Bone Marrow Edema Pattern Research Articles

Prevalence of Spondyloarthritis Among Patients Who Underwent Lumbar Disc Herniation Surgery.

This study aims to estimate the prevalence of spondyloarthritis (SpA) among patients who had been surgically treated for lumbar disc herniation (LDH), according to the modified New York (mNY) criteria for the diagnosis of ankylosing spondylitis and Amor, the European Spondyloarthropathy Study Group (ESSG), the Assessment of Spondyloarthritis International Society (ASAS) classification criteria for SpA. The study included 321 patients (142 males, 179 females; mean age 49±10.8 years; range, 18 to 79 years) who underwent LDH surgery between April 2008 and May 2012 in the neurosurgery clinic of our hospital. Patients were contacted by phone on at least two attempts. Totally, 123 patients accepted to come to the outpatient clinic, while the remaining 198 agreed to be interviewed on the phone. Patients who agreed to come to the outpatient rheumatology clinic underwent clinical examination, and pelvic X-ray and magnetic resonance imaging (MRI) scan of the sacroiliac joints when indicated. Inflammatory back pain was diagnosed in 108 patients (34%) and 40 patients (13%) according to Calin criteria and the ASAS criteria, respectively. Prevalence of SpA among all patients was estimated as 17.7% according to the ESSG criteria, and 8.7% according to Amor criteria. Five of the 308 pelvic radiographs had definite radiographic sacroiliitis as required by the mNY criteria. Four patients had a characteristic pattern of bone marrow edema on MRI examination in accordance with the ASAS definitions. The overall prevalence of sacroiliitis (MRI sacroiliitis+X-ray sacroiliitis) among the patients who came to the clinic was 7.3% ([4+5]/123). The relatively increased prevalence of SpA among patients who underwent LDH surgery indicates the necessity of increasing awareness on the new concept of axial SpA for specialists treating patients with low back pain.

Etiology of Lumbosacral Radiculoplexopathy: Sacral Insufficiency Fracture on Magnetic Resonance Imaging.

Sacral insufficiency fracture (SIF) can cause lumbosacral radiculoplexopathy (LSRP) and is probably under-recognized. Symptoms may include nonspecific lumbar spine or buttock pain that is exacerbated by physical activity and alleviated with rest. The frequency of LSRP secondary to SIF has not been reported. We aimed to determine the frequency of LSRP associated with SIF using magnetic resonance imaging (MRI) of the lumbar spine. We searched a radiology database at our institution using the keywords "sacral insufficiency fracture" and "lumbar spine MRI" for patient records from January 2014 through December 2017. We assessed for the presence of LSRP, reflected by elevated T2-weighted or short tau inversion recovery (STIR) signal intensity and enlargement of the nerve on noncontrast lumbar spine MRI. An incompletely healed vertically oriented SIF was confirmed if there was a persistent bone marrow edema pattern adjacent to the fracture site; we did not include purely transverse SIFs. The final cohort comprised 57 patients (48 female; age range, 14 to 89years). Abnormalities of the extraforaminal L5 nerve root or the combined L4 and L5 nerve roots (the lumbosacral trunk) were identified in 19 (33%) of 57 patients, with a total of 23 sites (bilateral involvement in four cases). Of the 23 abnormal nerves, 19 (82.6%) had corresponding, clinically documented radicular symptoms and 16 (69.6%) had no other explanation on MRI for their radicular symptoms other than SIF. LSRP caused by SIF is an entity all radiologists should be cognizant of, especially in cases of otherwise unexplained radicular symptoms. The diagnosis of SIF can be helpful in cases involving concomitant multilevel lumbar spondylosis and neural foraminal stenosis.

MRI with state-of-the-art metal artifact reduction after total hip arthroplasty: periprosthetic findings in asymptomatic and symptomatic patients.

