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Booth SM, Kapadia TH, Tang V, Maniyar AF. Pictorial review: challenges in distinguishing bilateral metaphyseal marrow abnormalities on magnetic resonance imaging. Pediatr Radiol 2024; 54:1247-1260. [PMID: 38491225 DOI: 10.1007/s00247-024-05896-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/18/2024]
Abstract
The paediatric metaphysis is afflicted by a wide range of pathological processes as it is the most metabolically active and well-vascularised part of the developing skeleton. This review focuses on metaphyseal marrow signal change detected with magnetic resonance imaging, which is most often occult on radiographs. When bilateral, these imaging appearances frequently present a diagnostic quandary. This review assists the radiologist to confidently dismiss physiological signal change and confidently work through the differential diagnosis. This is achieved by illustrating a practical method of classifying signal change into four categories: physiological red marrow, red marrow reconversion, marrow infiltration, and oedema-like marrow signal intensity. In doing so, various pathological entities are reviewed along with imaging pearls and next-step investigations.
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Affiliation(s)
- Sean M Booth
- Department of Radiology, Royal Manchester Children's Hospital, Oxford Road, Manchester, Lancashire, M13 9WL, UK.
| | - Tejas H Kapadia
- Department of Radiology, Royal Manchester Children's Hospital, Oxford Road, Manchester, Lancashire, M13 9WL, UK
| | - Vivian Tang
- Department of Radiology, Royal Manchester Children's Hospital, Oxford Road, Manchester, Lancashire, M13 9WL, UK
| | - Amit F Maniyar
- Department of Radiology, Royal Manchester Children's Hospital, Oxford Road, Manchester, Lancashire, M13 9WL, UK
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2
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Hansford BG, Li NP, Stacy GS, Mills MK, Tommack M, Yablon CM. Cubonavicular Coalition: Magnetic Resonance Imaging Findings and Associated Pathology of a Rarely Reported Condition in 27 Patients. Acad Radiol 2024; 31:846-856. [PMID: 37684180 DOI: 10.1016/j.acra.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023]
Abstract
RATIONALE AND OBJECTIVES (1) Describe multimodality imaging of cubonavicular coalition (CNC) with magnetic resonance imaging (MRI) focus, (2) evaluate CNC associated foot and ankle pathology, (3) examine clinical presentation/symptoms associated with CNC, (4) record CNC treatment. MATERIALS AND METHODS Retrospective Institutional Review Board (IRB) approved study. Picture Archiving and Communication System (PACS) databases searched for CNC. Final study population: 34 cases in 27 patients. Each CNC was reviewed for: coalition type (osseous versus non-osseous- cartilaginous versus fibrous), tendon and ligament pathology, bone marrow edema at CNC and adjacent joints, presence and severity of degenerative changes at CNC and adjacent joints, fractures, additional coalitions, laterality, and pes planus. MRI planes and radiographic views on which coalitions were best identified were recorded. Each CNC EMR was reviewed for: symptoms, trauma, management, patient demographics. Inter-reader reliability was performed for type of non-osseous coalition. RESULTS Final cohort included 34 cases in 27 patients (average age: 34.7, range: 10-76; 71% female). No CNC was completely osseous. On MRI, 89.5% of coalitions were non-osseous and 5.3% were partially osseous. 76.5% of patients had referable symptoms including pain, limited motion, inability to bear weight. 23.5% of patients were surgically managed/pathologically proven. On MRI, 36.8% of patients had tendon pathology, 52.6% had ligamentous pathology, 100% had bone marrow edema-like signal abnormality about the CNC, and 88.2% had CNC degenerative changes. There was bone marrow edema-like signal abnormality at bones adjacent to the CNC in 52.6% and adjacent joint degenerative disease present in 50%. CNC was best identified on oblique radiographs and axial MRI. Inter-reader reliability for non-osseous coalition type was poor, Cronbach's alpha 0.554. CONCLUSION CNC is subtle and findings of osteoarthritis or bone marrow edema-like about the cubonavicular articulation should raise suspicion for underlying coalition.
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Affiliation(s)
- Barry G Hansford
- Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239.
| | - Ningcheng Peter Li
- Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | | | - Megan K Mills
- University of Utah Hospitals, Salt Lake City, Utah (M.K.M.)
| | | | - Corrie M Yablon
- University of Michigan Hospitals, Ann Arbor, Michigan (C.M.Y.)
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Al-Mnayyis A, Obeidat S, Badr A, Jouryyeh B, Azzam S, Al Bibi H, Al-Gwairy Y, Al Sharie S, Varrassi G. Radiological Insights into Sacroiliitis: A Narrative Review. Clin Pract 2024; 14:106-121. [PMID: 38248433 PMCID: PMC10801489 DOI: 10.3390/clinpract14010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Sacroiliitis is the inflammation of the sacroiliac joint, the largest axial joint in the human body, contributing to 25% of lower back pain cases. It can be detected using various imaging techniques like radiography, MRI, and CT scans. Treatments range from conservative methods to invasive procedures. Recent advancements in artificial intelligence offer precise detection of this condition through imaging. Treatment options range from physical therapy and medications to invasive methods like joint injections and surgery. Future management looks promising with advanced imaging, regenerative medicine, and biologic therapies, especially for conditions like ankylosing spondylitis. We conducted a review on sacroiliitis using imaging data from sources like PubMed and Scopus. Only English studies focusing on sacroiliitis's radiological aspects were included. The findings were organized and presented narratively.
