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Axial Spondyloarthritis
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
With improved understanding of disease pathophysiology, radiolabeling of specific molecules that play a role in etiologic pathways is a promising future possibility. In AxSpA specifically, prior studies have used 18-F fluorodeoxyglucose (targeted for synovial tissue), 11-C (R)PK11105 (targeted for macrophage uptake), and 18-F fluoride (which is taken up into actively remodeling bone).91 The latter was demonstrated to have high correlation with structural bony changes on imaging, likely due to fluoride uptake by osteoblasts in involved sites. Notably, 18-F localized to sites with fat deposition and on syndesmophytes, but not in areas of bone marrow edema, possibly providing a novel means to visualize activity of these “noninflammatory” lesions.92
The cases
Published in Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young, Paediatric Radiology for MRCPCH and FRCR, 2020
Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young
Acute bone infarcts cause marked bone marrow oedema. In a fat-saturated T2 MRI image, the marrow fat should appear dark. The area of oedema stands out as a bright high-signal area, with surrounding low-density serpiginous lines. The area will appear as low signal on T1-weighted images.
Clinical Perspective on Dual Energy Computed Tomography
Published in Katsuyuki Taguchi, Ira Blevis, Krzysztof Iniewski, Spectral, Photon Counting Computed Tomography, 2020
Charis McNabney, Shamir Rai, Darra T. Murphy
Bone marrow edema secondary to trauma has traditionally been diagnosed on MRI with low signal on T1 and high signal on T2 fat-suppressed images. MRI is limited in the setting of trauma due to long acquisition scan times, prolonged and potentially painful patient positioning, patient contraindications, and variable “out-of-hours” availability. Conventional CT lacks the ability to detect bone marrow edema because attenuation changes caused by the edema are subtle (Alabsi et al. 2017). Non-calcium images (VNCa) produced by DECT have been validated by numerous studies for the detection of bone marrow edema (Bierry et al. 2014; Guggenberger et al. 2012; Pache et al. 2010; Wang et al. 2013). Color maps applied from DECT increase visibility and detection of subtle bone marrow edema (Mallinson et al. 2016) (Figure 3.5). Further research is required to validate the use of DECT in the setting of suspicion for minimally displaced hip fracture when no fracture is identified on pelvic radiograph. There are limitations for use of DECT for detection of small lesions with limited marrow edema, present adjacent to cortical bone; they are poorly visualized and can therefore be missed (Reddy et al. 2014).
Cat at home? Cat scratch disease with atypical presentations and aggressive radiological findings mimicking sarcoma, a potential diagnostic pitfall
Published in Acta Orthopaedica, 2021
Florian Amerstorfer, Jasminka Igrec, Thomas Valentin, Andreas Leithner, Lukas Leitner, Mathias Glehr, Jörg Friesenbichler, Iva Brcic, Marko Bergovec
Case no. 5. A 13-year-old female with osteomyelitis of distal humerus as a late manifestation of cat scratch disease. (A) AP radiography of the elbow with discrete permeative osteodestruction pattern, cortical irregularity, and no periosteal reaction (circle). (B–C) Bone marrow infiltration of the medial epicondyle with permeative destruction of underlying cortex on axial proton density image (arrow, B) and coronal T1-weighted (arrow, C). (D) Bone marrow edema in the area and extraosseous extension with cortex destruction. Abnormal thickening and increased T2-weighted signal intensity within the common flexor origin from the lateral epicondyle due to inflammatory infiltration (white arrow) with edema of the surrounding subcutaneous fat tissue. (E) Corresponding color Doppler sonography shows cortical discontinuity with extraosseous soft tissue extension without significant hypervascularisation of the surrounding structures (yellow star).
Immune checkpoint inhibitor-induced inflammatory arthritis: identification and management
Published in Expert Review of Clinical Immunology, 2020
Sandra G. Williams, Arash Mollaeian, James D. Katz, Sarthak Gupta
MRI is useful for evaluation and diagnosis of inflammatory peripheral arthritis. It can also provide information on inflammatory changes in the spine and pelvis [99]. In addition, MRI is able to reveal bone marrow edema (demonstrated as hyperintensity of trabecular bone on T2 and post gadolinium contrast) [99]. Bone marrow edema is not only a measure of active inflammation (and thus can help assess response to therapy) but also may provide prognostic value. For example, bone marrow edema is associated with early erosions and rapid progression to RA in undifferentiated inflammatory arthritis [101]. In a retrospective case series, our group reported MRI findings of nine patients with ICI-IIA. Tenosynovitis and synovitis were observed early and as a common feature [75]. In one patient without a preceding history of IA, MRI revealed synovitis, tenosynovitis, and bone marrow edema as early as 4 weeks after onset of symptoms [75]. While more information is needed, our observations lead us to speculate that as in RA, erosions, and bone marrow edema will prove to have predictive value in the context of ICI-IIA. Nevertheless, while MRI continues to be the most sensitive observer-independent imaging modality for evaluation of inflammatory arthritis [102], its use is limited by cost and availability.
Predictive value of magnetic resonance imaging for multifocal osteonecrosis screening associated with glucocorticoid therapy
Published in Modern Rheumatology, 2020
Kento Nawata, Junichi Nakamura, Shigeo Hagiwara, Yasushi Wako, Michiaki Miura, Yuya Kawarai, Masahiko Sugano, Kensuke Yoshino, Kazuhide Inage, Sumihisa Orita, Seiji Ohtori
MRI was utilised for the initial diagnosis of osteonecrosis in hip, knee, shoulder, ankle joint, which was defined as a high-intensity area demarcated by a low-intensity band on a coronal T1-weighted MRI in patients with pre-collapsed and asymptomatic osteonecrosis in the early phase of the disease [15]. Bone marrow edema and joint effusion were characteristics at the time of collapse in patients at an advanced phase of the disease [11]. Screening entailed T1-weighted and Short T1 Inversion Recovery (STIR) coronal images of both hip and knee joints in a single examination [10]. T1-weighted and STIR coronal images of both shoulders and ankle joints were examined on a different day. In this way, MRIs of both hips, knees, shoulders and ankles were obtained for all the patients regardless of symptom(s).