Detection Of Bone Marrow Edema Research Articles

Detection of Bone Marrow Edema in Patients with Osteoid Osteoma Using Three-Material Decomposition with Dual-Layer Spectral CT.

The aim of this study is to assess whether perifocal bone marrow edema (BME) in patients with osteoid osteoma (OO) can be accurately detected on dual-layer spectral CT (DLCT) with three-material decomposition. To that end, 18 patients with OO (25.33 ± 12.44 years; 7 females) were pairwise-matched with 18 patients (26.72 ± 9.65 years; 9 females) admitted for suspected pathologies other than OO in the same anatomic location but negative imaging findings. All patients were examined with DLCT and MRI. DLCT data was decomposed into hydroxyapatite and water- and fat-equivalent volume fraction maps. Two radiologists assessed DLCT-based volume fraction maps for the presence of perifocal BME, using a Likert scale (1 = no edema; 2 = likely no edema; 3 = likely edema; 4 = edema). Accuracy, sensitivity, and specificity for the detection of BME on DLCT were analyzed using MR findings as standard of reference. For the detection of BME in patients with OO, DLCT showed a sensitivity of 0.92, a specificity of 0.94, and an accuracy of 0.92 for both radiologists. Interreader agreement for the assessment of BME with DLCT was substantial (weighted κ = 0.78; 95% CI, 0.59, 0.94). DLCT with material-specific volume fraction maps allowed accurate detection of BME in patients with OO. This may spare patients additional examinations and facilitate the diagnosis of OO.

DECT in Detection of Vertebral Fracture-associated Bone Marrow Edema: A Systematic Review and Meta-Analysis with Emphasis on Technical and Imaging Interpretation Parameters.

Background Dual-energy CT (DECT) shows promising performance in detecting bone marrow edema (BME) associated with vertebral body fractures. However, the optimal technical and image interpretation parameters are not well described. Purpose To conduct a systematic review and meta-analysis to determine the diagnostic performance of DECT in detecting BME associated with vertebral fractures (VFs), using different technical and image interpretation parameters, compared with MRI as the reference standard. Materials and Methods A systematic literature search was performed on July 9, 2020, to identify studies evaluating DECT performance for in vivo detection of vertebral BME. A random-effects model was used to derive estimates of the diagnostic accuracy parameters of DECT. The impact of relevant covariates in technical, image interpretation, and study design parameters on the diagnostic performance of DECT was investigated using subgroup analyses. Results Seventeen studies (with 742 of 2468 vertebrae with BME at MRI) met inclusion criteria. Pooled estimates of sensitivity, specificity, and area under the curve of DECT for vertebral body BME were 89% (95% CI: 84%, 92%), 96% (95% CI: 92%, 98%), and 96% (95% CI: 94%, 97%), respectively. Single-source consecutive scanning showed poor specificity (78%) compared with the dual-source technique (98%, P < .001). Specificity was higher using bone and soft-tissue kernels (98%) compared with using only soft-tissue kernels (90%, P = .001). Qualitative assessment had a better specificity (97%) versus quantitative assessment (90%) of DECT images (P = .01). Experienced readers showed considerably higher specificity (96%) compared with trainees (79%, P = .01). DECT sensitivity improved using a higher difference between low- and high-energy spectra (90% vs 83%, P = .04). Conclusion Given its high specificity, the detection of vertebral bone marrow edema with dual-energy CT (DECT) associated with vertebral fracture may obviate confirmatory MRI in an emergency setting. Technical parameters, such as the dual-source technique, both bone and soft-tissue kernels, and qualitative assessment by experienced readers, can ensure the high specificity of DECT. © RSNA, 2021 Online supplemental material is available for this article.

Detection of bone marrow edema in osteonecrosis of the femoral head using virtual noncalcium dual-energy computed tomography

