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Diagnostic test, level III.

Idiopathic inflammatory myopathies are chronic diseases clinically characterized by symmetrical proximal muscle weakness. MRI has assumed a major role in the evaluation and management of these conditions. It is sensitive to the presence of inflammation and edema, especially with incorporation of fat suppression sequences, so it is a useful tool for establishing an early diagnosis, for evaluating the extent and number of lesions, and for determining the right site for biopsy. The noninvasive nature of the procedure makes it ideal for serial studies to evaluate response to treatment. Whole-body MRI can scan a large volume of muscles without prolonged acquisition time and has the potential to identify previously unsuspected sites of involvement. MRI is also an excellent technique for identifying areas of fatty infiltration within the muscles, which usually occurs in the late stages of inflammatory myopathies. In summary, MRI has revolutionized the way muscular diseases are diagnosed and treated.

This article will describe the different variants of the unicornuate uterus, their clinical presentation and imaging findings, as well their associated complications. We will also review the associated renal anomalies. Patients' symptoms and their imaging findings will vary depending on the unicornuate subtype. Radiologic evaluation includes a combination of hysterosalpingography, sonography, and magnetic resonance imaging. Complications include obstetric ones related to the small uterine size and endometriosis and ectopic pregnancies when a cavitary rudimentary uterine horn is present. Radiologists should be familiar with all variants of the unicornuate uterus as well as their clinical presentation and associated imaging findings.

Bone marrow edema syndrome (BMES), also known as transient regional osteoporosis, is a rare and poorly understood disease process. We present a case of an elderly patient with the BMES who had a relapsing and remitting course complicated by a hip fracture which presented the unique and a previously unreported opportunity to examine the bony architecture pathologically. The patient responded well to calcitonin and bisphosphonate therapy after surgical repair of his fracture.This case highlights an underappreciated potential complication of BMES. Though not previously reported in the literature, BMES may be associated with active osteoporotic changes, with an infrequent risk of fracture that may be amenable to potential therapeutic interventions. Pathologically, BMES may represent a spectrum of disease consisting of an osteoclast-rich phase (transient regional osteoporosis phase) predisposing to fracture in addition to the more indolent osteoclast-poor phase with bone marrow edema more commonly associated with the disease. We hypothesize that it is the osteoclastic-rich phase which may benefit from early introduction of weight bearing activities, calcitonin, bisphosphonates, or parathyroid hormone. For example, bisphosphonates reduce bone resorption directly. Indirectly, bisphosphonates may also increase osteoblast differentiation and number and thus improve bone quality, an added benefit in the treatment of bone involved in the BMES, whether in the osteoclast-rich or osteoclast-poor phase.Further study should evaluate this osteoclastic-rich phase, which may be a transient pathologic phenomenon and which has not been described previously. Transient regional osteoporosis, therefore, may represent one point in the spectrum of the BMES. Hence, we would argue that BMES is a more accurate name for the full spectrum of this disease entity.