Osteochondral Lesions of the Talus: Change in MRI Findings Over Time in Talar Lesions Without Operative Intervention and Implications for Staging Systems

Background: MRI findings are used in several staging systems to help determine appropriate treatment. The purposes of this study were to evaluate longitudinal changes in MRI characteristics of osteochondral lesions of the talus (OLT) and to evaluate published staging systems in a cohort of nonoperatively treated patients. Methods: Twenty-nine patients were identified; MR images were reviewed for location, size, and interface signal of OLT as well as cysts, marrow edema and osteoarthritis. Lesions were classified as unchanged, progressed, or improved based on changes in size or interface signal. Each lesion was assigned a stage based on four different staging systems. Results: Of the 29 lesions, 13 progressed, seven improved, and nine were unchanged over an average followup of 13.7 months. In the 13 that progressed, marrow edema remained present in ten and developed in two. Four had persistent cysts and four developed new cysts. Two had progression of osteoarthritis and two developed it anew. In the seven that improved, six had some degree of marrow edema that persisted and one had a persistent cyst. Initial staging changed for at least one classification system in 16 (55%) of the 29 lesions at followup. Change in stage was primarily due to development (four of 16) or disappearance of cysts or progression of the lesion in the extent of bone marrow edema (five of 16). Conclusions: OLT did not invariably progress over the short-term without operative intervention. Because some cysts and bone marrow edema resolved on MRI, they may not be reliable signs of lesion severity nor show progression of degenerative changes. Since these findings determine the stage and severity of OLT in some staging systems, they may require reconsideration and adjustment of the current staging systems.

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Prevalence of AALTF and relevant associated MR findings in persons with and without sinus tarsi pain

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00377 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0037

Author(s):

Chul-Hyun Park

Keyword(s):

Bone Marrow ◽

Cortical Thickness ◽

Bone Marrow Edema ◽

Mr Images ◽

Mri Findings ◽

Sinus Tarsi ◽

Calcaneal Cyst ◽

Surface Angle ◽

Marrow Edema ◽

Age And Sex

Category: Ankle Introduction/Purpose: Sinus tarsi pain is very common, however, etiology of this condition has not been well understood. The purpose of this study was to evaluate differences of MRI findings between persons with and without sinus tarsi pain and to investigate the relationships of sinus tarsi pain and accessory anterolateral talar facet (AALTF). Methods: We reviewed MR images of 120 ankles with sinus tarsi pain in 115 consecutively registered patients. And age- and sex-matched MR images of 120 ankles without pain were also reviewed. We compared the presence of AALTF, calcaneal cyst (CC), bone marrow edema (BME), sinus tarsi fat obliteration (STFO) at the Gissane angle, and coalition between persons with and without sinus tarsi pain. We also compared Gissane angle, talar infero-lateral surface angle (TILSA), and calcaneal cortical thickness (CCT). Of persons with sinus tarsi pain, we compared these parameters between persons with and without AALTF. Results: AALTF was present in 61 ankles (50.8%) with sinus tarsi pain and 34 ankles (28.3%) without sinus tarsi pain (P<0.001). BME (P=0.001) and STFO (P=0.009) were significantly more frequent in persons with sinus tarsi pain. Presences of CC (P=0.108) and coalition (P=0.605) were not different. The Gissane angle was significantly smaller in persons with sinus tarsi pain than in persons without sinus tarsi pain (P<0.001) and TILSA (P=0.032), and CCT (P<0.001) were significantly larger in persons without sinus tarsi pain (Table 1). Of persons with sinus tarsi pain, BME was significantly more frequent in persons with AALTF and TILSA (P=0.032) and CCT were significantly larger in persons with AALTF (Table 2). Conclusion: The MRI findings of patients with sinus tarsi pain showed higher prevalence of AALTF, BME, and STFO. The AALTF may be associated with the MRI findings of talar and calcaneal BME.

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Method for Diagnosing the Bone Marrow Edema of Sacroiliac Joint in Patients with Axial Spondyloarthritis Using Magnetic Resonance Image Analysis Based on Deep Learning

Diagnostics ◽

10.3390/diagnostics11071156 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1156

Author(s):

Kang Hee Lee ◽

Sang Tae Choi ◽

Guen Young Lee ◽

You Jung Ha ◽

Sang-Il Choi

Keyword(s):

