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PubMed2006

Effects of chloride flux modulators in an in vitro model of brain edema formation.

Brain edema is a serious consequence of hemispheric stroke and traumatic brain injury and contributes significantly to patient mortality. In the present study, we measured water contents in hippocampal slices as an in vitro model of edema formation. Excitotoxic conditions induced by N-methyl-D-aspartate (NMDA, 300 microM), as well as ischemia induced by oxygen-glucose deprivation (OGD), caused cellular edema formation as indicated by an increase of slice water contents. In the presence of furosemide, an inhibitor of the Na,K,Cl-cotransporter, NMDA-induced edema were reduced by 64% while OGD-induced edema were unaffected. The same observation, i.e., reduction of excitotoxic edema formation but no effect on ischemia-induced edema, was made with chloride transport inhibitors such as DIDS and niflumic acid. Under ischemic conditions, modulation of GABAA receptors by bicuculline, a GABA antagonist, or by diazepam, a GABAergic agonist, did not significantly affect edema formation. Further experiments demonstrated that low chloride conditions prevented NMDA-induced, but not OGD-induced, water influx. Omission of calcium ions had no effect. Our results show that NMDA-induced edema formation is highly dependent on chloride influx as it was prevented by low-chloride conditions and by various compounds that interfere with chloride influx. In contrast, OGD-induced edema observed in brain slices was not affected by modulators of chloride fluxes. The results are discussed with reference to ionic changes occurring during tissue ischemia.

Animals↗
PubMed2006

Measurement of intestinal edema using an impedance analyzer circuit.

BACKGROUND: Acute intestinal edema adversely affects intestinal transit, permeability, and contractility. Current resuscitation modalities, while effective, are associated with development of acute intestinal edema. Knowledge of levels of tissue edema would allow clinicians to monitor intestinal tissue water and may help prevent the detrimental effects of edema. However, there is no simple method to measure intestinal tissue water without biopsy. We sought to develop a tissue impedance analyzer to measure tissue edema, without the need for invasive biopsy. METHODS: Oscillating voltage input was applied to the analyzer circuit and an oscilloscope measured the voltage output across any load. Rats were randomized to three groups: sham, mild edema (80 mL/kg of NS resuscitation), and severe edema (80 mL/kg of NS resuscitation with intestinal venous hypertension). Intestinal edema was measured by wet-to-dry tissue weight ratio. Bowel impedance was measured and converted to capacitance using a standard curve. RESULTS: Acute intestinal edema causes a significant increase in bowel capacitance. This capacitance can be used to predict tissue water concentration. CONCLUSION: Using an impedance analyzer circuit, it is possible to measure intestinal edema reliably and quickly. This may prove to be a useful tool in the resuscitation of critically ill patients.

Acute Disease↗
PubMed2000

Cerebral edema complicating eclampsia.

OBJECTIVE: This study was undertaken to describe and correlate clinical findings with computed tomographic and magnetic resonance imaging scan results in 10 women with eclampsia and widespread cerebral edema. STUDY DESIGN: This was a clinical descriptive study of 10 women with eclampsia and symptomatic cerebral edema who were encountered at Parkland Hospital from 1986 through 1998. During this 13-year period nearly 175 women had eclampsia from a total of >160, 000 women delivered. The clinical courses of these 10 women with eclampsia and symptomatic cerebral edema are described, along with findings from computed tomographic and magnetic resonance imaging scans. RESULTS: In 3 cases symptoms followed an acute and severe elevation of blood pressure while the patient was being treated for eclampsia. All 3 of these women had severe generalized edema with radiographic findings of impending transtentorial herniation. Herniation did occur in 1 of these women, and she died. The other 7 women had central nervous system symptoms that persisted after an initial eclamptic convulsion. Symptoms ranged from lethargy, confusion, and blurred vision to obtundation and blindness. Five of these women had multiple areas of edema mostly apparent at the gray matter-white matter junction. Two women demonstrated extensive unilateral brain involvement; however, their symptoms were similar to those of the women with multifocal areas of cerebral edema. CONCLUSION: Symptomatic cerebral edema developed in almost 6% of women with eclampsia. Its genesis probably represents a continuum of central nervous system lesions that result from eclampsia. We postulate that women with symptoms of extensive cerebral edema have a cytotoxic edema caused by ischemia that is intensified by a vasogenic edema associated with sudden or severe hypertension.

