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Gondim Teixeira PA, Dubois L, Hossu G, Gillet R, Badr S, Cotten A, Blum A. Quantitative dynamic contrast-enhanced MRI of bone marrow perfusion at the proximal femur: influence of femoral head osteonecrosis risk factor and overt osteonecrosis. Eur Radiol 2023; 33:2340-2349. [PMID: 36394602 DOI: 10.1007/s00330-022-09250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/23/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the MRI perfusion changes in patients with risk factors for osteonecrosis and normally appearing femoral heads prior to overt femoral head osteonecrosis. METHODS Fifty-eight patients (105 hips) were prospectively included in this ethics committee-approved study. There were 46 hips with no image anomalies and no risk factors for osteonecrosis of the femoral head (ONFH) risk factors, 38 with ONFH risk factors and no image abnormalities, and 21 with overt ONFH. All patients underwent DCE-MRI. Semi-quantitative (peak enhancement [PE], area under the curve [AUC], time to maximum enhancement [TME]) and quantitative perfusion parameters (volume plasma, KTRANS, and KEP) were calculated. Excessive alcohol consumption, corticosteroid use, and trauma were considered major risk factors for osteonecrosis of the femoral head. RESULTS Measured at the femoral neck and compared to the healthy hips without OFNH risk factors, PE was significantly lower in the hips of patients with OFNH risk factors. Moreover, the difference was greater in females with risk factors, who presented significantly lower PE values (p = 0.0096). A PE threshold of 1.4% yielded a 92% sensitivity and 54% specificity for the presence of associated ONFH risk factors. The hips with overt OFNH compared to those with normally appearing showed an increase of PE of 45% in the neck (p < 0.014). Various epiphyseal femoral head perfusion parameters (PE, TME, AUC, and Ktrans) presented statistically significant differences in hips with ONFH and those without (p < 0.0001). CONCLUSION DCE-MRI can identify perfusion marrow changes related to the presence of ONFH risk factors and adjacent to osteonecrosis areas. KEY POINTS • Bone marrow perfusion changes may occur prior to overt ONFH and extend beyond the osteonecrosis area to the entire femoral head and neck. • Peak enhancement values were significantly reduced in patients with ONFH risk factors, compared to those without. • The presence of ONFH led to a significant increase in marrow perfusion adjacent to the osteonecrosis area.
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Affiliation(s)
- Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France. .,Université de Lorraine, Inserm, IADI, F-54000, Nancy, France.
| | - Lauriane Dubois
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
| | - Gabriela Hossu
- Université de Lorraine, Inserm, IADI, F-54000, Nancy, France
| | - Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
| | - Sammy Badr
- CHU Lille, Department of Radiology and Musculoskeletal Imaging, Centre de Consultations et Imagerie de l'Appareil Locomoteur, F-59000, Lille, France
| | - Anne Cotten
- CHU Lille, Department of Radiology and Musculoskeletal Imaging, Centre de Consultations et Imagerie de l'Appareil Locomoteur, F-59000, Lille, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
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[ 18F]FDG PET-MR in the Evaluation and Follow-Up of Incidental Bone Ischemic Lesions in a Mono-Center Cohort of Pediatric Patients Affected by Hodgkin's Lymphoma. Diagnostics (Basel) 2023; 13:diagnostics13030565. [PMID: 36766674 PMCID: PMC9914295 DOI: 10.3390/diagnostics13030565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Hodgkin's lymphoma (HL) is one of the neoplasms with the best prognosis in children, adolescents and young adults, but sufferers are burdened by the possibility of developing adverse effects such as Bone Ischemic Lesions (BILs) which are lesions of the bone caused by the loss of/reduction in blood flow. The main goal of this retrospective study was to evaluate the role of [18F]FDG-PET-MR in the early detection of BILs in a single-center cohort of uniformly treated pediatric HL patients. BILs were assessed through PET-MR images as the appearance of medullary lesion surrounded by a serpiginous, tortuous border. From 2017 to 2022, 10/53 (18.9%) HL patients developed BILs which were mostly (8/10 patients) multifocal. Overall, 30 lesions were identified in the 10 asymptomatic patients, all with the above-mentioned features at MR and with very low [18F]FDG uptake. BILs were incidentally detected during HL therapy (n = 6) and follow-up (n = 4), especially in the long bones (66.7%). No factors correlated with the occurrence of BIL were identified. No patients developed complications. PET-MR is a sensitive combined-imaging technique for detecting BILs that are asymptomatic and self-limiting micro-ischemic lesions. BILs can be monitored by clinical follow-up alone both during and after therapy.
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Mourad C, Omoumi P, Vande Berg B. The Many Faces of Marrow Necrosis. Semin Musculoskelet Radiol 2023; 27:103-113. [PMID: 36868248 DOI: 10.1055/s-0043-1761497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Depending on the age and location within the skeleton, bone marrow can be mostly fatty or hematopoietic, and both types can be affected by marrow necrosis. This review article highlights the magnetic resonance imaging findings of disorders in which marrow necrosis is the dominant feature.Fatty marrow necrosis is detected on T1-weighted images that show an early and specific finding: the reactive interface. Collapse is a frequent complication of epiphyseal necrosis and detected on fat-suppressed fluid-sensitive sequences or using conventional radiographs. Nonfatty marrow necrosis is less frequently diagnosed. It is poorly visible on T1-weighted images, and it is detected on fat-suppressed fluid-sensitive images or by the lack of enhancement after contrast injection.Pathologies historically "misnamed" as osteonecrosis but do not share the same histologic or imaging features of marrow necrosis are also highlighted.
