

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R8-2. Multimodality imaging in femoroacetabular impingement
Srikanth Narayanaswamy(India)
Sakra World Hospital, Bangalore

Femoroacetabular impingement (FAI) is a recognised major cause of early osteoarthritis in the hip and tends topresent in young and active patients. Cam impingement is secondary to a decrease in the normal waist and hence
asphericity at the femoral head-neck junction. The pincer impingement results from focal or generalized over
coverage of the acetabulum. These variances are thought to predispose a person to early pathologic contact
between the femoral head and acetabular articular and labral surfaces during movement of the hip joint, there by
resulting in early labral degeneration and osteoarthritis.
The diagnosis depends on a defined constellation of painful hip symptoms, restricted motion, and a positive resultof an impingement test at clinical orthopaedic examination that occur in the presence of certain morphologic
abnormalities that can be detected radiologically.
A number of radiological signs have been described both on plain film/CT and MRI to support the diagnosis of
FAI. The abnormal radiologic parameters associated with Cam type of FAI include, presence of Pistol grip
deformity, abnormal alpha angle (>55 ° ), reduced femoral head-neck offset (<8 mm) and herniation pits. The
abnormal parameters associated with Pincer variety include, the lateral centre edge angle of >39 ° , negative
acetabular index, positive Acetabular cross-over sign, presence of Coxa profunda/protrusion acetabuli and
Prominent posterior wall sign.
In the appropriate clinical context in primary care, the presence of these findings associated with or predisposing
to FAI on a radiograph can guide referral to a hip specialist for further management. The natural course of thedisease is largely unknown, but early diagnosis and appropriate treatment have been found to reduce symptoms
and improve function.
The diagnosis of FAI is often missed due to lack of awareness of the disease entity and its predisposing
morphological parameters among reporting radiologists. Reporting radiologists should exercise special carelooking for features associated with FAI when analysing radiographs of young patients with hip pain especiallywhen there is no other abnormality to explain patient’s symptoms.

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R8-3. The failing hip prosthesis: radiological considerations
Tuhin Sikdar(United Kingdom)
Princess Alexandra Hospital

Hip arthroplasty is an increasingly common orthopaedic operation since first introduction in the 1960s.
Complications of this procedure include infection, dislocation, leg length inequality, neurovascular injury, venous
thromboembolism, intraoperative fracture, persisting pain and implant loosening over time. Soft tissue conditions
may also result or be associated with the replaced hip joint that include synovitis, tendinopathy/tears andneuropathy.
Conventional Radiography is the mainstay of imaging evaluation of hip arthroplasty and can help evaluate leg
length, horizontal centre of rotation including offset, acetabular inclination and orientation, femoral stem
positioning for both cementless and cemented joints including assessment of the cement mantle. Two radiographs- AP pelvic and shoot-through lateral - are commonly used in the postoperative setting.
Specialist imaging such as CT supplements plain radiography in assessing the reconstructed hip. Modification ofimaging parameters helps minimize imaging artefacts. This is more so with MR imaging and both thesemodalities allows detailed evaluation of periprosthetic bone, implant-tissue interface, soft tissues, including thepseudocapsule and synovium, tendons, bursae, and nerves.
In addition ultrasound, radionuclide studies and arthrographic studies can provide valuable information forassessment of complications.

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R8-4. MR imaging of articular cartilage: knee
Steven Wong(Singapore)
Sengkang General Hospital

MRI is the ideal imaging modality to demonstrate and evaluate the articular cartilage. A routine knee MRI
protocol should include Coronal and Sagittal PD-W TSE and a T2W TSE Axial sequences. Chondral defects areclearly identified and classified. Less commonly appreciated are the subtle signal changes at the deep and surface
layers of the cartilage, hinting at areas of early injury. T2RV Colour Mapping aids in identification of these areasand can also increase diagnostic confidence with the routine PD-W and T2-W images.

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R8-5. Imaging subchondral bone lesions of the knee
Jianling Cui(China)- 59 -

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E-Poster&ŽŽƚdƐĐĂŶĂĐƋƵŝƌĞĚƵƐŝŶŐƚŚĞĚĞĚŝĐĂƚĞĚĨŽŽƚŚŽůĚĞƌ͗ĞĨĨĞĐƚƐŽĨŽƌƚŚŽŐŽŶĂůƉŽƐŝƚŝŽŶŽŶĚŽƐĞĂŶĚŝŵĂŐĞƋƵĂůŝƚǇ

EvaluationoftheSubscapularis TendonTearon3ǦTDirectMRArthrography:
ComparisonofT1SPIRandT2TSEwith
ArthroscopicFindingsastheStandardŽzĞŽŶ <ŝŵ͕Dϭ͕zŽƵŶŐ,ĂŶ>ĞĞ͕DϭΎ͕:ŝŶͲ^ƵĐŬ^ƵŚ͕DϭϭĞƉĂƌƚŵĞŶƚŽĨZĂĚŝŽůŽŐǇ͕ZĞƐĞĂƌĐŚ/ŶƐƚŝƚƵƚĞŽĨZĂĚŝŽůŽŐŝĐĂů^ĐŝĞŶĐĞ͕DĞĚŝĐĂů

Hoseok Lee, Joong Mo Ahn, Yusuhn Kang, Eugene Lee,
Joon Woo Lee, Heung Sik Kang, Joo Han OhŽŶǀĞƌŐĞŶĐĞZĞƐĞĂƌĐŚ/ŶƐƚŝƚƵƚĞ͕ĂŶĚ^ĞǀĞƌĂŶĐĞŝŽŵĞĚŝĐĂů^ĐŝĞŶĐĞ/ŶƐƚŝƚƵƚĞ͕zŽŶƐĞŝ hŶŝǀĞƌƐŝƚǇŽůůĞŐĞŽĨDĞĚŝĐŝŶĞ͕^ĞŽƵů͕ZĞƉƵďůŝĐŽĨ<ŽƌĞĂ͘

Seoul National University Bundang Hospital, Korea

1. Bo Yeon Kim(South Korea)

Ethnic differences in femoral neck geometry asassessed by HSA of QCT between elderly Caucasion
and Chinese populations: a Perth-Beijing groupstudy

2. Hoseok Lee(South Korea)/XHWLF FDXGDHTXLQHUDGLFXOLWLVPLPLFNLQJ*XLOODLQ%DUUHV\QGURPH

Ling Wang , Benjaming. Khoo  , Keenan Brown, Yongbin Su , Xiaoguang Cheng ,Richard Prince Radiology Department, Beijing Jishuitan Hospital, Peking University, Beijing China;
Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Perth, WA,
Australia
Mindways Software, Austin, TX, USA

Sunghoon Park, Kyu-Sung Kwack
Ajou University School of Medicine
mmedpark@gmail.com

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3. Ling Wang(China)

4. Sunghoon Park(South Korea)

Chin Teck Yew, Associate Consultant Radiologist
Chou Hong, Consultant Radiologist
Khoo Teck Puat Hospital

5. Chin Teck Yew(Singapore)- 60 -

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➨㻞㻤ᅇ㻌㻌᪥ᮏ㦵㌾㒊ᨺᑕ⥺◊✲఍

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第 28 回日本骨軟部放射線研究会 プログラム
2019 年 1 月 20 日（金）㻝㻝 䠖 㻜㻜㻌䠉㻌㻝㻞 䠖 㻠㻜䚷㻿㼑㼟㼟㼕㼛㼚㻌㻝㻹㼕㼟㼏㼑㼘㼘㼍㼚㼑㼛㼡㼟䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷㻌㻌㻹㼛㼐㼑㼞㼍㼠㼛㼞䚷㻦䚷㼀㼑㼠㼟㼡㼖㼕㻌㼅㼍㼙㼍㼓㼡㼏㼔㼕䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㼅㼡㼗㼛㻌㻷㼛㼎㼍㼟㼔㼕
1. MR finding of Deltoid ligament tear: How often the ATFL tear is complicated with the deltoid ligament tear?
Department of Radiology, Tokyo Dental College Ichikawa General Hospital
Yuko Kobashi
2. A case of osteomyelitis of the frontal bone following subdural hematoma
Department of Radiology, Shinshu University School of Medicine
Fumihito Ichinohe
3. A case of quadrilateral space syndrome
Radiology Department, St`Lukes International Hospital
Saya Horiuchi
4. A case of proliferative myositis of the thighDepartment of Radiology, Nagasaki Medical Center
Satomi Mine
5. Chronic expanding hematoma in the infrapatellar region of the knee
Department of Radiology, University of Occupational and Environmental Health
Akitaka Fujisaki
6. Atypical fractures of bilateral ulnae associated with bisphosphonate therapy
Department of Radiology, Nagasaki University Hospital
Tetsuji Yamaguchi
7. MR imaging findings of subchondral insufficiency fracture of the knee related to the prognosis
Iwate Medical University School of Medicine (Student)
Risa Dobashi㻝㻟 䠖 㻠㻜㻌䠉㻌㻝㻡 䠖 㻞㻜䚷㻿㼑㼟㼟㼕㼛㼚㻌㻞㻮㼛㼚㼑㻌㼍㼚㼐㻌㻿㼛㼒㼠㻌㼀㼕㼟㼟㼡㼑㻌㼀㼡㼙㼛㼞㼟䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷㻌㻌䚷㻹㼛㼐㼑㼞㼍㼠㼛㼞䚷㻦䚷㻷㼍㼠㼟㼡㼥㼡㼗㼕㻌㻺㼍㼗㼍㼚㼕㼟㼔㼕䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷㻌㻌㻌㻌㻌㻌㻌㻌㻌㼀㼟㼡㼠㼛㼙㼡㻌㻵㼚㼍㼛㼗㼍
8. Two cases of soft tissue lipoma with calcification/ossification
Department of Radiology, Nagasaki University School of Medicine
Nozomi Oki
9. A case of hybrid sclerosing epithelioid fibrosarcoma/low-grade fibromyxoid sarcoma of the right shoulder
Department of Radiology, Gifu University School of Medicine
Masaya䚷Kawaguchi- 63 -

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10. High-grade surface osteosarcoma of the femur: a case report
Department of Radiology, Saitama Medical University Hospital
Kayu Takezawa
11. Madelung’s disease in a patient with alcoholic liver disease
Department of Radiology, Toho University Sakura Medical Center
Tsutomu Inaoka
12. Bone metastases from Head & Neck Squamous Cell Carcinoma (HNSCC). Usage of Whole Body MRI (WB-MRI).
Department of Diagnostic Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases
Katsuyuki Nakanishi
13. A case of parosteal lipoma of the rib
Department of Radiology, Faculty of Medicine, Kagawa University
Hanae Okuda
14. A case of intra-articular synovial sarcoma of the knee
Department of Diagnostic Radiology, Keio University School of Medicine
Ryosuke Sakurai
15. Intravascular lymphoma presenting fasciitis of the thigh: a case report
Department of Radiology, Iwate Medical University
Michiko Suzuki
16. A report of a case with POEMS syndrome found by pulmonary hypertension
Department of Radiology, The Jikei University School of Medicine
Tadashi Tokashiki㻝㻢 䠖 㻜㻜㻌䠉㻌㻝㻢 䠖 㻠㻜䚷㻿㼑㼟㼟㼕㼛㼚㻌㻟㻶㼛㼕㼚㼠㻌㻰㼕㼟㼛㼞㼐㼑㼞㼟䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷㻌㻌䚷㻹㼛㼐㼑㼞㼍㼠㼛㼞䚷㻦䚷㼀㼍㼙㼛㼠㼟㼡㻌㻷㼍㼙㼕㼟㼔㼕㼙㼍
17. Three cases of diabetic cheiroarthropathy
Department of Radiology, Jichi Medical University
Hiroaki Onozawa
18. Tophaceous pseudogout involving rotator interval: a case report
Department of Radiology, Tokushima University Hospital
Naoko Kawano
19. Non hemophilic hemosiderotic synovitis of the knee in the elderly patients: MRI appearances
Department of Radiology, St. Marianna University School of Medicine
Kaoru Kitsukawa
20. A case of rapidly destructive osteoarthritis of the hip
Faculty of Health Sciences, Hokkaido University
Tamotsu Kamishima- 64 -

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㻝 ᭶ 㻞㻜 ᪥ 䠄㔠䠅㻌㻝㻝 䠖 㻜㻜䠉㻝㻞 䠖 㻠㻜㻿㼑㼟㼟㼕㼛㼚㻌㻝㻹㼕㼟㼏㼑㼘㼘㼍㼚㼑㼛㼡㼟䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷㻌㻹㼛㼐㼑㼞㼍㼠㼛㼞䚷㻦䚷㼀㼑㼠㼟㼡㼖㼕㻌㼅㼍㼙㼍㼓㼡㼏㼔㼕䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷㻌㻌㻌㻌㻌㻌㻌㼅㼡㼗㼛㻌㻷㼛㼎㼍㼟㼔㼕㻝㻚 ๓㊥⭌㠎ᖏᦆയ䛻㞃䛥䜜䛯୕ゅ㠌ᖏᦆയ䛾᭷↓䛾᳨ウ䚽ᑠᶫ䚷⏤⣠Ꮚ䚷௚䚷䚷ᮾிṑ⛉኱Ꮫᕷᕝ⥲ྜ⑓㝔䚷ᨺᑕ⥺⛉

