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

• Published in: European radiology 2020-03, Vol.30 (3), p.1534-1543
• Main Authors: Kox, L. S., Kraan, R. B. J., Mazzoli, V., Mens, M. A., Kerkhoffs, G. M. J. J., Nederveen, A. J., Maas, M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Bone marrow; Bone Marrow - pathology; Child; Correlation coefficients; Diagnosis; Diagnostic Radiology; Edema; Edema - diagnosis; Female; Gymnastics; Humans; Imaging; Injuries; Internal Medicine; Interventional Radiology; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Moisture content; Musculoskeletal; Neuroradiology; Quantitative analysis; Radiographs; Radiography; Radiology; Reliability analysis; Reproducibility of Results; Stress; Stress concentration; Ultrasound; Variance analysis; Water content; Water distribution; Water engineering; Wrist; Wrist Joint - pathology
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-019-06446-8

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