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Background: Lumbago is a global disease that affects more than 500 million people worldwide. Bone marrow oedema is one of the main causes of the condition and clinical diagnosis is mainly made by radiologists manually reviewing MRI images to determine whether oedema is present. However, the number of patients with Lumbago has risen dramatically in recent years, which has brought a huge workload to radiologists. In order to improve the efficiency of diagnosis, this paper is devoted to developing and evaluating a neural network for detecting bone marrow edema in MRI images. Related work: Inspired by the development of deep learning and image processing techniques, we design a deep learning detection algorithm specifically for the detection of bone marrow oedema from lumbar MRI images. We introduce deformable convolution, feature pyramid networks and neural architecture search modules, and redesign the existing neural networks. We explain in detail the construction of the network and illustrate the setting of the network hyperparameters. Results and discussion: The detection accuracy of our algorithm is excellent. And its accuracy of detecting bone marrow oedema reached up to 90.6 % , an improvement of 5.7 % compared to the original. The recall of our neural network is 95.1 % , and the F1-measure also reaches 92.8 % . And our algorithm is fast in detecting it, taking only 0.144 s per image. Conclusion: Extensive experiments have demonstrated that deformable convolution and aggregated feature pyramid structures are conducive for the detection of bone marrow oedema. Our algorithm has better detection accuracy and good detection speed compared to other algorithms. [ABSTRACT FROM AUTHOR]

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Abstract Background Lumbago is a global disease that affects more than 500 million people worldwide. Bone marrow oedema is one of the main causes of the condition and clinical diagnosis is mainly made by radiologists manually reviewing MRI images to determine whether oedema is present. However, the number of patients with Lumbago has risen dramatically in recent years, which has brought a huge workload to radiologists. In order to improve the efficiency of diagnosis, this paper is devoted to developing and evaluating a neural network for detecting bone marrow edema in MRI images. Related work Inspired by the development of deep learning and image processing techniques, we design a deep learning detection algorithm specifically for the detection of bone marrow oedema from lumbar MRI images. We introduce deformable convolution, feature pyramid networks and neural architecture search modules, and redesign the existing neural networks. We explain in detail the construction of the network and illustrate the setting of the network hyperparameters. Results and discussion The detection accuracy of our algorithm is excellent. And its accuracy of detecting bone marrow oedema reached up to 90.6 $$\%$$ % , an improvement of 5.7 $$\%$$ % compared to the original. The recall of our neural network is 95.1 $$\%$$ % , and the F1-measure also reaches 92.8 $$\%$$ % . And our algorithm is fast in detecting it, taking only 0.144 s per image. Conclusion Extensive experiments have demonstrated that deformable convolution and aggregated feature pyramid structures are conducive for the detection of bone marrow oedema. Our algorithm has better detection accuracy and good detection speed compared to other algorithms.

Purpose: Contrary to the self-limiting nature of reversible bone marrow lesions, irreversible bone marrow lesions require early surgical intervention to prevent further morbidity. Thus, early discrimination of irreversible pathology is necessitated. The purpose of this study is to evaluate the efficacy of radiomics and machine learning regarding this topic. Material and methods: A database was scanned for patients who had undergone MRI of the hip for differential diagnosis of bone marrow lesions and had had follow-up images acquired within 8 weeks after the first imaging. Images that showed resolution of oedema were included in the reversible group. The remainders that showed progression into characteristic signs of osteonecrosis were included in the irreversible group. Radiomics was performed on the first MR images, calculating first- and second-order parameters. Support vector machine and random forest classifiers were performed using these parameters. Results: Thirty-seven patients (seventeen osteonecrosis) were included. A total of 185 ROIs were segmented. Forty-seven parameters were accepted as classifiers with an area under the curve value ranging from 0.586 to 0.718. Support vector machine yielded a sensitivity of 91.3% and a specificity of 85.1%. Random forest classifier yielded a sensitivity of 84.8% and a specificity of 76.7%. Area under curves were 0.921 for support vector machine and 0.892 for random forest classifier. Conclusions: Radiomics analysis could prove useful for discrimination of reversible and irreversible bone marrow lesions before the irreversible changes occur, which could prevent morbidities of osteonecrosis by guiding the decision-making process for management. [ABSTRACT FROM AUTHOR]

