Detection of bone marrow edema in osteonecrosis of the femoral head using virtual noncalcium dual-energy computed tomography

Dual-energy CT-derived virtual noncalcium imaging to assess bone marrow lesions in patients with knee osteoarthritis

To determine the diagnostic performance of dual-energy CT (DECT) virtual noncalcium (VNCa) technique in the detection of bone marrow lesions (BMLs) in knee osteoarthritis, and further analyze the correlation between the severity of BMLs on VNCa image and the degree of knee pain. 23 consecutive patients with clinically diagnosed knee osteoarthritis were underwent DECT and 3.0T MRI between August 2017 and November 2018. Evaluation of two pain assessment scales (WOMAC and KOOS) were collected. VNCa images and MRI were independently scored by three readers using a four-level scoring system over 15 anatomical subregions in each knee joint. Spearman correlation coefficient was used for total BML scores on DECT and MRI correlation with WOMAC and KOOS. Specificity, Sensitivity, NPV and PPV of reader 1 and reader 2 were 99.4%/99.2%, 89.4%/87.2%, 98.6%/98.3% and 95.5%/93.2%. A cutoff value of - 41.5 HU/- 46.5 HU provided sensitivities of 93.2%/90.9% and specificities of 100.0%/93.9% for diagnosing BMLs with AUC of 0.970/0.996. A stronger correlation was observed between the WOMAC and total BML score compared to the KOOS. DECT possessed excellent diagnostic performance in the detection of BMLs in knee osteoarthritis. And the pain degree increased with the severity of BMLs on VNCa images.

Extracorporeal shock wave therapy with imaging examination for early osteonecrosis of the femoral head: a systematic review

BACKGROUND

Extracorporeal shockwave therapy (ESWT) is a traditional noninvasive therapy to treat osteonecrosis of the femur head (ONFH). This systematic review aims to investigate whether ESWT can improve the clinical function of ONFH and whether differences in improvement can be observed in radiographic outcomes.

MATERIALS AND METHODS

Two authors independently searched PubMed, Embase, Cochrane Library, and Web of Science for English articles until 21 October 2023. After screening and reading the literature, the two authors independently used corresponding scales to evaluate the quality of the included articles and extracted data. The key data extracted included the Harris Hip Score (HHS), Visual Analog Scale (VAS), changes in lesion size, the change in the Association Research Circulation Osseous (ARCO) stage, and bone marrow edema (BME) stage.

RESULTS

Nine articles included 468 males and 248 females. The average age was 43.29 years and the mean follow-up time was 15.19 months. After receiving ESWT, five studies involving 146 hips showed a higher HHS (MD=-33.38; 95% CI: -46.31, -20.45), and the difference was statistically significant ( P <0.00001). The average VAS before treatment was above 5, but it dropped to 1.2 after ESWT (MD=4.64; 95% CI: 3.63-5.64), and the difference was statistically significant ( P <0.00001). Three studies found no significant differences in the areas of femoral head necrosis before and after treatment with ESWT(MD=9.66; 95% CI: -0.36, 19.67; P =0.06; I2 =84%). Two articles showed that the use of ESWT had no significant effect on the change in the ARCO stage (MD=1.11; 95% CI: 0.76-1.62; P =0.60; I2 =0%). Three studies indicated that using ESWT could improve the BME symptom in the early stage of ONFH (MD=4.35; 95% CI: 1.32-14.37; P =0.02; I2 =62%).

CONCLUSION

Based on the current evidence, ESWT shows promise as a therapy to enhance hip function and alleviate pain in the early stage of ONFH. With the advancement of more precise imaging techniques, ESWT can potentially reduce the area affected by ONFH. However, such reduction was not found to be statistically significant at the imaging level. Additionally, ESWT could improve symptoms of BME in the early stage. However, no significant change in ARCO grade was observed with ESWT treatment.

Evaluation of Femoral Head Avascular Necrosis With Virtual Noncalcium Dual-Energy Computed Tomography

OBJECTIVE

Our aim was to investigate the effectiveness of the dual-energy computed tomography (DECT) virtual noncalcium (VNCa) technique in avascular necrosis (AVN) for detecting bone marrow edema (BME) and staging.