1. MR finding of Deltoid ligament tear:
How often the ATFL tear is complicated with the deltoid ligament tear?
䚽Yuko Kobashi

Yohei Munetomo

Akira Baba

Shinji Yamazoe

Takuji Mogami

Department of Radiology, Tokyo Dental College Ichikawa General Hospital[Objectives]
To know how often the deltoid ligament tear is detected in patients who only diagnosed with anterior talofibular
ligament tear.
[Materials and methods]
This study was approved by our institutional review board, and informed consent was obtained from all patients.
The study population comprised 57 patients. All of the 57 patients had a history of ankle sprain, and had an acuteor chronic anterior talofibular ligament (ATFL) tear. All of the 57 patients still had a medial ankle pain on thephysical examination.
Twenty-two of the 57 patients also diagnosed with a deltoid ligament tear and ATFL tear at the same time. We
categorized these patients into Deltoid group. Thirty-five of the 57 patients only had an acute or chronic ATFL
tear. We categorized these patients into ATFL group. We excluded patients with malleolar fracture. All of 57
patients underwent conservative therapy. During assessment of the MRI findings, we analyzed all deltoid ligament
components in each the Deltoid group and ATFL group using our preferred imaging planes.
[Results]
In ATFL group (n=35), six of the 35 patients (7%) had the deltoid ligament tear. All of the 6 patents had anterior
tibiotalaer ligament (ATTL) tear. None of posterior tibiotaler (PTTL) ligament tear nor tibiocalcaneal ligament
tear was detected. In Deltoid group (n=22), all of the 22 patients had ATTL tear. 12 of the 22 patients had both
ATTL and PTTL tear.
[Conclusion]
Most of patients with ATFL tear don't include deltoid ligament tear. However ATTL tear occurs when an externalrotation force is added to the foot.
[Keywords]
Deltoid ligament, Anterior taloficular ligament- 65 -

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㻞㻚 ◳⭷ୗ⾑⭘䜢ྜే䛧䛯๓㢌㦵㦵㧊⅖䛾 㻝 ౛䚽୍ᡞ䚷グே 㻝䠅 ௚䚷䚷㻝䠅 ಙᕞ኱Ꮫ་Ꮫ㒊⏬ീ་Ꮫᩍᐊ

２. A case of osteomyelitis of the frontal bone following subdural hematoma.
䚽Fumihito Ichinohe

1)

Yoshinori Tsukahara 1) Tomoki Kaneko 1) Masumi Kadoya 1) Satoshi Kitamura 2)

Takafumi Kiuchi 2) Kohei Kanaya 2) Midori Sato 3) Toshiaki Otsuki 3)1) Department of Radiology, Shinshu University School of Medicine
2) Department of Neurosurgery, Shinshu University School of Medicine
3) Department of Pathology, Shinshu University School of Medicine
We report a case of osteomyelitis of the frontal bone following subdural hematoma. A 64-year-old mancomplained of a chronic headache for five months. He had been treated with infliximab for Crohn’ s disease. The
neurological findings were normal. Hematological examination also showed no significant findings except for theelevation of CRP, ESR, and ALP, respectively. Computed tomography (CT) showed an osteolytic lesion of theleft-sided frontal bone with adjacent large subdural hematoma. The osteolytic lesion appeared a honeycomb or
moth-eaten pattern. The involved inner and outer table partially remained and periosteal reaction was notdelineated. On magnetic resonance (MR) imaging, the bony lesion was hypointense on T1-weighted image(T1-WI), heterogeneously hyperintense on T2-WI, and hyperintense on contrast-enhanced T1-WI, respectively.
The meninge adjacent to the bony lesion was thick and markedly enhanced, and meningitis was suspected.
Subdural hematoma was hypointense on T1-WI and definitely hyperintense on T2-WI. The rim of hematoma
appeared hypointense on T2*-WI, and the hemosiderin deposition was suspected after chronic hemorrhage. The
lesion had expanded for a few months and was suspected of a neoplasm such as hemangioma. Surgical resection
was performed. Histopathological examination showed the bone destruction and regeneration with abscess andgranulation, and tumor cells were not detected in the specimen. The final diagnosis was osteomyelitis of thefrontal bone associated with meningitis. According to the review in some literatures, osteomyelitis of thecalvarium is extremely rare and few cases with subdural hematoma have been reported.
[Keywords]
osteomyelitis, calvarium, subdural hematoma- 66 -

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㻟㻚㻌㻽㼡㼍㼐㼞㼕㼘㼍㼠㼑㼞㼍㼘㻌㼟㼜㼍㼏㼑㻌㼟㼥㼚㼐㼞㼛㼙㼑 䛾୍౛䚽ᇼෆ䚷Ἃ▮ 㻝䠅 ௚䚷䚷㻝䠅 ⪷㊰ຍᅜ㝿⑓㝔䚷ᨺᑕ⥺⛉

3. A case of quadrilateral space syndrome.
䚽Saya Horiuchi

1)

Taiki Nozaki 1) Masaki Matsusako 1) Yasuyo Teramura 1) Atsushi Tasaki 2)

Starkey Jay 1) Eishi Kuroda 2) Yasuyuki Kurihara 1)
1) Radiology Department, St`Lukes International Hospital
2) Orthopedic Department, St`Lukes International Hospital
The patient was 27-year-old man, a professional rugby player. He presented with discomfort of the right shoulder
since his last match held about one month ago. The range of motion in right shoulder joint was not restricted. On
manual muscle testing, right shoulder abduction was grade 4. MRI of the right shoulder showed diffuse highsignal intensity of the deltoid and the teres minor muscle without muscle atrophy on FS-PDWI. Signal change due
to muscle denervation from axillary nerve injury was suspected. Electromyography needle exam showed
denervation potentials of the right deltoid and no abnormality of the infraspinatus muscle, suggesting of axillary
nerve injury from quadrilateral space syndrome.
Quadrilateral space syndrome is a rare clinical entity, resulting from axillary nerve injury. Reports regarding the
MRI findings in the acute phase of quadrilateral space syndrome are few. We report a case with literature review.
[Keywords]
Quadrilateral space syndrome, Shoulder MRI, Rotator Cuff Denervation Syndromes- 67 -

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㻠㻚 ኱⭣㒊䛾ቑṪᛶ➽⅖䛾 㻝 ౛䚽ᓟ䚷⪽⨾ 㻝䠅 ௚䚷䚷㻝䠅 ⊂❧⾜ᨻἲேᅜ❧⑓㝔ᶵᵓ㛗ᓮ་⒪䝉䞁䝍䞊ᨺᑕ⥺⛉

4. A case of proliferative myositis of the thigh䚽Satomi Mine

1)

Kazunori Mitarai 1) Kenji Makino 1) Atsushi Miyazaki 1) Toshifumi Fujimoto 1)

Masataka Uetani 2) Hirokazu Kurohama 3) Masahiro Ito 3) Kenji Kumagai 4)1) Department of Radiology, Nagasaki Medical Center2) Department of Radiology, Nagasaki University Hospital3) Department of Pathology, Nagasaki Medical Center4) Department of Orthopedic surgery, Nagasaki Medical Center
Proliferative myositis is a rare inflammatory disease, which can mimic malignant tumors. We present a case of
proliferative myositis involving the sartorius muscle of the left thigh.
A 62-year-old woman presented with a painful swelling in the anterior aspect of her left thigh without a history of
trauma. Physical examination revealed an elastic hard mass in the proximal anterior aspect of the thigh.
CT revealed swelling of the left sartorius muscle that is mildly hypoattenuating relative to other skeletal muscles
with increased attenuation of adjacent fat. No calcification or ossification is identified in the lesion.
MR imaging revealed a fusiform swelling of the left sartorius muscle. The lesion had high signal intensity on
T2-weighted MR images and STIR, and was isointense compared with the signal intensity of skeletal muscle on
T1-weighted MR images. Contrast-enhanced T1-weighted images revealed inhomogeneous enhancement of thelesion. MR images also demonstrated continuous muscle fibers without disruption in the lesion.
The pathological diagnosis of a fine needle biopsy specimen was myxofibrosarcoma. Surgical resection of the left
sartorius muscle was subsequently performed and the final pathological diagnosis was proliferative myositis.
Although the MRI findings are non-specific, we highlight the importance of considering proliferative myositis in
the differential diagnosis of a soft tissue mass, which ultimately might prevent an overly aggressive resection.
[Keywords]
Proliferative myositis, pseudomalignant tumor- 68 -

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㻡㻚 ⭸⵹ୗ㒊䛻Ⓨ⏕䛧䛯 㻯㼔㼞㼛㼚㼕㼏㻌㼑㼤㼜㼍㼚㼐㼕㼚㼓㻌㼔㼑㼙㼍㼠㼛㼙㼍䚽⸨ᓮ䚷⍛㝯 㻝䠅 ௚䚷䚷㻝䠅 ⏘ᴗ་⛉኱Ꮫᨺᑕ⥺⛉Ꮫᩍᐊ

5. Chronic expanding hematoma in the infrapatellar region of the knee
䚽Akitaka Fujisaki

1)

Takatoshi Aoki 1) Michiko Kobayashi 1) Masami Fujii 1) Yoshiko Hayashida 1)

Yukunori Korogi 1) Masanori Hisaoka 2)1) Department of Radiology, University of Occupational and Environmental Health2) Department of Pathology and Oncology, University of Occupational and Environmental Health
Chronic expanding hematoma is an entity that was defined by Reid et al. in 1980, and is characterized by its
persistence and increasing size for more than a month after the initial hemorrhage. This entity may be
misdiagnosed as a malignant tumor due to its large size and slow progressive enlargement. We present a case ofchronic expanding hematoma occurring in the infrapatellar region of the knee without any history of trauma andsurgery.
An 86-year-old female patient noticed a painless mass that had been gradually enlarging in the left knee for theprevious 10 years. A radiograph of the left knee showed a soft tissue mass without calcification in the infrapatellar
region. The mass revealed heterogeneous high intensity on T1-weighted images. On T2-weighted images, theintensity of the mass varied with areas lower than muscle and higher than fat. The peripheral rim of low intensity
was observed on both T1-weighted and T2-weighted images. T2*-weighted image enhanced the low signal within
the mass due to the presence of hemosiderin. These MRI findings were considered to be characteristic of chronic
expanding hematoma. The mass, measured 8×6×3cm in diameter, was excised, and the histologic diagnosis washematoma without malignancy.
[Keywords]
Chronic expanding hematoma, infrapatellar region, soft tissue mass

- 69 -

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㻢㻚 䝡䝇䝣䜷䝇䝣䜷䝛䞊䝖〇๣ᢞ୚୰䛻Ⓨ⏕䛧䛯୧ഃᑻ㦵㠀ᐃᆺ㦵ᢡ䛾୍౛䚽ᒣཱྀ䚷ဴ἞ 㻝䠅 ௚䚷䚷㻝䠅 㛗ᓮ኱Ꮫ⑓㝔ᨺᑕ⥺⛉

6. Atypical fractures of bilateral ulnae associated with bisphosphonate therapy
䚽Tetsuji Yamaguchi

1)

Masataka Uetani 2) Yasuhiro Kawahara 3) Yuzo Honda 4) Aki Nishi 4)

Hiroaki Konishi 4) Akihito Tokuda 5)1) Department of Radiology, Nagasaki University Hospital2) Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University3) Department of Radiology, Nagasaki Rosai Hospital4) Department of Orthopedics, Nagasaki Rosai Hospital5) Senryu Tokuda Hospital

We report a case of atypical fractures of the bilateral ulnae associated with bisphosphonate use. The patient(73-year-old female) had been taking bisphosphonates for 4 years for treatment of osteoporosis.
She complained of a pain on the left forearm, which began after lifting a light object (kettle) seven days ago. She
had no recent history of trauma. She usually used a pushcart at walking since 3 years. Radiographs showed atransverse fracture of the left proximal ulna. The fracture was treated by osteosynthesis.
After 6 months, she suffered from a pain on the right forearm, which began after minor trauma one day before.
Radiographs showed an incomplete transverse fracture with adjacent cortical thickening of the right proximal
ulna, which suggested an incomplete fracture of right proximal ulna.
She was managed in a long-arm cast. However, follow-up radiographs 8 days later demonstrated a complete
transverse fracture. CT and MRI after 2 months showed a transverse fracture line with callus formation. The
fracture was also treated by osteosynthesis.
Atypical fractures, which mostly occur as the subtrochanteric and diaphyseal femoral fractures, have been known
to be common complication in patients with long-term use of bisphosphonates. The proximal ulna should beconsidered as a potential site of involvement of atypical fractures in bisphosphonate users.
[Keywords]
atypical fracture, ulna, bisphosphonate- 70 -

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㻣㻚 ⭸㌾㦵ୗ⬤ᙅᛶ㦵ᢡ䛾 㻹㻾㻵 ᡤぢ䛻䛚䛡䜛ணᚋᅉᏊᅵᶫ䚷䜚䛥 㻝䠅 ௚䚷䚷㻝䠅 ᒾᡭ་⛉኱Ꮫ་Ꮫ㒊 䠄Ꮫ⏕䠅

