Bone Marrow Edema Pattern Research Articles

Osteoporosis transitoria migratoria

Purpose To report on a case of transient migrant osteoporosis. Clinical case We present the case of a 50-year-old female who developed pain in the left hip, left knee and right ankle successively. Her hip MRi prompted a diagnosis of transient hip osteoporosis and successive migrations resulted in a diagnosis of transient migrating osteoporosis. Results Symptoms abated with conservative treatment comprising rest, analgesics, anti-inflammatories, non-weightbearing and physical therapy. Non-weightbearing relieved pain and prevented fatigue fractures. Medical treatment did not alter the course of the disease after 65 weeks. Conclusion Transient migrating osteoporosis is a rare, idiopathic and self-limiting disease. It is accompanied by migrating pain in the weight-bearing joints, as well as by diffuse periarticular radiographic osteopenia and a pattern of bone marrow edema seen on MRi. Treatment is conservative.

Posterior Ankle Impingement: Clarification and Confirmation of the Pathoanatomy

The diagnosis of posterior hindfoot pain may prove to be elusive as there are many potential causes of hindfoot pain, including both soft tissue and osseous abnormalities. This is a case presentation of os trigonum syndrome, with the diagnosis suggested by magnetic resonance imaging (MRI), confirmed by ultrasound, and treated with os trigonum resection. Specific findings of os trigonum syndrome can be seen on MRI, including bone marrow edema pattern and high signal intensity in the synchondrosis as well as in the surrounding soft tissues. Diagnostic injections performed with imaging guidance can help confirm the diagnosis in equivocal cases. Diagnostic and interventional imaging procedures can help confirm the diagnosis of os trigonum syndrome in a patient presenting with hindfoot pain.

Case Report: Longitudinal Stress Fracture of the Humerus: Imaging Features and Pitfalls

Longitudinal stress fractures are an uncommon injury in which a diaphyseal fracture line occurs parallel to the long axis of a bone in the absence of direct trauma. They have been described in the tibia and less commonly in the femur but apparently not in the upper limb. We report a longitudinal stress fracture occurring in the humerus of a 62-year-old woman who had a history of osteoporosis and had undergone recent surgery of the contralateral wrist. We present the radiographic, MRI, and CT features of the case and emphasize the difficulties in diagnosis caused by negative findings on early radiographs and by nonspecific bone marrow edema pattern on MRI. The risk of a contralateral upper extremity stress fracture from activities of daily living in a patient with osteoporosis whose other upper extremity is immobilized also is highlighted.

MAGNETIC RESONANCE IMAGING FINDINGS OF SUBSEQUENT FRACTURES AFTER VERTEBROPLASTY

The biomechanical effect of injected cement has been considered as the cause of adjacent vertebral fracture (AVF) after vertebroplasty, but the clinical evidence supporting this hypothesis is still insufficient. We retrospectively reviewed 33 patients with subsequent fractures among 278 patients who underwent percutaneous vertebroplasty at our hospital from January 2002 to December 2005. The bone marrow edema pattern of subsequent fractures on magnetic resonance imaging was analyzed in 33 patients. In addition, the relationship between the location and distribution pattern of inserted cement and site of subsequent fractures was investigated. Among 33 subsequent fractures, we found 13 cranial AVFs, 7 caudal AVFs, and 13 remote fractures. The incidence rate of AVFs was 7.3% of 273 patients. Among 33 subsequent vertebral fractures, 13 were cranial AVFs (Group 1), 3 were superior, 7 were inferior, and 3 were overall (23.1%, 53.8%, and 23.1%, respectively). Of 7 caudal AVFs (Group 2), 7 were superior (100%). In 13 remote fractures (Group 3), 10 were superior, 1 was inferior, 2 were overall (76.9%, 7.7%, and 15.4%, respectively). In AVFs, bone marrow edema appeared mainly toward injected cement (P = 0.005). When injected cement made a solid mass rather than interdigitation, the occurrence rate of cranial AVFs was high (P = 0.004). Bone marrow edema of AVFs appeared significantly toward the previous injected cement. This phenomenon supports the idea that the biomechanical effect of injected cement is one of the causative factors which affect the occurrence of AVF after percutaneous vertebroplasty. In particular, when injected cement forms a solid mass rather than interdigitation, the risk of cranial AVF may increase.

