Imaging of Trabecular Microfracture and Bone Marrow Edema and Hemorrhage

1. Introduction.- 2. Pinhole Bone Scanning.- 3. Gamma Correction.- 4. Technical Processing of Gamma Correction.- 5. Gamma Correction Pinhole Bone Scan.- 6. Experimental Gamma Correction 99mTc-HDP Pinhole Bone Scan, Diagnosis of Trabecular Microfracture in Young Rats.- 7. Preoperative Confirmatory Imaging Diagnosis of Femoral Neck Fracture.- 8. Gamma Correction Pinhole Scan of Surgical Specimen and Correlation of Thereof and H&E Stain Findings for Histological Identification.- 9. Hematoxylin-Eosin Stain of Calcifying Calluses in Trabecular Microfractures.- 10. Identification of Trabecular Microcalluses in GCPBS and H&E Stain.- 11. Quantitation of 99mTc-HDP Uptake in Microcallus Using Pixelized Method.- 12. Quantitation of Gamma Correction Pinhole Bone Scan and H&E Stain.- 13. Reciprocal Correlation of Shapes of Tracer Uptake and Findings of Surgical Specimen, GCPBS and H&E Stain.- 14. Morphobiochemical Diagnosis of Acute Trabecular Microcallus Using Gamma Correction 99mTc-HDP Pinhole Bone Scan with Histological Verification.- 15. Preoperative Diagnosis by Radiography and 99mTcHDP Pinhole Bone Scan.- 16. Surgical Specimens from Human Subjects.- 17. Preoperative Diagnosis by Radiography and 99mTcHDP Pinhole Bone Scan.- 18. Gamma Correction Pinhole Scanof Surgical Specimen and Correlation of Thereof and H&E Stain Findings for Histological Identification.- 19. Gamma Correction Pinhole Bone Scan.- 20. Identification of Trabecular Microfractures in GCPBS and H&E Stain.- 21. Quantification of Micro-Fracture Tracer Uptake Using Pixelized Measurement.- 22. Overall Considerations.- 23. Precise Differntial Diagnosis of Acute Bone Marrow Edema and Hemorrhage and Trabecular Microfracture Using Nave and Gamma Correction Pinhole Bone Scans, NIH ImageJ Densitometry, and Pixelized.- 24. Micofracture Measurement.- 25. Introduction.- 26. Clinical Materials.- 27. Techniques of Seriated Nave and Gamma Correction Pinhole Bone Scanning and Reference Conventional Radiography and Corroborative Coronal FS T2 weighted MRI.- 28. NIH ImageJ Densitometry of 99mTc-HDP Uptake Intensity Measurement in Bone Marrow Edema and Hemorrhage and Trabecular Microfracture on Seriated Naive and Gamma Correction Pinhole Bone Scans.- 29. Mathematic Measurement of Trabecular Microfracture Size with Unsuppressed 99mTc-HDP uptake.- 30. Differential 99mTc-HDP Uptake Intensity Measurement of Bone Marrow Edema and Hemorrhage Using ImageJ Densitometry.- 31. Histopathological Validation.- 32. Differential Diagnosis of Bone Marrow Edema and Hemorrhage Using ImageJ Densitometry.- 33. Innocuousness of Bone Marrow Edema to Intact Trabecula on Nave Pinhole Scan Showing Mild Tracer Uptake Which is Suppressed.- 34. Differential Image J Densitometry Intensity Values of 99mTc-HDP Uptake in Bone Marrow Edema and Hemorrhage and Trabecular Microfracture.- 35. Fractured Trabeculae with Unsuppressed Enhanced Tracer Uptake.- 36. Innocuousness of Edema to Intact Trabecula and Injuriousness of Hemorrhage to Already Broken Trabecula.- 37. H&E Stain Validation of Additive Bone Marrow Hemorrhage Which Injures Already.- 38. NIH Image J Densitometric Analysis of an Old MR Image of Histologically Proven "Edemalike"Bone Marrow Change in Knee.- 39. Discussion.- 40. Summary and Conclusions.

This excellently illustrated monograph summarizes the updated fresh information on the theoretical, practical, and rapidly extended facets of gamma correction 99mTc-hydroxymethylene diphosphonate pinhole bone scan (99mTc-GCPBS) to MRI, CR, and MDCT. Basically, 99mTc-GCPBS is able to precisely visualize and quantitate callused trabecular microfracture (CTMF) which is as little as 200 m in size. The extended gamma correction images can very neatly demonstrate CTMF on MRI, conventional radiography (CR), and multidetector computed tomography (MDCT). Whenever appropriate, histological correlation is provided in conjunction with fine gamma corrected images. In this setting, ACDSee 10 gamma correction MRI and CR have been found to offer a highly useful option that deserves wider clinical interest. In practice, gamma correction MRI, CR, and MDCT can distinctly visualize CTMF so that CTMF can be precisely measured simply using an optic lens. By comparison, the naive MRI, for example, shows CTMF which measures as big as 2 mm in size. Furthermore, 99mTc-GCPBS can now differentiate bone marrow edema from hemorrhage using the visuospatial mathematic method, which includes the ImageJ of the NIH.

Yong-Whee Bahk, Professor Emeritus, M.D., Ph.D.
The Catholic University of Korea School of Medicine
Affiliated Yangji Hospital, Seoul, South Korea