Assessment of Bone Perfusion with Contrast-Enhanced Magnetic Resonance Imaging

Abstract

Osteoarthritis and avascular necrosis are common clinical entities with unknown etiologies. Recently, vascular changes have been implicated in the pathogenesis of both conditions. This review discusses the use of novel non-invasive imaging techniques, using dynamic contrast-enhanced magnetic resonance imaging, as a means of assessing bone perfusion and therefore quantifying differences seen in both osteoarthritis and avascular necrosis. We have found changes in fluid dynamics in both osteoarthritis and avascular necrosis as compared to normal bone as well as changes between osteoarthritis and avascular necrosis. Review of our human data suggest that the magnetic resonance imaging contrast dye is retained for longer periods of time, suggesting decreased perfusion out of regions of osteoarthritis and avascular necrosis. This finding was corroborated in a guinea-pig animal model of osteoarthritis. Use of such a non-invasive measure of assessing bone perfusion could be useful in the diagnosis, prevention, and treatment of not only osteoarthritis and avascular necrosis but many other entities that affect the musculoskeletal system.

The relationship of tibial bone perfusion to pain in knee osteoarthritis

“…Contrast elimination reflects venous stasis and intraosseous hypertension as a consequence of venous outflow obstruction. The finding of a significant association with BML size and the rate of contrast elimination is consistent with previous work on perfusion parameters that point to outflow obstruction as the primary change in kinetic parameters 24 . These authors demonstrated that perfusion out of the ROI was significantly lower in BMLs when compared with normal bone.…”

Relationship between bone marrow lesions, cartilage loss and pain in knee osteoarthritis: results from a randomised controlled clinical trial using MRI

“…There are clues that BML may precede changes in cartilage morphology42 and may also predict or be linked to the progression of structural changes in knee OA 3 20 28 43. Our findings documented a significant negative correlation between BML score and cartilage volume in all three compartments at baseline.…”

Vascularized Bone Grafting in a Canine Carpal Avascular Necrosis Model

“…Thus, these results confirm the need for some caution in the interpretation of apparently normal T1 and T2 signal areas in human AVN conditions such as Kienböck's disease, particularly in correlating signal changes in conventional MRI to the presence of blood flow. The use of contrast-enhanced MRI may offer more reliable information on bone perfusion [17,29].…”