Assessment of cartilage-dedicated sequences at ultra-high-field MRI: comparison of imaging performance and diagnostic confidence between 3.0 and 7.0 T with respect to osteoarthritis-induced changes at the knee joint

ObjectiveThe objectives of the study were to optimize three cartilage-dedicated sequences for in vivo knee imaging at 7.0 T ultra-high-field (UHF) magnetic resonance imaging (MRI) and to compare imaging performance and diagnostic confidence concerning osteoarthritis (OA)-induced changes at 7.0 and 3.0 T MRI.Materials and methodsOptimized MRI sequences for cartilage imaging at 3.0 T were tailored for 7.0 T: an intermediate-weighted fast spin-echo (IM-w FSE), a fast imaging employing steady-state acquisition (FIESTA) and a T1-weighted 3D high-spatial-resolution volumetric fat-suppressed spoiled gradient-echo (SPGR) sequence. Three healthy subjects and seven patients with mild OA were examined. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), diagnostic confidence in assessing cartilage abnormalities, and image quality were determined. Abnormalities were assessed with the whole organ magnetic resonance imaging score (WORMS). Focal cartilage lesions and bone marrow edema pattern (BMEP) were also quantified.ResultsAt 7.0 T, SNR was increased (p < 0.05) for all sequences. For the IM-w FSE sequence, limitations with the specific absorption rate (SAR) required modifications of the scan parameters yielding an incomplete coverage of the knee joint, extensive artifacts, and a less effective fat saturation. CNR and image quality were increased (p < 0.05) for SPGR and FIESTA and decreased for IM-w FSE. Diagnostic confidence for cartilage lesions was highest (p < 0.05) for FIESTA at 7.0 T. Evaluation of BMEP was decreased (p < 0.05) at 7.0 T due to limited performance of IM-w FSE.ConclusionGradient echo-based pulse sequences like SPGR and FIESTA are well suited for imaging at UHF which may improve early detection of cartilage lesions. However, UHF IM-w FSE sequences are less feasible for clinical use.

Correlations Between Joint Morphology and Pain and Between Magnetic Resonance Imaging, Histology, and Micro-Computed Tomography

Chronic or recurrent pain in the knee is a central feature of osteoarthritis, and diagnostic imaging techniques that are used to evaluate osteoarthritis ideally should correlate with the amount of pain. However, consistent correlations have not been found between pain and radiographic and magnetic resonance imaging findings consistent with osteoarthritis (i.e., cartilaginous, ligamentous, and meniscal abnormalities) or between pain and radiographic grades that are used to assess osteoarthritis. On the other hand, an association between bone marrow edema pattern on magnetic resonance images and knee pain has been suggested. To better understand the evolution of osteoarthritis and the importance of imaging findings in relation to joint morphology and function, the histological basis of magnetic resonance imaging findings was studied and the adaptation processes of trabecular bone induced by osteoarthritis were analyzed. In addition to summarizing the current knowledge on pain and imaging findings, the current review presents available data that demonstrate the ability of noninvasive radiographic techniques to depict cartilage-bone interactions in patients with joint degeneration.

Bone Marrow Edema

A bone marrow edema pattern on MRI has a similar signal quality as an inflamed synovium and may, in fact, reflect true inflammatory infiltrates rather than a pure accumulation of extracellular fluid. Bone lesions near sites of rheumatoid arthritis-related inflammation are heavily vascularized, contributing to the high water content and enhanced visibility on MRI. However, even without erosive change, periarticular bone marrow lesions may be seen. This chapter describes the nature of bone marrow lesions detected by MRI in patients with inflammatory arthritis.

MRI Findings of Patients With Temporomandibular Joint Internal Derangement: Before and After Performance of Arthrocentesis and Stabilization Splint

The purpose of this study was to evaluate the clinical outcome and magnetic resonance imaging (MRI) changes of patients with temporomandibular joint (TMJ) internal derangement before and after performance of arthrocentesis and stabilization splint therapy. Thirty-three patients with unilateral TMJ internal derangement that was successfully treated were included in this study. The clinical outcome and changes in the disc position, disc mobility, disc morphology, joint effusion, bone marrow edema pattern in the mandibular condyle, and the degenerative change before and after arthrocentesis and stabilization splint therapy were compared using MRI. The average maximum mouth opening (MMO) was increased and the average pain during MMO was decreased significantly after treatment. The disc position, disc mobility, and joint effusion were significantly improved after treatment. The results in this study indicate that arthrocentesis and stabilization splint therapy provide significant improvement in the clinical outcome, disc position, disc mobility and joint effusion.

