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This review discusses how to avoid common mistakes in the imaging diagnosis of subchondral lesions, focusing on descriptive terminology, imaging scenarios, and reporting key imaging features that affect prognosis in these lesions.<\/jats:p>","DOI":"10.1055\/s-0045-1807712","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T22:35:13Z","timestamp":1759876513000},"page":"733-746","source":"Crossref","is-referenced-by-count":1,"title":["Common Mistakes in Diagnosis of Subchondral Bone Lesions"],"prefix":"10.1055","volume":"29","author":[{"given":"Tetyana","family":"Gorbachova","sequence":"additional","affiliation":[{"name":"Department of Radiology, Jefferson Einstein Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulia","family":"Melenevsky","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Alabama at 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Gulati","year":"2024","journal-title":"Skeletal Radiol"},{"issue":"03","key":"ref43","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.ejrad.2014.11.022","article-title":"MR imaging of transient osteoporosis of the hip: an update on 155 hip joints","volume":"84","author":"M E Klontzas","year":"2015","journal-title":"Eur J Radiol"},{"issue":"03","key":"ref44","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.ejrad.2004.01.020","article-title":"MR imaging findings in transient osteoporosis of the hip","volume":"50","author":"K N Malizos","year":"2004","journal-title":"Eur J Radiol"},{"issue":"05","key":"ref45","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s002560100350","article-title":"Subchondral changes in transient osteoporosis of the hip","volume":"30","author":"K Miyanishi","year":"2001","journal-title":"Skeletal 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