Cortical Bone Erosion Research Articles

Evaluation of mandibular odontogenic keratocyst and ameloblastoma by panoramic radiograph and computed tomography.

The purpose of this study was to describe and compare the main imagenological features of mandibular ameloblastomas and odontogenic keratocyst (OKC) using panoramic radiograph (PR) and CT. The sample consisted of nine cases of ameloblastomas and nine cases of OKC. PR and CT images were analyzed according to shape, internal structure, borders, associated unerupted tooth, root resorption, expansion and perforation of cortical bones. PR evaluation allowed the identification of the lesion's location, presence of sclerosis in the periphery, presence of associated non-erupted tooth and expansion of the mandible's lower border cortical bone. CT was more accurate than PR in the assessment of the lesion shape, presence of inner bone septa, root resorption, buccolingual expansion and rupture of cortical bone. Most cases of ameloblastoma and OKC presented buccolingual expansion and erosion of cortical bone. Only ameloblastomas showed tooth root resorption. Although PR is very helpful and widely used, CT provides more precise information on buccolingual expansion, calcification, bone septa, perforation of cortical bones and tooth resorption, features that are frequently underdescribed in the literature, particularly in OKC.

Cortical erosion after elastic stable intramedullary nail fixation for pediatric long bone fractures: Case series according to the site

BackgroundElastic stable intramedullary nail (ESIN) is widely used for treatment of long bone fractures in children. However, migration of the nail or cortical bone erosion in children has been reported. This study was conducted to investigate the incidence of cortical erosion according to the site and cortical erosion type. Materials and methodsA total of 221 normally developing children (223 fractures) who were treated with ESIN for fractures of the long bones without cortical breakage at immediate postoperative radiography and with the ESIN in position for more than 6 months were included. Two pediatric orthopaedic surgeons reviewed all the radiographs. Cortical bone erosion was defined when the two investigators agreed that there was cortical breakage by the ESIN. ResultsPenetration of nails through the bone cortex was observed in 25 patients (11.2%). Fifteen patients (6.7%) showed cortical erosion at the diaphysis and ten patients (4.5%) showed protrusion of the tip of the ESIN at the metaphysis–diaphysis junction. The average time for hardware removal in patients with cortical erosion was 14.2 months. ConclusionCortical bone erosion by ESIN could occur in pediatric long bones without any iatrogenic problem or disease related to the bony structure. Erosion at diaphysis was more common than at metaphysis–diaphysis junction. Cortical erosion should be considered in children who retain their ESIN for a long time.

Diagnostic accuracy of multi-detector row computed tomography and magnetic resonance imaging in assessment of mandibular involvement, cervical lymph node metastases and T parameter staging of squamous cell carcinomas of tongue and floor of mouth

Background: Tongue and floor malignancies can be diagnosed based on biopsy and clinical examination, but diagnostic imaging is essential to confirm and define the size and extent of the disease.Objectives: The aim of this study was to recognise and understand the extent and precision of the diagnostic accuracy of multi-detector row computed tomography (MDCT) and magnetic resonance imaging (MRI) in mandibular tumour involvement, cervical lymph node metastases, T staging of tongue and floor of mouth malignancies in order to represent the proper treatment plan.Methods: Fifty patients with histologically proven squamous cell carcinomas (SCC) of tongue and floor of mouth malignancies underwent both multi-detector row computed tomography and magnetic resonance imaging before surgery. Two radiologists independently, unaware of the findings, in consensus reviewed and interpreted all images to determine the extent of the primary tumour (T), mandibular tumour invasion and cervical lymph node metastasis. Imaging results obtained were correlated with postoperative histopathologic findings that represented our referencestandard. Cohen’s kappa index and McNemar test were used to verify the concordance between the two radiologists and above mentioned three study parameters.Results: Magnetic resonance imaging showed superiority to multi-detector row computed tomography in the evaluation of the T parameter staging of TNM classifi cation and medullary bone involvement while multi-detector row computed tomography was more accurate compared to magnetic resonance imaging in the visualization of small cortical bone erosions. However, both the modalities demonstrated similar diagnostic performance in detection of metastatic lymph nodes.Conclusion: Multi-detector row computed tomography and magnetic resonance imaging have nearly equal potential for detecting the tumour size, mandibular infiltration and nodal metastases.Journal of Kathmandu Medical College, Vol. 5, No. 4, Issue 18, Oct.-Dec., 2016, page:104-111