Bone marrow edema pattern in advanced hip osteoarthritis: quantitative assessment with magnetic resonance imaging and correlation with clinical examination, radiographic findings, and histopathology

Bone marrow edema pattern in advanced hip osteoarthritis: quantitative assessment with magnetic resonance imaging and correlation with clinical examination, radiographic findings, and histopathology

Chronic medial knee pain without history of prior trauma: correlation of pain at rest and during exercise using bone scintigraphy and MR imaging

The objective of this study was to correlate chronic medial knee pain at rest and during exercise with bone scintigraphic uptake, bone marrow edema pattern (BMEP), cartilage lesions, meniscal tears, and collateral ligament pathologies on magnetic resonance MR imaging (MRI). Fifty consecutive patients with chronic medial knee pain seen at our institute were included in our study. Pain level at rest and during exercise was assessed using a visual analog scale (VAS). On MR images, BMEP volume was measured, and the integrity of femoro-tibial cartilage, medial meniscus, and medial collateral ligament (MCL) were assessed. Semiquantitative scintigraphic tracer uptake was measured. Multivariate linear regression analysis was performed. At the day of examination, 40 patients reported medial knee pain at rest, 49 when climbing stairs (at rest mean VAS 33 mm, range 0-80 mm; climbing stairs mean VAS, 60 mm, range 20-100 mm). Bone scintigraphy showed increased tracer uptake in 36 patients (uptake factor, average 3.7, range 2.4-18.0). MRI showed BMEP in 31 studies (mean volume, 4,070 mm(3); range, 1,200-39,200 mm(3)). All patients with BMEP had abnormal bone scintigraphy. Ten percent of patients with pain at rest and 8% of patients with pain during exercise showed no BMEP but tracer uptake in scintigraphy. Tracer uptake and signal change around MCL predicted pain at rest significantly (tracer uptake p = 0.004; MCL signal changes p = 0.002). Only MCL signal changes predicted pain during exercise significantly (p = 0.001). In chronic medial knee pain, increased tracer uptake in bone scintigraphy is more sensitive for medial knee pain than BMEP on MRI. Pain levels at rest and during exercise correlate with signal changes in and around the MCL.

Transient Osteoporosis

Transient osteoporosis is characterized primarily by bone marrow edema. The disease most commonly affects the hip, knee, and ankle in middle-aged men. Its cause remains unknown. The hallmark that separates transient osteoporosis from other conditions presenting with a bone marrow edema pattern is its self-limited nature. Laboratory tests usually do not contribute to the diagnosis. Plain radiographs may reveal regional osseous demineralization. Magnetic resonance imaging is used primarily for early diagnosis and monitoring disease progression. Early differentiation from more aggressive conditions with long-term sequelae is essential to avoid unnecessary treatment. Clinical entities such as transient osteoporosis of the hip and regional migratory osteoporosis are spontaneously resolving conditions. However, early differential diagnosis and surgical treatment are crucial for the patient with osteonecrosis of the hip or knee.

Bone marrow edema syndrome

Bone marrow edema syndrome (BMES) refers to transient clinical conditions with unknown pathogenic mechanism, such as transient osteoporosis of the hip (TOH), regional migratory osteoporosis (RMO), and reflex sympathetic dystrophy (RSD). BMES is primarily characterized by bone marrow edema (BME) pattern. The disease mainly affects the hip, the knee, and the ankle of middle-aged males. Many hypotheses have been proposed to explain the pathogenesis of the disease. Unfortunately, the etiology of BMES remains obscure. The hallmark that separates BMES from other conditions presented with BME pattern is its self-limited nature. Laboratory tests usually do not contribute to the diagnosis. Histological examination of the lesion is unnecessary. Plain radiographs may reveal regional osseous demineralization. Magnetic resonance imaging is mainly used for the early diagnosis and monitoring the progression of the disease. Early differentiation from other aggressive conditions with long-term sequelae is essential in order to avoid unnecessary treatment. Clinical entities, such as TOH, RMO, and RSD are spontaneously resolving, and surgical treatment is not needed. On the other hand, early differential diagnosis and surgical treatment in case of osteonecrosis is of crucial importance.

