Subchondral bone marrow edema in patients with degeneration of the articular cartilage of the knee joint

PURPOSE: To retrospectively determine at magnetic resonance (MR) imaging the prevalence of subchondral bone marrow edema beneath arthroscopically proved articular cartilage defects. MATERIALS AND METHODS: The study was performed in compliance with HIPAA regulations, and a waiver of informed consent was obtained from the institutional review board before the study was performed. The study consisted of 132 patients (70 men, 62 women; average age, 53 years) with articular cartilage defects of the knee joint who underwent MR imaging of the knee and subsequent arthroscopic knee surgery. At the time of arthroscopy, each articular cartilage lesion was graded by using the Noyes classification system. MR examinations were retrospectively reviewed to determine the size, depth, and location of subchondral bone marrow edema without knowledge of the arthroscopic findings. Pairwise Fisher exact tests and two-sample t tests were used to correlate MR imaging findings of subchondral bone marrow edema with the arthroscopic grade of articular cartilage degeneration. RESULTS: Subchondral bone marrow edema was seen beneath 105 (19%) of 554 articular cartilage defects identified at arthroscopy. It was not observed beneath any of the six grade 1 cartilage defects but was observed beneath eight (4.9%) of 163 grade 2A defects, 40 (14.4%) of 278 grade 2B defects, 54 (55.1%) of 98 grade 3A defects, and three (33.3%) of nine grade 3B defects. Subchondral bone marrow edema was also seen beneath four (1.4%) of 238 articular surfaces that appeared normal at arthroscopy. The mean depth and cross-sectional area of subchondral bone marrow edema increased with increasing grade of the articular cartilage lesion. CONCLUSION: Higher grades of articular cartilage defects are associated with higher prevalence and greater depth and cross-sectional area of subchondral bone marrow edema.     

Subchondral lucencies and synovial disease: A case report and discussion

The case of a young female with hip pain and acetabular subchondral lucencies on conventional radiographs is presented. Computed tomography (CT) demonstrated subchondral lucencies in the femoral head as well, and an arthrogram revealed synovial irregularities. The differential diagnosis is discussed with an approach to subchondral lucencies. A synovectomy was performed on this patient with pigmented villonodular synovitis.     

Spondylometaphyseal dysplasia, Sutcliffe type: a rediscovered entity.

The authors describe two children with spondylometaphyseal dysplasia, Sutcliffe type. This easily recognizable form of bone dysplasia is characterized by coxa vara, minimal metaphyseal changes, oval vertebral bodies and metaphyseal corner fractures later in life. It is probably the most common type of spondylometaphyseal dysplasia. Early diagnosis is important for proper management.     

Subchondral bone infractions in acute ligamentous knee injuries demonstrated on bone scintigraphy and magnetic resonance imaging.

Bone scintigraphy is used to detect radiographically silent fractures. Magnetic resonance imaging (MRI) is currently used to screen knee injuries for cartilage and ligament damage. MRI also delineates bone marrow and fractures. We investigated the bone scintigraphic findings in patients who had subchondral bone injuries demonstrated on MRI. Thirteen patients underwent MRI, three-phase bone scintigraphy with SPECT, and arthroscopic surgery after sustaining acute traumatic hemarthrosis of a knee. They all had clinically unsuspected subchondral bone injuries demonstrated on MRI with normal radiographs and normal overlying articular cartilage at arthroscopy, consistent with occult fractures. All showed focal bone repair on scintigraphy. Two of the 13 patients showed additional bone injuries only on bone scan. Two other patients scintigraphically showed focal bone repair at the medial femoral condyle due to avulsion of the medial collateral ligament. SPECT was easier to interpret than multi-view planar imaging. Bone scintigraphy confirms subchondral fractures demonstrated on MRI but also demonstrates ligament avulsion injuries and additional more subtle bone injuries.     

Degenerative joint disease: cartilage or vascular disease?

