Rikin Hargunani

• MBBS BSc MRCS FRCR
• Consultant at Royal National Orthopaedic Hospital NHS Trust

Image-guided biopsy of the synovium is a relatively uncommon but safe procedure with a high-diagnostic yield in the correct clinical scenario. Whilst surgical and arthroscopic techniques are still commonly performed and remain the gold standard, they are more invasive, expensive and not widely available. Ultrasound and X-ray-guided synovial biopsy...

Objective To identify if morphology of the entering and exiting nerve involved by a nerve sheath tumour in the brachial plexus can help differentiate between benign (B) and malignant (M) peripheral nerve sheath tumours (PNSTs).Materials and methodsRetrospective review of 85 patients with histologically confirmed primary PNSTs of the brachial plexus...

Objectives Guidelines suggest that lesions over 5 cm in dimension should be referred to a specialist sarcoma centre due to the possibility of malignancy. Few epidermal cysts (ECs) reach or exceed this size and are termed giant ECs (GECs). The purpose of this study is to report on a large series of GECs. Methods Retrospective review of histological...

Aim To evaluate the response measures in continuing an image-guided intervention service in two tertiary-level musculoskeletal oncology centres during the COVID-19 pandemic. Materials and methods The present study was a retrospective review of all patients undergoing image-guided intervention in the computed tomography (CT) and normal ultrasound (...

Introduction In response to the COVID-19 pandemic, there was a rapidly implemented restructuring of UK healthcare services. The The Royal National Orthopaedic Hospital, Stanmore, became a central hub for the provision of trauma services for North Central/East London (NCEL) while providing a musculoskeletal tumour service for the south of England, t...

Anatomical variant patella tendon

A spectrum of anatomic variants of the conventional single patellar tendon have been described however a double patellar tendon is a highly rare finding, which has only been described once before where a cross-over tendon morphology was illustrated. We report the case of a 46-year-old man with a 3 month history of left knee pain who was found to ha...

An ovine total hip arthroplasty model was developed to evaluate metal ion release, wear, the biological response and adverse tissue reaction to metal‐on‐metal (MoM) bearing materials. The performance of an advanced superlattice ceramic coating (SLC) was evaluated as a bearing surface and experimental groups divided into; (1) MoM articulating surfac...

The role of MRI in distinguishing benign from malignant vertebral compression fractures is well documented however there is limited understanding in patients with multiple myeloma (MM). Although there has been an increasing use of diffusion weighted imaging in evaluating MM, many patients with acute spinal fractures are referred to specialist spina...

Objective: Suspected soft-tissue sarcomas are typically investigated using magnetic resonance imaging (MRI), with a view to planning image-guided core needle biopsy for confirmation of the histological diagnosis. Indeterminate superficial lesions may be small and therefore potentially difficult to biopsy safely, such lesions possibly being more am...

The skeletal manifestations of osteogenesis imperfecta are investigated. The antenatal and postnatal diagnosis of the disease is briefly mentioned and the characteristic appearances of bone deformities are analyzed in detail. The distinctive bony manifestations of osteogenesis imperfecta are illustrated using typical examples. Finally, we comment o...

Background Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory bone disorder affecting children and adolescents, characterised by sterile bone inflammation. There is a clinical spectrum, ranging from presentation with a single, non-recurrent bone lesion to a chronic relapsing course affecting multiple, often symmetrical bone s...

The incidence of complications following total hip arthroplasty is low, but due to the frequency of the procedure, they are quite commonly encountered and require appropriate investigation. Complications include aseptic loosening, infection, foreign body granulomatosis (osteolysis), adverse reactions to metal debris, periprosthetic fracture, hetero...

Summary Musculoskeletal MRI covers the entire musculoskeletal system and related conditions, both common and rare. The text is neatly divided into sections based on the major anatomic divisions. Each section discusses anatomic subdivisions or joints, keeping sections on normal anatomy and pathologic findings close to each other, allowing radiologi...

Background and objectives: Balloon kyphoplasty (BKP) is a percutaneous treatment for cancer-related vertebral compression fractures (VCF). Posterior vertebral body wall (PVBW) involvement is considered a contraindication for BKP. This study assesses whether BKP is safe and effective for cancer-related VCFs involving the PVBW. Methods: This study...