7. MR imaging findings of subchondral insufficiency fracture of the knee related to the prognosis
Risa Dobashi 1) 䚽Shigeru Ehara 2)
1) Iwate Medical University School of Medicine (Student)
2) Department of Radiology, Iwata Medical University
At 2013 meeting, we reported the natural course of subchondral insufficiency fracture of the knee. To assess theoverall prognosis in the current cases, we again retrospectively reviewed cases seen in the current 5 years,
diagnosed and followed by MR imaging. Total of 13 cases (24-83 year old, M:F=3:10) were divided into twogroups depending on the prognosis. The first group consisted of 8 cases in which the subchondral cortex andmarrow changes disappeared with no deformity. The second group consisted of 5 cases in which subchondralbone collapse developed, resulted in arthroplasty. In the second group, subchondral cyst formation was evident in
the subchondral boned marrow on MR imaging. Medial meniscus injury was associated in 6 cases in the 1stgroup, and 5 cases in the 2nd group, and medial collateral ligament injury was seen in 1 case in the 1st group and4 cases in the 2nd group. Patients’ age was not a significant factor if the24-year-old patient, the yongest, was
excluded.
In conclusion, development of subchondral cyst and association of medial collateral ligament injury on MR
imaging are associated with subchondral bone collapse in subchondral insufficiency fracture of the knee.
[Keywords]
subchondral insufficiency fracture, osteonecrosis- 71 -

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㻝 ᭶ 㻞㻜 ᪥ 䠄㔠䠅㻌㻝㻟 䠖 㻠㻜䠉㻝㻡 䠖 㻞㻜㻿㼑㼟㼟㼕㼛㼚㻌㻞㻮㼛㼚㼑㻌㼍㼚㼐㻌㻿㼛㼒㼠㻌㼀㼕㼟㼟㼡㼑㻌㼀㼡㼙㼛㼞㼟䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷㻹㼛㼐㼑㼞㼍㼠㼛㼞䚷㻦䚷㻷㼍㼠㼟㼡㼥㼡㼗㼕㻌㻺㼍㼗㼍㼚㼕㼟㼔㼕䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷㻌㻌㻌㻌㻌㻌㻌㻌㻌㼀㼟㼡㼠㼛㼙㼡㻌㻵㼚㼍㼛㼗㼍㻤㻚 ▼⅊໬ 㻛 㦵໬䜢క䛖⬡⫫⭘䛾 㻞 ౛䚽኱ᮌ㻌㻌ᮃ 㻝䠅 ௚䚷䚷㻝䠅 㛗ᓮ኱Ꮫ⑓㝔㻌ᨺᑕ⥺⛉

8. Two cases of soft tissue lipoma with calcification/ossification
䚽Nozomi Oki

1)

Hirofumi Koike 1) Tetsuji Yamaguchi 1) Masataka Uetani 1) Masato Tomita 2)

Noriaki Miyata 2) Makoto Osaki 2) Naoe Kinoshita 3) Junya Fukuoka 3)1) Nagasaki University School of Medicine, Department of Radiology
2) Nagasaki University School of Medicine, Department of Orthopaedic Surgery3) Nagasaki University School of Medicine, Department of Pathology

Lipomas are the most common benign soft tissue tumors. Some lipomas contain other mesenchymal elements,
which make the radiological distinction from other benign and malignant soft tissue tumors difficult.
We present two rare cases of lipoma with bone or cartilage formation.
Case 1: A 70’ s man with right palmer mass. Radiographs showed a calcified a soft tissue mass adjacent to the
2nd metacarpal bone. The mass demonstrated heterogeneous low and high signal intensity(SI) on T1 and T2
weighted images(WI). The mass appeared to contain some adipose tissue with calcification or ossification. The
excisional biopsy revealed a pathological diagnosis of ossifying lipoma.
Case 2: A 70’ s woman with right palmer mass increasing in one year. Radiographs showed a calcified soft tissue
mass between the 3rd and 4th metacarpal bones. The mass demonstrated heterogeneous low and high SI in T1 andT2WI. Enhancement after Gd-DTPA administration was not seen except for the distal part. The mass appeared tocontain some adipose tissue, calcification, and cartilaginous element. The excisional biopsy revealed apathological diagnosis of chondrolipoma.
[Keywords]
lipoma, calcification, ossification- 72 -

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㻥㻚 ⼥ྜᆺ◳໬ᛶ㢮ୖ⓶⥺⥔⫗⭘ 㻛 పᝏᛶᗘ⥺⥔⢓ᾮᛶ⫗⭘䛾 㻝 ౛䚽ᕝཱྀ䚷┿▮ 㻝䠅 ௚䚷䚷㻝䠅 ᒱ㜧኱Ꮫ㝃ᒓ⑓㝔ᨺᑕ⥺⛉

9. A case of hybrid sclerosing epithelioid fibrosarcoma/
low-grade fibromyxoid sarcoma of the right shoulder
䚽Masaya Kawaguchi 1) Hiroki Kato 1) Masayuki Matsuo 1) Yusuke Kito 2) Kenji Hisamatsu 2)
1) Gifu University School of Medicine, Department of Radiology
2) Gifu University School of Medicine, Department of Pathology
Sclerosing epithelioid fibrosarcoma (SEF) is a rare variant of low-grade fibrosarcoma, originally described in
1995 by Meis-Kindblom JM et al. SEF is a rare soft-tissue tumor exhibiting considerable morphologic overlap
with low-grade fibromyxoid sarcoma (LGFMS). SEF usually occurs in young and middle ages, commonly arisesin the deep skeletal muscle in the lower extremity, limb girdle, upper extremity, head and neck region. We
presented a 32-year-old woman with an indolent mass in the right shoulder for two years. She received afollow-up examination through her primary care doctor, but the mass did not increase during the follow-up period.
However, because many pulmonary nodules were pointed out by annual chest X-ray examination two month ago,
she was referred to our hospital. Subsequently performed CT images revealed a soft-tissue mass in the rightshoulder and many lung metastases. The mass showed isointensity on T1-weighted images, hypo- tohyperintensity on T2-weighted images, and heterogeneous enhancement. Strong diffusion restriction was notobserved (ADC value: 1.6×10-3mm2/sec). The resection of the right shoulder tumor and pulmonary nodule was
performed. Histopathologically, the tumor was composed of hypercelluar components with fibrosis andhypocellular components with myxoid matrix. Immnohistochemistrical analyses showed positive for Vimentin,
MUC-4, and EMA and negative for CD34, S100 protein, desmin, and SMA. Based on fluorescence in situ
hybridization (FISH) and fusion gene detection, the final diagnosis was hybrid SEF/LGFMS.
[Keywords]
Sclerosing epithelioid fibrosarcoma, low grade fibromyxoid sarcoma- 73 -

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㻝㻜㻚㻌㻴㼕㼓㼔㻙㼓㼞㼍㼐㼑㻌㼟㼡㼞㼒㼍㼏㼑㻌㼛㼟㼠㼑㼛㼟㼍㼞㼏㼛㼙㼍㻌䛾୍౛䚽➉⃝䚷ె⏤ 㻝䠅 ௚䚷䚷㻝䠅 ᇸ⋢་⛉኱Ꮫ⑓㝔䚷ᨺᑕ⥺⛉

10. High-grade surface osteosarcoma of the femur: a case report䚽Kayu Takezawa

1)Mamoru Niitsu 1) Hiroyuki Morisaka 2) Ken Nakazawa 2) Akira Uchino 2)

Jungo Imanishi 3) Tomoaki Torigoe 4) Yasuo Yazawa 4) Takashi Fujino 5)
1) Saitama medical university hospital, department of radiology
2) Saitama medical university international medical center, department of radiology
3) Saitama medical university international medical center, department of orthopedic surgery
4) Saitama medical university international medical center,
department of Orthopaedic Oncology and Surgery5) Saitama medical university international medical center, department of pathology
A high-grade surface osteosarcoma is rare and the least common subtype of juxtacortical osteosarcomas(parosteal, periosteal, and high-grade surface osteosarcoma). The imaging characteristics frequently overlap
among those subtypes and make an accurate diagnosis challenging. We report a case of the juxtacortical tumor in
the femur which aggressive clinicopathological features led to the diagnosis of high-grade surface osteosarcoma.
A 53-year-old male presented with a three-month duration of a painful mass in the dorsal right thigh. The
radiograph and CT showed ill-defined cortical erosion and spiculated periosteal reaction along the middle
diaphysis of the right femur with fluffy and striated mineralization in a juxtacortical soft-tissue mass. MRI
demonstrated a broad-based lobulated bulky mass arose on the surface of the bone and encased the bone
circumferentially. The extraosseous mass formed multilocular fluid-fluid levels with some amount ofmineralization and showed peripheral enhancement. Faint intramedullary enhancement was also observed. Bone
scintigraphy revealed intense uptake in the cortex and extraossesous mineralization. There was no evidence ofmetastasis.
A wide resection of the tumor and limb salvage procedure was performed. Pathological features of the tumor werecompatible with osteosarcoma with high mitotic activity. The tumor produced osteoid and cartilaginous matrix,
and the former was observed more dominantly. We made a diagnosis of high-grade surface osteosarcoma, withcompositional findings from clinical, radiographic, and pathological features.
[Keywords]
High-grade surface osteosarcoma- 74 -

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㻝㻝㻚 䜰䝹䝁䞊䝹ᛶ⫢㞀ᐖᝈ⪅䛻⏕䛨䛯 㻹㼍㼐㼑㼘㼡㼚㼓 ⑓䛾䠍౛䚽✄ᒸ䚷ດ 㻝䠅 ௚䚷䚷㻝䠅 ᮾ㑥኱Ꮫబ಴⑓㝔ᨺᑕ⥺⛉

11. Madelung’s disease in a patient with alcoholic liver disease
䚽Tsutomu Inaoka

1)

Noriko Kitamura 1) Shusuke Kasuya 1) Masayuki Odashima 1)

Tomoya Nakatsuka 1) Rumiko Ishikawa1) Haruka Masuda 1) Hitoshi Terada 1)
Tamako Irie 2) Yasuhiro Watanabe 2) Nobuyuki Hiruta 3)1) Department of Radiology, Toho University Sakura Medical Center2) Department of Internal Medicine, Toho University Sakura Medical Center
3) Division of Surgical Pathology, Toho University Sakura Medical Center[Objectives]
Madelung’s disease (benign symmetric lipomatosis) is a rare lipid metabolism disorder. We report a case ofMadelung’s disease due to alcoholism with a brief review of the literature.
[Materials and methods]
A 65-year-old male presenting with rapid-growing palpable mass lesions in the submandibular area. [PH]
Alcoholic liver disease, hypertension, hyperuremia. [clinical presentation] Multiple, symmetric, painless masslesions in the submandibular area, posterior neck, and bilateral arms. Laboratory data showed liver dysfunction
due to alcoholism.
[Results]
CT showed multiple, fatty mass lesions involving the submandibular area, posterior neck, and bilateral arms.
Hepatomegaly with fatty liver was seen. Neck MRI showed diffuse fatty proliferation in the submandibular areaand posterior neck.
[Conclusion]
From these clinico-radiologic findings, the diagnosis of Madelung’ s disease (benign symmetric lipomatosis) was
made.
[Keywords]
Madelung's disease, Alcoholism, CT- 75 -

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㻝㻞㻚 㢌㢁㒊ᡥᖹୖ⓶⒴㦵㌿⛣䛾඲㌟ 㻹㻾㻵 ᡤぢ䚽୰す䚷ඞஅ 㻝䠅 ௚䚷䚷㻝䠅 ኱㜰ᗓ❧ᡂே⑓䝉䞁䝍䞊ᨺᑕ⥺デ᩿⛉

12. Bone metastases from Head & Neck Squamous Cell Carcinoma (HNSCC).
Usage of Whole Body MRI (WB-MRI)
䚽Katsuyuki Nakanishi

1)

Akio Tsukabe 1) Hiromitsu Sumikawa 1) Mio Sakai 1) Nobuhito Araki 2)

1) Department of Diagnostic Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases2) Department of Orthopaedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases[Objectives]
To assess cases of bone metastases from HNSCC retrospectively, using WB-MRI including diffusion weighted
images (DWI).
[Materials and methods]
13 cases of HNSCC were reviewed (2, nasopharynx; 2, oropharynx; 2, hypopharynx; 4, tongue; 2, larynx; 1, nasal
cavity). In all cases, CT findings regarding the degree of osteoblastic change, MR findings (especially the signal
characteristics of DWI) and the degree of the FDG accumulation were analyzed.
[Results]
In five of these 13 cases, bone metastases were independently the new-onset metastases. In the other four, bonemetastases and other metastases were together the new-onset metastases and in the remaining four, bonemetastases were secondary onset.
In four of our 13 cases, osteoblastic patterns were recognized in CT and in all four, lesions were shown as highintensity on DWI. Additionally, ADC values were less than 1.2mm2/sec. In the other four cases, neither
osteoblastic nor lytic patterns were shown. Hence, they were classified as intratrabecular patterns. Also in thesefour cases, these lesions were shown as high intensity on DWI and ADC values were less than 1.2mm2/sec. In
one of these four cases, osteolytic change appeared in the process of disease progression. In the other five cases,
osteolytic patterns were recognized.
[Conclusion]
Bone metastases from HNSCC are rare but need to be detected. It is often found with lung or liver metastases, but
it can appear alone. WB-MRI is useful as a screening and staging tool.
[Keywords]
Bone metastases, whole body MRI, Head & Neck SCC- 76 -

