1
|
Gulati A, Kamel SI, Desai V, Belair JA. Presence of subchondral fracture in cases diagnosed as transient osteoporosis of the hip: a retrospective independent reader-based study. Skeletal Radiol 2024; 53:871-879. [PMID: 37932432 DOI: 10.1007/s00256-023-04500-7] [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] [Received: 07/05/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Transient osteoporosis of the hip (TOH) is an uncommon, typically self-limited diagnosis of uncertain etiology. We hypothesize that TOH represents an underlying subchondral fracture, and a discrete fracture line can often be detected on high-resolution MRI. MATERIALS AND METHODS A retrospective PACS query identified patients meeting imaging criteria for TOH with intense bone marrow edema (BME) in the femoral head on MRI. Those with poor quality studies, other underlying pathologies, or antecedent trauma were excluded. Three musculoskeletal radiologists independently reviewed each case for presence of a definite subchondral fracture line on small field of view (FOV) MR images of the affected hip. Extent of BME, reciprocal acetabular BME, and joint effusion size were also recorded. Binomial logistic regression was performed to determine statistically significant predictors of subchondral fracture. RESULTS Fifty patients met inclusion criteria (29 females, 0 pregnant). Mean age was 62±12 years (range 35-84). Average duration of symptoms before MRI was 102±135 days. Ten patients had bone densitometry within 2 years of MRI, six demonstrating osteopenia or osteoporosis. Subchondral fractures were unanimously identified in 44/50 (88%). Interclass correlation coefficient with absolute agreement was 0.73, 95% CI (0.57-0.84), indicating near-excellent agreement. Most cases demonstrated a large joint effusion (23/50, 46%) and acetabular BME (31/50, 62%). Increasing size of joint effusion was a statistically significant predictor of subchondral fracture (p=0.05), with 6.9 higher odds. There was a strong correlation with osteopenia/osteoporosis and fracture (p<0.001). CONCLUSION Discrete subchondral fractures were identified unanimously on small FOV imaging in the majority of TOH cases.
Collapse
Affiliation(s)
- Aishwarya Gulati
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA
| | - Sarah I Kamel
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA
| | - Vishal Desai
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA
| | - Jeffrey A Belair
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA.
| |
Collapse
|
2
|
Griffith JF, Yip SWY, van der Heijden RA, Valenzuela RF, Yeung DKW. Perfusion Imaging of the Musculoskeletal System. Magn Reson Imaging Clin N Am 2024; 32:181-206. [PMID: 38007280 DOI: 10.1016/j.mric.2023.07.004] [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] [Indexed: 11/27/2023]
Abstract
Perfusion imaging is the aspect of functional imaging, which is most applicable to the musculoskeletal system. In this review, the anatomy and physiology of bone perfusion is briefly outlined as are the methods of acquiring perfusion data on MR imaging. The current clinical indications of perfusion related to the assessment of soft tissue and bone tumors, synovitis, osteoarthritis, avascular necrosis, Keinbock's disease, diabetic foot, osteochondritis dissecans, and Paget's disease of bone are reviewed. Challenges and opportunities related to perfusion imaging of the musculoskeletal system are also briefly addressed.
Collapse
Affiliation(s)
- James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong.
| | - Stefanie W Y Yip
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Rianne A van der Heijden
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Raul F Valenzuela
- Department of Musculoskeletal Imaging, The University of Texas, MD Anderson Cancer Center, USA
| | - David K W Yeung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong
| |
Collapse
|
3
|
Samet JD, Alizai H, Chalian M, Costelloe C, Deshmukh S, Kalia V, Kamel S, Mhuircheartaigh JN, Saade J, Walker E, Wessell D, Fayad LM. Society of skeletal radiology position paper - recommendations for contrast use in musculoskeletal MRI: when is non-contrast imaging enough? Skeletal Radiol 2024; 53:99-115. [PMID: 37300709 DOI: 10.1007/s00256-023-04367-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/01/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
The following White Paper will discuss the appropriateness of gadolinium administration in MRI for musculoskeletal indications. Musculoskeletal radiologists should consider the potential risks involved and practice the judicious use of intravenous contrast, restricting administration to cases where there is demonstrable added value. Specific nuances of when contrast is or is not recommended are discussed in detail and listed in table format. Briefly, contrast is recommended for bone and soft tissue lesions. For infection, contrast is reserved for chronic or complex cases. In rheumatology, contrast is recommended for early detection but not for advanced arthritis. Contrast is not recommended for sports injuries, routine MRI neurography, implants/hardware, or spine imaging, but is helpful in complex and post-operative cases.
Collapse
Affiliation(s)
- Jonathan D Samet
- Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, USA.
| | - Hamza Alizai
- CHOP Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Majid Chalian
- Department of Radiology, University of Washington, Seattle, USA
| | | | | | - Vivek Kalia
- Children's Scottish Rite Hospital, Dallas, USA
| | - Sarah Kamel
- Thomas Jefferson University Hospital, Philadelphia, USA
| | | | - Jimmy Saade
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, USA
| | - Eric Walker
- Penn State Health Milton S Hershey Medical Center, Hershey, USA
| | - Daniel Wessell
- Mayo Clinic Jacksonville Campus: Mayo Clinic in Florida, Jacksonville, USA
| | - Laura M Fayad
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, USA.