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Affiliation(s)
- Charbel Mourad
- Department of Diagnostic and Interventional Radiology, Hôpital Libanais Geitaoui - CHU, Beyrouth, Lebanon.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bruno Vande Berg
- Department of Radiology, Musculoskeletal Section, Centre Hospitalier Chretien, CHC, Clinique Mont Legia, Liege, Belgium
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Mourad C, Cosentino A, Nicod Lalonde M, Omoumi P. Advances in Bone Marrow Imaging: Strengths and Limitations from a Clinical Perspective. Semin Musculoskelet Radiol 2023; 27:3-21. [PMID: 36868241 PMCID: PMC9984270 DOI: 10.1055/s-0043-1761612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Conventional magnetic resonance imaging (MRI) remains the modality of choice to image bone marrow. However, the last few decades have witnessed the emergence and development of novel MRI techniques, such as chemical shift imaging, diffusion-weighted imaging, dynamic contrast-enhanced MRI, and whole-body MRI, as well as spectral computed tomography and nuclear medicine techniques. We summarize the technical bases behind these methods, in relation to the common physiologic and pathologic processes involving the bone marrow. We present the strengths and limitations of these imaging methods and consider their added value compared with conventional imaging in assessing non-neoplastic disorders like septic, rheumatologic, traumatic, and metabolic conditions. The potential usefulness of these methods to differentiate between benign and malignant bone marrow lesions is discussed. Finally, we consider the limitations hampering a more widespread use of these techniques in clinical practice.
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Affiliation(s)
- Charbel Mourad
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Diagnostic and Interventional Radiology, Hôpital Libanais Geitaoui- CHU, Beyrouth, Lebanon
| | - Aurelio Cosentino
- Department of Radiology, Hôpital Riviera-Chablais, Vaud-Valais, Rennaz, Switzerland
| | - Marie Nicod Lalonde
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Pascart T, Falgayrac G, Cortet B, Paccou J, Bleuse M, Coursier R, Putman S, Quinchon JF, Bertheaume N, Delattre J, Marchandise P, Cultot A, Norberciak L, Kerckhofs G, Budzik JF. Subchondral involvement in osteonecrosis of the femoral head: insight on local composition, microstructure and vascularization. Osteoarthritis Cartilage 2022; 30:1103-1115. [PMID: 35568111 DOI: 10.1016/j.joca.2022.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine changes of subchondral bone composition, micro-structure, bone marrow adiposity and micro-vascular perfusion in end-stage osteonecrosis of the femoral head (ONFH) compared to osteoarthritis (OA) using a combined in vivo and ex vivo approach. DESIGN Male patients up to 70 years old referred for total hip replacement surgery for end-stage ONFH were included (n = 14). Fifteen patients with OA were controls. Pre-operative MRI was used to assess bone perfusion (dynamic contrast-enhanced (DCE) sequences) and marrow fat content (chemical shift imaging). Three distinct zones of femoral head subchondral bone - necrotic, sclerotic, distant - were compared between groups. After surgery, plugs were sampled in these zones and Raman spectroscopy was applied to characterize bone mineral and organic components (old and newly-formed), and contrast-enhanced micro-computed tomography (CE-μCT) to determine bone micro-structural parameters and volume of bone marrow adipocytes, using conventional 2D histology as a reference. RESULTS In the necrotic zone of ONFH patients compared to OA patients: 1) the subchondral plate did not exhibit significant changes in composition nor structure; 2) the volume fraction of subchondral trabecular bone was significantly lower; 3) type-B carbonate substitution was less pronounced, 4) collagen maturity was more pronounced; and 5) bone marrow adipocytes were significantly depleted. The sclerotic zone from the ONFH group showed greater trabecular thickness, and higher DCE-MRI AUC and Ktrans. Volume fraction of subchondral bone, trabecular number, and Kep were significantly lower in the distant zone of the ONFH group. CONCLUSIONS This study demonstrated alterations of subchondral bone microstructure, composition, perfusion and/or adipose content in all zones of the femoral head.
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Affiliation(s)
- T Pascart
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France; Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France.
| | - G Falgayrac
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France
| | - B Cortet
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR 4490, Department of Rheumatology, 59000 Lille, France
| | - J Paccou
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR 4490, Department of Rheumatology, 59000 Lille, France
| | - M Bleuse
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France
| | - R Coursier
- Department of Orthopaedic Surgery, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - S Putman
- Department of Orthopaedic Surgery, CHU Lille, Lille University, Lille, France
| | - J-F Quinchon
- Department of Anatomopathology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - N Bertheaume
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France
| | - J Delattre
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France
| | - P Marchandise
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France
| | - A Cultot
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - L Norberciak
- Department of Research, Biostatistics, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - G Kerckhofs
- Biomechanics Lab - Institute of Mechanics, Materials, and Civil Engineering, Louvain-la-Neuve, UCLouvain, Belgium; IREC - Institute of Experimental and Clinical Research, UCLouvain, Woluwe, Belgium; Department Materials Engineering, Leuven, KU Leuven, Belgium; Prometheus, Division for Skeletal Tissue Engineering, Leuven, KU Leuven, Belgium
| | - J-F Budzik
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France; Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
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