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Affiliation(s)
- Asma’a Al-Mnayyis
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
| | - Shrouq Obeidat
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (S.O.); (A.B.); (B.J.); (S.A.); (H.A.B.); (Y.A.-G.)
| | - Ammar Badr
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (S.O.); (A.B.); (B.J.); (S.A.); (H.A.B.); (Y.A.-G.)
| | - Basil Jouryyeh
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (S.O.); (A.B.); (B.J.); (S.A.); (H.A.B.); (Y.A.-G.)
| | - Saif Azzam
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (S.O.); (A.B.); (B.J.); (S.A.); (H.A.B.); (Y.A.-G.)
| | - Hayat Al Bibi
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (S.O.); (A.B.); (B.J.); (S.A.); (H.A.B.); (Y.A.-G.)
| | - Yara Al-Gwairy
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (S.O.); (A.B.); (B.J.); (S.A.); (H.A.B.); (Y.A.-G.)
| | - Sarah Al Sharie
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (S.O.); (A.B.); (B.J.); (S.A.); (H.A.B.); (Y.A.-G.)
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4
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Kim DK, Lee SW. Value of Edema-like Marrow Signal Intensity in Diagnosis of Joint Pain: Radiologists' Perspective. Semin Musculoskelet Radiol 2023; 27:649-654. [PMID: 37935211 DOI: 10.1055/s-0043-1775740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Musculoskeletal pain is a significant contributor to disability. The mechanism and target of the treatment should be optimized by imaging, but currently no accepted gold standard exists to image pain. In addition to end-organ pathology, other mediators also contribute to nociception, such as angiogenesis, axonal extension, immunologic modulation, and central sensitization. Recent research indicates that local inflammation is a significant contributor to pain in the extremities; therefore, we focus here on edema-like marrow signal intensity (ELMSI). We examine both the relevance of ELMSI for pain and novel imaging techniques.
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Affiliation(s)
- Dong Kyun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sheen-Woo Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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McPhee S, Kershaw LE, Daniel CR, Peña Fernández M, Cillán-García E, Taylor SE, Wolfram U. QCT-based computational bone strength assessment updated with MRI-derived 'hidden' microporosity. J Mech Behav Biomed Mater 2023; 147:106094. [PMID: 37741181 DOI: 10.1016/j.jmbbm.2023.106094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/10/2023] [Accepted: 08/26/2023] [Indexed: 09/25/2023]
Abstract
Microdamage accumulated through sustained periods of cyclic loading or single overloading events contributes to bone fragility through a reduction in stiffness and strength. Monitoring microdamage in vivo remains unattainable by clinical imaging modalities. As such, there are no established computational methods for clinical fracture risk assessment that account for microdamage that exists in vivo at any specific timepoint. We propose a method that combines multiple clinical imaging modalities to identify an indicative surrogate, which we term 'hidden porosity', that incorporates pre-existing bone microdamage in vivo. To do so, we use the third metacarpal bone of the equine athlete as an exemplary model for fatigue induced microdamage, which coalesces in the subchondral bone. N = 10 metacarpals were scanned by clinical quantitative computed tomography (QCT) and magnetic resonance imaging (MRI). We used a patch-based similarity method to quantify the signal intensity of a fluid sensitive MRI sequence in bone regions where microdamage coalesces. The method generated MRI-derived pseudoCT images which were then used to determine a pre-existing damage (Dpex) variable to quantify the proposed surrogate and which we incorporate into a nonlinear constitutive model for bone tissue. The minimum, median, and maximum detected Dpex of 0.059, 0.209, and 0.353 reduced material stiffness by 5.9%, 20.9%, and 35.3% as well as yield stress by 5.9%, 20.3%, and 35.3%. Limb-specific voxel-based finite element meshes were equipped with the updated material model. Lateral and medial condyles of each metacarpal were loaded to simulate physiological joint loading during gallop. The degree of detected Dpex correlated with a relative reduction in both condylar stiffness (p = 0.001, R2 > 0.74) and strength (p < 0.001, R2 > 0.80). Our results illustrate the complementary value of looking beyond clinical CT, which neglects the inclusion of microdamage due to partial volume effects. As we use clinically available imaging techniques, our results may aid research beyond the equine model on fracture risk assessment in human diseases such as osteoarthritis, bone cancer, or osteoporosis.
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Affiliation(s)
- Samuel McPhee
- School of Engineering and Physical Sciences, Institute of Mechanical, Process and Energy Engineering, Heriot-Watt University, Edinburgh, UK
| | - Lucy E Kershaw
- Centre for Cardiovascular Sciences and Edinburgh Imaging, The University of Edinburgh, Edinburgh, UK
| | - Carola R Daniel
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, The University of Edinburgh, Edinburgh, UK
| | - Marta Peña Fernández
- School of Engineering and Physical Sciences, Institute of Mechanical, Process and Energy Engineering, Heriot-Watt University, Edinburgh, UK
| | | | - Sarah E Taylor
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, The University of Edinburgh, Edinburgh, UK
| | - Uwe Wolfram
- School of Engineering and Physical Sciences, Institute of Mechanical, Process and Energy Engineering, Heriot-Watt University, Edinburgh, UK.