To assess the spectrum of periprosthetic MRI findings after primary total hip arthroplasty (THA). This multi-center cohort study analyzed 31 asymptomatic patients (65.7 ± 12.7 years) and 27 symptomatic patients (62.3 ± 11.9 years) between 6 months and 2 years after THA. 1.5-T MRI was performed using Compressed Sensing SEMAC and high-bandwidth sequences. Femoral stem and acetabular cup were assessed for bone marrow edema, osteolysis, and periosteal reaction in Gruen zones and DeLee and Charnley zones. Student t test and Fisher's exact test were performed. The asymptomatic and symptomatic groups showed different patterns of imaging findings. Bone marrow edema was seen in 19/31 (61.3%) asymptomatic and 22/27 (81.5%) symptomatic patients, most commonly in Gruen zones 1, 7, and 8 (p ≥ 0.18). Osteolysis occurred in 14/31 (45.2%) asymptomatic and 14/27 (51.9%) symptomatic patients and was significantly more common in Gruen zone 7 in the symptomatic group (8/27 (29.6%)) compared to the asymptomatic group (2/31 (6.5%)) (p = 0.03). Periosteal reaction was present in 4/31 asymptomatic (12.9%) and 9/27 symptomatic patients (33.3%) and more common in Gruen zones 5 and 6 in the symptomatic group (p = 0.04 and 0.02, respectively). In the acetabulum, bone marrow edema pattern was encountered in 3/27 (11.1%) symptomatic patients but not in asymptomatic patients (p ≥ 0.21). Patient management was altered in 8/27 (29.6%) patients based on MRI findings. Periprosthetic bone marrow edema is common after THA both in asymptomatic and symptomatic patients. Osteolysis and periosteal reaction are more frequent in symptomatic patients. MRI findings led to altered patient management in 29.6% of patients. • Bone marrow edema pattern was frequent in both asymptomatic and symptomatic patients after THA, particularly around the proximal femoral stem in Gruen zones 1, 7, and 8. • Osteolysis was significantly more frequent in symptomatic patients in Gruen zone 7. • Periosteal reaction occurred more frequently in symptomatic patients in Gruen zones 5 and 6.

MRI Analysis for Clarification of Mechanism of Ankle Osteoarthritis: When the Talar Tilt Exceeds 15 Degrees, the BME Pattern of the Ankle Are Changes

Category:Ankle ArthritisIntroduction/Purpose:In recent years, total ankle arthroplasty (TAA) has been widely performed for severe ankle osteoarthritis (OA). However, TAA is not always successful in cases of advanced varus; in fact, some researchers have stated caution regarding its indication. Previously, to elucidate the pathological condition of ankle OA using MRI, we investigated that confirmed the existence of an association among the Takakura–Tanaka classification, foot and ankle alignment, and bone marrow edema (BME). In this study, we focused on the talar tilt angle and compared the cases of terminal ankle OA as per Takakura– Tanaka classification (stage 3b and 4) wherein this angle exceeded 15° with those wherein it did not exceed in terms of the mode of BME onset.Methods:Of 616 cases of ankle OA diagnosed in our hospital between May 2009 and January 2018, we examined the MRI images of 52 feet of 50 patients diagnosed with severe ankle OA. The talar tilt angle with the ankle under load was measured using frontal X-ray, following which the presence/absence of BME was determined by dividing the talus, subtalar, and Chopart’s joints into 22 regions (areas 1–11 and 1’–11’). In statistical analysis, we first obtained the total number of BME incidences for each case. Then, after dividing this disease group into severe varus (SV; talar tilt angle = 15° or more) and mild varus (MV; talar tilt angle < 15°) groups, we compared t-test scores for the respective BME incidence rates. Furthermore, we used Fisher’s exact test to examine differences in terms of BME incidence rates between the two groups for each subdivided region.Results:No significant differences were found between the two groups in terms of BME incidence rates for each case. However, the rates in each area were significantly lower in the SV group than in the MV group for area 2 (SV group, 14%; MV group, 57%) and area 4 (SV group, 7%; MV group, 39%), i.e. the SV groups corresponding to the outer surface of the trochlea talar.Conversely, in the subtalar joint, the rates were significantly higher in the SV group than in the MV group for area 10 (SV group, 36%; MV group, 11%) and area 10’ (SV group, 29%; MV group, 5%), i.e. the medial surface of the calcaneus.Conclusion:In cases of severe ankle OA wherein the talar tilt angle exceeds 15°, the load exerted on the outer side of the talus decreases in the talar joint, whereas a greater load is exerted on the medial subtalar joint located at the innermost side in the subtalar joint. Differences in terms of the mode of BME incidence in the subtalar joint, which is not replaced with normal TAA, may be a poor prognostic factor for postoperative TAA.

MR variability of collagen meniscal implant remodelling in patients with good clinical outcome.

