Study on the relationship between severe knee osteoarthritis and bone marrow edema / 中国骨伤

OBJECTIVE@#To investigate the relationship between bone marrow edema and pathological changes, symptoms and signs of severe knee osteoarthritis.@*METHODS@#From January 2020 to March 2021, 160 patients with severe knee osteoarthritis who underwrent MRI of the knee at the Department of Bone and Joint, Wangjing Hospital, China Academy of Chinese Medical Sciences were included. Eighty patients with bone marrow edema were selected as the case group, including 12 males and 68 females, aged from 51 to 80 years old with an average of (66.58±8.10) years old, the duration of disease 5 to 40 months with an average of (15.61±9.25) months. Eighty patients without bone marrow edema were selected as the control group, including 15 males and 65 females, aged from 50 to 80 years old with an average of (67.82±8.05) years old, the duration of disease 6 to 37 months with an average of (15.75±8.18) months, BMI was (28.26±3.13) kg·m-2 ranged from 21.39 to 34.46 kg·m-2. The degree of bone marrow edema was evaluated by knee whole oragan magnetic resonance imaging score (WORMS). The degree of knee osteoarthritis was evaluated by Kellgren- Lawrence(K-L) grade and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). The degree of joint pain was evaluated by visual analogue scale(VAS) and WOMAC pain score, the joint signs were evaluated by tenderness, percussion pain, joint swelling and joint range of motion. To explore the relationship between bone marrow edema and knee osteoarthritis, the prevalence of bone marrow edema and K-L grade were compared between the two groups. Furthermore the WORMS score and WOMAC index, pain-related score, and sign-related score correlation coefficient were analyzed to further explore the relationship between bone marrow edema and knee osteoarthritis index, joint pain symptoms and signs.@*RESULTS@#There was 68.75% (55/80) of the patients in the case group were in K-L grade Ⅳ, and 52.5% (42/80) in the control group, indicating a higher proportion of patients with grade Ⅳ in the case group than the control group (χ2=4.425, P<0.05). In the case group, there was a strong correlation between bone marrow edema WORMS score and knee osteoarthritis WOMAC index. (r=0.873>0.8, P<0.001), a moderate correlation between WORMS score and VAS score and WOMAC pain score(r=0.752, 0.650>0.5, P<0.001), a moderate correlation between WORMS score and percussion pain score (r=0.784>0.5, P<0.001), and a weak correlation between WORMS score and VAS and tenderness score, joint swelling score and joint range of motion score (r=0.194, 0.259, 0.296<0.3, P<0.001).@*CONCLUSION@#Our study suggests that severe knee osteoarthritis is associated with an increased risk of bone marrow edema. Bone marrow edema can also lead to knee osteoarthritis joint pain, with percussion pain being a positive sign, but tenderness, joint swelling and limitation of activity are not significantly related to bone marrow edema.

Study on correlation between bone marrow edema and osteoporosis in patients with severe knee osteoarthritis / 中国骨伤

OBJECTIVE@#To explore relationship between bone marrow edema(BME) and osteoporosis in patients with severe knee osteoarthritis.@*METHODS@#Unmatched case-control study was conducted. Totally 160 patients with severe knee osteoarthritis who had undergone knee magnetic resonance imaging (MRI) and bone mineral density examination (BMD) from January 2020 to March 2021 were included. Eighty patients complicated with BME were included in BME group, and 80 patients without BME were selected as NBME group. In BME group, there were 12 males and 68 females, aged from 51 to 80 years old with an average of(66.58±8.10) years old;the courses of disease ranged from 5 to 40 months with an average of (15.61±9.25) months;body mass index(BMI) ranged from 21.81 to 34.70 with an average of (27.79±3.00) kg·m-2;25 patients classified to grade Ⅲ and 55 patients grade Ⅳ according to Kellgren- Lawrence(K-L). In NBME group, there were 15 males and 65 females, aged from 50 to 80 years old with an average of(67.82±8.05) years old;the course of disease ranged from 6 to 37 months with an average of(15.75±8.18) months;BMI ranged from 21.39 to 34.46 with an average of (28.26±3.13) kg·m-2;25 patients were K-L Ⅲ and 55 patients with K-L Ⅳ. The degree of bone marrow edema was evaluated by knee whole oragan magnetic resonance imaging score(WORMS). Osteoporosis was diagnosed and BMD was evaluated by DXA T value. To explore the relationship between bone marrow edema and osteoporosis by comparing prevalence rate of osteoporosis between two groups, and to further explore relationship between BME and BMD by Spearman correlation analysis of BME WORMS score and DXA T value in BME group.@*RESULTS@#The complete case data were obtained on the first diagnosis, and there was no significant difference in sex, age, courses of disease and BMI between two groups (P>0.05). The proportion of K-L Ⅳ in BME group was significantly higher than that in NBME (P<0.05). The prevalence rate of osteoporosis in BME group was significantly higher than in NBME group with the same K-L grade (P<0.001), and there was a strong negative correlation between BME WORMS score and DXA BMD T value (r=-0.812, |r|=0.812 >0.8, P<0.001).@*CONCLUSION@#Osteoporosis is one of the risk factors of bone marrow edema in patients with severe knee osteoarthritis, and the lower the bone mineral density is, the easier it is to be complicated with bone marrow edema.