RADIOGRAPHIC FINDINGS IN PATIENTS WITH MEDICATION-RELATED OSTEONECROSIS OF THE JAW

Knowledge of imaging aspects of medication-related osteonecrosis of the jaw (MRONJ) represents valuable importance, since some cases may be asymptomatic. The aim of this study was to retrospectively assess the radiographic findings in patients with MRONJ. The study was conducted with records and panoramic radiographs of 35 patients treated with bisphosphonates and diagnosed with MRONJ. During radiographic analysis, findings such as osteolytic area, erosion of cortical bone, bone sequestration, bone sclerosis, periosteal reaction, abnormalities in the lamina dura, presence of pathologic fracture were surveyed. Medical information and staging were also recorded to correlate with radiographic findings. All panoramic radiographs showed important findings in the jaws. Osteosclerosis was the most frequent alteration, followed by osteolysis and abnormalities of the lamina dura. The mandible was more affected than maxilla. There was no significant difference between genders nor significant correlation between the number of injuries with age, bisphosphonate usage time, and staging of the disease. Panoramic radiograph is a useful screening tool in patients submitted to antiresorptive and antiangiogenic therapies, especially with bisphosphonates. In this study, although all cases had been previously diagnosed as MRONJ, radiographic findings may improve early diagnosis, establishing preventive approach for this complication. FAPESP 2014/13055-0.

Radiographic Findings in Patients with Medication-Related Osteonecrosis of the Jaw.

A retrospective study was conducted of the records and panoramic radiographs of 35 patients treated with bisphosphonates (BP) and diagnosed with MRONJ. Panoramic radiography was used for evaluation, by two examiners, the following findings were subject of search: osteolysis (OT), cortical bone erosion (EC), bone sclerosis focal (FS) and diffuse (DS), bone sequestration (BS), thickening of lamina dura (TD), prominence of the inferior alveolar nerve canal (IAN), persisting alveolar sockets (SK), and the presence of a pathological fracture (PF). Medical information and staging were also recorded in order to correlate with radiographic findings. Bone sclerosis was the most frequent alteration, followed by OT and TD. The mandible was more affected than the maxilla. There was no significant difference between genders or significant correlation between the number of injuries with age and duration of BP usage. Considering the association between the radiographic findings and MRONJ staging, EC was predominant in stage 3 and DS in stage 2. IAN and PF demonstrated greater association with stage 3. In conclusion, the higher the clinical staging, the greater the severity of the bone alteration. Panoramic radiographic examination is a useful screening tool in patients submitted to antiresorptive therapy.

P1.03-028 Wolf in Sheep's Clothing - Primary Lung Cancer Mimicking Benign Diseases