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Chan SS, Coblentz A, Bhatia A, Kaste SC, Mhlanga J, Parisi MT, Thacker P, Voss SD, Weidman EK, Siegel MJ. Imaging of pediatric hematopoietic stem cell transplant recipients: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e30013. [PMID: 36546505 PMCID: PMC10644273 DOI: 10.1002/pbc.30013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/28/2022] [Accepted: 09/05/2022] [Indexed: 12/24/2022]
Abstract
Imaging in hematopoietic stem cell transplantation patients is not targeted at evaluating the transplant per se. Rather, imaging is largely confined to evaluating peri-procedural and post-procedural complications. Alternatively, imaging may be performed to establish a baseline study for comparison should the patient develop certain post-procedural complications. This article looks to describe the various imaging modalities available with recommendations for which imaging study should be performed in specific complications. We also provide select imaging protocols for different indications and modalities for the purpose of establishing a set minimal standard for imaging in these complex patients.
Collapse
Affiliation(s)
- Sherwin S Chan
- Department of Radiology, Children’s Mercy Kansas City, Kansas City, MO; Department of Radiology, University of Missouri at Kansas City School of Medicine, Kansas City, MO
| | - Ailish Coblentz
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Aashim Bhatia
- Department of Radiology, Division of Neuroradiology Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sue C. Kaste
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
| | - Joyce Mhlanga
- Department of Radiology, Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Marguerite T. Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA
| | | | - Stephan D. Voss
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA. 02115
| | - Elizabeth K. Weidman
- Department of Radiology, Weill Cornell Medicine – New York Presbyterian Hospital, New York, NY
| | - Marilyn J Siegel
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
| |
Collapse
|
6
|
Gondim Teixeira PA, Dubois L, Hossu G, Gillet R, Badr S, Cotten A, Blum A. Quantitative dynamic contrast-enhanced MRI of bone marrow perfusion at the proximal femur: influence of femoral head osteonecrosis risk factor and overt osteonecrosis. Eur Radiol 2023; 33:2340-2349. [PMID: 36394602 DOI: 10.1007/s00330-022-09250-z] [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: 06/22/2022] [Revised: 09/23/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the MRI perfusion changes in patients with risk factors for osteonecrosis and normally appearing femoral heads prior to overt femoral head osteonecrosis. METHODS Fifty-eight patients (105 hips) were prospectively included in this ethics committee-approved study. There were 46 hips with no image anomalies and no risk factors for osteonecrosis of the femoral head (ONFH) risk factors, 38 with ONFH risk factors and no image abnormalities, and 21 with overt ONFH. All patients underwent DCE-MRI. Semi-quantitative (peak enhancement [PE], area under the curve [AUC], time to maximum enhancement [TME]) and quantitative perfusion parameters (volume plasma, KTRANS, and KEP) were calculated. Excessive alcohol consumption, corticosteroid use, and trauma were considered major risk factors for osteonecrosis of the femoral head. RESULTS Measured at the femoral neck and compared to the healthy hips without OFNH risk factors, PE was significantly lower in the hips of patients with OFNH risk factors. Moreover, the difference was greater in females with risk factors, who presented significantly lower PE values (p = 0.0096). A PE threshold of 1.4% yielded a 92% sensitivity and 54% specificity for the presence of associated ONFH risk factors. The hips with overt OFNH compared to those with normally appearing showed an increase of PE of 45% in the neck (p < 0.014). Various epiphyseal femoral head perfusion parameters (PE, TME, AUC, and Ktrans) presented statistically significant differences in hips with ONFH and those without (p < 0.0001). CONCLUSION DCE-MRI can identify perfusion marrow changes related to the presence of ONFH risk factors and adjacent to osteonecrosis areas. KEY POINTS • Bone marrow perfusion changes may occur prior to overt ONFH and extend beyond the osteonecrosis area to the entire femoral head and neck. • Peak enhancement values were significantly reduced in patients with ONFH risk factors, compared to those without. • The presence of ONFH led to a significant increase in marrow perfusion adjacent to the osteonecrosis area.
Collapse
Affiliation(s)
- Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France. .,Université de Lorraine, Inserm, IADI, F-54000, Nancy, France.
| | - Lauriane Dubois
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
| | - Gabriela Hossu
- Université de Lorraine, Inserm, IADI, F-54000, Nancy, France
| | - Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
| | - Sammy Badr
- CHU Lille, Department of Radiology and Musculoskeletal Imaging, Centre de Consultations et Imagerie de l'Appareil Locomoteur, F-59000, Lille, France
| | - Anne Cotten
- CHU Lille, Department of Radiology and Musculoskeletal Imaging, Centre de Consultations et Imagerie de l'Appareil Locomoteur, F-59000, Lille, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
| |
Collapse
|
7
|
Ha AS, Chang EY, Bartolotta RJ, Bucknor MD, Chen KC, Ellis HB, Flug J, Leschied JR, Ross AB, Sharma A, Thomas JM, Beaman FD. ACR Appropriateness Criteria® Osteonecrosis: 2022 Update. J Am Coll Radiol 2022; 19:S409-S416. [PMID: 36436966 DOI: 10.1016/j.jacr.2022.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Osteonecrosis is defined as bone death due to inadequate vascular supply. It is sometimes also called "avascular necrosis" and "aseptic necrosis" when involving epiphysis, or "bone infarct" when involving metadiaphysis. Common sites include femoral head, humeral head, tibial metadiaphysis, femoral metadiaphysis, scaphoid, lunate, and talus. Osteonecrosis is thought to be a common condition most commonly affecting adults in third to fifth decades of life. Risk factors for osteonecrosis are numerous and include trauma, corticosteroid therapy, alcohol use, HIV, lymphoma/leukemia, blood dyscrasias, chemotherapy, radiation therapy, Gaucher disease, and Caisson disease. Epiphyseal osteonecrosis can lead to subchondral fracture and secondary osteoarthritis whereas metadiaphyseal cases do not, likely explaining their lack of long-term sequelae. Early diagnosis of osteonecrosis is important: 1) to exclude other causes of patient's pain and 2) to allow for possible early surgical prevention to prevent articular collapse and need for joint replacements. Imaging is also important for preoperative planning. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
- Alice S Ha
- Panel Vice-Chair, University of Washington, Seattle, Washington.
