Bone Marrow Edema Research Articles

Significance of three-dimensional turbo spin-echo magnetic resonance imaging with semiquantitative assessment of knee osteoarthritis: correlation to two-dimensional routine magnetic resonance imaging

Abstract Background As one of the most prevalent chronic degenerative diseases, knee osteoarthritis (KOA) is associated with the progressive degradation of articular cartilage, meniscus, synovium, ligaments, bone, muscles, and tendons. Knee osteoarthritis affects the quality of life and can cause chronic disability worldwide. Magnetic resonance imaging (MRI) is a crucial imaging modality for the morphological assessment of cartilage and all other joint tissues involved in osteoarthritis. The objective of this study was to evaluate the effectiveness of the three-dimensional (3D) turbo spin-echo (TSE) MRI and to compare its relevance to two-dimensional (2D) routine MRI in adding additional information and in the early detection of KOA. Results Total agreement between the two techniques ranged between 82.7% (cartilage degeneration), 91.4% (osteophytes), 98.3% for bone marrow edema and periarticular cyst up to 100% of other several features regarding meniscal injury and ligamentous tear. Conclusions When compared to standard 2D TSE MRI, 3D TSE MRI demonstrates substantial to almost complete agreement and high accuracy for semiquantitative assessment of knee osteoarthritis (OA). 3D TSE MRI also takes less time, which is important for large OA studies and can be used for the detection of early knee joint changes.

Diagnostics and classification of fractures of the thoracic and lumbar spine in adults : Approach depending on the bone structure

The epidemiology, treatment and prognosis of thoracolumbar vertebral fractures are fundamentally influenced by the bone quality of the patient. In individuals with healthy bone structure, ahigh-energy trauma is typically required to cause afracture. In contrast, osteoporosis can cause fractures and also be present as acomorbid pathology in traumatic fractures. Comprehensive diagnostics and a precise classification are essential for appropriate treatment. This narrative review outlines the diagnostic approach and classification of thoracolumbar vertebral fractures depending on the bone quality as the basis of treatment. In addition to aphysical examination, conventional radiographs with the patient in a standing position and computed tomography (CT) scans of the affected region serve as the foundation for fracture classification. Supplementary magnetic resonance imaging (MRI) primarily assesses discoligamentous and neurological structures of the spine as well as the age of the fracture. In suspected cases of osteoporotic fractures, ashort-tau inversion recovery (STIR) sequence of the entire thoracic and lumbar spine is recommended for reliable detection of bone marrow edema. For patients with healthy bone structure, the AOSpine classification is used, whereas the osteoporotic fracture (OF) classification and the OF score are applied in cases of osteoporosis.

Exploring the Correlation Between Bone Marrow Edema in the Tibial Plateau and Surgical Preferences in Stage 3 Gonarthrosis Patients

Abstract:* Objective: This research aimed to investigate the association between the presence of bone marrow edema in the tibial plateau and the patient's inclination towards surgery in individuals diagnosed with stage 3 gonarthrosis. Background/Purpose: A cohort of 40 patients with confirmed stage 3 gonarthrosis was enrolled in this study. Magnetic Resonance Imaging (MRI) scans were employed to assess the presence and severity of bone marrow edema in the tibial plateau. Patient demographics, clinical history, and radiographic data were collected. A comprehensive statistical analysis, including chi-square tests and logistic regression, was performed to identify any significant relationships. Results: A statistically significant positive correlation was found between edema and age (r = 0.47, p < 0.01), indicating that as age increases, the presence of edema also tends to increase. No significant correlations were found between edema and BMI (r = -0.06, p = 0.70), or between BMI and age (r = 0.08, p = 0.62). This suggests that, within this sample, BMI does not significantly relate to either edema or age. Patients with more pronounced bone marrow edema were more likely to opt for surgery. Additionally, age and previous conservative treatment outcomes were identified as potential confounding factors influencing the decision-making process. Conclusion: The findings of this research underscore the relevance of bone marrow edema in the tibial plateau as a factor influencing the surgical inclination of stage 3 gonarthrosis patients. Understanding this relationship can contribute to a more personalized approach to treatment decisions in orthopedic practice, allowing healthcare professionals to better plan the interventions based on individual patient characteristics and preferences. Further studies are warranted to explore additional factors that may contribute to the complex decision-making process in managing advanced knee osteoarthritis.

Application of extracorporeal shockwave to regulate subchondral bone homeostasis through tumor necrosis factor-α/hypoxia-inducible factor-1α/vascular endothelial growth factor signaling pathway in treatment of talus bone marrow edema.