Intraosseous lipomas are very uncommon, benign primary bone lesions with an incidence of <1%. The overwhelming majority occur within the intramedullary canal. We present an uncommon intracortical intraosseous lipoma with 3 T MRI findings to help differentiate this from other differential diagnoses.

Melanotic or melanocytic schwannoma is a rare tumour usually involving spinal nerve roots but can also present at other anatomical locations. Although there are less than 200 cases reported, melanotic schwannomas can have distinctive imaging features but there is limited recent literature on its often characteristic radiological appearances. Recent...

Data on NJR is not 100% accurtate with respect to hip infection

Obtaining standardised post-operative radiographs following total knee arthroplasty is common practice. Little is known regarding how measurements taken from the initial post-operative radiograph correlate to functional outcome. The initial post-operative radiographs for 110 primary total knee arthroplasties were reviewed retrospectively. Femoral a...

This study assesses whether balloon kyphoplasty (BKP) can safely restore height and correct deformity for cancer-related vertebral compression fractures (VCFs) involving the posterior vertebral body wall (PVBW), which is normally considered a relative contraindication. Retrospective cohort study of 158 patients (99M:59F; mean age 63 years) with 2...

Purpose: Tumour-like lesions in the musculoskeletal system are not infrequently encountered by the radiologist and represent a diagnostic challenge. The aim of the study was to evaluate the incidence, location and imaging features of non-neoplastic tumour-like lesions of bone and soft tissue in the upper limb. Materials and Methods: Referrals to...

The spine is a complex structure that comprises multiple joints and soft tissue elements that in concert allow weight bearing and function. There are numerous clinical indications for imaging in the spine; 'back' pain and neurological symptoms are the most common presenting complaints with a wide variety of disorders that could contribute to sympto...

The high intensity zone (HIZ) was first described by Aprill and Bogduk on lumbar spine magnetic resonance imaging (MRI) studies in 1992. Correlation with lumbar computed tomography (CT) discography showed that the HIZ represents a deep radial tear of the annulus fibrosus, which may be a cause of chronic low back pain. Initial studies comparing the...

Objective: The purpose of this article is to describe the imaging appearances of musculoskeletal injuries related to yoga. We performed an automated search in the database of a large tertiary care center and conducted a retrospective analysis of the imaging findings in 38 patients over a 9-year period. Conclusion: The most frequently encountered...

Vertebroplasty is a cost-effective procedure for the relief of pain in appropriately selected patients when performed by a skilled practitioner. The currently accepted indications and contraindications for vertebroplasty are reviewed. The techniques routinely used by the authors are presented, including a discussion of recognized complications. Rec...

Magnetic resonance imaging (MRI) is playing an increasingly important role in the diagnosis and followup of juvenile idiopathic arthritis (JIA). Carpal depressions are commonly observed in healthy children and in patients with JIA. The aim of our study was to further characterize these depressions in patients with JIA. A total of 29 MRI wrist exami...

Advances in imaging and the development of commercially available enzyme therapy have significantly altered the traditional radiology of Gaucher disease. The cost of treatment and need for monitoring response to therapy have magnified the importance of imaging. There are no recent comprehensive reviews of the radiology of this relatively common lys...

PURPOSE/AIM To review the indications, imaging, interventional methods and potential complications of thermal ablation of musculoskeletal metastases, with a particular emphasis on the role of Radiofrequency Ablation and Cryoablation CONTENT ORGANIZATION 1. Epidemiology of Musculoskeletal Metastases 2. Role of Interventional Radiology in the Multid...

Vertebroplasty is a cost-effective procedure for the relief of pain and suffering in the appropriate patient when done by a skilled practitioner under good image guidance. No study has ever shown any cost benefit of any balloon-based osteoporotic spine intervention over simple vertebroplasty. No study has ever shown any benefit of any intravertebra...

PURPOSE/AIM 1) Describe the imaging experiences of a National Scleroderma Treatment Center 2) Review the basic clinical and pathological findings 3) Outline the new and novel imaging techniques in the diagnosis and prognosis 4) Illustrate a comprehensive pictorial review CONTENT ORGANIZATION Scleroderma can affect a wide range of organs. Manifest...