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㻝㻟㻚 ⫘㦵䛻Ⓨ⏕䛧䛯ഐ㦵ᛶ⬡⫫⭘䛾䠍౛䚽ዟ⏣䚷ⰼỤ䚷௚䚷䚷㤶ᕝ኱Ꮫ䚷་Ꮫ㒊䚷ᨺᑕ⥺་Ꮫㅮᗙ

13. A case of parosteal lipoma of the rib
䚽Hanae Okuda

Yuko Ono

Yuko Fukuda

Yoshihiro Nishiyama

Department of Radiology, Faculty of Medicine, Kagawa University

A 30s man presented with a 2-years history of a slowly enlarging painless chest wall mass near his right fourthrib. Chest X-ray showed extrapleural mass in right upper lung field. CT scan showed a well-defined fatty mass
with peripheral ossification in close proximity to the right posterior fourth or third rib, measuring 35 x 25 mm. On
MRI, it showed high SI on T1WI and T2WI, iso-high SI on STIR. Bone scintigraphy showed mildly increased
activity around the lesion. Subsequently, He underwent en bloc resection of the mass with the right third andfourth ribs. Microscopically, the lesion was circumscribed by a ossifying capsule and mainly constituted bymature adipose tissue. Adipocytes were benign without evidence of atypia or pleomorphism. Mitosis or necrosis
were not appreciated. The final diagnosis was consistent with parosteal lipoma of the rib. We report a case ofparosteal lipoma of the rib with some literature review.
[Keywords]
lipoma- 77 -

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㻝㻠㻚 ⭸㛵⠇ෆ㛵⠇⫗⭘䛾୍౛䚽Ḉ஭䚷ுభ䚷௚䚷䚷៞᠕⩏ሿ኱Ꮫᨺᑕ⥺デ᩿⛉

14. A case of intra-articular synovial sarcoma of the knee
䚽Ryosuke Sakurai Sota Oguro Shunsuke Matsumoto Hiroaki Sugiura Shigeo Okuda Akihiro Tanimoto
Masahiro Jinzaki
Department of Diagnostic Radiology, Keio University School of Medicine
A 56-year-old man presented with a two-year history of right knee pain under extension. Physical examination
showed a loss in extension of 20 ° . An anterior cruciate ligament (ACL) tear and a 3cm multiloculated mass infront of ACL was suspected on pre-operative magnetic resonance imaging of the knee. The mass was
homogenous, and without contrast enhancement, its signal intensity was isotense on T1-weighted images andhyperintense on T2-weighted images, compared to those of the surrounding muscle. Preoperative diagnosis was
ACL tear and intra-articular ganglion cyst of the knee. ACL reconstruction and excision of the mass was
performed under arthroscopy. The lesion was solid mass, and was excised in several divisions. Postoperative
diagnosis was biphasic type of synovial sarcoma. Immunohistochemical stains showed positive for bcl-2,
epithelial membrane antigen and CD99. Split-signal FISH for SS18 was also positive. Adjuvant
chemoradiotherapy was added after excision of the tumor based on pathological diagnosis. Radiologicalevaluation of two months, nine months and one year after surgery showed no evidence of recurrence nor
metastasis. Intra-articular synovial sarcoma is extremely rare, and there are only few case reports focused onradiological features. We report this case with some literature review.
[Keywords]
intra-articular tumor, synovial sarcoma- 78 -

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㻝㻡㻚㻌㻹㻾㻵 䛷➽⭷⅖ᵝᡤぢ䜢࿊䛧䛯 㼕㼚㼠㼞㼍㼏㼍㼟㼏㼡㼘㼍㼞㻌㼘㼥㼙㼜㼔㼛㼙㼍 䛾୍౛䚽㕥ᮌ䚷⨾▱Ꮚ 㻝䠅 ௚䚷䚷㻝䠅 ᒾᡭ་⛉኱Ꮫ䚷ᨺᑕ⥺་Ꮫㅮᗙ

15. Intravascular lymphoma presenting fasciitis of the thigh: a case report䚽Michiko Suzuki

1)

Shigeru Ehara 1) Yuzo Suzuki 2) Takashi Satoh 3)

1) Department of Radiology, Iwate Medical University2) Department of Hematology, Iwate Medical University3) Department of pathology, Iwate Medical University
A 65-year-old man presented with painful swelling of the thigh with thick skin. The patient’ s symptoms initially
improved by steroid, but he came back with general malaise and bilateral pedal edema. CT scan of the abdomen &pelvis failed to demonstrate any abnormalities, but MR imaging of the thigh revealed extensive edema along thefascia of the thigh and gluteal regions mimicking fasciitis. Biopsy of the bone marrow and skin and subcutaneous
region of the thigh revealed intravascular lymphoma. The immunohistochemistry revealed intravascular large
B-cell lymphoma in both specimens.
Intravascular malignant lymphoma is uncommon, and CNS involvement is common in most reports. We report acase of intravascular lymphoma presenting as fasciitis-like thigh change on MR imaging, which was reported only
once in the previous literature.
[Keywords]
Intravascular lymphoma, fasciitis of the thigh- 79 -

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㻝㻢㻚 ⫵㧗⾑ᅽ⑕䜢ዎᶵ䛻デ᩿䛥䜜䛯 㻼㻻㻱㻹㻿 ⑕ೃ⩌䛾୍౛䚽Ώ჆ᩜ䚷၏ྖ䚷௚䚷䚷ᮾிឿᜨ఍་⛉኱Ꮫ㻌ᨺᑕ⥺་Ꮫㅮᗙ

16. A report of a case with POEMS syndrome found by pulmonary hypertension
䚽Tadashi Tokashiki

Toru Sakuma

Kunihiko Fukuda

Department of Radiology, The Jikei University School of Medicine.

A 45-year-old woman was admitted to our hospital because of dyspnea on exercise, peripheral edema, and bodyweight gain of 10kg. The physical examination shows palpable cervical lymph nodes and tenderness anddistention of abdomen. Transthoracic echocardiography showed pulmonary hypertension with right heart
enlargement. Contrast enhanced CT of the chest and abdomen was performed to investigate the cause of thepulmonary hypertension. CT revealed neck, axillar, and para-aortic lymph adenopathy, pleural effusions, andascites. In addition, bone window CT showed multiple sclerotic nodules in the skeletal system. POEMS syndrome
was suspected from the imaging findings.
Bone marrow biopsy revealed no monoclonal proliferation of the plasma cell, however, the ulnar nerve
conduction velocity was reduced on nerve conduction study, which is one of the mandatory major criteria of
POEMS syndrome. Multiple minor criteria such as elevation of the serum vascular endothelial growth factor(VEGF), hepatosplenomegaly, hypothyroidism, skin pigmentation, peripheral edema, papilledema, clubbed finger
was positive. Therefore, this case was diagnosed as POEMS syndrome. A rare case of POEMS syndrome
admitted with pulmonary hypertension will be presented.
[Keywords]
POEMS syndrome- 80 -

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㻝 ᭶ 㻞㻜 ᪥ 䠄㔠䠅㻌㻝㻢 䠖 㻜㻜䠉㻝㻢 䠖 㻠㻜㻿㼑㼟㼟㼕㼛㼚㻌㻟㻶㼛㼕㼚㼠㻌㻰㼕㼟㼛㼞㼐㼑㼞㼟䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷㻹㼛㼐㼑㼞㼍㼠㼛㼞䚷㻦䚷㼀㼍㼙㼛㼠㼟㼡㻌㻷㼍㼙㼕㼟㼔㼕㼙㼍㻝㻣㻚㻌㼐㼕㼍㼎㼑㼠㼕㼏㻌㼏㼔㼑㼕㼞㼛㼍㼞㼠㼔㼞㼛㼜㼍㼠㼔㼥 䛾 㻟 ౛䚽ᑠ㔝⃝䚷⿱ᫀ䚷௚䚷䚷⮬἞་⛉኱Ꮫ㝃ᒓ⑓㝔㻌ᨺᑕ⥺⛉

17. Three cases of diabetic cheiroarthropathy
䚽Hiroaki Onozawa

Hideharu Sugimoto

Ryoma Kobayashi

Atsushi Ugajin

Atsuko Sakamoto

Yuko Otake
Department of Radiology, Jichi Medical University

Diabetic cheiroarthropathy is a complication of long-term diabetes mellitus. Since its clinical features resemble
rheumatoid arthritis (RA) or other arthropathy, it can be an important differential diagnosis in arthritis of hands.
Here we report three cases of diabetic cheiroarthropathy and review of literatures. The patients are two females
and a male in their 60s-80s, each of them had a thick past medical history of diabetes mellitus treated with insulin
for decades. The chief complaints were swelling, impairment or painful stiffness of their hands and fingers. The
physical examination showed swollen joints and soft tissues of their hands. Rheumatoid factors and anti-CCP
antibodies were negative. One patient had a skin biopsy of that the result came out mucinous deposition.
Radiography of the hands did not show marginal erosion or osteopenia that suggests RA. On MRI, the findingsthat suggest RA (e.g. synovitis, bone marrow edema etc.) were not detected; effusion surrounding flexor andextensor tendons that suggesting tendonitis were shown. Both radiography and MRI showed extension disorder of
DIP and PIP joints, which is compatible with diabetic cheiroarthropathy.
[Keywords]
diabetes cheiroarthropathy LJMS

- 81 -

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㻝㻤㻚 ⭝ᯈ␯㒊䛻⏕䛨䛯⤖⠇ᛶഇ③㢼䛾䠍౛䚽Ἑ㔝䚷ዉ⥴Ꮚ 㻝䠅 ௚䚷䚷㻝䠅 ᚨᓥ኱Ꮫ⑓㝔ᨺᑕ⥺⛉

18. Tophaceous pseudogout involving rotator interval: a case report
䚽Naoko Kawano

1)

Shoichiro Takao 2) Junji Ueno 2) Masafumi Harada 1) Ryo Miyagi 3)

Toshihiko Nishisho 3) Akiko Yoneda 4) Yoshimi Bando 4)1) Department of Radiology, Tokushima University Hospital, Tokushima, Japan
2) Department of Diagnostic Radiology, Graduate School of Health Sciences,
Tokushima University, Tokushima, Japan
3) Department of Orthopedics, Institute of Biomedical Sciences,
Tokushima University Graduate School, Tokushima, Japan
4) Division of Pathology, Tokushima University Hospital, Tokushima, Japan
We present a case of tophaceous pseudogout involving a rare location, rotator interval. A 57-year-old woman had
right shoulder pain for 6 years. Despite conservative treatment, her shoulder pain got worse. Physical examination
showed no tenderness, local warmth or local redness. Plain radiography revealed calcified mass in the rightshoulder. Computed tomography revealed calcified mass as large as 18 x 12 x 27 mm in the right shoulder joint
with adjacent bony erosion of the scapula. On magnetic resonance imaging, the mass was located in the rotator
interval with iso-signal intensity on T1-weighted images and relatively higher signal intensity on T2-weighted
images compared with skeletal muscles. After administration of gadolinium contrast medium, the adjacent soft
tissue showed contrast enhancement, however the mass did not. En-block resection was performed and the mass
was diagnosed histologically as calcium pyrophosphate dehydrate (CPPD) crystal deposition. Since tophaceouspseudogout commonly involves knee, foot, finger and temporomandibular joints, rotator interval seemed to be arare location. We describe the imaging findings of this case focused on the computed tomography and magnetic
resonance imaging.
[Keywords]
tophaceous pseudogout, rotator interval- 82 -

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2017/01/18 23:14:53

㻝㻥㻚 㧗㱋⪅䛻Ⓨ⑕䛧䛯⭸㛵⠇㠀⾑཭⑓ᛶ㻌㼔㼑㼙㼛㼟㼕㼐㼑㼞㼛㼠㼕㼏㻌㼟㼥㼚㼛㼢㼕㼠㼕㼟㻌䛾 㻹㻾㻵 ᡤぢ䚽ᶲᕝ䚷⸅ 㻝䠅 ௚䚷䚷㻝䠅 ⪷䝬䝸䜰䞁䝘་⛉኱Ꮫᨺᑕ⥺་Ꮫㅮᗙ

19. Non hemophilic hemosiderotic synovitis of the knee in the elderly patients: MRI appearances䚽Kaoru Kitsukawa

1)

Satoshi Kishiro 2) Kenji Uehara 2) Yasuo Nakajima 1) Masayuki Takagi 3)1) Department of Radiology, St. Marianna University School of Medicine
2) Department of Orthopedic Surgery, St. Marianna University School of Medicine
3) Department of Pathology, St. Marianna University School of Medicine
Hemosiderotic synovitis is a result of recurrent hemarthrosis that occurs as a consequence of conditions includingtrauma, synovial hemangioma, bleeding disorders (hemophilia), and arthritis. This condition is sometimes
confused with pigmented villonodular synovitis. Using MRI, we demonstrate diffuse hemosiderin deposition in
the knees of three elderly patients. Eighty-eight and 65-year-old females, and an 84-year-old male patientcomplained of swelling and pain in the knee joints. Only one side was involved in each patient. Two patients had
a history of trauma but one patient had no trauma history. No patients had a bleeding disorder but one patient was
taking an anti-coagulant. MRI of the knee showed extensive very low-signal intensity areas within the joint on
gradient-echo images indicating hemosiderin deposition.