| | - Eric Y Chang
- Panel Chair, VA San Diego Healthcare System, San Diego, California
| | - Roger J Bartolotta
- Division Chief, Musculoskeletal Imaging, Weill Cornell Medical College, New York, New York
| | - Matthew D Bucknor
- Associate Chair, Department of Radiology, University of California, San Francisco, San Francisco, California
| | - Karen C Chen
- Musculoskeletal Radiology Section Chief, VA San Diego Healthcare System, San Diego, California
| | - Henry B Ellis
- Medical Director, Clinical Research, Texas Scottish Rite Hospital for Children, Dallas, Texas; American Academy of Orthopaedic Surgeons; Board of Directors, Pediatric Research in Sports Medicine; Board of Directors, Texas Orthopaedic Association; Council of Delegates, Texas Representative, AAOS
| | - Jonathan Flug
- Committee Chair, Radiology Quality Oversight, Mayo Clinic Arizona, Phoenix, Arizona
| | - Jessica R Leschied
- Committee on Emergency Radiology-GSER, Henry Ford Health System, Detroit, Michigan
| | - Andrew B Ross
- University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - Akash Sharma
- Chair, Research Committee, Radiology and Chair, PET-MRI Workgroup, Mayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging
| | - Jonelle M Thomas
- Vice-Chair, Clinical Affairs and Director, Radiology Informatics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | |
Collapse
|
8
|
Klontzas ME, Stathis I, Spanakis K, Zibis AH, Marias K, Karantanas AH. Deep Learning for the Differential Diagnosis between Transient Osteoporosis and Avascular Necrosis of the Hip. Diagnostics (Basel) 2022; 12:diagnostics12081870. [PMID: 36010220 PMCID: PMC9406993 DOI: 10.3390/diagnostics12081870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
Differential diagnosis between avascular necrosis (AVN) and transient osteoporosis of the hip (TOH) can be complicated even for experienced MSK radiologists. Our study attempted to use MR images in order to develop a deep learning methodology with the use of transfer learning and a convolutional neural network (CNN) ensemble, for the accurate differentiation between the two diseases. An augmented dataset of 210 hips with TOH and 210 hips with AVN was used to finetune three ImageNet-trained CNNs (VGG-16, InceptionResNetV2, and InceptionV3). An ensemble decision was reached in a hard-voting manner by selecting the outcome voted by at least two of the CNNs. Inception-ResNet-V2 achieved the highest AUC (97.62%) similar to the model ensemble, followed by InceptionV3 (AUC of 96.82%) and VGG-16 (AUC 96.03%). Precision for the diagnosis of AVN and recall for the detection of TOH were higher in the model ensemble compared to Inception-ResNet-V2. Ensemble performance was significantly higher than that of an MSK radiologist and a fellow (P < 0.001). Deep learning was highly successful in distinguishing TOH from AVN, with a potential to aid treatment decisions and lead to the avoidance of unnecessary surgery.
Collapse
Affiliation(s)
- Michail E. Klontzas
- Department of Medical Imaging, University Hospital, 71110 Heraklion, Greece or (M.E.K.); (I.S.); (K.S.)
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), 70013 Heraklion, Greece;
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), 70013 Heraklion, Greece
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, 71003 Heraklion, Greece
| | - Ioannis Stathis
- Department of Medical Imaging, University Hospital, 71110 Heraklion, Greece or (M.E.K.); (I.S.); (K.S.)
| | - Konstantinos Spanakis
- Department of Medical Imaging, University Hospital, 71110 Heraklion, Greece or (M.E.K.); (I.S.); (K.S.)
| | - Aristeidis H. Zibis
- Department of Anatomy, Medical School, University of Thessaly, 41334 Larissa, Greece;
| | - Kostas Marias
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), 70013 Heraklion, Greece;
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), 70013 Heraklion, Greece
- Department of Electrical & Computer Engineering, Hellenic Mediterranean University, 71004 Heraklion, Greece
| | - Apostolos H. Karantanas
- Department of Medical Imaging, University Hospital, 71110 Heraklion, Greece or (M.E.K.); (I.S.); (K.S.)
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), 70013 Heraklion, Greece;
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), 70013 Heraklion, Greece
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, 71003 Heraklion, Greece
- Correspondence: or
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Passon T, Germann C, Fritz B, Pfirrmann C, Sutter R. Bone marrow edema of the medioplantar talar head is associated with severe ligamentous injury in ankle sprain. Skeletal Radiol 2022; 51:1937-1946. [PMID: 35359219 PMCID: PMC9381494 DOI: 10.1007/s00256-022-04043-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the predictive value of talar head edema (THE) in acute ankle sprain for the presence of concomitant ligament injuries. METHODS This retrospective study was approved by the ethics committee and informed consent was obtained. One hundred patients (mean age: 37 years ± 14 [standard deviation], range 13-77 years) with MRI of the ankle after acute trauma were included. The cohort in this matched-pair study consisted of 50 patients with THE (group 1) and 50 patients without THE (group 2). Two readers independently evaluated presence and size of bone marrow edema of the talus head and injuries of the lateral, medial, talonavicular, and spring ligament complex. Statistics included intraclass correlation coefficient (ICC) and Kappa statistics as well as parametric and non-parametric tests. RESULTS On average, patients with THE demonstrated significantly more ligament injuries in comparison to patients without THE (3.7 vs. 1.3, p ≤ 0.01). Also, in patients with THE, the number of injured ligaments was significantly higher at the lateral (p = 0.03), medial (p ≤ 0.01), and talonavicular (p ≤ 0.01) compartment in comparison to patients without THE. The most frequently injured ligaments in patients with THE were the anterior talofibular ligament (60%) and the anterior tibiotalar ligament (42%). There was no significant correlation between edema size and the number of injured ligaments or compartments (p = 0.5). CONCLUSION THE is associated with more extensive ligamentous ankle injury, in particular to the medial and lateral collateral ligament complex, and therefore indicative of severe ankle trauma.