Adolescent↗
PubMed1999

Association of antiretinal antibodies and cystoid macular edema in patients with retinitis pigmentosa.

PURPOSE: To report the association of antiretinal antibodies in patients with bilateral cystoid macular edema and retinitis pigmentosa. METHODS: In a prospective study, 30 consecutive patients with bilateral cystoid macular edema and retinitis pigmentosa were tested for antiretinal antibodies. As control subjects, 30 consecutive patients with retinitis pigmentosa who did not have cystoid macular edema and 50 normal subjects without retinitis pigmentosa or cystoid macular edema were tested for antiretinal antibodies. Laboratory personnel performing the antiretinal antibody testing were masked regarding the diagnosis of each patient. RESULTS: Twenty-seven (90%) of 30 patients with retinitis pigmentosa with cystoid macular edema had antiretinal protein antibody activity, compared with three (6%) of 50 normal controls (P < .001) and only four (13%) of 30 control patients with retinitis pigmentosa (P < .001). CONCLUSIONS: We found a significant association between cystoid macular edema and the presence of circulating antiretinal antibodies in patients who presented with retinitis pigmentosa and cystoid macular edema. This study suggests that patients with retinitis pigmentosa with cystoid macular edema may have an autoimmune process that is contributing to the formation of cystoid macular edema in retinitis pigmentosa, but to date, there is no direct evidence that the cystoid macular edema is caused by the antiretinal antibodies.

Adolescent↗
PubMedDate not supplied

Plasma level of interleukin-6 is an indicator for predicting diabetic macular edema.

PURPOSE: To find a predictor in the pathogenesis of macular edema, we investigated ocular and systemic risk factors. METHODS: One hundred and fifty-nine patients with mild diabetic retinopathy who showed one or more soft exudates were recruited. We selected the possible predictors on the basis of relevant factors, including concentration of vascular endothelial growth factor, interleukin-6 (IL-6), transforming growth factor (TGF)-beta(1), tumor necrosis factor (TNF)-alpha, and lipoprotein(a) in plasma, and serum level of von Willebrand factor and thrombomodulin. RESULTS: Macular edema was not detected in 94 eyes; focal macular edema was detected in 46 eyes; diffuse macular edema was detected in 18 eyes; and cystoid macular edema was present in 1 eye. The plasma level of IL-6 concentration and the state of the posterior vitreous detachment (PVD) correlated significantly with the severity of macular edema (odds ratios = 3.68, 1.70, respectively). Other risk factors were not significantly associated with macular edema. We estimated the probability of macular edema according to the IL-6 level in plasma and the state of the PVD, and were able to predict the probability of macular edema. CONCLUSION: The results of the present study indicate that IL-6 concentration in plasma and the state of the PVD can be predictors of macular edema.

Adult↗
PubMed1997

Association between the short-term natural history of diabetic macular edema and the vitreomacular relationship in type II diabetes mellitus.

PURPOSE: The authors ascertain the association between the short-term natural history of untreated diabetic macular edema and the vitreomacular relationship. METHODS: The authors prospectively studied 82 type II diabetic patients with clinically significant macular edema over a six-month period. They used multiple linear regression analysis to evaluate the effect of ten variables on the short-term natural history of macular edema 6 months after diagnosis: age; gender; diabetes duration at diagnosis of macular edema; hemoglobin A1; insulin use; presence of proteinuria; presence of systemic hypertension, cardiac disorders, or both; degree of diabetic retinopathy; history of panretinal photocoagulation; and vitreomacular relationships, as determined by present lens biomicroscopy. RESULTS: At study entry, 22 (27%) eyes had vitreomacular separation and 60 (73%) eyes did not. Macular edema spontaneously resolved in 27 (33%) eyes 6 months after diagnosis. Of the 22 eyes with vitreomacular separation at study entry, 12 (55%) had spontaneous resolution of macular edema after 6 months, whereas only 15 of 60 (25%) of the eyes with vitreomacular adhesion at study entry had spontaneous resolution (P = 0.01). Stepwise regression analysis indicated that vitreomacular separation (P = 0.01) and diabetes duration (P = 0.03) contribute to resolution of macular edema. Of the 27 eyes with resolved macular edema, 17 (63%) had improved visual acuity of more than two lines, whereas no eyes had improved visual acuity if macular edema persisted. The prevalence of improved visual acuity of more than two lines was significantly higher in eyes with vitreomacular separation at study entry (36%, 8/22) than in eyes without (15%, 9/60; P = 0.04). CONCLUSION: Our findings suggest that vitreomacular separation may promote the spontaneous resolution of diabetic macular edema and consequently improve visual acuity.

