Extrusion, meniscal signal change, loss of shape, synovitis and bone marrow oedema are reliable scoring parameters to assess MRI appearance post meniscal transplant

Background:The incidence of inflammatory and structural lesions on magnetic resonance imaging of sacroiliac joints (MRI SIJs) in patients with hypermobility related disorders has not been fully investigated. Hypermobile patients are more susceptible to pelvic instability and biomechanical stress of the SIJs, leading to MRI SIJ changes similar to those occurring in spondyloarthritis (SpA). Patients with hypermobility and suspected SpA pose a unique challenge owing to the high prevalence of back pain in the hypermobility cohort and the absence of spinal restriction on clinical examination.Objectives:In this study, we aim to investigate the incidence of MRI SIJ lesions in patients with hypermobility.Methods:We performed a retrospective study of all patients with a confirmed diagnosis of hypermobility related disorders (including hypermobility syndrome, hypermobility spectrum disorders and Ehlers-Danlos Syndromes) referred for an MRI lumbar spine and SIJ between 2011 and 2019 to investigate long-standing back pain. MRIs were examined by a musculoskeletal (MSK) radiologist with more than 25 years of experience, who was blinded to the clinical outcome of the patients. MRI SIJs were assessed for the presence of bone marrow oedema, subchondral sclerosis, erosion, fatty change, enthesitis, ankylosis, joint fluid and capsulitis.Results:51 patients with confirmed hypermobility related disorders were referred for MRI SIJ and lumbar spine between 2011 and 2019. 3 patients demonstrated clinical features in keeping with a diagnosis of SpA and were excluded from the study. 15/48 (31.3%) of patients with hypermobility and back pain (but no clinical picture of SpA) were found to have inflammatory and/or structural lesions on MRI SIJ. The most frequent lesions were small foci of bone marrow oedema (16.6%) followed by subchondral sclerosis (12.5%) and fatty change (10.4%). The incidence of erosions was 4.2%.Conclusion:There is a relatively high incidence of inflammatory and structural lesions on MRI SIJ of patients with hypermobility. The presence of hypermobility should be taken into consideration when interpreting MRI changes in patients with suspected SpA. Further research into long-term outcomes of MRI SIJs in patients with hypermobility and back pain is required to establish the clinical significance of these findings.Disclosure of Interests: :Alexis Jones: None declared, Coziana Ciurtin Grant/research support from: Pfizer, Consultant of: Roche, Modern Biosciences, Hanadi Kazkaz: None declared, Margaret Hall-Craggs: None declared

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Incidence of pubic bone marrow oedema in Australian rules football players: relation to groin pain

British Journal of Sports Medicine ◽

10.1136/bjsm.35.1.28 ◽

2001 ◽

Vol 35 (1) ◽

pp. 28-33 ◽

Cited By ~ 130

Author(s):

G M Verrall

Keyword(s):

Bone Marrow ◽

Groin Pain ◽

Bone Marrow Oedema ◽

Pubic Bone ◽

Football Players ◽

Australian Rules Football

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Is active sacroiliitis on MRI associated with radiographic damage in axial spondyloarthritis? Real-life data from the ASAS and DESIR cohorts

Rheumatology ◽

10.1093/rheumatology/key387 ◽

2018 ◽

Vol 58 (5) ◽

pp. 798-802 ◽

Cited By ~ 2

Author(s):

Alexandre Sepriano ◽

Sofia Ramiro ◽

Robert Landewé ◽

Maxime Dougados ◽

Désirée van der Heijde ◽

...

Keyword(s):