Collagen meniscal implants (CMI) have variable imaging findings on MRI and it remains ambiguous, if alterations may be present in asymptomatic patients. The aim was, to evaluate MR morphological characteristics and volume of CMI in the early, mid- and long-term follow-up. Fifty-seven patients (mean age, 43.6±11years; 41 male/16 female) with good clinical outcome (subjective visual analogue scale for satisfaction < 2 and a Lysholm-score ≥ 84) after CMI were assessed retrospectively using MRI 1, 2 and 3-8years postoperatively. CMI morphology, signal intensity (SI), homogeneity and size were assessed and a meniscal score was calculated. Chondral defects and bone marrow edema pattern were reported and summarized in a chondral score. Meniscal extrusion and volume were evaluated. Intra- and inter-reader reliabilities were calculated. Spearman and partial correlations were used (p < 0.05). One year postoperatively, the CMI varied in size [10% (4/40) normal, 30% (12/40) small, 60% (24/40) hypertrophic] and was hyperintense and inhomogeneous in all patients. At long-term follow-up, the size of CMI decreased [6% (1/17) resorbed, 18% (3/17) normal, 41% (7/17) small, 35% (6/17) hypertrophic]. The SI of the CMI changed to normal in only 13% (2/16). The majority was still hyperintense [87% (14/16)]. Less meniscal extrusion was present in the follow-up [71% (11/16) versus initially 93% (37/40)]. The meniscal score improved significantly (ρ = 0.28). Over time, full-thickness femoral chondral defects were increasingly present [65% (10/17) versus initially 33% (13/40)] and the chondral score worsened significantly (p = 0.017). Abnormal and inhomogeneous SI and irregular margins of the early postoperative CMI on MRI are findings seen in patients with good clinical results and should not necessarily be overcalled when reporting MRI. These features tend to decrease over time. IV.

MR Imaging of the Hip: An Update on Bone Marrow Edema.

Bone marrow edema (BME) represents a frequent and easily detected MR imaging finding that is recognized as a common source of pain. It is considered a nonspecific finding that constitutes a central component of a wide spectrum of pathologies affecting the hip joint, showing high variability in terms of prognosis and treatment requirements. Solid knowledge of the various BME patterns and associated imaging findings indicative of these conditions can aid in differentiation. Additionally, correlation with clinical and laboratory data are essential for arriving at a final diagnosis in several cases. In this review, we describe the disease characteristics and imaging findings and also highlight the differential diagnostic clues regarding common hip disorders associated with BME including avascular necrosis, transient osteoporosis, stress injuries, and infectious/inflammatory disorders.

Is treated HIV infection associated with knee cartilage degeneration and structural changes? A longitudinal study using data from the osteoarthritis initiative

BackgroundMetabolic disorders presenting in HIV-infected patients on antiretroviral therapy (ART) may increase the risk of osteoarthritis. However, structural changes of the knee in HIV infected subjects are understudied. The aim of this study is to investigate knee cartilage degeneration and knee structural changes over 8 years in subjects with and without HIV infection determined based on the use of ART.MethodsWe studied 10 participants from the Osteoarthritis Initiative who received ART at baseline and 20 controls without ART, frequency matched for age, sex, race, baseline body mass index (BMI) and Kellgren & Lawrence grade. Knee abnormalities were assessed using the whole-organ magnetic resonance imaging score (WORMS) and cartilage T2 including laminar and texture analyses were analyzed using a multislice-multiecho spin-echo sequence. Signal abnormalities of the infrapatellar fat pad (IPFP) and suprapatellar fat pad (SPFP) were assessed separately using a semi-quantitative scoring system. Linear regression models were used in the cross-sectional analysis to compare the differences between ART/HIV subjects and controls in T2 (regular and laminar T2 values, texture parameters) and morphologic parameters (subscores of WORMS, scores for signal alterations of IPFP and SPFP). Mixed effects models were used in the longitudinal analysis to compare the rate of change in T2 and morphological parameters between groups over 8 years.ResultsAt baseline, individuals on ART had significantly greater size of IPFP signal abnormalities (P = 0.008), higher signal intensities of SPFP (P = 0.015), higher effusion scores (P = 0.009), and lower subchondral cysts sum scores (P = 0.003) compared to the controls. No significant differences were found between the groups in T2-based cartilage parameters and WORMS scores for cartilage, meniscus, bone marrow edema patterns and ligaments (P > 0.05). Longitudinally, the HIV cohort had significantly higher global knee T2 entropy values (P = 0.047), more severe effusion (P = 0.001) but less severe subchondral cysts (P = 0.002) on average over 8 years.ConclusionsKnees of individuals with HIV on ART had a more heterogeneous cartilage matrix, more severe synovitis and abnormalities of the IPFP and SPFP, which may increase the risk of incident knee osteoarthritis.