PurposeTo determine the diagnostic performance of virtual noncalcium (VNCa) dual-energy computed tomography (DECT) in the detection of bone marrow edema (BME) in participants with osteonecrosis of the femoral head (ONFH). MethodsIn this prospective study, 24 consecutive participants (15 men, 9 women; mean age, 44 years, range, 21–72 years) diagnosed with ONFH who underwent DECT and magnetic resonance imaging (MRI) between September 2019 and January 2020 were involved. Two independent readers visually evaluated color-coded VNCa images using a binary classification (0 = normal bone marrow, 1 = BME). MRI served as the reference standard for the presence of BME. Interobserver agreement for the visual evaluation of VNCa DECT images was calculated with κ statistics. We determined computed tomography (CT) numbers on VNCa images and weighted-average CT sets using region-of-interest-based quantitative analysis. The t-test was used to compare the differences of CT values between BME areas and normal bone marrow areas. Receiver operating characteristic (ROC) curve was used to select an optimal CT values of VNCa images for detecting BME. A p value of <0.05 was considered as statistically significant. ResultsThe sensitivity, specificity, and accuracy of Reader 1 and Reader 2, respectively, in the identification of BME at DECT were 95 % and 89 % (18 and 17 of 19), 96 % and 96 % (25 and 25 of 26), and 93 % (43 and 42 of 45). Interobserver agreement was excellent (κ = 0.86). The VNCa CT numbers of the BME area and the normal bone marrow area were −28.6 (−17.9–−39.4) HU and −97.9 (−91.3–−104.4) HU, respectively, with statistical significance (t = −10.6, p < 0.001). The weighted-average CT numbers of the BME area and the normal bone marrow area were 152.4(122.2–182.7) HU and 121.1(103.6–183.6) HU, respectively, with no statistical significance (t = −2.0, p > 0.05). The area under the receiver operating characteristic curve was 0.99 in differentiation of the BME from normal bone marrow. A cut-off value of −57.2 HU yielded overall sensitivity, specificity, and accuracy, respectively, of 95 % (18 of 19), 100 % (26 of 26), and 98 % (44 of 45) detection of BME in participants with ONFH. ConclusionVisual and quantitative analyses of VNCa images shows excellent diagnostic performance for assessing BME in participants with ONFH.

Dual-Energy Computed Tomography Virtual Noncalcium Imaging for the Detection of Acute Bone Marrow Edema in Vertebrae: Qualitative and Quantitative Analysis

Purpose: To evaluate the feasibility of dual-energy computed tomography (DECT) virtual noncalcium (VNCa) images for detecting vertebral bone marrow edema (BME), both in qualitative and quantitative analyses. Materials and Methods: Nineteen cases with acute spinal trauma were enrolled. DECT and MR Imaging were performed over an interval of 0–3 days within 3 weeks of injury. Both gray-scale and color-coded VNCa images were evaluated in an independent and blind manner using a three-scale grading system (2 = distinct BME, 1 = suspicious BME, and 0 = no edema) by two radiologists. CT value of bone marrow were measured for each region and subjected to receiver operating characteristic (ROC) curve analysis for diagnosis of BME on VNCa images from DECT. Subsequently, as a standard of reference, MR imaging was evaluated by a third radiologist for the presence of traumatic BME. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection of BME using VNCa images were evaluated. Kappa analysis and one-way ANOVA were performed to evaluate the consistency and variance of VNCa images in the BME. Results: For two observers, the sensitivity of VNCa images for detecting BME (grade 2) were 97.8% and 96.7%, with the specificity 76% and 72%, the PPV 93.8% and 92.7%, the NPV 90.5% and 85.7%, respectively. And the sensitivity for detecting BME (grade 1–2) were 94.3% and 94.3%, with the specificity 96.7% and 93.3%, the PPV 98.8% and 97.6%, the NPV 85.3% and 84.8%, respectively. The consistency test between the two observers showed that Kappa value was 0.650 (P &lt; 0.001). The VNCa images had higher CT value in the positive regions than in the negative regions (P &lt; 0.05). Statistically significant differences in the CT value were identified in different regions with the three-scale grading system (thoracic levels: F = 136.690, P &lt; 0.001; lumbar levels: F = 92.689, P &lt; 0.001). Conclusions: Acute traumatic BME in the vertebrae can be detected on VNCa images in both qualitative and quantitative analyses. DECT VNCa images are expected to serve as an additional method for the evaluation of BME.

