To evaluate the occurrence, location, and shape of the fluid sign in acute osteoporotic and neoplastic vertebral compression fractures at magnetic resonance (MR) imaging.
The study group comprised 87 ...consecutive patients with acute vertebral compression fractures due to osteoporotic (n = 52) or neoplastic (n = 35) infiltration. The MR imaging protocol included nonenhanced T1-weighted spin-echo and short inversion time inversion-recovery sequences and a 1.5-T system. Readers blinded to the outcome documented the occurrence, shape, and location of the fluid sign with consensus. The fluid sign was correlated with the cause, age, and severity of the fracture. The diagnosis was confirmed with surgery, follow-up MR imaging, clinical follow-up, or unequivocal imaging findings. Wilcoxon and chi(2) tests were used to assess significance.
In fractured vertebral bodies, the fluid sign was adjacent to the fractured end plates and exhibited signal intensity isointense to that of cerebrospinal fluid. The fluid sign was linear (n = 16), triangular (n = 5), or focal (n = 2) and was significantly associated with osteoporotic fractures (21 40% of 52; P <.001). The fluid sign occurred in two (6%) of 35 neoplastic compression fractures. Histologic examination demonstrated osteonecrosis, edema, and fibrosis at the site of the fluid sign. There was a tendency toward older fractures exhibiting the fluid sign, but this relationship was not significant (P >.05). In osteoporotic fractures, the fluid sign was significantly associated with fracture severity (P <.05).
The fluid sign is featured in acute vertebral compression fractures that show bone marrow edema. It can be an additional sign of osteoporosis and rarely occurs in metastatic fractures.
Background
In this pilot study, we investigated the therapeutic efficacy of intravenous Ibandronate compared to pain medication on the outcome of bone marrow edemas (BME) of the knee and talus.
...Patients and methods
Fifteen patients with a painful BME of the knee and 15 patients with a BME of the ankle, confirmed on MRI, were enrolled and treated with three ambulatory infusions of each 6 mg Ibandronate (group 1). A control group (group 2) of 10 patients with a BME of the knee and 10 patients with a BME of the talus was treated with pain medication and partial weight bearing. Patients were evaluated clinically at baseline and at 1, 3, 6 and 12 months after therapy start with a visual analog pain-scale (VAS) and specific joint scores (Larson knee- and Mazur ankle-score). BMEs were assessed with MRI at baseline and after 6 months in both groups.
Results
In the knee group, the mean VAS pain score decreased from 8.5 at baseline to 1.2 at 12 months (
p
< 0.0001) in patients treated with Ibandronate and, respectively, from 8.1 to 4.0 in the control group (
p
< 0.001). In the ankle group, the mean VAS pain score decreased from 8.2 at baseline to 0.9 at 12 months (
p
< 0.0001) in patients treated with Ibandronate and, respectively, from 7.9 to 3.9 in the control group (
p
< 0.001). The mean Mazur ankle score increased from 51 to 91 points (
p
< 0.001) in group 1, and from 52 to 72 points in group 2 (
p
< 0.01). The mean Larson knee score increased from 54 to 89 points (
p
< 0.001) at 12 months in group 1, and from 51 to 70 points in group 2 (
p
< 0.01). For both joints, we observed a significant clinical improvement in the Ibandronate treatment group and in the control group, but functional results were significantly more improved in the Ibandronate treatment group. Only the Ibandronate treatment group showed a significant BME regression at the 6 months MRI follow-up.
Conclusions
Intravenous Ibandronate therapy showed significantly better clinical results and BME regression rates on MR-imaging compared to analgesic medication in combination with partial weight bearing in the treatment of BME of the knee and talus and shortens the natural course of the disease.
The purpose of our study was to compare the detection rate of bone manifestations of multiple myeloma in whole-body MRI compared with MDCT and to assess accuracy in staging.
Forty-one patients with ...histologically confirmed myeloma were prospectively examined with a whole-body MDCT protocol and whole-body MRI on a 1.5-T system. The MRI protocol consisted of T1-weighted spin-echo and STIR sequences. For data analysis, the entire skeleton was divided into 61 regions per patient. Image evaluation was performed in a consensus reading by two radiologists blinded to the patients' history, with separate evaluation of each technique. The patients were staged by MRI and MDCT data separately according to the Durie and Salmon PLUS staging system.
On MRI, 15 patients showed no involvement. In 26 patients, 975 regions were affected: 21 patients were stage I, two were stage II, and 18 were stage III. On MDCT, 19 patients showed no involvement. In 22 patients, 462 regions were affected. For the detection rate, MRI was statistically superior to MDCT (p < 0.001, Wilcoxon's signed rank test). According to MDCT, 25 patients were stage I, seven were stage II, and nine were stage III. In 21 patients with involvement detected on both methods, MRI showed more extensive disease than MDCT. Eleven patients were understaged with MDCT compared with MRI, which was statistically significant (p < 0.001, chi-square test).
Whole-body MDCT leads to a significantly lower detection rate and staging in patients with multiple myeloma.
Approximately 30% of myeloma patients express cyclin D1 RNA and protein. The low incidence of translocation t(11; 14) detected by conventional cytogenetics suggests that the up‐regulation of cyclin ...D1 protein might result from other mechanisms as well as from gene amplification. Therefore, the frequency and the clinical and prognostic implications of cyclin D1 amplification were examined. We highly purified myeloma cells from bone marrow by magnetic cell sorting and analysed 50 myelomas by fluorescence in situ hybridization (FISH) using probes specific for cyclin D1 and 20 samples by immunoblotting to detect cyclin D1 expression. The amplification of cyclin D1 gene was found in 19 of 50 analysed patients and was associated with expression of cyclin D1 protein. The amplification correlated significantly with the bone marrow infiltration, plasma cell morphology and labelling index as well as serum β2‐microglobulin, C‐reactive protein (CRP) and creatinine levels. In univariate analysis, the amplification of the cyclin D1 gene was a significantly unfavourable parameter with regard to overall survival (P = 0·0064) and progression‐free survival (P = 0·0005). In multivariate analysis, cyclin D1 amplification and serum β2‐microglobulin were independent and well‐suited parameters for predicting survival. The detection of cyclin D1 amplification seems to be of promising prognostic value in multiple myeloma.
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