Adolescent↗
PubMed2001

Losartan versus enalapril on cerebral edema and proteinuria in stroke-prone hypertensive rats.

Stroke-prone spontaneously hypertensive rats (SHRSP), subjected to high NaCl, show severe hypertension, organ damage, and early death. Preventive treatment with angiotensin II type 1 (AT1) receptor antagonists is known to be effective. Previously, we found that angiotensin converting enzyme (ACE) inhibition could reduce cerebral edema when treatment was started after manifestation of either proteinuria or cerebral edema. In this study AT1 receptor blockade was started at the same time points to evaluate whether this had an effect superior to ACE inhibition. SHRSP drank 1% NaCl. Group 1 served as controls. Group 2 and 3 rats were started on losartan and enalapril after proteinuria exceeded 40 mg/day. Group 4 and 5 rats were started on losartan and enalapril after the first observation of cerebral edema with T2-weighted magnetic resonance imaging scans. In controls, median survival was 54 days (range, 35 to 80 days) after the start of salt loading. With early-onset losartan and enalapril, survival increased to 305 days (range, 184 to 422 days) and 320 days (range, 134 to 368 days) (both P < .01 v group 1). Cerebral edema formation was prevented in all but two rats, one from each treatment modality. Development of proteinuria was markedly reduced. With late-onset treatment with losartan and enalapril, survival was 290 days (range, 120 to 367 days) and 264 days (range, 154 to 319 days) (both P < .01). Both losartan and enalapril decreased cerebral edema to baseline levels. Ultimately cerebral edema reoccurred, despite continued treatment, in 75% of the rats. Systolic blood pressure did not decrease after losartan treatment, but, similarly to early-onset treatment, decreased transiently after enalapril treatment. Cerebral edema and proteinuria were prevented and reduced in SHRSP treated with either an AT1 receptor antagonist or an ACE inhibitor. Survival was markedly and similarly prolonged by both treatments, whether initiated directly before or after development of cerebral edema. In rats where treatment was initiated after manifestation of cerebral edema, both cerebral edema and proteinuria reappeared despite continued treatment. Apparently, when hypertension is sustained, reappearance of target organ damage may not be entirely dependent on angiotensin.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2004

[Edema and the tropics].

People visiting or living in tropical or subtropical regions are exposed to various factors, which can lead to edema. Tourists staying for only a short time in the tropics are exposed to different risks, with other disease patterns, than people living in the tropics or immigrants from tropical regions. The differential diagnosis of edema and swelling is extensive and it can sometimes be difficult to distinguish classical edema with fluid retention in the extravascular interstitial space, from lymphedema or swelling due to other aetiologies. The patients often connect the edema to their stay in the tropics although it may have been pre-existing with no obvious relation to their travels. Already the long trip in the plane can lead to an "economy class syndrome" due to deep venous thrombosis. Contacts with animal or plant toxins, parasites or parasitic larvae can produce peripheral edema. The diagnosis can often only be made by taking a meticulous history, checking for eosinophilia and with the help of serological investigations. Chronic lymphedema or elephantiasis of the limbs is often due to blocked lymph vessels by filarial worms. It has to be distinguished from other forms as e.g. podoconiosis due to blockage by mineral particles in barefoot walking people. The trend to book adventure and trekking holidays at high altitude leads to high altitude peripheral edema or non-freezing cold injuries such as frostbites and trench foot. Edema can be an unwanted side effect of a range of drugs e.g. nifedipine, which is used to prevent and treat high altitude pulmonary edema. Protein malnutrition, (Kwashiorkor), and vitamin B6 deficiency, (Beri-Beri) are very rarely observed in immigrants and almost never in tourists. A very painful swelling of fingers and hands in children and young adults of African origin can be observed during a sickle cell crisis. Many protein loosing nephropathies connected with plant and animal toxins but also bacterial, viral or parasitic agents, can lead to edema. But very often edema in tourists or immigrants from the tropics is not related to their stay abroad. To take an accurate history of the itinerary, eating habits and exposure to water etc. is very important. Knowledge of the precise epidemiology and geographic distribution of diseases are essential.