Meniscus Tear Presented as Bone Marrow Edema Manifested in Hybrid Images in Skeletal Scintigraphy: A Case Report

Chronic knee pain is a common degenerative disorder amongst the elderly, and differential diagnosis through imaging remains crucial. Bone marrow edema represents an increase of water content in the normally fatty bone marrow. The size of the bone marrow edema is associated with the development of knee pain in Osteoarthritis (OA). Bone marrow edema cannot be seen on plain radiography, and while a SPECT/CT scan is more sensitive than MRI in detection of bone marrow edema, the definite diagnosis of bone marrow edema is dependent upon MRI. SPECT/CT is the combination of 3D scintigraphy and computed tomography, which provides more specific anatomical localization and improved sensitivity. It is a valuable tool for the early evaluation of knee pain, as the increase of bone tracer uptake can be seen in bone marrow edema (BME), cartilage lesions, meniscus tear or derangement and valgus/varus alignment. Hence acquiring information from both MRI and SPECT/CT can help determine the optimal treatment. We present a case of chronic knee pain as evaluated by MRI and SPECT/CT.

Meniscus Tear Presented as Bone Marrow Edema Manifested in Hybrid Images in Skeletal Scintigraphy: A Case Report

Chronic knee pain is a common degenerative disorder amongst the elderly, and differential diagnosis through imaging remains crucial. Bone marrow edema represents an increase of water content in the normally fatty bone marrow. The size of the bone marrow edema is associated with the development of knee pain in Osteoarthritis (OA). Bone marrow edema cannot be seen on plain radiography, and while a SPECT/CT scan is more sensitive than MRI in detection of bone marrow edema, the definite diagnosis of bone marrow edema is dependent upon MRI. SPECT/CT is the combination of 3D scintigraphy and computed tomography, which provides more specific anatomical localization and improved sensitivity. It is a valuable tool for the early evaluation of knee pain, as the increase of bone tracer uptake can be seen in bone marrow edema (BME), cartilage lesions, meniscus tear or derangement and valgus/varus alignment. Hence acquiring information from both MRI and SPECT/CT can help determine the optimal treatment. We present a case of chronic knee pain as evaluated by MRI and SPECT/CT.

Dual-energy computed tomography for the detection of sacroiliac joints bone marrow oedema in patients with axial spondyloarthritis.

To investigate the diagnostic performance of dual-energy computed tomography (DECT) in detection bone marrow oedema (BME) in patients with sacroiliitis associated with axial spondyloarthritis (axial SpA). Patients with axial SpA according to the ASAS criteria underwent DECT and 1.5-T magnetic resonance imaging (MRI). DECT was post-processed for generating virtual non-calcium (VNCa) images. The presence of abnormal bone marrow attenuation was scored on DECT VNCa images and MRI using a four-point classification system: 0-1 = absent or non-significant oedema, 2 = oedema present in a third of the articular surface, 3 = oedema present in 2/3 of the articular surface, 4 = diffuse oedema throughout the articular surface. Diagnostic accuracy values for BME were calculated for DECT images (quantitative assessment) by using receiver operating characteristic (ROC) curves analysis, applying MRI as gold standard. Eighty sacroiliac joints from 40 axial SpA patients were included for study analysis, and 36 sacroiliac joints (45%) were classified as having BME at MRI and compared to DECT. Sensitivity, specificity, and positive likelihood ratio (LR+) in the identification of BME at DECT were 90.0%, 92.8%, and 12.6 respectively. Negative LR was 0.11, positive predictive value 93.1%, and negative predictive value 89.7%. The area under the curve (AUC) was 0.953 in the differentiation of the presence of BME. A cut-off value of -1.6 HU (Youden's index = 0.828) yielded a sensitivity of 90.0% and specificity of 92.8%, with an LR+ of 12.6, in the detection of BME in the sacroiliac joints. DECT VNCa images had good diagnostic performance in the evaluation of the extent of BME in patients with sacroiliitis associated with axial SpA.

Quantitative Assessment of Bone Marrow Edema in Adolescent Athletes with Lumbar Spondylolysis Using Contrast Ratio on Magnetic Resonance Imaging.