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6
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Malghem J, Lecouvet F, Vande Berg B, Kirchgesner T, Omoumi P. Subchondral insufficiency fractures, subchondral insufficiency fractures with osteonecrosis, and other apparently spontaneous subchondral bone lesions of the knee-pathogenesis and diagnosis at imaging. Insights Imaging 2023; 14:164. [PMID: 37782395 PMCID: PMC10545656 DOI: 10.1186/s13244-023-01495-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/17/2023] [Indexed: 10/03/2023] Open
Abstract
Subchondral insufficiency fractures (SIFs) and SIFs with osteonecrosis (SIF-ONs) of the knee (previously misnamed spontaneous osteonecrosis of the knee (SONK)) are bone lesions that appear without prior traumatic, tumoral, or inflammatory event.Both conditions are characterized in the early stages by epiphyseal bone marrow edema (BME)-like signal at MRI. However, while SIFs usually heal spontaneously, they can also evolve to osteonecrosis (i.e., SIF-ON), which may progress to an irreversible collapse of the articular surface. Careful analysis of other MRI signs may help differentiate the two conditions in the early phase. In SIFs, the BME edema-like signal extends to the area immediately adjacent to the subchondral plate, while in SIF-ONs, this subchondral area shows low signal intensity on fluid-sensitive MR images due to altered bone marrow. The thickness and length of subchondral areas with low fluid-sensitive signal intensity are important factors that determine the prognosis of SIF-ONs. If they are thicker than 4 mm or longer than 14 mm, the prognosis is poor. The differential diagnosis of SIFs and SIF-ONs include bone lesions associated with the "complex regional pain syndrome" (CRPS), epiphyseal osteonecrosis of systemic origin, and those related to cartilage pathology.Clinical relevance statement Imaging plays an essential role in diagnosing subchondral insufficiency fractures (SIFs) from subchondral insufficiency fractures with osteonecrosis (SIF-ONs) and collapse, as well as in distinguishing them from other spontaneous knee subchondral bone lesions presenting with bone marrow edema-like signal.Key points• Subchondral insufficiency fractures may affect the knee, especially in older adults.• Subchondral insufficiency fractures usually heal spontaneously.• Sometimes, subchondral osteonecrosis and collapse may complicate subchondral insufficiency fractures.• Bone marrow-like edema is an aspecific sign seen in all these lesions.• Degraded marrow in osteonecrosis complicating fractures is hypointense on fluid-sensitive sequences.
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Affiliation(s)
- Jacques Malghem
- Department of Radiology, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Frédéric Lecouvet
- Department of Radiology, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Bruno Vande Berg
- Department of Medical Imaging, Clinique CHC Montlégia, Boulevard Patience Et Beaujonc 2, 4000, Liège, Belgium
| | - Thomas Kirchgesner
- Department of Radiology, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne, Rue du Bugnon 46, 1010, Lausanne, Switzerland.
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7
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Karimi A, El-Abtah M, Sinkler M, Faraji N, Voos J, Harlow E, Miskovsky S. Asymptomatic Bone Marrow Edema in Weight-bearing Bones in Athletes and Military Trainees: A Systematic Literature Review. Int J Sports Med 2023; 44:683-691. [PMID: 37263276 DOI: 10.1055/a-2013-2226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Asymptomatic bone marrow edema (aBME) is a non-specific radiographic finding often found in athletes. Although aBME may represent the body's physiological response to training load, the etiology, MRI characteristics, and natural history of aBME remain unknown. To better characterize aBME in the lower extremities of military trainees and athletes. A systematic literature review in accordance with PRISMA guidelines was performed to identify primary research articles reporting on aBME in the lower extremities of athletes and military trainees. We identified 347 unique articles and after applying inclusion and exclusion criteria, 10 articles were included for qualitative synthesis. There were a total of 444 patients with an average age of 28.4±9.6 included. The most commonly used MRI sequences were proton-density with fat-saturation and T1-weighted imaging. The pattern of BME was inconsistently described, with various classification schemas used. The changes in aBME during longitudinal follow-up were dynamic and demonstrated both radiographic progression and regression. aBME is a highly prevalent and radiographically dynamic entity observed in high-level athletes and military trainees. Although follow-up was limited in the included studies, aBME may represent a natural, non-pathologic, reaction in response to specific biomechanical stressors.