PURPOSE/AIM This educational exhibit aims to familiarise the reader with both the normal and abnormal appearance of the various surgical options that exist for prosthetic replacement of the shoulder joint. This includes total joint replacement, hemiarthroplasty, reverse geometry arthroplasty, resurfacing prostheses and fracture prostheses. CONTENT...

The hourglass biceps, an intra-articular entrapment of the long head of the biceps (LHB), is a possible diagnosis in cases of shoulder pain associated with loss of passive elevation. The objective of this study is to investigate the role of dynamic ultrasound (U/S) in determining the diagnosis of the hourglass biceps lesion. A prospective cohort of...

Objective To illustrate a novel finding in the deep cartilage of patients with Juvenile Rheumatoid Arthritis, as demonstrated by ultrasound. Materials and methods During a large multi-centre study on JIA, including plain radiographs, ultrasound and MRI of the wrist or of the hip joints, we observed hyperechoic changes in deep cartilage in five p...

The detection of gastric neoplasia has traditionally been limited to barium examination and direct visualization at endoscopy. The rapid development of techniques such as multidetector computed tomography (MDCT) and endoscopic ultrasound (EUS) has resulted in more accurate diagnosis and staging of gastric neoplasia. In this review we describe the n...

Haemophilia disorders are characterised by a blood coagulation anomaly leading to prolonged and excessive bleeding. Imaging provides an essential role in the investigation of both the musculoskeletal and the non-musculoskeletal complications of haemophilia. Our institution is home to a large tertiary referral centre for haemophilia treatment. Using...

PURPOSE/AIM A comprehensive, extensively illustrated review aimed at the radiology resident, showing the imaging features of arthritis and related conditions as seen in the hands. This interactive presentation will encompass the inflammatory arthritides, crystal deposition diseases, osteoarthritis, and neuropathic and infectious arthropathies. CON...

PURPOSE/AIM A comprehensive, illustrated teaching file on uterine artery embolization. This poster will provide the viewer with a clearer understanding of the relevant anatomy, indications, procedural techniques and complications, and review the contentious issues surrounding who should perform these procedures. CONTENT ORGANIZATION Radiographic a...

Infection control of the body is crucial for survival. Systemic inflammatory response syndrome indicates a failure of local control and may progress to sepsis and multiorgan dysfunction. Intense research has provided new insights into the underlying mechanisms of this complex inflammatory process offering new therapeutic options. Sepsis-induced mit...

Haematuria is a classical symptom of urological disease often signifying a primary bladder cancer. Rarely, however, the presence of blood in the urine can be due to secondary spread of tumours into the bladder from distant sites. Notably this has been reported to occur in breast cancer, malignant melanoma and gastric cancers. Haematuria due to spre...

PURPOSE/AIM 1. To illustrate the radiological features of HIV related renal disease including antiretroviral related nephropathies. 2. To describe and illustrate the histopathological features of HIV related renal disease. CONTENT ORGANIZATION 1. Pathophysiology of HIV related renal disease. 2. Imaging and associated histopathological features of...

PURPOSE/AIM 1. To describe the current treatment options for prostate cancer. 2. To demonstrate the spectrum of imaging findings following treatment for prostate cancer, including normal post-therapy changes and complications. Using our experience as a large regional referral centre we present a comprehensive pictorial review, highlighting the abov...

PURPOSE/AIM Aim • Define Wegener’s Granulomatosis • Understand the basic clinical, histopathology, bronchoscopy and laboratory findings. • A comprehensive pictorial review of the disease. • Demonstrate the differential diagnosis of major imaging and clinical findings CONTENT ORGANIZATION •Definition •Features: (1) signs and symptoms (2) histopatho...

PURPOSE/AIM The purpose of this exhibit is: 1. To review the radiological features of extra-renal tract pathologies that clinically mimic renal stone disease and can be diagnosed on low dose MDCT KUB. 2. To review the literature evidence on the role of unenhanced low-dose MDCT KUB in the detection of extra-renal tract alternative diagnoses. CONTEN...

PURPOSE/AIM 1. To assist the training radiologist to understand expected MDCT features following hepato-biliary and pancreatic surgery. 2. To illustrate the radiological appearances of commonly encountered complications following hepatobiliary and pancreatic surgery. CONTENT ORGANIZATION 1. Illustration of normal hepato-biliary and pancreatic anat...