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Meng Z, Xiong A, Liu M, Guo Y, Zhu X, Luo T, Tian X, Meng X, Li X, Lin X, Wang X, Qin J. Quantitative evaluation of disc degeneration using dual-energy CT: advantages of R-VH, D-VH values and the IVNCa + CT model. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2022-2030. [PMID: 38431753 DOI: 10.1007/s00586-024-08176-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 12/21/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To evaluate the correlation between dual-energy CT (DECT) virtual calcium free (VNCA), CT attenuation, the ratio and difference of VNCA to CT attenuation, and Pfirrmann grading of lumbar disc degeneration. METHODS A retrospective analysis on 135 intervertebral discs from 30 patients who underwent DECT and MR. Discs was graded using the Pfirrmann system. ROIs on the sagittal plane assessed HU value, VNCA value, Rho value, Z value, R-VH value, and D-VH value. Correlation, grade differences, and multivariate regression models were assessed. Diagnostic performance and cut-off values were determined using AUC. RESULTS VNCA (r = 0.589, P < 0.001), R-VH (r = 0.622, P < 0.001), and D-VH (r = 0.613, P < 0.001) moderately correlated with Pfirrmann grading. HU (r = 0.388, P < 0.001), Rho (r = 0.142, P = 0.102), and Z (r = -0.125, P = 0.153) showed a weak correlation. R-VH, D-VH, and VNCA had significantly higher correlation than HU. Statistically significant differences were observed in P values of VNCA, HU, R-VH, and D-VH in relative groups (P < 0.05), but not in Rho and Z values (P > 0.05). R-VH and D-VH had significant differences between Pfirrmann grades 1 and 2, and grades 2 and 3 (early stage) (P < 0.05). AUC readings of R-VH and D-VH (≥2, ≥3, ≥4) were higher. The multivariate model IVNCa + CT had the highest AUC. CONCLUSION The new quantitative indices R-VH value and D-VH value of DECT have advantages over VNCA value and HU value in evaluating early-stage disc degeneration (≥2 grades, ≥3 grades). The multivariate model IVNCa + CT has the best AUC values for evaluating disc degeneration at all stages.
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Affiliation(s)
- Zhanao Meng
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Anni Xiong
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Mengmeng Liu
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Yahao Guo
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xuan Zhu
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Tao Luo
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xiangjie Tian
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xiangbo Meng
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xiaolei Li
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xue Lin
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xiaohong Wang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China.
| | - Jie Qin
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China.
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Ooi MWX, Marzetti M, Rowbotham E, Bertham D, Robinson P. MRI findings in athletic groin pain: correlation of imaging with history and examination in symptomatic and asymptomatic athletes. Skeletal Radiol 2024:10.1007/s00256-024-04603-9. [PMID: 38302788 DOI: 10.1007/s00256-024-04603-9] [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] [Received: 10/11/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To determine differences in prevalence and diagnostic accuracy of MRI findings between asymptomatic athletes and athletes with longstanding groin pain. MATERIALS AND METHODS One hundred twenty-three adult male athletes were approached with 85 consecutive athletes recruited. Group 1 (symptomatic, n = 34) athletes referred for longstanding groin pain (insidious onset, > 3 weeks duration). Group 2 (control, n = 51) athletes referred for injuries remote from the pelvis and no groin pain in the last 12 weeks. All referrers completed a clinical examination proforma documenting absence or presence of pelvis and hip abnormality. All patients completed the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire and underwent a 3T MRI groin and hip protocol. MRIs were scored independently by two musculoskeletal radiologists blinded to clinical details. Statistical analysis was performed to evaluate associations between MRI findings, inter-reader reliability, clinical examination and HAGOS scores. RESULTS Pubic body subchondral bone oedema, capsule/aponeurosis junction tear and soft tissue oedema were more prevalent in the symptomatic group (p = 0.0003, 0.0273 and 0.0005, respectively) and in athletes with clinical abnormality at symphysis pubis, adductor insertion, rectus abdominis, psoas and inguinal canal (p = 0.0002, 0.0459 and 0.00002, respectively). Pubic body and subchondral oedema and capsule/aponeurosis tear and oedema significantly correlated with lower (worse) HAGOS scores (p = 0.004, 0.00009, 0.0004 and 0.002, respectively). Inter-reader reliability was excellent, 0.87 (range 0.58-1). Symphyseal bone spurring, disc protrusion and labral tears were highly prevalent in both groups. CONCLUSION Clinical assessment and MRI findings of pubic subchondral bone oedema and capsule/aponeurosis abnormality appear to be the strongest correlators with longstanding groin pain.