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Affiliation(s)
- Amir Karimi
- Medical School, Case Western Reserve University School of Medicine, Cleveland, United States
| | - Mohamed El-Abtah
- Medical School, Case Western Reserve University School of Medicine, Cleveland, United States
| | - Margaret Sinkler
- Department Of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, United States
| | - Navid Faraji
- Department of Diagnostic Radiology, Division of Musculoskeletal Radiology, University Hospitals Cleveland Medical Center, Cleveland, United States
| | - James Voos
- Department Of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, United States
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, United States
| | - Ethan Harlow
- Department Of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, United States
| | - Shana Miskovsky
- Department Of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, United States
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, United States
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8
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Miskovsky S, Khambete P, Faraji N, Harlow ER, Ina J, Mengers S, Voos J. Prevalence of Asymptomatic Talar Bone Marrow Edema in Professional Ballet Dancers: Preliminary Data From a 2-Year Prospective Study. Orthop J Sports Med 2023; 11:23259671231159910. [PMID: 37152549 PMCID: PMC10159254 DOI: 10.1177/23259671231159910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/15/2022] [Indexed: 05/09/2023] Open
Abstract
Background Compared with symptomatic bone marrow edema (BME) associated with stress fractures, asymptomatic BME seen on magnetic resonance imaging (MRI) is a phenomenon that has been described in high-level athletes and is thought to be related to bone adaptation to biomechanical loading unique to each sport. However, the prevalence, natural history, and management of these lesions remain poorly understood, particularly in dance, which places tremendous stress on the feet and ankles. Purposes/Hypothesis The purposes of this study were to (1) determine the prevalence of asymptomatic BME in the talus before the start of the performance season, (2) identify contributing demographic and training factors, and (3) compare the radiological evidence of talar BME with validated functional foot and ankle scores. We hypothesized that talar BME would be highly prevalent among asymptomatic professional dancers. Study Design Case series; Level of evidence, 4. Methods A total of 14 professional ballet dancers (6 female and 8 male; mean age, 24 years) were included in this 2-year prospective study. For each participant, we recorded complete medical and surgical history along with scores on the Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Disability Index. Bilateral foot and ankle 3.0-T MRI scans without contrast were completed before the start of the performance season and were evaluated for BME of the talus using the Fredericson criteria. Results Evidence of talar BME was seen in 15 of the 28 (54%) ankles examined and in 9 of 14 (64%) dancers. We found that 6 dancers demonstrated bilateral talar BME, 3 dancers demonstrated unilateral BME, and 5 dancers demonstrated no evidence of BME. The most common location of BME was the posterior talus, seen in 8 of 15 (53%) ankles. No statistically significant differences were noted in dancers with versus those without talar BME with regard to functional scores, demographic characteristics, or weekly training hours. Conclusion Asymptomatic talar BME was highly prevalent (64%) in professional ballet dancers and tended to occur posteriorly. Long-term clinical and radiographic follow-up is necessary to determine the natural history of these lesions.
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Affiliation(s)
- Shana Miskovsky
- Department of Orthopaedic Surgery,
University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Sports Medicine Institute, University
Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Shana Miskovsky, MD,
Department of Orthopaedic Surgery, University Hospitals Cleveland Medical
Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA (
)
| | - Pranav Khambete
- Case Western Reserve University School
of Medicine, Cleveland, Ohio, USA
| | - Navid Faraji
- Musculoskeletal Imaging Division,
Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland,
Ohio, USA
| | - Ethan R. Harlow
- Department of Orthopaedic Surgery,
University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jason Ina
- Department of Orthopaedic Surgery,
University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sunita Mengers
- Department of Orthopaedic Surgery,
University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - James Voos
- Department of Orthopaedic Surgery,
University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Sports Medicine Institute, University
Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Zhao H, Li H, Xie X, Tang HY, Liu XX, Wen Y, Xiao X, Ye L, Tang YW, Dai GY, He JN, Chen L, Wang Q, Tang DQ, Pan SN. Dual-energy CT virtual non-calcium: an accurate method for detection of knee osteoarthritis-related edema-like marrow signal intensity. Insights Imaging 2023; 14:74. [PMID: 37121955 PMCID: PMC10149542 DOI: 10.1186/s13244-023-01407-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/11/2023] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVES To evaluate the performance of a dual-energy computed tomography (DECT) virtual non-calcium (VNCa) technique in the detection of edema-like marrow signal intensity (ELMSI) in patients with knee joint osteoarthritis (OA) compared to magnetic resonance imaging (MRI). METHODS The study received local ethics board approval, and written informed consent was obtained. DECT and MRI were used to examine 28 knees in 24 patients with OA. VNCa images were generated by dual-energy subtraction of calcium. The knee joint was divided into 15 regions for ELMSI grading, performed independently by two musculoskeletal radiologists, with MRI as the reference standard. We also analyzed CT numbers through receiver operating characteristics and calculated cut-off values. RESULTS For the qualitative analysis, we obtained CT sensitivity (Readers 1, 2 = 83.7%, 89.8%), specificity (Readers 1, 2 = 99.5%, 99.5%), positive predictive value (Readers 1, 2 = 95.3%, 95.7%), and negative predictive value (Readers 1, 2 = 97.9%, 98.7%) for ELMSI. The interobserver agreement was excellent (κ = 0.92). The area under the curve for Reader 1 and Reader 2 was 0.961 (95% CI 0.93, 0.99) and 0.992 (95% CI 0.98, 1.00), respectively. CT numbers obtained from the VNCa images were significantly different between regions with and without ELMSI (p < .001). CONCLUSIONS VNCa images have good diagnostic performance for the qualitative and quantitative analysis of knee osteoarthritis-related ELMSI.