Prevalence of pathologic findings in asymptomatic knees of marathon runners before and after a competition in comparison with physically active subjects—a 3.0 T magnetic resonance imaging study

To determine the prevalence of pathologic findings in asymptomatic knees of marathon runners before and after a competition in comparison with physically active subjects. To compare the diagnostic performance of cartilage-dedicated magnetic resonance imaging (MRI) sequences at 3.0 T. Ten marathon runners underwent 3.0 T MRI 2-3 days before and after competition. Twelve physically active asymptomatic subjects not performing long-distance running were examined as controls. Pathologic condition was assessed with the whole-organ magnetic resonance imaging score (WORMS). Cartilage abnormalities and bone marrow edema pattern (BMEP) were quantified. Visualization of cartilage pathology was assessed with intermediate-weighted fast spin-echo (IM-w FSE), fast imaging employing steady-state acquisition (FIESTA) and T1-weighted three-dimensional (3D) high-spatial-resolution volumetric fat-suppressed spoiled gradient-echo (SPGR) MRI sequences. Eight of ten marathon runners and 7/12 controls showed knee abnormality. Slightly more and larger cartilage abnormalities, and BMEP, in marathon runners yielded higher but not significantly different WORMS (P > 0.05) than in controls. Running a single marathon did not alter MR findings substantially. Cartilage abnormalities were best visualized with IM-w FSE images (P < 0.05). A high prevalence of knee abnormalities was found in marathon runners and also in active subjects participating in other recreational sports. IM-w FSE sequences delineated more cartilage MR imaging abnormalities than did FIESTA and SPGR sequences.

Bone marrow edema in the knee in osteoarthrosis and association with total knee arthroplasty within a three-year follow-up

ObjectiveThe purpose of this study was to determine if a correlation exists between magnetic resonance imaging (MRI) findings of bone marrow edema (BME) in osteoarthrosis (OA) of the knee joint and need for total knee arthroplasty (TKA) within a follow-up period of 3 years.Materials and methodsThe entire database of knee MR studies over a 3-year period was used to select individuals with knee OA. A chart review was conducted to identify and include only those who had a 3-year follow-up appointment from the time of the initial MR study. There were 25 patients in the OA-only group (four men and 21 women; age range, 28–75; average age, 49.3 years). The OA and BME group had 48 patients (23 men and 25 women; average age, 55.5 years). The MRs were reviewed and interpreted by a musculoskeletal radiologist and were classified into one of four patterns of BME: none, focal, global, or cystic pattern. Meniscal tear and degree of cartilage loss were also assessed.ResultsSubjects who had BME of any pattern type were 8.95 times as likely to progress rapidly to a TKA when compared to subjects with no BME (p = 0.016). Subjects with a global pattern of BME were 5.45 times as likely to have a TKA compared to subjects with focal, cyst, or no BME (p < 0.05). Subjects with a global edema pattern were 13.04 times as likely to have a TKA than subjects with no marrow edema in the knee (p < 0.01). There was no correlation of TKA with meniscal tear or cartilage loss. The group of subjects who had a TKA were 12.6 years older than those who did not have a TKA (p < 0.001). However, the BME results were still significant after accounting for the age difference.ConclusionOur classification of patterns into global, focal, cystic, and absence of BME is an attempt to further define edema in osteoarthrosis and how it relates to clinical progression. Patients with BME and OA have an increased risk of TKA as opposed to OA and no marrow edema. The BME pattern with the worst prognosis for the knee is the global pattern.

Diagnostic performance of in vivo 3-T MRI for articular cartilage abnormalities in human osteoarthritic knees using histology as standard of reference

The purpose of this study was (1) to evaluate the sensitivity, specificity and accuracy of sagittal in vivo 3-T intermediate-weighted fast spin-echo (iwFSE) sequences in the assessment of knee cartilage pathologies using histology as the reference standard in patients undergoing total knee replacement, and (2) to correlate MR imaging findings typically associated with osteoarthritis such as bone marrow edema pattern (BMEP) and cartilage swelling with histological findings. Tibial plateaus and femoral condyles of eight knees of seven patients were resected during surgery, and sagittal histological sections were prepared for histology. Preoperative MRI findings were compared to the corresponding region in histological sections for thickness, surface integrity and signal pattern of cartilage, and histological findings in areas of BMEP and swelling were documented. The overall sensitivity, specificity and accuracy were 72%, 69% and 70% for thickness, 69%, 74% and 73% for surface and 36%, 62% and 45% for intracartilaginous signal pattern. For all cases of BMEP on MRI subchondral ingrowth of fibrovascular tissue and increased bone remodeling were observed. MRI using fat-saturated iwFSE sequences showed good performance in assessing cartilage thickness and surface lesions, while signal changes of cartilage were not suited to characterize the severity of cartilage degeneration as validated by histology.

