Posttreatment Imaging

Welcome to this issue of Seminars in Musculoskeletal Radiology, dedicated to posttreatment imaging, which is also one focus of the annual European Society of Musculoskeletal Radiology (ESSR) meeting in June 2022 in Rostock, Germany. Posttreatment imaging interpretation is often complex and challenging. Thus an organized, systematic approach is essential to distinguish between expected posttherapeutic changes and new or existing pathology. In general, review of the patient's clinical and surgical history and pretreatment imaging studies very much aids in diagnosis.

In this issue, we learn about special aspects of established and the most recent treatment procedures and the principal questions the radiologist has to answer following musculoskeletal (MSK) interventions. We also learn various hints and tips, along with an understanding of the needs and expectations of our clinical partners, such as orthopaedic and trauma surgeons and MSK interventional radiologists.

I would like to thank the editors in chief for the opportunity to serve as guest editor of this ESSR 2022 special issue. It was truly an honor and pleasure while organizing the ESSR annual meeting to review these fine contributions and to have fruitful discussions with the authors.

This issue includes 10 selected manuscripts that provide practicing radiologists, residents, and fellows with the most accurate and current updates on posttreatment imaging. In addition is an opinion article, “Research in Musculoskeletal Radiology: Setting Goals and Strategic Directions,” by Apostolos Karantanas and colleagues, all from Heraklion, Greece. Research in MSK radiology is rapidly evolving, along with advancements in molecular imaging biomarkers, radiomics, artificial intelligence, and three-dimensional printing. The article surveys the future of research in MSK imaging. Upcoming developments in artificial intelligence, image-guided treatments, and imaging of artificial tissues will present a significant challenge for radiologists in the near future, and requirements for trainees, leaders, and academic centers are suggested.

The first article related to posttreatment imaging, “Postoperative Ankle Imaging, 2022,” comes from Michael G. Fox and colleagues, all from Phoenix, Arizona. They point out in their update that radiographs are usually the initial imaging modality used in the postinterventional state, especially when osseous structures are involved. Computed tomography (CT) (including standing/weight-bearing CT) or magnetic resonance imaging (MRI) are often recruited when additional detail about an osseous procedure is needed or a postoperative complication is concerning.

The next article, “Update: Posttreatment Imaging of the Knee after Cartilage Repair” by Rafael Heiss, Erlangen, Germany, and colleagues from Germany and the United States, stresses the urgent need to better define outcomes clinically and by MRI, including repair site assessment and long-term osteoarthritis onset and progression. MRI plays an essential role in the postsurgical follow-up after focal cartilage repair at the knee, especially when treatment failure or complications are suspected. Cruciate ligament and meniscus surgery have increased in prevalence in the last few decades, and imaging the postoperative condition requires an understanding of the basic anatomy and biomechanics of the knee, together with possible surgical interventions.

Andreas Heuck and Klaus Woertler, both from Munich, Germany, report on the posttreatment imaging of the knee: cruciate ligaments and menisci. They review the anatomy, operative techniques, and imaging interpretation in this common postsurgical evaluation. The mainstays of postoperative knee imaging are still radiography and conventional MR imaging. The following article by Mohammad Samim and colleagues, all from New York, review and illustrate in their article, “Postoperative Musculoskeletal Imaging and Interventions following Hip Preservation Surgery, Deformity Correction, and Hip Arthroplasty,” the expected postoperative imaging appearances and complications following chondrolabral repair, acetabuloplasty, osteochondroplasty, periacetabular osteotomy, realigning and derotational femoral osteotomies, and hip arthroplasty.

In addition to the hip, imaging of the postoperative shoulder is also a frequent routine examination.

The next article by Christoph Schäffeler, Chur, Switzerland, “Posttreatment Imaging of the Shoulder,” addresses postoperative imaging with an emphasis on CT and MRI after rotator cuff repair, shoulder arthroplasty, and surgery for shoulder stabilization. This is followed by “Posttreatment Changes of the Elbow” by Thomas Grieser, Augsburg, Germany. He points out that in the case of posttraumatic surgical elbow procedures, attention should be paid to correct postoperative elbow joint alignment, appropriate fixation of joint-forming fragments, and proper insertion of screws, plates, and anchor devices not to get into intra-articular or bony conflict. He further stresses that to report soft tissue repair procedures correctly, radiologists should know the broad spectrum of different techniques applied and their consecutive appearance on MRI.

To provide adequate evaluation of postoperative imaging of the wrist and hand, we as radiologists must be familiar with both the basic principles of these surgical procedures, the imaging appearance of normal postoperative findings, and the potential complications.

Mihra S. Taljanovic, Albuquerque, New Mexico, and colleagues from Arizona, Illinois, and New Mexico take this a step further with their contribution, “Posttreatment Imaging of the Wrist and Hand: Update 2022.”

The next article with corresponding author Antoine Feydy and his collaborators, all from Paris, France, discusses lumbar spine posttherapeutic imaging and focuses on imaging features following lumbar vertebroplasty and vertebral augmentation because of osteoporotic fractures, diskectomy, and percutaneous interventional radiology for lumbar disk herniation, surgical decompression because of lumbar spinal stenosis and/or spondylolisthesis, and osteotomies for degenerative scoliosis.

The final two articles comprise rather general aspects of the posttreatment condition. The first, by Paul Mick, Heidelberg, Germany, and Christian Fischer, Pforzheim, Germany, reviews delayed fracture healing. It includes a discussion of physiologic and delayed fracture healing and nonunion formation. Although nonunions are relatively common, they are often difficult to treat. It is therefore important to understand the different radio-morphological presentations of nonunions, their interrelations with the quality of the osteosynthesis, tissue vitality, or possible infections.

The second article, “Effects of Radiation Therapy and Chemotherapy on the Musculoskeletal System,” was written by corresponding author Alberto Bazzocchi, Bologna, Italy, and a team from Italy, Spain, and New Zealand. The effects of radiation and chemotherapy on the musculoskeletal system are diverse, and the assessment of bone marrow in cancer patients may be especially challenging because treatments are often complex and involve radiotherapy and chemotherapy, so the effects are seen in combination, and treatment effects have to be separated from recurrence or progression of the disease. Awareness of the spectrum of changes and potential complications and their imaging appearances are paramount for the correct diagnosis to improve outcomes in these patients.

I would like to thank each of the authors for contributing their time and expertise to this outstanding issue of Seminars, and I expect this issue will provide a helpful update on the many challenges encountered in the evaluation of posttreatment imaging. I hope you will find many useful pearls to take away from this issue that will aid in your daily MSK work, and I hope to see you all at the ESSR 2022 annual meeting in Rostock.

Publication History

Article published online:
02 June 2022