All patients had meniscal injuries; lateral meniscal

tears were more significant than medial meniscal tears. Arthroscopic findings showed hypertrophy of brown
synovium but no definitive bleeding point was found. Histopathological examination of resected synovium
revealed synovial thickening and granules of hemosiderin within the synovial cells compatible with hemosiderotic
synovitis.
[Keywords]
hemosiderin, knee, MRI- 83 -

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2017/01/18 23:14:54

㻞㻜㻚 ᛴ㏿◚ቯᆺ⫤㛵⠇⑕䛾 㻝 ౛䚽⚄ᓥ䚷ಖ 㻝䠅 ௚䚷䚷㻝䠅 ໭ᾏ㐨኱Ꮫ኱Ꮫ㝔ಖ೺⛉Ꮫ◊✲㝔䚷་⏝⏕య⌮ᕤᏛศ㔝㻌㻌

20. A case of rapidly destructive osteoarthritis of the hip䚽Tamotsu Kamishima

1)

Daisuke Takahashi 2) Tomohiro Onodera 2) Teppei Imamoto 3)

Hiromi Okada 3) Tomoko Mitsuhashi 3) Norimasa Iwasaki 2)
1) Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
2) Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo,
Hokkaido, Japan
3) Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
A 72-year-old female patient was referred to the orthopedic service of our university hospital 8 weeks after onset
of moderate left groin pain. She had been seen in an outside orthopedic clinic 2 years earlier and diagnosed withosteoarthritis of bilateral hips. A radiograph of the left hip taken at symptom onset showed severe degenerative
disease, with slight flattening and irregularity of the femoral head. She had been scheduled for total hip
arthroplasty of the left hip 4 weeks after onset of moderate left groin pain, however it was canceled because of
progressive anemia and elevated CRP level of 5.0 mg/L. Follow-up radiograph showed complete femoral headdisintegration possibly representative of septic arthritis or rapidly destructive osteoarthritis of the hip (RDOA).
MRI and CT demonstrated hypoplastic acetabulum and fragmentation of the femoral head of the left hip. She
underwent total hip arthroplasty at our university hospital. Intraoperative findings revealed no pus, but abundantsynovial tissue. Pathologically, there was severe deformation and flattening of the femoral head with necroticbone fragments. Surrounding synovium contained increased vascular proliferation. Hence diagnosis of RDOA
was made clinically, radiologically and pathologically. RDOA is a rare and poorly understood disease of the hip.
This case represents an example of the rapidly destructive potential of this unusual entity.
[Keywords]
osteoarthritis, septic arthritis, rapidly destructive osteoarthritis of the hip- 84 -

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2017/01/18 23:14:54ྜྠ㛤ദ➨㻞㻤ᅇ㻌㻌᪥ᮏ㦵㌾㒊ᨺᑕ⥺◊✲఍➨㻡㻣ᅇ㻌㻌᪥ᮏ㦵㌾㒊⭘⒆◊✲఍

第28回骨軟部放射線研究会̲他2学会開催̲抄録.indd 85

2017/01/18 23:14:54

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第28回骨軟部放射線研究会̲他2学会開催̲抄録.indd 87

2017/01/18 23:14:55


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第28回骨軟部放射線研究会̲他2学会開催̲抄録.indd 88

2017/01/18 23:14:56

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第28回骨軟部放射線研究会̲他2学会開催̲抄録.indd 89

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Joint Meeting
The 57th Meeting of Bone and Soft Tissue Tumor Club of Japan (BTC)
The 28th Meeting of Japanese Society of Musculoskeletal Radiology(JSMR)
Annual Meeting 2017 of Asian Musculoskeletal Society (AMS)

⑕౛㸯
ྑ๓⭎㌾

Jan 21, 2017
The Jikei University School of Medicine, Tokyo, Japan
Lists of BTC Cases
Case 1
Soft Tissue Tumor of the Right Forearm
Kazuyoshi Uchihashi1), Toshitaka Aoki2), Yuichi Matsuki3), Atsuji Matsuyama1), Eisuke Shiba1),
Masanori Hisaoka1)
1)
Department of Pathology & Oncology, School of Medicine, University of Occupational andEnvironmental Health2)
Department of Radiology, School of Medicine, University of Occupational and 3)Environmental
Health)Department of Radiology, Kitakyushu General Hospital
Case 217-year-old female, Osteolytic Bone Tumor in the Right Acetabulum of the Pelvis
Kenji Yamada
Department of Orthopedic Surgery, Aichi Cancer Center Aichi Hospital
Case 3
A Case of Chondrosarcoma Containing Osteosarcoma Component Arising from the
Humerus
Sugiura Y1), Kanda H1),, Y. Takazawa Y1),. Ishikawa Y1), Machinami R2), Ueno T3), Hayakawa K4),
Tanizawa T4), Mastumoto S4)
1)
Department of Pathology, Cancer Institute2)
Department of Pathology, Kawakita General Hospital3)
Department of Diagnostic Imaging, Cancer Institute Hospital
4)
Department of Orthopedic Surgery, Cancer Institute Hospital
Case 4
A Case of Liposarcoma Presented an Interesting Clinical Course
Ayataka Ishikawa1), Kazunori Nishida1), Masafumi Kurosumi1), Hirotaka Koyanagi2), Takashi
Shimoji2), Jun Manabe2), Hiroaki Kanda3
1)
Department of Pathology, 2)Department of Orthopedic surgery2), Saitama Cancer Center,3)
Department of Pathology, the Cancer Institute of the Japanese Foundation for Cancer
Research
Case 5
Soft Tissue Mass of the Left Neck
Eiichi Konishi1), Sanae Yamazaki1), Mitsuo Kishimoto1), Yusei Katsuyama2), Toshiharu Shirai2),
Ryu Terauchi2), Masatsugu Tsuchida2), Naoki Mizojiri2), Hirotaka Mori2), Toshikazu Kubo2)
1)
Department of Surgical Pathology, 2Department of Orthopaedics
Kyoto Prefectural University of Medicine
Case 6
Left Parotid Tumor
Izumi Kinoshita, Yuichi Yamada, Junkichi Takemoto, Kenichi Kohashi, Yoshinao Oda
Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University- 90 -

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2017/01/18 23:14:57

⑕౛㸯ྑ๓⭎㌾㒊⭘⒆
ෆᶫ࿴ⰾ ࠊ㟷ᮌ㝯ᩄ ࠊᯇᮌ⿱୍ ࠊᯇᒣ⠜஧  ᰘ⍛௓  ஂᒸṇ඾㸧⏘ᴗ་⛉኱Ꮫ་Ꮫ㒊 ➨㸯⑓⌮Ꮫࠊ㸧⏘ᴗ་⛉኱Ꮫ་Ꮫ㒊 ᨺᑕ⥺⛉Ꮫࠊ㸧໭஑ᕞ⥲ྜ⑓㝔 ᨺᑕ⥺⛉࠙⑕ ౛ࠚ ṓࠊ⏨ᛶ࠙୺ ッࠚᕥ๓⭎⭘⒗࠙᪤ Ṕ࣭ᐙ᪘Ṕࠚ≉グ஦㡯࡞ࡋ࠙⌧⑓Ṕࠚ⣙  ᖺ๓ࠊྑ๓⭎ᑻഃ࡟⭘⒗ࢆㄆࡵࡓࠋࡇࡇᩘᖺ࡛ᚎࠎ࡟ቑ኱ࡋ࡚ࡁࡓࡓࡵ㏆
་ࢆཷデࡋࠊษ㝖⾡ࢆཷࡅࡓࠋ⑓ኚࡣ FP ኱࡛࠶ࡾࠊୗᗋ࡜ࡢ⒵╔ࢆㄆࡵࡓࡀࠊ⿕そࡋ࡚࠸ࡿ⓶⭵࡜ࡢ⒵╔ࡣ࡞࠿ࡗࡓࠋ࠙⏬ീᡤぢࠚ
05, ࡟࡚ࠊ⭘⒗ࡣ 7 ᙉㄪീ࡛➽⫗࡜➼ಙྕࠊ7 ᙉㄪീ࡛⬡⫫࡜ྠ⛬ᗘࡢ㧗ಙྕࢆ♧ࡋࠊ⭘⒗㎶⦕࡟ࡣ⿕⭷ᵝࡢపಙྕࡀࡳࡽࢀࡓࠋ㐀ᙳ࡛ࡣ⭘⒗ෆ㒊࡟ᙉ࠸ቑᙉຠᯝࢆㄆࡵࡓࠋ
࠙㓄ᕸᶆᮏཬࡧ⑓⌮ᡤぢࠚ㓄ᕸᶆᮏࡣ⭘⒆ࡢ᭱኱๭㠃࡛࠶ࡿࠋ
⑓⌮ᡤぢ㸸ẟ⣽⾑⟶࡟ᐩࡴ⥺⥔⢓ᾮ⭘≧ࡢ㛫㉁ࢆ⫼ᬒ࡟ࠊ␗ᆺ࡟ஈࡋ࠸▷⣳㗽ᙧ࡞࠸ࡋᫍⰢ≧ࡢ⭘⒆⣽⬊ࡀ≉ᐃࡢ㓄ิࢆ♧ࡉࡎ࡟ቑṪࡋ࡚࠸ࡿࠋ㍍ᗘࡢࣜࣥࣃ⌫ᾐ₶࡜ᩓᅾᛶ࡟⫧‶⣽⬊ࡀࡳࡽࢀࡿࠋ
ච␿ᰁⰍ㸸(0$ IRFDOO\ Ș60$  GHVPLQ  &'  08&  FODXGLQ  
*OXW  0L7)  ࠙⮫ᗋ⤒㐣ࠚ
ᡭ⾡࡛ࡣࠊὸ➽⭷ࢆษ㛤ࡋࠊᅛ᭷➽⭷⭝㠧࡟ἢࡗ୍࡚㒊ࡣ➽య࡟ໟࡲࢀࡓቃ⏺᫂░࡞⭘⒗
ࢆ୍ሢ࡜ࡋ࡚᦬ฟࡋࡓࠋ᫂ࡽ࠿࡞⚄⤒⤌⧊࡜ࡢ㐃⥆ᛶࡣㄆࡵ࡞࠿ࡗࡓࠋ
࠙ၥ㢟Ⅼࠚ

