Background: Soft tissue tumors (STTs) represent a heterogeneous group of rare lesions that frequently mimic bone sarcomas in both clinical and radiologic appearance. Accurate differentiation between benign and malignant lesions is critical for appropriate treatment planning, yet conventional imaging often remains inconclusive. Ultrasound (US) elastography, a non-invasive method that quantifies tissue stiffness, has recently emerged as a potential adjunct to standard musculoskeletal imaging for improving diagnostic confidence and guiding biopsy. Methods: A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Web of Science, and Cochrane Library were searched using the keywords “elastography”, “sonoelastography”, and “soft tissue tumor”. Twelve studies encompassing 1554 patients met the inclusion criteria, assessing the diagnostic accuracy of strain, compression, and shear wave elastography for differentiating benign from malignant STTs. Results: Elastography alone demonstrated limited specificity when used as a single diagnostic technique. However, its integration into multiparametric ultrasound approaches—combining grayscale, Doppler, and contrast-enhanced imaging—significantly improved diagnostic performance. Several studies reported sensitivities and specificities exceeding 85% when elastographic parameters were incorporated into composite diagnostic scores. Conclusions: Ultrasound elastography shows promise as a quantitative imaging biomarker for the preoperative evaluation of musculoskeletal tumors, particularly in distinguishing soft tissue from bone-related lesions. Although not a substitute for histopathological confirmation, its application within multimodal ultrasound protocols may reduce unnecessary biopsies, enhance diagnostic accuracy, and facilitate tailored management of bone and soft tissue sarcomas.

Myositis ossificans (MO) is a benign, self-limiting heterotopic ossification process that typically develops within soft tissues following trauma, although non-traumatic forms have also been described. Despite its benign nature, MO frequently represents a diagnostic challenge, particularly in its early stages when imaging findings may mimic aggressive soft-tissue tumors, leading to unnecessary biopsies or surgical interventions. This narrative review provides an updated overview of the classification, pathophysiology, and imaging features of myositis ossificans, with a specific focus on the time-dependent evolution of radiologic appearances across different imaging modalities. Radiologic findings are discussed according to disease stage, highlighting key diagnostic clues such as the zonal phenomenon and peripheral maturation pattern. In addition, the main entities included in the differential diagnosis are reviewed, with particular emphasis on imaging features that help distinguish myositis ossificans from soft-tissue sarcomas and other calcified or ossified lesions. Finally, current management strategies and the role of imaging in patient follow-up are summarized. A thorough understanding of the evolving imaging spectrum of myositis ossificans is essential for radiologists and clinicians to achieve an accurate diagnosis, guide appropriate management, and avoid overtreatment.

Tibial pilon fractures are complex articular injuries that involve the weight-bearing surface of the distal tibia (tibial plafond). They typically result from high-energy axial loading, which drives the talus into the tibial plafond, leading to significant articular comminution and associated soft-tissue damage. While radiography represents the first-line investigation for tibial fractures, CT is indispensable for accurate diagnosis and surgical planning. CT provides detailed three-dimensional (3D) visualisation of fracture patterns, articular surface depression, and fragment orientation, which is essential for proper classification and formulating a treatment strategy. Management is challenging and often follows a staged protocol, beginning with temporary external fixation to allow soft-tissue recovery, followed by definitive open reduction and internal fixation. The primary treatment goal is the anatomical restoration of the articular surface. The quality of surgical reduction, as assessed on post-operative radiographs, is a critical prognostic factor for functional outcomes. The primary aim of this article was to provide a comprehensive and up-to-date review of tibial pilon fractures, encompassing their pathophysiology, relevant clinical anatomy, modern diagnostic imaging techniques, classification systems, principles of treatment, and associated complications.

Objectives: To analyze the added value of Zero Echo Time (ZTE) MRI compared with a standard MRI protocol in detecting osseous alterations in diabetic foot. To compare ZTE performance with CT for detecting osseous abnormalities and to evaluate inter-observer reproducibility using Cohen’s kappa coefficient. Materials and methods: This retrospective study included 46 patients (33 men, 13 women; median age, 64 years) with clinically confirmed diabetes mellitus and clinically suspected diabetic foot complications. A standard MRI protocol including a ZTE sequence was performed in all patients; all patients also underwent CT for comparison. Three readers (two radiologists and one radiology resident) independently assessed image quality and osseous abnormalities, including bone erosions, bone and soft tissue pneumatosis, dislocations, and sclerosis. Sensitivity, specificity, accuracy, and inter-observer agreement (Cohen’s κ) were calculated. Results: ZTE demonstrated superior detection in almost all osseous alterations compared with the standard MRI protocol, with the exception of bone exposure and erosions, where performance was comparable. Image quality of ZTE was rated as good to excellent in the majority of examinations. Inter-observer agreement for ZTE was excellent between the two musculoskeletal radiologists and ranged from moderate to excellent between the senior radiologist and the resident. ZTE showed high concordance with CT for detection of bone abnormalities. Conclusion: ZTE significantly improves detection of osseous alterations in diabetic foot, even under suboptimal imaging conditions. Its high image quality and strong inter-reader agreement support integration into standard MRI protocols for improved bone assessment.

We report the case of a 58-year-old male with prior Billroth II gastrectomy who presented with worsening abdominal pain. Contrast-enhanced CT revealed a hyperdense, corticated, triangular-shaped foreign body (FB), consistent with a chicken bone, which had undergone retrograde migration and become impacted in the afferent duodenal loop. The FB’s orientation and location were precisely characterized, with associated inflammatory changes but no perforation. Push enteroscopy confirmed and successfully removed the FB. Post-procedural imaging excluded complications. This case highlights the diagnostic value of CT in identifying ingested FBs and illustrates the exceptional risk of retrograde FB migration and potential perforation in the afferent loop following Billroth II surgery.

Spinal non-traumatic extradural emergencies (SNTEE) represent critical emergencies that demand prompt recognition and intervention to prevent irreversible neurologic deficits. Radiography offers rapid initial evaluation of alignment and gross osseous changes in resource-limited settings, while CT provides superior characterization of bone architecture, subtle fractures, endplate erosion in spondylodiscitis and is essential for surgical planning. Magnetic resonance imaging (MRI) is currently considered the reference standard for evaluation of spinal non-traumatic extradural emergencies, lesion characterization and differential diagnosis, thanks to its superior soft tissue contrast and ability to distinguish extradural, intradural, and intramedullary pathologies. This review emphasizes the importance of a standardized MRI to differentiate infectious, neoplastic, traumatic and degenerative causes of acute compressive myelopathy. Furthermore, we highlight characteristic imaging features of key pathologies -such as spinal infections, neoplastic lesions, osteoporotic fractures, degenerative conditions and spontaneous epidural hematomas- providing practical tips for accurate identification.