scholarly journals Subchondral insufficiency fracture of the knee: review of current concepts and radiological differential diagnoses

2021 ◽  
Author(s):  
Junko Ochi ◽  
Taiki Nozaki ◽  
Akimoto Nimura ◽  
Takehiko Yamaguchi ◽  
Nobuto Kitamura
Keyword(s):  
Bone Marrow ◽  
Signal Intensity ◽  
Bone Marrow Edema ◽  
Insufficiency Fracture ◽  
Differential Diagnoses ◽  
Osteochondral Lesions ◽  
Imaging Features ◽  
Subchondral Insufficiency Fracture ◽  
Increased Risk ◽  
Marrow Edema

AbstractSubchondral insufficiency fracture of the knee (SIFK) is a common cause of knee joint pain in older adults. SIFK is a type of stress fracture that occurs when repetitive and excessive stress is applied to the subchondral bone. If the fracture does not heal, the lesion develops into osteonecrosis and results in osteochondral collapse, requiring surgical management. Because of these clinical features, SIFK was initially termed “spontaneous osteonecrosis of the knee (SONK)” in the pre-MRI era. SONK is now categorized as an advanced SIFK lesion in the spectrum of this disease, and some authors believe the term “SONK” is a misnomer. MRI plays a significant role in the early diagnosis of SIFK. A subchondral T2 hypointense line of the affected condyle with extended bone marrow edema-like signal intensity are characteristic findings on MRI. The large lesion size and the presence of osteochondral collapse on imaging are associated with an increased risk of osteoarthritis. However, bone marrow edema-like signal intensity and osteochondral collapse alone are not specific to SIFK, and other osteochondral lesions, including avascular necrosis, osteochondral dissecans, and osteoarthritis should be considered. Chondral lesions and meniscal abnormalities, including posterior root tears, are also found in many patients with SIFK, and they are considered to be related to the development of SIFK. We review the clinical and imaging findings, including the anatomy and terminology history of SIFK, as well as its differential diagnoses. Radiologists should be familiar with these imaging features and clinical presentations for appropriate management.

scholarly journals Rapid Destructive Arthrosis Due to Subchondral Insufficiency Fracture of the Shoulder: Clinical Characteristics, Radiographic Appearances, and Outcomes of Treatment

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 885
Author(s):  
Chul-Hyun Cho ◽  
Byung-Woo Min ◽  
Kyung-Jae Lee ◽  
Jun-Young Kim ◽  
Du-Han Kim
Keyword(s):  
Bone Marrow ◽  
Clinical Characteristics ◽  
Bone Marrow Edema ◽  
Insufficiency Fracture ◽  
Joint Effusion ◽  
Radiographic Appearance ◽  
Subchondral Insufficiency Fracture ◽  
Subchondral Fracture ◽  
The Mean ◽  
Marrow Edema

The purpose of our study was the clinical characteristics, radiographic appearance, and outcomes after treatment in patients with rapid destructive arthrosis (RDA) due to subchondral insufficiency fracture (SIF) of the shoulder. Twenty-two cases of RDA of the shoulder were retrospectively reviewed. Clinical outcomes for 15 cases who underwent shoulder arthroplasty were evaluated at an average of 41.4 months. The mean age of patients was 73.7 years (range 50–83 years), and there were 20 women and 2 men. The mean time from onset of symptoms to head collapse was 6.8 months (range 1–12 months). The mean t-score of bone mineral density was −3.1. Nine patients had pseudoparalysis. Based on radiographic appearance, a diversity of types of head destruction with subchondral fracture, bone marrow edema, joint effusion, and synovitis were observed in all cases. In conclusion, RDA due to SIF of the shoulder, presenting with severe short-term pain and functional disability, commonly occurred in elderly women with bone fragility. MRI revealed bone marrow edema, extensive joint effusion, and synovitis as well as a diversity of types of head destruction with subchondral fracture within several months from onset of symptoms.

scholarly journals The role of bone marrow edema on autologous matrix induced chondrogenesis for the treatment of osteochondral lesions of the talus

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Riccardo D’Ambrosi ◽  
Camilla Maccario ◽  
Federico Giuseppe Usuelli
Keyword(s):  
Bone Marrow ◽  
Repeated Measures ◽  
Bone Marrow Edema ◽  
Lesion Size ◽  
Osteochondral Lesions ◽  
Significant Difference ◽  
T1 And T2 ◽  
Marrow Edema