Clinical analysis of distal radius core decompression for chronic wrist pain / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of distal radius core decompression in the treatment of chronic wrist pain caused by various etiologies.@*METHODS@#A retrospective analysis was performed for the clinical data of 10 patients with chronic wrist pain treated with distal radial core decompression between January 2018 and December 2021. There were 6 males and 4 females with an average age of 37.4 years (range, 21-55 years). The disease duration ranged from 7 to 72 months, with an average of 26.5 months. Preoperative MRI examination showed that 10 cases had bone marrow edema at the distal radius on the affected side, and 8 cases had bone marrow edema in the carpal bones such as scaphoid and lunate bone. Among them, 3 patients had a history of wrist fracture, and 2 patients had Kienböck diseases (1 case each in stage ⅡB and stage ⅢA). Three cases were combined with triangular fibrocartilage complex (TFCC) type 1A injury. Two cases were combined with osteoarthritis, 1 of them was complicated with severe traumatic arthritis, the wrist arthroscopy showed that the TFCC was completely lost and could not be repaired, and the cartilage of the lunate bone and the ulnar head were severely worn.Visual analogue scale (VAS) score was used to evaluate the relief of wrist pain before operation, at 6 months after operation, and at last follow-up, and the range of motion of the affected wrist in dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was measured. The degree of bone marrow edema was evaluated according to T1WI, T2WI, and STIR sequences of MRI.@*RESULTS@#All the patients were followed up 12-22 months, with an average of 16.4 months. Except for 1 patient who experienced persistent wrist joint pain and limited mobility after operation, the remaining 9 patients showed significant improvement in pain symptoms and wrist joint mobility. The VAS score and range of motion of wrist dorsiflexion, palmar flexion, ulnar deviation, and radial deviation at 6 months after operation and at last follow-up were significantly improved when compared with those before operation, the VAS score and the range of motion of wrist ulnar deviation and radial deviation at last follow-up were further improved when compared with those at 6 months after operation, all showing significant differences ( P<0.05). There was no significant difference in wrist dorsiflexion and palmar flexion between at 6 months after operation and at last follow-up ( P>0.05). Bone marrow edema was improved in 6 patients on MRI at 6 months after operation, and was also improved in other patients at last follow-up.@*CONCLUSION@#For chronic wrist pain caused by a variety of causes, distal radius core decompression can directly reduce the pressure of the medullary cavity of the distal radius, improve the blood supply of the corresponding distal structure, significantly alleviate chronic wrist pain, and provide an option for clinical treatment.

Osteoclast-mediated pain and collapse mechanisms in the femoral head necrosis with bone marrow edema / 西安交通大学学报(医学版)

【Objective】 To explore pain and collapse mechanisms in fosteonecrosis of the femoral head (ONFH) with bone marrow edema (BME). 【Methods】 ONFH patients at ARCO Ⅲ stage who underwent total hip arthroplasty in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were enrolled; the femoral head samples, clinical and imaging data were collected. These patients were divided into BME group and non-BME group according to the MR data in one week preoperative. Hematoxylin-eosin and Sirius red staining were performed to observe the morphological changes in bone tissue of femoral head specimens. Western blotting and qPCR were used to semi-quantitatively analyze the expression levels of CTSK, RANKL, and Netrin-1 proteins and mRNA in different regions of the bone tissue. 【Results】 Clinical and imaging data showed that ONFH patients with BME had significantly higher scores of VAS than ONFH patients without BME. Hematoxylin-eosin staining showed that bone structure disorder and a large number of empty bone lacunae were found in the necrotic areas in both groups, but there exited significant granulation tissue in the BME group, and spindle-shaped fibroblastic cells and inflammatory cells aggregated in the repaired region. Sirius red staining revealed the necrotic and sclerotic areas were accumulated with many collagenous fiber in the BME group. The results of Western blotting and qPCR showed that Netrin-1 expressions in the necrotic, sclerotic and health areas in the BME group were higher than those in the non-BME group (P<0.05), while osteoclast related proteins and mRNA expressions of the necrotic and sclerotic areas in the BME group was higher than those in the non-BME group (P<0.05). 【Conclusion】 All these findings indicated that hip pain was positively correlated with femoral head necrosis with BME, hyperactive osteoclasts participated in the femoral head collapse with BME, and the upregulated expression of Netrin-1 mediated the pain mechanism.