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Affiliation(s)
- Heng Zhao
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
- Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, 110004, Liaoning, China
| | - Hui Li
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
- Department of Radiology, The First People's Hospital of Zhaoqing City, Zhaoqing, China
| | - Xia Xie
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Hai-Yan Tang
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Xiao-Xin Liu
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Yi Wen
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Xin Xiao
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Lu Ye
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - You-Wei Tang
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Gao-Yue Dai
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Jia-Ni He
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Li Chen
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Qian Wang
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - De-Qiu Tang
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
| | - Shi-Nong Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, 110004, Liaoning, China.
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10
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Littman J, Gil H, Aaron R. Spontaneous Bone Marrow Edema: Perfusion Abnormalities and Treatment with Surgical Decompression. Int J Mol Sci 2023; 24:ijms24076761. [PMID: 37047734 PMCID: PMC10095188 DOI: 10.3390/ijms24076761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023] Open
Abstract
Bone marrow edema (BME), also termed bone marrow lesions, is a syndrome characterized by bone pain and the appearance of high signal intensity on T2 fat-suppressed and short tau inversion recovery (STIR) MRI sequences. BME can be related to trauma or a variety of non-traumatic diseases, and current treatment modalities include non-steroidal anti-inflammatory drugs (NSAIDS), bisphosphonates, denosumab, extracorporeal shockwave therapy (ESWT), the vasoactive prostacyclin analogue iloprost, and surgical decompression. Spontaneous BME is a subset that has been observed with no apparent causative conditions. It is most likely caused by venous outflow obstruction and intraosseous hypertension. These are mechanistically related to impaired perfusion and ischemia in several models of BME and are related to bone remodeling. The association of perfusion abnormalities and bone pain provides the pathophysiological rationale for surgical decompression. We present a case of spontaneous BME and a second case of spontaneous migratory BME treated with surgical decompression and demonstrate resolution of pain and the high signal intensity on MRI. This report provides an integration of the clinical syndrome, MR imaging characteristics, circulatory pathophysiology, and treatment. It draws upon several studies to suggest that both the bone pain and the MRI characteristics are related to venous stasis, and when circulatory pathologies are relieved by decompression or fenestration, both the bone pain and the MRI signal abnormalities resolve.
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Affiliation(s)
- Jake Littman
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Holly Gil
- Department of Radiology, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Roy Aaron
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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11
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Hackenbroch C, Kreitner KF. [Stress reactions and stress fractures]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:259-267. [PMID: 36882548 DOI: 10.1007/s00117-023-01129-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
Bone stress injuries is an umbrella term that encompasses repetitive microtraumatic events that accumulate to surpass the threshold of bone failure, which can range from bone marrow edema to frank stress fracture as the end point. Due to nonspecific clinical complaints and physical findings, imaging plays a central role in the diagnostic workup of these entities. Magnetic resonance imaging (MRI) is the most important imaging modality with a high sensitivity and specificity and allows for differential diagnosis of other diseases. Edema-sensitive with fat suppression and T1-weighted sequences are the core sequence types, and contrast-enhanced imaging-albeit displaying subtle fractures much more easily-is rarely necessary. Furthermore, MRI enables differentiation of injury severity, which has an impact on length of rehabilitation, therapeutic regimen, and the time to return to sports in athletes.
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Affiliation(s)
- Carsten Hackenbroch
- Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Karl-Friedrich Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie der Universitätsmedizin Mainz, Johannes Gutenberg-Universität, Langenbeckstraße 1, 55131, Mainz, Deutschland.
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12
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Edema-like marrow signal intensity (ELMSI) associated with nonossifying fibroma (NOF) on MRI: an uncommon finding in a common bone lesion. Skeletal Radiol 2023. [PMID: 36867220 DOI: 10.1007/s00256-023-04312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE To investigate the association between nonossifying fibroma (NOF) and perilesional edema-like marrow signal intensity (ELMSI) on MRI and discuss the clinical and diagnostic implications of this finding. MATERIALS AND METHODS A retrospective search for "nonossifying fibroma" and "NOF" on knee MRI reports of patients up to 20 years of age over a 5-year period was performed. A total of 77 patients (34 males, 43 females, ages 11-20) were identified, and each MRI was reviewed to evaluate for ELMSI associated with the NOF. Statistical analysis was performed to determine if there was a correlation with the presence of perilesional ELMSI and age, gender, lesion size, or signal characteristics. RESULTS Twelve patients out of 77 (16%) had ELMSI associated with a NOF. Excluding patients who had additional findings of pathologic fracture (n = 2), a known potential complication of NOFs, and edema related to an adjacent osteoid osteoma (n = 1), a total of 9 patients (12%) had otherwise unexplained perilesional ELMSI. There was no statistically significant difference between patients with vs. without perilesional ELMSI with respect to age (p = 0.08), gender (p = 0.28), lesion size (p = 0.52), or appearance on fluid-sensitive sequences (p = 0.81). CONCLUSION ELMSI can be seen about NOFs encountered around the knee joint on MRI, which may represent active healing and/or involutional change of this "do not touch" lesion in cases where no other explanation is identified.