Collapse
Affiliation(s)
- Tina Passon
- grid.412373.00000 0004 0518 9682Department of Radiology, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - Christoph Germann
- grid.412373.00000 0004 0518 9682Department of Radiology, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - Benjamin Fritz
- grid.412373.00000 0004 0518 9682Department of Radiology, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - Christian Pfirrmann
- grid.412373.00000 0004 0518 9682Department of Radiology, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - Reto Sutter
- grid.412373.00000 0004 0518 9682Department of Radiology, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
| |
Collapse
|
11
|
Radiomics and Machine Learning Can Differentiate Transient Osteoporosis from Avascular Necrosis of the Hip. Diagnostics (Basel) 2021; 11:diagnostics11091686. [PMID: 34574027 PMCID: PMC8468167 DOI: 10.3390/diagnostics11091686] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023] Open
Abstract
Differentiation between transient osteoporosis (TOH) and avascular necrosis (AVN) of the hip is a longstanding challenge in musculoskeletal radiology. The purpose of this study was to utilize MRI-based radiomics and machine learning (ML) for accurate differentiation between the two entities. A total of 109 hips with TOH and 104 hips with AVN were retrospectively included. Femoral heads and necks with segmented radiomics features were extracted. Three ML classifiers (XGboost, CatBoost and SVM) using 38 relevant radiomics features were trained on 70% and validated on 30% of the dataset. ML performance was compared to two musculoskeletal radiologists, a general radiologist and two radiology residents. XGboost achieved the best performance with an area under the curve (AUC) of 93.7% (95% CI from 87.7 to 99.8%) among ML models. MSK radiologists achieved an AUC of 90.6% (95% CI from 86.7% to 94.5%) and 88.3% (95% CI from 84% to 92.7%), respectively, similar to residents. The general radiologist achieved an AUC of 84.5% (95% CI from 80% to 89%), significantly lower than of XGboost (p = 0.017). In conclusion, radiomics-based ML achieved a performance similar to MSK radiologists and significantly higher compared to general radiologists in differentiating between TOH and AVN.
Collapse
|
12
|
Siu RWH, Liu JHP, Man GCW, Ong MTY, Yung PSH. Avascular necrosis of the first metatarsal head in a young female adult: A case report and review of literature. World J Clin Cases 2021; 9:7445-7452. [PMID: 34616810 PMCID: PMC8464454 DOI: 10.12998/wjcc.v9.i25.7445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/19/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This case study describes an atypical presentation of avascular necrosis (AVN) of the first metatarsal head, which is largely unfounded in the literature.
CASE SUMMARY A healthy 24-year-old female initially presented with pain at the first metatarsophalangeal joint (MTPJ) and was diagnosed with AVN by physical examination and magnetic resonance imaging. The patient demonstrated atypically poor progress in recovery, despite being in otherwise good health and being of young age, with no history of corticosteroid or alcohol use. The patient also did not have any history or clinical features of autoimmune disease or vasculitis, such as systemic lupus erythematosus. The patient was managed with conservative treatment for 18 mo, which allowed for gradual return of full range of motion of the first MTPJ and subsiding pain, permitting the patient to return to high-intensity sports training and full weight-bearing. Throughout her recovery, many differential diagnoses were ruled out through specific investigations leading to further reinforcement of the diagnosis of AVN of the 1st metatarsal head.
CONCLUSION Atypical AVN may occur with no predisposing risk factors. Treatment is mainly conservative, with unclear guidelines in literature on management.
Collapse
Affiliation(s)
- Ronald Wing Hei Siu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Jeremy Ho Pak Liu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Gene Chi Wai Man
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Michael Tim Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
- The Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Patrick Shu Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
- The Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| |
Collapse
|
13
|
Geith T, Stellwag AC, E Müller P, Reiser M, Baur-Melnyk A. Is bone marrow edema syndrome a precursor of hip or knee osteonecrosis? Results of 49 patients and review of the literature. ACTA ACUST UNITED AC 2021; 26:355-362. [PMID: 32558648 DOI: 10.5152/dir.2020.19188] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Diagnosis of bone marrow edema syndrome (BMES) can be challenging. There is sometimes uncertainty about the correct diagnosis of BMES on morphologic magnetic resonance imaging (MRI), since subchondral findings like lines and spots can be misinterpreted as "beginning" or "possible" avascular osteonecrosis (AVN). The aim of our study was to systematically assess the temporal course of BMES from first diagnosis on MRI until the end of clinical symptoms and the full disappearance of bone marrow edema (BME) to determine whether subchondral lines and spots detected in these patients can develop into osteonecrosis. METHODS In a combined retrospective and prospective study, we retrieved serial MRI scans of hips and knees with BME from the hospital database. According to clinical and imaging data, all patients with degenerative, infectious/inflammatory, rheumatic, neoplastic conditions and those showing typical osteonecrosis were excluded. We collected all available MRI examinations from first detection of BME until its disappearance. In case edema had not fully resolved in the last available MRI scan, we performed an MRI with an additional dynamic contrast-enhanced (DCE-MRI) sequence. For each MRI scan, we recorded the severity of edema, the presence of subchondral hypointense lines and the presence of subchondral focal hypointense zones on T1-weighted images by two independent readers. The DCE-MRI scans were used to calculate parameter maps to assess the perfusion characteristics. RESULTS The study comprised 49 patients aged 22-71 years. In total, 171 morphologic and 5 DCE-MRI scans were evaluated. In 44 patients (89.8%), the BMES completely healed without remnants. In 18 of 49 patients (36.7%), a subchondral line was present in the first MRI exam. Nine patients (18.4%) developed a subchondral line within 1-5 months after the first MRI. In total, 27 out of 49 patients (55.1%) had subchondral lines (12 knees, 15 hips) during the timeframe of the study. All subchondral lines disappeared in the timeframe of the study. Subchondral focal hypointense zones were present in 14 out of 49 patients (28.6%): in 9 cases, subchondral focal hypointense zones disappeared after a median of 5.5 months (range, 1-85 months), while in 5 cases, subchondral focal lesions persisted until the end of the study (up to more than 85 months) without edema in the surrounding bone. All persisting subchondral focal lesions were hyperperfused. These 5 patients had associated meniscal lesions. CONCLUSION Our study shows that subchondral lines and spots found in patients with BMES do not develop into AVN. Subchondral lines, which resemble subchondral insufficiency fractures, are associated with BMES. Subchondral focal T1-hypointense zones do not represent AVN; most probably these areas represent reparative processes within the subchondral bone, where tensile and shear force overload is present due to altered biomechanics.