To investigate the effect of extracorporeal shock wave on the treatment of talus bone marrow edema by regulating subchondral bone homeostasis through tumor necrosis factor-α (TNF-α)/hypoxia-inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) signaling pathway. A total of 81 patients with talus bone marrow edema admitted to our hospital from May 2019 to May 2021 were studied and divided into control group (n = 40) and extracorporeal shock group (n = 41) according to random number table method. The control group was given conventional treatment, and the extracorporeal shock group was combined with extracorporeal shock wave therapy on the basis of the control group. The expression of TNF-α, HIF-1α, and VEGF in the 2 groups were compared, pain degree, and the area of talus bone marrow edema was evaluated by magnetic resonance imaging. The visual analogue scale scores of 1 month, 2 months and 5 months after treatment were decreased in both groups, and the extracorporeal shock group was lower than the control group (P < .05). After 5 months of treatment, the expressions of TNF-α and HIF-1α were decreased in both groups, and the extracorporeal shock group was lower than the control group, VEGF was increased, and the extracorporeal shock group was higher than the control group (P < .05), and the western blot expression levels of TNF-α, HIF-1α and VEGF in the extracorporeal shock group were higher than the control group (P < .05). The dorsiflexion motion and plantar flexion motion of both groups were increased, and the extracorporeal shock group was higher than the control group (P < .05). Extracorporeal shock wave therapy can regulate subchondral bone homeostasis through TNF-α/HIF-1α/VEGF signaling pathway to treat talus bone marrow edema, reduce the pain degree of talus bone marrow edema, and improve ankle joint function.

Spondylodiscitis of the thoraco-lumbar spine: diagnostic performance of dual-energy CT vs MRI.

Dual-energy computed tomography (DECT) could combine the high-resolution bone window images made available by multi-detector CT technology with its capability to identify bone marrow edema (BME) in the spine, for diagnosing spondylodiscitis. Our objective was to compare the diagnostic performance of contrast-enhanced MRI and non-contrast DECT to identify spondylodiscitis of the thoraco-lumbar spine. This prospective study included 77 consecutive participants (39 males; mean age of 61) who underwent DECT and MRI (within 7 days) between January 2020 and October 2023. DECT data were post-processed on a dedicated offline workstation (SyngoVia® VB20) by using a three-material decomposition algorithm. Four radiologists, blinded to clinical data, evaluated non-contrast DECT and contrast-enhanced MRI images. The diagnosis of spondylodiscitis was based on vertebral edema, disc edema, endplate erosions, and paraspinal involvement. Diagnostic accuracy values were calculated by using biopsy as a standard of reference. A multi-reader multi-case analysis was performed. Biopsy revealed a diagnosis of spondylodiscitis in 46 patients (60%). Thoracic and lumbar spondylodiscitis were diagnosed in 37/46 (80%) and 9/46 (20%) patients, respectively. DECT and MRI overall sensitivity, specificity, and AUC were 0.91, 0.89, and 0.90, and 0.94, 0.93, and 0.93, respectively. At lumbar and thoracic levels, the difference between AUC values between DECT and MRI was not significant (p = 0.15). For DECT and MRI, a very good inter-reader agreement was achieved (k = 0.90 and k = 0.97, respectively). Contrast-enhanced MRI represents the most accurate imaging tool for the diagnosis of spondylodiscitis. However, only a non-significant drop in diagnostic performance was achieved by evaluating non-contrast DECT images. Question To compare the diagnostic performance of contrast-enhanced MRI and non-contrast DECT for identifying spondylodiscitis of the thoraco-lumbar spine. Findings MRI was not significantly superior compared to DECT in diagnosing spondylodiscitis, whereas the inter-reader agreement was near perfect for both MRI and DECT. Clinical relevance DECT represents a fast and accurate imaging tool for the demonstration of BME, erosions, and peri-vertebral inflammation in thoraco-lumbar spondylodiscitis.

Diagnostic Accuracy of Dual-Energy CT for Bone Stress Injury of the Lower Limb.

Background Because of its ability to help assess the presence of subtle morphologic changes in bone and bone marrow edema, dual-energy CT (DECT) could be an alternative to MRI in the diagnosis of bone stress injury that includes a stress fracture (SF) and stress reaction (SR). Purpose To determine the diagnostic accuracy of DECT in identifying bone stress injury of the lower limb using MRI as the reference standard. Materials and Methods This prospective study, conducted between June 2021 and January 2024, included consecutive patients clinically suspected of having stress injury (SF or SR) of the lower limb (leg, ankle, or foot). Imaging diagnosis was based on the absence or presence of cortical or periosteal changes, bone marrow edema, or a fracture line. The diagnostic performance of four blinded independent readers was determined for the entire cohort and for the subset of participants without fracture lines. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. Interobserver agreement was evaluated with Kendall coefficient of concordance (W). Results A total of 184 patients (mean age, 58 years ± 17 [SD]; 97 male) were enrolled. At MRI, 107 of 184 participants (58%) had positive diagnoses, including 70 with SF and 37 with SR. The mean overall sensitivity and specificity were 91% (390 of 428; 95% CI: 0.85, 0.95) and 93% (287 of 308; 95% CI: 0.87, 0.97), respectively, with an AUC of 0.94 (95% CI: 0.91, 0.97). Among patients without fracture lines (n = 114), the mean overall sensitivity and specificity of DECT were 79% (117 of 148; 95% CI: 0.65, 0.88) and 93% (287 of 308; 95% CI: 0.87, 0.97), respectively, with an AUC of 0.87 (95% CI: 0.81, 0.94). The interobserver agreement was very good for diagnosis of SF and SR combined (Kendall W = 0.90) and SR alone (Kendall W = 0.84). Conclusion DECT helped to accurately diagnose bone stress injury of the lower limb by identifying fracture lines and osseous stress reactions. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Breighner in this issue.