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13
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Saifuddin A, Tyler P, Rajakulasingam R. Imaging of bone marrow pitfalls with emphasis on MRI. Br J Radiol 2023; 96:20220063. [PMID: 35522786 PMCID: PMC9975530 DOI: 10.1259/bjr.20220063] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 01/27/2023] Open
Abstract
Normal marrow contains both hematopoietic/red and fatty/yellow marrow with a predictable pattern of conversion and skeletal distribution on MRI. Many variations in normal bone marrow signal and appearances are apparent and the reporting radiologist must differentiate these from other non-neoplastic, benign or neoplastic processes. The advent of chemical shift imaging has helped in characterising and differentiating more focal heterogeneous areas of red marrow from marrow infiltration. This review aims to cover the MRI appearances of normal marrow, its evolution with age, marrow reconversion, variations of normal marrow signal, causes of oedema-like marrow signal, and some common non-neoplastic entities, which may mimic marrow neoplasms.
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Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Philippa Tyler
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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14
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Ward MM, Yao L. Sacroiliac Bone Marrow Edema: Innocent Until Proven Guilty? Arthritis Rheumatol 2022; 74:1474-1476. [PMID: 35436388 PMCID: PMC9427687 DOI: 10.1002/art.42143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 03/21/2022] [Accepted: 04/12/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Michael M Ward
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Lawrence Yao
- Radiology and Imaging Sciences, NIH, Clinical Center, Bethesda, Maryland
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15
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Moran J, Katz LD, Schneble CA, Li DT, Kahan JB, Wang A, Porrino J, Fosam A, Cheng R, Jokl P, Hewett TE, Medvecky MJ. A Novel MRI Mapping Technique for Evaluating Bone Bruising Patterns Associated With Noncontact ACL Ruptures. Orthop J Sports Med 2022; 10:23259671221088936. [PMID: 35480066 PMCID: PMC9036340 DOI: 10.1177/23259671221088936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Bone bruise patterns in the knee can aid in understanding the mechanism of injury in anterior cruciate ligament (ACL) ruptures. There is no universally accepted magnetic resonance imaging (MRI) mapping technique to describe the specific locations of bone bruises. Hypothesis: The authors hypothesized that (1) our novel mapping technique would show high interrater and intrarater reliability for the location of bone bruises in noncontact ACL-injured knees and (2) the bone bruise patterns reported from this technique would support the most common mechanisms of noncontact ACL injury, including valgus stress, anterior tibial translation, and internal tibial rotation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 43 patients who underwent ACL reconstruction between 2018 and 2020, with MRI within 30 days of the injury on a 3.0-T scanner, documentation of a noncontact mechanism of injury, and no concomitant or previous knee injuries. Images were retrospectively reviewed by 2 radiologists blinded to all clinical data. The locations of bone bruises were mapped on fat-suppressed T2-weighted coronal and sagittal images using a novel technique that combined the International Cartilage Repair Society (ICRS) tibiofemoral articular cartilage surgical lesions diagram and the Whole-Organ Magnetic Resonance Imaging Scoring (WORMS) mapping system. Reliability between the reviewers was assessed using the intraclass correlation coefficient (ICC), where ICC >0.90 indicated excellent agreement. Results: The interrater and intrarater ICCs were 0.918 and 0.974, respectively, for femoral edema mapping and 0.979 and 0.978, respectively, for tibial edema mapping. Significantly more bone bruises were seen within the lateral femoral condyle compared with the medial femoral condyle (67% vs 33%; P < .0001), and more bruises were seen within the lateral tibial plateau compared with the medial tibial plateau (65% vs 35%; P < .0001). Femoral bruises were almost exclusively located in the anterior/central regions (98%) of the condyles as opposed to the posterior region (2%; P < .0001). Tibial bruises were localized to the posterior region (78%) of both plateaus as opposed to the anterior/central regions (22%; P < .0001). Conclusion: The combined mapping technique offered a standardized and reliable method for reporting bone bruises in noncontact ACL injuries. The contusion patterns identified using this technique were indicative of the most commonly reported mechanisms for noncontact ACL injuries.