MRI-based investigation of characteristics and outcome of knee bone marrow edema in children with juvenile idiopathic arthritis / 中华放射学杂志

Objective:To investigate the prevalence, distribution, and prognosis of knee joint bone marrow edema (BME) in children with juvenile idiopathic arthritis (JIA).Methods:From January 2017 to December 2019, 128 JIA children in the Children′s Hospital, Capital Institute of Pediatrics were analyzed retrospectively, and 136 knees were included totally. BME was evaluated and counted from eight regions according to the juvenile arthritis MRI scoring system (JAMRIS). Chi-square test, independent sample t test or Mann-Whitney U test were used to compare the clinical characteristics between BME group (36 cases) and non-BME group (92 cases). The prognosis of BME were observed. Results:BME was found in 37 of 136 knee joints (27.2%). The ages of the children in BME group and non-BME were (8±4) and (6±4) years old, and the disease duration were 9 (3, 22) and 4 (2, 18) months, respectively, both with statistically significant differences (age: t=-2.63, P=0.010; duration: Z=-5.78, P=0.013). In 23 joints (62.2%,23/37), BME occurred at multiple locations simultaneously in the knee. Locations with BME, according to the frequency of involvement from most to least, were the lateral tibial plateau with 17, the lateral weight-bearing femur with 16, the medial tibial plateau and the medial femoral condyle both with 15, the medial weight-bearing femur with 12, the lateral femoral condyle with 8, the lateral patella with 7, and the medial patella with 5. The MRI score of most of medial femoral conclyle was 1(7/15). Of the 15 BME joints with the MRI follow-up data with interval (7±3) months, BME disappeared in 10 joints, improved in 3 joints and progressed in 2 joints within 12 months after the treatments. Conclusions:There is a low incidence of BME in JIA affected knee joint. Older children and the children with long disease duration have a higher risk for BME, and more likely involved the weight-bearing surfaces of the joint. The overall prognosis is satisfactory after the standard treatments.

Correlation between cold pain of knee joint and subchondral bone marrow edema in patients with knee osteoarthritis / 中国骨伤

OBJECTIVE@#To investigate relationship between cold pain of knee joint and subchondral bone marrow edema (BME).@*METHODS@#From May 2018 to August 2019, 92 patients with knee osteoarthritis (KOA) associated with cold pain of knee were admitted, all patients were underwent MRI examination. The patients were divided into observation group (47 patients with BME) and control group(45 patients without BME). In observation group, there were 6 males and 41 females aged from 36 to 87 years old with an average of (63.2±12.3) years old. In control group, there were 10 males and 35 females, aged from 48 to 84 years old with an average of (62.7±8.3) years old. All patientswere treated with drugs. The degree of joint degeneration was evaluated by Kellgren-Lawrence (K-L) grading. Degree of cold pain of knee was evaluated by knee cold pain score, and degree of BME was evaluated according to WORMS. The correlation between cold pain of knee and K-L grading and BME was analyzed.@*RESULTS@#Score of cold pain in observation group (15.55±7.68) was higher than that of control group (9.42± 5.50), which had significant difference (@*CONCLUSION@#The cold pain of KOA patients is not related to K-L grading, but corelate with BME grading. The Cold pain of knee was more pronounced in KOA patients with BME, and the severity of BME is often related to degree of cold pain. It seemed to be a tendency:the more serious BME, the heavier coldpain.

Correlation Between Patterns of Bone Marrow Edema and Their Associated Soft-Tissue Injuries, as seen on Magnetic Resonance Imaging of Knee joint in Patients with a Recent History of Trauma