P01 Adult-onset chronic recurrent multifocal osteomyelitis – case series of four adult patients in Liverpool University Teaching Hospitals Foundation Trust

Abstract Introduction Chronic recurrent multifocal osteomyelitis (CRMO) is a rare inflammatory bone disorder. Classically known as a childhood disorder and diagnosis of exclusion, it characteristically presents with relapsing sterile bone inflammation affecting the metaphysis of lung tubular bones, shoulder girdle, clavicle, vertebral column or bony pelvis. Links with autoimmune conditions have been suggested. Evidence of adult-onset cases (age &amp;gt;18 at diagnosis) remains sparse and sporadic, with mostly individual case reports on searches. We present a case series of four patients with adult-onset CRMO in Liverpool, with varying responses to bisphosphonate treatment and no clinical features of SAPHO. Case description We list four cases of adult patients with CRMO. Case 1: 53-year-old female presented in 2023 with a 10 year history of on-off chest pain isolated to her sternum, and back pain since 2021. MRI confirmation of bone marrow oedema. Bone biopsy normal. Treated with zoledronate. MRI following treatment suggested some improvement but patient remained in pain. Case 2: 24-year-old female presented in 2019 to services with a 10 year history of worsening back pain. Medical background of asthma, type 1 diabetes mellitus, primary biliary cirrhosis and psoriasis. MRI suggestive of persistent pre-sacral soft tissue and sacral oedema since 2015. ANA, Anti-CCP, ENA and dsDNA were negative. Bone biopsy done was positive for inflammation. Pain improved with pamidronate. Case 3: 31-year-old male presented in 2022 with 14 years of relapsing pains and swelling in left clavicle and improvement with NSAIDs. Initially presented via orthopaedic services who arranged an MRI scan that demonstrated oedema of his left clavicle. Received zoledronate infusion with improvement in pain. Case 4: 45-year old-female presented in 2024 with eight year history of chronic right hip and right sacroiliac joint pain. Persistent lower back pain, central right sided with radiation down right knee to her knee. Examination showed tenderness over her lumbar spine and sacroiliac joints. PET-CT done showed avid uptake in L3/4, with subtle lucencies in left frontal bone, right femur and right sacrum. Treated as CRMO with pamidronate with a positive response. All patients received bisphosphonate therapy and varied response to treatment was seen. Two of the four patients had an excellent response with complete resolution of symptoms. One patient has had initial positive response to treatment with resolution of pain but is still planned for more bisphosphonate cycles. One patient had no response to treatment. Discussion Current literature searches describe CRMO mostly in the paediatric populace, with peak incidence aged 10. Most cases of CRMO are diagnoses of exclusion, hence leading to diagnostic delays as differentials such as malignancy, infection, and histiocytosis are first excluded. The Bristol review study suggested a mean time of 15 months to diagnosis in the paediatric populace. We highlight here our findings that CRMO can also present within the adult populace. Typically in adults when similar symptoms arise, SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is considered as a differential. Our patients, whilst having features on imaging suggestive of bone inflammation, did not have any features of SAPHO syndrome. Our findings are corroborated by the Eurofever International Registry study that enrolled 485 patients and showed adult-onset disease in 6.3% of their cohort, accounting for 31 cases. Our patients were all treated with bisphosphonate therapies. Currently, bisphosphonate therapies are often agreed as a first line treatment approach. Some reports exist of beneficial effects in the use of corticosteroids, DMARDS - particularly sulfasalazine and methotrexate - and biologic treatments (anti-TNF agents), though no common consensus guideline for treatment of CRMO within the UK exist at the moment to our knowledge. We feel the varied clinical response of our patients highlights a need for more research to be targeted towards this area. Key learning points Learning points are as follows: • Few cases of adult-onset CRMO are reported in the UK. Most are single site case reports or case series of paediatric patients. • This cases series is the largest adult-onset cohort in Europe from a single hospital site. • Bisphosphonates are used first line - typically pamidronate. • Corticosteroids, DMARDs (SLZ/MTX) and biologic treatments (anti-TNF agents) have been reported to be effective in some single case reports. • Additional research is required for a national consensus guideline for the treatment of CRMO, including additional management options for those patients that fail first line treatment (bisphosphonate).