Category: Ankle, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: to assess the functional and radiological outcomes after AT-AMIC® (arthroscopic talus autologous matrix induced chondrogenesis) in 2 groups: patients with and without bone marrow edema (BME). Methods: Thirty-seven patients of which 24 without edema (GNE) and 13 with edema (GE) were evaluated. All patients were treated with AT-AMIC® repair for osteochondral talar lesion. MRI and CT-scan evaluations, as well as clinical evaluations measured by the VAS score for pain, AOFAS and SF-12 were performed preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively. Results: GNE consisted of 24 patients while GE consisted of 13 patients. In both groups we found a significant difference for clinical and radiological parameters with ANOVA for repeated measures through four time points(p<0.001). In GNE, AOFAS improved significantly at each follow-up(p<0.05); while CT and MRI showed a significant decrease between T1 and T2 and T2 and T3(p<0.05). In GE, AOFAS improved significantly between T0 and T1 and T2 and T3(p<0.05); CT decreased between T1 and T2(p<0.05), while MRI showed a reduction at each follow-up(p<0.05). Lesion size was significantly higher both in MRI and CT in GE in respect to GNE(p<0.05). In the GNE no patients presented edema at T3, while in GE only 23.08% of the patients presented edema at T3. Conclusion: The study revealed that osteochondral lesions of the talus were characterized by bigger size both in MRI and CT in patients with edema. We conclude that AT-AMIC® can be considered a safe and reliable procedure that allows effective healing, regardless of edema and more than half of patients did not present edema six months after surgery.

scholarly journals Reviewing Bone Marrow Edema in Athletes: A Difficult Diagnostic and Clinical Approach

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1143
Author(s):  
Umberto Tarantino ◽  
Chiara Greggi ◽  
Ida Cariati ◽  
Guglielmo Manenti ◽  
Matteo Primavera ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Signal Intensity ◽  
Bone Marrow Edema ◽  
Current Knowledge ◽  
Correct Diagnosis ◽  
High Signal ◽  
Clinical Approach ◽  
Therapeutic Treatment ◽  
Sports Activity ◽  
Marrow Edema

Bone marrow edema (BME) is defined as an area of low signal intensity on T1-weighted (T1W) MRI images and associated with intermediate or high signal intensity findings on T2-weighted (T2W) MRI images. BME represents a typical imaging finding that characterizes common stress-related bone injuries of professional and amateur athletes. The etiology of stress-related injuries is influenced by numerous factors, including the initiation of a new sports activity or changes in an existing training protocol. The clinical significance of BME remains unclear. However, a correlation between the imaging pattern of BME, the clinical history of the patient and the type of sports activity practiced is essential for correct diagnosis and adequate therapeutic treatment. It is also important to clarify whether there is a specific threshold beyond which exercise can adversely affect the bone remodeling process, as the clinical picture may degenerate into the presence of BME, pain and, in the most severe cases, bone loss. In our review, we summarize the current knowledge on the etiopathogenesis and treatment options for BME and highlight the main aspects that make it difficult to formulate a correct diagnosis and establish an adequate therapeutic treatment.

Erosions Are the Most Relevant Magnetic Resonance Imaging Features in Quantification of Sacroiliac Joints in Ankylosing Spondylitis

2010 ◽  
Vol 37 (3) ◽  
pp. 622-627 ◽  
Author(s):  
MARIUS C. WICK ◽  
RÜDIGER J. WEISS ◽  
WERNER JASCHKE ◽  
ANDREA S. KLAUSER
Keyword(s):  
Magnetic Resonance Imaging ◽  
Bone Marrow ◽  
Ankylosing Spondylitis ◽  
Magnetic Resonance ◽  
Contrast Medium ◽  
Rheumatic Diseases ◽  
Bone Marrow Edema ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Marrow Edema

Objective.To determine the most relevant radiological features in quantitative magnetic resonance imaging (MRI) of sacroiliac (SI) joints in patients with recent-onset ankylosing spondylitis (AS) versus patients with SI involvement due to other rheumatic diseases, or to degenerative SI pain.Methods.We retrospectively analyzed laboratory values, clinical data, and MRI of the SI joints of 179 patients admitted for evaluation of AS-suspicious SI pain. Standardized MRI sequences were performed at time of first presentation, then archived, and retrospectively quantitatively assessed using a modified SPARCC method for formal statistical comparisons.Results.Of all patients, 27 (15%) were diagnosed with definite AS. The remainder had SI involvement in other rheumatic diseases, HLA-B27– spondyloarthropathy, or nonspecific degenerative changes. While joint space irregularities, bone marrow edema, subcortical cysts, and contrast medium enhancement were found in MRI of all patients, these features were inconsistent, and only erosions were statistically significantly (p < 0.02) in patients diagnosed with AS. Only in AS, the presence of erosions and the quantitative SPARCC erosion subscore correlated to a statistically significant degree (p < 0.02) with laboratory levels of inflammation.Conclusion.Erosions alone, not bone marrow edema or contrast medium enhancement, are the most disease-specific measurable imaging findings in SI MRI of patients with AS.