⏬ീデ᩿ࠊ⑓⌮⤌⧊デ᩿

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⑕౛㸰 ṓዪᛶ ⁐㦵ᛶ㦵◚ቯࢆ࿊ࡍࡿྑ㦵┙⮻⵹㒊㦵⭘⒆
ᒣ⏣೺ᚿ ឡ▱┴ࡀࢇࢭࣥࢱ࣮ឡ▱⑓㝔 ᩚᙧእ⛉࠙⑕ ౛ࠚ  ṓࠊዪᛶ࠙୺ ッࠚ ྑ⫤㛵⠇③࠙⌧⑓Ṕࠚ ᙜ㝔ึデ  ᖺ๓࠿ࡽ㒊άࣁࣥࢻ࣮࣎ࣝᚋ࡟㍍࠸ྑ⫤㛵⠇③ࢆ⮬ぬࠊᚎࠎ࡟⑕≧ࡀ㢧ᅾ໬ࡋ  ࢝᭶๓㡭࠿ࡽࡣ཭ே࡟㊤⾜ࢆᣦ᦬ࡉࢀࠊࣁࣥࢻ࣮࣎ࣝ➇ᢏࡣ㞴ࡋࡃ࡞ࡗ࡚ࡁࡓ  ࢝᭶࡯࡝๓࠿ࡽࡣࢲࢵࢩࣗ㉮ࡀᅔ㞴࡜࡞ࡿࡢࢆ⮬ぬ ᙜ㝔ึデ  ࢝᭶๓࡟㏆఩ᩚᙧእ⛉࡛⫤㛵⠇༢⣧ࣞࣥࢺࢤࣥ෗┿ࢆ᧜ᙳࡋࡓࡀ᫂ࡽ࠿࡞⑓
ኚࢆᣦ᦬ࡉࢀࡎ㸦ᚋ᪉どⓗ࡟ࡣྑ⮻⵹㒊࡟⁐㦵ኚ໬࠶ࡾ㸧 ⥲ྜ⑓㝔ࢆཷデࡋࠊ&7ࠊ05, ࡞࡝ࡢ⏬ീ⢭ᰝ࡛ྑ㦵┙⮻⵹㒊ࡢ⁐㦵ᛶ㦵⭘⒆⑓ኚࢆᣦ᦬ࡉࢀࡓ࠙⏬ീᡤぢࠚ
༢⣧ࣞࣥࢺࢤࣥ෗┿㸸ྑ⮻⵹㒊࡟⁐㦵ᛶ㦵◚ቯ⑓ኚࠋ⭠㦵ෆᯈࡢ㦵⓶㉁ࡣ⳼ⷧ໬ࡋ࡚࠾ࡾ
㍍ᗘࡢ 6FDOORSLQJ ࡀㄆࡵࡽࢀࡿࠋ⮻⵹እ⦕࡟ࡣ⑓ⓗ㦵ᢡࢆ␲ࢃࡏࡿ⓶㉁㦵◚⥢࠶ࡾࠋ⮻⵹
ഃࡢ㌾㦵ୗ㦵ࡣᾘኻࡋ࡚࠸ࡿࡀࠊ⫤㛵⠇㛵⠇ิ㝽ࡢ⊃ᑠ໬ࡸ㛵⠇ኚᙧࡣㄆࡵࡽࢀ࡞࠸ࠋ
&7㸸ྑ⮻⵹㒊࠿ࡽ⫼ഃᆘ㦵᪉ྥ࡬ඃ఩࡞㐍ᒎࢆ࿊ࡍࡿ㦵ෆ⁐㦵ᛶ㦵◚ቯ⑓ኚࠋ⑓ኚ࿘ᅖࡢ
㦵⓶㉁ࡣ౵㣗ࡉࢀ⳼ⷧ໬ࡋ࡚࠸ࡿࡀࠊ୺࡟⮻⵹ᚋ᪉࡛ࡣ 6FDOORSLQJ ᵝࡢ⭾㝯ᛶኚᙧࡀぢࡽࢀࡿࠋ୍㒊࡟㦵⓶㉁㏵⤯ࡀ࠶ࡾࠊ⮻⵹⦕ࡢࡸࡸ㢌ഃ࡛⑓ⓗ㦵ᢡ࡜ᛮࢃࢀࡿ⓶㉁㦵◚⥢ࡀぢࡽࢀࡿࠋ⮻⵹ഃࡢ㌾㦵ୗ㦵ࡣ࡯ࡰᾘኻࡋ࡚࠸ࡿࠋ
05,㸸⑓ኚࡣ 7 ᙉㄪ࡛➽⫗࡜࡯ࡰྠ㍤ᗘࠊ7 ᙉㄪ࡛ࡣ㎶⦕ࢆ୰ᚰ࡟ࡸࡸ㧗㍤ᗘ࡛ప㍤ᗘ࡜ࡢΰᅾࠊ࢞ࢻࣜࢽ࣒࢘㐀ᙳ࡛ࡣ୰ᚰ㒊ࡢ㐀ᙳᛶࡣᙅࡃ㎶⦕ඃ఩࡟㐀ᙳࡉࢀࡿࠋ᫂ࡽ࠿࡞㦵እ࡬ࡢ㐍ᒎࠊᾐ₶ࡣぢࡽࢀ࡞࠸ࠋ
㦵ࢩࣥࢳ㸸㦵ᕧ⣽⬊⭘࡟ぢࡽࢀࡿࡼ࠺࡞ &ROGLQ+RW ᵝࡢ㞟✚ࢆ࿊ࡍࡿࠋ
࠙㓄ᕸᶆᮏཬࡧ⑓⌮ᡤぢࠚ㸦ᚲせ࡟ᛂࡌ࡚⫗║ᡤぢࠊච␿ᰁⰍ⤖ᯝࢆྵࡵ࡚ࡃࡔࡉ࠸㸧㓄ᕸᶆᮏࡣᥙ∐ᡭ⾡࡛ࡢ⭘⒆ᥙ∐ษ㝖ᶆᮏ㸦⭘⒆ሢࡢ◳ᗘࡸ⫗║ᡤぢࡣୗグ⮫ᗋ⤒㐣ෆ࡟グ㍕㸧ࠊ
⮻⵹㢌ഃࡢ⭠㦵యእഃ㦵⓶㉁࡟㛤ࡅࡓࠊ⭘⒆ᥙ∐⏝ࡢ㦵❆㒊ᶆᮏ⭠㦵యእഃ㦵⓶㉁ࡀෆ㒊ࡢ⭘⒆࡜㐃⥆ࡋ࡚᥇ྲྀࡉࢀ࡚࠸ࡿ

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ࠊࠊ ⭘⒆ෆᥙ∐⑓ኚ ᥙ∐ษ㝖ࡉࢀࡓ⭘⒆඲యࢆᶆᮏ໬ࡋ࡚࠸ࡿ ⤌⧊ᡤぢ㸸⭘⒆ࡣ⥺⥔ᛶ⤖ྜ⧊ࢆకࡗ࡚␯࡟ቑ⏕ࡍࡿࠊ༢⣳㗽ᙧ⣽⬊ࢆ୺య࡜ࡍࡿ⥺⥔ᛶ⭘⒆࡛࠶ࡿࠋศ໬ഴྥࡢ୙᫂░࡞ẚ㍑ⓗᑠᆺࡢ༢⣳㗽ᙧ⣽⬊ࡀቑ⏕ࡋ࡚࠾ࡾࠊᄞ⬊ᛶኚ໬ࠊᓥ≧ࡢ㌾㦵ჾ㉁ࠊከ᰾⣽⬊ࡣぢࡽࢀ࡞࠸ࠋ
㦵ෆ⥺⥔ᛶ⭘⒆࡛࠶ࡿࡀࠊ%HQLJQILEURXVKLVWLRF\WRPDࠊ1RQRVVLI\LQJILEURPD ࡞࡝࡜ࡣ⤌⧊ീࡀ␗࡞ࡿࠋ⥺⥔ᛶ⭘⒆ 'HVPRLGWXPRU ࡜ࡣ⤌⧊ീࢆ␗࡟ࡍࡿࠋ
࠙⮫ᗋ⤒㐣ࠚ ⤌⧊デ᩿☜ᐃࡢࡓࡵࠊ࢖࣓࣮ࢪ࢞࢖ࢻୗ࡟ഃ᪉࢔ࣉ࣮ࣟࢳ࡛⮻⵹ࡢ⣙ PP 㢌ഃ࡟ᑠ㦵Ꮝࢆ✸ࡕࠊࣃࣥࢳ࡛⤌⧊᥇ྲྀࢆ⾜ࡗࡓࠋ⏕᳨ᶆᮏࡢ⤌⧊デ᩿࡛ࡣࠊⰋᛶ⥺⥔ᛶ⭘⒆࡛☜ᐃデ᩿ࡣᅔ㞴࡜ࡢ㏉⟅࡛࠶ࡗࡓࠋ ⮬ぬ⑕≧࡜ࡋ࡚ࡢྑ⫤㛵⠇③ࡣ᪥ᖖ⏕ά࡟኱ࡁ࡞ᨭ㞀ࢆ᮶ࡍ࡯࡝࡛ࡣ࡞࠿ࡗࡓࡀࠊᨺ⨨ࡍࢀࡤ⑓ኚࡀᣑ኱ࡋ࡚⑓ⓗ㦵ᢡࠊࡉࡽ࡟⫤㛵⠇ࡢ୰ᚰᛶ⬺⮻࡟⮳ࡿྍ⬟ᛶࡀᠱᛕࡉࢀࡓࡓ
ࡵࠊ⭘⒆ᥙ∐⾡ࢆ⾜ࡗࡓࠋ኱㌿Ꮚࢆ㦵ษࡾࡋࠊ⫤㛵⠇ഃ᪉࢔ࣉ࣮ࣟࢳ࡟‽ࡌ࡚⭠㦵య㒊እഃࢆᒎ㛤ࠊ[PP ࡯࡝ࡢ▴ᙧ㦵❆ࢆ㛤ࡅ࡚ྍཬⓗ࡟⭘⒆ࢆᥙ∐ࡋࡓࠋ⭘⒆ࡣᾘࡋࢦ࣒ࡼࡾࡸࡸ㌾࡛࠶ࡾࠊ㏻ᖖࡢ⭘⒆⑓ኚ࡜ẚ㍑ࡍࡿ࡜ᙎຊࡀ࠶ࡾ◳࠸㒊㢮࡟ධࡿࡶࡢ࡛࠶ࡗࡓࠋ࿘㎶ࡢ㦵㧊㦵ᱱ࡜ࡢ⒵╔ࡣẚ
㍑ⓗ㍍ࡃࠊ⭘⒆ᮏయࢆᢕᣢࡍࡿ࡜୍ሢࡢᙧែࢆಖࡗࡓࡲࡲ᦬ฟ࡛ࡁࡿࡼ࠺࡞ᛶ㉁࡛࠶ࡗࡓࠋ
⫤㛵⠇⮻⵹㠃ࡢ㌾㦵ୗ㦵ࡣ࡯ࡰᾘኻࡋ࡚࠾ࡾࠊ⫤㛵⠇࠿ࡽぢࡿ࡜㌾㦵ࡀᾋືࡍࡿࡼ࠺࡞≧ែ࡛࠶ࡗࡓࠋ ྠഃᚋ᪉⭠㦵࠿ࡽ᥇ྲྀࡋࡓ⮬ᐙ㦵࡜ࠊș7&3 ࢆΰࡌ࡚ࠊษ㝖㒊࡬ࡢ㦵⛣᳜ࢆ⾜ࡗࡓࠋ ⾡ᚋࡣ  ࠿᭶᏶඲චⲴࠊࡑࡢᚋⲴ㔜ࢆ㛤ጞࠋ⌧ᅾ⾡ᚋ༙ᖺࢆ㐣ࡂ࡚࠾ࡾ᮫  ᮏ౑⏝ࡋ࡚ࡣ࠸ࡿࡀ࡯ࡰ඲Ⲵ㔜ࡋ࡚࠾ࡾࠊྑ⫤㛵⠇ࡢ⑊③ࡢッ࠼ࡣ↓࠸ࠋ ᐃᮇ⏬ീ᳨ᰝ࡛⭘⒆෌Ⓨࡣぢࡽࢀ࡚࠸࡞࠸ࡀࠊ ṓ࡜࠸࠺ᖺ㱋ࡢ๭࡟ࡣ㦵⛣᳜㒊ࡢ㦵෌⏕ࡀ୙༑ศ࡞ࡢ࡛ࡣ࡞࠸࠿࡜࠸࠺ᠱᛕࢆᣢࡕ࡞ࡀࡽ⤒㐣ほᐹࢆ⾜ࡗ࡚࠸ࡿࠋ
࠙ၥ㢟Ⅼࠚ ⏬ീ࠾ࡼࡧ⤌⧊デ᩿༢⣧ࣞࣥࢺࢤࣥ෗┿ࡸ &7 ࡛ࡣࠊ㦵ᕧ⣽⬊⭘ࠊື⬦⒗⁐㦵ᄞ⭘࡞࡝ࢆ㚷ูデ᩿ࡢୖ఩࡜⪃࠼ࡓࡀࠊ05, ࡢ⏬ീᡤぢࡣ኱ࡁࡃ␗࡞ࡿࠋ
⏕᳨࡛㦵ෆⰋᛶ⥺⥔ᛶ⭘⒆࡛࠶ࡿ࡜ࡢ⤖ᯝࢆ㋃ࡲ࠼࡚ࠊ%HQLJQILEURXVKLVWLRF\WRPD
ࡸ 'HVPRSODVWLFILEURPD ࡞࡝ࢆ⮫ᗋഃ࠿ࡽࡢ㚷ูデ᩿࡜ࡋ࡚ᣲࡆࡓࡀࠊ⤌⧊ᡤぢ࡜ࡣ஋㞳ࡀ࠶ࡿ࡜ࡢࡇ࡜࡛࠶ࡗࡓࠋ

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ⱝᖺᝈ⪅࡛ᗈ⠊ᅖ࡟⫤㛵⠇Ⲵ㔜㒊ࢆ౵ࡍ㦵⭘⒆⑓ኚ࡛࠶ࡾࠊ௒ᚋࡢ⤒㐣ほᐹࡸࠊࡶࡋ⑕౛㸱ᚲせ࡛࠶ࡿ࡞ࡽ㏣ຍ἞⒪ࡢᚲせᛶࢆ᳨ウࡍࡿࡓࡵ࡟ࠊ⏬ീᡤぢࠊ⤌⧊ᡤぢࠊ཮᪉࠿ࡽࡢୖ⭎㦵࡟᳨ウࢆ࠾㢪࠸ࡋࡓ࠸ࠋ

