Pharmacological therapy for subchondral pathologies of the knee joint

AB0727 MAGNETIC RESONANCE IMAGING IN SYMPTOMATIC BACK PAIN IN INFLAMMATORY BOWEL DISEASE: STRUCTURAL LESIONS AND HLA-B27 IMPROVE THE DIAGNOSTIC ACCURACY IN AXIAL SPONDYLOARTHRITIS

Recommendation on the nomenclature for oral anticoagulants: communication from the SSC of the ISTH

Bone marrow edema (BME) is a significant imaging finding in musculoskeletal and emergency radiology, often associated with trauma or nontraumatic etiologies such as inflammation, infection, or neoplasms. Magnetic resonance imaging (MRI) remains the gold standard for BME evaluation. However, dual-energy CT (DECT) has emerged as a valuable alternative due to its faster acquisition times, lower costs, and more rapid access in emergency settings (when compared with MRI), facilitating timely decision-making when MRI is impractical or contraindicated. Despite its benefits, accurate interpretation of BME on DECT requires careful understanding of its limitations and potential pitfalls. This article addresses the technical and clinical challenges in DECT-based BME assessment and proposes strategies to enhance diagnostic accuracy.A review of the literature was performed by searching the PubMed and ScienceDirect databases, using the keywords ("DECT" or "Dual-Energy") and ("BME" or "bone marrow edema") and ("musculoskeletal" or "bone" or "skeleton") for the title and abstract query. The inclusion criteria were scientific papers presented in the English language. Exclusion criteria included articles which had no relevant focus on BME and case reports. Of the 168 articles initially identified, 75 were deemed relevant and were reviewed in detail. Insight from this literature search and the authors' clinical experience forms the basis of this review, highlighting key pitfalls and strategies for accurate BME interpretation.DECT provides significant advantages for detecting BME, such as material-specific color overlays and high anatomical correlation. However, key pitfalls include the misinterpretation of artifacts, difficulties in cases of severe displacement or sclerosis, and challenges posed by imaging artifacts in large-sized patients or those with metallic implants. Radiologists can improve diagnostic accuracy by understanding the limitations and pitfalls of DECT, and by adopting the solutions outlined in the article to optimize its use. · DECT effectively identifies BME in both traumatic and non-traumatic conditions, with sensitivity and specificity comparable to magnetic resonance imaging (MRI).. · Key interpretation pitfalls include artifacts from photon starvation, metallic implants, severe displacement, and motion, as well as limitations in algorithm processing.. · Misdiagnoses can arise due to mimics of BME, such as sclerosis, red marrow, or pathological fractures, necessitating clinical and imaging correlation.. · Parameter optimization (e.g., spectral FOV, kernel selection, image calibration) enhances diagnostic accuracy and reduces errors.. · Yap JA, Ong YX, Weber M. Pitfalls in Bone Marrow Edema Interpretation on Dual-Energy CT: Challenges and Solutions. Rofo 2025; DOI 10.1055/a-2653-9256.

Therefore, the aim of the work was to evaluate the value of intravertebral fluid with osteoporosis and metastatic vertebral compression fractures using magnetic resonance imaging. Objectives of the study were to investigate: MRI semiotics of osteoporotic compression fractures with their diagnostic value; intravertebral fluid in pathological fractures.Methods. 120 patients with pathologic compression fractures of the spine, which included 70 patients with acute osteoporotic and 50 - with metastatic, are examined. Among patients with osteoporotic fractures were 62 women (88.6 %) men - 8 (11.4 %) with an average age of 65.6 ± 11.1 years, and among patients with MCP fractures was 30 (60.0 %) men and 20 (40.0 %) women with a mean age 60.8 ± 12.5 years. All patients underwent an MRI on devices with a magnetic field strength of 0.2, 1.5 and 0.36 Tс (AIRIS Mate, ECHELON firm "Hitachi medical Corp.", Japan, "I-Open 0.36", China). Dual-energy X-ray absorptiometry (DXA) held 59 (39.1 %) patients. DXA was performed on the unit «Lunar PRODIGY Primo DHA"Results. The basic structural and morphological changes with osteoporotic compression fractures of the spine such as - bone marrow edema, annular seal paravertebral soft tissue, compression of the veins bazivertebrales, remains of yellow bone marrow, involvement arches and rear elements of the vertebra, curved (intact) the back surface of the body, the fracture of the reflex plates, rear corner pieces with indicators of sensitivity, specificity, and accuracy. It was shown that the intravertebral fluid of the compressed vertebral bodies found in 72 (88.9 %) patients. This feature may also be an indicator of the seam (or splice) the data fractures.Conclusions. Intravertebral fluid in the compressed vertebral bodies was found in 88.9 % of patients with osteoporotic fractures, and this feature can be another tool in the diagnosis of this category of fractures with high sensitivity, specificity and accuracy. This feature may also be an indicator of the seam (or splice) the data fractures. When metastatic compression fractures of this symptom is rare (6 %) and it is located mainly in the anterior body of compressed vertebrae