Bone Marrow ◽

Odds Ratio ◽

Structural Damage ◽

Axial Spondyloarthritis ◽

Multivariable Analysis ◽

Real Life ◽

Daily Practice ◽

Bone Marrow Oedema ◽

Number Of Patients ◽

Structural Progression

Abstract Objective To assess any association between bone marrow oedema on MRI of the sacroiliac joints (MRI-SIJ) according to local readings in daily practice and the development of structural damage on radiographs of the SIJ (X-SIJ) in axial spondyloarthritis (axSpA). Methods Patients with axSpA from the Assessment of the SpondyloArthritis international Society (ASAS) and DEvenir des Spondylarthopathies Indifférenciées Récentes (DESIR) multicentre cohorts were included. MRI-SIJ and X-SIJ were obtained at baseline, and X-SIJ at follow-up after a mean 4.6 years (ASAS) and 5.1 years (DESIR). All images were scored by local readers. Structural damage in the X-SIJ was defined according to the modified New York criteria. The percentage of structural net progression (number of ‘progressors’ minus the number of ‘regressors’ divided by the total number of patients) was assessed and the effect of bone marrow oedema on MRI-SIJ on X-SIJ damage evaluated by multivariable logistic regression. Results In total, 125 (ASAS-cohort) and 415 (DESIR-cohort) patients had baseline MRI-SIJ and complete X-SIJ data available. According to local readings, progression and ‘improvement’ in X-SIJ was seen in both the ASAS- and DESIR-cohort, yielding a net progression that was higher in the former than in the latter (19.2% and 6.3%). In multivariable analysis, baseline bone marrow oedema on MRI-SIJ was strongly associated with X-SIJ structural progression in both ASAS (odds ratio = 3.2 [95% CI: 1.3; 7.9]), and DESIR (odds ratio = 7.6 [95% CI: 4.3; 13.2]). Conclusion Inflammation on MRI-SIJ is associated with future radiographic progression according to local readings despite an expected increased imprecision invoked by local readings.

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Assessment of bone marrow Oedema-like lesions using MRI in patellofemoral knee osteoarthritis: Comparison of different MRI pulse sequences

British Journal of Radiology ◽

10.1259/bjr.20201367 ◽

2021 ◽

pp. 20201367

Author(s):

Henry Noorveriandi ◽

Matthew J Parkes ◽

Michael J Callaghan ◽

David T Felson ◽

Terence W O'Neill ◽

...

Keyword(s):

Bone Marrow ◽

Knee Pain ◽

Intraclass Correlation ◽

Pulse Sequences ◽

Correlation Coefficients ◽

Bone Marrow Oedema ◽

Volume Distribution ◽

Data Set ◽

Knee Oa ◽

Contrast Enhanced

Objective: To compare bone marrow oedema-like lesion (BML) volume in subjects with symptomatic patellofemoral (PF) knee OA using four different MRI sequences and to determine reliability of BML volume assessment using these sequences and their correlation with pain. Methods: Seventy-six males and females (mean age 55.8 years) with symptomatic patellofemoral knee OA had 1.5 T MRI scans. PD fat suppressed (FS), STIR, contrast-enhanced (CE) T1-w FS, and 3D T1-w FFE sequences were obtained. All sequences were assessed by one reader, including repeat assessment of 15 knees using manual segmentation and the measurements were compared. We used random-effects panel linear regression to look for differences in the log-transformed BML volume (due to positive skew in the BML volume distribution) between sequences and to determine associations between BML volumes and knee pain. Results: Fifty-eight subjects had PF BMLs present on at least one sequence. Median BML volume measured using T1-w FFE sequence was significantly smaller (224.7 mm3, interquartile range [IQR] 82.50–607.95) than the other three sequences. BML volume was greatest on the CE sequence (1129.8 mm3, IQR 467.28–3166.02). Compared to CE sequence, BML volumes were slightly lower when assessed using PDFS (proportional difference = 0.79; 95% confidence interval [CI] 0.62, 1.01) and STIR sequences (proportional difference = 0.85; 95% CI 0.67, 1.08). There were strong correlations between BML volume on PDFS, STIR, and CE T1-w FS sequences (ρs = 0.98). Correlations were lower between these three sequences and T1-w FFE (ρs = 0.80–0.81). Intraclass correlation coefficients were excellent for PDFS, STIR, and CE T1-w FS sequences (0.991 to 0.995), while the ICC for T1-w FFE was good at 0.88. We found no significant association between BML volumes assessed using any of the sequences and knee pain. Conclusion: T1-w FFE sequences were less reliable and measured considerably smaller BML volume compared to other sequences. BML volume was larger when assessed using the contrast enhanced T1-w FS although not statistically significantly different from BMLs when assessed using PDFS and STIR sequences. Advances in knowledge: This is the first study to assess BMLs by four different MRI pulse sequences on the same data set, including different fluid sensitive sequences and gradient echo type sequence.

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Treatment of bone-marrow oedema of the talus with the prostacyclin analogue iloprost

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.83b6.0830855 ◽

2001 ◽

Vol 83-B (6) ◽

pp. 855-858 ◽

Cited By ~ 12

Author(s):

N. Aigner ◽

G. Petje ◽

G. Steinboeck ◽

W. Schneider ◽

C. Krasny ◽

...