Introduction: Bone bruise or bone marrow edema is a common innocuous finding in magnetic resonance imaging (MRI) knee ofpatients with trauma. The pattern of bone marrow edema provides insight into the mechanism of injury which, in turn, helps to evaluatethe injuries with a more discerning eye. Five basic mechanisms of knee injury which are commonly seen in MRI scan of knee traumapatients are pivot shift, dashboard injury, hyperextension, clip injury, and lateral patellar dislocation. Each of these mechanisms causescharacteristic bone marrow edema patterns and has associated soft-tissue injuries, following the musculoskeletal biomechanics.Aim: The purpose of this study is to assess the correlation between bone marrow edema patterns and associated soft-tissue injuries.Settings and Design: This is a cross-sectional study of 200 patients conducted at the Department of Radiodiagnosis andImaging, MGM Medical College and Associated Hospitals, Indore.Materials and Methods: MRI of 200 cases of recent knee injury was analyzed to determine bone marrow edema pattern. Thepattern of edema and soft-tissue injuries was plotted and analyzed to see a significant correlation.Statistical Analysis Used: Variables were expressed as percentages and comparison was done by Chi-square analysis. Twotailed P < 0.05 was considered statistically significant.Results: Significant correlation was seen between pivot shift injury and anterior cruciate ligament (ACL) tear, pivot shift injury andmedial meniscus tear, dashboard injury and posterior cruciate ligament (PCL) tear, lateral patellar dislocation and medial patellofemoralligament (MPFL) tear, and clip injury and medial collateral ligament (MCL) tear. Pivot shift was the most common bone marrowedema pattern, accounting for 55.5% of cases and hyperextension was the least common pattern, seen in only 3% of cases.Conclusion: The pattern of bone marrow edema can provide a road map to associated soft-tissue injuries which assist in finerevaluation and can help in creating better patient management outcomes.

Dual-energy CT virtual noncalcium imaging for detecting bone marrow edema in vertebrae / 中国医学影像技术

Objective: To observe the value of dual-energy virtual noncalcium (DE-VNCa) using dual-source CT in diagnosis of vertebral bone marrow edema under different relative contrast material ratio (RCMR). Methods Totally 37 patients with spinal trauma and low back pain who underwent dual-source CT dual-energy scan and MR examination were enrolled. Taken RCMR value as 1.28, 1.45, 1.75 and 1.85, respectively, the 4 groups of DE-VNCa images were reconstructed. The best RCMR value was obtained through calculating the effect of 4 groups of images in diagnosis of vertebral bone marrow edema taken MRI diagnosis as golden standards. CT value and fat content of lumbar vertebral bone marrow edema area and normal vertebral body were measured and compared on the optimal imaging. The efficacy of CT value and fat content in diagnosis of lumbar bone marrow edema were evaluated using ROC curve. Results: When RCMR value was 1.28, 1.45, 1.75 and 1.85, the Youden index in diagnosis of lumbar bone marrow edema was 0.02, 0.35, 0.82 and 0.73, respectively. DE-VNCa imaging had the highest diagnostic efficiency when RCMR value was 1.75. The difference of CT value and fat content between the edema area of lumbar vertebrae and normal vertebrae was statistically significant on images of RCMR=1.75 (both P<0.01). Taking CT value=10.25 HU and fat content=24.50% as the critical value, the AUC under ROC curves in diagnosis of lumbar bone marrow edema was 0.95 and 0.91, respectively (both P<0.01). Conclusion: DE-VNCa imaging of dual-source CT has high clinical value in diagnosis of vertebral bone marrow edema when RCMR is 1.75, and CT value and fat content are helpful to diagnosis of lumbar bone marrow edema.

Diagnostic value of different related contrast material in dual-energy CT virtual noncalcium for detecting traumatic bone marrow edema in knee joint / 中华放射学杂志

Objective To evaluate the diagnostic value of related contrast material(Rel.CM)of the dual-energy CT (DECT) virtual noncalcium (VNCa) for detecting acute traumatic bone marrow edema in knee joint.Methods A total of 17 patients(18 knees)with definite trauma history and knee joint disorders were prospectively enrolled. Conventional CT, VNCa and MRI images were obtained by MRI and DECT scan. Each knee was divided into 12 regions, respectively, to observe the performance of MRI and VNCa images. The diagnostic efficacy of different Rel. CM values (1.25, 1.45, 1.75) was analyzed for the knee traumatic bone marrow edema,select the best Rel.CM value.And the CT values of bone marrow and bone marrow damage were measured on VNCa of the optimal Rel. CM parameters. Using ROC to evaluate the efficacy of VNCa in different Rel.CM values for diagnosing traumatic bone marrow edema,the difference of CT value between bone marrow lesion and bone marrow in normal region of bone marrow was obtained by using rank sum test. Results DECT and MRI were performed in 17 patients (18 knees). Eighteen knees were divided into 216 areas.MRI showed 94 areas of bone marrow edema,including 35 in distal portion of femur, 59 in proximal tibia. Rel.CM values of 1.25, 1.45, 1.75 of the VNCa map were used to diagnose traumatic bone marrow edema in the knee with the area under the ROC curve of 0.643, 0.871, 0.656, respectively. Rel.CM with 1.45 VNCa diagram was the most accurate. The CT values of the bone marrow edema region and the normal region were -64.3(-20.6 to-90.8)HU,-93.4(-70.5 to-120.7)HU, respectively, on the VNCa graph with the optimal Rel.CM parameters (1.45) (Z=-8.270, P<0.05). Conclusions The VNCa image with a Rel.CM value of 1.45 has a better diagnostic performance for traumatic bone marrow edema in knee joint. CT value measurement in VNCa image can be used for quantitative analysis of traumatic bone marrow edema.