Quantitative evaluation of the effects of dual-energy CT acquisition, reconstruction and postprocessing parameters on virtual Non-Calcium (VNCa) images

PurposeThe appearance and associated interpretation of Virtual Non-Calcium (VNCa) images extracted from dual-energy CT (DECT) acquisitions are influenced by many parameters. This study aimed to investigate the effects of acquisition, reconstruction, and postprocessing parameters on VNCa images. Material and methodsA human cadaver leg was scanned using a dual-source DECT scanner, with variations in tube current, tube voltage, reconstruction kernels, and post-processing settings (resolution, upper threshold, lower threshold, beam-hardening correction). The impact of noise was investigated by scanning the specimen five times using the same standard acquisition, reconstruction and postprocessing parameters. VNCa values were measured in four different regions of interest within different bones. ResultsTube current and reconstruction kernels had no significant effect on VNCa values, with maximal standard deviations of 6.2 and 6.1 HU respectively. However, reducing the kVp difference between both tubes, reduced the spectral separation which resulted in lower VNCa values. For postprocessing parameters, variations in resolution and lower and upper thresholds as well as applying beam-hardening correction showed a large impact on VNCa values. ConclusionThe results of this study improve the understanding of the impact of certain CT parameters on VNCa images. Tube voltage and post-processing settings have a large impact on VNCa values. An inappropriate choice of threshold range, resolution and incorrect use of calcium beam-hardening correction can potentially lead to false positive findings of bone marrow edema. This can furthermore impact the ability to compare results from the literature and between institutions, which emphasizes the importance of optimizing and standardizing acquisition, reconstruction and postprocessing parameters for consistent VNCa imaging.

Unmet Needs in Spondyloarthritis: Imaging in Axial Spondyloarthritis.

Imaging biomarkers in axial spondyloarthritis (axSpA) are currently the most specific biomarkers for the diagnosis of this condition. Despite advances in imaging, from plain radiographs-which detect only damage-to magnetic resonance imaging (MRI)-which identifies disease activity and structural change-there are still many challenges that remain. Imaging in sacroiliitis is characterized by active and structural changes. Current classification criteria stress the importance of bone marrow edema (BME); however, BME can occur in various diseases, mechanical conditions, and healthy individuals. Thus, the identification of structural lesions such as erosion, subchondral fat, backfill, and ankylosis is important to distinguish from mimics on differential diagnosis. Various imaging modalities are available to examine structural lesions, but computed tomography (CT) is considered the current reference standard. Nonetheless, recent advances in MRI allow for direct bone imaging and the reconstruction of CT-like images that can provide similar information. Therefore, the ability of MRI to detect and measure structural lesions is strengthened. Here, we present an overview of the spectrum of current and cutting-edge techniques for SpA imaging in clinical practice; namely, we discuss the advantages, disadvantages, and usefulness of imaging in SpA through radiography, low-dose and dual-energy CT, and MRI. Cutting-edge MRI sequences including volumetric interpolated breath-hold examination, ultrashort echo time, zero echo time, and deep learning-based synthetic CT that creates CT-like images without ionizing radiation, are discussed. Imaging techniques allow for quantification of inflammatory and structural lesions, which is important in the assessment of treatment response and disease progression. Radiographic damage is poorly sensitive to change. Artificial intelligence has already revolutionized radiology practice, including protocolization, image quality, and image interpretation.

Comparison of low-dose computed tomography and magnetic resonance imaging in enthesitis-related arthritis patients with sacroiliitis.

This study investigated the utility of low-dose computed tomography (ldCT) compared with magnetic resonance imaging (MRI) in diagnosing sacroiliitis in enthesitis-related arthritis (ERA) patients. Thirty patients diagnosed with ERA were evaluated, with a median follow-up of 1.47 years. Imaging data from these patients were examined by two blinded pediatric radiologists. For each patient, we assessed the density changes on ldCT at corresponding locations, employing the signal intensity observed on MRI across each joint surface as a reference. While measurements in areas without edema on MRI showed relatively high density, measurements in areas with edema on MRI showed relatively low density. MRI revealed bilateral bone marrow edema in 22 (73.3%) patients. During the ldCT evaluation of the right iliac crest, lower density was identified on ldCT in regions displaying heightened signal intensity on MRI in 20 (66.6%) patients. On the right sacral side, lower density was observed in the ldCT of 22 (73.3%) patients. Moving to the left iliac crest, 18 (60%) patients displayed a lower density. On the left sacral side, lower density was identified on ldCT in 22 (73.3%) patients. Erosion was detected in 23 patients on ldCT, whereas only 11 patients showed erosion on MRI. This study suggests that ldCT is superior to MRI for early structural change detection. Pixel-based density evaluation in ldCT aligns with MRI findings for bone marrow edema. The present study showed that ldCT is superior to MRI for early structural change detection in pediatric patients. Pixel-based density evaluation in ldCT aligns with MRI findings for bone marrow edema.

