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It's a thin line: development and validation of Dixon MRI-based semi-quantitative assessment of stress-related bone marrow edema in the wrists of young gymnasts and non-gymnasts.


ABSTRACT:

Purpose

To assess reliability and clinical utility of evaluating stress-related metaphyseal water distribution using a semi-quantitative Dixon MRI-based method for early diagnosis of physeal stress injuries in adolescent gymnasts.

Methods

Twenty-four gymnasts with clinically suspected overuse injury of the distal radial physis, 18 asymptomatic gymnasts, and 24 non-gymnast controls aged 12 ± 1.5 years prospectively underwent hand radiographs and 3T MRI of the wrist including coronal T1-weighted and T2-weighted Dixon sequences. Two raters measured metaphyseal water signal fraction in 13 radial and ulnar regions of interest (ROI). Inter- and intrarater reliability, interslice (between 3 middle radial slices), and inter-ROI (between 3 ROIs on same level) reliability were assessed using intraclass correlation coefficients (ICC). Water signal fractions and their within-person ratios in distal versus most proximal ROIs were compared between groups using one-way analysis of variance.

Results

Inter- and intrarater ICCs were 0.79-0.99 and 0.94-1.0 for T1-weighted, and 0.88-1.0 and 0.88-1.0 for T2-weighted Dixon. Interslice and inter-ROI ICCs were 0.55-0.94 and 0.95-0.97 for T1-weighted, and 0.70-0.96 and 0.96-0.97 for T2-weighted Dixon. Metaphyseal water signal fraction in symptomatic gymnasts was higher in six distal ROIs compared with asymptomatic gymnasts and in nine ROIs compared with non-gymnasts (p < 0.05). Metaphyseal water score (ratio of distal versus most proximal ROIs) was 1.61 in symptomatic gymnasts and 1.35 in asymptomatic gymnasts on T2-weighted Dixon (p < 0.05).

Conclusion

Semi-quantitative Dixon MRI-based water signal fraction assessment has good to excellent reproducibility and shows increased metaphyseal water scores in symptomatic gymnasts compared with asymptomatic gymnastic peers.

Key points

• The proposed Dixon MRI-based semi-quantitative method for assessment of metaphyseal bone marrow water content is reliable, with off-the-shelf availability and short scan times. • The metaphyseal water score allows comparisons between gymnasts using a within-person reference area for unaffected metaphyseal bone. • As metaphyseal water score was increased in symptomatic gymnasts compared with asymptomatic gymnasts, this semi-quantitative method can potentially be used as an indicator of bone marrow edema in the early diagnosis of gymnastic physeal stress injury.

SUBMITTER: Kox LS 

PROVIDER: S-EPMC7033069 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Publications

It's a thin line: development and validation of Dixon MRI-based semi-quantitative assessment of stress-related bone marrow edema in the wrists of young gymnasts and non-gymnasts.

Kox L S LS   Kraan R B J RBJ   Mazzoli V V   Mens M A MA   Kerkhoffs G M J J GMJJ   Nederveen A J AJ   Maas M M  

European radiology 20191127 3


<h4>Purpose</h4>To assess reliability and clinical utility of evaluating stress-related metaphyseal water distribution using a semi-quantitative Dixon MRI-based method for early diagnosis of physeal stress injuries in adolescent gymnasts.<h4>Methods</h4>Twenty-four gymnasts with clinically suspected overuse injury of the distal radial physis, 18 asymptomatic gymnasts, and 24 non-gymnast controls aged 12 ± 1.5 years prospectively underwent hand radiographs and 3T MRI of the wrist including corona  ...[more]

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