Adult↗
PubMed2006

Voice analysis of patients with diverse types of Reinke's edema and clinical use of electroglottographic measurements.

CONCLUSIONS: Reinke's edema shows a variety of clinical patterns and differences in voice analysis depending on its type. Electroglottographic measurements help to objectively assess the severity of edema and voice quality before and after surgery. OBJECTIVES: Reinke's edema manifests various clinical findings and different voice characteristics depending on the degree of swelling and the severity of voice impairment. The aim of this study was to compare the aerodynamic, acoustic and electroglottographic parameters for the different types of Reinke's edema according to its morphological, perceptual and histopathological classifications, and to assess voice quality in patients with Reinke's edema before and after laryngomicrosurgery. We also aimed to determine which parameter was most associated with the improvement in postoperative voice quality and to investigate the clinical usefulness of electroglottographic analysis in Reinke's edema. MATERIAL AND METHODS: The clinical and voice records of 61 patients with Reinke's edema were reviewed. All the patients were classified according to stroboscopic findings (Yonekawa's classification), perceptual grade and histopathological findings. Voice analysis of the perceptual, acoustic, aerodynamic and electroglottographic measurements was carried out using various classifications, and the voices of 23 patients who underwent laryngomicrosurgery were evaluated 2 months after surgery. Furthermore, the voices of 30 normal speakers (controls) were recorded and analyzed. RESULTS: The fundamental frequency (FxM) of Yonekawa Type III was significantly lower than those of the other types of Reinke's edema, and the SD of the FxM, the percentage irregularity of the FxM (CFx) and the percentage irregularity of the amplitude were larger than those of the other types of Reinke's edema. The closed quotient was significantly higher in Yonekawa Type III. In addition, the mean flow rate (MFR), maximum phonation time and harmonics:noise ratio (HNR) differed significantly among the different types of Reinke's edema. The postoperative results showed an increase in the FxM and an improvement in the MFR, subglottic pressure, shimmer and HNR. Correlation analysis showed that jitter, the HNR, the mean closed quotient and the irregularity of the frequency were the parameters that had the best correlation with improvement in postoperative voice quality.

Adolescent↗
PubMed1997

Time course of cerebral edema after traumatic brain injury in rats: effects of riluzole and mannitol.

Brain trauma is the main cause of morbidity and mortality in young adults. One delayed events that occurs after a head trauma and compromises the survival of patients is cerebral edema. The present study examined first the occurrence of cerebral edema after a traumatic brain injury (TBI) induced by moderate fluid percussion in rats. Brain water content was measured from 1 h to 7 days posttrauma, in the hippocampus and cortex, on both ipsi- and contralateral hemispheres. Second, the effects of mannitol, an osmotic agent frequently used in the clinic, and riluzole, a neuroprotective compound, were investigated on regional edema formation. After TBI, the ipsilateral edema began early at 1-6 h, was maximal at 48 h and was resorbed by 5-7 days. No edema was observed in the contralateral hemisphere. Mannitol at 1 g/kg or vehicle was administered iv 15 min, 2 h and 4 h postinjury. At this dose, mannitol significantly attenuated the ipsilateral injured cortex edema measured at 6 h (p < 0.05). Riluzole at 4 and 8 mg/kg or vehicle was administered 15 min (IV) and 6 h, 24 h, and 30 h (SC) post-TBI. Riluzole at 4 x 4 mg/kg significantly reduced edema measured at 48 h, in the ipsilateral hippocampus (p < 0.05), whereas at 4 x 8 mg/kg, the reduction was observed in the hippocampus (p < 0.01) and the injured cortex (p < 0.05). Our results demonstrate that (1) cerebral edema begins early after the injury and is resorbed over 1 week; (2) mannitol could attenuate cerebral edema; and (iii) riluzole in addition to its neuroprotective effects reduces the brain edema. Thus, riluzole could be useful in human TBI treatment.

Animals↗
PubMed2003

Gemcitabine-induced peripheral edema: report on 15 cases and review of the literature.