Collapse
Affiliation(s)
- Tobias Geith
- Department of Interventional Radiology, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | - Ann-Cathrin Stellwag
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Maximilian Reiser
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andrea Baur-Melnyk
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| |
Collapse
|
14
|
Cultot A, Norberciak L, Coursier R, Putman S, Cortet B, Paccou J, Pascart T, Budzik JF. BONE PERFUSION AND ADIPOSITY BEYOND THE NECROTIC ZONE IN FEMORAL HEAD OSTEONECROSIS: A QUANTITATIVE MRI STUDY. Eur J Radiol 2020; 131:109206. [PMID: 32871293 DOI: 10.1016/j.ejrad.2020.109206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/29/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe bone perfusion and adiposity beyond the necrotic zone with quantitative MRI techniques in osteonecrosis of the femoral head (ONFH). METHOD In this cross-sectional multicentre study, we recruited patients suffering from late-stage ONFH or hip osteoarthritis. Hip MRI included quantitative MRI sequences: chemical-shift imaging and dynamic contrast-enhanced MRI. We drew regions of interest inside the necrotic zone (inner necrosis and its border) and outside (femoral head, neck and greater trochanter) in ONFH. In the control group, regions of interest were drawn in the femoral head, femoral neck and the greater trochanter. For each region of interest, we measured fat fraction, and calculated semi-quantitative (area under the curve, initial slope) and pharmacokinetic perfusion parameters (Ktrans and Kep). RESULTS Thirty-two male adults (mean age 58 ± 9 years, range 38-74 years) were included. Sixteen patients formed the ONFH group and fifteen the control group; one was excluded. In the normal-appearing non-necrotic part of the femoral head, fat fraction was not significantly different in comparison with controls (p = 1), but Ktrans was significantly lower than in controls (0.012 ± 0.018 vs. 0.027 ± 0.045; p = 0.05). This perfusion parameter reflects exchanges between blood microvessels and bone marrow. CONCLUSIONS Our results question the concept of adipose toxicity on the macroscopic scale, and bring up the concept of regional ischemic penumbra that goes beyond the visible necrotic zone. Further studies are required to test these hypotheses in larger populations and earlier disease states.
Collapse
Affiliation(s)
- Aurélie Cultot
- Diagnostic and interventional imaging department, Lille Catholic University Hospital Group, Lille, France.
| | - Laurène Norberciak
- Biostatistics, Clinical research department, Lille Catholic University Hospital Group, Lille, France.
| | - Raphaël Coursier
- Orthopaedic surgery department, Lille Catholic University Hospital Group, Lille, France.
| | - Sophie Putman
- Orthopaedic surgery department, Roger Salengro hospital, Lille University Hospital, France.
| | - Bernard Cortet
- Rheumatology department, Roger Salengro hospital, Lille University Hospital, France; UR 4490 - PMOI - PMOI (Physiopathologie des Maladies Osseuses Inflammatoires)/MABLab (Marrow Adiposity and Bone Laboratory), Lille, France.
| | - Julien Paccou
- Rheumatology department, Roger Salengro hospital, Lille University Hospital, France; UR 4490 - PMOI - PMOI (Physiopathologie des Maladies Osseuses Inflammatoires)/MABLab (Marrow Adiposity and Bone Laboratory), Lille, France.
| | - Tristan Pascart
- UR 4490 - PMOI - PMOI (Physiopathologie des Maladies Osseuses Inflammatoires)/MABLab (Marrow Adiposity and Bone Laboratory), Lille, France; Rheumatology department, Lille Catholic University Hospital Group, Lille, France.
| | - Jean-François Budzik
- Diagnostic and interventional imaging department, Lille Catholic University Hospital Group, Lille, France; UR 4490 - PMOI - PMOI (Physiopathologie des Maladies Osseuses Inflammatoires)/MABLab (Marrow Adiposity and Bone Laboratory), Lille, France.
