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ObjectivesTo explore the diagnostic value of MRI-based 3D texture analysis to identify texture features that can be used for discrimination of low-grade chondrosarcoma from enchondroma.MethodsEleven patients with low-grade chondrosarcoma and 11 patients with enchondroma were retrospectively evaluated. Texture analysis was performed using mint Lesion: Kurtosis, entropy, skewness, mean of positive pixels (MPP) and uniformity of positive pixel distribution (UPP) were obtained in four MRI sequences and correlated with histopathology. The Mann-Whitney U-test and receiver operating characteristic (ROC) analysis were performed to identify most discriminative texture features. Sensitivity, specificity, accuracy and optimal cut-off values were calculated.ResultsSignificant differences were found in four of 20 texture parameters with regard to the different MRI sequences (p<0.01). The area under the ROC curve values to discriminate chondrosarcoma from enchondroma were 0.876 and 0.826 for kurtosis and skewness in contrast-enhanced T1 (ceT1w), respectively; in non-contrast T1, values were 0.851 and 0.822 for entropy and UPP, respectively. The highest discriminatory power had kurtosis in ceT1w with a cut-off ≥3.15 to identify low-grade chondrosarcoma (82 % sensitivity, 91 % specificity, accuracy 86 %).ConclusionMRI-based 3D texture analysis might be able to discriminate low-grade chondrosarcoma from enchondroma by a variety of texture parameters.Key Points• MRI texture analysis may assist in differentiating low-grade chondrosarcoma from enchondroma.• Kurtosis in the contrast-enhanced T1w has the highest power of discrimination.• Tools provide insight into tumour characterisation as a non-invasive imaging biomarker.

Herein, we report an unusual presentation of a 38-year-old heathy lady with a painless slowly growing lesion in the volar aspect of her left distal forearm reaching the thenar area for >15 years. Magnetic resonance imaging of the lesion showed multilobulated soft tissue mass with low and high signal in T1- and T2-weighted images with homogenous contrast enhancement. Additionally, a stable serpiginous bony lesion was noted in the first metacarpal bone showing low T1 and high T2 signals with peripheral enhancement. Histopathological examination was consistent with cylindroma and enchondroma, respectively. The patient had full recovery with no recurrence at a 1-year follow-up visit. While enchondroma is the most common benign tumor of the hand, sporadic dermal cylindroma, in contrast, rarely affects the upper extremity. The coexistence of these two pathological entities was not previously reported and it may complicate the diagnosis.

ObjectivesTo evaluate the role of clinical assessment, conventional and dynamic contrast-enhanced MRI in differentiating enchondromas from chondrosarcomas of long bone.MethodsThe following clinical and MRI findings were assessed: age, gender, pain, pain attributable to lesion, tumour location, tumour length, presence, depth of endosteal scalloping, bone marrow oedema, soft tissue oedema, cortical destruction, periosteal reaction, bone expansion, macroscopic fat, calcification, soft tissue mass, haemorrhage, dynamic contrast-enhanced MRI. Clinical and MRI findings were compared with histopathological grading.ResultsSixty patients with central chondroid tumours were included (27 enchondromas, 10 cartilaginous lesions of unknown malignant potential, 15 grade 1 chondrosarcomas, 8 high-grade chondrosarcomas). Pain attributed to lesion, tumour length, endosteal scalloping > 2/3, cortical destruction, bone expansion and soft tissue mass were differentiating features between enchondromas and grade 1 chondrosarcomas. Dynamic contrast-enhanced MRI could not differentiate enchondromas from grade 1 chondrosarcomas.ConclusionsPreviously reported imaging signs of chondrosarcomas are useful in the diagnosis of grade 1 lesions but have lower sensitivity than in higher grade lesions. Deep endosteal scalloping is the most sensitive imaging sign of grade 1 chondrosarcomas. Pain due to the lesion is an important clinical sign of grade 1 chondrosarcomas. Dynamic contrast-enhanced MRI is not useful in differentiating enchondromas from grade 1 chondrosarcomas.Key Points• Differentiation of enchondroma from low-grade chondrosarcoma is challenging for radiologists and pathologists.• The utility of clinical assessment, conventional and dynamic contrast-enhanced MRI was uncertain.• Clinical assessment and conventional MRI aid in differentiating enchondromas from low-grade chondrosarcoma.• Dynamic contrast-enhanced MRI cannot differentiate enchondromas from grade 1 chondrosarcoma.

