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Clinical Updates in Imaging of Musculoskeletal Diseases
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Clinical Updates in Imaging of Musculoskeletal Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nuclear Medicine & Radiology".

Deadline for manuscript submissions: 20 October 2026 | Viewed by 1998

Special Issue Editors

Dr. Federico Zaottini

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Guest Editor
Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
Interests: musculoskeletal imaging; rheumatology; neurology; ultrasound
Dr. Riccardo Picasso

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Co-Guest Editor
Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
Interests: musculoskeletal imaging; ultrasound; sport imaging; radiology

Special Issue Information

Dear Colleagues,

In recent years, rapid technological progress has transformed musculoskeletal imaging, enabling earlier diagnosis, improved disease characterization, and more precise treatment planning. Innovations such as high-resolution MRI, dual-energy CT, and ultrasound elastography offer unprecedented detail in assessing diseases affecting bones, nerves, ligaments, and tendons. Moreover, artificial intelligence and machine learning are being increasingly integrated into imaging workflows, enhancing diagnostic accuracy and efficiency. These advances not only improve outcomes in trauma, arthritis, and sports injuries but also expand our understanding of musculoskeletal diseases. In this Special Issue, we invite authors to submit papers on the latest developments in musculoskeletal imaging, with a special focus on both clinical applications and future directions.

Dr. Federico Zaottini
Dr. Riccardo Picasso
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • musculoskeletal imaging
  • ultrasound
  • magnetic resonance
  • sport imaging
  • rheumatology
  • nerve imaging

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Published Papers (3 papers)

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Research

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14 pages, 1695 KB  
Article
Development of a Simplified Protocol for Respiratory Muscle Segmentation in Unenhanced Chest CT and Identification of New Radiomic Biomarkers of Sarcopenia in Lung Diseases: A Retrospective Study
by Riccardo Picasso, Maria Elena Susi, Giovanni Marcenaro, Marta Macciò, Federico Zaottini, Federico Pistoia, Ludovico La Grutta, Giulia Sollami, Arianna Maggio, Diego Bagnasco, Fulvio Braido, Melissa Ferraris, Ludovica Napoli, Benedetta Bondi, Giulia Carpani, Gaia Vettori, Maurizio Mongelli, Alessia Paglialonga and Carlo Martinoli
J. Clin. Med. 2025, 14(24), 8712; https://doi.org/10.3390/jcm14248712 - 9 Dec 2025
Viewed by 484
Abstract
Background/Objectives: Respiratory muscle sarcopenia worsens outcomes in chronic lung disease, and quantitative Computed Tomography (CT) may provide objective biomarkers; this study aimed to develop a time-efficient segmentation protocol and identify radiomic biomarkers of respiratory muscle sarcopenia. Methods: This retrospective study analyzed 30 unenhanced [...] Read more.
Background/Objectives: Respiratory muscle sarcopenia worsens outcomes in chronic lung disease, and quantitative Computed Tomography (CT) may provide objective biomarkers; this study aimed to develop a time-efficient segmentation protocol and identify radiomic biomarkers of respiratory muscle sarcopenia. Methods: This retrospective study analyzed 30 unenhanced chest CT from adult patients. The whole volume of the pectoralis major (PM), pectoralis minor (Pm), serratus anterior (SA), and fourth intercostal (4I) muscles was manually segmented. Patients were classified as sarcopenic or non-sarcopenic. Radiomics features and mean muscle density were extracted using PyRadiomics. Features associated with sarcopenia were selected using Least Absolute Shrinkage and Selection Operator (LASSO) regression and backward stepwise selection. Four sets of slices consisting of one, three, five, and seven slices were then sampled from each muscle around a fixed anatomical landmark. Deviations of each set of slices from whole-muscle metrics were evaluated using Mean Absolute Error (MAE) and Mean Absolute Percentage Error (MAPE). Results: Features selection identified 25 biomarkers of sarcopenia in PM, 24 in Pm, and 34 in SA. Variability-related features were significantly associated with sarcopenia (OR = 2.26; p = 0.012), while structural features showed an inverse association (OR = 0.18; p = 0.004). Mean muscle density and most radiomic features were well represented by single slice for every muscle. In the PM and Pm, eight and six radiomic features were better approximated segmenting more than one slice (p < 0.05). Conclusions: Radiomics enables quantitative assessment of sarcopenia. For SA, a simplified segmentation protocol consisting of a single slice enables approximating muscle density and radiomics of whole muscle volume. For PM and Pm, three or more slices allow a better representation of 8 and 6 radiomic features, respectively. Full article
(This article belongs to the Special Issue Clinical Updates in Imaging of Musculoskeletal Diseases)
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14 pages, 2670 KB  
Article
Ultrasound Evaluation of the Regenerating Tendon of the Semitendinosus After Harvest for Anterior Cruciate Ligament Reconstruction
by Marco Becciolini, Michele Bisogni, Salvatore Massimo Stella, Carlo Trompetto, Laura Mori, Luca Puce, William Campanella, Orlando Catalano and Filippo Cotellessa
J. Clin. Med. 2025, 14(21), 7862; https://doi.org/10.3390/jcm14217862 - 5 Nov 2025
Cited by 1 | Viewed by 1150
Abstract
Objectives: Previous studies have suggested the potential for semitendinosus (ST) tendon regeneration following harvesting for anterior cruciate ligament (ACL) reconstruction. This retrospective cross-sectional (observational) study aims to evaluate ST tendon regeneration using high-resolution ultrasound (US), with special reference to morphological and structural [...] Read more.
Objectives: Previous studies have suggested the potential for semitendinosus (ST) tendon regeneration following harvesting for anterior cruciate ligament (ACL) reconstruction. This retrospective cross-sectional (observational) study aims to evaluate ST tendon regeneration using high-resolution ultrasound (US), with special reference to morphological and structural changes in the muscle–tendon unit. Methods: Twenty-four patients who had undergone ST tendon harvesting at least 24 months prior were evaluated. Ultrasound assessment included neotendon (NT) detection, thickness, echotexture, insertion site, dynamic gliding, myotendinous junction (MTJ) shifting, and muscle cross-sectional area (CSA), compared with the healthy contralateral side. Results: ST tendon regeneration was detected in 19/24 patients (79%). In regenerated tendons, NT thickness was significantly greater than the native tendon (3.40 ± 1.38 mm vs. 2.40 ± 0.27 mm; mean difference 0.98 mm; p = 0.005. Subgroup analysis revealed that fibrillar-like NTs were associated with a smaller MTJ shift (3.91 ± 1.14 cm vs. 7.75 ± 2.43 cm; p = 0.001) and higher muscle CSA preservation (0.85 ± 0.10 vs. 0.55 ± 0.09; p < 0.001). A strong inverse correlation was found between MTJ displacement and muscle CSA (ρ = −0.96; p < 0.001). Patients without NT regeneration (n = 5) exhibited more pronounced MTJ retraction (11.0 ± 1.0 cm) and muscle hypotrophy (CSA ratio 0.41 ± 0.07), although these results were descriptive. Conclusions: High-resolution US is an effective, non-invasive method for assessing ST tendon regeneration from a qualitative and quantitative perspective. Our findings indicate possible changes in the architecture and position of the regenerated tendon, the MTJ, and the muscle belly, which may reflect structural remodeling of the muscle–tendon unit. Full article
(This article belongs to the Special Issue Clinical Updates in Imaging of Musculoskeletal Diseases)
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Review