Background: Hip labral tear (LT) causes various degrees of hip pain, for which there are few objective measures. Bone marrow oedema (BME), characterized by a diffuse, widely spreading change in the bone marrow, is observed in some patients with LT. However, its pathological role has not been fully understood. The purpose of this study was to investigate the prevalence of BME on hip magnetic resonance imaging (MRI) in patients with LT and to determine whether BME was an objective indicator of hip pain. Methods: In total, 84 patients with LT who underwent MRI scanning under the same conditions were included. We determined the presence or absence of BME and its size on MRI and evaluated the relationships between BME and sex, age, and pain and total scores on the modified Harris hip score (MHHS). In addition, we collected data on surgical treatments such as hip arthroscopy within a one-year follow-up period and examined whether the presence of BME affected the course of therapy. Results: BME was found in 34.5% of patients. MHHS pain and total scores were significantly lower in patients with BME (MHHS pain score: non-BME vs. BME ≤ 1 cm: p = 0.022, non-BME vs. BME > 1 cm: p < 0.001; MHHS total score: non-BME vs. BME ≤ 1 cm: p = 0.131, non-BME vs. BME > 1 cm: p = 0.027). The presence of BME did not differ between patients who did and did not undergo surgery during follow-up (p = 0.563). Conclusion: BME on MRI in patients with LT might be an indicator of hip pain and hip joint dysfunction. [ABSTRACT FROM AUTHOR]

Objective Several pharmacological treatments have been proposed for the treatment of complex regional pain syndrome type-I (CRPS-I) in adults, but data regarding the efficacy of various agents for this disease is scarce. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to analyse the efficacy of the various pharmacological approaches in adults with CRPS-I. Methods We systematically searched PubMed, Scopus, and Web of Science databases from the inception date to 30 June 2021 to identify placebo-controlled or active-controlled RCTs using bisphosphonates, ketamine, CSs, anti-epileptics, NSAIDs/COXIBs, opiates, antidepressants, scavengers/magnesium sulphate or IVIGs for the treatment of CRPS-I. The primary outcomes included changes in the visual analogue scale (VAS) or numeric rating scale (NRS) for pain before and after treatment. Results We included 20 placebo-controlled or active-controlled RCTs (including a total of 818 adults with CRPS-I) that used bisphosphonates (n  = 7), ketamine (n  = 2), CSs (n  = 2), anti-epileptics (n  = 1), NSAIDs/selective inhibitors of cyclooxygenase-2 (COXIBs) (n  = 2), scavengers/magnesium sulphate (n  = 5), or IVIGs (n  = 1) to treat CRPS-I during a median follow-up of 26 weeks. Treatment with bisphosphonates showed a significant reduction in the values of the VAS/NRS pain scale compared with placebo or reference therapy (random effects weighted mean difference [WMD]: −23.8, 95% CI: −28.0 to −19.6; I 2 = 36.4%). Treatment with ketamine also documented a reduction in the values of the VAS/NRS for pain (random effects WMD: −8.27, 95% CI: −12.9 to −3.70; I 2 = 0%). Treatment with other agents did not reduce the values of the VAS/NRS assessments of pain. Conclusion This systematic review and meta-analysis supports the recommendation of parenteral bisphosphonates as the first-line agent in the treatment of CRPS-I. Trial registration Open Science Framework registries, https://osf.io/et9gu/ , osf.io/et9gu. [ABSTRACT FROM AUTHOR]

