title: Evaluation of Diffusion-weighted MR Imaging as a Technique for Detecting Bone Marrow Edema in Patients with Osteitis Pubis.
abstract: OBJECTIVE
  Our aims were to determine the feasibility of diffusion-weighted magnetic resonance imaging (DWI) in the detection of bone marrow edema (BME) and explore the apparent diffusion coefficient (ADC) alterations in patients with osteitis pubis (OP).
  
  
  METHODS
  42 consecutive patients clinically suspected to have athletic pubalgia and 31 control subjects were enrolled in the study. All subjects underwent diagnostic focused magnetic resonance imaging (MRI) and DWI at b values of 0 and 600 s/mm2. Two radiologists reviewed the images for the presence of active OP. The presence of subchondral BME and contrast enhancement were considered to indicate active OP. ADC values were measured from public bodies of both groups. DWI results were correlated with routine MRI findings. Receiver-operating-characteristic curves were formed. Cut-off values for ADC, sensitivity and specificity values were measured.
  
  
  RESULTS
  36/42 (85%) of the cases had BME/enhancement on routine MRIs and identified as active OP. ADC measurements of the patients were greater than the controls (P < 0.05). For the optimal cut-off values DWI showed sensitivity and specificity values of 97.3%, and 90.3%, for the right, and 97.1%, and 96.7% for the left side, respectively (Area under the curve 0.965 and 0.973). Intra-and inter-rater reliability for readers were substantial-perfect for all sessions.
  
  
  CONCLUSIONS
  DWI is fast, accurate, and highly reproducible technique for the detection of BME in patients with active OP. It allows distinct bone marrow contrast without the use of gadolinium contrast, increases visual perception of active lesions, gives objective information by quantifying the diffusion coefficients, thus increase diagnostic confidence. We suggest the use of DWI as a cost-effective adjunctive tool for the diagnosis of active OP particularly in early cases and inconclusive diagnostic MRI. Future studies are necessary to determine the utility of DWI to evaluate severity of the disease and treatment response before returning athletes to play.
authors.affiliation: Department of Radiology, Antalya Training and Research Hospital.
authors.forename: Iclal Erdem
authors.initials: IE
authors.lastname: Toslak
authors.affiliation: Department of Radiology, Antalya Training and Research Hospital.
authors.forename: Bulent
authors.initials: B
authors.lastname: Cekic
authors.affiliation: Department of Sports Medicine, Antalya Training and Research Hospital.
authors.forename: Aysen
authors.initials: A
authors.lastname: Turk
authors.affiliation: Department of Sports Medicine, Antalya Training and Research Hospital.
authors.forename: Ali
authors.initials: A
authors.lastname: Eraslan
authors.affiliation: Department of Radiology, Antalya Training and Research Hospital.
authors.forename: A Eda
authors.initials: AE
authors.lastname: Parlak
mesh_terms: D000328:Adult; D000368:Aged; D001265:Athletic Injuries / Q000000981:diagnostic imaging* / Q000473:pathology; D001853:Bone Marrow / Q000000981:diagnostic imaging* / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D004487:Edema / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010000:Osteitis / Q000000981:diagnostic imaging* / Q000473:pathology*; D011446:Prospective Studies; D011630:Pubic Bone / Q000000981:diagnostic imaging* / Q000473:pathology; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: athletic pubalgia; bone marrow edema; diffusion weighted imaging; magnetic resonance imaging; osteitis pubis