Magnetic resonance perfusion and diffusion imaging characteristics of transient bone marrow edema, avascular necrosis and subchondral insufficiency fractures of the proximal femur

Müeller, Dirk; Schaeffeler, Christoph; Baum, Thomas; Walter, Flavia; Rechl, H.; Rummeny, Ernst J.; Woertler, Klaus

doi:10.1016/j.ejrad.2014.07.017

Cited by 36 publications

(37 citation statements)

References 30 publications

(41 reference statements)

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“…However, as has been discussed under the LCP section above, osteonecrosis regions show little perfusion while in bone marrow edema syndrome, DCE‐MRI enhancement is significantly greater . In addition, Mueller et al reported that the maximum enhancement on DCE‐MRI is higher in patients with subchondral fractures and bone marrow edema syndrome than in those patients with avascular necrosis …”

Section: Bone Perfusionmentioning

confidence: 97%

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Review of dynamic contrast‐enhanced MRI: Technical aspects and applications in the musculoskeletal system

Sujlana

Skrok

Fayad

2017

Magnetic Resonance Imaging

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Section: Bone Perfusionmentioning

confidence: 97%

“…51,52 In addition, Mueller et al reported that the maximum enhancement on DCE-MRI is higher in patients with subchondral fractures and bone marrow edema syndrome than in those patients with avascular necrosis. 53…”

Section: Bone Marrow Edema/subchondral Fractures Versus Osteonecrosismentioning

confidence: 99%

Review of dynamic contrast‐enhanced MRI: Technical aspects and applications in the musculoskeletal system

Sujlana

Skrok

Fayad

2017

Magnetic Resonance Imaging

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“…Although there is common agreement on diffusion increase in adult FHAVN, Öner et al (45) analyzed diffusion in different disease stages, showing no significant difference. Mueller et al (46), despite the evidence of diffusion increase in the epiphysis and metaphysis, failed to demonstrate any difference in Apparent Diffusion Coefficient (ADC) between Transient Bone Marrow Edema (TBME), FHAVN, and Subchondral Insufficiency Fractures (SIV). In our opinion previously mentioned results and the absence of a stage dependent ADC value, in contrast to what was recently demonstrated in LCP disease, limit the actual value of this technique.…”

Section: Advanced Magnetic Resonance Imagingmentioning

confidence: 99%

The role of imaging in diagnosis and management of femoral head avascular necrosis

Manenti

Altobelli

Pugliese

et al. 2015

ccmbm

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SummaryThe aim of this paper is to critically review the literature documenting the imaging approach in adult Femoral Head Avascular Necrosis (FHAVN). For this purpose we described and evaluated different radiological techniques, such as X-ray, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Nuclear Medicine. Plain films are considered the first line imaging technique due to its ability to depict femoral head morphological changes, to its low costs and high availability. CT is not a routinely performed technique, but is useful to rule out the presence of a subchondral fracture when MRI is doubtful or contraindicated. MRI is unanimously considered the gold standard technique in the early stages, being capable to detect bone marrow changes such as edema and sclerosis. It may be useful also to guide treatment and, as CT, it is a validated technique in follow-up of patients with FHAVN. Nuclear medicine imaging is mostly applied in post-operative period to detect graft viability or infective complications. More advanced techniques may be useful in particular conditions but still need to be validated; thus new research trials are desirable. In conclusion, X-ray examination is the first line approach, but lacks of sensitivity in early stage whereas MRI is indicated. CT easily depicts late stage deformation and may decrease MRI false positive results in detecting the subchondral fracture. However, the role of both Nuclear Medicine Imaging and advanced MR techniques in FHAVN still need to be investigated.

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“…Dynamic contrast material-enhanced MR imaging is a noninvasive method to measure perfusion at high spatial resolution, and results of previous studies (10)(11)(12)(13) have shown that evaluation of perfusion parameters can aid in the characterization of diseases of bone marrow such as metastases, primary bone tumors, or vertebral body fractures. Various studies (14)(15)(16) in which dynamic contrast-enhanced MR imaging was used showed promising results in clarifying the pathogenesis of bone marrow edema in patients with osteonecrosis and TBMES.…”

Section: Resultsmentioning

confidence: 99%

Transient Bone Marrow Edema Syndrome versus Osteonecrosis: Perfusion Patterns at Dynamic Contrast-enhanced MR Imaging with High Temporal Resolution Can Allow Differentiation

et al. 2017

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Purpose To prospectively evaluate the perfusion patterns at quantitative dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging of transient bone marrow edema syndrome (TBMES) and avascular osteonecrosis. Materials and Methods Institutional review board approval and written informed consent were obtained. Thirty-two patients (21 men, 11 women; mean age, 48 years; 26 hips, 10 knees) underwent conventional MR imaging and a dynamic contrast-enhanced three-dimensional spoiled gradient-echo sequence at 3 T. Parameter maps for mean transit time (MTT) and plasma flow (PF) were evaluated qualitatively and quantitatively. Differences in perfusion patterns were analyzed by using the Fisher exact test. Regions of interest were drawn in areas of high PF and long MTT on each parametric map. Mean, median, standard deviation, minimum, and maximum values were determined. TBMES and osteonecrosis were compared statistically by using the Mann-Whitney U and Wilcoxon signed-rank tests, with a P value of less than .05 considered indicative of a significant difference. Results Nineteen joints with TBMES and 17 joints with osteonecrosis were evaluated. TBMES joints showed a subchondral elongated area of high PF and low MTT that was surrounded by an area of long MTT and low PF. Osteonecrosis joints showed a subchondral area with low or no detectable PF and MTT adjacent to the joint surface, which was surrounded by a rim of high PF and intermediate MTT. Patterns for TBMES and osteonecrosis did not overlap. A significant difference (P < .001) in PF in the immediate subchondral area was found between TBMES and osteonecrosis; in joints with osteonecrosis, this was comparable to background noise, and therefore, could not be quantified. In the circumscribed rim of high PF and intermediate MTT, which was only found in joints with osteonecrosis, mean ± standard deviation PF was 18.9 mL/100 mL per minute ± 11.0 and mean MTT was 213.3 seconds ± 56.8. No significant difference between TBMES and osteonecrosis was found for MTT (P = .09) and PF (P = .75) in the surrounding area. Conclusion Parameter maps derived at dynamic contrast-enhanced MR imaging with high temporal resolution can allow differentiation of osteonecrosis from TBMES in hip and knee joints. RSNA, 2016 Online supplemental material is available for this article.

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Magnetic resonance perfusion and diffusion imaging characteristics of transient bone marrow edema, avascular necrosis and subchondral insufficiency fractures of the proximal femur

Cited by 36 publications

References 30 publications

Review of dynamic contrast‐enhanced MRI: Technical aspects and applications in the musculoskeletal system

Review of dynamic contrast‐enhanced MRI: Technical aspects and applications in the musculoskeletal system

The role of imaging in diagnosis and management of femoral head avascular necrosis

Transient Bone Marrow Edema Syndrome versus Osteonecrosis: Perfusion Patterns at Dynamic Contrast-enhanced MR Imaging with High Temporal Resolution Can Allow Differentiation

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