Calcium-Suppressed Technique in Dual-Layer Detector Computed Tomography to Evaluate Knee Articular Cartilage

Background: Calcium-suppressed (CaSupp) technique involving spectral-based images has been used to observe bone marrow edema by removing calcium components from the image. Objective: This study aimed to evaluate the knee articular cartilage using the CaSupp technique in dual-layer detector computed tomography (DLCT). Methods: Twenty-eight healthy participants and two patients with osteoarthritis were enrolled, who underwent DLCT and magnetic resonance imaging (MRI) examination. CaSupp images were reconstructed from spectral-based images using a calcium suppression algorithm and were overlaid conventional CT images for visual evaluation. The morphology of the knee cartilage was evaluated, and the thickness of the articular cartilage was measured on sagittal proton density– weighted and CaSupp images in the patellofemoral compartment. Results: No abnormal signal or density, cartilage defect, and subjacent bone ulceration were observed in the lateral and medial femorotibial compartments and the patellofemoral compartment on MRI images and CaSupp images for the 48 normal knee joints. CaSupp images could clearly identify cartilage thinning, defect, subjacent bone marrow edema, and edema of the infrapatellar fat pad in the same way as MRI images in the three knee joints with osteoarthritis. A significant difference was found in the mean thickness of the patellar cartilage between MRI images and CaSupp images, while the femoral cartilage presented no significant difference in thickness between MRI images and CaSupp images over all 48 knee joints. Conclusion: The present study demonstrated that CaSupp images could effectively be used to perform the visual and quantitative assessment of knee cartilage.

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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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Dual-Energy Computed Tomography Virtual Noncalcium Imaging for the Detection of Acute Bone Marrow Edema in Vertebrae: Qualitative and Quantitative Analysis

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3363 ◽

2021 ◽

Vol 11 (3) ◽

pp. 752-759

Author(s):

Lingjing Gu ◽

Jianchao Liang ◽

Yingying Zhan ◽

Jielin Pan ◽

Yi Zhang ◽

...

Keyword(s):

Computed Tomography ◽

Bone Marrow ◽

Mr Imaging ◽

Bone Marrow Edema ◽

Dual Energy ◽

Grading System ◽

Qualitative And Quantitative ◽

Ct Value ◽

Quantitative Analyses ◽

Marrow Edema

Purpose: To evaluate the feasibility of dual-energy computed tomography (DECT) virtual noncalcium (VNCa) images for detecting vertebral bone marrow edema (BME), both in qualitative and quantitative analyses. Materials and Methods: Nineteen cases with acute spinal trauma were enrolled. DECT and MR Imaging were performed over an interval of 0–3 days within 3 weeks of injury. Both gray-scale and color-coded VNCa images were evaluated in an independent and blind manner using a three-scale grading system (2 = distinct BME, 1 = suspicious BME, and 0 = no edema) by two radiologists. CT value of bone marrow were measured for each region and subjected to receiver operating characteristic (ROC) curve analysis for diagnosis of BME on VNCa images from DECT. Subsequently, as a standard of reference, MR imaging was evaluated by a third radiologist for the presence of traumatic BME. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection of BME using VNCa images were evaluated. Kappa analysis and one-way ANOVA were performed to evaluate the consistency and variance of VNCa images in the BME. Results: For two observers, the sensitivity of VNCa images for detecting BME (grade 2) were 97.8% and 96.7%, with the specificity 76% and 72%, the PPV 93.8% and 92.7%, the NPV 90.5% and 85.7%, respectively. And the sensitivity for detecting BME (grade 1–2) were 94.3% and 94.3%, with the specificity 96.7% and 93.3%, the PPV 98.8% and 97.6%, the NPV 85.3% and 84.8%, respectively. The consistency test between the two observers showed that Kappa value was 0.650 (P < 0.001). The VNCa images had higher CT value in the positive regions than in the negative regions (P < 0.05). Statistically significant differences in the CT value were identified in different regions with the three-scale grading system (thoracic levels: F = 136.690, P < 0.001; lumbar levels: F = 92.689, P < 0.001). Conclusions: Acute traumatic BME in the vertebrae can be detected on VNCa images in both qualitative and quantitative analyses. DECT VNCa images are expected to serve as an additional method for the evaluation of BME.

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Meta-analysis of dual-energy computed tomography virtual non-calcium imaging to detect bone marrow edema

European Journal of Radiology ◽

10.1016/j.ejrad.2017.08.005 ◽

2017 ◽

Vol 95 ◽

pp. 124-129 ◽

Cited By ~ 10

Author(s):

Mou Li ◽

Yali Qu ◽

Bin Song

Keyword(s):

Computed Tomography ◽

Bone Marrow ◽

Calcium Imaging ◽

Bone Marrow Edema ◽

Meta Analysis ◽

Dual Energy ◽

Dual Energy Computed Tomography ◽

Marrow Edema

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Detection of bone marrow edema in osteonecrosis of the femoral head using virtual noncalcium dual-energy computed tomography

European Journal of Radiology ◽

10.1016/j.ejrad.2021.109681 ◽

2021 ◽

pp. 109681

Author(s):

Tianzi Zuo ◽

Yingmin Chen ◽

Hongming Zheng ◽

Xiuchuan Jia ◽

Yunfeng Bao ◽

...

Keyword(s):

Computed Tomography ◽

Bone Marrow ◽

Femoral Head ◽

Bone Marrow Edema ◽

Dual Energy ◽

Dual Energy Computed Tomography ◽

Marrow Edema

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Subchondral Bone Marrow Edema in Patients with Degeneration of the Articular Cartilage of the Knee Joint

Radiology ◽

10.1148/radiol.2382050122 ◽

2006 ◽

Vol 238 (3) ◽

pp. 943-949 ◽

Cited By ~ 77

Author(s):

Richard Kijowski ◽

Paul Stanton ◽

Jason Fine ◽

Arthur De Smet

Keyword(s):

Bone Marrow ◽

Articular Cartilage ◽

Knee Joint ◽

Subchondral Bone ◽

Bone Marrow Edema ◽

Marrow Edema

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Dual-Energy Computed Tomography–Based Display of Bone Marrow Edema in Incidental Vertebral Compression Fractures

Investigative Radiology ◽

10.1097/rli.0000000000000458 ◽

2018 ◽

Vol 53 (7) ◽

pp. 409-416 ◽

Cited By ~ 18

Author(s):

Claudia Frellesen ◽

Mehrnoush Azadegan ◽

Simon S. Martin ◽

Katharina Otani ◽

Tommaso DʼAngelo ◽

...

Keyword(s):

Computed Tomography ◽

Bone Marrow ◽

Bone Marrow Edema ◽

Dual Energy ◽

Vertebral Compression Fractures ◽

Dual Energy Computed Tomography ◽

Compression Fractures ◽

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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