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Affiliation(s)
- Jay Moran
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Lee D. Katz
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher A. Schneble
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Don T. Li
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Joseph B. Kahan
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Annie Wang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jack Porrino
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andin Fosam
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Ryan Cheng
- Yale University, New Haven, Connecticut, USA
| | - Peter Jokl
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Michael J. Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
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16
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Yu TJ, Bangura A, Bodanapally U, Nascone J, O'Toole R, Liang Y, Dreizin D. Dual-Energy CT and Cinematic Rendering to Improve Assessment of Pelvic Fracture Instability. Radiology 2022; 304:353-362. [PMID: 35438566 PMCID: PMC9340240 DOI: 10.1148/radiol.211679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Grading of pelvic fracture instability is challenging in patients with pelvic binders. Dual-energy CT (DECT) and cinematic rendering can provide ancillary information regarding osteoligamentous integrity, but the utility of these tools remains unknown. Purpose To assess the added diagnostic value of DECT and cinematic rendering, with respect to single-energy CT (SECT), for discriminating any instability and translational instability in patients with pelvic binders. Materials and Methods In this retrospective analysis, consecutive adult patients (age ≥18 years) were stabilized with pelvic binders and scanned in dual-energy mode using a 128-section CT scanner at one level I trauma center between August 2016 and January 2019. Young-Burgess grading by orthopedists served as the reference standard. Two radiologists performed blinded consensus grading with the Young-Burgess system in three reading sessions (session 1, SECT; session 2, SECT plus DECT; session 3, SECT plus DECT and cinematic rendering). Lateral compression (LC) type 1 (LC-1) and anteroposterior compression (APC) type 1 (APC-1) injuries were considered stable; LC type 2 and APC type 2, rotationally unstable; and LC type 3, APC type 3, and vertical shear, translationally unstable. Diagnostic performance for any instability and translational instability was compared between reading sessions using the McNemar and DeLong tests. Radiologist agreement with the orthopedic reference standard was calculated with the weighted κ statistic. Results Fifty-four patients (mean age, 41 years ± 16 [SD]; 41 men) were analyzed. Diagnostic performance was greater with SECT plus DECT and cinematic rendering compared with SECT alone for any instability, with an area under the receiver operating characteristic curve (AUC) of 0.67 for SECT alone and 0.82 for SECT plus DECT and cinematic rendering (P = .04); for translational instability, the AUCs were 0.80 for SECT alone and 0.95 for SECT plus DECT and cinematic rendering (P = .01). For any instability, corresponding sensitivities were 61% (22 of 36 patients) for SECT alone and 86% (31 of 36 patients) for SECT plus DECT and cinematic rendering (P < .001). The corresponding specificities were 72% (13 of 18 patients) and 78% (14 of 18 patients), respectively (P > .99). Agreement (κ value) between radiologists and orthopedist reference standard improved from 0.44 to 0.76 for SECT versus the combination of SECT, DECT, and cinematic rendering. Conclusion Combined use of single-energy CT, dual-energy CT, and cinematic rendering improved instability assessment over that with single-energy CT alone. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Theresa J Yu
- From the Department of Diagnostic Radiology and Nuclear Medicine (T.J.Y., U.B., D.D.) and Division of Orthopaedic Traumatology (A.B., J.N., R.O.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; and Department of Epidemiology and Public Health, University of Maryland School of Medicine (Y.L.)
| | - Abdulai Bangura
- From the Department of Diagnostic Radiology and Nuclear Medicine (T.J.Y., U.B., D.D.) and Division of Orthopaedic Traumatology (A.B., J.N., R.O.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; and Department of Epidemiology and Public Health, University of Maryland School of Medicine (Y.L.)
| | - Uttam Bodanapally
- From the Department of Diagnostic Radiology and Nuclear Medicine (T.J.Y., U.B., D.D.) and Division of Orthopaedic Traumatology (A.B., J.N., R.O.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; and Department of Epidemiology and Public Health, University of Maryland School of Medicine (Y.L.)
| | - Jason Nascone
- From the Department of Diagnostic Radiology and Nuclear Medicine (T.J.Y., U.B., D.D.) and Division of Orthopaedic Traumatology (A.B., J.N., R.O.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; and Department of Epidemiology and Public Health, University of Maryland School of Medicine (Y.L.)
| | - Robert O'Toole
- From the Department of Diagnostic Radiology and Nuclear Medicine (T.J.Y., U.B., D.D.) and Division of Orthopaedic Traumatology (A.B., J.N., R.O.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; and Department of Epidemiology and Public Health, University of Maryland School of Medicine (Y.L.)
| | - Yuanyuan Liang
- From the Department of Diagnostic Radiology and Nuclear Medicine (T.J.Y., U.B., D.D.) and Division of Orthopaedic Traumatology (A.B., J.N., R.O.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; and Department of Epidemiology and Public Health, University of Maryland School of Medicine (Y.L.)
| | - David Dreizin
- From the Department of Diagnostic Radiology and Nuclear Medicine (T.J.Y., U.B., D.D.) and Division of Orthopaedic Traumatology (A.B., J.N., R.O.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; and Department of Epidemiology and Public Health, University of Maryland School of Medicine (Y.L.)
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17
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MRI in the Diagnosis and Treatment Response Assessment of Chronic Nonbacterial Osteomyelitis in Children and Adolescents. Curr Rheumatol Rep 2022; 24:27-39. [PMID: 35133566 DOI: 10.1007/s11926-022-01053-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To explain the central role of magnetic resonance imaging (MRI) in the diagnosis and follow-up of chronic nonbacterial osteomyelitis (CNO) in children and adolescents, centering on practical technical aspects and salient diagnostic features. RECENT FINDINGS In the absence of conclusive clinical features and widely accepted laboratory tests, including validated disease biomarkers, MRI (whether targeted or covering the entire body) currently plays an indispensable role in the diagnosis and therapy response assessment of CNO. Whole-body MRI, which is the reference imaging standard for CNO, can be limited to a short tau inversion recovery (STIR) coronal image set covering the entire body and a STIR sagittal set covering the spine, an approximately 30-min examination with no need for intravenous contrast or diffusion-weighted imaging. The hallmark of CNO is periphyseal (metaphyseal and/or epi-/apophyseal) osteitis, identified as bright foci on STIR, with or without inflammation of the adjacent periosteum and surrounding soft tissue. Response to bisphosphonate treatment for CNO has some unique MRI findings that should not be mistaken for residual or relapsing disease. Diagnostic features and treatment response characteristics of MRI in pediatric CNO are discussed, also describing the techniques used, pitfalls encountered, and differential diagnostic possibilities considered during daily practice.