Bone marrow edema pattern in advanced hip osteoarthritis: quantitative assessment with magnetic resonance imaging and correlation with clinical examination, radiographic findings, and histopathology

To correlate the amount of bone marrow edema (BME) calculated by magnetic resonance imaging(MRI) with clinical findings, histopathology, and radiographic findings, in patients with advanced hip osteoarthritis(OA). The study was approved by The Institutional Human Subject Protection Committee. Coronal MRI of hips was acquired in 19 patients who underwent hip replacement. A spin echo (SE) sequence with four echoes and separate fast spin echo (FSE) proton density (PD)-weighted SE sequences of fat (F) and water (W) were acquired with water and fat suppression, respectively. T2 and water:fat ratio calculations were made for the outlined regions of interest. The calculated MRI values were correlated with the clinical, radiographic, and histopathologic findings. Analyses of variance were done on the MRI data for W/(W + F) and for T2 values (total and focal values) for the symptomatic and contralateral hips. The values were significantly higher in the study group. Statistically significant correlations were found between pain and total W/(W + F), pain and focal T2 values, and the number of microfractures and calculated BME for the focal W/(W + F) in the proximal femora. Statistically significant correlations were found between the radiographic findings and MRI values for total W/(W + F), focal W/(W + F) and focal T2 and among the radiographic findings, pain, and hip movement. On histopathology, only a small amount of BME was seen in eight proximal femora. The amount of BME in the OA hip, as measured by MRI, correlates with the severity of pain, radiographic findings, and number of microfractures.

Bone stress injury of the ankle in professional ballet dancers seen on MRI

BackgroundBallet Dancers have been shown to have a relatively high incidence of stress fractures of the foot and ankle. It was our objective to examine MR imaging patterns of bone marrow edema (BME) in the ankles of high performance professional ballet dancers, to evaluate clinical relevance.MethodsMR Imaging was performed on 12 ankles of 11 active professional ballet dancers (6 female, 5 male; mean age 24 years, range 19 to 32). Individuals were imaged on a 0.2 T or 1.5 T MRI units. Images were evaluated by two musculoskeletal radiologists and one orthopaedic surgeon in consensus for location and pattern of bone marrow edema. In order to control for recognized sources of bone marrow edema, images were also reviewed for presence of osseous, ligamentous, tendinous and cartilage injuries. Statistical analysis was performed to assess the strength of the correlation between bone marrow edema and ankle pain.ResultsBone marrow edema was seen only in the talus, and was a common finding, observed in nine of the twelve ankles imaged (75%) and was associated with pain in all cases. On fluid-sensitive sequences, bone marrow edema was ill-defined and centered in the talar neck or body, although in three cases it extended to the talar dome. No apparent gender predilection was noted. No occult stress fracture could be diagnosed. A moderately strong correlation (phi = 0.77, p= 0.0054) was found between edema and pain in the study population.ConclusionBone marrow edema seems to be a specific MRI finding in the talus of professional ballet dancers, likely related to biomechanical stress reactions, due to their frequently performed unique maneuvers. Clinically, this condition may indicate a sign of a bone stress injury of the ankle.

Acute non-traumatic marrow edema syndrome in the knee: MRI findings at presentation, correlation with spinal DEXA and outcome

