{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T09:31:16Z","timestamp":1787045476650,"version":"build-2736575974"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Jpn J Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate the diagnostic performance of bone marrow hyperattenuation (BMH) on CT for detecting fractures in patients without definite cortical disruption on CT and assessing the extent of intertrochanteric (IT) fracture extension in patients with suspected isolated greater trochanter fractures (IGTFs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This retrospective study included two groups of patients aged\u2009\u2265\u200965 years undergoing CT for suspected hip fractures: the cortical disruption\u2013negative group (without definite cortical disruption on CT) and the suspected IGTF group (with a cortical fracture confined to the greater trochanter on CT). BMH was defined as a visually appreciable, localized increase in bone marrow attenuation on CT. Three radiologists independently evaluated CT images. In the cortical disruption\u2013negative group, BMH was visually assessed for fracture detection, using MRI or clinical follow-up as the reference standard. In the suspected IGTF group, visual assessment evaluated whether BMH extended\u2009\u2265\u200950% of the IT line, using MRI as the reference standard. Patients with bilaterally evaluable femora underwent ROI-based quantitative assessment. Diagnostic performance, agreement, ROC analysis, and reproducibility were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the cortical disruption\u2013negative group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200957), visual BMH assessment showed median sensitivity and specificity of 90.5% and 97.2% for fracture detection, with almost perfect agreement (\u03ba\u2009=\u20090.90). In the suspected IGTF group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200925), visual assessment showed median sensitivity and specificity of 86.7% and 80.0% for detecting IT extension\u2009\u2265\u200950%, with substantial agreement (\u03ba\u2009=\u20090.72). In ROI assessment, performed in 50 and 16 patients, reader-specific AUCs were 0.720\u20130.935 for fracture detection and 0.945\u20131.000 for IT extension assessment; corresponding ICCs were 0.70 and 0.86.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BMH on CT allows fracture detection without definite cortical disruption and assessment of IT extension in suspected IGTFs, supporting its role as an adjunctive CT finding. Quantitative assessment may provide complementary information in selected patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11604-026-02065-8","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T08:53:28Z","timestamp":1787043208000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bone marrow hyperattenuation on CT for detection of hip fractures without cortical disruption and assessment of intertrochanteric extension in greater trochanter fractures"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9725-0687","authenticated-orcid":false,"given":"Bunta","family":"Tokuda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Tsuboi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Kimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuki","family":"Miwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiko","family":"Tsuji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsuke","family":"Asai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichiro","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Ashida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Yamada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"2065_CR1","first-page":"1","volume":"3","author":"R Marks","year":"2010","unstructured":"Marks R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970\u20132009. Int J Gen Med. 2010;3:1\u201317.","journal-title":"Int J Gen Med"},{"key":"2065_CR2","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1148\/rg.2020190173","volume":"40","author":"B Gosangi","year":"2020","unstructured":"Gosangi B, Mandell JC, Weaver MJ, Uyeda JW, Smith SE, Sodickson AD, et al. Bone marrow edema at dual-energy CT: a game changer in the emergency department. Radiographics. 2020;40:859\u201374.","journal-title":"Radiographics"},{"key":"2065_CR3","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1016\/j.injury.2009.01.010","volume":"40","author":"SK Khan","year":"2009","unstructured":"Khan SK, Kalra S, Khanna A, Thiruvengada MM, Parker MJ. Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291,413 patients. Injury. 