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BACKGROUND: The clinical significance of foot and ankle bone marrow edema (BME) is poorly understood. METHODS: Magnetic resonance imaging (MRI) and the visual analog scale (VAS) pain scores were collected for 17 runners who participated in the Twin Cities Marathon, immediately postmarathon and at a 6-week follow-up. Bone marrow edema lesions were classified using lesion frequency, anatomical location, and grading scale change to calculate a BME score for each affected bone. Spearman rank correlation coefficient test was used to identify a possible correlation between VAS and postmarathon BME. A paired Student t test was used to detect differences between total mileage ran 6 weeks postmarathon in participants with or without BME. RESULTS: After completing the marathon, 8 BME lesions were identified in 5 participants (29.4%; 5/17), 3 were men, and 2 were women, with a mean age of 33.8 years (range: 24-52), and BMI of 22.9 ± 4. All lesions were resolved on 6-week follow-up imaging. VAS pain scores did not correlate with postmarathon BME. A significant difference in total miles logged over 6 weeks postmarathon could not be found among participants with and without BME. CONCLUSION: Foot and ankle BME changes identified by MRI were not correlated to clinical symptoms and may resolve with self-directed activity in less time than other areas of the lower extremity. LEVEL OF EVIDENCE: Level II, Prospective Cohort Study.

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Skeletal traumas are among the most common routine challenges faced by Emergency Radiologists, in particular in case of radiographically occult nondisplaced fractures or in case of soft tissue injuries. With the development of Dual Energy Computed Tomography (DECT) technology, new post-processing applications have gained a useful diagnostic role in many fields of musculoskeletal imaging including acute skeletal trauma imaging. In addition to conventional CT images, DECT allows for the generation of virtual calcium-suppressed images subtracting calcium from unenhanced CT images based on the fact that material attenuation varies at different energy levels. In this way, virtual-non-calcium (VNC) images can precisely characterize traumatic bone marrow edema in both axial and appendicular skeleton, facilitating prompt clinical decision, especially when magnetic resonance method is contraindicated or unavailable. Other DECT emerging applications in the trauma setting include metal artifact reduction and collagen mapping for the evaluation of injuries affecting ligament, tendon, and intervertebral disk. This review focuses on the basic principles of DECT and related post-processing algorithms, highlighting the current advantages and limitations of these new imaging advances in the Emergency Department related to skeletal traumas.

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PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of different related contrast material (Rel.CM) values in dual-energy computed tomography (DECT) virtual non-calcium (VNCa) images for the detection of bone marrow edema (BME) in knee. METHOD: This prospective study was approved by the institutional research ethics board, and written informed consent was obtained from all participants. Twenty-three patients (24 knees) who underwent dual-energy CT and MRI within three weeks from July 2018 to June 2019 with a definite history of trauma were enrolled. Each knee was divided into 12 regions. First, MR images served as the reference standard, Receiver operating characteristic (ROC) curve was used and diagnostic accuracy of VNCa images corresponding to different Rel.CM values (1.25, 1.35, 1.45, 1.55, 1.65, 1.75) were analyzed, aimed to select an optimal Rel.CM value of VNCa images for detecting BME. Then, CT values of the normal areas and BME areas were measured on the VNCa images corresponding to the optimal Rel.CM value for preliminary quantitative analysis. The rank-sum test was used to compare the differences of CT values between BME areas and normal bone marrow areas on the VNCa images. RESULTS: The 24 knees were divided into 288 areas. MR Imaging showed BME in 121 areas. The areas under the ROC curve with different Rel.CM values (1.25, 1.35, 1.45, 1.55, 1.65, and 1.75) were 0.633, 0.674, 0.882, 0.684, 0.651, and 0.649, respectively. On the VNCa images of Rel.CM = 1.45, the diagnostic accuracy was the highest (up to 89.2 %), the CT values of the BME area and the normal area were -67.9 (1.7∼-100.1) HU and -94.5 (-69.7∼-144.9) HU, respectively, with statistical significance (Z=-9.804, P < 0.05). CONCLUSIONS: The VNCa images with a Rel.CM value of 1.45 is optimal for the detection of BME in knee.

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In this commentary, we discuss the potential of advanced imaging, particularly Dynamic Contrast Enhanced (DCE) magnetic resonance imaging (MRI) for the objective assessment of the inflammatory process in rheumatoid arthritis (RA). We emphasise the potential of DCE-MRI in advancing the field and exploring new areas of research and development in RA. We hypothesize that different grades of bone marrow edema (BME) and synovitis in RA can be examined and monitored in a more sensitive manner with DCE-MRI. Future treatments for RA may benefit from the application of enhanced imaging of BMEs and synovitis. DCE-MRI may also facilitate enhanced stratification and phenotyping of patients enrolled in clinical trials.

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Bone marrow edema (BME) is a descriptive term for a common finding in magnetic resonance imaging (MRI). Although pain is the major symptom, BME differs in terms of its causal mechanisms, underlying disease, as well as treatment and prognosis. This complexity together with the lack of evidence-based guidelines, frequently makes the identification of underlying conditions and its management a major challenge. Unnecessary multiple consultations and delays in diagnosis as well as therapy indicate a need for interdisciplinary clinical recommendations. Therefore, an interdisciplinary task force was set up within our large osteology center consisting of specialists from internal medicine, endocrinology/diabetology, hematology/oncology, orthopedics, pediatrics, physical medicine, radiology, rheumatology, and trauma surgery to develop a consenus paper. After review of literature, review of practical experiences (expert opinion), and determination of consensus findings, an overview and an algorithm were developed with concise summaries of relevant aspects of the respective underlying disease including diagnostic measures, clinical features, differential diagnosis and treatment of BME. Together, our single-center consensus review on the management of BME may help improve the quality of care for these patients.

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BACKGROUND: The clinical significance of an incidental finding of bone marrow edema (BME) on MRI in professional runners is poorly understood. PURPOSE: To investigate the prevalence and clinical and radiological progression of BME lesions in professional runners who consider themselves to be asymptomatic. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Sixteen athletes (13 men and 3 women; mean age, 22.9 ± 2.7 years) were recruited from the Dutch National Committee middle-distance and long-distance running selection. All athletes had been injury free for the year before the study. Magnetic resonance imaging scans were obtained before the start of the season and at the end of the season. Both pubic bones, hips, knees, and ankles were scanned in a single session. Preseason and postseason Lysholm scores were obtained. RESULTS: Fourteen of the 16 athletes had BME lesions before the start of the season (45 BME lesions in total). Most BME lesions (69%; 31/45) were located in the ankle joint and foot. More than half of the lesions (58%; 26/45) fluctuated during the season, with new lesions occurring (20%; 9/45) and old lesions disappearing (22%; 10/45). The few clinical complaints that occurred throughout the season were not related to the presence of BME lesions. CONCLUSION: Almost all asymptomatic athletes showed BME lesions, with more than half of the lesions fluctuating during the season. These data suggest that the incidental finding of a BME lesion on MRI of professional runners should not immediately be related to clinical complaints or lead to an altered training program.

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