Dual energy computed tomography in assessment of bone marrow edema in pathologies of the appendicular skeleton

BackgroundBone marrow edema cannot be detected on the conventional computed tomography scan. MRI has excellent diagnostic performance in detecting bone marrow edema but multiple difficulties in the emergency setting makes performing MRI logistically challenging. The aim of the study was to assess dual energy computed tomography accuracy for bone marrow edema in pathologies of the appendicular skeleton. This was based on color-coded maps and quantitative analysis of Hounsfield unit (HU) in subtraction images, compared with MRI. Materials and methodsProspective observational study was performed by including 60 patients who underwent Dual energy CT (DECT) and MRI. Statistical analysis was performed by calculating p-value and ROC curve analysis. The derived cut off value was used to identify bone marrow edema and diagnostic accuracy, sensitivity, specificity, negative predictive value and positive predictive value of DECT was calculated using MRI as gold standard. A further sub-analysis between the traumatic and non-traumatic groups was done. ResultsBone marrow edema on Color coded virtual non-calcium (VNCa) images and Mean HU of bone marrow edematous site was calculated. Attenuation difference between edematous bone marrow and rest of the bone were correlated with MRI, (p-value 0.0001). The sensitivity, specificity, negative predictive, positive predictive value, and diagnostic accuracy were 91.1, 93.3, 97.6, 77.8 and 91.67 % respectively. ConclusionOur results confirmed that Dual energy CT has high overall sensitivity, specificity and diagnostic accuracy in depicting bone marrow edema when compared to MRI, in various etiologies of the appendicular skeleton. This will lead to reduced missed cases by early detection of bone marrow edema secondary to fractures that are not identifiable in conventional CT. Marrow edema in DECT can be used as an indicator for disease activity and progression in conditions such as transient osteoporosis, tumour, arthritis, avascular necrosis and various other etiologies, generally missed in conventional radiography.

Clinical Outcomes of Talus Bone Marrow Edema: Comparing Plaster Cast, Crutches, and Walking Boot Treatments.

BACKGROUND Bone marrow edema (BME) basically involves localized hemorrhage and subtle compression fracture within the bone. We compared outcomes of 70 patients with traumatic BME of the talus, treated with a plaster cast, crutches, or walking boot. MATERIAL AND METHODS MRIs diagnosed 70 patients with talus BME who were randomly assigned into 3 groups of different treatments: Group 1 (n=33) patients were treated with plaster cast's Group 2 (n=21) patients used crutches, and Group 3 (n=16) patients used walking boots. The outcome variables were AOFAS and VAS scores. RESULTS No significant difference was demonstrated in the pre-treatment AOFAS scores between the groups (P>0.05). The AOFAS scores differed significantly after treatment, with Group 2 had the greatest increase in scores (P=0.002) and significantly higher AOFAS scores compared to Group 1 (100 [79-100] vs 94 [75-100], P=0.001). No significant difference was found in pre-treatment VAS scores between the groups (P=0.007). The post-treatment VAS scores were significantly reduced, especially for Group 2. Within-group analysis demonstrated a significant decrease of VAS scores for all groups (P<0.001). CONCLUSIONS Use of non-weight-bearing crutches for 3 weeks had better clinical results than use of a plaster cast when treating talus traumatic bone marrow edema. This was reflected in higher AOFAS and VAS, suggesting use of crutches is associated with better pain management and improved function.

Quantitative Evaluation of Knee Cartilage in Professional Martial Arts Athletes Using T2 Mapping: A Comparative Study.