Values of fat saturation sequence in MRI for juvenile arthritis / 中南大学学报(医学版)

Objective:To explore the values of fat saturation sequence in MRI for juvenile arthritis.Methods:A total of 1 131 cases with juvenile arthritis and 1 601 with symptomatic arthritis were examined by MRI normal T1 weighted imaging (T1WI) and T2 weighted imaging (T2WI)sequence and spectral presaturation attenuatedinversion recovery (SPAIR) T2 fat saturation sequence.All the images were independently evaluated by two senior doctors from the Department of Radiology and the Department of Pediatric Rheumatology and Immunology respectively to confirm the types and degree of pathological changes of joint tissues.Results:Among the subjects,847 patients demonstrated positive in MRI,accounting for 52.9％;409 patients showed positive in normal sequence,accounting for 48.3％;816 patients showed positive in fat saturation sequence,accounting for 96.3％.Joint hydrops accounted for 59.5％.Bone marrow edema accounted for 39.7％.The relevant ratio of bone marrow edema,joint hydrops,thickening of synovium and cartilage injuries in fat saturation sequence were higher than that in normal sequence (P＜0.05).The relevant ratio of bone erosion in normal sequence was higher than that in fat saturation sequence (P＜0.05).However,no significant difference of joint cysts was found between the fat saturation sequence and normal sequence (P＜0.05).Conclusion:Application of fat saturation sequence by MRI to check juvenile arthritis could obviously improve the positive MRI relevant ratio.In addition,the relevant ratio of the early pathological changes of juvenile arthritis (such as bone marrow edema and joint hydrops) was high,which might provide references for the early diagnosis of juvenile arthritis.

Primary exploration of energy spectral CT water -based material decomposition technology for the detection of bone marrow edema in sacroiliitis / 中国基层医药

Objective To explore the value of water -based material decomposition images for detection of bone marrow edema (BME)in sacroiliitis with energy spectral CT.Methods The sacroiliac (SI)joints of nine spondyloarthropathy patients with sacroiliitis (the research group)and eight healthy volunteers (the control group) were underwent MRI and energy spectral CT.The mixed energy image of energy spectral CT was reconstructed to be mono energy image.Then,the mono image was divided into water -based image and calcium image by material divid-ed and analyzed software.The SI para -articular marrow region water -calcium relative concentration of research group was compared with that of control group.The BME diagnosis efficiency and optimal water -based concentration of energy spectral CT was analyzed by receiver operating characteristic (ROC)curve.Then,the sensitivity,specificity, positive likelihood ratio and negative likelihood ration were calculated.Results The water -based concentration of BME in research group (1 067.43 ±10.84)g/L was higher than that of control group (1 039.43 ±8.01)g/L(t =-3.14,P =0.003).Meanwhile,the calcium -based concentration of research group (68.98 ±20.53)g/L was not different from control group (78.03 ±26.39)g/L(t =1.88,P =0.066).ROC curve showed that the diagnosis efficiency was medium as the area of under curve was 0.75.When the optimal concentration of water -based was 1 052.00g/L,the diagnosis efficiency was the best.The sensitivity and specificity was 84.00%,62.50% respectively. Conclusion There are reference value and potential clinical value with energy spectral CT water -based concentra-tion detection for diagnosis BME in patients with sacroiliitis.

Value of diffusion weighted imaging and contrast-enhanced MRI in the assessment of the active phase of ankylosing spondylitis / 中国综合临床