Objective ACHILLES aimed to demonstrate efficacy of secukinumab on Achilles' tendon enthesitis in spondyloarthritis (SpA) patients. Methods Patients ≥18 years (n  = 204) with active PsA or axial SpA and heel enthesitis were randomized 1:1 to secukinumab 150/300 mg or placebo up to week 24, and thereafter placebo patients were switched to secukinumab. Results At week 24, a higher, yet statistically non-significant (P  = 0.136), proportion of patients in secukinumab vs placebo reported resolution of Achilles tendon enthesitis in affected foot (42.2% vs 31.4%; odds ratio [OR] = 1.63; 95% CI: 0.87, 3.08). Proportion of patients reporting resolution of enthesitis based on Leeds Enthesitis Index was higher with secukinumab vs placebo (33.3% vs 23.5%; OR = 1.65; 95% CI: 0.85, 3.25) at week 24. Mean change from baseline in heel pain at week 24 was higher in secukinumab patients vs placebo (−2.8 [3.0] vs −1.9 [2.7]). Greater improvements with secukinumab were observed in heel enthesopathy activity and global assessment of disease activity. Imaging evaluation by local reading confirmed heel enthesitis on MRI at screening for all patients. Based on central reading, 56% presented with bone marrow oedema and/or tendinitis; according to Heel Enthesitis MRI Scoring System (HEMRIS) post hoc analysis, 76% had signs of entheseal inflammation while 86% had entheseal inflammation and/or structural changes. Conclusion A substantial proportion of patients showed no signs of inflammation on the centrally read MRIs despite a clinical diagnosis of heel enthesitis, thus highlighting that the discrepancy between the clinical and imaging assessments of enthesitis requires further investigation. Although ACHILLES did not meet the primary end point, the study reported clinically meaningful improvements in patient-related outcomes. Trial registration clinicaltrials.gov, NCT02771210 [ABSTRACT FROM AUTHOR]

Background: Extracorporeal shock wave therapy (ESWT) has been used for various pathologies associated with bone marrow oedema (BME). However, it is still not clear whether ESWT may be favourable in the treatment of BME. Therefore, the aim of this systematic review was to assess the efficacy of ESWT for the treatment of BME. Methods: MEDLINE was searched for relevant literature with no time constraints. Both randomized and non-randomized trials were included. Case reports and conference abstracts were excluded. Titles and abstracts were screened and full-text articles of included studies were retrieved. Data on the effect of ESWT on pain, function, and the BME area on magnet resonance imaging were extracted. Results: Pain, function, and magnet resonance imaging results all improved across the studies — regardless of whether it was a randomized or non-randomized study. This effect was consistent across multiple pathologies such as osteonecrosis of the femoral head, BME associated with knee osteoarthritis, Kienböck's disease, and osteitis pubis. The meta-analysis showed that pain (after 1 month: weighted mean difference (WMD) = − 2.23, 95% CI − 2.58 to − 1.88, P < 0.0001; after 3–6 month: WMD = − 1.72, 95% CI − 2.52 to − 0.92, P < 0.00001) and function (after 1 month: WMD = − 1.59, 95% CI − 2.04 to − 1.14, P < 0.0001; after 3–6 month: WMD = − 2.06, 95% CI − 3.16 to − 0.96, P = 0.0002; after ≥ 12 month: WMD = − 1.20, 95% CI − 1.83 to − 0.56, P = 0.0002) was reduced in terms of ESWT treatment compared to a control group. Conclusions: Based on the available evidence, ESWT may be an adequate option for conservative therapy in pathologies involving BME. Trial registration: PROSPERO, CRD42021201719. Registered 23 December 2020 [ABSTRACT FROM AUTHOR]