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2017/01/18 23:14:58

⑕౛㸱ୖ⭎㦵࡟⏕ࡌࡓࠊ㦵⫗⭘ᡂศࢆక࠺㌾㦵⫗⭘ࡢ୍౛ࡀࢇ◊✲఍ࡀࢇ◊✲ᡤ⑓⌮㒊 ᮡᾆၿᘺࠊ⚄⏣ᾈ᫂ࠊ㧗⃝㇏ࠊ▼ᕝ㞝୍Ἑ໭⥲ྜ⑓㝔 ⏫୪㝣⏕ࡀࢇ◊᭷᫂⑓㝔ᨺᑕ⥺デ᩿⛉ ᳜㔝ᫎᏊ ࡀࢇ◊᭷᫂⑓㝔ᩚᙧእ⛉ ᪩ᕝᬒᏊࠊ㇂⃝Ὀ௓ࠊᯇᮏㄔ୍࠙⑕ ౛ࠚ ṓࠊዪᛶ࠙୺ ッࠚᕥୖ⭎㏆఩㒊③࠙᪤ Ṕࠚ࠙ᐙ᪘Ṕࠚ≉グ஦㡯࡞ࡋ࠙⌧⑓Ṕࠚ; ᖺ < ᭶ୖグ୺ッ࡟࡚㏆་ཷデ< ᭶  ᪥ᙜ㝔ᩚᙧእ⛉⤂௓ཷデ       ⏬ീୖ⬺ศ໬ᆺ㌾㦵⫗⭘ࡀ␲ࢃࢀࡓࠋ㦵እ⭘⒗࠶ࡾࠋ       ୍᪉ࠊ⏕᳨࡛ࡣ㠀ᖖ࡟㧗ศ໬࡞㌾㦵ᛶ⭘⒆ᡂศࢆక࠺ * ࡢ㦵⫗⭘࡜デ᩿ࡉࢀࡓࠋ    < ᭶  ᪥ᗈ⠊ษ㝖⾡㸩㏆఩ேᕤୖ⭎㦵⨨᥮⾡ࢆ᪋⾜ࡉࢀࡓ࠙⏬ീᡤぢࠚ
 ;S㸸ෆ㌾㦵㦵໬ࡢ┠❧ࡘ⑓ኚࡀୖ⭎㦵㦵㢌ࡢ㛵⠇㠃࠿ࡽ㦵ᖿࡲ࡛ᗈࡀࡿࠋ⑓ኚ㏆఩㒊࡛ࡣ⓶㉁◚ቯࡀ࠶ࡾ㦵እ⭘⒗ࢆక࠺ࠋ㐲఩㒊 㦵ᖿ㒊 ࡛ࡣ⓶㉁◚ቯࡀ┠❧ࡓ࡞࠸ࠋ
 &7㸸㦵➃࠿ࡽ㦵ᖿ࡟࠿ࡅ࡚ࠊ㝸ቨ≧ࡢ◳໬ ෆ㌾㦵㦵໬࡜ࡳࡽࢀࡿ ࢆక࠺⁐㦵ᛶ⑓ኚࡀᏑᅾࠋ⑓ኚ㏆఩㒊ෆഃࡢ㦵⓶㉁ࡣ⹸㣗࠸≧࡟◚ቯࡉࢀࠊῐ࠸◳໬ 㢮㦵࡜ࡳࡽࢀࡿ ࢆక࠺㦵እ⑓ኚࢆᙧᡂࠋ୍᪉ࠊ⑓ኚ㐲఩㒊࡛ࡣ㦵⓶㉁ࡢ◚ቯࡣ┠❧ࡓ࡞࠸ࠋ
 05,㸸ᕥୖ⭎㦵㛵⠇㌾㦵࠿ࡽ PP 㐲఩ࡲ࡛ 7 పಙྕࠊ7 㧗ಙྕ࡞⑓ኚࡀᗈࡀࡾࠊ㏆఩㒊๓᪉ෆഃ⫼ഃ࡟㦵እ⑓ኚࢆᙧᡂࠋ㦵ᖿ㒊⑓ኚࡣ㎶⦕ࡢࡳ㐀ᙳࡉࢀࡿࠋ㦵እ⑓ኚ࡟ࡣ᪩
ᮇ⃰ᰁ࠾ࡼࡧ㐀ᙳຠᯝ㑄ᘏࡀㄆࡵࡽࢀࡿࠋ
࠙㓄ᕸᶆᮏཬࡧ⑓⌮ᡤぢࠚ⫗║ീ㸸ศⴥ≧ࡢ㌾㦵ᛶᡂศࡀ୺యࡔࡀࠊ୺࡟㦵እ⭘⒗ࢆ୰ᚰ࡟㉥〓Ⰽ࡛◳࠸㒊ศࡀᓥ≧࡟ΰࡌࡿࠋ⭘⒆ෆ࡟ࡣ㯤ⓑⰍㄪࡢቯṚᕢࡀᩓᅾࡍࡿࠋ⭘⒆ࡣ㦵ᖿ➃࡟୺ᗙࢆ⨨ࡁࠊ㢌ᑿഃ࡟㐍ᒎࡋ㦵➃㛵⠇㌾㦵┤ୗ࠿ࡽ㦵ᖿ࡟ᗈࡀࡿࠋ㦵ᖿ➃࡛ࡣ㦵⓶㉁ࢆ◚ቯࡋ࡚⁥⭷ࢆྵࡴ࿘ᅖ㌾㒊⤌⧊࡟ᾐ₶ࡋ࡚࠸ࡿࠋ
⤌⧊ീ㸸*UDGH ୍㒊ࡣ*UDGH࡟┦ᙜࡍࡿ㧗ศ໬࡞㌾㦵⫗⭘࡜ࠊ㦵ཬࡧ㢮㦵ᙧᡂࡢⴭ᫂࡞
㦵ࡀ⣽⬊ᆺࡢ㦵⫗⭘ᡂศࡀቃ⏺᫂░࡟᥋ࡋ࡚࠸ࡿࠋ
㑇ఏᏊゎᯒ㸸㦵⫗⭘ᡂศ࡜㌾㦵⫗⭘ᡂศࡢ㛵ಀࢆ☜࠿ࡵࡿ┠ⓗ࡛ࠊ୧ᡂศࡢ ))3( ᮦᩱ࠿ࡽ '1$ ࢆࡑࢀࡒࢀ᥇ྲྀࡋࢧࣈࢡ࣮ࣟࢽࣥࢢࢆ⾜࠸ ,'+,'+ ࡢⅬ✺↛ኚ␗ࢆ᳨⣴ࡋ- 95 -

第28回骨軟部放射線研究会̲他2学会開催̲抄録.indd 95

2017/01/18 23:14:58

ࡓࠋࡇࢀࡽࡢኚ␗ࡣ㌾㦵ᛶ⭘⒆ࡢ GULYHUPXWDWLRQ ࡛ᮏ᮶㦵⫗⭘࡟ࡣ᳨ฟࡉࢀ࡞࠸ࠋࡼ

⑕౛㸲ࡗ࡚ࡶࡋᮏ౛࡛㌾㦵⫗⭘ᡂศࡢࡳ࡞ࡽࡎ㦵⫗⭘ᡂศ࡟ࡶ᳨ฟࡉࢀࢀࡤࠊ㌾㦵⫗⭘ࡀ⬺ศ⯆࿡῝࠸໬ࡋ࡚㦵⫗⭘ᡂศࡀฟ⌧ࡋࡓࡇ࡜ࡀᙉࡃ♧၀ࡉࢀࡿࠋ௒ᅇࢱ࣮ࢤࢵࢺ࡜ࡋࡓࡢࡣ,'+ࡢ 5࠾ࡼࡧ ,'+ ࡢ 55ࠋ
ࡋ࠿ࡋࠊ⤖ᯝࡣ࠸ࡎࢀࡶⅬ✺↛ኚ␗ࡣ᳨ฟࡉࢀࡎ㔝⏕ᆺ࡛࠶ࡗࡓࠋ
࠙⮫ᗋ⤒㐣ࠚ
< ᭶  ᪥ࡢ⬚㒊 &7 ࡛ྑ⫵࡟ᚤᑠ࡞㌿⛣ᕢࢆᣦ᦬ࡉࢀࡓࠋ
⾡ᚋ໬Ꮫ⒪ἲ㸦< ᭶  ᪥ $'0 PJP[ࢆ  ࢥ࣮ࢫ< ᭶  ᪥&%'&$PJ
P[ࢆ  ࢥ࣮ࢫ< ᭶  ᪥,( ,JP[(PJP[㸧ࢆ  ࢥ࣮ࢫࢆ᪋⾜ࡉࢀࡿࡶዌຌࡏࡎࠊ⫵㌿⛣ࡣቑᝏࡋ < ᭶  ᪥ࡢ &7 ࡛ࡣྑ⬚Ỉࠊ⬚⭷᧛✀ࡀฟ⌧ࠊ࿧྾ⱞࢆッ࠼ࡿࡼ࠺࡟࡞ࡗࡓࠋ< ᭶  ᪥࠿ࡽࡣ⦆࿴ 57 ࢆ᪋⾜ࡉࢀࡓࡀዌຌࡏࡎࠋ< ᭶  ᪥࡟࿧྾ⱞቑᝏࡋධ㝔ࡉࢀࡿ࡜⦆࿴ࢣ࢔࡬⛣⾜ࡉࢀࡓࠋ࿧྾୙඲ࡀቑᝏࡢ୍㏵ࢆ
㎺ࡾ < ᭶  ᪥Ọ╀ࡉࢀࡓࠋ
࠙ၥ㢟Ⅼࠚ

㸬ᡭ⾡ᮦᩱ࡛ࡢ᭱⤊⑓⌮デ᩿ࡣ⬺ศ໬ᆺ㌾㦵⫗⭘࡜ࡋࡲࡋࡓࡀࠊ㌾㦵ⱆ⣽⬊ᆺࡢ㦵⫗⭘➼ࡑࢀ௨እࡢデ᩿ࡢྍ⬟ᛶࡣ࠶ࡾࡲࡍ࠿㸽㸬⏬ീデ᩿Ꮫⓗ࡟ࡣࠊ⬺ศ໬ᆺ㌾㦵⫗⭘ࡢ඾ᆺ౛࡞ࡢ࡛ࡋࡻ࠺࠿㸽௒ᅇ ,'+,'+ ࡢ᪤▱ࡢⅬ✺↛ኚ␗ࡣ᳨ฟࡉࢀࡎࠊศᏊ⏕≀Ꮫⓗ࡟㌾㦵⫗⭘ᡂศ࡜㦵⫗⭘ᡂศࡢ FORQDOLW\ ࡟ࡘ࠸࡚ㄽࡌࡽࢀࡲࡏࢇ࡛ࡋࡓࠋࡇࢀ௨ୖࡢ㑇ఏᏊゎᯒࡢᡭẁࡀ࠶ࡾࡲࡍ࡛ࡋࡻ࠺࠿㸽

- 96 -

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⑕౛㸲⯆࿡῝࠸⤒㐣ࢆࡓ࡝ࡗࡓ⬡⫫⫗⭘ࡢ㸯౛▼ᕝᩥ㝯 㸪す⏣୍඾ 㸪㯮ఫᫀྐ 㸪ᑠᰗᗈ㧗 㸪ୗᆅᑦ 㸪┾㘠῟ 㸪⚄⏣ᾈ᫂ ᇸ⋢┴❧ࡀࢇࢭࣥࢱ࣮㸪 ⑓⌮デ᩿⛉㸪 ᩚᙧእ⛉ࡀࢇ◊✲఍ࡀࢇ◊✲ᡤ⑓⌮㒊࠙⑕ ౛ࠚ  ṓࠊ⏨ᛶ࠙୺ ッࠚ ᕥୗ⭣⭘⒗࠙⌧⑓Ṕࠚ
 ᖺ㡭࠿ࡽᕥୗ⭣ᚋ㠃ࡢ⭘⒗࡟Ẽ࡙ࡃࠋᚎࠎ࡟ቑ኱ࡋࠊ ᖺ  ᭶ࠊ๓་࡟࡚ 05, ࡛㌾㒊⭘⒆ࢆᣦ᦬ࡉࢀࠊ ᖺ  ᭶ᙜ㝔⤂௓ཷデ࡜࡞ࡿࠋ࠙⏬ീᡤぢࠚ
㐀ᙳ 05,㸸⭸❐࠿ࡽୗ⭣ᚋ㠃ࠊ⾲ᒙ➽⭷ୗ࡟ᒁᅾࡍࡿ㌾㒊⭘⒆ࠋࢧ࢖ࢬࡣ FP ኱ࠋಙྕᙉᗘࡣ 7KLJK7KLJK࡛㐀ᙳຠᯝࡣஈࡋࡃࠊෆ㒊࡟ 77ORZ ࡢࢃࡎ࠿࡟㐀ᙳࡉࢀࡿ⥺⥔ᵝ⤌⧊ࡢΰᅾࢆㄆࡵࡿࠋࡲࡓࠊ⭘⒆ෆ㐲఩࡟ 7ORZ7KLJK ࡛㐀ᙳຠᯝࢆ᭷ࡍࡿ FP ኱ࡢ⤖⠇ᵝ㡿ᇦࢆㄆࡵࡿࠋ
࠙㓄ᕸᶆᮏཬࡧ⑓⌮ᡤぢࠚ㸦ᚲせ࡟ᛂࡌ࡚⫗║ᡤぢࠊච␿ᰁⰍ⤖ᯝࢆྵࡵ࡚ࡃࡔࡉ࠸㸧 ᖺ  ᭶ࡢ㔪⏕᳨ᶆᮏ࡛ࡣ㧗ศ໬ᆺ⬡⫫⫗⭘ࡢീ࡛ࠊᗈ⠊࡞ኚᛶࠊ⥺⥔໬ࠊቯṚࡀࡳࡽࢀࡓࡀࠊ᫂ࡽ࠿࡞⬺ศ໬ᡂศࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࠋ,+&⤖ᯝ㸸0'0 ୍㒊࡟ &'.  㸬 ᖺ  ᭶ࡢᡭ⾡ᮦᩱ࡛ࡣ PP ኱ࡢ㯤Ⰽࠊ⬡⫫ᛶࡢ㌾ࡽ࠿࠸⭘⒆ࡢ୍㒊࡟PP ኱ࡢⓑⰍࠊቃ⏺᫂░࡛◳࠸㒊ศࢆㄆࡵࡓࠋ⤌⧊Ꮫⓗ࡟ࡣࠊ⬡⫫ᛶࡢ㒊ศࡣ㧗ศ໬ᆺ⬡⫫⫗⭘ࡢീࢆ♧ࡋࠊ୍㒊࡟ቯṚࡀࡳࡽࢀࠊ▼⅊ỿ╔ࡀᩓぢࡉࢀࡓࠋⓑⰍࡢ㒊ศ࡟ࡣ 0)+836 ᵝࡢീࢆ♧ࡍ⣳㗽ᙧ⣽⬊⫗⭘ࢆㄆࡵࡓࠋ
⣳㗽ᙧ⣽⬊⫗⭘ࡢ ,+& ⤖ᯝ㸸0'0 ୍㒊࡟ &'. ୍㒊࡟ᙅ㝧ᛶ㹼㝧ᛶ S  60$ &' ୍㒊࡟ $($(  (0$  6  YLPHQWLQ  GHVPLQ ୍㒊
࡟" 㸬௨ୖࡢᡤぢ࠿ࡽ⬺ศ໬ᆺ⬡⫫⫗⭘࡜⪃࠼ࡽࢀࡓࠋ
࠙⮫ᗋ⤒㐣ࠚ
 ᖺ  ᭶ᙜ㝔ึデࠋ㧗ศ໬ᆺ⬡⫫⫗⭘ࡲࡓࡣ⬺ศ໬ᆺ⬡⫫⫗⭘ࡀ␲ࢃࢀࠊྠ᪥⭘⒆ෆ㐲఩ࡢಙྕᙉᗘࡢ␗࡞ࡿ⤖⠇ᵝ㡿ᇦࢆ≺ࡗ࡚㔪⏕᳨᪋⾜ࠋ㧗ศ໬ᆺ⬡⫫⫗⭘ࡢデ᩿ࠋ- 97 -