Magnetic resonance imaging appearances of the capsulo-osseous layer of the iliotibial band and femoral attachments of the iliotibial band in the normal and pivot-shift ACL injured knee

BackgroundBiomechanical evidence suggests that the anterolateral structures of the knee may be important restraints against anterolateral rotatory instability (ALRI) in the setting of anterior cruciate ligament (ACL) injury.ObjectiveTo describe the anatomy and presence of injury of the capsule-osseous layer of the iliotibial band (CITB), the iliotibial band, and its deep distal femoral attachments in patients with a ‘normal’ knee (no pivot-shift bone marrow edema (BME) pattern) and patients with a pivot-shift BME pattern indicative of a pivot-shift injury associated with ACL tears.MethodsGroup 1: 20 consecutive patients with no MRI evidence of pivot-shift injury and group 2: 20 consecutive patients with a pivot-shift BME pattern on MRI were identified. Retrospective consensus analysis of the anatomy and appearances of the CITB and the ‘proximal’ and ‘epicondylar’ distal femoral attachments of the ITB was performed for each MRI by two experienced musculoskeletal radiologists.ResultsThe positive predictive value (PPV) of CITB injury for pivot-shift ACL injury was 74%, negative predicted Value (NPV) was 80%. The PPV for injury of the ‘proximal’ ITB femoral attachment with pivot-shift ACL injury was 93%, NPV was 84%. The PPV for ‘epicondylar’ iliotibial femoral attachment injury was 62%, NPV was 45%.ConclusionsInjury of the CITB and ‘proximal’ deep femoral attachments of the ITB are good markers for ACL injury even in the absence of a Segond fracture and should be evaluated on all MRIs as they may prove important in the further management of ALRI.

MRI Findings at the Bone-Component Interface in Symptomatic Unicompartmental Knee Arthroplasty and the Relationship to Radiographic Findings.

The most common modes of failure of cemented unicompartmental knee arthroplasty (UKA) designs are aseptic loosening and unexplained pain at short- to mid-term follow-up, which is likely linked to early fixation failure. Determining these modes of failure remains challenging; conventional radiographs are limited for use in assessing radiolucent lines, with only fair sensitivity and specificity for aseptic loosening. We sought to characterize the bone-component interface of patients with symptomatic cemented medial unicompartmental knee arthroplasty (UKA) using magnetic resonance imaging (MRI) and to determine the relationship between MRI and conventional radiographic findings. This retrospective observational study included 55 consecutive patients with symptomatic cemented UKA. All underwent MRI with addition of multiacquisition variable-resonance image combination (MAVRIC) at an average of 17.8±13.9months after surgery. MRI studies were reviewed by two independent musculoskeletal radiologists. MRI findings at the bone-cement interface were quantified, including bone marrow edema, fibrous membrane, osteolysis, and loosening. Radiographs were reviewed for existence of radiolucent lines. Inter-rater agreement was determined using Cohen's κ statistic. The vast majority of symptomatic UKA patients demonstrated bone marrow edema pattern (71% and 75%, respectively) and fibrous membrane (69% and 89%, respectively) at the femoral and tibial interface. Excellent and substantial inter-rater agreement was found for the femoral and tibial interface, respectively. Furthermore, MRI findings and radiolucent lines observed on conventional radiographs were poorly correlated. MRI with the addition of MAVRIC sequences could be a complementary tool for assessing symptomatic UKA and for quantifying appearances at the bone-component interface. This technique showed good reproducibility of analysis of the bone-component interface after cemented UKA. Future studies are necessary to define the bone-component interface of symptomatic and asymptomatic UKA patients.

Arthroscopic Treatment of Osteochondral Lesions of the Talus Using Juvenile Articular Cartilage Allograft and Autologous Bone Marrow Aspirate Concentration