| |
Collapse
|
15
|
Chang C, Greenspan A, Gershwin ME. The pathogenesis, diagnosis and clinical manifestations of steroid-induced osteonecrosis. J Autoimmun 2020; 110:102460. [PMID: 32307211 DOI: 10.1016/j.jaut.2020.102460] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/28/2022]
Abstract
Corticosteroid associated osteonecrosis is bone death resulting from the use of chronic glucocorticoids and most commonly affects the femoral head, although the bones such as around knee joint, wrist joint and ankle joint can be affected. The pathogenesis is likely multifactorial, with genetic and environmental factors playing a role. Epigenetics may be the mechanism by which environment exerts it effects. In spite of recent discoveries, the exact pathogenesis of corticosteroid associated osteonecrosis is unknown. Over the past few years, more miRNA's have been found to be associated with osteonecrosis. The older mechanisms such as a coagulopathy, abnormalities in apoptosis and lipid metabolism dysfunction are still believed to play a role. The role of inflammatory pathways including the PDK1/AKT/mTOR signaling pathway, the PERK and Parkin pathways have been increasingly recognized as playing a mechanistic role. Histological damage to the joint can occur before the presence of symptoms. The most common symptoms are pain and an inability to bear weight. Differential diagnosis includes infection, bone marrow edema syndrome or subchondral fracture. Early detection is important for successful management of the condition. MRI is the best radiologic technique to diagnosis femoral head osteonecrosis. Multiple staging systems for osteonecrosis have been used over the years, including the Ficat and Arlet system and the Steinberg criteria. The later stages of these staging systems are irreversible. Both non-surgical (conservative) and surgical modes of therapy are used in the treatment of osteonecrosis.
Collapse
Affiliation(s)
- Christopher Chang
- Division of Pediatric Immunology and Allergy, Joe DiMaggio Children's Hospital, Hollywood, FL, 33021, USA; Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, Davis, CA, 95616, USA.
| | - Adam Greenspan
- Department of Radiology, University of California, Davis School of Medicine, Sacramento, CA, 95817, USA
| | - M Eric Gershwin
- Division of Pediatric Immunology and Allergy, Joe DiMaggio Children's Hospital, Hollywood, FL, 33021, USA.
| |
Collapse
|
16
|
Baumbach SF, Pfahler V, Bechtold-Dalla Pozza S, Feist-Pagenstert I, Fürmetz J, Baur-Melnyk A, Stumpf UC, Saller MM, Straube A, Schmidmaier R, Leipe J. How We Manage Bone Marrow Edema-An Interdisciplinary Approach. J Clin Med 2020; 9:jcm9020551. [PMID: 32085459 PMCID: PMC7074543 DOI: 10.3390/jcm9020551] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/21/2020] [Accepted: 02/03/2020] [Indexed: 12/11/2022] Open
Abstract
Bone marrow edema (BME) is a descriptive term for a common finding in magnetic resonance imaging (MRI). Although pain is the major symptom, BME differs in terms of its causal mechanisms, underlying disease, as well as treatment and prognosis. This complexity together with the lack of evidence-based guidelines, frequently makes the identification of underlying conditions and its management a major challenge. Unnecessary multiple consultations and delays in diagnosis as well as therapy indicate a need for interdisciplinary clinical recommendations. Therefore, an interdisciplinary task force was set up within our large osteology center consisting of specialists from internal medicine, endocrinology/diabetology, hematology/oncology, orthopedics, pediatrics, physical medicine, radiology, rheumatology, and trauma surgery to develop a consenus paper. After review of literature, review of practical experiences (expert opinion), and determination of consensus findings, an overview and an algorithm were developed with concise summaries of relevant aspects of the respective underlying disease including diagnostic measures, clinical features, differential diagnosis and treatment of BME. Together, our single-center consensus review on the management of BME may help improve the quality of care for these patients.
Collapse
Affiliation(s)
- Sebastian F. Baumbach
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Vanessa Pfahler
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Susanne Bechtold-Dalla Pozza
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of Pediatric Endocrinology and Diabetology, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstraße 4, 80337 Munich, Germany
| | - Isa Feist-Pagenstert
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Julian Fürmetz
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Andrea Baur-Melnyk
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Ulla C. Stumpf
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Maximilian M. Saller
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
- Experimental Surgery and Regenerative Medicine (ExperiMed), Department of General, Trauma and Reconstructive Surgery, Ludwig-Maximilians-University (LMU), Fraunhoferstraße 20, 82152 Planegg-Martinsried, Germany
| | - Andreas Straube
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Ralf Schmidmaier
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department for Endocrinology and Diabetology, Department of Internal Medicine IV, Ludwig-Maximilians-University Munich, Ziemssenstraße 1, 80336 Munich, Germany
- Correspondence: (R.S.); (J.L.); Tel.: +49-89-4400-52101 (R.S.); Fax: +49-89-4400-54410 (R.S.)
| | - Jan Leipe
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig-Maximilians-University Munich, Ziemssenstraße 1, 80336 Munich, Germany
- Division of Rheumatology, Department of Medicine V, University Hospital Mannheim, Medical Faculty Mannheim of the University Heidelberg, Ludolf-Krehl-Straße 13–17, 68167 Mannheim, Germany
- Correspondence: (R.S.); (J.L.); Tel.: +49-89-4400-52101 (R.S.); Fax: +49-89-4400-54410 (R.S.)