Objectives The objectives of this study were to study with Power Doppler US (PDUS) the SI joints (SIJs) of patients with suspected active sacroiliitis, to describe SIJ flows with spectral wave analysis (SWA) on Doppler US, and to correlate US data with both clinical characteristics and presence of SIJ bone marrow oedema (BME) in subsequent MRI. Methods A total of 42 patients (32 females and 10 males, mean age 46.8 years) with recent onset of inflammatory back pain (IBP) were included. Every patient underwent US examination with a convex 1–8 MHz probe [scoring PDUS signals with a three-point scale and describing flows in SWA calculating the mean Resistive Index (RI)] and subsequent MRI of the SIJs. Results PDUS signals were detected in 34 patients and 62 SIJs. In 29 patients and 56 SIJs, MRI revealed BME. A definite diagnosis of SpA was made in 32 patients. PDUS signals were more frequent (P  < 0.0001) in patients with a final diagnosis of SpA, yielding a higher PDUS score (P  = 0.0304). PDUS grading correlated with both BME grading (r  = 0.740, P  = 0.0001) and AS DAS (ASDAS) (r  = 0.6257, P  = 0.0004), but not with inflammatory reactants nor anthropometric data. Mean RI were, respectively, 0.60 and 0.73 (P  < 0.0001) in patients with or without diagnosis of active sacroiliitis. The most inclusive RI cut-off resulted <0.70 [positive predictive value (PPV) 94%, accuracy 90%, P  = 0.0001]. The best Likelihood Ratio (5.471) for RI to detect pathologic cases was obtained with a cut-off of <0.60 (PPV 96%). Conclusions PDUS and SWA of SIJs demonstrate good diagnostic accuracy for active sacroiliitis compared with MRI. [ABSTRACT FROM AUTHOR]

Longstanding groin pain is a non-infectious and inflammatory chronic condition that causes inguinal pain in athletes. We compared dextrose prolotherapy (15% dextrose solution) and platelet-rich plasma (autologous platelet gel, plasma rich in growth factors, platelet concentrate) injections in male soccer players with longstanding groin pain. Forty elite male soccer players, ages between 13 and 33, with longstanding groin pain were treated. Patients were randomly divided into the dextrose prolotherapy (n= 9) and platelet- rich plasma injection (n= 6) groups. Following three injections, all patients were enrolled in the 12-week progressive home exercise protocol. Pain and function were assessed using the visual analogue (VAS) and Nirschl Pain Phase Scale (NPPS) scores before, one month after, and six months after the injection, respectively. VAS and NPPS scores decreased in both of the dextrose prolotherapy and the platelet-rich plasma injection groups. A decrease in pain and improvement in function were evident at a month after injection, and they remained favourable at the end of six months (VAS overall, p <0.001 and p= 0.003, respectively) (NPPS overall, p <0.001 and p= 0.007, respectively). A difference between the dextrose prolotherapy and the platelet-rich plasma injection groups was not observed at both time points (VAS, p= 0.3, p= 0.7, and p= 0.6 respectively) (NPPS, p= 0.6, p= 0.9, and p= 0.9 respectively). Dextrose prolotherapy and platelet-rich plasma injections decreased pain and improved function in longstanding groin pain treatment of male soccer players. These treatments should be considered in patients who are not responding to conservative treatment modalities. [ABSTRACT FROM AUTHOR]

Objectives: To determine the association between traumatic bone marrow abnormalities, the knee injury mechanism, and associated soft tissue injuries in a larger cohort than those in the published literature.Method: Retrospective study including 220 patients with traumatic knee injuries. Knee MRIs were evaluated for trauma mechanism, soft tissue injury, and the location of bone marrow abnormalities. The locations of the abnormalities were correlated with trauma mechanisms and soft tissue injuries using the chi-square test with Bonferroni correction.Results: One hundred and forty-four valgus injuries, 39 pivot shift injuries, 25 lateral patellar dislocations, 8 hyperextensions, and 4 dashboard injuries were included. Valgus and pivot shift injuries showed traumatic bone marrow abnormalities in the posterolateral regions of the tibia. Abnormalities after patellar dislocation were found in the anterolateral and centrolateral femur and patella. Hyperextension injuries were associated with abnormalities in almost all regions, and dashboard injuries were associated with changes in the anterior regions of the tibia and femur.Conclusions: Our study provides evidence of associations between traumatic bone marrow abnormality patterns and different trauma mechanisms in acute knee injury, and reveals some overlap, especially of the two most common trauma mechanisms (valgus and pivot shift), in a large patient cohort.Key Points: • Specific bone marrow oedema patterns after knee trauma were confirmed. • New associations between bone marrow oedema patterns and knee trauma were shown. • Bone marrow oedema patterns help in identifying associated soft tissue injuries. [ABSTRACT FROM AUTHOR]