Bone Marrow ◽

Deep Learning ◽

Bone Marrow Edema ◽

Axial Spondyloarthritis ◽

Mr Images ◽

Sacroiliac Joints ◽

Learning Network ◽

Active Sacroiliitis ◽

Deep Learning Network ◽

Marrow Edema

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease of the sacroiliac joints. In this study, we develop a method for detecting bone marrow edema by magnetic resonance (MR) imaging of the sacroiliac joints and a deep-learning network. A total of 815 MR images of the sacroiliac joints were obtained from 60 patients diagnosed with axSpA and 19 healthy subjects. Gadolinium-enhanced fat-suppressed T1-weighted oblique coronal images were used for deep learning. Active sacroiliitis was defined as bone marrow edema, and the following processes were performed: setting the region of interest (ROI) and normalizing it to a size suitable for input to a deep-learning network, determining bone marrow edema using a convolutional-neural-network-based deep-learning network for individual MR images, and determining sacroiliac arthritis in subject examinations based on the classification results of individual MR images. About 70% of the patients and normal subjects were randomly selected for the training dataset, and the remaining 30% formed the test dataset. This process was repeated five times to calculate the average classification rate of the five-fold sets. The gradient-weighted class activation mapping method was used to validate the classification results. In the performance analysis of the ResNet18-based classification network for individual MR images, use of the ROI showed excellent detection performance of bone marrow edema with 93.55 ± 2.19% accuracy, 92.87 ± 1.27% recall, and 94.69 ± 3.03% precision. The overall performance was additionally improved using a median filter to reflect the context information. Finally, active sacroiliitis was diagnosed in individual subjects with 96.06 ± 2.83% accuracy, 100% recall, and 94.84 ± 3.73% precision. This is a pilot study to diagnose bone marrow edema by deep learning based on MR images, and the results suggest that MR analysis using deep learning can be a useful complementary means for clinicians to diagnose bone marrow edema.

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000151 ◽

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.

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Successful conservative management of symptomatic bilateral dorsal patellar defects presenting with cartilage involvement and bone marrow edema: MRI findings

Skeletal Radiology ◽

10.1007/s00256-016-2335-5 ◽

2016 ◽

Vol 45 (5) ◽

pp. 723-727 ◽

Cited By ~ 3

Author(s):

Thomas C. Kwee ◽

Heleen Sonneveld ◽

Maarten Nix

Keyword(s):

Bone Marrow ◽

Conservative Management ◽

Bone Marrow Edema ◽

Mri Findings ◽

Marrow Edema

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MRI Findings in the Subchondral Bone Marrow: A Discussion of Conditions Including Transient Osteoporosis, Transient Bone Marrow Edema Syndrome, SONK, and Shifting Bone Marrow Edema of the Knee

Seminars in Musculoskeletal Radiology ◽

10.1055/s-2006-957171 ◽

2006 ◽

Vol 10 (3) ◽

pp. 177-186 ◽

Cited By ~ 36

Author(s):

Holly Gil ◽

Scott Levine ◽

Adam Zoga

Keyword(s):

Bone Marrow ◽

Subchondral Bone ◽

Bone Marrow Edema ◽

Transient Osteoporosis ◽

Mri Findings ◽

Bone Marrow Edema Syndrome ◽

Transient Bone Marrow Edema ◽

Marrow Edema

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

Japanese Journal of Radiology ◽

10.1007/s11604-021-01224-3 ◽

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.

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Clinical outcomes after arthroscopic microfracture for osteochondral lesions of the talus are better in patients with decreased postoperative subchondral bone marrow edema

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-06303-y ◽

2020 ◽

Author(s):

Jungtae Ahn ◽

Jung Gyu Choi ◽

Bi O Jeong

Keyword(s):

Bone Marrow ◽

Clinical Outcomes ◽

Subchondral Bone ◽

Bone Marrow Edema ◽

Osteochondral Lesions ◽

Arthroscopic Microfracture ◽

Marrow Edema

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Bone Marrow Edema and Associated Pain in Early Stage Osteonecrosis of the Femoral Head: Prospective Study with Serial MR Images

Radiology ◽

10.1148/radiology.213.3.r99dc06715 ◽

1999 ◽

Vol 213 (3) ◽

pp. 715-722 ◽

Cited By ~ 85

Author(s):

Kyung-Hoi Koo ◽

In-Oak Ahn ◽

Rokho Kim ◽

Hae-Ryong Song ◽

Soon-Taek Jeong ◽

...

Keyword(s):

Bone Marrow ◽

Femoral Head ◽

Prospective Study ◽

Bone Marrow Edema ◽

Early Stage ◽

Mr Images ◽

Marrow Edema

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

The American Journal of Sports Medicine ◽

10.1177/0363546518782701 ◽

2018 ◽

Vol 46 (10) ◽

pp. 2503-2508 ◽

Cited By ~ 4

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.

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