Juvenile allogenic chondrocyte implantation (JACI; DeNovo NT Natural Tissue Graft®; Zimmer, Warsaw, IN) with autologous bone marrow aspirate concentrate (BMAC) is a relatively new all-arthroscopic procedure for treating critical-size osteochondral lesions (OCLs) of the talus. Few studies have investigated the clinical and radiographic outcomes of this procedure. We collected the clinical and radiographic outcomes of patients who had undergone JACI-BMAC for talar OCLs to assess treatment efficacy and cartilage repair tissue quality using magnetic resonance imaging (MRI). Forty-six patients with critical-size OCLs (≥6 mm widest diameter) received JACI-BMAC from 2012 to 2014. We performed a retrospective medical record review and assessed the functional outcomes pre- and postoperatively using the Foot and Ankle Outcome Score (FAOS) and Short-Form 12-item general health questionnaire. MRI was performed preoperatively and at 12 and 24 months postoperatively. Cartilage morphology was evaluated on postoperative MRI scans using the magnetic resonance observation of cartilage tissue (MOCART) score. The pre- to postoperative changes and relationships between outcomes and lesion size, bone grafting, lesion location, instability, hypertrophy, and MOCART scores were analyzed. Overall, the mean questionnaire scores improved significantly, with almost every FAOS subscale showing significant improvement postoperatively. Concurrent instability resulted in more changes that were statistically significant. The use of bone grafting and the presence of hypertrophy did not result in statistically significant changes in the outcomes. Factors associated with outcomes were lesion size and hypertrophy. Increasing lesion size was associated with decreased FAOS quality of life subscale and hypertrophy correlating with changes in the pain subscale. Of the 46 patients, 22 had undergone postoperative MRI scans that were scored. The average MOCART score was 46.8. Most patients demonstrated a persistent bone marrow edema pattern and hypertrophy of the reparative cartilage. Juvenile articular cartilage implantation of the DeNovo NT allograft and BMAC resulted in improved functional outcome scores; however, the reparative tissue still exhibited fibrocartilage composition radiographically. Further studies are needed to investigate the long-term outcomes and determine the superiority of the arthroscopic DeNovo procedure compared with microfracture and other cartilage resurfacing procedures.

Influence of Bone Marrow Edema on Medial Unicompartmental Knee Arthroplasty among Patients with Patellofemoral Osteoarthritis.

AbstractThis study aims to compare clinical outcomes in unicompartmental knee arthroplasty (UKA) patients with or without magnetic resonance imaging (MRI) evidence of bone marrow edema (BME) in the patella and to evaluate the effect of functional outcomes after UKA in patients with patellofemoral osteoarthritis (PF OA). Outcomes of 146 knees in 141 patients who underwent medial UKA were included. According to their preoperative condition of patellofemoral joints, patients were divided into three groups: Group A, non-PF OA (Kellgren–Lawrence [K–L] scale = 0); group B, PF OA without BME (K–L ≥ 1, bone marrow edema pattern [BMEP] = 0); group C, PF OA with BME (K–L ≥ 1, BMEP ≥ 1). Clinical outcomes including visual analog scale (VAS) scores of knee pain, Hospital for Special Surgery (HSS) scores, and range of motions (ROMs) were evaluated and analyzed at the postoperative follow-up of 3 months and 2 years. From our results, BME was highly correlated to poor outcome in patients with UKA. At follow-up of 3 months, BME influenced the clinical outcome of UKA at an early postoperative stage in terms of VAS scores, HSS scores, and ROMs. At the final follow-up of 2 years, the clinical outcome was improved in terms of HSS score, although the anterior knee pain and active ROMs were still worse than that of patients without BME. In conclusion, there was no significant difference in clinical outcomes in patients without BME regardless of PF OA. However, the condition of BME should be taken serious consideration because of its indication of an adverse effect on the outcome after UKA.

MR imaging of BioCartilage augmented microfracture surgery utilizing 2D MOCART and KOOS scores

ObjectivesBioCartilage is a novel scaffold-based microfracture augmentation technique that has been shown to aid in chondrogenic differentiation of adult progenitor cells resulting in formation of more hyaline-like cartilage. As this cartilage repair technique becomes more commonplace, it is essential that the musculoskeletal radiologist and orthopedic surgeon gain familiarity with the surgical technique and its post-operative MR imaging findings. MethodsWe present several case studies regarding MRI findings (modified clinical 2D MOCART) and clinical outcome (KOOS) scores in patients who have undergone this novel surgical procedure. For data analysis KOOS scores where dichotomized to scores greater or less than 80, and MOCART scores were dichotomized to scores greater or less than 50. A fisher exact test was then performed to determine if there was any correlation between parameters of the modified 2D MOCART and KOOS scores (Tables 2 and 3). ResultsMarrow elements travel through the microfracture holes and interact with the scaffold created by BioCartilage, rather than creating their own fibrin scaffold, as is typically anticipated from a marrow stimulation procedure. Interestingly, the amount defect fill, presence of an intact surface, intact subchondral bone, or lack of effusion did not correlate with positive outcomes. Parameters that trended towards significance included presence of adhesions and subchondral lamina. Completeness of cartilage interface, homogeneity, and signal intensity also failed to reach statistical significance. In our experience, patients that demonstrated mild repair tissue surface irregularity, but with preservation of greater than 50% thickness compared to surrounding native cartilage, mild irregularity of subchondral plate, with vertical low signal intensity lines (sequela of prior microfracture surgery), and mild or no bone marrow edema pattern demonstrated higher KOOS scores. ConclusionBiocartilage in conjunction with microfracture is an encouraging cartilage restoration technique that promotes regeneration of more robust hyaline-like cartilage compared to the fibrocartilage formed after conventional microfracture. The T2 mapping properties of the repair tissue after successful BioCartilage augmented microfracture surgery are very similar to that of the adjacent native cartilage. Although there appear to be characteristic trends in a successful repair, further research is warranted to elucidate any correlations between specific characteristics of the repair and patient clinical outcomes.