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21 pages, 808 KB  
Review
From Invisible to Visible: Cutting-Edge Ultrasound Insights into Entheses of the Distal Extremities in Rheumatology
by Luis Coronel, Chiara Rizzo, Juan José de Agustin, David Bong, Maribel Miguel-Pérez, Stefano Alivernini, Lene Terslev, Maria Antonietta D’Agostino and Ingrid Möller
J. Clin. Med. 2026, 15(10), 3753; https://doi.org/10.3390/jcm15103753 - 13 May 2026
Abstract
Musculoskeletal ultrasound (MSUS) is a well-established and reliable tool for the evaluation of entheses and enthesitis, particularly at larger and accessible sites. Recent technological advances, including high- and ultra-high-frequency transducers, have expanded its potential, enabling detailed assessment of distal extremity entheses. This narrative [...] Read more.
Musculoskeletal ultrasound (MSUS) is a well-established and reliable tool for the evaluation of entheses and enthesitis, particularly at larger and accessible sites. Recent technological advances, including high- and ultra-high-frequency transducers, have expanded its potential, enabling detailed assessment of distal extremity entheses. This narrative review provides a focused and updated perspective on this evolving field, highlighting three key advances. First, the identification and characterization of previously underrecognized entheseal sites in the distal extremities, such as pulley systems, retinacula, novel tendon insertions, and collateral ligaments, broadening the morphological spectrum of entheseal imaging. This is complemented by improved evaluation of vascularization through microvascular imaging and contrast-enhanced US (CEUS). Second, the emergence of interventional approaches, particularly US-guided entheseal biopsy, offers a novel means to investigate entheseal tissue in vivo and may establish a link between imaging and histopathology. Third, the integration of advanced functional imaging modalities, including elastography and multispectral optoacoustic tomography (MSOT), provides preliminary additional insights into the biomechanical and molecular properties of the enthesis beyond conventional structural assessment. Collectively, these developments support new investigational perspectives, positioning MSUS as a dynamic and integrative modality capable of exploring new anatomical territories and biological dimensions, with the potential to reshape the understanding and evaluation of entheseal involvement in rheumatology. Full article
(This article belongs to the Special Issue Clinical Updates in Imaging of Musculoskeletal Diseases)
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