Lung cancer is the biggest cancer killer and typically presents as mass or nodule, round or oval in shape. Recognition and diagnosis of these typical cases is often straightforward, whereas diagnosis of uncommon manifestations of primary lung cancer certainly is far more challenging. The aim of this pictorial essay is to illustrate the Computed Tomography (CT) and histopathology findings of uncommon manifestations of primary lung cancer with focus on these entities that mimic benign diseases. Cases presented were collected during the Multidisciplinary Thoracic Oncology Tumor Board between January 2014 and May 2016 and have histopathologic proof. Lung cancer can mimic a variety of benign diseases, including infection, granulomatous disease, lung abscess, postinfectious scarring, mediastinal mass, emphysema, atelectasis and pleural disease. Previous history, clinical and biochemical parameters are certainly helpful and necessary in the assessment of these cases, but often aspecific and inconclusive. Whereas 18FDG-PET is the cornerstone in diagnosis and staging of lung cancer, it’s role in these uncommon manifestations is less straightforward since benign diseases, such as granulomatous and infectious diseases may also present with increased FDG-uptake. Chest CT is the imaging modality of choice and plays a central role in these cases. ‘Irregular air bronchogram sign’ in pneumonia-like lung cancer, ‘drowned lung sign’ in obstructive atelectasis and cortical bone erosion in lung cancer mimicking pleural disease are important signs that point to a malignant etiology. The stippled and eccentric morphology of calcifications in apical lesions aids in differentiating these lesions from postinfectious scarring. Mucinous tumors can mimic a pulmonary abscess and small cell lung cancer can typically present as mediastinal mass without parenchymal abnormalities. Lung cancer presenting with a miliary pattern or cavitating nodules can mimic granulomatous disease. Lung cancer presenting with cystic airspaces and ‘emphysema-like’ morphology is an uncommon entity in which early recognition is crucial since these tumors have an aggressive nature. Key imaging findings and tips and tricks for recognizing these uncommon faces of primary lung cancer will be discussed and illustrated. Primary lung cancer can mimic a wide variety of benign entities. Knowledge of these uncommon and atypical manifestations is crucial to avoid delay in diagnosis and treatment. A multidisciplinary approach in these cases is mandatory.

Association of COL1A1 polymorphism with subchondral bone degeneration of the temporomandibular joint

The G/T polymorphism of the COL1A1 gene exhibits a clinically significant influence on bone remodelling, leading to a predisposition to degenerative diseases. The enhancement of bone turnover and further loss of bone mass are thought to be the primary pathological changes in the early degenerative course of temporomandibular joint osteoarthritis (TMJ OA), with the appearance of low-density lesions. Thus, it was hypothesized that this polymorphism may also affect this type of bone lesion in TMJ OA. A total of 130 TMJ OA patients with low-density lesions (cortical bone erosion, condylar head resorption, cyst-like lesion) and 186 healthy individuals were recruited. DNA samples were extracted from buccal mucosa swabs; genotyping was performed by high-resolution melting assay. The distribution of genotypes in these groups was compared using a multivariate logistic regression model. No significant differences in the distributions of TT and TG genotypes were observed between the groups (P>0.05). Significance was detected for GG homozygous carriers (P=0.043); this genotype might be a risk factor for this type of low-density lesion (odds ratio 1.643, 95% confidence interval 1.016–2.658). This study indicates that the GG genotype might be a risk factor for low-density lesions in the TMJ.

36 Radiographic manifestations of pubic symphysis osteomyelitis in the prostate cancer survivor: Definitive diagnosis lies in findings on magnetic resonance imaging