Protocol optimization of sacroiliac joint MR Imaging at 3 Tesla: Impact of coil design and motion resistant sequences on image quality.

To evaluate the impact of coil design and motion-resistant sequences on the quality of sacroiliac magnetic resonance imaging (MRI) examination in patients with spondyloarthropathy. One hundred and twenty-one patients with suspected sacroiliitis and referred for MRI of the sacroiliac joints were retrospectively evaluated with MRI at 3-Tesla. There were 78 women and 43 men with a mean age of 36.7±11.5 (SD) years (range: 15.8-78.4 years). Conventional and motion-resistant fat-saturated fast-spin echo T2-weighted sequences were performed with two different coils. Image quality was subjectively evaluated by two independent readers (R1 and R2) using a four-point scale. Confidence in the identification of bone marrow edema pattern (BMEP) was also evaluated subjectively using a three-point scale. Phased array body coil yielded improved image quality compared to surface coil (14.1 to 30.4% for R1 and 14.6 to 25.7% for R2; P<0.0001). The impact of the sequence type on quality was also statistically significant (P=0.0046). BMEP was identified in 40 patients and best inter-reader agreement was obtained using the combination of phased-array body coil with motion-resistant T2-weighted sequence (kappa 0.990). The smallest number of indeterminate BMEP zones was seen on MRI set acquired with the phased-array body coil and motion-resistant T2-weighted sequence. Phased array body coil and motion-resistant T2-weighted sequences perform better than surface coil and conventional T2-weighted sequences for the evaluation of sacroiliac joints, increasing confidence in the identification of BMEP.

Osteitis condensans ilii may demonstrate bone marrow edema on sacroiliac joint magnetic resonance imaging.

To reveal whether bone marrow edema (BME) may appear with osteitis condensans ilii (OCI) on sacroiliac joint (SIJ) magnetic resonance imaging (MRI) and to evaluate the characteristics of BME demonstrated with OCI. Altogether 27 symptomatic female OCI patients with both complete clinical records and SIJ-MRI examination data were enrolled for retrospective analysis. SIJ-MRI exams were retrospectively analyzed by two musculoskeletal radiologists. Patients were separated into BME group and non-BME group according to whether there was BME of SIJ demonstrated as high signal intensity on MR short tau inversion recovery sequences beneath the SIJ articular surface. For the BME group the characteristics of BME including distribution pattern and location, depth and signal intensity were assessed. BME could be seen in 48.1% (13/27) OCI patients. Ilium side BME demonstrated with OCI was centered at the ventral-cartilaginous joint part and had a trend of extending to bone marrow beneath the arcuate line in a continuous distribution pattern. There was a trend that OCI patients with BME demonstrated on MRI were younger (P = 0.054, Student's t-test) and with shorter pain duration (P = 0.091, Student's t-test) than OCI patients without BME, but the differences did not reaching statistical significance. More cases endured diagnosis delay in the BME group than the non-BME group (nine cases vs. two cases, P = 0.006, Fisher's exact test). Some OCI may demonstrate BME on SIJ-MRI. Careful observation of the location and distribution pattern of BME may give some help in differentiating OCI from early spondyloarthritis.

Prevalence of Os Styloideum in National Hockey League Players.