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Affiliation(s)
- Michelle Wei Xin Ooi
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Matthew Marzetti
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Emma Rowbotham
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dominic Bertham
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip Robinson
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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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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Di Martino A, Brunello M, Villari E, Cataldi P, D'Agostino C, Faldini C. Bone marrow edema of the hip: a narrative review. Arch Orthop Trauma Surg 2023; 143:6901-6917. [PMID: 37378892 DOI: 10.1007/s00402-023-04961-4] [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: 03/22/2023] [Accepted: 06/22/2023] [Indexed: 06/29/2023]
Abstract
Bone marrow edema (BME) of the hip is a radiological-clinical condition with symptoms ranging from asymptomatic to severe, and it is characterized by increased interstitial fluid within the bone marrow, usually at the femur. Depending on the etiology it can be classified as primary or secondary. The primary cause of BME is unknown, while the secondary forms include traumatic, degenerative, inflammatory, vascular, infectious, metabolic, iatrogenic, and neoplastic etiologies. BME could be classified as reversible or progressive. Reversible forms include transient BME syndrome and regional migratory BME syndrome. Progressive forms include avascular necrosis of the femoral head (AVNH), subchondral insufficiency fracture, and hip degenerative arthritis. The diagnosis can be difficult, because at the beginning, the outbreak of hip pain, typically acute and disabling without any prior trauma or exceptional physical activity, is poorly supported by radiographic findings. MRI is the gold standard, and it shows an area of intermediate signal on T1-weighted MRI scans and a high signal on T2-weighted scans, usually lacking sharps margins. In the reversible form, BME is typically self-limiting, and it can be managed conservatively by means of pharmacological and physical therapy. Surgery is generally required for progressive forms in patients who failed non-operative treatment, and it ranges from femoral head and neck core decompression to total hip arthroplasty.
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Affiliation(s)
- Alberto Di Martino
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy.
| | - Matteo Brunello
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - Eleonora Villari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - Piergiorgio Cataldi
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - Claudio D'Agostino
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
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Schierenbeck M, Grözinger M, Reichardt B, Jansen O, Kauczor HU, Campbell GM, Sedaghat S. Detecting Bone Marrow Edema of the Extremities on Spectral Computed Tomography Using a Three-Material Decomposition. Diagnostics (Basel) 2023; 13:2745. [PMID: 37685282 PMCID: PMC10486895 DOI: 10.3390/diagnostics13172745] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Detecting bone marrow edema (BME) as a sign of acute fractures is challenging on conventional computed tomography (CT). This study evaluated the diagnostic performance of a three-material decomposition (TMD) approach for detecting traumatic BME of the extremities on spectral computed tomography (SCT). METHODS This retrospective diagnostic study included 81 bone compartments with and 80 without BME. A TMD application to visualize BME was developed in collaboration with Philips Healthcare. The following bone compartments were included: distal radius, proximal femur, proximal tibia, distal tibia and fibula, and long bone diaphysis. Two blinded radiologists reviewed each case independently in random order for the presence or absence of BME. RESULTS The interrater reliability was 0.84 (p < 0.001). The different bone compartments showed sensitivities of 86.7% to 93.8%, specificities of 84.2% to 94.1%, positive predictive values of 82.4% to 94.7%, negative predictive values of 87.5% to 93.3%, and area under the curve (AUC) values of 85.7% to 93.1%. The distal radius showed the highest sensitivity and the proximal femur showed the lowest sensitivity, while the proximal femur presented the highest specificity and the distal tibia presented the lowest specificity. CONCLUSIONS Our TMD approach provides high diagnostic performance for detecting BME of the extremities. Therefore, this approach could be used routinely in the emergency setting.
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Affiliation(s)
- Marie Schierenbeck
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, 24105 Kiel, Germany
| | - Martin Grözinger
- German Cancer Research Center, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Benjamin Reichardt
- Department of Interventional Radiology and Neuroradiology, Klinikum Hochsauerland, 59821 Arnsberg, Germany
| | - Olav Jansen
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, 24105 Kiel, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | | | - Sam Sedaghat
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
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Navas A, Kassarjian A. Bone Marrow Lesions in Athletic Stress Injuries: An Overview. Semin Musculoskelet Radiol 2023; 27:54-72. [PMID: 36868245 DOI: 10.1055/s-0043-1761613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
This article discusses the presumed pathophysiology of osseous sport-related stress changes, the optimal imaging strategy for detecting the lesions, and the progression of the lesions as seen on magnetic resonance imaging. It also describes some of the most common stress-related injuries in athletes by anatomical location and introduces some new concepts in the field.
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Affiliation(s)
- Ana Navas
- Department of Radiology, Division of Musculoskeletal Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Radiology, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
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Iolascon G, Tarantino U, Moretti A. Challenges and Solutions for Musculoskeletal Disorders in Athletes. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:80. [PMID: 35056388 PMCID: PMC8781726 DOI: 10.3390/medicina58010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 02/05/2023]
Abstract
The etymology of the word "athlete" derives from the ancient Greek ἀθλητής (athletés, from âthlos that is, fight, competition) [...].
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Affiliation(s)
- Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy;
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, Faculty of Medicine and Surgery, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy;
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy;
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