Study DesignProspective cohort study.PurposeTo quantitatively evaluate bone marrow edema (BME) in the pedicle on magnetic resonance imaging (MRI) for adolescent athlete patients with spondylolysis.Overview of LiteratureSpondylolysis, a stress fracture of the pars interarticularis, is a common occurrence in adolescent athletes with low back pain. T2-weighed fat-saturated MRI is reportedly useful for the detection of BME in the pedicle in the early stage of spondylolysis; however, to our knowledge, the quantitative assessment of BME in spondylolysis has not been reported.MethodsAdolescent athletes with spondylolysis, including those with symptoms of low back pain, were enrolled. The sporting activity of the patients was restricted, and a hard brace was attached to the spine. The BME range of interest was taken on T2-weighed fat-saturated MRI, and the signal intensity (SI) of the BME (SIedema) was measured. The contrast ratio (CR) between the SI of the BME and SI of the spinal cord (SIcord) was calculated per the following formulae: CRedema=(SIedema−SIcord)/(SIedema+SIcord). The CR of the normal pedicle was measured as a control per the following formulae: CRcontrol=(SIcontrol−SIcord)/(SIcontrol+SIcord).ResultsThe study enrolled 32 men and one woman; the mean patient age was 15.2 years (range, 12–18 years). The average CR of the edema and normal pedicle at the first visit was 0.506 (range, 0.097–0.804) and 0.137 (range, −0.741 to 0.572), respectively. The CR of the edema was significantly higher as compared to that of the normal pedicle (p<0.01). MRI that was performed 1 month after the first visit showed that the CR of the edema had decreased to 0.204 (range, −0.152 to 0.517). The CR of the edema 1 month thereafter was significantly lower than that at the first visit (p<0.01).ConclusionsQuantitative assessment of BME using CR on MRI is useful in the evaluation of the healing process of spondylolysis.

Diagnostic accuracy of dual-energy CT virtual non-calcium images with different related contrast material values for the detection of bone marrow edema in knee

PurposeThe purpose of this study was to evaluate the diagnostic accuracy of different related contrast material (Rel.CM) values in dual-energy computed tomography (DECT) virtual non-calcium (VNCa) images for the detection of bone marrow edema (BME) in knee. MethodThis prospective study was approved by the institutional research ethics board, and written informed consent was obtained from all participants. Twenty-three patients (24 knees) who underwent dual-energy CT and MRI within three weeks from July 2018 to June 2019 with a definite history of trauma were enrolled. Each knee was divided into 12 regions. First, MR images served as the reference standard, Receiver operating characteristic (ROC) curve was used and diagnostic accuracy of VNCa images corresponding to different Rel.CM values (1.25, 1.35, 1.45, 1.55, 1.65, 1.75) were analyzed, aimed to select an optimal Rel.CM value of VNCa images for detecting BME. Then, CT values of the normal areas and BME areas were measured on the VNCa images corresponding to the optimal Rel.CM value for preliminary quantitative analysis. The rank-sum test was used to compare the differences of CT values between BME areas and normal bone marrow areas on the VNCa images. ResultsThe 24 knees were divided into 288 areas. MR Imaging showed BME in 121 areas. The areas under the ROC curve with different Rel.CM values (1.25, 1.35, 1.45, 1.55, 1.65, and 1.75) were 0.633, 0.674, 0.882, 0.684, 0.651, and 0.649, respectively. On the VNCa images of Rel.CM = 1.45, the diagnostic accuracy was the highest (up to 89.2 %), the CT values of the BME area and the normal area were -67.9 (1.7∼-100.1) HU and -94.5 (-69.7∼-144.9) HU, respectively, with statistical significance (Z=-9.804, P < 0.05). ConclusionsThe VNCa images with a Rel.CM value of 1.45 is optimal for the detection of BME in knee.

Diagnostic accuracy of dual-energy CT for detecting bone marrow edema in patients with acute knee injuries: a systematic review and meta-analysis

This systematic review and meta-analysis evaluated the diagnostic accuracy of dual-energy CT (DECT) for detecting bone marrow edema (BME) in adult patients with acute knee injuries. A systematic review of MEDLINE, EMBASE, Scopus, the Cochrane Library, and gray literature was performed from inception to January 31, 2020, using PRISMA-DTA guidelines. The review included studies assessing the diagnostic accuracy of DECT for detecting BME in at least 10 adult patients with acute knee injuries and with an MRI reference standard. Study details were independently extracted by two reviewers. Meta-analysis was performed using a bivariate mixed-effects regression model with subgroup analysis performed to evaluate for sources of variability. Risk of bias (ROB) was evaluated using the QUADAS-2 tool. Eight studies evaluating 267 patients between the ages of 25-54 with acute knee injuries undergoing DECT and MRI were included in analysis. Summary sensitivity, specificity, and AUROC values for BME were 84% (95% confidence interval (CI) 74-91%), 96% (95% CI 93-98%), and 0.97 (95% CI 0.95-0.98), respectively. Bone-based characterization was found to have lower specificity than region-based characterization (83% (57-95%) versus 97 (96-98%), p < 0.05), but no difference in sensitivity. No other statistical differences were identified amongst study subgroups to account for presumed variability amongst studies. Most studies were rated low risk for bias and applicability concerns. DECT is specific and accurate for detecting BME in adult patients with acute knee injuries and can be used as an alternative to MRI, particularly when MRI is contraindicated or unavailable.