Background:Os styloideum describes an accessory carpal ossicle between the trapezoid, the capitate, and the second and third metacarpals. Injuries to this tissue have been described as part of the carpal boss syndrome. While the etiology of os styloideum remains uncertain, it may represent a physiologic response to altered loading forces in the wrist, similar to the development of cam-type deformity in the hips of ice hockey players or the Bennett lesion in the shoulders of baseball pitchers.Hypothesis:Professional hockey players will have a higher prevalence of os styloideum compared with the general population.Study Design:Case series.Level of Evidence:Level 4.Methods:A retrospective review of 16 professional hockey players from 4 different National Hockey League (NHL) teams who underwent unilateral imaging of the wrist was performed. Seventeen wrists were reviewed for the presence of os styloideum.Results:Thirteen of 16 players (81%) had an os styloideum, representing an increased prevalence compared with the general population. Previous clinical and cadaveric studies estimated a general prevalence of up to 19% (P < 0.001). For the 10 players who had their leading wrist scanned, 9 had an os styloideum (90%). Ten of 11 (91%) players demonstrated a bone marrow edema pattern within the metacarpal and the os styloideum on magnetic resonance imaging. There was no significant association between the presence of an os styloideum and the player’s position, leading wrist, or years in the league.Conclusion:There appears to be an increased prevalence of os styloideum among NHL players, and team physicians should consider this finding while formulating a differential diagnosis for dorsal wrist pain.Clinical Relevance:This study identified NHL players as having an increased prevalence of os styloideum compared with the general population. By doing so, these findings represent an opportunity to enhance our understanding of the etiology, clinical significance, and treatment of os styloideum.

Osteochondritis Dissecans: Baseball and Familial Connections.

The exact mechanism by which osteochondritis dissecans (OCD) lesions develop is poorly understood. The etiology is likely multifactorial, with repetitive microtrauma, focal bone ischemia, and genetic factors having been proposed as contributors to this condition, which is characterized by injury to articular cartilage and underlying subchondral bone. This month’s “Case Connections” spotlights 3 case reports of OCD in young baseball players, 2 of whom developed the condition in the shoulder. A fourth case report details 3 presentations of bilateral OCD of the femoral head that occurred in the same family over 3 generations. In the December 28, 2016, edition of JBJS Case Connector, Grau et al. report on a 16-year-old Major League Baseball (MLB) pitching prospect in whom an OCD lesion of the shoulder healed radiographically and clinically after 8 months of non-throwing and physical therapy focused on improving range of motion and throwing mechanics. The patient presented with no history of trauma, but, despite 6 weeks of physical therapy, he reported persistent pain in the posterior aspect of the right throwing shoulder—to the point where he couldn’t throw a baseball >90 ft (27.4 m) without excruciating pain. Physical examination revealed an internal rotation deficit of 35°; other range-of-motion and strength tests were normal. Shoulder radiographs were normal, but MRI scans showed a 1.7 × 1.9-cm chondral lesion with associated subchondral bone irregularity that encompassed approximately 40% of the glenoid articular surface (Fig. 1). Fig. 1 Two MRI scans of the same shoulder, showing a large osteochondral lesion involving the central and posterior margins of the glenoid, with irregularity and sclerosis of the subchondral plate. Arrows indicate a subtle bone marrow edema pattern. The patient was told to stop all throwing activities, and he embarked on a regimen of physical therapy concentrating on capsular stretching to address the internal rotation …

Abnormal Bone Marrow Signal Intensity in the Phalanges of the Foot as a Manifestation of Raynaud Phenomenon: A Report of Six Patients.

The objectives of our study were to describe the MRI findings of pedal phalangeal bone marrow edema in patients with Raynaud phenomenon (RP) and discuss the clinical implications of these MRI findings. There is a progressive distal-to-proximal pattern of pedal phalangeal bone marrow edema on MRI in patients with RP. This knowledge may allow early diagnosis and treatment of rheumatologic disorders that are potentially associated with RP.

Subchondral linear hyperintensity of the femoral head: MR imaging findings and associations with femoro-acetabular joint pathology

