Clinical Perspective on Dual Energy Computed Tomography
Katsuyuki Taguchi, Ira Blevis, Krzysztof Iniewski in Spectral, Photon Counting Computed Tomography, 2020
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).
Axial Spondyloarthritis
Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide in 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
Management of osteoporotic pelvic fractures
Peter V. Giannoudis, Thomas A. Einhorn in Surgical and Medical Treatment of Osteoporosis, 2020
Magnetic resonance imaging (MRI) of the pelvic ring is the most sensitive examination for detecting occult fractures. Bone bruise in the sacrum is already visible when fissures or fractures are not yet detectable on pelvic overviews or CT. MRI is not part of our diagnostic workup of FFP. We recommend using MRI if conventional radiographs and CT cannot explain the clinical picture of the patient, especially low back and posterior pelvic pain. A positive MRI finding does not mean that an FFP is already present. Differentiation between bone marrow edema and malignancy is possible with MRI (17).
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.
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).
Measuring disease activity and response to treatment in rheumatoid arthritis
Published in Expert Review of Clinical Immunology, 2019
Casandra Buzatu, Robert J. Moots
MRI is another sensitive tool, mostly used in clinical trials to observe disease activity and damage progression. The advantages of this lie in its high objectivity, sensitivity in detecting subtle changes in joints, lack of operator dependency, and a well-developed and approved scoring system. The Outcome Measure in Rheumatology RA MRI Scoring System was developed and validated between 1998 and 2002. The progress in both technical field (hardware, software) and RA evolution and management raised the need for scoring system updates. In 2005, an Atlas was published in order to make MRI scoring accessible worldwide [61]. Different variables can be applied in individual clinical trials depending on what changes are of interest [61, 55]. This approach led to the observation that one of the anticipating factors for developing bone erosions in early arthritis patients was bone marrow edema at diagnosis [62, 63]. On the other hand, the expense and time-consuming process of MRI limit its use to mainly clinical trials with less usage in clinical practice.