Bone edema on MRI is highly associated with low bone mineral density in patients with early inflammatory back pain: results from the DESIR cohort.

Bone oedema on MRI is highly associated with low bone mineral density in patients with early inflammatory back pain: results from the DESIR cohort.

Nov 2012

Briot K, Durnez A, Paternotte S, Miceli-Richard C, Dougados M, Roux C.

Source

1Department of Rheumatology, Cochin Hospital, Paris Descartes University, Paris, France.

Abstract

OBJECTIVES:

 To assess bone mineral density (BMD) at lumbar spine and hip in a large cohort of patients with early inflammatory back pain (IBP) suggestive of axial spondyloarthritis (SpA), and to assess systemic and bone inflammation (according to MRI) as risk factors of low BMD.

PATIENTS AND METHODS:

 332 (52.4% male) patients with IBP suggestive of axial SpA defined by Calin or Berlin criteria were recruited; they had lumbar spine and hip BMD and body composition measurements. Low BMD was defined by Z≤-2 (at least one site). Clinical, biological (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and imaging (x-rays, spine and sacroiliac joint MRI) parameters were compared in patients with and without low BMD (Z≤-2). Significant parameters in univariate analysis were tested in multivariate models.

RESULTS:

 Patients (mean age 33.8 years) had a short duration of axial symptoms (mean 1.6 years); 71.4% fulfilled the Assessment of Spondyloarthritis International Society criteria for axial SpA and HLA-B27 was present in 62.1%. 43 (13.0%) had low BMD (88% male). Multivariate logistic regression showed that parameters significantly associated with low BMD (any site) were the presence of bone marrow oedema (inflammatory lesions) on MRI (OR 4.63, p=0.001), either ESR or CRP (OR 2.60, p=0.037) and male gender (OR 9.60, p=0.0004).

CONCLUSIONS:

This study conducted in a large cohort of young adults with early IBP suggestive of SpA shows that 13.0% of patients have a low BMD and that the main risk factor associated with low BMD was inflammation on MRI.

PubMed

Flash Pulmonary Edema in Multiple Sclerosis.

Sept 2012

Plummer C, Campagnaro R.

Source

Centre for Neuroscience and Neurological Research, St Vincent's Hospital, Fitzroy, Melbourne, Victoria, Australia.

Abstract

BACKGROUND:

Neurogenic pulmonary edema (NPE) occurs in the setting of an acute neurological insult and in the absence of a primary cardiopulmonary cause. No unifying theory on NPE pathogenesis exists. NPE triggered by a discrete neurological lesion is rare, but such cases offer valuable insight into NPE pathogenesis.

OBJECTIVE:

To describe an unusual and instructive case of NPE in multiple sclerosis.

CASE REPORT:

A young woman with multiple sclerosis presented to the Emergency Department in acute respiratory failure. She was cyanotic centrally, hypertensive, and tachycardic. The chest X-ray study suggested pulmonary edema. She required non-invasive mechanical ventilation for 12 h. Echocardiography revealed left ventricular hypokinesis. The asymmetrical pulmonary infiltrate raised the suspicion of pneumonia; she was given intravenous antibiotics. By 36 h, she had persistent dyspnea, paroxysmal tachycardia, nausea, and facial flushing; carcinoid syndrome was excluded. By 48 h, she had facial numbness and ataxia. Magnetic resonance imaging (MRI) revealed a demyelinating lesion at the rostromedial medulla. Her symptoms promptly resolved with intravenous steroids, as did the perilesional edema on follow-up MRI.

CONCLUSION:

Life-threatening pulmonary edema can complicate medullary demyelination. Lack of awareness of this diagnostic possibility and an asymmetrical pulmonary infiltrate culminated in diagnostic delay in this case. The case provides clinico-radiological evidence of the pathogenic link between medullary lesions and NPE. The pathogenesis is likely to rely on lesion involvement of the nucleus tractus solitarius or its immediate pathways. Non-uniform vasoconstriction of the pulmonary arterial bed might account for the other peculiarity of this case: the asymmetrical pulmonary infiltrate. Timely diagnosis of NPE is essential because the condition is best managed by nullifying the "neurogenic" trigger.

PubMed

Significant improvement in MRI-proven bone edema is associated with protection from structural damage in very early RA patients managed using the tight control approach.