Background/Objectives: Atypical cartilaginous tumours (ACTs) are intermediate, locally aggressive chondroid tumours in the appendicular skeleton. Due to the potential for transformation into high-grade chondrosarcomas, management typically consists of regular MRI follow-up and, occasionally, surgery. We primarily aimed to examine the rate of malignant transformation in ACTs in our hospital; secondarily, we aimed to identify the factors influencing management choices and outcomes. Methods: All patients referred between 2013 and 2020 with a long-bone ACT were identified from the unit database. For this retrospective study, we analysed the imaging, management, and outcomes for the patients discussed at our musculoskeletal radiological conference. Results: A total of 59 patients were included; of these, 0 cases of malignant transformation were observed with a mean follow-up time of 8.4 years. Of the presenting cases, the musculoskeletal radiological conference advised that 6 should be biopsied, 40 should receive MRI follow-up, 7 should receive X-ray follow-up, and 6 should be re-examined in clinic. Subsequently, 12 patients underwent surgery due to continued pain, diagnostic uncertainty, and historical practices. Of these, seven experienced continued post-operative pain. Conclusions: None of the encountered ACTs underwent malignant transformation, supporting previous findings that this transformation is a rare phenomenon. Furthermore, of the small sample of patients undergoing surgery, less than half were left pain-free. These findings support a more conservative approach to ACT management, with the potential to discharge after an initial review.

ObjectiveEnchondromas (EC) of the shoulder joint are benign intraosseous cartilage neoplasms, with atypical cartilaginous tumours (ACT) representing their intermediate counterpart. They are usually found incidentally on clinical imaging performed for other reasons. Thus far the prevalence of ECs of the shoulder has been analysed in only one study reaching a figure of 2.1%.Materials and methodsThe aim of the current study was to validate this number via retrospective analysis of a 45 times larger, uniform cohort consisting of 21.550 patients who had received an MRI of the shoulder at a single radiologic centre over a time span of 13.2 years.ResultsNinety-three of 21.550 patients presented with at least one cartilaginous tumour. Four patients showed two lesions at the same time resulting in a total number of 97 cartilage tumours (89 ECs [91.8%], 8 ACTs [8.2%]). Based on the 93 patients, the overall prevalence was 0.39% for ECs and 0.04% for ACTs. Mean size of the 97 ECs/ACTs was 2.3 ± 1.5 cm; most neoplasms were located in the proximal humerus (96.9%), in the metaphysis (60.8%) and peripherally (56.7%). Of all lesions, 94 tumours (96.9%) were located in the humerus and 3 (3.1%) in the scapula.ConclusionFrequency of EC/ACT of the shoulder joint appears to have been overestimated, with the current study revealing a prevalence of 0.43%.

An enchondroma is a benign neoplasm of mature hyaline cartilage that proliferates from the medullary cavity toward the cortical bone. This results in the formation of a significant endogenous mass within the medullary cavity. Although enchondromas are predominantly asymptomatic, they may exhibit various clinical manifestations contingent on the size of the lesion, its localization, and the characteristics observed on radiological imaging. This study aimed to identify and present cases of bone tissue enchondromas to field specialists as preliminary data. In this study, authentic X-ray radiographs of patients were obtained following ethical approval and subjected to preprocessing. The images were then annotated by orthopedic oncology specialists using advanced, state-of-the-art object detection algorithms trained with diverse architectural frameworks. All processes, from preprocessing to identifying pathological regions using object detection systems, underwent rigorous cross-validation and oversight by the research team. After performing various operations and procedural steps, including modifying deep learning architectures and optimizing hyperparameters, enchondroma formation in bone tissue was successfully identified. This achieved an average precision of 0.97 and an accuracy rate of 0.98, corroborated by medical professionals. A comprehensive study incorporating 1055 authentic patient data from multiple healthcare centers will be a pioneering investigation that introduces innovative approaches for delivering preliminary insights to specialists concerning bone radiography.

