Seminars in musculoskeletal radiology
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Stress injuries and associated bone marrow changes are a common finding in athletes of all levels. Magnetic resonance imaging (MRI) is the imaging modality of choice for detecting characterizing and staging these injuries. However, because bone marrow edema patterns may also be seen in asymptomatic athletes, it is imperative for the sports medicine physician and the radiologist to closely correlate the imaging findings with the clinical signs and symptoms to assess the clinical significance of the imaging findings. This article reviews the pathophysiology, MRI findings, and clinical implications of stress injuries in athletes.
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Magnetic resonance imaging (MRI) is gaining increasing significance to study disease burden and progression in osteoarthritis. Bone marrow edema pattern has been identified as a typical MR finding associated with osteoarthritis. Histologically, bone marrow edema pattern is characterized by a mix of different pathologies, including bone marrow necrosis, fibrosis, microfractures, and bone remodeling as well as fibrovascular ingrowth. ⋯ Bone marrow edema pattern may be found in association with other abnormalities such as subchondral insufficiency fractures. Clinically the significance of bone marrow edema is controversially discussed with some studies showing evidence of associated pain. In summary, bone marrow signal abnormalities are frequent MRI signs of osteoarthritis with different histological findings, typical associated abnormalities, and also clinical significance.
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Semin Musculoskelet Radiol · Jul 2011
ReviewBone marrow edema pattern around the knee on magnetic resonance imaging excluding acute traumatic lesions.
Magnetic resonance imaging (MRI) is very sensitive for the detection of marrow abnormalities. Bone marrow edema on MRI has been defined as an area of low signal intensity on T1-weighted images, associated with intermediate or high signal intensity findings on T2-weighted images. The bone marrow edema pattern is a nonspecific finding with multiple etiologies. ⋯ Besides contusions and fractures from acute trauma, there are a variety of other causes of the bone marrow edema pattern. It is important for the interpreter of the study to be aware of the different etiologies responsible for producing these changes and to be able to narrow the differential diagnosis without mistaking such a pattern for acute trauma or infiltrative tumor. This article concentrates on those entities that produce a bone marrow edema pattern not related to acute trauma including red marrow proliferation, stress, osteochondral lesions, osteonecrosis, bone marrow edema syndrome, arthropathy, infection, Paget's disease, and marrow replacement disorders.
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The frequency and variety of spinal instrumentation has increased tremendously over the past 100 years, and imaging plays an important role in evaluating the postoperative spine. Although assessment of spinal hardware often involves a multimodality approach, plain radiographs are the most commonly used modality, given accessibility, cost, relatively low radiation dose compared with computed tomography, and provision of positional information. An approach to assessment of plain radiographs of the postoperative spine is discussed, and examples of common postoperative complications are provided, including infection, hardware failure, incomplete fusion, and junctional failure.
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Semin Musculoskelet Radiol · Apr 2011
ReviewPercutaneous vertebral augmentation: the status of vertebroplasty and current controversies.
Vertebroplasty is a cost-effective procedure for the relief of pain and suffering in the appropriate patient when done by a skilled practitioner under good image guidance. No study has ever shown any cost benefit of any balloon-based osteoporotic spine intervention over simple vertebroplasty. No study has ever shown any benefit of any intravertebral implant over vertebroplasty for osteoporotic compression fracture. Recent controversy has highlighted weaknesses in our practice of technology evaluation, and we need to address these issues across the board in the future more scientifically then we have done in the past.