The goal of this study was to evaluate the associations between linear hyperintensity in the subchondral bone of the femoral head on T2-weighted MR imaging and structural bone lesions. The MR imaging examinations of 63 patients (66 hips) that showed a bone marrow edema pattern (BMEP) of the hip were retrospectively evaluated (study group). The study group comprised 43 men and 20 women, with a mean age of 55.3 years±16.9 (SD) (range: 19-84 years). A control group of 61 patients (77 hips) without BMEP of the hip on MR imaging was created. The control group comprised 30 men and 31 women, with a mean age of 53.1 years±15.6 (SD) (range: 25-83 years). The presence of linear abnormalities of the subchondral bone on T2-weighted fat-saturated sequences (TR/TE=4220-4340/42-45ms) was evaluated and MR imaging findings were correlated with structural femoro-acetabular pathology (advanced chondropathy, osteonecrosis, subchondral insufficiency fractures and macroscopic fractures) and with pain duration. A linear hyperintensity in the subchondral bone on T2-weighted MR imaging was found in 43/66 hips with areas of BMEP (65.1%) and in 3/77 hips without BMEP (3.8%). Subchondral linear hyperintensity was seen in 15/16 (93.7%) hips with a subchondral insufficiency fracture. Among the 16 hips with an ARCO stage III osteonecrosis, 13 (76.9%) presented BMEP associated with a subchondral linear hyperintensity. BMEP was present in 6/8 hips with ARCO stage IV osteonecrosis; however, only two hips (25%) exhibited subchondral linear hyperintensities. Finally, 77.7% of patients with subchondral linear hyperintensities presented with acute or subacute hip pain (P<0.0001). Femoral head subchondral linear hyperintensity on T2-weighted MR imaging is common and is associated with acute subchondral bone damage.

Association of bone marrow edema with temporomandibular joint (TMJ) osteoarthritis and internal derangements

Purpose: This study reviewed the dental literature in order to determine the association of bone marrow edema with osteoarthritis and temporomandibular joint (TMJ) internal derangement disorders.Methods: A literature search was performed using electronic databases PubMed/Medline (National Library of Medicine, Bethesda, Maryland) and Cochrane for articles published during the last 15 years (January 2000–December 2014). A predetermined inclusion and exclusion criteria were used for filtering the scientific papers. Research articles fulfilling the basic inclusion criteria were included in the review.Results: The reviewed studies showed that bone marrow edema is found in painful joints with osteoarthritis in a majority of cases. A few cases with no pain or significant degenerative changes are reported to have a bone marrow edema pattern as well.Conclusions: Bone marrow edema, increased fluid level, and pain are associated with osteoarthritis in the majority of patients reporting TMJ arthritis. Degenerative and disc displacement conditions are multifactorial and require further investigations. Magnetic resonance imaging can be employed to detect bone marrow edema even in the absence of pain and clinical symptoms in the patients of internal derangements.

Longitudinal assessment of MRI in hip osteoarthritis using SHOMRI and correlation with clinical progression.

To assess the evolution of MR imaging findings in normal volunteers and subjects with hip osteoarthritis (OA) over 1.5 years described by the semi-quantitative Scoring Hip OA with MRI (SHOMRI) scoring system and their correlation with the evolution of clinical parameters. Hip MRI studies of 18 subjects with [Kellgren-Lawrence (KL) score = 2/3; mean age = 54.4 ± 11.2 years; 27.8% women] and 36 controls without radiographic OA [KL = 0/1; mean age = 43.7 ± 12.8 years; 50.0% women] were assessed at baseline and after 1.5 years by using SHOMRI, and their clinical status was evaluated by using Harris Hip Score and Hip Disability and Osteoarthritis Outcome Score (HOOS). Imaging and clinical parameters at baseline and their change over time were compared between groups using Mann-Whitney U and Fisher׳s exact tests. Spearman׳s rank correlations and generalized linear models adjusted for age, sex, BMI, and KL were used to assess associations between imaging and clinical findings. At baseline, OA subjects had significantly higher SHOMRI total scores than controls [median (IQR): 12.5 (6-19.5) vs. 7 (4-13.5); p = 0.024]. Over 1.5 years, only the progression rate of subchondral cysts was significantly higher in OA subjects than in controls (16.7% vs. 0.0%; p = 0.033), while no significant differences were found for any of the other SHOMRI subscales. Baseline bone-marrow edema pattern (BMEP) was significantly associated with worsening pain (HOOS subscale; p = 0.018) and hip-related quality of life (HOOS subscale; p = 0.044). Progression of subchondral cysts was significantly associated with worsening symptoms other than pain (HOOS subscale, p = 0.030). Baseline KL did not significantly correlate with worsening of any clinical symptoms (each, p > 0.05). In this relatively young study population without or with mild to moderate radiographic hip OA, only minimal differences were found between groups regarding the progression of hip abnormalities as assessed by SHOMRI over 1.5 years. However, BMEP predicted clinical worsening and subchondral cyst progression was associated with worsening symptoms. Although longer follow-up periods are required, this suggests that SHOMRI is a useful tool to monitor hip abnormalities and their progression longitudinally.