Although the relationship between high-impact sports like football and basketball and the development of knee osteoarthritis is well established, the effect of martial arts on the knee joint remains unclear. To compare the imaging abnormalities of knee joints and T2 relaxation times of cartilage in professional martial arts athletes and healthy controls. Cross-sectional study. Hospital imaging center. Nine asymptomatic professional martial arts athletes and 18 healthy volunteers. We performed 3T magnetic resonance imaging of the knee on both legs of athletes and the dominant leg of controls. The magnetic resonance imaging protocol included conventional sequences used for morphological assessment (cartilage, meniscus, ligaments, joint effusion, and bone marrow edema) and T2 mapping used for quantitatively evaluating the cartilage. Knee cartilage was manually divided into 8 regions, and T2 relaxation times of the corresponding subregions were measured. Fisher exact test and t test were used to compare the frequency of lesions and cartilage T2 values both between groups and between the athletes' limbs. P < .05 was considered significant. Professional martial arts athletes exhibited significantly higher frequencies of cartilage (55.6% vs 11.1%, P = .023) and ligament lesions (66.7% vs 16.7%, P = .026) compared with the control group. Athletes showed higher T2 values in 3 distinct cartilage segments: the central weight-bearing segment of the medial femoral condyle (P = .006), the medial tibial plateau (P = .012), and the trochlea (P = .032), when compared with the controls. Additionally, the dominant leg of athletes showed significantly higher T2 values compared with the nondominant leg. The findings demonstrated the impact of martial arts on the knee joint, characterized by higher prevalence of lesions and elevated cartilage T2 values, particularly in the medial compartment. The dominant legs of martial arts athletes seem to have higher risk of cartilage degeneration due to the observed interlimb differences in T2 values.

A comprehensive MRI analysis of osteoid osteomas in patients with diverse radiological features across various regions.

Magnetic resonance imaging (MRI), which does not involve ionizing radiation, is the preferred imaging modality for diagnosing osteoid osteoma (OO), an ailment more common in children and young adults. This study aims to perform a literature review and delineate the MRI findings of OO lesions in patients exhibiting varying radiological features across different regions. A retrospective study included 63 patients diagnosed with OO through MRI, assessed independently by two blinded radiologists using both standard and dynamic contrast-enhanced MRI techniques. After excluding 7 patients with prior biopsy, surgery, or RFA, the study included 56 patients with 57 lesions. Of 57 lesions evaluated, 50 were in long, and 7 in flat bones. One patient presented with two separate nidi within the intertrochanteric region. Most of the lesions, 49 (86%), were extra-articular, while 8 (14%) were intra-articular. The nidus was intracortical in 45 (78.9%) patients, intramedullary in 5 (8.8%), subperiosteal in 5 (8.8%), and endosteal in 2 (3.5%). Average nidus diameter was 7.02 ± 2.64 mm (3-12.6 mm). Central nidal calcification was present in 68.4% (n = 39) cases. Contrast enhancement was intense at 90.5%, moderate at 9.5%. Reactive sclerosis around the nidus was severe (50.9%), moderate (22.8%), and mild (26.3%). Bone marrow edema was severe (70.2%), moderate (14.0%), and mild (15.8%). Soft tissue edema was identified in 77.2% of all lesions. To minimize delays in diagnosis and treatment, radiologists should become acquainted with the typical OO MRI findings and the atypical MRI findings that might be mistaken for other conditions.

Effect of apremilast on hand and whole-body MRI assessments of inflammation in patients with psoriatic arthritis (MOSAIC): a phase 4, multicentre, single-arm, open-label study.

The Psoriatic Arthritis Magnetic Resonance Imaging Scoring System (PsAMRIS) and MRI Whole-Body Scoring System for Inflammation in Peripheral Joints and Entheses in Inflammatory Arthritis (MRI-WIPE) have not been used together to assess treatment of psoriatic arthritis in a clinical trial. We aimed to assess the effect of apremilast treatment on inflammation, with outcomes measured by PsAMRIS and MRI-WIPE. MOSAIC was a phase 4, multicentre, single-arm, open-label study conducted at 29 sites across ten countries (Belgium, Canada, Denmark, Germany, Italy, Russia, Spain, Switzerland, the UK, and the USA). Adults aged 18 years or older with a documented diagnosis of psoriatic arthritis for a duration of 3 months to 5 years self-enrolled and were included if they met the classification criteria for active psoriatic arthritis at screening. Patients were required to have at least three swollen and three tender joints with hand involvement and at least one active enthesitis site according to the Spondyloarthritis Research Consortium of Canada enthesitis index or the Leeds enthesitis index. Patients were excluded if they had previous treatment with a biological disease-modifying antirheumatic drug or previous treatment with more than two conventional synthetic disease-modifying antirheumatic drugs. After a 5-day titration period, patients received apremilast 30 mg orally twice per day. Concomitant stable methotrexate up to 25 mg per week was permitted. The primary endpoint was change from baseline to week 24 in a composite inflammation score of bone marrow oedema, synovitis, and tenosynovitis in the hand as assessed by PsAMRIS. The full analysis set and safety population included all enrolled patients who received at least one dose of apremilast. This completed study is registered with ClinicalTrials.gov (NCT03783026). Between Feb 6, 2019, and May 11, 2022, 123 patients were enrolled in the MOSAIC study. Of these 123 patients, 122 (99%) were treated with apremilast and included in the full analysis set and safety population. 67 (55%) of 122 patients were female, 55 (45%) were male, and 116 (95%) were White. 80 (66%) of 122 patients completed 48 weeks of treatment. The least squares mean change from baseline to week 24 in the composite inflammation score of bone marrow oedema, synovitis, and tenosynovitis as assessed by PsAMRIS was -2·32 (95% CI -4·73 to 0·09). 95 (78%) of 122 patients had at least one treatment-emergent adverse event. Six (5%) patients had a severe treatment-emergent adverse event and six (5%) patients had a serious treatment-emergent adverse event. No serious treatment-emergent adverse events were considered to be related to apremilast. Apremilast improved inflammation in joints and entheses on assessment of MRI measures in the hand and the whole body. Our findings encourage the use of MRI, including whole-body MRI, as an objective outcome measure in trials in patients with psoriatic arthritis. Amgen.