Modified therapy concepts for fragility fractures of the pelvis after additional MRI.

BackgroundFractures of the pelvic ring in elderly patients have increased in frequency over time. These injuries are associated with a high morbidity and have a socio-economic impact. The diagnostic procedures and their influence of therapy decisions are still controversial.MethodsIn a retrospective study, we investigate the value of additional MRI examination on therapy decision of fragility fractures of the pelvis. The evaluation of all patients with pelvic fractures without adequate trauma and with performed CT and MRI was conducted at three large German hospitals. The imaging procedure took place within a maximum interval of 4 weeks. After evaluation of the imaging, the resulting therapeutic consequences either based on CT alone or on CT and MRI were reviewed by experienced pelvic surgeons.ResultsOf 754 patients with pelvic injuries, 67 (age 80 +/- 9.7 years, f: m 54:13) could be included. The detection of vertical fractures in CT (n = 40 unilateral, n = 11 bilateral) could be increased by the additional MRI (n = 44 unilateral, n = 23 bilateral). A horizontal fracture component was identified in CT in 9.0% (n = 6) vs. MRI in 25.4% (n = 17) of the cases. An anterior pelvic ring injury was detected in 71.6% (n = 44; 4x bilateral) in CT, in 80.6% in MRI (n = 50, 4 bilateral). Additive MRI imaging increased the decision rate for surgical therapy from 20.9% (n = 14) to 31.3% (n = 21).ConclusionsThe results of this study further support the value of bone marrow edema detection by MRI diagnostics (or dual source CT which showed promising initial results) for the detection of pelvic ring fractures. For the first time, the study identifies an additional therapeutic consequence by an increased rate of surgical procedures.

Diagnostic accuracy of dual-energy CT for the detection of bone marrow edema in the appendicular skeleton: a systematic review and meta-analysis.

This meta-analysis evaluated the diagnostic accuracy of dual-energy CT (DECT) for detecting bone marrow edema (BME) in the appendicular skeleton. A systematic review of MEDLINE, EMBASE, Scopus, the Cochrane Library, and gray literature from inception through January 31, 2020, was performed. Original articles with > 10 patients evaluating the accuracy of DECT for detecting BME in the appendicular skeleton with a reference standard of MRI and/or clinical follow-up were included. Study details were independently extracted by two reviewers. Meta-analysis was performed using a bivariate random-effects model with multivariable meta-regression. Risk of bias (RoB) was evaluated with QUADAS-2. Twenty studies evaluating 790 patients for BME in the appendicular skeleton were included in analysis. The summary sensitivity, specificity, and AUC values for BME in the appendicular skeleton were 86% (95% confidence interval [CI] 82-89%), 93% (95% CI 90-95%), and 0.95, respectively. Quantitative analysis had a higher sensitivity than qualitative analysis on meta-regression (p = 0.01), but no difference in specificity (p = 0.28). No other covariates contributed to variability in accuracy (etiology (trauma vs non-trauma); location (upper vs lower extremity); and RoB). Studies demonstrated generally low or unclear RoB and applicability. Eight studies included index tests with high RoB when quantitative assessments used a retrospective cut-off value. DECT demonstrates a higher specificity than sensitivity and AUC > 0.9. In scenarios where MRI availability is limited or contraindicated, DECT could be an alternative to MRI for detecting BME in the appendicular skeleton. However, limitations in sources of variability and RoB warrant continued study. • Twenty studies evaluating 790 patients for bone marrow edema in the appendicular skeleton with dual-energy CT were included in analysis. • The summary sensitivity, specificity, and AUC values for detecting bone marrow in the appendicular skeleton were 86% (95% confidence interval [CI] 82-89%), 93% (95% CI 90-95%), and 0.95, respectively. • In scenarios where MRI availability is limited or is contraindicated, DECT could be an alternative to MRI for detecting bone marrow edema in the appendicular skeleton.