Some degree of peripheral edema occurs in up to 20% of patients treated with gemcitabine (Gemzar). The edema is typically mild, requiring discontinuation of the drug in less than 1% of patients. Most patients require no therapy. However, in cases of peripheral edema, grade II or higher, suspension of gemcitabine and treatment with corticosteroids are often necessary, and permanent discontinuation of gemcitabine may be required on occasion. We have identified 15 cases of peripheral edema, grade II or greater, developing in patients receiving gemcitabine chemotherapy at Memorial Sloan-Kettering Cancer Center. The diagnosis was made based on temporal association with drug administration, and exclusion of other potential acute causes of edema including progression of disease and deep vein thrombosis. The 15 patients in this series represent less than 1% of all patients treated with gemcitabine at this institution over the same time period. Gemcitabine was immediately discontinued at the time of the onset of edema in 7 of the 15 patients due to severity of the symptoms. Thirteen of the 15 patients in this case series had experienced peripheral edema previously, and 6 had active low-grade edema at the time the gemcitabine was first administered. Patients receiving gemcitabine should be advised of this potential complication and urged to promptly report its development so that comorbid conditions can be excluded and proper supportive measures initiated. Patients predisposed to peripheral edema from some other cause may be at increased risk for developing severe peripheral edema with gemcitabine.

Aged↗
PubMed2006

Effect of edema, relative biological effectiveness, and dose heterogeneity on prostate brachytherapy.

Many factors influence response in low-dose-rate (LDR) brachytherapy of prostate cancer. Among them, edema, relative biological effectiveness (RBE), and dose heterogeneity have not been fully modeled previously. In this work, the generalized linear-quadratic (LQ) model, extended to account for the effects of edema, RBE, and dose heterogeneity, was used to assess these factors and their combination effect. Published clinical data have shown that prostate edema after seed implant has a magnitude (ratio of post- to preimplant volume) of 1.3-2.0 and resolves exponentially with a half-life of 4-25 days over the duration of the implant dose delivery. Based on these parameters and a representative dose-volume histogram (DVH), we investigated the influence of edema on the implant dose distribution. The LQ parameters (alpha=0.15 Gy(-1) and alpha/beta=3.1 Gy) determined in earlier studies were used to calculate the equivalent uniform dose in 2 Gy fractions (EUD2) with respect to three effects: edema, RBE, and dose heterogeneity for 125I and 103Pd implants. The EUD2 analysis shows a negative effect of edema and dose heterogeneity on tumor cell killing because the prostate edema degrades the dose coverage to tumor target. For the representative DVH, the V100 (volume covered by 100% of prescription dose) decreases from 93% to 91% and 86%, and the D90 (dose covering 90% of target volume) decrease from 107% to 102% and 94% of prescription dose for 125I and 103Pd implants, respectively. Conversely, the RBE effect of LDR brachytherapy [versus external-beam radiotherapy (EBRT) and high-dose-rate (HDR) brachytherapy] enhances dose effect on tumor cell kill. In order to balance the negative effects of edema and dose heterogeneity, the RBE of prostate brachytherapy was determined to be approximately 1.2-1.4 for 125I and 1.3-1.6 for 103Pd implants. These RBE values are consistent with the RBE data published in the literature. These results may explain why in earlier modeling studies, when the effects of edema, dose heterogeneity, and RBE were all ignored simultaneously, prostate LDR brachytherapy was reported to show an overall similar dose effect as EBRT and HDR brachytherapy, which are independent of edema and RBE effects and have a better dose coverage.

Body Burden↗
PubMed2000

Isotope choice and the effect of edema on prostate brachytherapy dosimetry.

In prostate brachytherapy, post implant dosimetry quality parameters may be strongly affected by edema brought on by the trauma of the implant procedure since the amount of edema and the time course of its resolution are highly variable from patient to patient. Edema was simulated from preplans on three prostates which had ultrasound prostate volumes of 18.7, 40.7 and 60.2 cm3 expanded to planning volumes of 32.9, 60.0 and 87.8 cm3, respectively. The preplans were designed so that identical seed distributions for a given prostate gave virtually identical target dose coverage of 99.7+/-0.3% of the planning volume when using either 125I or 103Pd. Simulated CT edema volume expansions of 0%, 10%, 20% and 30% were imposed anisotropically in accordance with clinical observations so that the expansion in the superior-inferior direction was twice that of the transverse dimensions. Dose-volume histograms (DVHs) were analyzed for each prostate as a function of isotope and degree of edema. The 103Pd implants were more greatly affected by fixed amounts of edema than 125I implants, and the slopes of the DVH curves indicate less homogeneity from 103Pd implants. The DVHs were then weighted according to the portion of the isotope decay curve occupied by each edema step for half-lives of edema resolution of 5, 10 and 20 days which are within the range of clinically observed resolution times. The weighted DVHs were summed to give a net DVH corresponding to the overall dynamic effect of edema. A greater fraction of the defined prostate volume received doses in the range of likely therapeutic significance, from 75% to 125% of the prescribed minimal peripheral dose (mPD), from 125I implants than from 103Pd implants. These differences in dosimetric quality arise from two differences in the physical properties of the isotopes: more rapid attenuation of 103Pd photons with distance creates cool spots in an edematous prostate, and the shorter half-life of 103Pd causes a greater fraction of the isotope decay to consist of the prostate in an edematous state. An increase in 103Pd seed strength by about 10% beyond that required to achieve equal coverage with an identical seed distribution using 125I should minimize the differences brought on by edema.