54-Year-Old Man With Hip Pain

54-Year-Old Man With Hip Pain

Guidance for Transitioning Among Anticoagulants.

BackgroundTo explore the relationship between the magnetic resonance imaging (MRI) characteristics of osteoporotic vertebral compression fractures (OVCFs) and the efficacy of percutaneous vertebroplasty (PVP).MethodsA prospective study was conducted to analyze the clinical and imaging data of 93 patients with OVCFs treated via PVP. A visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the Medical Outcomes Study(MOS) 36-Item short-form health survey (SF-36) were completed before surgery as well as 1 day and 1, 6, and 12 months after surgery. In addition, postoperative complications were recorded. According to the degree and ranges of bone marrow edema on MRI, the patients were divided into three groups: the mild (group A), moderate (group B), and severe (group C) bone marrow edema groups. Pain and dysfunction scores were compared across the three groups of patients before surgery as well as 1 day and 1, 6, and 12 months after surgery.ResultsThe VAS, ODI, and SF-36 scores showed significant differences (P < 0.05) before and after surgery among the three groups. The ODI and SF-36 scores were significantly different (P < 0.05) at 1 day and 1 month after surgery among the three groups. Groups A and B showed significantly better pain relief than group C. Group B experienced better pain relief than group A. These results indicate that PVP was associated with better pain relief effects among patients with a greater extent of bone marrow edema. The edema ranges of the vertebral fractures were negatively correlated with the postoperative VAS and ODI scores 1 month after surgery, whereas the ranges were positively correlated with postoperative SF-36 scores 1 month after surgery.ConclusionsPVP is an effective treatment for OVCFs. Better outcomes were observed among patients with severe or moderate bone marrow edema rather than those with mild bone marrow edema. A greater degree of pain relief after PVP was correlated with faster recovery of the postoperative function. However, this correlation gradually became weak over time and disappeared 6 months after surgery. Therefore, PVP should be an option for early stage OVCFs, especially among patients with bone marrow edema signs on MRI.

Determine the incidence, location, and features of insufficiency fractures (IFs) in sacral chordoma patients treated with high-dose radiation therapy (HDR) with(out) resection, relative to radiation therapy type and irradiation plans. Clinical data, including details of all surgical procedures and radiotherapies of patients histologically diagnosed with sacral chordoma between 2008 and 2023 available at our database, were retrospectively reviewed. Inclusion criteria were as follows: availability of diagnostic, treatment planning and follow-up magnetic resonance and/or computed tomography scans, and completed treatment. Scans were re-evaluated for the presence and location of IF defined as linear abnormalities with(out) bone marrow oedema (BME)-like changes. From 48 included patients (29 male, median age 66, range 27-85), 22 were diagnosed with 56 IF (45.8%). IF occurred 3-266 months following the treatment. All sacral and iliac bone IF had vertical components parallel to the SI joint. Twenty patients had bilateral and 16 unilateral IF. BME-like changes were visible in 46 IF (82.1%, 0.80, P ≤ .001). In 13/56 IF (23.2%), BME-like changes were seen prior to IF diagnosis; in only 1 patient, BME-like changes did not develop into an IF. Thirty-nine IF (84.7%) occurred within low-dose volume and 7 (15.3%) outside of irradiated volume in 16/44 irradiated patients. Six IF occurred in 1 patient treated with surgery only. Pelvic IFs are common in sacral chordoma patients treated with definitive or (neo)adjuvant HDR, occurring months to years following treatment. Not all IF occur in the irradiated volume. When present, BME-like changes indicate risk of IF developing. IF do not heal over time.