Significant improvement in MRI-proven bone edema is associated with protection from structural damage in very early RA patients managed using the tight control approach.

June 2012



Kita J, Tamai M, Arima K, Kawashiri SY, Horai Y, Iwamoto N, Okada A, Koga T, Nakashima Y, Suzuki T, Yamasaki S, Nakamura H, Origuchi T, Ida H, Aoyagi K, Uetani M, Eguchi K, Kawakami A.

Source

Unit of Translational Medicine, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.

Abstract

OBJECTIVE:

To identify the value of magnetic resonance imaging (MRI)-proven bone edema in patients with very early rheumatoid arthritis (RA).

METHODS:

All of the 13 patients included in the study were positive at entry for MRI-proven bone edema of the wrist and finger joints and anti-cyclic citrullinated peptide antibodies or IgM-rheumatoid factor. A tight control approach was applied for 12 months. Plain MRI and radiographs of both wrist and finger joints were examined every 6 months. MRI was scored by the RA MRI scoring (RAMRIS) technique and plain radiographs were scored using the Genant-modified Sharp score. Variables that were correlated with plain radiographic changes at 12 months were examined.

RESULTS:

Simplified disease activity index (SDAI) remission was achieved in 7 patients, and a significant reduction in the RAMRIS bone edema score, which declined to .... see article at link below. Program does not allow complete paragraph to be shown here.

CONCLUSIONS:

Improvement in  bone edema may be associated with protection against structural damage in very early RA patients managed using the tight control methods.

Singerlink

Nail Disease in Psoriatic Arthritis: Distal Phalangeal Bone Edema Detected by Magnetic Resonance Imaging Predicts Development of Onycholysis and Hyper

Nail Disease in Psoriatic Arthritis: Distal Phalangeal Bone Edema Detected by Magnetic Resonance Imaging Predicts Development of Onycholysis and Hyperkeratosis.

Dalbeth N, Pui K, Lobo M, Doyle A, Jones PB, Taylor WJ, McQueen FM.

Source

From the Department of Medicine, University of Auckland, Auckland; Department of Rheumatology, Auckland District Health Board, Auckland; Department of Anatomy with Radiology, University of Auckland, Auckland; Department of Medicine, University of Otago, Wellington; and Department of Molecular Medicine, University of Auckland, Auckland, New Zealand.

Abstract

OBJECTIVE:

To examine the association between magnetic resonance imaging (MRI) features of distal phalanx (DP) disease and the progression of nail pathology in psoriatic arthritis (PsA).

METHODS:

Clinical nail assessment and hand MRI scans were done on 34 patients with PsA. Twenty patients had repeat nail assessments after 1 year.

RESULTS:

Nails with onycholysis and hyperkeratosis at baseline were more likely to have corresponding DP bone erosion and proliferation on MRI. DP bone edema on baseline MRI was associated with development of onycholysis and hyperkeratosis in corresponding nails.

CONCLUSION:

Our data suggest that DP inflammation is central in the development of psoriatic nail disease.

PubMed

Validating Imaging Biomarkers of Cerebral Edema in Patients with Severe Ischemic Stroke.

Feb 2012

Yoo AJ, Sheth KN, Kimberly WT, Chaudhry ZA, Elm JJ, Jacobson S, Davis SM, Donnan GA, Albers GW, Stern BJ,González RG.

Source

Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.

Abstract

BACKGROUND:

There is no validated neuroimaging marker for quantifying brain edema. We sought to test whether magnetic resonance imaging (MRI)-based metrics would reliably change during the early subacute period in a manner consistent with edema and whether they would correlate with relevant clinical endpoints.

METHODS:

Serial MRI studies from patients in the Echoplanar Imaging Thrombolytic Evaluation Trial with initial diffusion-weighted imaging (DWI) lesion volume >82 cm(3) were analyzed. Two independent readers outlined the hemisphere and lateral ventricle on the involved side and calculated respective volumes at baseline and days 3 to 5. We assessed interrater agreement, volume change between scans, and the association of volume change with early neurologic deterioration (National Institutes of Health Stroke Scale score worsening of ≥4 points), a 90-day modified Rankin scale (mRS) score of 0 to 4, and mortality.