A study to find the utility of MRI in the evaluation of painful hip joints

Introduction: Magnetic resonance (MR) imaging is a valuable tool in the evaluation of hip disorders. With these, a study was conducted to assess the role of MRI in the early evaluation of painful hip joints. Materials and Methods: It was a cross-sectional study conducted in the department of Radiodiagnosis, GSL Medical College, Rajahmundry. The study protocol was approved by the Institutional Ethical Committee. Patients presenting with acute or chronic hip pain pathology of all age groups, both gender who referred for MRI were included in the study. Imaging has been done with 1.5 Tesla Philips Achieva machines using abdominal surface coils and spine coils. Results: Out of the 30 participants, avascular necrosis was diagnosed in 46.6% (14) participants, joint effusion in 10% (3) cases, osteoarthritis (OA) in 4 (13.3%) cases, tuberculosis (TB) in 10% (3), 6.6% (2) each was diagnosed to be Perthe’s, developmental dysplasia of the hip (DDH) and metastasis, respectively. All the pathological findings were diagnosed using MRI also. Conclusion: MRI helps in the evaluation of the involvement of articular cartilage in the form of T2W hyperintensity. It also helps in the evaluation of soft tissue involvement along with the detection of bone marrow edema.

Dual-Energy CT for Suspected Radiographically Negative Wrist Fractures: A Prospective Diagnostic Test Accuracy Study.

Background Patients with wrist trauma and negative findings on radiographs often undergo additional MRI examinations to assess for radiographically occult fractures. Dual-energy CT may be more readily available than MRI in some settings. Purpose To evaluate the diagnostic test accuracy of dual-energy CT in helping detect bone marrow edema and fracture in participants with wrist trauma and clinical suspicion of a wrist fracture but with negative findings on radiographs. Materials and Methods Adults were prospectively enrolled between January 2018 and November 2018. Wrists were examined with dual-energy CT and MRI, and images were read by four readers who were blinded to clinical information. The presence of bone marrow edema and fracture was rated per bone. The reference standard for bone marrow edema was the combined reading of MRI scans. The reference standard for fracture was a combined reading of MRI and dual-energy CT scans. A fifth radiologist arbitrated results in case of discrepancies. Diagnostic test accuracy was calculated per reader and for readers combined using exact binomial tests. Results Forty-six participants (mean age, 47 years ± 19 [standard deviation]; 24 men [52%]) were enrolled, and 750 bones (50 wrists) were assessed. Dual-energy CT had an average sensitivity of 94% (95% confidence interval [CI]: 80%, 99%; 31 of 33 wrists) and specificity of 65% (95% CI: 38%, 86%; 11 of 17 wrists) in the detection of wrists with bone marrow edema and a sensitivity of 69% (95% CI: 55%, 81%; 36 of 52 bones) and a specificity of 98% (95% CI: 97%, 99%; 682 of 696 bones) in the detection of edema in individual bones. MRI had a sensitivity of 80% (95% CI: 63%, 91%; 28 of 35 wrists) and a specificity of 93% (95% CI: 68%, 100%; 14 of 15 wrists) in helping detect wrists with fractures. Dual-energy CT had a sensitivity of 91% (95% CI: 77%, 98%; 32 of 35 wrists) and a specificity of 87% (95% CI: 60%, 98%; 53 of 60 wrists) in helping detect wrists with fractures. McNemar tests showed no significant differences between MRI and dual-energy CT (P = .07 to >.99) for all readers. Conclusion Dual-energy CT had a high sensitivity and a moderate specificity in the detection of bone marrow edema of the wrist. Dual-energy CT had high sensitivity and specificity in depicting fractures of the wrist in patients with suspected wrist fractures and negative findings on radiographs. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Fukuda in this issue.

Is bone marrow edema syndrome a precursor of hip or knee osteonecrosis? Results of 49 patients and review of the literature.

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. 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. 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. 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.

Bone marrow edema around the hip in non-traumatic pain: dual-energy CT vs MRI.

To evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) in identifying bone marrow edema (BME) around the hip joint in non-traumatic patients. This prospective IRB-approved study was conducted between January 2019 and October 2019 and included 59 consecutive patients (18 males, 41 females; mean age 61.5years, range 32-82) who were assessed by DECT and magnetic resonance imaging (MRI) within a 5-day period. Diagnostic accuracy values for diagnosing BME on a per-patient and on a per-partition-basis analysis were calculated for DECT images by two readers (R1 and R2, with 15 and 10years of experience, respectively), using MRI as reference for diagnosis. Inter-observer agreements were calculated with k-statistics. A p value of < 0.05 was considered as statistically significant. MRI depicted BME in 44/59 patients (74.58%), with the involvement of 83/708 (11.72%) partitions. The sensitivity, specificity, and accuracy of R1 and R2 were 95.45% (42/44), 86.67% (13/15), and 93.22% (55/59) for R1, and 86.36% (38/44), 80.00% (12/15), and 84.75% (50/59) for R2. For both readers, the BME detection rate was higher in patients with severe edema (100%) in comparison to patients with mild edema (91.30% and 73.91%). In the partition-basis analysis, sensitivity, specificity, and accuracy ranges were 33.3 to 100%, 91.84 to 100%, and 88.14 to 100%, respectively. The inter-observer agreement for patients' analysis was substantial (k = 0.7065), whereas for partition analysis ranged from fair (k = 0.2976) to near-perfect (k = 1.000). DECT can accurately identify BME around the hip joint, in comparison to MRI. • DECT can accurately identify bone marrow edema around the hip joint in a cohort of non-traumatic patients. • The detection of bone marrow edema by means of DECT may help the radiologist to identify associated findings, including avascular necrosis of the femoral head and insufficiency or stress fractures. • In cases of patients suffering from groin pain with bone marrow edema identified by DECT, the concurrent reading of high-resolution conventional CT images may increase the confidence of diagnosis and/or reduce the reading time.

The occurrence of sacroiliitis in HLA-B*35-positive patients with undifferentiated spondyloarthritis. A cross sectional MRI study.

To investigate possible association between sacroiliitis and HLA-B*35 positivity. After excluding patients with axial spondyloarthritis and HLA-B*27 positivity, psoriasis inflammatory bowel disease, preceding infections, or juvenile type of spondyloarthritis, 110 patients were recruited with a diagnosis of undifferentiated axial spondyloarthritis. All of them had inflammatory back pain of short duration (3months to 2years) and 72 were HLA-B*35 positive. In order to determine if there is a possible association of sacroiliitis and HLA-B*35 positivity, all patients underwent MRI of sacroiliac joints. A statistically significant association between the detection of bone marrow edema at sacroiliac joints on MRI and HLA-B*35 positivity (χ2 = 6.25; p = 0.022) was found. A logistic regression analysis revealed that the presence of HLA-B*35 allele was associated with a 6 times greater chance of identifying bone marrow edema at sacroiliac joints on MRI (OR 6, 95% CI 1.3-27, p = 0.021). HLA-B*35 positivity was also associated with a 4.7 times greater chance of finding elevated CRP (OR 4.7, 95% CI 1-11.9, p = 0.047) and a 5 times greater chance of finding peripheral joint synovitis (OR 5, 95% CI 1.75-14.3, p = 0.003). HLA-B*35-positive patients had high disease activity (mean ± SD of Bath Ankylosing Spondylitis Disease Activity Index 6.1 ± 1.72 and Ankylosing Spondylitis Disease Activity Score C-reactive protein Index 3 ± 0.64) with a high degree of functional limitations (mean ± SD of Bath Ankylosing Spondylitis Functional Index 5.3 ± 2.16). The data clearly show the association between bone marrow edema on MRI at sacroiliac joints and HLA-B*35 allele in patients with undifferentiated spondyloarthritis. Further work is needed to understand how much this result may influence follow-up of these patients. Key Points • HLA-B*35 allele was associated with a 6 times greater chance of identifying bone marrow edema at sacroiliac joints on MRI in un-axSpa patients. • HLA-B*35 allele was also associated with a 4.7 times greater chance of finding elevated CRP and a 5 times greater chance of finding peripheral joint synovitis in un-axSpa patients. • HLA-B*35 allele could be a potential risk factor for developing sacroiliitis and axSpA.

Bone marrow edema in sacroiliitis: detection with dual-energy CT.