The aetiology of degenerative joint diseases is multifactorial, but one main cause is overloading (mechanical stress). While until recently it was well accepted that this represented primarily a disorder of cartilage with reactive subchondral changes, there is now some evidence that it might be primarily a subchondral problem with secondary changes in the articular cartilage. Early subchondral changes include redistribution of blood supply with marrow hypertension, oedema and probably micro-necrosis. These findings are very similar to those in avascular necrosis of bone and raise the question of a vascular aetiology. While these first reports need further proof, it seems clear that the articular cartilage and subchondral regions are one functional unit, in which the subchondral region is more stress sensitive. Recently described channels connecting these two regions strengthen this opinion. These new concepts are exciting and may make a major impact in the near future on the management of and research into degenerative joint disease.     

Ultrasound of femoral head cartilage: a new method of assessing bone age

This paper analyses the relationship between the thickness of the anterior femoral head cartilage (FHC), as measured by ultrasound, and some anthropometric parameters, such as height, weight, skeletal and chronological age. In addition, it provides standard norms for FHC thickness in a paediatric population. Both hips were examined in 213 consecutive subjects (99 boys and 114 girls), aged 1.9–14 years. Seventy-four subjects underwent hand and wrist X-rays for skeletal maturation: 32 of these were dropped from the study because a discrepancy as high as two standard deviations was found between their skeletal and their chronological age. The thickness of FHC correlated strongly with skeletal and chronological age, standing height and body weight. A side difference of 0.2 mm in FHC was considered to be abnormal. The study population was divided into 13 groups according to chronological age and values of FHC for boys and girls are provided for each group. It is suggested that the magnitude of hyaline FHC is a valuable feature in the evaluation of skeletal maturation in children.     

Malignant chest wall neoplasms of bone and cartilage: a pictorial review of CT and MR findings

Malignant tumours of the chest wall are uncommon. The purpose of this pictorial essay is to describe the CT and MRI findings of malignant neoplasms affecting the bony skeleton of the chest wall and the costal cartilages. The most common primary malignant neoplasms involving the bony skeleton of the chest wall are chondrosarcoma, osteosarcoma and Ewing's sarcoma/primitive neuroectodermal tumour. Metastases, multiple myeloma and invasive primary lung cancer are the most frequent secondary lesions. We performed a retrospective review of the radiology and pathology archive at our institution from 1 July 2000 to 31 December 2004 and identified 31 of these lesions. Several of these tumours have distinctive radiological features, allowing a confident radiological diagnosis to be suggested.     

Magnetic resonance imaging of articular cartilage and evaluation of cartilage disease

Clinical magnetic resonance imaging of articular cartilage is possible by using techniques that offer high contrast between articular cartilage and adjacent structures in reasonable examination times. The fat-suppressed, three-dimensional, spoiled gradient-echo sequence has been reported to be accurate and reliable, and the addition of this sequence to a routine examination does not significantly compromise patient throughput. Fast spin-echo imaging also shows promise in the clinical evaluation of articular cartilage, because the newer, stronger-gradient systems allow thinner slice acquisition with two-dimensional sequences. Together, these sequences allow the evaluation of intrachondral lesions and surface defects. Furthermore, quantitative measurements of cartilage volume for follow-up studies are possible with the use of the fat-suppressed, three-dimensional, spoiled gradient-echo sequence.     

Hounsfield unit for the diagnosis of bone mineral density disease: A proof of concept study

ObjectivesOur aim is to correlate Hounsfield units (HU) from lumbar Computed Tomography scans (CT) with Bone Mineral Density (BMD) values from Dual-energy X-ray Absorptiometry scans (DXA) for the diagnosis of bone mineral density disease.MethodsWe enrolled 114 women, conducted both CT and DXA scans on them to assess the correlations between the mean lowest HU at lumbar vertebrae and the BMD values from DXA scan. Statistical analysis was used to assess the correlations between HU and the patients' BMD and age.ResultsWe noted moderate correlations between the lowest HU at L1–L4 and the BMD from DXA scan which is significant (correlation coefficient, 0.563). DXA scans showed a normal BMD in 33.3% of patients, osteopenia in 43.9%, and osteoporosis in 22.8% respectively. We also determined that a HU of 203 would exclude osteoporosis (90% sensitivity for normal BMD) and a threshold of <91 would exclude normal bone mineral density (86% sensitivity for osteopenia, 60% sensitivity for osteoporosis). Mean HU values consistently decreased with increasing decade of life, from 182.8 ± 42 in the fourth decade to 82.13 ± 32 in the eighth (correlation coefficient, 0.527).ConclusionsHU values are moderately correlated with the patients' age and BMD values from DXA scan, with 203, safely excluding osteoporosis and <91 excluding normal BMD. Prospective studies with a larger number of patients are needed, where multiple thresholds could be applied and more distinguished values for normal bone density, osteopenia, and osteoporosis can be obtained.     

