@article{GrunzSailerLangetal.2022,
  author    = {Grunz, Jan-Peter and Sailer, Lukas and Lang, Patricia and Sch{\"u}le, Simone and Kunz, Andreas Steven and Beer, Meinrad and Hackenbroch, Carsten},
  title     = {Dual-energy CT in sacral fragility fractures: defining a cut-off Hounsfield unit value for the presence of traumatic bone marrow edema in patients with osteoporosis},
  series = {BMC Musculoskeletal Disorders},
  volume    = {23},
  journal   = {BMC Musculoskeletal Disorders},
  number    = {1},
  doi       = {10.1186/s12891-022-05690-2},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-301125},
  year      = {2022},
  abstract  = {Background Demographic change entails an increasing incidence of fragility fractures. Dual-energy CT (DECT) with virtual non-calcium (VNCa) reconstructions has been introduced as a promising diagnostic method for evaluating bone microarchitecture and marrow simultaneously. This study aims to define the most accurate cut-off value in Hounsfield units (HU) for discriminating the presence and absence of bone marrow edema (BME) in sacral fragility fractures. Methods Forty-six patients (40 women, 6 men; 79.7 ± 9.2 years) with suspected fragility fractures of the sacrum underwent both DECT (90 kVp / 150 kVp with tin prefiltration) and MRI. Nine regions-of-interest were placed in each sacrum on DECT-VNCa images. The resulting 414 HU measurements were stratified into "edema" (n = 80) and "no edema" groups (n = 334) based on reference BME detection in T2-weighted MRI sequences. Area under the receiver operating characteristic curve was calculated to determine the desired cut-off value and an associated conspicuity range for edema detection. Results The mean density within the "edema" group of measurements (+ 3.1 ± 8.3 HU) was substantially higher compared to the "no edema" group (-51.7 ± 21.8 HU; p < 0.010). Analysis in DECT-VNCa images suggested a cut-off value of -12.9 HU that enabled sensitivity and specificity of 100\% for BME detection compared to MRI. A range of HU values between -14.0 and + 20.0 is considered indicative of BME in the sacrum. Conclusions Quantitative analysis of DECT-VNCa with a cut-off of -12.9 HU allows for excellent diagnostic accuracy in the assessment of sacral fragility fractures with associated BME. A diagnostic "one-stop-shop" approach without additional MRI is feasible.},
  language  = {en}
}
@article{EidmannEisertRudertetal.2022,
  author    = {Eidmann, Annette and Eisert, Marius and Rudert, Maximilian and Stratos, Ioannis},
  title     = {Influence of Vitamin D and C on bone marrow edema syndrome — A scoping review of the literature},
  series = {Journal of Clinical Medicine},
  volume    = {11},
  journal   = {Journal of Clinical Medicine},
  number    = {22},
  issn      = {2077-0383},
  doi       = {10.3390/jcm11226820},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-297356},
  year      = {2022},
  abstract  = {Bone marrow edema syndrome (BMES) is a rare disease with a largely unknown etiology. The aim of this scoping review is to systematically evaluate and combine the available evidence about vitamin D and C and BMES. The analysis of the manuscripts was based on country of origin, number of patients, gender, study type, epidemiology, localization, bone mineral density measurements, vitamin status and therapy. Sixty studies were included. The overall number of patients was 823 with a male-to-female ratio of 1.55:1 and a mean age of 40.9 years. Studies were very heterogeneous and of diverging scientific scope with a weak level of evidence. The hip was the most affected joint, followed by the foot and ankle and the knee; 18.3\% of patients suffered from multifocal BMES. Sixteen studies reported on vitamin D levels, resulting in a high prevalence of vitamin D deficiency (47\%) and insufficiency (17.9\%) among BMES patients. Three BME manuscripts were associated with vitamin C deficiency. Current therapeutic interventions include conservative measures (mainly unloading), various osteoactive drugs and iloprost. In summary, data about BMES in association with vitamin status is limited. A causal relationship between vitamin D or vitamin C status, osteopenia, and BMES cannot be determined from the existing literature.},
  language  = {en}
}