METHODS

This prospective study included adult patients diagnosed with unilateral or bilateral femoral head AVN between January 2023 and December 2023, who had magnetic resonance imaging (MRI) and DECT. Two participants were excluded from the study due to undergoing surgical procedures during the period between the scans. Two reviewers, blinded to MRI images and clinical data, visually examined color-coded VNCa pictures to assess BME using a binary classification (0 = normal bone marrow, 1 = BME). Same 2 reviewers also used color-coded and nonmapped images to stage AVN in accordance to the "Association for Research on Osseous Circulation" (ARCO) staging system. Interobserver agreements for the visual evaluation and staging were calculated with κ coefficient. Following a visual assessment of BME and the staging of AVN, same 2 reviewers conducted CT density measurements on regions of BME regions utilizing DECT noncalcium images. An independent third investigator (reference standard) utilized MRI, x-ray, and clinical data to confirm the definitive diagnosis and staging of AVN. A P value less than 0.05 was considered statistically significant.

RESULTS

Fifty patients (28 men, 22 women, mean age: 44.2 ± 13.1 years, range: 25-75 years) were included in the final analysis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the VNCa technique in detecting BME were 96.0%, 94.4%, 97.9%, 89.4%, and 95.6%, respectively, for reviewer 1; and 96.0%, 88.9%, 96.0%, 88.9%, and 94.1%, respectively, for reviewer 2. Interobserver agreement was almost perfect ( κ = 0.84). Both reviewer 1 and reviewer 2 accurately classified 92.7% of the AVNs. The density measurements showed a statistically significant difference ( P = 0.001) between the edema regions and the normal marrow regions. No statistically significant difference was observed in the density measurements of edema regions at different stages ( P = 0.13).

CONCLUSIONS

DECT VNCa technique exhibits excellent performance in detecting BME in hip AVN cases, as well as accurately determining the stage of AVN.

Diagnostic performance of dual-energy CT in detecting bone marrow edema in lower limb joint injuries: a meta-analysis

OBJECTIVE

We aimed to evaluate the diagnostic performance of dual-energy computed tomography (DECT) in detecting bone marrow edema (BME) in patients with lower limb joint injuries.

METHODS

A thorough literature search was conducted across the PubMed, Embase, and Web of Science databases to identify relevant studies up to April 2024. Studies examining the diagnostic performance of DECT in detecting BME in lower limb joint injuries patients were included. Sensitivity and specificity were evaluated using the inverse variance method and transformed via the Freeman-Tukey double arcsine transformation. Furthermore, the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was utilized to evaluate the methodological quality of the included studies.

RESULTS

This meta-analysis included 17 articles involving 625 patients. The pooled sensitivity, specificity, and AUC for DECT in detecting BME in lower limb joint injuries patients were 0.82 (95 % CI: 0.76-0.87), 0.95 (95 % CI: 0.92-0.97), and 0.95 (95 % CI: 0.93-0.97), respectively. The pooled sensitivity of DECT for detecting BME in knee, hip, and ankle joint injuries was 0.80, 0.84, and 0.80, with no significant difference among these joints (P = 0.55). The pooled specificity for knee, hip, and ankle injuries was 0.95, 0.97, and 0.89. Specificity differed significantly among the joints (P < 0.01), with the highest specificity in hip injuries.

CONCLUSIONS

Our meta-analysis indicates that DECT demonstrates high diagnostic performance in detecting BME in patients with lower limb joint injuries, with the highest specificity observed in hip joint injuries. To validate these findings, further larger prospective studies are necessary.

Value of Edema-like Marrow Signal Intensity in Diagnosis of Joint Pain: Radiologists' Perspective

Musculoskeletal pain is a significant contributor to disability. The mechanism and target of the treatment should be optimized by imaging, but currently no accepted gold standard exists to image pain. In addition to end-organ pathology, other mediators also contribute to nociception, such as angiogenesis, axonal extension, immunologic modulation, and central sensitization. Recent research indicates that local inflammation is a significant contributor to pain in the extremities; therefore, we focus here on edema-like marrow signal intensity (ELMSI). We examine both the relevance of ELMSI for pain and novel imaging techniques.

Clinical Application of Shock Wave in the Treatment of Avascular Necrosis of the Femoral Head in the Early and Middle Stages

In order to observe the clinical efficacy of shock waves in the treatment of avascular necrosis of the femoral head in the early and middle stages, a clinical application method of a shock wave in the treatment of avascular necrosis of the femoral head in the early and middle stages was proposed. The method combines the CT image segmentation technology to further segment the hip joint image, thereby speeding up the treatment speed and achieving a better treatment effect. Experimental results show that CT image segmentation takes 10.9 hours with an average time of 8 seconds, which is faster than other methods. The shock wave is an effective treatment method for early avascular necrosis of the femoral head, and this method will become one of the main methods for the clinical treatment of this kind of disease.