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18
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Tarantino U, Greggi C, Cariati I, Caldora P, Capanna R, Capone A, Civinini R, Colagrande S, De Biase P, Falez F, Iolascon G, Maraghelli D, Masi L, Cerinic MM, Sessa G, Brandi ML. Bone Marrow Edema: Overview of Etiology and Treatment Strategies. J Bone Joint Surg Am 2022; 104:189-200. [PMID: 34780382 DOI: 10.2106/jbjs.21.00300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Bone marrow edema (BME) is a nonspecific but relevant finding, usually indicating the presence of an underlying pathology. ➤ The gold standard technique for detecting BME is magnetic resonance imaging (MRI), as it allows for a correct diagnosis to be made, which is extremely important given the heterogeneity of BME-related diseases. ➤ Depending on the severity of painful symptomatology and the MRI evidence, different treatment strategies can be followed: physical modalities, pharmacological options, and surgical therapy.
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Affiliation(s)
- Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy.,Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - Chiara Greggi
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy.,Medical-Surgical Biotechnologies and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - Ida Cariati
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy.,Medical-Surgical Biotechnologies and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | | | - Rodolfo Capanna
- Department of Orthopaedics and Traumatology, Universal Hospital of Pisa, Pisa, Italy
| | - Antonio Capone
- Department of Surgical Sciences, University of Cagliari, Monserrato, Italy
| | - Roberto Civinini
- Department of Surgical Science, University of Florence, Florence, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Pietro De Biase
- General Orthopaedics and Traumatology, AOU Careggi, Florence, Italy
| | - Francesco Falez
- Orthopaedic and Traumatology Department, S. Spirito Hospital, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli," Caserta, Italy
| | - Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Laura Masi
- Metabolic Bone Diseases Unit, University Hospital of Florence, AOU Careggi, Florence, Italy
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuseppe Sessa
- Section of Orthopaedics and Traumatology, Department of General Surgery and Medical Surgical Specialties, University Hospital Policlinico Rodolico-San Marco, University of Catania, Catania, Italy
| | - Maria L Brandi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Automated segmentation of magnetic resonance bone marrow signal: a feasibility study. Pediatr Radiol 2022; 52:1104-1114. [PMID: 35107593 PMCID: PMC9107442 DOI: 10.1007/s00247-021-05270-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/12/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Manual assessment of bone marrow signal is time-consuming and requires meticulous standardisation to secure adequate precision of findings. OBJECTIVE We examined the feasibility of using deep learning for automated segmentation of bone marrow signal in children and adolescents. MATERIALS AND METHODS We selected knee images from 95 whole-body MRI examinations of healthy individuals and of children with chronic non-bacterial osteomyelitis, ages 6-18 years, in a longitudinal prospective multi-centre study cohort. Bone marrow signal on T2-weighted Dixon water-only images was divided into three color-coded intensity-levels: 1 = slightly increased; 2 = mildly increased; 3 = moderately to highly increased, up to fluid-like signal. We trained a convolutional neural network on 85 examinations to perform bone marrow segmentation. Four readers manually segmented a test set of 10 examinations and calculated ground truth using simultaneous truth and performance level estimation (STAPLE). We evaluated model and rater performance through Dice similarity coefficient and in consensus. RESULTS Consensus score of model performance showed acceptable results for all but one examination. Model performance and reader agreement had highest scores for level-1 signal (median Dice 0.68) and lowest scores for level-3 signal (median Dice 0.40), particularly in examinations where this signal was sparse. CONCLUSION It is feasible to develop a deep-learning-based model for automated segmentation of bone marrow signal in children and adolescents. Our model performed poorest for the highest signal intensity in examinations where this signal was sparse. Further improvement requires training on larger and more balanced datasets and validation against ground truth, which should be established by radiologists from several institutions in consensus.
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Diekhoff T, Lambert R, Hermann KG. MRI in axial spondyloarthritis: understanding an 'ASAS-positive MRI' and the ASAS classification criteria. Skeletal Radiol 2022; 51:1721-1730. [PMID: 35199195 PMCID: PMC9283193 DOI: 10.1007/s00256-022-04018-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023]
Abstract
In 2009, the Assessment of SpondyloArthritis international Society (ASAS) published a definition of 'active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis'. This new definition of an 'ASAS-positive MRI' was integral to new classification criteria for axial spondyloarthritis that were published in the same year. The ASAS MRI definition had the considerable advantage of simplicity and the definition gained popularity as guidance for interpreting MRI of the sacroiliac joints in clinical practice. However, classification criteria are not designed for use in clinical practice with the consequence that overreliance on the presence of bone marrow edema, which is the principal determinant of an 'ASAS-positive MRI', may result in a tendency to overcall inflammatory sacroiliitis in the clinical setting. This article aims to inform the reader about the rationale behind the ASAS definition of a positive MRI and ASAS classification criteria, their proper use in research and why they should not be used in clinical practice. The article also contains guidance for an updated imaging protocol and interpretation of images including typical imaging findings, differential diagnosis, and common pitfalls.
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Affiliation(s)
- Torsten Diekhoff
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Robert Lambert
- Department of Radiology & Diagnostic Imaging, University of Alberta, 2A2.41MC, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
- Medical Imaging Consultants, 202-11010 - 101 Street, Edmonton, AB, T5H 4B9, Canada
| | - Kay Geert Hermann
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
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