RESULTS:

Of 12 patients who met study criteria, average baseline and follow-up DWI lesion size was 138 cm(3) and 234 cm(3), respectively. The mean time to follow-up MRI was 62 hours. Concordance correlation coefficients between readers were >0.90 for both hemisphere and ventricle volume assessment. Mean percent hemisphere volume increase was 16.2 ± 8.3% (P < .0001), and the mean percent ventricle volume decrease was 45.6 ± 16.9% (P < .001). Percent hemisphere growth predicted early neurologic deterioration (area under the curve [AUC] 0.92; P = .0005) and 90-day mRS 0 to 4 (AUC 0.80; P = .02).

CONCLUSIONS:

In this exploratory analysis of severe ischemic stroke patients, statistically significant changes in hemisphere and ventricular volumes within the first week are consistent with expected changes of cerebral edema. MRI-based analysis of hemisphere growth appears to be a suitable biomarker for edema formation

Bone Marrow Edema in the Cervical Spine of Symptomatic Rheumatoid Arthritis Patients

Bone Marrow Edema in the Cervical Spine of Symptomatic Rheumatoid Arthritis Patients

Semin Arthritis Rheum. 2008 Mar 11

Narváez JA, Narváez J, Albert MD, De Lama E, Serrallonga M, Nolla JM.
Department of Radiology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain.

OBJECTIVE: To investigate the frequency and clinical significance of bone marrow edema (BME) in a series of patients with rheumatoid arthritis (RA) and symptomatic involvement of the cervical spine.

METHODS: We studied 19 consecutive RA patients with cervical spine magnetic resonance imaging (MRI) according to a specifically designed protocol that included short inversion time inversion recovery sequences. All cases had neck pain unresponsive to conventional treatment, neurological symptoms, or signs suggestive of cervical myelopathy, or cervical pain with evidence of atlantoaxial subluxation on radiographs.

RESULTS: The mean age of the 19 patients (15 women and 4 men) at time of the study was 59 +/- 12 years (range, 23-82) and the median disease duration was 14 +/- 7.4 years (range, 4-30). BME was observed in 74% (14/19) of the patients: at the atlantoaxial level alone in 16% of the patients; subaxially alone in 16%; and at both levels in 42% of the patients. At the atlantoaxial level, BME was usually observed involving the odontoid process, whereas subaxially BME was limited to the vertebral plates and the interapophyseal joints. Patients with BME had higher erythrocyte sedimentation rate (ESR) values at the time of MRI examination (P = 0.014) and more severe atlantoaxial joint MRI synovitis scores (P = 0.05) compared with the remaining patients; the frequency of odontoid erosions was also greater in this group, but the difference did not reach statistical significance. Altogether, these data suggest a more severe inflammatory response in these patients. In this group a significant correlation was found between BME scores at atlantoaxial level and (1) ESR values (r = 0.854; P = 0.001) and (2) atlantoaxial joint MRI synovitis scores (r = 0.691; P = 0.001).

CONCLUSION: BME is frequently observed in patients with established RA and symptomatic cervical spine involvement. Both atlantoaxial and subaxial levels are equally affected. Presence of BME seems related to the intensity of the inflammatory response and to the severity of the atlantoaxial joint synovitis.

PubMed

Differentiation of cytotoxic and vasogenic edema in a patient with reversible posterior leukoencephalopathy syndrome using diffusion-weighted MRI.

Differentiation of cytotoxic and vasogenic edema in a patient with reversible posterior leukoencephalopathy syndrome using diffusion-weighted MRI.

Doelken M, Lanz S, Rennert J, Alibek S, Richter G, Doerfler A.
From the Departments of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany.

In recent years reversible posterior leukoencephalopathy syndrome (RPLS) has become increasingly recognized. It represents an uncommon entity related to multiple pathologies, the most common being hypertensive crisis. The underlying pathophysiological mechanism is proposed to be one of vasogenic edema, without infarction; however, differentiation from cytotoxic edema can be crucial for therapeutic and clinical outcome. Diffusion-weighted magnetic resonance imaging (DWI), including calculation of the apparent diffusion coefficient (ADC), may be helpful for differentiation. We present a case of a healthy young woman in the 40th week of gestation, with no prior complications, who suddenly developed RPLS with vasogenic edema, which was differentiated with DWI and quantification of ADC. Follow-up cranial MRI showed complete remission. Pre-eclampsia could not be proven according to pathognomonic laboratory findings.

Diagnostic and Interventional Radiology