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 µm 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 naïve 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.

Features
• Reviews in detail the value of gamma correction 99mTc-HDP pinhole bone scan for the evaluation of trabecular microcallus
• Compares the technique with radiography, CT, and MRI
• Includes histological correlation

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