INTRODUCTION AND OBJECTIVES: Pubic symphysis osteomyelitis (PSO) represents a debilitating complication of radiation and ablative treatments for prostate cancer. The definitive radiographic diagnosis of this is not described. In this review, we characterize the plain film radiographic and magnetic resonance imaging (MRI) findings of PSO in prostate cancer survivors treated at a tertiary referral center providing multidisciplinary treatment for PSO. METHODS: We conducted a retrospective review of an IRB approved database of prostate cancer survivors diagnosed with PSO from 2011 to 2015. Demographic and radiographic data were collected and analyzed. All patients suspected of having PSO underwent a plain film radiograph of the pelvis and a pelvic MRI with T1-weighted and fatsuppressed T2-weighted fast spin echo sequences. Intravenous gadolinium was utilized as determined by the clinical scenario. RESULTS: 17 patients were identified with PSO. All patients underwent plain radiographs of the pelvis at our institution. 16 had MRIs performed and interpreted at our institution and one MRI at another facility. The median age of these patients was 71 (range 64-84). All patients demonstrated increased signal on T2-weighted sequences and decreased signal on T1-weighted sequences along the pubic symphysis and the marrow of the involved pubic rami. High T2 signal at the origin of the obturator and adductor muscle groups (69%) along with diastasis of the pubic symphysis with cortical bone erosion (63%) were identified in the majority of patients. A fluid collection was identified in 75% of patients with the periprostatic space (n1⁄44), parasymphyseal region (n1⁄44), and left rectus muscle (n1⁄42) being the most common locations. 65% of plain films demonstrated no radiographic evidence of PSO CONCLUSIONS: MRI of pubic symphysis osteomyelitis in the prostate cancer survivor is characterized by high signal on T2 weighted images and low signal on T1-weighted images of the pubic symphysis and the bone marrow of involved pubic rami, with the majority of patients demonstrating regional myositis. Cortical erosion and fluid collections were also common findings in our cohort. The constellation of these findings combined with one’s clinical assessment should prompt consideration for PSO and will facilitate appropriate management. Plan radiography of the pelvis will miss the majority of radiographic findings critical to establishing a diagnosis. We consider MRI to be the definitive diagnostic modality for this clinical entity.

Retrospective study of sonographic findings in bone involvement associated with rotator cuff calcific tendinopathy: preliminary results of a case series

ObjectiveThe present study was aimed at investigating bone involvement secondary to rotator cuff calcific tendonitis at ultrasonography.Materials and MethodsRetrospective study of a case series. The authors reviewed shoulder ultrasonography reports of 141 patients diagnosed with rotator cuff calcific tendonitis, collected from the computer-based data records of their institution over a four-year period. Imaging findings were retrospectively and consensually analyzed by two experienced musculoskeletal radiologists looking for bone involvement associated with calcific tendonitis. Only the cases confirmed by computed tomography were considered for descriptive analysis.ResultsSonographic findings of calcific tendinopathy with bone involvement were observed in 7/141 (~ 5%) patients (mean age, 50.9 years; age range, 42-58 years; 42% female). Cortical bone erosion adjacent to tendon calcification was the most common finding, observed in 7/7 cases. Signs of intraosseous migration were found in 3/7 cases, and subcortical cysts in 2/7 cases. The findings were confirmed by computed tomography. Calcifications associated with bone abnormalities showed no acoustic shadowing at ultrasonography, favoring the hypothesis of resorption phase of the disease.ConclusionPreliminary results of the present study suggest that ultrasonography can identify bone abnormalities secondary to rotator cuff calcific tendinopathy, particularly the presence of cortical bone erosion.

Thermal ablation for the treatment of bone metastases (BM) in patients (pts) with metastatic renal cell carcinoma (mRCC): Experience from IGR.

437 Background: Local treatment of BM in mRCC pts comprises different approaches including thermal ablation techniques as well as radiofrequency ablation (RFA) and cryotherapy. We report our experience for the treatment of BM of mRCC pts using thermal ablation. Methods: The medical records of all pts with mRCC submitted to thermal ablation of BM from Feb 2008 to Oct 2013 were retrospectively analyzed. Intention of treatment was recorded in 3 categories: complete treatment of all BM in pts with oligometastatic disease or prevention of skeletal related events (SRE) risk and/or pain relief in pts with multimetastatic disease. The local control rate and prognostic factors for local failure (LF) were analyzed including patient characteristics, extension of disease, BM characteristics and type of treatment. Results: 22 pts with BM of mRCC were treated by thermal ablation techniques, with 32 procedures (3 pts had >=3 BM treated). Histology of primary tumor was clear cell in 20 and chromophobe carcinoma in 2 pts. At time of BM treatment, Heng prognostic score was good, intermediate and poor in 36, 59 and 5% of pts. Median age was 67 yrs (48-85). A majority of men were treated (16/22=73%). In 34%, pts had BM synchronous with the primary. BM presented cortical bone erosion in 69% and neurological structures in the vicinity in 50%. Intention of treatment was complete control of BM in 43% and prevention of risk of SRE and/or pain relief in 57% of pts. Cryotherapy was performed in 72% and RF in 28% of cases. Concomitant cimentoplasty and arterial embolization was performed in 70% and 30% respectively. Pain relief was achieved in 81% of pts. LF occurred in 19% of pts (n=6) (95% CI: 4-33%). The median follow-up was 13.4 months (95% CI: 11-21). Median OS was not reached. 86% of pts are still alive at 12 months. The unfavorable prognostic factors for LF were BM size >50 mm (p=0.035) and neurological structures in the vicinity (p=0.0083). Conclusions: Thermal ablation techniques are treatment options that should be considered in the curative and palliative treatment of BM in pts with mRCC. When indications are carefully discussed, these techniques have the potential to achieve good local control and acceptable survival.