ObjectivesTo evaluate extensor carpi ulnaris (ECU) tendon pathology and ulnar styloid process bone marrow edema (BME) as diagnostic MRI markers for peripheral triangular fibrocartilage complex (TFCC) tears.MethodsOne hundred thirty-three patients (age range 21–75, 68 females) with wrist 1.5-T MRI and arthroscopy were included in this retrospective case–control study. The presence of TFCC tears (no tear, central perforation, or peripheral tear), ECU pathology (tenosynovitis, tendinosis, tear or subluxation), and BME at the ulnar styloid process were determined on MRI and correlated with arthroscopy. Cross-tabulation with chi-square tests, binary logistic regression with odds ratios (OR), and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were used to describe diagnostic efficacy.ResultsOn arthroscopy, 46 cases with no TFCC tear, 34 cases with central perforations, and 53 cases with peripheral TFCC tears were identified. ECU pathology was seen in 19.6% (9/46) of patients with no TFCC tears, in 11.8% (4/34) with central perforations and in 84.9% (45/53) with peripheral TFCC tears (p < 0.001); the respective numbers for BME were 21.7% (10/46), 23.5% (8/34), and 88.7% (47/53) (p < 0.001). Binary regression analysis showed additional value from ECU pathology and BME in predicting peripheral TFCC tears. The combined approach with direct MRI evaluation and both ECU pathology and BME yielded a 100% positive predictive value for peripheral TFCC tear as compared to 89% with direct evaluation alone.ConclusionsECU pathology and ulnar styloid BME are highly associated with peripheral TFCC tears and can be used as secondary signs to diagnose tears.Key Points• ECU pathology and ulnar styloid BME are highly associated with peripheral TFCC tears and can be used as secondary signs to confirm the presence of TFCC tears.• If there is a peripheral TFCC tear on direct MRI evaluation and in addition both ECU pathology and BME on MRI, the positive predictive value is 100% that there will be a tear on arthroscopy compared to 89% with direct evaluation alone.• If there is no peripheral TFCC tear on direct evaluation and neither ECU pathology nor BME on MRI, the negative predictive value is 98% that there will be no tear on arthroscopy compared to 94% with direct evaluation alone.

P4757Vitamin k antagonists are associated with higher risk of osteoporotic fractures compared to non-vitamin k antagonist oral anticoagulants among atrial fibrillation patients: a nationwide cohort study

To the Editor: I read with great interest the recent report of Yang et al[1], “Clinical Characteristics and Treatment of Spontaneous Osteonecrosis of Medial Tibial Plateau: A retrospective case study” (published on November 5, 2018, Chin Med J, page 2544–2550), because there have been very few reports on isolated spontaneous medial tibial plateau osteonecrosis and little is known about osteonecrosis of the tibial plateau. I would like to comment on diagnostic issues in this letter. Osteonecrosis of the knee can be a devastating disease that leads to end-stage arthritis of the knee. The knee is the second most commonly affected site after the hip.[2] Spontaneous osteonecrosis of the knee (SPONK) involving medial femoral condyle was described as a distinct entity by Ahlback et al in 1968[3] and is also called idiopathic or primary osteonecrosis to distinguish it from secondary osteonecrosis, which is associated with corticosteroid therapy, blood dyscrasias, Gaucher disease, caisson disease,[4] and other rare conditions, for example, laser-assisted arthroscopic chondroplasty.[5] The condition usually involves a single condyle, most often the medial femoral condyle, affected in 94% of the cases and can also occur in the lateral femoral condyle or in the tibial plateaus.[6] Involvement of the tibial plateau, which was first reported in the French literature by d’Angelijan et al[7] in 1967 and was described in the English literature by Houpt et al[8] is less common. Only 2% of osteonecrosis around the knee may affect the tibial plateau. The medial tibial plateau is more frequently affected than the lateral.[9] Therefore, to our knowledge, it remains a rare cause of knee pain. In the article, the case group contains 22 patients in 15 months (from March 2015 to June 2016), it means real prevalence may be underestimated. Magnetic resonance imaging (MRI) is both sensitive and specific for recognizing SPONK of both medial femoral condyle and tibial plateau and recommended for detection of the disease, due to its high sensitivity in detecting bone marrow edema.[10] MRI characteristics include a diffuse area of hyperintensity widespread into the metaphysics on T2-weighted images, the focal subchondral area of low signal intensity adjacent to the subchondral bone plate on T1-weighted images and focal epiphyseal contour depressions. But the MRI-detected subchondral bone marrow lesion, comprised of fibrosis, necrosis, edema, and bleeding into fatty marrow in different proportions as well as abnormal trabeculae, is also a common finding in patients with OA.[11] In the article, the MRI images showed in Figures 2 and 5 have no typical MRI signs of spontaneous medial tibial plateau osteonecrosis, MRI T1 and T2 images show cartilage degeneration, narrow of joint space, focal bone marrow edema and formation of subchondral cysts in medial knee compartment. We think it is more likely anteromedial osteoarthritis of knee, not a typical SPONK of medial tibial plateau. Although medial unicompartmental knee arthroplasty is also appropriate surgical indication. We also noted that in the series, there are 17 patients (77%) with a Level III medial meniscus posterior root tears (MMPRT) and the lesions of 68% patients involved the central tibial plateau. Subchondral marrow edema deep to the MMPRT was described as a harbinger of meniscal root failure. Ipsilateral tibiofemoral compartment bone marrow edema and insufficiency fractures are commonly noted in the presence of posterior meniscal tears.[12] Therefore, differential diagnosis is important and the condition has not been clearly discussed. Funding This work was supported by a grant from Ministry of Science and Technology of China (No. 2017YFC0108003). Conflicts of interest None.