The Presence and Degree of Bone Marrow Edema Influence Midterm Clinical Outcomes After Microfracture for Osteochondral Lesions of the Talus

2018 ◽  
Vol 46 (10) ◽  
pp. 2503-2508 ◽  
Author(s):  
Yoshiharu Shimozono ◽  
Eoghan T. Hurley ◽  
Youichi Yasui ◽  
Timothy W. Deyer ◽  
John G. Kennedy
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Bone Marrow Edema ◽  
Prognostic Indicator ◽  
Osteochondral Lesions ◽  
Short Term ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Marrow Edema

Background: Subchondral bone marrow edema (BME) has been associated with articular cartilage loss, with the potential to be a negative prognostic indicator for clinical outcomes after microfracture. However, no single study has investigated the association between BME and clinical outcomes after microfracture for osteochondral lesions of the talus (OLTs) at midterm follow-up. Purpose: To clarify the association between postoperative subchondral BME and clinical outcomes in patients treated with microfracture for OLTs at both short-term and midterm follow-up using a grading system that classified the extent of BME of the talus. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent microfracture between 2008 and 2013 were assessed at 2- and 4-year postoperative follow-up. BME was evaluated using magnetic resonance imaging, and the presence of subchondral BME was determined with fat-suppressed T2-weighted sequences. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS). P < .05 was considered to be statistically significant. Results: Forty-three (83%) of 52 eligible patients were included. No significant differences were found in the FAOS between the BME and no BME groups at 2-year follow-up (83.1 ± 6.5 vs 88.6 ± 8.0, respectively; P = .109), but there was a significant difference at 4-year follow-up (77.5 ± 11.1 vs 84.7 ± 8.4, respectively; P = .041). A significant difference was found among BME grades at 4-year follow-up (grade 0: 84.7 ± 7.4, grade 1: 80.1 ± 10.5, grade 2: 74.0 ± 10.3, and grade 3: 67.5 ± 7.1; P = .035). A post hoc analysis showed significant differences between grades 0 and 2, 0 and 3, and 1 and 3 ( P = .041, .037, and .048, respectively). In addition, at 4-year follow-up, a significant correlation was noted between the FAOS and BME grade ( r = −0.453, P = .003) but not at 2-year follow-up ( r = −0.212, P = .178). Seventy-four percent of patients still had subchondral BME at 4-year follow-up after microfracture for OLTs. Conclusion: Patients with subchondral BME at midterm follow-up after microfracture for OLTs had worse clinical outcomes than those without subchondral BME. In addition, the degree of subchondral BME at midterm follow-up was correlated with clinical outcomes. However, at short-term follow-up, there were no significant differences in clinical outcomes based on both the presence and degree of BME, and no correlation was found between clinical outcomes and the degree of BME. The current study suggests that BME at short-term follow-up is a normal physiological reaction. However, BME at midterm follow-up after microfracture for OLTs may be pathological and is associated with poorer clinical outcomes.

scholarly journals Short tau inversion recovery (STIR) after intravenous contrast agent administration obscures bone marrow edema-like signal on forefoot MRI

2021 ◽  
Author(s):  
Tim Fischer ◽  
Yassir El Baz ◽  
Stephan Waelti ◽  
Simon Wildermuth ◽  
Sebastian Leschka ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Contrast Agent ◽  
Signal Intensity ◽  
Bone Marrow Edema ◽  
Healthy Tissue ◽  
Intravenous Contrast ◽  
Signal Change ◽  
Contrast Agent Administration ◽  
Intravenous Contrast Agent ◽  
Marrow Edema

Abstract Objective Short tau or short TI inversion recovery (STIR) MRI sequences are considered a robust fat suppression technique. However, STIR also suppresses signals from other tissues with similar T1 relaxation times. This study investigates the in vivo effect of intravenous gadolinium-based T1-shortening contrast agent on STIR signal. Materials and methods Institutional board approval and informed consent was obtained. MRI examinations (1.5-T or 3-T) of 31 prospectively included patients were analyzed by two readers. Signal intensity of degenerative bone marrow edema-like signal at the Lisfranc joint on precontrast STIR images and on STIR images acquired after intravenous contrast agent administration (gadoteric acid, gadolinium: 0.5 mmol/ml, 15 ml) was measured. The medial cuneiform bone without observable bone marrow edema-like signal was considered a healthy tissue and served as a reference. Relative changes in signal intensity between precontrast and postcontrast images were calculated for the two tissues. Wilcoxon signed-rank test served for statistical analyses. Results In bone marrow edema-like signal, both readers observed a median signal change of -35% (interquartile range (IQR) 24) and -34% (IQR 21), respectively, on postcontrast STIR images compared to precontrast STIR. In healthy tissue, the signal remained constant on postcontrast STIR images (median change -2%, IQR 15, and 0%, IQR 17) respectively. For both readers, postcontrast signal change in bone marrow edema-like signal differed from that in healthy tissue (p < 0.001). Conclusion Intravenous gadolinium-based contrast agent causes a significant reduction of signal intensity in bone marrow edema-like signal on routine STIR images. Thus, pathological MRI findings may be obscured.