第28回骨軟部放射線研究会̲他2学会開催̲抄録.indd 97

2017/01/18 23:14:59

 ᖺ  ᭶ᡭ⾡ணᐃ࡛࠶ࡗࡓࡀᮏே㒔ྜ୍࡛᪦࢟ࣕࣥࢭࣝࠋࡑࡢᚋ᮶㝔ࡉࢀࡎࠋ

⑕౛㸳 ᖺ  ᭶ᕥୗ⭣⭘⒗ࡀࡉࡽ࡟ቑ኱ࡋᕥୗ⭣③ࡀฟ⌧ࡋࡓࡓࡵ෌デࠋᕥ㢕㒊㌾ ᖺ  ᭶⭘⒆ᗈ⠊ษ㝖᪋⾜ࠋ࠙ၥ㢟Ⅼࠚ
ึデ᫬ࡣ⏬ീࠊ⑓⌮ᡤぢ࡜ࡶ᫂ࡽ࠿࡞⬺ศ໬ᡂศࡣ☜ㄆ࡛ࡁࡲࡏࢇ࡛ࡋࡓࡀࠊᡭ⾡᫬࡟ࡣ㛗ᚄ PP ࡢ 0)+836 ᵝࡢീࢆ♧ࡍ⣳㗽ᙧ⣽⬊⫗⭘࠿ࡽ࡞ࡿ⬺ศ໬ᡂศࢆㄆࡵࡲࡋࡓࠋ⣙ ᖺࡢ⤒㐣࡛⬺ศ໬ᡂศࡀฟ⌧ࡋቑ኱ࡋࡓ࡜⪃࠼࡚ࡶࡼ࠸࡛ࡋࡻ࠺࠿ࠋ

- 98 -

第28回骨軟部放射線研究会̲他2学会開催̲抄録.indd 98

2017/01/18 23:14:59

⑕౛㸳ᕥ㢕㒊㌾㒊⭘⒗ி㒔ᗓ❧་⛉኱Ꮫ ⑓㝔⑓⌮㒊ᑠすⱥ୍ࠊᒣ㷂᪩ⱑࠊᓊᮏගኵ

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5HVHFWHGVSHFLPHQ+
:HOOFLUFXPVFULEHGOREXODWHG\HOORZLVKPDVV [[FP 0'0 UDUHO\ &'.  0,%࠙)ROORZXSࠚ
1RUHFXUUHQFHPRQWKVDIWHUWKHRSHUDWLRQ࠙0DWWHURIGHEDWHࠚ
5DGLRORJLFDODQGSDWKRORJLFDOGLDJQRVLV
7KLVFDVHZDVSUHVHQWHGDWWKHWK$QQXDO0HHWLQJRI.DQVDL0XVFXORVNHOHWDO2QFRORJ\*URXS-DSDQ - 99 -

第28回骨軟部放射線研究会̲他2学会開催̲抄録.indd 99

2017/01/18 23:14:59⑕౛㸴ᕥ⪥ୗ㒊⭘⒆
ᮌୗఀᑑ⨾ࠊᒣ⏣⿱୍ࠊṊᮏ῟ྜྷࠊᏕᶫ㈼୍ࠊᑠ⏣⩏┤஑ᕞ኱Ꮫᙧែᶵ⬟⑓⌮Ꮫ࠙⑕ ౛ࠚ ṓࠊዪඣ࠙୺ ッࠚᕥ⪥ୗ㒊⭘⬽࠙⌧⑓Ṕࠚ ṓ᫬࡟ᕥ⪥ୗ㒊ࡢ⭘⒗࡟Ẽ࡙ࡁࠊ⭘⒆᦬ฟ⾡ࢆ᪋⾜ࡉࢀࡓ ᶆᮏ  ࠋ ṓ᫬࡟ࡶྠ㒊఩ࡀ⭘኱ࡋࠊ⭘⒆᦬ฟ⾡ࢆ᪋⾜ࡉࢀࡓ ᶆᮏ  ࠋࡑࡢᚋᨺ⨨ࡋ࡚࠾ࡾࠊ ṓ᫬࡟෌ᗘྠ㒊఩ࡀ⭘኱ࡋࡓࠋ05, ࡛ࡣᕥ⪥ୗ㒊࠿ࡽ๪ဗ㢌㛫㝽࣭⯉ୗ㒊࡟ᗈࡀࡿᚄ FP ࡢ⭘⒆ࢆㄆࡵࠊ⭘⒆᦬ฟ⾡ࢆ᪋⾜ࡉࢀࡓ ᶆᮏ  ࠋ࠙⏬ീᡤぢࠚ
05,㸦 ṓ᫬㸧ᕥ⪥ୗ㒊࠿ࡽ๪ဗ㢌㛫㝽࣭⯉ୗ㒊࡟ᗈࡀࡿ᭱኱ᚄ FPࡢ⭘⒆ࢆㄆࡵࡿࠋ
7:, ࡛పಙྕࠊ7:, ࡛୙ᆒ୍࡞㧗ಙྕࢆ࿊ࡋࠊ*G ࡟ࡼࡾ୙ᆒ୍࡟ቑᙉࡉࢀࡿࠋಙྕࣃࢱ࣮
ࣥࡣ௨๓ྠ㒊఩࡟ぢࡽࢀࡓ⑓ኚ࡜ྠᵝ࡛ࠊဗ㢌࣭⯉᰿㒊ࡀᅽ᤼ࡉࢀ࡚࠸ࡿࠋ
࠙⮫ᗋ⤒㐣ࠚ
⾡ᚋࠊ⫵ࡢከⓎ㌿⛣ࢆᣦ᦬ࡉࢀࡓࠋከ๣ే⏝໬Ꮫ⒪ἲࠊᨺᑕ⥺἞⒪ࢆ⾜࡞ࡗࡓࡀ἞⒪᢬ᢠ
ᛶ࡛ཎⓎᕢቑ኱࣭㦵㌿⛣࣭⫵㌿⛣ቑᝏࢆࡁࡓࡋࠊ ᅇ┠ࡢ⭘⒆᦬ฟ⾡ᚋ  ࣨ᭶┠࡟⭘⒆Ṛࡉࢀࡓࠋ࠙ၥ㢟Ⅼࠚᶆᮏ ࠊᶆᮏ ࠊᶆᮏ  ࡢ⤌⧊デ᩿ᶆᮏ  ࡜ᶆᮏ ࣭ᶆᮏ  ࡜ࡢ㛵㐃ᛶ

- 100 -

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&ŝůŵƌĞĂĚŝŶŐ
ĐĂƐĞϭ
Michiko SuzukiĂƐĞ͗ϭϰͲǇĞĂƌͲŽůĚďŽǇdŚĞƉĂƚŝĞŶƚƵŶĚĞƌǁĞŶƚĐƵƌĞƚƚĂŐĞŽĨƌŝŐŚƚĚŝƐƚĂůƚŝďŝĂů ůĞƐŝŽŶĂƚƚŚĞĂŐĞŽĨϵZĞĐƵƌƌĞŶƚƉĂŝŶŝŶƚŚĞƌŝŐŚƚŬŶĞĞ
 >ĞŐůĞŶŐƚŚĚŝƐĐƌĞƉĂŶĐǇ;ƐƉŝŶŽŵĂůůĞŽůĂƌ
ĚŝƐƚĂŶĐĞͿ͗ZϵϭĐŵ͕>ϵϰĐŵ- 101 -

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ZĂĚŝŽŐƌĂƉŚǇϭZĂĚŝŽŐƌĂƉŚǇϮ- 102 -

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dϭ
䠍
䠎
䠏

䠐

䠍

䠎

䠏

䠐

dϮ

- 103 -

第28回骨軟部放射線研究会̲他2学会開催̲抄録.indd 103

2017/01/18 23:15:01

DZ/
dϭ

^d/Z

ŝĂŐŶŽƐŝƐ ƉůĞĂƐĞ

- 104 -

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&ŝůŵƌĞĂĚŝŶŐ
ĐĂƐĞϮ
Asako Yamamoto

A 67-year-old man with a posterior neck hump.
Gradual increase in size over 8-year period.
He has now difficulty in looking upward.
Redness (-) Pain (-) Tenderness (-)
Soft mass palpable without fixation to deep tissue

What is his condition?
160cm 57Kg BMI 22.3
>ĂďŽƌĂƚŽƌǇĚĂƚĂ

RBC
Hb
Ht
Plt
WBC

447 104/Pl
14.1 g/dl
41.4%
33.9 104/Pl
50 102/Pl(Lym 32% Mono 6% Eos 6%
Baso 0% Neut 56%)

TP
Alb
T-bil
AST
ALT
LDH
ALP
J-GTP
CK

7.3
4.1
0.66
35
27
157
319
81
119

g/dl
g/dl
mg/dl
IU/l
IU/l
IU/l
IU/l
IU/l
IU/l

T-Chol
TG
BUN
Cr
Na
K
Cl
BS
CRP

210
190
14.1
1.05
139
4.4
103
114
0.01

mg/dl
mg/dl
mg/dl
mg/dl
mEq/l
mEq/l
mEq/l
mg/dl
mg/dl

- 105 -

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T2WI

T2WI

T1WI

FST2WIŝĂŐŶŽƐŝƐ ƉůĞĂƐĞ

- 106 -

第28回骨軟部放射線研究会̲他2学会開催̲抄録.indd 106

2017/01/18 23:15:02

&ŝůŵƌĞĂĚŝŶŐ
ĐĂƐĞϯ
Waka Nakata

 A 36-year-old woman had a 9-year history of
rheumatoid arthritis. She complained of 3year history of recurrent pain in lateral side ofher knee while walking. She noted clicking andlocking with flexion and extension of the knee.
On physical examination a firm lump was
palpable on the lateral side of the patella.

- 107 -

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radiograph

MRI
T2WI axial

FS Gd axial- 108 -

第28回骨軟部放射線研究会̲他2学会開催̲抄録.indd 108

2017/01/18 23:15:03

PD coronal

FS Gd coronal

T2*WI coronalŝĂŐŶŽƐŝƐ ƉůĞĂƐĞ

- 109 -

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2017/01/18 23:15:04

&ŝůŵƌĞĂĚŝŶŐ
ĐĂƐĞϰ
For discusser

Takeshi FukudaϯϵͲǇĞĂƌͲŽůĚĨĞŵĂůĞ
͗stiffness and pain of right hand,ŝƐƚŽƌǇŽĨƉƌĞƐĞŶƚŝůůŶĞƐƐ͗She presented with 3 months history of morning
stiffness and pain on right hand. The symptom has
got worsened these days.
WĂƐƚŵĞĚŝĐĂůŚŝƐƚŽƌǇ͗DM&ĂŵŝůǇŚŝƐƚŽƌǇ͗nothingpainWŚǇƐŝĐĂůĞǆĂŵ͗BT 36.9Υ
Pain
Slightly swelling- 110 -

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>ĂďŽƌĂƚŽƌǇĨŝŶĚŝŶŐ
WBC
Hb

14300
15.4

ʅl
g/dl

Plt
CRP
Cr

263
0.53
0.64

103/ʅl
mg/dl
mg/dl

HbA1C
RF

7.0
3.0>

%
IU/ml

ANA

negativeZĂĚŝŽŐƌĂƉŚ

- 111 -

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EŽŶĐŽŶƚƌĂƐƚĞŶŚĂŶĐĞĚDZ/^d/ZĐŽƌŽŶĂů

EŽŶĐŽŶƚƌĂƐƚĞŶŚĂŶĐĞĚDZ/^d/ZƚƌĂŶƐǀĞƌƐĞ
3rd PIPMCP

MCP

4th PIP- 112 -

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ŝĂŐŶŽƐŝƐ ƉůĞĂƐĞ

- 113 -

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2017/01/18 23:15:08