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 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.

MR Imaging of Bone Marrow Edema and Joint Effusion in Patients with Osteonecrosis of the Femoral Head: Relationship to Pain

2003 ◽  
Vol 181 (2) ◽  
pp. 545-549 ◽  
Author(s):  
Guo-Shu Huang ◽  
Wing P. Chan ◽  
Yue-Cune Chang ◽  
Cheng-Yen Chang ◽  
Cheng-Yu Chen ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Femoral Head ◽  
Mr Imaging ◽  
Bone Marrow Edema ◽  
Joint Effusion ◽  
Marrow Edema

AB1100 PERFORMANCE OF MAGNETIC RESONANCE IMAGING FOR DETECTING SACROILIITIS IN EARLY STAGES OF SPONDYLOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1839.1-1839
Author(s):  
F. Ladeb ◽  
D. Ben Nessib ◽  
M. Bouaziz ◽  
W. Hamdi ◽  
E. Labbene ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Bone Marrow ◽  
Magnetic Resonance ◽  
Positive Predictive Value ◽  
Bone Marrow Edema ◽  
Resonance Imaging ◽  
Sacroiliac Joints ◽  
Early Stages ◽  
The Mean ◽  
Marrow Edema

Background:In view of the limited accuracy of clinical evaluation to recognize sacroiliitis, several imaging techniques such as conventional radiographs, scintigraphy, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) have been used to examine the sacroiliac joints (SIJ).Objectives:The aim of this study was to assess the performance of MRI for detecting sacroiliitis in early stages of spondyloarthritis (SpA).Methods:This cross-sectional prospective monocentric double-blind study included 57 patients consulting for symptoms suggestive of SpA during more than 3 months between February 2014 and February 2017. Patients with conventional radiograph showing a confirmed sacroiliitis (grade 3 or 4) were not included. After clinical examination and blood sampling, eligible patients underwent MRI of SIJ. MR images were interpreted by 2 experimented musculoskeletal radiologists blinded to clinical and laboratory data. Two professors in rheumatology blinded to radiologists’ conclusions, analyzed clinical data, laboratory tests, HLA typing, X-rays and MRI images and divided the patients into 2 groups: confirmed non radiographic SpA (nr-SpA) or no SpA. This classification was considered as the gold standard when analyzing the results.Results:Fifteen men and 42 women were enrolled. The mean age at inclusion was 39.75 ± 11 years [17-59]. The mean duration from the first symptom was 47 ± 39 months [6.6-180]. Forty-three patients were assessed as nr-SpA (75.4%) and 14 patients as no SpA (24.6%). Thirty-three percent of patients were HLA B27 positive. Totally 22 patients had sacroiliitis at MRI, all of them classified as confirmed nr-SpA. Among the nr-SpA group, MRI showed bone marrow edema (BME) in 34.9% of patients and erosions in 44.2% of patients. Among the patients in whom the diagnosis of SpA was excluded, MRI showed bone marrow edema (BME) in 7% of patients and erosions in 7% of patients. A statistically significant association was observed between the presence of sacroiliitis at MRI and rheumatologists’ diagnosis of SpA (p=0.001). The diagnostic value of MRI lesions is presented in the following table:Sensitivity (%)Specificity (%)Positive Predictive Value (%)Positive Predictive Value (%)BME34.992.993.731.7Erosions44.292.99535.1MRI conclusion: sacroiliitis51.210010040Conclusion:SIJ MRI had an excellent specificity for the diagnosis of SpA but a moderate sensitivity. Consequently, some patients in early stages of SpA might be missed by MRI. In addition, we found that diagnostic based solely on BME lacked sensitivity. Detection of erosions in addition to BME enhanced sensitivity (from 34.9% to 44.9%) without changing specificity. Indeed, many recent studies have pointed out the importance of considering structural lesions of SIJ in addition to inflammatory lesions [1, 2].References:[1]Weber U, Lambert RGW, Pedersen SJ, et al (2010) Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis. Arthritis Care Res 62:1763–1771.https://doi.org/10.1002/acr.20312[2]Weber U, Jurik AG, Lambert RGW, Maksymowych WP (2016) Imaging in Spondyloarthritis: Controversies in Recognition of Early Disease. Curr Rheumatol Rep 18:58.https://doi.org/10.1007/s11926-016-0607-7Disclosure of Interests:None declared

scholarly journals Transient Osteoporosis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A227-A228
Author(s):  
Caroline A Poku ◽  
Pauline M Camacho ◽  
Zubair Ilyas
Keyword(s):  
Bone Marrow ◽  
Avascular Necrosis ◽  
Bone Marrow Edema ◽  
Joint Effusion ◽  
Transient Osteoporosis ◽  
X Rays ◽  
Ankle Pain ◽  
Duration Of Symptoms ◽  
Regional Migratory Osteoporosis ◽  
Marrow Edema

Abstract Background: Transient osteoporosis is an uncommon and self-limited clinical syndrome characterized by acute joint pain with evidence of bone marrow edema on MRI. It predominantly affects healthy middle-aged men or women in the third trimester of pregnancy. The hips, knee, foot and ankle are affected in decreasing order of frequency. Pathophysiology is unknown but multiple etiologies such as ischemia, neurogenic compression or impaired venous return have been proposed. Classically, it is unilateral and bilateral in only 20%-40% of cases. It has been reported to periodically involve different joints over time with one report showing the progression to regional migratory osteoporosis in at least 20% of patients. There are no specific biomarkers to aid with diagnosis, MRI shows diffuse bone marrow edema sometimes associated with joint effusion with infrequent subchondral microfractures. Other etiologies to consider for bone marrow edema include osteomyelitis, avascular necrosis, trauma, tumors and inflammatory arthropathy. Transient osteoporosis can be self- limiting however, bisphosphonate use has been associated with shortened recovery time. In our patient given lack of access to his previous records to review and ascertain his previous diagnosis, his diagnosis of record was transient osteoporosis rather than regional migratory osteoporosis. Clinical Case: A 47 yo male presented to clinic with complaint of left ankle pain. Pain initially noted when he tripped and fell one year ago. Initial x-rays did not reveal any fractures. He was unable to weight bear due to pain although he had full range of motion at the ankle with a normal neurological and vascular exam of the foot. Due to persistence of pain, an MRI was done which showed cutaneous edema around the medial and lateral aspects of the ankle, trace tibiotalar joint effusion, marrow edema in the distal tibia and navicular with no acute fracture or definite evidence of avascular necrosis. On further questioning he reported a previous history of hip pain at age 32 and 41 with no preceding trauma. X-rays were negative for fracture and MRI showed marrow edema. Symptoms resolved after a few weeks with possible treatment with Alendronate. With the current presentation biochemical work up including Vitamin D, PTH, 24-hour urine calcium, electrolytes, phosphorus and alkaline phosphatase was unremarkable. Given the marrow edema reported on MRI, absence of fracture, osteochondral lesion or recent trauma transient osteoporosis was diagnosed. Given the duration of symptoms he was treated with Reclast 5mg IV once and reported 80% improvement in ankle pain during follow up 4 weeks later. Conclusion: It is important to identify transient osteoporosis and regional migratory osteoporosis to prevent unnecessary medical or surgical therapy.

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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