The aim of this study is to verify the prevalence of risk factors for transient osteoporosis (TO) in a cohort of patients selected by strict diagnostic criteria. Retrospective observational cohort study on outpatients' data. Inclusion criteria were: (1) acute onset of pain at a lower limb joint exacerbated by weight bearing; (2) no history of trauma, tumors, rheumatic diseases, or infection; (3) presence bone marrow edema on MRI in a weight bearing joint without signs of intraarticular lesions; (4) no hyperesthesia and/or allodynia and/or sweeting changes. The following risk factors were search for in all patients: (1) previous episode of TO; (2) disorders of bone metabolism; (3) cigarette smoke; (4) sudden lower limb overuse; (5) presence of osteoporosis/osteopenia. Twenty-three patients (8 females, 15 males, mean age 48.4 years) fulfilled the inclusion criteria. An average of 1.96 risk factors for TO was present in the cohort. The most frequent risk factor was overuse (in 15 patients, 65.2 %) and the second risk factor was bone metabolism disorders (in 10 patients, 43.5 %). Seven patients (30.4 %) were heavy smokers (more than 20 cigarettes per day) and seven patients showed a previous episode of TO. Six patients (26.1 % of the overall cohort but 60 % of those investigated with DEXA) resulted osteoporotic or osteopenic. Our results suggest there are risk factors that must be investigated in these patients. The presence of these risk factors might support the thesis that their disorder is tied to a decoupling between microdamage accumulation and self-reparative ability of bone tissue. The identification of risk factors with a precise diagnostic pathway can accelerate the diagnostic process and reduce recurrences. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the moderate survival data of porous tantalum rod implants for the treatment of osteonecrosis of the femoral head (ONFH). Additionally, some independent prognostic factors for conversion to total hip arthroplasty (THA) were identified.Methods: The porous tantalum rod population was obtained from a prospective, consecutive group of patients treated for Steinberg stage I and II osteonecrosis from April 2009 through July 2011. The historical core decompression and impaction of bone filling particle subjects underwent surgery from April 2007 through March 2009. Surgical data including time of surgery, blood loss, and cell transfusions were recorded. Post-operative values were measured for hospitalization length as well as days requiring a patient-controlled analgesia (PCA) pump. Primary outcomes were Harris hip score and survivorship analysis. Demographics and baseline characteristics included age, sex, etiology, bilateral disease, associated chronic systemic disease, Steinberg stage, Harris hip score, accompanied with bone marrow edema of femoral head, and osteonecrotic lesion size.Results: Demographic/baseline characteristics were similar between two groups. At the post-operative follow-up of 62 months, Harris hip scores were significantly increased (P < 0.0001) when compared to that before surgery in both groups. The magnitude of increase in the tantalum rod implant group was significantly greater than that in the control group (P = 0.0426). With an average follow-up of 48 months (range, 38-62 months), the tantalum rod group had an 84.6 % survival rate. With an average follow-up of 72 months (range, 67-85 months), the control group had a 63.3 % survival rate. A comparison of Kaplan-Meier curves showed significantly higher cumulative survival rates (P = 0.048) for hips with implantation of the porous tantalum rod (74.1 % at 62 months) than for those with impaction composite bone material (49.9 % at 62 months). The Cox proportional-hazard model revealed that implantation of tantalum rod (P = 0.012), bone marrow edema (P = 0.003), corticosteroids intake (P = 0.007), and age less than 50 years (P = 0.014) were the independent prognostic factors related to conversion into THA.Conclusions: Compared with the traditional impaction composite bone material technique, implantation of tantalum rod in the treatment of Steinberg stages I and II ONFH can obtain better clinical results and higher cumulative survival rates. For patients without the use of corticosteroids, and especially for hips without bone marrow oedema, the clinical results from our study show highly encouraging survival rates and a delay in or prevention of conversion into THA. [ABSTRACT FROM AUTHOR]