To evaluate the feasibility and diagnostic accuracy of dual-energy computed tomography (DECT) for the detection of bone marrow edema (BME) in patients suspected for sacroiliitis. Patients aged 18-55years with clinical suspicion for sacroiliitis were enrolled. All patients underwent DECT and 3.0T MRI of the sacroiliac joints on the same day. Virtual non-calcium (VNCa) images were calculated from DECT images for demonstration of BME. VNCa images were scored by two readers independently using a binary system (0 = normal bone marrow, 1 = BME). Diagnostic performance was assessed with fluid-sensitive MRI as the reference standard. ROIs were placed on VNCa images, and CT numbers were displayed. Cutoff values for BME detection were determined based on ROC curves. Forty patients (16 men, 24 women, mean age 37.1years±9.6years) were included. Overall inter-reader agreement for visual image reading of BME on VNCa images was good (κ = 0.70). The sensitivity and specificity of BME detection by DECT were 65.4% and 94.2% on the quadrant level and 81.3% and 91.7% on the patient level. ROC analyses revealed AUCs of 0.90 and 0.87 for CT numbers in the ilium and sacrum, respectively. Cutoff values of - 44.4HU (for iliac quadrants) and - 40.8HU (for sacral quadrants) yielded sensitivities of 76.9% and 76.7% and specificities of 91.5% and 87.5%, respectively. Inflammatory sacroiliac BME can be detected by VNCa images calculated from DECT, with a good interobserver agreement, moderate sensitivity, and high specificity. • Virtual non-calcium images calculated from dual-energy CT can detect sacroiliac bone marrow edema in patients suspected for sacroiliitis. • Dual-energy CT has a high specificity in bone marrow edema detection. • Virtual non-calcium images for bone marrow edema in patients with a large amount of red bone marrow or obvious sclerosis near the articular surface should be interpreted with caution.

Detection of Bone Marrow Edema in the Head and Neck With Dual-Energy CT: Ready for Clinical Use?

OBJECTIVE. The aim of this study is to evaluate the ability of dual-energy CT (DECT) to identify bone marrow edema (BME) in the head and neck region in comparison with MRI as the standard of reference. MATERIALS AND METHODS. A total of 33 patients who underwent imaging between February 2016 and February 2018 were included in this retrospective study. All patients underwent both DECT and MRI for head and neck abnormalities. Two radiologists independently visually assessed virtual noncalcium (VNCa) reconstructions with color-coded maps for the presence of BME. STIR or T2-weighted MRI reconstructions with fat suppression were used as the standard of reference for BME. Subjective quality assessment and severity of metal artifacts were scored on both imaging modalities. RESULTS. BME was detected in 18 patients on DECT compared with 20 patients on MRI. Most BME seen on DECT was located in the mandible. VNCa DECT images had a sensitivity, specificity, positive predictive value, and negative predictive value for BME of 85%, 92%, 94%, and 80% respectively, using MRI as the reference. The quality of the images was rated as excellent to moderate in 94% of the patients for VNCa DECT compared with 82% of the patients for MRI, but this difference was not statistically significant. Significantly more metal artifacts were scored on the mixed DECT images than on the MR images, but these artifacts did not interfere with diagnosis. CONCLUSION. BME detection in the head and neck region seems possible with VNCa DECT images and has the potential to provide an alternative for MRI in clinical practice.

Diagnostic accuracy of dual energy CT in the assessment of traumatic bone marrow edema of lower limb and its correlation with MRI

Background:Bone marrow edema is assumed to be caused as a result of trabecular microfractures that are detected by MRI. As MRI is not widely available in countries like India, this study aims to encourage the use of DECT in detection of bone edema as evidence with comparable efficiency to MRI.Aim:To assess the diagnostic accuracy of dual-energy CT in detecting bone marrow edema in patients of trauma of lower limb and correlate it with MRI.Setting and Design:It is a cross-sectional study.Materials and Methods:The study included 40 patients of age 15–70 years irrespective of sex. All the patients of lower extremity trauma underwent DECT and MRI evaluation after clinical evaluation. All the images were postprocessed on a work station and were further evaluated by a radiologist.Results:Mean attenuation at fractured site observed by Dual energy CT was found to be significantly higher as compared to that at adjacent site (170.75 ± 33.99 vs. 19.73 ± 22.50 HU). The sensitivity and specificity of dual energy CT as compared to MRI in detecting bone marrow edema were 94.1% and 91.3%, respectively. Of the 40 cases enrolled in the study, agreement of MRI and Dual energy CT was observed in 37 (92.5%).Conclusion:Dual energy CT can be an effective alternative to MRI in the detection of bone marrow edema in patients of lower limb trauma. Dual energy CT can also be used in patients in whom MRI is contraindicated.