Brain microbleeds resulting from presumed extensive fat emboli in a patient with bone marrow necrosis following a sickle cell disease vaso-occlusive crisis.

Acute manifestations of sickle cell disease (SCD) are numerous and multisystemic.Cerebral fat embolism (CFE) is a rare but serious complication of SCD caused by bone marrow necrosis (BMN) during vaso-occlusive crises (VOC). We present the case of a41-year-old man with SCD who developed severe VOC and multi-organ dysfunction.He subsequently experienced neurological deterioration with decreased consciousness and diffuse encephalopathy on serial electroencephalograms. Bone marrow aspiration confirmed BMN. Brain MRI revealed extensive diffuse leukoencephalopathy, vasogenic and cytotoxic edema in the white matter, patchy edema in the cranial vault bone marrow on fat-suppressed FLAIR sequence (a finding consistent with the confirmed BMN), and multiple cerebral microbleeds on susceptibility-weighted imaging consistent with CFE. The management of acute neurological complications of SCD varies depending on the specific complication. Brain MRI plays a crucial role in the accurate diagnosis of these complications to guide appropriate treatment.

Evaluation of Inflammatory Disease Activity in the Sacroiliac Joints Using Magnetic Resonance Imaging: A Comparative Analysis of Short-Tau Inversion Recovery, Post-Contrast, and Diffusion-Weighted Imaging –Preliminary Study

Introduction: It is essential to detect sacroiliitis earlier to decrease morbidity and unwanted complications such as ankylosing of sacroiliac joints. In recent studies, magnetic resonance imaging (MRI) serves as a key diagnostic tool for identifying sacroiliitis and is now included in the diagnostic criteria. We aim to detect the utility of diffusion-weighted imaging on the MRI in diagnosing sacroiliitis and measure ADC values for the response to treatment in future studies. Materials -methods: There were 39 patients (16 male, 20 female). A 1.5 Tesla MR device with a pelvic coil was used. The sequences were T1 (before and after intravenous contrast administration of gadolinium), T2-weighted fast field echo, short tau inversion recovery (STIR), diffusion-weighted (DW) images, and apparent diffusion coefficient (ADC) mapping. Sacroiliac joints were divided into four quadrants, and two radiologists interpreted all the sequences by giving scores from 0 to 3 depending on bone marrow edema from none to severe. The concordance of scores assigned to STIR, T1-weighted gadolinium-enhanced images, ADC mapping, and diffusion-weighted MR images was evaluated by calculating intraclass correlation coefficients. Results: A statistically significant positive correlation was observed between the activity scores derived from short tau inversion recovery (STIR) and other magnetic resonance (MR) sequences, namely T1-weighted gadolinium-enhanced images, apparent diffusion coefficient (ADC) mapping, and diffusion-weighted MR images. Conclusion: Active bone marrow abnormalities were identified with comparable efficacy using STIR imaging and other MR sequences (T1W-Gad, ADC mapping, DW-MR). In our study, we tried to emphasize the role of the diffusion-weighted images near the other sequences. Diffusion is a fast, easy-applied sequence. After increased experience in the diffusion-weighted images, routine application of this sequence will increase, and even becoming one of the diagnostic criteria will be inevitable. The difference in DWI from the other sequences is that it is measurable. The response to treatment may be followed up by ADC values.

Prevalence of Abnormalities and Normal Variants in the Adolescent Knee on MRI in a Population-Based Cohort of 3800 Knees