Objective To investigate the value of diffusion weighted imaging combined with contrast-enhanced MRI(CE-MRI)in activity of sacroiliitis of patients with ankylosing spondylitis(AS).Methods The AS patients diagnosed in Beijing Jishuitan Hospital were selected as the experimental group,and healthy volunteers were selected as the control group.The AS group was divided into the active group and the stable group according to the clinical diagnostic criteria.All subjects were examined with both MRI plain scan and CE-MRI of bilateral sacroiliac joints.ROIs were drawn in the lesion region and the ADC values and signal intensity enhancement rate(△SI)were recorded.△SI and ADC value among the active AS group,chronic group and control group was compared and analyzed.The clinical diagnostic criteria was regarded as the gold standard for the active AS group and the chronic group.The ROC curve was used to evaluate the value of ADC,△SI,ADC, and ADC combined with △SI can detect the efficiency of AS activity.Results Ninety-eight AS patients were enrolled in this study,including 63 cases in the active AS group,35 cases in the chronic AS group,and 23 cases in the control group.The ADC values of the active group,the chronic group and the control group were(1.35 ±0.17)×10-3mm2/s,(1.07±0.20)×10-3mm2/s,(0.36±0.14)×10-3mm2/s,respectively,and ΔSI values were (2.42±0.80)%,(1.28 ± 0.34)% and(0.74 ± 0.22)%.There were significant differences in ΔSI and ADC values among the three groups(F=216.559,56.522.P=0.000).When ADC values were used to assess the activity of AS,the area under the ROC curve was 0.809 and the optimal diagnostic threshold was 1.35×10-3 mm2/s,the sensitivity and specificity of AS activity were 57.1% and 94.3%.When ΔSI values were used,the area under the ROC curve was 0.837 and the sensitivity and specificity were 71.40% and 97.10% with the optimal diagnostic threshold of 1.79%.When ΔSI values were combined with the ADC values,the area was 0.963 and the sensitivity and specificity were 74.6% and 94.3%.Conclusion In assessment of the activity of AS,DWI combined with CE-MRI is most valuable.

Value of diffusion weighted imaging and contrast-enhanced MRI in the assessment of the active phase of ankylosing spondylitis / 中国综合临床

Objective To investigate the value of diffusion weighted imaging combined with contrast-enhanced MRI(CE-MRI)in activity of sacroiliitis of patients with ankylosing spondylitis(AS).Methods The AS patients diagnosed in Beijing Jishuitan Hospital were selected as the experimental group,and healthy volunteers were selected as the control group.The AS group was divided into the active group and the stable group according to the clinical diagnostic criteria.All subjects were examined with both MRI plain scan and CE-MRI of bilateral sacroiliac joints.ROIs were drawn in the lesion region and the ADC values and signal intensity enhancement rate(△SI)were recorded.△SI and ADC value among the active AS group,chronic group and control group was compared and analyzed.The clinical diagnostic criteria was regarded as the gold standard for the active AS group and the chronic group.The ROC curve was used to evaluate the value of ADC,△SI,ADC, and ADC combined with △SI can detect the efficiency of AS activity.Results Ninety-eight AS patients were enrolled in this study,including 63 cases in the active AS group,35 cases in the chronic AS group,and 23 cases in the control group.The ADC values of the active group,the chronic group and the control group were(1.35 ±0.17)×10-3mm2/s,(1.07±0.20)×10-3mm2/s,(0.36±0.14)×10-3mm2/s,respectively,and ΔSI values were (2.42±0.80)%,(1.28 ± 0.34)% and(0.74 ± 0.22)%.There were significant differences in ΔSI and ADC values among the three groups(F=216.559,56.522.P=0.000).When ADC values were used to assess the activity of AS,the area under the ROC curve was 0.809 and the optimal diagnostic threshold was 1.35×10-3 mm2/s,the sensitivity and specificity of AS activity were 57.1% and 94.3%.When ΔSI values were used,the area under the ROC curve was 0.837 and the sensitivity and specificity were 71.40% and 97.10% with the optimal diagnostic threshold of 1.79%.When ΔSI values were combined with the ADC values,the area was 0.963 and the sensitivity and specificity were 74.6% and 94.3%.Conclusion In assessment of the activity of AS,DWI combined with CE-MRI is most valuable.

Correlation between marrow edema and related MRI and clinical manifestations in patients with knee osteoarthritis / 实用放射学杂志

Objective To investigate the relationship between the marrow edema and general clinical index,quadriceps muscle area,and the meniscus grade of knee osteoarthritis(OA).Methods 72 patients were collected with knee OA in our hospital, underwent X-ray and routine MRI examination of knee, and the same X-ray and MRI were reviewed at 12 months later in different time point.The K-L grading, bone marrow edema score, meniscal grading and VAS score of each knee joint were evaluated.The t-test and Rank-sum test were used to compare the two groups of general data, Spearman was used to perform bivariate correlation analysis.Results The age and VAS score of bone marrow edema group at the initial follow-up were significantly lower than those without edema group(P<0.05),the degree of marrow edema was moderately correlated with age and VAS score, and was not significantly correlated with other indexes.12 months later, BMI and the area of quadriceps femoris in the group with marrow edema were different from those in the group without bone marrow edema(P<0.05), the degree of marrow edema was moderately correlated with age, quadriceps area and VAS.Conclusion The range of marrow edema was related to age, quadriceps area, BMI index and VAS score in MRI.The MRI measurement could reflect the progression of knee OA more than that of X-ray.It also revealed some factors related to the progression of knee OA.