Position of magnetic resonance in the imaging of inflammatory rheumatic diseases.

Position of magnetic resonance in the imaging of inflammatory rheumatic diseases.

SAT0165 Cortical Breaks and Bone Erosions in the Hand Joints: A Cadaver Study Comparing Conventional Radiography with High-Resolution and Micro-Computed Tomography

BackgroundConventional radiography (CR) is considered the gold standard for diagnosing bone erosions in rheumatic diseases. However, High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT) and microCT (μCT) allow analysis of bone erosions...

SP0202 How to Measure Bone Quality in Daily Practice?

In recent years a number of new imaging techniques have been developed in order to evaluate components of bone quality in-vivo, in particular advanced three-dimensional Quantitative Computer Tomography (QCT), high...

Thermal ablation techniques: a curative treatment of bone metastases in selected patients?

Thermal ablation techniques (radiofrequency-ablation/cryotherapy) can be indicated with a curative intent. The success rate and prognostic factors for complete treatment were analysed. The medical records of all patients who had undergone curatively intended thermal ablation of bone metastases between September 2001 and February 2012 were retrospectively analysed. The goal was to achieve complete treatment of all bone metastases in patients with oligometastatic disease (group 1) or only of bone metastases that could potentially lead to skeletal-related events in patients with a long life expectancy (group 2). We report the rate of complete treatment according to patient characteristics, primary tumour site, bone metastasis characteristics, radiofrequency ablation/cryotherapy and the treatment group (group 1/group 2). Eighty-nine consecutive patients had undergone curatively intended thermal ablation of 122 bone metastases. The median follow-up was 22.8 months [IQR = 12.2-44.4]. In the intent-to-treat analysis, the 1-year complete treatment rate was 67% (95%CI: 50%-76%). In the multivariate analysis the favourable prognostic factors for complete local treatment were oligometastatic status (p = 0.02), metachronous (p = 0.004) and small-sized (p = 0.001) bone metastases, without cortical bone erosion (p = 0.01) or neurological structures in the vicinity (p = 0.002). Thermal ablation should be included in the therapeutic arsenal for the cure of bone metastases. • Thermal ablation techniques are currently performed to palliate pain caused by bone metastases. • In selected patients, thermal ablation can also be indicated with a curative intent. • Oligometastatic and/or metachronous diseases are good prognostic factors for local success. • Small-size (<2 cm) bone metastases and no cortical erosion are good prognostic factors.

High-resolution in vivo imaging of bone and joints: a window to microarchitecture

Imaging is essential to the evaluation of bone and joint diseases, and the digital era has contributed to an exponential increase in the number of publications on noninvasive analytical techniques for the quantification of changes to bone and joints that occur in health and in disease. One such technique is high-resolution peripheral quantitative CT (HR-pQCT), which has introduced a new dimension in the imaging of bone and joints by providing images that are both 3D and at high resolution (82 μm isotropic voxel size), with a low level of radiation exposure (3-5 μSv). HR-pQCT enables the analysis of cortical and trabecular properties separately and to apply micro-finite element analysis for calculating bone biomechanical competence in vivo at the distal sites of the skeleton (distal radius and distal tibia). Moreover, HR-pQCT makes possible the in vivo assessment of the spatial distribution, dimensions and delineation of cortical bone erosions, osteophytes, periarticular cortical and trabecular microarchitecture, and 3D joint-space volume of the finger joints and wrists. HR-pQCT is, therefore, a technique with a high potential for improving our understanding of bone and joint diseases at the microarchitectural level.