Background: Many adolescents experience knee pain, and only some undergo detailed imaging. In this population, the prevalence of abnormalities and normal variants on magnetic resonance imaging (MRI) scans is unknown. Purpose: To investigate the prevalence of abnormalities and normal variants of the knee on MRI scans and their relationship with participant characteristics in the general young adolescent population. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study was part of an open population-based cohort study that focuses on health, growth, and development from fetal life until adulthood. Between 2017 and 2020, adolescents aged 12 to 15 years underwent MRI of both knees. These MRI scans were assessed in a standardized way for abnormalities and normal variants to determine their prevalence. Logistic regression was used to analyze the presence of abnormalities and normal variants in relation to sex, height, weight, body mass index–standard deviation (BMI-SD), and ethnicity. Results: A total of 1910 participants (median age, 13.5 years; interquartile range, 13.4-13.7 years; 52% girls) were included in this study. Of them, 370 (19.4%) participants had at least 1 abnormality or normal variant. Bone marrow edema around the knee was the most prevalent finding, affecting 140 (7.3%) participants. In 107 (5.6%) participants, nonossifying fibromas were found. A total of 43 (2.3%) participants had characteristics of Osgood-Schlatter disease, 16 (0.8%) showed characteristics of Sinding-Larsen-Johansson syndrome, and osteochondritis dissecans was found in 13 (0.7%) participants. Variants such as discoid menisci were found in 40 (2.1%) participants and a bipartite patella in 21 (1.1%) participants. There were multiple associations between abnormalities or variants and participant characteristics, including bone marrow edema being more often present in boys (odds ratio [OR], 2.44; 95% CI, 1.69-3.52) and those with a lower BMI-SD (OR, 0.85; 95% CI, 0.73-0.98). Osgood-Schlatter and osteochondritis dissecans were more often present in boys (OR, 4.21 [95% CI, 2.01-8.85] and OR, 13.18 [95% CI, 1.71-101.58], respectively). Discoid menisci were associated with a non-Western ethnicity (OR, 2.06; 95% CI, 1.07-3.96) and higher BMI-SD (OR, 2.34; 95% CI, 1.76-3.11). Conclusion: Abnormalities and normal variants on MRI scans of the knees are common in adolescents. Physicians who are involved in the treatment of adolescents with knee pain need to be aware of this prevalence so that these children will not be overtreated or misdiagnosed.

Etiopathogenetic features of bone metabolism in patients with diabetes mellitus and Charcot foot

Diabetic neuropathy is one of the most common diabetes mellitus complications associated with mediocalcinosis of the lower extremities, a significant decrease in feet bone mineral density, and a high incidence of cardiovascular disease. In most cases, calcium-phosphorus metabolism changes occur in patients with diabetic neuroarthropathy, or Charcot foot, when we can observe feet local osteoporosis, which in 90% of cases associated with a vessel's calcification of the lower extremities in the majority of diabetes population. A large number of studies presented literature have demonstrated that patients with Charcot foot can have accelerated bone metabolism and increased bone resorption. Patients with Charcot foot often have crucial abnormalities in the calcium-phosphorus parameters, bone metabolism, and levels of vitamin D and its metabolites. In addition, the duration of diabetes mellitus, the degree of its compensation widely affects the development of its micro- and macrovascular complications, which could also accelerate the development of mineral and bone disorders in these types of patients. Multifactorial pathogenesis of these disorders complicates the management of patients with a long and complicated course of diabetes mellitus. This review discusses the peculiarities of vitamin D metabolism, the importance of timely diagnosis in phosphorus-calcium disorders, and the specifics of therapy in these patients. Special attention is paid to the timely diagnosis of the Charcot's foots acute stage based on the bone marrow edema by MRI evaluation and the possibility of reducing the immobilization period.

Comparison of Percutaneous Endoscopic Transforaminal Discectomy, Chemonucleolysis, Microdiscectomy, and Microendoscopic Discectomy for Symptomatic Lumbar Disc Herniation: One-year Follow-up Clinical Results and Disc Degeneration.

This study compared the 1-year clinical outcomes and disc degeneration rates after transforaminal full-endoscopic lumbar discectomy (TF-FED), condoliase injection, open discectomy (OD), and microendoscopic discectomy (MED) for lumbar disc herniation (LDH). In total, 279 patients with LDH were divided into four treatment groups: TF-FED, OD, MED, and condoliase injection. Outcomes were evaluated on the basis of the complication rate, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), visual analog scale (VAS) scores, and the modified MacNab criteria. Surgical and hospital costs were assessed. Disc degeneration and endplate bone marrow edema were evaluated using magnetic resonance images. The mean postoperative JOABPEQ, VAS, or modified MacNab scores among the four groups had no significant differences. Additionally, the nerve injury or reoperation rate among the TF-FED, OD, and MED groups had no significant difference. However, the reoperation rate with condoliase injection was high because of residual disc herniation. Surgical and hospital costs were lower with condoliase injection and higher with OD and MED than those with TF-FED. With TF-FED and condoliase injection, the Pfirrmann grade progressed, and the disc height was significantly smaller than that with OD and MED. Endplate bone marrow edema was more common with condoliase injection and TF-FED. All groups had good outcomes. TF-FED and condoliase injection may reduce the burden of surgery because they can be performed under local anesthesia with little blood loss and low medical costs but tend to be associated with disc degeneration and endplate bone marrow edema. A randomized controlled study with a larger sample is needed.