Clinical and MRI features of sacral insufficiency fractures after radiotherapy in patients with cervical cancer

2020 ◽  
Author(s):  
Xi Zhong ◽  
Linqi Zhang ◽  
Tianfa Dong ◽  
Hui Mai ◽  
Bingui Lu ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Bone Marrow ◽  
Bone Marrow Edema ◽  
Insufficiency Fracture ◽  
Soft Tissue Tumors ◽  
Sacral Insufficiency Fracture ◽  
Pelvic Mri ◽  
Mri Features ◽  
Marrow Edema

Abstract Background To determine the incidence, clinical and MRI features of sacral insufficiency fracture (SIF) after radiotherapy (RT) in patients with cervical cancer. Methods Our study included 167 patients with cervical cancer after radiotherapy that underwent pelvic MRI for follow-up. MRIs included pre-enhanced T1-weighted, coronal fat-Suppressed T2-weighted (FS-T2W) and enhanced T1-weighted imaging. The clinical and MRI dates were reviewed. The gold standard of SIF was based on radiologic findings, clinical data and follow-up at least 12 months. Results 28 patients (10.8%) with 47 sites were diagnosed with SIFs, including 9 patients with unilateral SIF and 19 patients with bilateral SIFs. The median age was 60 years (range 41–72 years), and 89.3% (25/28) of patients were postmenopausal. 64.3% (18/28) of patients were symptomatic, and 53.6% of patients (15/28) had concomitant pelvic fractures. The median interval time from RT to SIFs was 10 months (range 3 − 34 months). For the lesion-wise analysis based on all MR images, all lesions were detected by visualizing bone marrow edema patterns, and fracture lines were detected in 64.6% (31/47) of SIFs. No soft-tissue tumors were founded. For each MRI sequence analysis, coronal FS-T2WI detected the most bone marrow edema pattern and fracture line than T1WI or enhanced T1WI. Conclusion SIF is a common complication in cervical cancer after radiotherapy, which has some certain clinical and MRI features. Coronal FS-T2WI may be more useful to detect and characterize these fractures than other imaging sequences.

Imaging appearance of post-arthroscopic radiocarpal chondrolysis: comparison with osteoarthritis associated with scapholunate dissociation

2020 ◽  
pp. 028418512092281
Author(s):  
Euddeum Shim ◽  
Baek Hyun Kim ◽  
In Young Choi ◽  
Suk-Joo Hong ◽  
Chang Ho Kang ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Edema ◽  
Joint Destruction ◽  
Joint Effusion ◽  
Imaging Features ◽  
Imaging Findings ◽  
Scapholunate Dissociation ◽  
Radial Styloid ◽  
Radiocarpal Joint ◽  
Marrow Edema

Background Since the diagnosis of post-arthroscopic chondrolysis is very difficult, it can be underdiagnosed and confused with other diseases in clinical practice. Purpose To propose imaging features of post-arthroscopic radiocarpal chondrolysis (PRCC) and to compare these with osteoarthritis associated with scapholunate dissociation which are the most common misdiagnoses of PRCC. Material and Methods To identify missed diagnoses of PRCC, 994 magnetic resonance imaging scans performed in 910 patients were retrospectively reviewed. After the identification of 73 patients who exhibited significant radiocarpal cartilage loss, 11 were diagnosed with PRCC. Since scapholunate advanced collapse was the most common incorrect diagnosis of PRCC (4/11), the imaging findings were compared among the 11 patients with PRCC and 14 patients with osteoarthritis caused by scapholunate dissociation who were diagnosed in the same period. The following imaging features were evaluated: scapholunate dissociation; the center of disease and grade of radiocarpal joint destruction; characteristics of bone marrow edema; the presence of radial styloid and distal scaphoid osteophytes; and the extent of joint effusion and synovitis. Results The imaging diagnosis of PRCC was significantly differentiated from osteoarthritis associated with scapholunate dissociation based on occurrence at a younger age, bone marrow edema crossing the joint, center of disease in the proximal radioscaphoid joint, and absence of radial styloid and scaphoid osteophytes ( P < 0.05). PRCC occasionally presented with arch-shape bone marrow edema based on the proximal carpal row. Conclusion The diagnosis of PRCC can be aided if its characteristic imaging findings are differentiated from other disease entities in patients with a history of arthroscopy.

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