Combined SPECT/CT improves detection of initial bone invasion and determination of resection margins in squamous cell carcinoma of the head and neck compared to conventional imaging modalities

Knowledge of the presence and extent of bone infiltration is crucial for planning the resection of potential bone-infiltrating squamous cell carcinomas of the head and neck (HNSCC). Routinely, plain-film radiography, multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) are used for preoperative staging, but they show relatively high rates of false-positive and false-negative findings. Scintigraphy with (99m)Tc-bisphosphonate has the ability to show increased metabolic bone activity. If combined with anatomical imaging (e.g. (SPECT)/CT), it facilitates the precise localization of malignant bone lesions. The aim of this study was to analyse the indications and advantages of SPECT/CT compared with standard imaging modalities and histology with regard to specificity and sensitivity A longitudinally evaluated group of 30 patients with biopsy-proven HNSCC adjacent to the mandible underwent (99m)Tc-bisphosphonate SPECT/CT, MRI, MSCT and conventional radiography before partial or rim resection of the mandible was performed. Bone infiltration was first evaluated with plain films, MSCT and MRI. In a second reading, SPECT/CT data were taken into account. The results (region and certainty of bone invasion) were evaluated among the different imaging modalities and finally compared with histological specimens from surgical resection as the standard of reference. For a better evaluation of the hybrid property of SPECT/CT, a retrospectively evaluated group of 20 additional patients with tumour locations similar to those of the longitudinally examined SPECT/CT group underwent SPECT, MSCT and MRI. To assess the influence of dental foci on the specificity of the imaging modalities, all patients were separated into two subgroups depending on the presence or absence of teeth in the area of potential tumour-bone contact. Histologically proven bone infiltration was found in 17 patients (57 %) when analysed by conventional imaging modalities. SPECT/CT data revealed bone infiltration in two additional patients (7 %), who both showed discrete cortical bone erosion not visible by MSCT or MRI. There were no false-positive or false-negative findings on SPECT/CT. The quality criteria for detecting bone involvement in HNSCC by SPECT/CT were as follows: sensitivity 100 % (lower 95 % confidence interval limit 80 %), specificity 100 % (75 %), positive predictive value 100 % (80 %) and negative predictive value 100 % (75 %). Corresponding data for MRI were 95 % (76 %), 94 % (73 %), 95 % (76 %) and 94 % (73 %), and for MSCT were 89 % (71 %), 100 % (85 %), 100 % (86 %) and 88 % (69 %). In the retrospective evaluation SPECT showed results similar to SPECT/CT. Hybrid SPECT/CT has a high specificity as it can provide additional information about the existence and local extent of malignant bone infiltration of the mandible. Although the sensitivity of conventional SPECT is similar to that of SPECT/CT, the latter provides a much better delineation of the local tumour-bone contact area. Based on this information, surgical intervention of the rim versus partial resection can be planned and performed more precisely. Patient outcome can be improved by avoiding undertreatment and unnecessary or overextended bone resections.