Purpose The aim of the study was to present the MRI findings of non-traumatic edema-like lesions presented acutely in the adult knee and to correlate them with the 3-year outcome and the bone mineral density (BMD) in the spine. Materials and methods Ninety-eight patients (40 men, 58 women, mean age 60.1 ± 11 years, age range 27–82 years), were followed up clinically as well as with MR imaging, when indicated, for at least 3 years. Patients were classified according to presentation in 3 groups (A: bone marrow edema (BME), B: BME and subchondral fracture, C: BME and articular collapse) and according to outcome in 2 groups (A: reversible BME, B: articular collapse). BMD measurements of the spine were carried out in males over 70 and females over 60 years old using DEXA. Results The isolated BME pattern was observed in 64.3% (Group A), subchondral fractures without articular collapse in 11.2% (Group B) and articular collapse in 24.5% (Group C). Significant differences were found among the 3 groups at presentation, regarding the age, sex, BMD, affected area and duration of symptoms prior to imaging ( p < 0.05). Localization of the lesions in the weight-bearing areas of the knee was shown in 100% of C, in 90.9% of B and in 50.8% of A. The duration of symptoms prior to imaging was longer in C (7.6 ± 2.8 m) than in A (2.5 ± 1.7 m) and B (4.0 ± 3.2 m) ( p < 0.05). Group B progressed to articular collapse in 45.5%, the rest demonstrating a favourable outcome. Group C showed clinical improvement in 75% and persistent symptoms that required knee arthroplasty in 25% of cases. Articular collapse was the final outcome in 29.6% and transient BME in 70.4% of patients. These two groups showed significant differences regarding the age ( p ∼ 0), sex ( p = 0.002), low BMD ( p = 0.004), affected area ( p ∼ 0), presence of subchondral sparing ( p ∼ 0), duration of symptoms prior to imaging ( p ∼ 0), time from onset of symptoms to the final outcome ( p ∼ 0) and need for arthroplasty ( p = 0.001). None of the patients with transient BME syndrome eventually progressed to articular collapse. Conclusion In the context of acute non-traumatic knee BME, the age and sex of the patient, the duration of symptoms before imaging, the pattern of BME, and the BMD appear to correlate with the final outcome.

A Specific Bone Marrow Edema around the Foot and Ankle Following Trauma and Immobilization Therapy: Pattern Description and Potential Clinical Relevance

We describe a characteristic pattern of bone marrow edema about the foot and ankle seen by MRI in patients who have undergone recent immobilization therapy and investigate potential etiologies as well as possible clinical significance. Three reviewers retrospectively evaluated 52 ankle MRI examinations in 18 patients with abnormal signals compatible with bone marrow edema who had been treated with various types and durations of immobilization of the lower limb after traumatic injury. Bone marrow edema patterns were characterized by distribution, extent, location, and interval evolution or resolution on subsequent followup MRI examination. These MRI findings were then correlated with clinical history, symptomatology and treatment regimens. All patients had a characteristic pattern of bone marrow edema about the foot and ankle predominating in subchondral, subcortical, and subenthesial locations. The occurrence of this edema pattern was most often noted on MRI within the first 12 weeks after completion of immobilization therapy or resumption of partial or full weightbearing and did not correlate well with new symptomatology or pain. In patients with protracted imaging followup, the bone marrow edema ultimately resolved and was not associated with reported setbacks in recovery course or unexpected delays in restoration of function. All MRI examinations performed more than 18 weeks after the immobilization period showed resolution or stabilization of bone marrow signal, with no continued evolution. No patient had a clinical picture suspicious for reflex sympathetic dystrophy. A distinctive pattern of bone marrow edema on MRI of the foot and ankle can be seen on MRI after a variety of weightbearing and nonweightbearing immobilization therapies. This pattern has a consistent appearance on MRI and does not seem to be related to clinical symptomatology. At present, no substantial conclusions can be made regarding the etiology of this phenomenon. However, these bone marrow signal alterations should not mandate further imaging or a change in therapy on the basis of MRI findings alone.

Lead arthropathy: radiographic, CT and MRI findings

Lead arthropathy is a well-known complication of gunshot injuries with retained intra-articular bullets. Although several previous reports have discussed the radiological findings of this entity, computed tomography (CT) and magnetic resonance imaging (MRI) findings have never been described before in this setting. In this paper the authors review the imaging findings of 11 patients with lead arthropathy (1 of whom had clinical signs of lead poisoning as well), all of them studied by means of radiographs. In addition, non-enhanced CT scans were obtained in 3 patients and gadolinium-enhanced MRI in 1. Classic findings of intra-articular speckled lead deposits (occasionally with a "lead arthrogram" appearance), joint space narrowing and preserved bone density were found at radiographs in the great majority of cases. Furthermore, extension of intra-articular lead to adjacent tendon sheaths was observed in almost half of the patients, an observation rarely reported in the literature. CT scans and MRI, in their turn, were superior with regard to soft tissue abnormalities, accurately depicting joint effusion and the thickened synovium with lead particles embedded in it. Post-gadolinium MRI had the advantage of showing the enhancement pattern of the inflamed synovium and associated bone marrow edema pattern. Although it is not possible to establish the role of axial imaging in lead arthropathy from the small number of cases studied, this initial experience shows that both methods hold promise in this setting and may be useful, at least in selected cases.