Biophysical Phenomena↗
PubMed1997

Molecular characterization of Escherichia coli strains isolated from pigs with edema disease.

The present study was conducted to investigate the epidemiological relationship of isolates of Escherichia coli causing edema disease. Classical edema disease has not previously been described in Denmark, but between February 1994 and November 1995 cases appeared in 51 pig herds, among which direct or indirect trading contacts were confirmed for 36 of the herds. A total of 213 isolates from pigs with edema disease in Denmark and other countries and 23 E. coli O139 isolates from pigs with diarrhea or healthy pigs were analyzed to characterize their O serogroups, HindIII ribotypes, and pulsed-field gel electrophoresis (PFGE) types, and 183 of the isolates were also analyzed for their plasmid profiles. The resulting PFGE types of the isolates from pigs with edema disease were examined by cluster analysis. Ten isolates from three herds could not be typed with the available O antisera, whereas all other isolates were of serotype O139. However, all isolates from pigs with edema disease belonged to the same HindIII ribotype, which was not observed among the isolates from pigs with diarrhea or healthy pigs. All isolates from Danish pigs with edema disease except for three isolates originating from two herds belonged to the same or closely related XbaI PFGE types; the other three isolates were assigned to possibly related types. Isolates from pigs with edema disease in different countries belonged to different PFGE types. All isolates from Danish pigs with edema disease grouped together in one cluster, in contrast to isolates from other countries, which did not form any clusters. E. coli strains of serogroup O139 from pigs with diarrhea or isolated from the feces of healthy Danish pigs were very different. Plasmid profiles differed largely among isolates. However, among the isolates from Danish pigs with edema disease, one type predominated within herds. The present study indicated that most, if not all, of the observed cases of edema disease in Denmark were part of the same outbreak. The combination of PFGE typing and ribotyping was useful for studying the possible clonal relationship among strains, whereas plasmid profiling was less informative.

Animals↗
PubMed2002

Clinical outcome of edema-like bone marrow abnormalities of the foot.

PURPOSE: To evaluate the clinical outcome of edema-like bone marrow abnormalities seen on magnetic resonance (MR) images of the foot when their cause is unknown. MATERIALS AND METHODS: The clinical outcome of 31 patients (15 female patients, 16 male patients; mean age, 51; range, 10-79 years) with edema-like bone marrow abnormalities on MR images of the foot was determined. The relevance of three different edema patterns was compared: (a) exclusively ill-defined edema-like zones, (b) edema-like zones plus well-defined necrosis-like zones, and (c) edema-like zones plus linear structures indicating possible fractures. The different edema patterns were compared with persistence of pain. RESULTS: Fifty-four percent of all patients had pain persisting after 1 year, as calculated with the Kaplan-Meier method. The duration of pain in the various subgroups varied significantly (P =.049, log-rank test). The subgroup of patients with a well-defined necrosis-like zone had substantially longer-lasting pain than those with edema-like abnormalities only (n = 16) (P =.065). Only one of seven patients with a well-defined necrosis-like zone (n = 7) was pain free after 1 year. Conversely, patients with possible stress fracture (n = 8) had shorter pain compared with those with edema-like abnormalities only (P =.036); six of eight patients were pain free after 1 year. CONCLUSION: Edema-like bone marrow abnormalities of the foot predict long-lasting pain. Analysis of the image patterns of such abnormalities allows prediction of the clinical outcome to a certain degree.