Keyword(s):

Bone Marrow ◽

Bone Marrow Oedema ◽

Prostacyclin Analogue

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Bone marrow oedema of the radius presenting as tennis elbow

Rheumatology ◽

10.1093/rheumatology/kes290 ◽

2012 ◽

Vol 52 (2) ◽

pp. 234-234

Author(s):

R. Lee ◽

N. K. Al-Adhoubi ◽

A. S. M. Jawad

Keyword(s):

Bone Marrow ◽

Tennis Elbow ◽

Bone Marrow Oedema

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MRI in early rheumatoid arthritis: synovitis and bone marrow oedema are independent predictors of subsequent radiographic progression

Annals of the Rheumatic Diseases ◽

10.1136/ard.2009.123950 ◽

2010 ◽

Vol 70 (3) ◽

pp. 428-433 ◽

Cited By ~ 88

Author(s):

Pernille Bøyesen ◽

Espen A Haavardsholm ◽

Mikkel Østergaard ◽

Désirée van der Heijde ◽

Sølve Sesseng ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Bone Marrow ◽

Early Rheumatoid Arthritis ◽

Radiographic Progression ◽

Bone Marrow Oedema ◽

Tender Joint Count ◽

X Rays ◽

Tender Joint ◽

Reactive Protein

ObjectivesTo determine whether MRI and conventional (clinical and laboratory) measures of inflammation can predict 3-year radiographic changes measured by the van der Heijde Sharp score in patients with early rheumatoid arthritis (RA).Methods55 patients with RA with disease duration <1 year participated in this 3-year follow-up study. Patients were evaluated at baseline, 3, 6, 12 and 36 months by swollen and tender joint count, disease activity score based on 28-joint count, erythrocyte sedimentation rate (ESR), C reactive protein, MRI measures of synovitis, bone marrow oedema and tenosynovitis of the dominant wrist, as well as conventional x-rays of the hands and wrists.ResultsAll measures of inflammation decreased during the follow-up period. ESR, MRI synovitis and MRI bone marrow oedema were independent predictors of 3-year radiographic progression adjusted for age, sex and anti-citrullinated protein antibodies. The 1-year cumulative measures of MRI synovitis and bone marrow oedema provided an improved explanation of variation (adjusted R2) in radiographic change compared with the baseline MRI values (adjusted R2=0.32 and 0.20 vs 0.11 and 0.04, respectively).ConclusionsBoth baseline and 1-year cumulative measures of MRI synovitis and bone marrow oedema independently predicted 3-year radiographic progression. These results confirm that MRI synovitis and MRI bone marrow oedema precede radiographic progression in patients with early RA.

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Dimethyl fumarate–associated transient bone marrow oedema syndrome

Multiple Sclerosis Journal ◽

10.1177/1352458518791132 ◽

2018 ◽

Vol 25 (6) ◽

pp. 876-879 ◽

Cited By ~ 2

Author(s):

James Triplett ◽

Srimathy Vijayan ◽

Richard Prince ◽

Allan Kermode

Keyword(s):

Multiple Sclerosis ◽

Bone Marrow ◽

Dimethyl Fumarate ◽

Symptomatic Improvement ◽

Bone Marrow Oedema ◽

Related Factor ◽

Relapsing Remitting ◽

Remitting Multiple Sclerosis ◽

And Function ◽

Relapsing Remitting Multiple Sclerosis

Background: Dimethyl fumarate (DMF) is a commonly used and effective treatment for relapsing and remitting multiple sclerosis. Its use results in impairment of the transcription factor nuclear factor erythroid-derived 2 (E2)-related factor (Nrf2), which is involved in both immunomodulation and bone health. DMF has not previously been reported to cause bone marrow complications, though other fumarates including tenofovir have. The mechanism of fumarate-associated bone toxicity remains unclear with altered osteoblastic gene expression and function suggested. Methods: We present a case of a 54-year-old female with relapsing remitting multiple sclerosis (RRMS) treated for 30 months with DMF who developed relapsing atraumatic lower limb bone pain. Results: Serial imaging revealed multifocal areas of bone marrow oedema and trabecular fractures. The patient was diagnosed with transient bone marrow oedema syndrome. Management consisted of cessation of therapy and treatment with the pro-osteobalstic agent denosumab. Conclusion: In this instance of DMF-associated bone marrow oedema, cessation of DMF and treatment with denosumab resulted in symptomatic improvement. DMF therapy may potentially result in bone marrow oedema due to inhibition of common upstream signalling pathways, including the Nrf2 signalling pathway.

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