Influence of Vertebral Bone Marrow Edema on Outcome in Non-Acute Osteoporotic Patients Treated with Percutaneous Vertebroplasty

STUDY DESIGN: Prospective cohort study. PURPOSE: To prospectively investigate the influence of presence of bone marrow edema (BME) in non acute osteoporotic verterbral compression fractures on postoperative clinical outcome in patients treated by percutaneous vertebroplasty (PV). OVERVIEW OF LITERATURE: Although PV is widely used to treat osteoporotic collapsed vertebral compression fractures (VCF); little is known about the influence of BME in osteoporotic VCF or about its relation with relief of pain. METHODS: Sixty seven patients with non acute osteoporotic verterbral compression fractures treated with PV. They were divided into edema group (56 patients with apparent vertebral BME in their magnetic resonance [MR] images), and non edema group (11 patients with no vertebral BME detected in their MR images). Pain was evaluated one week, one month, six months, and one year post procedure using visual analogue scale. Statistical analysis including a 2-tailed t test comparing postoperative data with preoperative values was done. RESULTS: A good clinical response to PV procedure was seen in all patients. Significant difference was seen between two groups in one week, and one month follow up periods. Regarding pain relief in the other periods of follow up, no significant difference was seen between two groups. CONCLUSIONS: PV resulted in significantly clinical improvement in patients with BME pattern than in those without in one week and one month follow up periods. But the absence of vertebral BME did not influence pain relief in patients with osteoporotic VCFs in six months, and one year post procedure.

Influence of Vertebral Bone Marrow Edema on Outcome in Non-Acute Osteoporotic Patients Treated with Percutaneous Vertebroplasty

STUDY DESIGN: Prospective cohort study. PURPOSE: To prospectively investigate the influence of presence of bone marrow edema (BME) in non acute osteoporotic verterbral compression fractures on postoperative clinical outcome in patients treated by percutaneous vertebroplasty (PV). OVERVIEW OF LITERATURE: Although PV is widely used to treat osteoporotic collapsed vertebral compression fractures (VCF); little is known about the influence of BME in osteoporotic VCF or about its relation with relief of pain. METHODS: Sixty seven patients with non acute osteoporotic verterbral compression fractures treated with PV. They were divided into edema group (56 patients with apparent vertebral BME in their magnetic resonance [MR] images), and non edema group (11 patients with no vertebral BME detected in their MR images). Pain was evaluated one week, one month, six months, and one year post procedure using visual analogue scale. Statistical analysis including a 2-tailed t test comparing postoperative data with preoperative values was done. RESULTS: A good clinical response to PV procedure was seen in all patients. Significant difference was seen between two groups in one week, and one month follow up periods. Regarding pain relief in the other periods of follow up, no significant difference was seen between two groups. CONCLUSIONS: PV resulted in significantly clinical improvement in patients with BME pattern than in those without in one week and one month follow up periods. But the absence of vertebral BME did not influence pain relief in patients with osteoporotic VCFs in six months, and one year post procedure.

Platelet Indices Are Associated with Disease Activity Scores and the Severity of Sacroiliitis on Magnetic Resonance Imaging in Axial Spondyloarthritis Patients

OBJECTIVE: To investigate the associations among platelet indices, disease activity scores, and inflammatory markers in axial spondyloarthritis, and to determine the relation between platelet indices and inflammation measured on magnetic resonance imaging (MRI). METHODS: The study included 161 patients who fulfilled Assessment of Spondyloarthritis International Society criteria. Platelet indices such as mean platelet volume (MPV), plateletcrit (PCT), platelet large cell ratio (PLCR), and platelet distribution width (PDW) were measured. Ninety patients underwent sacroiliac (SI) MRI at baseline. Bone marrow edema (BME) and erosion on MRI were scored using the SPondyloArthritis Research Consortium of Canada (SPARCC) method. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score (ASDAS) and spinal radiologic progression were also assessed. The associations among platelet indices and disease activity scores and inflammatory markers were evaluated. RESULTS: Of the 161 patients, 130 (81%) were male. MPV, PLCR, and PDW were negatively associated with ASDAS and inflammatory marker expression, whereas PCT was positively associated with these parameters. MPV, PLCR, and PDW were negatively associated with BME and erosion scores on SI MRI. However, platelet indices were not associated with the BASDAI and BASFI. The mean erythrocyte sedimentation rate, C-reactive protein, and BME and erosion scores were significantly higher in patients with low MPV. Changes in MPV, PCT, and PDW at baseline and after one year were associated with changes in ASDAS and inflammatory marker expression. CONCLUSION: Platelet indices are associated with ASDAS, inflammatory marker levels, and severity of BME and erosion measured on MRI.