| |
Collapse
|
17
|
Zippelius T, Matziolis G, Röhner E, Windisch C, Lindemann C, Strube P. Psychological distress and health-related quality of life in patients with bone marrow edema syndrome. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:552. [PMID: 31807533 DOI: 10.21037/atm.2019.09.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The aim of the study was to investigate psychological distress and health-related quality of life (HrQoL) in patients with bone marrow edema syndrome (BMES) of the hip or knee joint. METHODS This retrospective study included patients with the diagnosis BMES treated in the period 2016-2017. As well as analyzing the epidemiological data (age, sex, vascular disease, hypertension, etc.), we used the Hospital Anxiety and Depression Scale (HADS) to document anxiety and depression and the five-level version of the EuroQol Group's EQ-5D instrument (EQ-5D-5L) to assess HrQoL and compared it to historical controls of the healthy population. RESULTS The study group comprised 56 patients (26 females, 30 males) with a mean age of 55.8 (range, 15-84) years. HADS: there was no difference between the study and control cohorts in the rates of anxiety (P=0.595) or depression (P=0.241). EQ-5D-5L: the HrQoL was significantly lower in the patients with BMES than in the healthy controls both for parameters of the EQ-5D-5L index and in the various age groups. No difference in HrQoL was seen between BMES of the hip and the knee or among the different radiological stages of BMES. CONCLUSIONS The patients with BMES displayed a clear reduction in HrQoL, but this was not associated with psychological distress with regard to significant anxiety and depression. Patients with BMES and a high score for anxiety and depression are at great risk of chronic pain, and we recommend they should receive psychological counseling.
Collapse
Affiliation(s)
- Timo Zippelius
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
| | - Eric Röhner
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
| | - Christoph Windisch
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany.,Orthopaedic Department, Helios Klinik Blankenhain, Blankenhain, Germany
| | - Chris Lindemann
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
| | - Patrick Strube
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
| |
Collapse
|
18
|
Grieser T. [Differential diagnoses of osteonecrosis of large joints]. DER ORTHOPADE 2019; 48:975-990. [PMID: 31642951 DOI: 10.1007/s00132-019-03829-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Subchondral insufficiency fractures and idiopathic bone marrow edema syndrome are the most important differential diagnoses to be distinguished from osteonecrosis because they have a deviating and as a rule more favorable prognosis and also different therapeutic strategies. Osteochondritis dissecans represents a different entity in many respects, which should not be confused or unified with osteonecrosis. Based on recent knowledge intractable subchondral insufficiency fractures may be the underlying cause of rapidly destructive osteoarthritis at least in some cases. Septic involvement of bone and joints can eo ipso cause severe articular damage due to direct destruction but also secondary to septic vascular occlusion resulting in septic osteonecrosis. Whereas bone marrow infiltrating systemic diseases and the therapeutic regimens can lead to osteonecrosis, bone tumors or tumor-like diseases, rarely pose a differential diagnostic problem with respect to the differentiation from osteonecrosis.
Collapse
Affiliation(s)
- T Grieser
- Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.
| |
Collapse
|
19
|
Abstract
Avascular femoral head necrosis (AVNFH) is difficult to diagnose on plain radiographs in early stages of the disease. Since early stages are often clinically occult, early use of MRI is required to rule out or verify a clinical suspicion. MRI and, in some cases, additional CT are the cornerstones of AVNFH diagnosis and classification. Anteroposterior radiography of the pelvis and a second plane of the involved hip remains the primary basic imaging examination for follow-up and to rule out other pathologies. Correct staging of adult disease has been shown to be the key factor in therapeutic decision-making. According to the German S3 guideline on diagnosis and treatment of AVNFH, use of the ARCO classification is recommended for staging. This paper presents the current status of diagnosis and classification of adult AVNFH. The criteria for ascribing disease to a particular ARCO stage are defined and critically discussed.
Collapse
|
20
|
Stumpp P, Roth A. [Bone marrow edema-differential diagnosis of the femoral head necrosis]. DER ORTHOPADE 2019; 47:717-721. [PMID: 30128596 DOI: 10.1007/s00132-018-3621-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In patients with hip pain, clinical examination is of only restricted value in the differential diagnosis. Besides a patient's age, their medical history is often helpful in finding the correct diagnosis. Additionally, imaging can give valuable hints for excluding or validating a differential diagnosis. Nowadays, magnetic resonance imaging (MRI) is often used as a primary imaging modality in Germany. These MRIs show a bone marrow edema (BME) in many different pathologies. BME occurs in transitory bone marrow edema and outside of the atraumatic femoral head necrosis, concomitant with coxarthrosis, arthritis, herniation pit, and osteoid osteoma, amongst other conditions. This article describes several frequent differential diagnoses and gives hints on how to find the correct diagnosis.
Collapse
Affiliation(s)
- P Stumpp
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Deutschland.
| | - A Roth
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie Bereich Endoprothetik/Orthopädie, Universitätsklinik Leipzig AöR, Leipzig, Deutschland
| |
Collapse
|
21
|
Differenzialdiagnosen der Osteonekrose großer Gelenke. Radiologe 2019; 59:755-770. [DOI: 10.1007/s00117-019-0566-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
Abstract
OBJECTIVE. The purpose of this article is to summarize the nomenclature of nonneoplastic conditions affecting subchondral bone through a review of the medical literature and expert opinion of the Society of Skeletal Radiology Subchondral Bone Nomenclature Committee. CONCLUSION. This consensus statement summarizes current understanding of the pathophysiologic characteristics and imaging findings of subchondral nonneoplastic bone lesions and proposes nomenclature to improve effective communication across clinical specialties and help avoid diagnostic errors that could affect patient care.