Bone marrow lesions (BMLs) around the knee are a common magnetic resonance imaging (MRI) finding. However, despite the growing interest on BMLs in multiple pathological conditions, they remain controversial not only for the still unknown role in the etiopathological processes, but also in terms of clinical impact and treatment. The differential diagnosis includes a wide range of conditions: traumatic contusion and fractures, cyst formation and erosions, hematopoietic and infiltrated marrow, developmental chondroses, disuse and overuse, transient bone marrow oedema syndrome and, lastly, subchondral insufficiency fractures and true osteonecrosis. Regardless the heterogeneous spectrum of these pathologies, a key factor for patient management is the distinction between reversible and irreversible conditions. To this regard, MRI plays a major role, leading to the correct diagnosis based on recognizable typical patterns that have to be considered together with coexistent abnormalities, age, and clinical history. Several treatment options have been proposed, from conservative to surgical approaches. In this manuscript the main lesion patterns and their management have been analysed to provide the most updated evidence for the differential diagnosis and the most effective treatment. [ABSTRACT FROM AUTHOR]

Background: Bone marrow oedema (BMO) is included in MRI-based scoring systems of disease activity in adults with rheumatoid arthritis. Similar systems in juvenile idiopathic arthritis (JIA) are lacking. Objective: To assess the reproducibility in a multi-centre setting of an MRI BMO scoring system in children with JIA. Materials and methods: Seventy-six wrist MRIs were read twice, independently, by two experienced paediatric radiologists. BMO was defined as ill-defined lesions within the trabecular bone, returning high and low signal on T2- and T1-weighted images respectively, with or without contrast enhancement. BMO extension was scored for each of 14 bones at the wrist from 0 (none) to 3 (extensive). Results: The intra-observer agreement was moderate to excellent, with weighted kappa ranging from 0.85 to 1.0 and 0.49 to 1.0 (readers 1 and 2 respectively), while the inter-observer agreement ranged from 0.41 to 0.79. The intra- and inter-observer intraclass correlation coefficients were excellent and satisfactory, respectively. Conclusion: The scoring system was reliable and may be used for grading bone marrow abnormality in JIA. The relatively large variability in aggregate scores, particularly between readers, underscores the need for thorough standardisation. [ABSTRACT FROM AUTHOR]

Objectives--To examine the relation between the clinical features of groin pain and groin magnetic resonance imaging (MRI) appearances in a group largely comprising elite Australian Rules football players. The incidence of bone marrow oedema and other MRI findings in the pubic symphysis region was noted. The relation between a past history of groin pain and these other MRI findings was also examined. Method--In a prospective study, 116 male subjects (89 footballers, 17 umpires, 10 sedentary men) were examined before history taking and groin MRI. The clinical history was not known to the examiner (GMV) and radiologists (JPS, GTF). Clinical evidence of groin pain and examination findings were correlated with the presence of increased signal intensity within the pubic bone marrow. A past history of groin pain was correlated with the presence of other I MRI findings such as cyst formation, fluid signal within the pubic symphysis disc, and irregularity of the pubic symphysis. Results--Fifty two athletes (47 footballers, five umpires) had clinical features of groin pain with pubic symphysis and/or superior pubic ramus tenderness. A high incidence of increased signal intensity (77%) within the pubic bone marrow was identified in this group. There was an association between this group of athletes and the MRI finding of increased signal intensity (p<0.1). There was also an association between a past history of groin pain and the presence of other MRI findings (p<0.1). Conclusions--Athletes with groin pain and tenderness of the pubic symphysis and/or superior pubic ramus have clinical features consistent with the diagnosis of osteitis pubis. The increased signal intensity seen on MRI is due to pubic bone marrow oedema. An association exists between the clinical features of osteitis pubis and the Mill finding of pubic bone marrow oedema. [ABSTRACT FROM AUTHOR]