Background Differentiating chondroid tumors is crucial for proper patient management. This study aimed to develop a deep learning model (DLM) for classifying enchondromas, atypical cartilaginous tumors (ACT), and high-grade chondrosarcomas using CT images. Methods This retrospective study analyzed chondroid tumors from two independent cohorts. Tumors were segmented on CT images. A 2D convolutional neural network was developed and tested using split-sample and geographical validation. Four radiologists blinded to patient data and the DLM results with various levels of experience performed readings of the external test dataset for comparison. Performance metrics included accuracy, sensitivity, specificity, and area under the curve (AUC). Results CTs from 344 patients (175 women; age = 50.3 ± 14.3 years;) with diagnosed enchondroma ( n  = 124), ACT ( n  = 92) or high-grade chondrosarcoma ( n  = 128) were analyzed. The DLM demonstrated comparable performance to radiologists ( p  > 0.05), achieving an AUC of 0.88 for distinguishing enchondromas from chondrosarcomas and 0.82 for differentiating enchondromas from ACTs. The DLM and musculoskeletal expert showed similar performance in differentiating ACTs from high-grade chondrosarcomas ( p  = 0.26), with an AUC of 0.64 and 0.56, respectively. Conclusions The DLM reliably differentiates benign from malignant cartilaginous tumors and is particularly useful for the differentiation between ACTs and Enchondromas, which is challenging based on CT images only. However, the differentiation between ACTs and high-grade chondrosarcomas remains difficult, reflecting known diagnostic challenges in radiology.

Background To develop a multiclass radiomics model for differentiating chondroid bone tumors using preoperative MRI. Methods This retrospective study included 120 patients (92 enchondromas, 16 low-grade chondrosarcomas, and 12 intermediate-to-high-grade chondrosarcomas) who underwent contrast-enhanced MRI between 2009 and 2019. Tumor segmentation was manually performed by a musculoskeletal radiologist and validated by a senior radiologist. We used least absolute shrinkage and selection operator (LASSO) and random forest (RF) for feature selection and classification, with and without synthetic minority oversampling technique (SMOTE). Model performance was evaluated using five-fold cross-validation with average precision, accuracy, area under the curve (AUC), and weighted kappa statistics. Results The LASSO + RF model based on all sequences achieved the highest accuracy (0.826 ± 0.065) and AUC (0.967 ± 0.027). The highest mAP (0.750 ± 0.095) was observed in the SMOTE-enhanced T2WI-based model, highlighting the potential impact of class imbalance. Quadratic weighted kappa values ranged from 0.648 to 0.731 across models, indicating substantial agreement with pathological results. Conclusions Preoperative MRI-based radiomics provides a robust method for the classification of chondroid bone tumors, potentially enhancing clinical decision-making.

Metachondromatosis which was first described in 1971 by Maroteaux is a rare genetic disease consisting of osteochondromas and enchondromas, caused by loss of function of the PTPN11 gene. It is distinct from other cartilaginous tumors such as multiple osteochondromas and hereditary multiple exostosis by the distribution and orientation of lesions, and pattern of inheritance. In Metachondromatosis osteochondromas typically occur in hands, feet, femur, and tibia while enchondromas commonly affect the pelvic bones and femurs. Both tumors are generally reported to regress in adulthood. To the best of our knowledge only one case of Chondrosarcoma has been reported, and our case is the second reported case of Chondrosarcoma in metachondromatosis.

IntroductionThe conventional treatment of enchondromas is the open surgery with curettage of lesions. Osteoscopic surgery is a minimally invasive endoscopic approach for lesions inside bone. The aim of this study was to evaluate the feasibility of the osteoscopic surgery in comparison with the conventional open surgery for patients with foot enchondromas.Materials and methodsA retrospective cohort study comparing patients with foot enchondromas treated with osteoscopic or open surgery from 2000 to 2019. Functional evaluations were based on both the AOFAS score and the Musculoskeletal Tumor Society (MSTS) functional rate. Complication and local recurrence were evaluated.ResultsSeventeen patients underwent endoscopic surgery, and eight patients underwent open surgery. The AOFAS score was higher in the osteoscopic group than the open group at 1 and 2 weeks after surgery (mean, 89.18 vs 67.25 [p = 0.001], 93.88 vs 79.38 [p = 0.004]). The MSTS functional rate was also higher in the osteoscopic group than the open group at 1 and 2 weeks after surgery (mean, 81.96 vs 59.58% [p = 0.00], 90.98 vs 75.00% [p = 0.02]). No statistical differences were found after 1-month of surgery. The osteoscopic group had lower complication rate than the open group (12 vs 50%; p = 0.04). No local recurrence was found in any groups.ConclusionThe osteoscopic surgery is feasible to provide earlier functional recovery and fewer complications than the open surgery.