Collapse
|
23
|
Hynes JP, Hughes N, Cunningham P, Kavanagh EC, Eustace SJ. Whole‐body MRI of bone marrow: A review. J Magn Reson Imaging 2019; 50:1687-1701. [DOI: 10.1002/jmri.26759] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 12/16/2022] Open
Affiliation(s)
- John P. Hynes
- Mater Misericordiae University Hospital Dublin Republic of Ireland
- National Orthopaedic Hospital of Ireland Cappagh, Dublin Republic of Ireland
| | - Nicola Hughes
- National Orthopaedic Hospital of Ireland Cappagh, Dublin Republic of Ireland
| | | | - Eoin C. Kavanagh
- Mater Misericordiae University Hospital Dublin Republic of Ireland
- National Orthopaedic Hospital of Ireland Cappagh, Dublin Republic of Ireland
| | - Stephen J. Eustace
- Mater Misericordiae University Hospital Dublin Republic of Ireland
- National Orthopaedic Hospital of Ireland Cappagh, Dublin Republic of Ireland
| |
Collapse
|
24
|
Zaldibar Barinaga MB, Reoyo Díez JI. [Idiopathic bone marrow oedema: Outcome of 3 cases treated with denosumab]. Rehabilitacion (Madr) 2019; 53:126-130. [PMID: 31186095 DOI: 10.1016/j.rh.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/03/2018] [Accepted: 01/06/2019] [Indexed: 06/09/2023]
Abstract
Idiopathic bone marrow oedema is considered an unclarified pathophysiological entity of multifactorial origin affecting middle-aged persons; it is characterised by pain and functional limitation of the lower extremities. Characteristic findings on magnetic resonance imaging are hypointense T1 and hyperintense T2 images in the affected joints. We present 3clinical cases of BMO in men (age: 45-64 years), involving 2knees and one hip. Onset occurred with intense pain (VAS ≥ 5), with no clear cause and functional limitation with characteristic images on magnetic resonance imaging. Treatment consisted of vitamin D 20,000 IU/week orally and a single subcutaneous dose of denosumab 60mg (off label use). The patients avoided weight bearing on affected joints and conducted self-assisted exercises to maintain range of movement. Outcome was favourable with clinical and bone oedema resolution, with no notable complications. This report demonstrates that denosumab is a treatment option for the clinical/radiological resolution of bone marrow oedema and seems to shorten the clinical course of the process.
Collapse
Affiliation(s)
| | - J I Reoyo Díez
- Servicio de Rehabilitación, Hospital de Santa Marina, Bilbao (Vizcaya), España
| |
Collapse
|
25
|
Hackl W, Henninger B, Liebensteiner M, Ferlic P. Bildgebung des Knochenmarködems. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-018-0258-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
26
|
Jäger M, Dittrich F, Harren K. Das Knochenmarködem am Kniegelenk: eine diagnostische Herausforderung. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s15002-018-1272-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
27
|
Bone Marrow Edema Syndrome of the Medial Femoral Condyle Treated With Extracorporeal Shock Wave Therapy: A Clinical and MRI Retrospective Comparative Study. Arch Phys Med Rehabil 2017; 99:873-879. [PMID: 29223709 DOI: 10.1016/j.apmr.2017.10.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/26/2017] [Accepted: 10/26/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the validity of extracorporeal shock wave therapy (ESWT) in the treatment of bone marrow edema (BME) of the medial condyle of the knee. DESIGN Retrospective. SETTING Orthopedic Surgery outpatient clinic. PARTICIPANTS Symptomatic patients (N=56) affected by BME of the medial condyle of the knee. Patients were equally divided into an ESWT-treated group and a control group, which was managed conservatively. INTERVENTIONS ESWT delivery to the medial condyle of the affected knee. MAIN OUTCOME MEASURES Clinical and functional assessment of the knee was performed with the use of the clinical and functional scores of the Knee Society Score (KSS). Pain was measured with the visual analog scale (VAS). BME area was measured with magnetic resonance imaging (MRI) before treatment and at 4 months' follow-up. RESULTS Clinical evaluation of patients at final follow-up of 4 months posttreatment showed a significant improvement (P<.0001) of symptoms and knee functionality, both for range of motion and strength in both groups. VAS values were significantly improved (P<.0001) in both groups, with 3 patients in the ESWT group being pain-free (VAS=0) at 4 months' follow-up. At 4 months, MRI assessments on both sagittal and coronal views showed a significant reduction in BME in the ESWT group compared with the control group. CONCLUSIONS Our findings show that ESWT is a valid nonpharmacologic and noninvasive therapy for spontaneous BME of the medial condyle that improves the affected vascular and metabolic state present in this pathologic disorder through its metabolic mechanisms of action.
Collapse
|
28
|
Abstract
The bone marrow basically consists of red blood-forming bone marrow and yellow fat. In the skeleton, there is an age-dependent distribution of these two parts. In the context of medical interventions or therapies, bone marrow changes can occur, whereby the normal bone marrow can basically be replaced by fat, edema, or fibrosis/sclerosis. Here, specific signal intensities and patterns are shown in imaging. After irradiation therapies, edematous changes, hemorrhages, and osteoradionecroses are observed. Likewise, insufficiency fractures, impairment of the growth gaps, or the development of tumors is possible. In patients on dialysis, deposit of protein in the bone marrow is possible in the case of the so-called amyloidosis osteoarthropathy. Postoperative bone marrow edema, insufficiency fractures, or osteonecrosis can be observed after arthroscopy. Changes in the distribution of fat markers and blood-forming bone marrow can be observed after stem cell transplants. In the therapy with cortisone, insufficiency fractures and osteonecroses are possible. Depending on their effect on the hematopoietic system, chemotherapyies can first lead to edematous changes and then to fatty bone marrow, which is reversible after therapy. Angiogenesis inhibitors in combination with other chemotherapeutic agents often lead to mixed images of stimulated and fatty bone marrow.
Collapse
Affiliation(s)
- T Geith
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistraße 15, 81375, München, Deutschland.
| | - A-C Stellwag
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistraße 15, 81375, München, Deutschland
| | - A Baur-Melnyk
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistraße 15, 81375, München, Deutschland
| |
Collapse
|