Early Bone Marrow Edema Pattern of the Osteoporotic Vertebral Compression Fracture : Can Be Predictor of Vertebral Deformity Types and Prognosis?

OBJECTIVE: To evaluate whether an early bone marrow edema pattern predicts vertebral deformity types and prognosis in osteoporotic vertebral compression fracture (OVCF). METHODS: This retrospective study enrolled 64 patients with 75 acute OVCFs who underwent early MRI and followed up MRI. On early MRI, the low SI pattern of OVCF on T1WI were assessed and classified into 3 types (diffuse, globular or patchy, band-like). On followed up MRI, the vertebral deformity types (anterior wedge, biconcave, crush), degree of vertebral body height loss, incidence of vertebral osteonecrosis and spinal stenosis were assessed for each vertebral fracture types. RESULTS: According to the early bone marrow edema pattern on T1WI, 26 vertebrae were type 1, 14 vertebrae were type 2 and 35 vertebrae were type 3. On followed up MRI, the crush-type vertebral deformity was most frequent among the type 1 OVCFs, the biconcave-type vertebral deformity was most frequent among the type 2 OVCFs and the anterior wedge-type vertebral deformity was most frequent among the type 3 OVCFs (p<0.001). In addition, type 1 early bone marrow edema pattern of OVCF on T1WI were associated with higher incidence of severe degree vertebral body height loss, vertebral osteonecrosis and spinal stenosis on the follow up MRI. CONCLUSION: Early bone marrow edema pattern of OVCF on T1WI, significant correlated with vertebral deformity types on the follow up MRI. The severe degree of vertebral height loss, vertebral osteonecrosis, and spinal stenosis were more frequent in patients with diffuse low SI pattern.

Bilateral Bone Marrow Edema Syndrome of the Femoral Head with a Unique Onset: A Case Report / 대한고관절학회지

Bone marrow edema syndrome (BMES) is a rare condition which mainly affects the hip area. The etiology and pathogenesis of BMES is still unclear. Pain near the affected area, regional osteoporosis, bone marrow edema (identified using magnetic resonance imaging) and spontaneous regression within 6-12 months are the main characteristics of BMES. In this case, a 52-year-old male was diagnosed with BMES of the right hip followed by spontaneous subsiding of symptoms. After 3 years, and under nearly the same social and physical conditions, he was admitted again with newly developed left hip pain and again diagnosed with BMES. We report this rare case since a similar one has not been previously reported in the domestic literature and may be considered valuable for basic research relating to the pathogenesis of BMES.

Detection of inflammation in early rheumatoid arthritis patients: a comparison study of single photon emission computed tomography combined with computed tomography and magnetic resonance imaging / 中华风湿病学杂志

Objective To evaluate the interactive relationship between inflammation detected by single photon emission computed tomography combined with computed tomography (SPECT/CT) and magnetic resonance imaging (MRI) detection of synovitis,bone marrow edema (BME) in the early rheumatoid arthritis (RA) patients.Methods Twenty patients with early RA were included into this study.All patients were diagnosed based on the 2010 ACR/EULAR classification criterion.Patients' unilateral hands (MCP 2-5 and PIP 2-5 joints) were inspected by SPECT/CT (label:99Tcm-MDP) and MRI (3.0 T).SPECT/CT and MRI images were analyzed by two reviewers blinded to other clinical information.Increased bone metabolism of the regional area of interest (ROI) was analyzed and the uptake ratio was calculated.MRI quantitative evaluation was completed by RAMRIS score system.Statistical analysis was performed using SPSS 17.0 software.Student's t-test,analysis of variance (ANOVA),x2 test and post-hoc analysis (Scheffe) were used for comparison of datas,correlation analysis was carried out with Spearman rank correlation test.Results Twent ypatients with a total of 160 joints were examined.MRI examination revealed synovitis (39,24.4％),or BME (24,15.0％) in 63(39.4％) joints.99Tcm-MDP uptake increased in 79(49.4％) joints,and the uptake ratio was higher than normal joints (1.59±0.26 vs 1.15±0.09,t=6.408,P＜0.01).The uptake ratio between the graded synovitis level and RAMRIS synovitis score had a moderate correlation (r=0.535,P=0.001).The uptake ratio of BME level and BME score was well correlated (r=0.765,P=0.001).Conclusion In early RA patients,MRI is sensitive for synovitis and BME.SPECT/CT can detect early abnormal bone metabolism associated with inflammation,which is more sensitive than MRI.SPECT/CT can be used to detect changes of RA at the molecular level.Compared with synovitis,BME is more closely related to bone metabolism changes,which may suggest that BME may play a major role in the bone destruction in RA.However,further studies are needed to verify this hypothesis.