Association of cortical shape of the mandible on panoramic radiographs with mandibular trabecular bone structure in Japanese adults: a cone-beam CT-image analysis

The purpose of this study was to assess the association between the cortical shape of the mandible, as detected on panoramic radiographs, and trabecular bone structure, as assessed by cone-beam computed tomography (CBCT), in Japanese adults. Panoramic radiographs and CBCT images of the mandibles of 50 subjects (18 men, 32 women), aged 45–86 years, were evaluated. An experienced oral and maxillofacial radiologist categorized the cortical shape of the mandible as detected on panoramic radiographs as normal, mildly to moderately eroded, and severely eroded cortices, respectively. All mandibles were scanned using CBCT. Four bone structure parameters of the basal portion of the mandible were calculated in three dimensions using an image-analysis system: total bone volume (mm3); cortical bone volume fraction (%); trabecular bone volume fraction (%); fractal dimension. One-way analysis of covariance with Bonferroni correction was employed to evaluate differences in the four bone parameters among the three cortical shape groups. Pearson’s correlation coefficient was calculated to examine correlations between age and cortical and trabecular bone volume fractions. Progression of cortical bone erosion was significantly associated with increased trabecular bone volume fraction (P < 0.001) and increased fractal dimension (P = 0.01). Cortical bone volume fraction decreased significantly with age (P = 0.04). However, trabecular bone volume fraction tended to increase with age (P = 0.06). The change in the trabecular bone structure of the mandible may differ from that of the general skeleton in Japanese adults.

Sclerostin inhibition reverses systemic, periarticular and local bone loss in arthritis

ObjectiveTo test whether inhibition of sclerostin by a targeted monoclonal antibody (Scl-Ab) protects from bone and cartilage damage in inflammatory arthritis. Sclerostin is a potent inhibitor of bone formation and...

Bone metastasis versus bone marrow metastasis? Integration of diagnosis by 18F-fluorodeoxyglucose positron emission/computed tomography in advanced malignancy with super bone scan: Two case reports and literature review

Super scan pattern on technetium-99m methyldiphosphonate (Tc-99m MDP) bone scintigraphy is a special condition of extremely high bone uptake relative to soft tissue with absent or faint renal radioactivity visualization, which is usually seen in diffuse bone metastases or discrete endocrine entities. Here, two cases with super bone scan are presented. One was a young man diagnosed with gastric cancer. The other was a middle-aged woman with a history of breast cancer with recent recurrence. Both cases had 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) diagnosis simultaneously. Based on imaging of 18F-FDG PET/CT, diffusely incremental 18F-FDG avidity in spine/pelvis on PET and subtle erosion of cortical bone on CT were seen. The cytological results of bone marrow biopsy showed evidence of malignant metastasis. However, there were several focal discrepant findings between the 18F-FDG PET/CT and Tc-99m MDP bone scan. According to integration of both imaging findings and the result of bone marrow biopsy, we believe that the disseminated malignant spread in bone marrow is a primitive alternation in the super bone scan and that it is also as a result of neoplasm-related endocrine factors.

Interobserver Agreement of Magnetic Resonance Imaging Signs of Osteomyelitis in Pelvic Pressure Ulcers in Patients With Spinal Cord Injury

ObjectiveTo examine the interobserver reliability of magnetic resonance imaging (MRI) signs of osteomyelitis in complex chronic pressure ulcers in patients with spinal cord injury (SCI). DesignRetrospective review study. SettingSpecialist SCI rehabilitation center. ParticipantsAdult patients with SCI and pressure ulceration investigated with MRI. InterventionsAnalysis of MRI examinations and clinical records collected over a 4-year period. Images were independently assessed by 2 experienced radiologists for osteomyelitis based on assigned predictive indicators including cortical bone erosion, soft tissue edema, deep collections, heterotopic new bone, hip effusion, and abnormal signal change of the marrow. Main Outcome MeasuresInterobserver agreement for indicative MRI signs of osteomyelitis in complex pressure ulcers. ResultsThirty-seven patients underwent 41 MRI scans. Concordance for marrow edema was 71% on both short tau inversion recovery and T1-weighted sequences, and for cortical erosion was 85%. ConclusionsFor the assessment of pelvic osteomyelitis related to pressure ulcers, the T1-weighted MRI signal for marrow edema and cortical erosion has strong interobserver agreement.