某部传染病疫情调查分析

目的了解某部传染病发病情况、流行规律,为制定有效的预防策略和措施提供依据。方法利用该部所属单位的传染病上报资料信息,使用Excel进行统计分析。结果该部2009年度共报告各类传染病637例（含食物中毒）。其中,甲类传染病无报告;乙类传染病共报告14种432例,占报告发病数的67.82%;丙类10种203例,占31.87%;其他非法定传染病108例;食物中毒2例。该部传染病疫情发生有明显的季节性,年初和年末发病数较少,4、6、9月份发病数最多,为215例,占所有发病数的33.75%。呼吸道传染病在以传播途径划分的各类传染病中居首位,高达56.04%;肺结核共报告发病184例,居报告传染病第一位,占全部传染病报告发病数的28.89%。结论该部传染病疫情不容乐观,要重点加强对呼吸道传染病、暴发疫情和聚集性发病疫情的监控力度,尤其是要对甲型H1N1流感和聚集性发热病例给予高度重视,必须加强对新发传染病和重大疫情的监测,加强对发病数较高的传染病的防控力度,重视部队官兵的主动预防意识和平时的教育管理。要从疫情监测、疾病预防、易感人群的保护、传染病的综合防治等多个环节做起,才能有效地减少暴发和聚集性疫情的发生。     

Angiomatosis of bone and soft tissue: a spectrum of disease from diffuse lymphangiomatosis to vanishing bone disease in young patients

The application of cross-sectional imaging in the investigation of patients with angiomatosis reveals that lymphangiomatosis and vanishing bone disease should not be considered as separate entities, but rather as a spectrum of disease. We present a pictorial review of eight patients demonstrating the manifestations of soft tissue and bony involvement. We highlight a subgroup of patients with chyloid pleural effusions who have a poor prognosis.     

Structural and functional features of human muscle-tendon unit

This paper reviews the architectural details and the in vivo behavior of the human muscle-tendon unit with the focus on the triceps surae and quadriceps femoris muscles. Recent advances in experimental techniques allow in vivo measurements of muscle-tendon architecture and function. In particular, the use of ultrasonography for measurement of tendon and muscle has expanded our knowledge in the last decade. Furthermore, the nuclear magnetic resonance imaging is opening up new insights not only for three-dimensional anatomical information but also for examining musculo-skeletal motion in vivo. While these two completely non-invasive methods provide kinematic data, in vivo force measurements still require somewhat invasive procedures and are scarce. Thus, muscle forces are frequently calculated using both simple and complex models. These models can give us suggestions for further experimental work. There is a need to examine the experimental data ranging from single-fiber experiments to the muscle function in human movement in order to understand the muscle-tendon function in vivo fully. Furthermore, appreciation of the structure-function relationships may help us to understand the entity of muscle-tendon function both from the perspective of mechanical behavior and neural control.     

Plasma cell sclerosis of bone: a spectrum of disease

We describe the clinical, radiographic, and pathologic manifestations of a group of disorders characterized by osteosclerosis in association with plasmacytic infiltration of bone marrow. These conditions include multiple myeloma, plasma cell granuloma, sternocostoclavicular hyperostosis, the POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes), and chronic symmetric plasma cell osteomyelitis of childhood. Although clinically unrelated in many respects, features shared by these diseases support the existence of a specific factor linking the plasma cell to local osteogenesis.     