Background/Aims This is a case series of patients treated with a single dose of denosumab to improve bone marrow oedema. Bone marrow oedema can cause significant pain and functional limitations. On MRI imaging, bone marrow oedema is identified as T1 hypointensities and T2 hyperintensities. Denosumab is a human monoclonal antibody that inhibits osteoclast bone absorption via binding to the cytokine RANKL [receptor activator of nuclear factor kappa-B ligand]. The exact aetiology of bone marrow oedema is unknown. It typically occurs in those aged between 40 to 60 years old. Studies have described therapeutic improvement with antiresorptive medications. Bone marrow oedema will generally resolve if left untreated. However, pharmacological treatments can curtail the clinical course. Methods This case series has emerged from Chelsea and Westminster hospital. Data was collected over a five year period for seven patients with bone marrow oedema [demonstrated on MRI] that were treated with denosumab. Six of the seven patients had a spontaneous insufficiency fracture associated with the bone marrow oedema on imaging. In our case series, two of the patients had bone marrow oedema in their hips and five in their knees. Denosumab was administered as a single 60mg subcutaneous injection. Response to treatment was ascertained by repeat MRI scan 2-4 months after denosumab treatment as well as patient reported outcomes. Results The average age of the patients was 56.4 years [age range 48-68 years]. Five of the patients [71%] reported improved symptoms at the affected site. Four patients [57%] had complete resolution of their bone marrow oedema on imaging with a further patient [14%] having an improved radiological appearance. Visual analogue scale [VAS] scores improved by 50%, although this data was only collected for some of the patients. No side-effects or complications were noted from the treatment. One of the patients who did not improve with denosumab treatment went on to have a total hip replacement due to complete loss of joint space. It is noteworthy that following further investigations, five of the seven patients were diagnosed with osteopenia on dual-energy x-ray absorptiometry [DEXA] scan, one had osteoporosis [and was subsequently commenced on alendronic acid] and one did not attend for their DEXA scan. Conclusion This series demonstrates that denosumab is an effective treatment for bone marrow oedema. Denosumab given as a single dose can be considered a safe treatment; there is not the risk of rebound worsening of bone density on treatment cessation that can be seen with prolonged treatment. Denosumab should be offered to patients who are symptomatic from bone marrow oedema to allow for quicker symptom relief and radiological improvement. Our findings are similar to that of a slightly larger case series of fourteen patients by Rolvien et al. published in 2017. Disclosure M. Galloway: None. A. Jacobs: None. M. Ismajli: None.

AB0298 LONG-TERM SUPPRESSION OF RAPID RADIOGRAPHIC PROGRESSION AFTER DISCONTINUATION/REDUCTION OF SHORT-TERM BIOLOGIC THERAPY IN PATIENTS WITH EARLY DESTRUCTIVE RHEUMATOID ARTHRITIS ACCOMPANIED WITH EXTENSIVE BONE MARROW EDEMA.

Scientific and Standardization Committee Communication: Guidance document on the periprocedural management of patients on chronic oral anticoagulant therapy: Recommendations for standardized reporting of procedural/surgical bleed risk and patient‐specific thromboembolic risk