Adolescent↗
PubMed1999

Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial MR images.

PURPOSE: To determine whether the marrow edema around focal osteonecrosis on magnetic resonance (MR) images is associated with clinical symptoms. MATERIALS AND METHODS: Thirty-three patients with 37 hips showing early stage osteonecrosis of the femoral head were followed up at 3-month intervals with clinical evaluation, conventional radiography, and serial MR imaging. RESULTS: Seven (50%) of 14 symptomatic hips showed marrow edema around focal osteonecrosis on initial MR images, whereas only one (4%) of 23 asymptomatic hips showed edema (P < .01). Six (86%) of seven hips that were moderately to severely painful were associated with surrounding marrow edema. All eight hips showing osteonecrosis with marrow edema at the initial MR examination had joint effusion and exhibited intense radionuclide uptake in the proximal femur, which corresponded to the extent of edema on MR images. In all eight hips, the marrow edema resolved on follow-up MR images, and the pain subsided with the resolution of edema. CONCLUSION: The results of this study suggest that the combination of marrow edema of the proximal femur and focal osteonecrosis of the femoral head are strongly associated with hip pain in early stage osteonecrosis, even prior to collapse. Pain improvement usually parallels the resolution of edema.

Adolescent↗
PubMed1999

Acute ureterolithiasis: nonenhanced helical CT findings of perinephric edema for prediction of degree of ureteral obstruction.

PURPOSE: To determine whether the extent of perinephric edema on helical computed tomographic (CT) images without contrast material enhancement can be used to predict the degree of ureteral obstruction in patients with acute ureterolithiasis. MATERIALS AND METHODS: Nonenhanced helical CT and excretory urographic images in 82 patients with flank pain were retrospectively reviewed. For each patient, a radiologic diagnosis was established, and the degree of ureteral obstruction determined on urograms was compared with the extent of perinephric edema assessed on CT images. RESULTS: None of 29 patients with no abnormalities seen at urography had evidence of perinephric edema at CT. Of six patients with noncalculous disease, two with acute pyelonephritis had perinephric edema at CT. Of 47 patients with acute ureterolithiasis, eight had no perinephric edema at CT and a nonobstructing calculus at urography, 21 had limited edema at CT and low-grade obstruction at urography, and 15 had extensive edema at CT and high-grade obstruction at urography. Three patients had extensive perinephric edema at CT but low-grade obstruction at urography. The extent of edema allowed accurate prediction of the degree of ureteral obstruction in 44 (94%) of 47 patients with acute ureterolithiasis. CONCLUSION: The extent of perinephric edema on nonenhanced helical CT images can be used to predict the degree of ureteral obstruction in acute ureterolithiasis.

Acute Disease↗
PubMed2000

Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings.

PURPOSE: To correlate magnetic resonance (MR) images of a bone marrow edema pattern with histologic findings in osteoarthritic knees. MATERIALS AND METHODS: Sixteen consecutive patients (age range, 43-79 years; mean, 67 years) referred for total knee replacement were examined with sagittal short inversion time inversion-recovery (STIR) and T1- and T2-weighted turbo spin-echo MR imaging 1-4 days before surgery. Tibial plateau abnormalities on MR images were compared quantitatively with those on histologic maps. RESULTS: The bone marrow edema pattern zone (ill-defined and hyperintense on STIR images and hypointense on T1-weighted MR images) mainly consisted of normal tissue (53% of the area was fatty marrow, 16% was intact trabeculae, and 2% was blood vessels) and a smaller proportion of several abnormalities (bone marrow necrosis [11% of area], abnormal [necrotic or remodeled] trabeculae [8%], bone marrow fibrosis [4%], bone marrow edema [4%], and bone marrow bleeding [2%]). The bone marrow edema pattern zone and the zone with a normal MR imaging appearance differed significantly in the presence of bone marrow necrosis (P =.021), bone marrow fibrosis (P =.014), and abnormal trabeculae (P =.011) but not in the prevalence of bone marrow edema (P =.069). Bone marrow edema also was found in zones with an unremarkable MR appearance (perifocal zone, 5% edema; control zone, 2% edema). CONCLUSION: A bone marrow edema pattern in osteoarthritic knees represents a number of noncharacteristic histologic abnormalities. Edema is not a major constituent of MR imaging signal intensity abnormalities in such knees.

Adult↗