Rapid palliative radiotherapy unit: multidisciplinary management of bone metastases

PURPOSE: The aim of this study was to highlight the advantages of rapid access to a palliative radiotherapy unit adopting a multidisciplinary approach to symptom management to relieve pain and improve quality of life in patients with bone metastases. MATERIALS AND METHODS: From January 2007 to December 2008, 142 oncological patients were treated with linear accelerator radiotherapy (RT) administered in a single 8-Gy fraction. The European Organization for Research and Treatment Quality of Life Questionnaire (EORTC QLQ-C30) was administered to each patient at admission and at subsequent intervals. A traditional simulator was used to define the correct patient setup, and all treatment plans were performed with a two-dimensional technique.. RESULTS: Ninety-six patients agreed to fill in the EORTC QLQ-C30 questionnaire; 80 actually completed it. Twelve weeks after RT, a reduction in pain level compared with baseline (T0) was recorded, which was classified as 1 in 36 patients (45%) and 2 in 44 patients (55%). Pain interference with daily activities was also recorded, with significantly reduced scores with respect to T0: 1 in eight patients (10%), 2 in 28 patients (35%) and 3 in 44 patients (55%); quality of life scores also improved with respect to T0: 2 in 28 patients (35%), 3 in 23 patients (29%), 4 in 22 patients (27%) and 5 in seven patients (9%). CONCLUSIONS: The proposal for treating patients with painful bone metastases with a single 8-Gy fraction of RT, with all the procedures being performed on the same day, offers many advantages in terms of pain relief, quality of life and clinical management.     

Erdheim-Chester disease: a rare syndrome with a characteristic bone scintigraphy pattern

Erdheim-Chester disease is a rare noninherited, non-Langerhans' cell histiocytosis, with multiorgan involvement. The skeleton is frequently involved in as many as 70-80% of all cases. In nearly half of the cases, there is an involvement of other organs such as the cardiovascular system, lung, kidneys, brain, and orbits. Extra-skeletal involvement is correlated with increased morbidity and mortality. In recent years, the disease is being described with increasing frequency although fewer than 200 cases have been identified worldwide. Besides its rarity, the disease has a characteristic almost pathognomonic bone scan appearance, which in some cases facilitates diagnosis of the syndrome. Bone scans also contribute to the qualitative assessment of skeletal involvement.     

Diaphyseal bone disease: scintigraphic-radiographic correlation

Though generally nonspecific, the patterns of diaphyseal uptake of bone seeking radionuclides, when correlated with the radiographic findings and clinical histories, often suggest specific diagnoses and may obviate the need for further imaging. Diaphyseal uptake is considered in terms of "hot spots," unilateral long segment lesions and bilateral processes that may be symmetric or asymmetric in distribution. Scintigrams and corresponding radiographs of 18 different lesions are illustrated.     

Acute injury of the articular cartilage and subchondral bone: a common but unrecognized lesion in the immature knee

OBJECTIVE: We studied the prevalence of injuries of the articular cartilage and subchondral bone after acute trauma in skeletally immature knees using high-resolution MRI. MATERIALS AND METHODS: We reviewed knee MRIs of 126 young children and adolescents suspected to have internal knee derangement, including 82 with open physes and a control group of 44 who were skeletally mature. High-resolution proton density and T2-weighted pulse sequences were used in all patients. The prevalence of common injuries in the two groups was compared using chi-square analysis. Levels of interobserver agreement for evaluation of chondral lesions in the skeletally immature group were determined using the kappa statistic. RESULTS: In the skeletally immature group, chondral lesions were the most prevalent injuries (prevalence = 0.34, p = 0.009) followed by meniscal and anterior cruciate ligament injuries (prevalence = 0.23 and 0.24, respectively). No significant difference in the prevalence of chondral injury before and after physeal closure was seen (p = 0.45). There was no significant difference in the prevalence of anterior cruciate ligament injuries between the two groups, but meniscal injuries were more prevalent in the skeletally mature patients (prevalence = 0.41, p = 0.037). Interobserver agreement for chondral injuries in the group with open physes was good (weighted kappa = 0.45-0.51). CONCLUSION: The most common injuries occurring as a result of acute trauma to the immature knee were chondral. In patients with open physes, chondral injuries were significantly more prevalent than anterior cruciate ligament and meniscal injuries.