2009;40:692\u20137.","journal-title":"Injury"},{"key":"2065_CR4","doi-asserted-by":"publisher","first-page":"1436","DOI":"10.2106\/JBJS.G.00890","volume":"90","author":"AN Al-Ani","year":"2008","unstructured":"Al-Ani AN, Samuelsson B, Tidermark J, Norling \u00c5, Ekstr\u00f6m W, Cederholm T, et al. Early operation on patients with a hip fracture improved the ability to return to independent living: a prospective study of 850 patients. JBJS. 2008;90:1436\u201342.","journal-title":"JBJS"},{"key":"2065_CR5","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1148\/radiol.2020192167","volume":"296","author":"A Haj-Mirzaian","year":"2020","unstructured":"Haj-Mirzaian A, Eng J, Khorasani R, Raja AS, Levin AS, Smith SE, et al. Use of Advanced imaging for radiographically occult hip fracture in elderly patients: a systematic review and meta-analysis. Radiology. 2020;296:521\u201331.","journal-title":"Radiology"},{"key":"2065_CR6","doi-asserted-by":"publisher","first-page":"S18","DOI":"10.1016\/j.jacr.2019.02.028","volume":"16","author":"AB Ross","year":"2019","unstructured":"Ross AB, Lee KS, Chang EY, Amini B, Bussell JK, Gorbachova T, et al. ACR Appropriateness criteria\u00ae acute hip pain-suspected fracture. J Am Coll Radiol. 2019;16:S18\u201325.","journal-title":"J Am Coll Radiol"},{"key":"2065_CR7","doi-asserted-by":"publisher","first-page":"751","DOI":"10.2106\/00004623-199405000-00018","volume":"76","author":"KJ Koval","year":"1994","unstructured":"Koval KJ, Zuckerman JD. Functional recovery after fracture of the hip. J Bone Joint Surg Am. 1994;76:751\u20138.","journal-title":"J Bone Joint Surg Am"},{"key":"2065_CR8","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1148\/radiology.211.1.r99mr24237","volume":"211","author":"E Schultz","year":"1999","unstructured":"Schultz E, Miller TT, Boruchov SD, Schmell EB, Toledano B. Incomplete intertrochanteric fractures: imaging features and clinical management. Radiology. 1999;211:237\u201340.","journal-title":"Radiology"},{"key":"2065_CR9","doi-asserted-by":"publisher","first-page":"23","DOI":"10.5371\/hp.2019.31.1.23","volume":"31","author":"J Noh","year":"2019","unstructured":"Noh J, Lee KH, Jung S, Hwang S. The frequency of occult intertrochanteric fractures among individuals with isolated greater trochanteric fractures. Hip Pelvis. 2019;31:23\u201332.","journal-title":"Hip Pelvis"},{"key":"2065_CR10","doi-asserted-by":"crossref","unstructured":"Moon NH, Shin WC, Do MU, Woo SH, Son SM, Suh KT. Diagnostic strategy for elderly patients with isolated greater trochanter fractures on plain radiographs. BMC Musculoskelet Disord. 2018;19:256.","DOI":"10.1186\/s12891-018-2193-5"},{"key":"2065_CR11","doi-asserted-by":"publisher","first-page":"112","DOI":"10.5371\/hp.2016.28.2.112","volume":"28","author":"PH Chung","year":"2016","unstructured":"Chung PH, Kang S, Kim JP, Kim YS, Lee HM, Back IH, et al. Occult intertrochanteric fracture mimicking the fracture of greater trochanter. Hip Pelvis. 2016;28:112\u20139.","journal-title":"Hip Pelvis"},{"key":"2065_CR12","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.2214\/AJR.19.21510","volume":"213","author":"TT Kellock","year":"2019","unstructured":"Kellock TT, Khurana B, Mandell JC. Diagnostic performance of CT for occult proximal femoral fractures: a systematic review and meta-analysis. Am J Roentgenol. 2019;213:1324\u201330.","journal-title":"Am J Roentgenol"},{"key":"2065_CR13","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1258\/ar.2011.110466","volume":"53","author":"M Geijer","year":"2012","unstructured":"Geijer M, Dunker D, Collin D, G\u00f6thlin JH. Bone bruise, lipohemarthrosis, and joint effusion in CT of non-displaced hip fracture. Acta Radiol. 2012;53:197\u2013202.","journal-title":"Acta Radiol"},{"key":"2065_CR14","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1097\/BOT.0000000000002973","volume":"39","author":"MA Moriarty","year":"2025","unstructured":"Moriarty MA, Stefanov DG, Cohn RM, Brown MS, Walz DM, Walsh PJ. Utility of pelvis CT to assess occult intertrochanteric extension of greater trochanteric fractures. J Orthop Trauma. 2025;39:308\u201313.","journal-title":"J Orthop Trauma"},{"key":"2065_CR15","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1007\/s10140-024-02293-3","volume":"32","author":"MA Moriarty","year":"2025","unstructured":"Moriarty MA, Stefanov DG, Brown MS, Walz DM, Walsh PJ. Quantitative ROI differences for assessment of occult intertrochanteric extension of greater trochanteric fractures on pelvis CT. Emerg Radiol. 2025;32:13\u201322.","journal-title":"Emerg Radiol"},{"key":"2065_CR16","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1002\/jbmr.4821","volume":"38","author":"CW Sing","year":"2023","unstructured":"Sing CW, Lin TC, Bartholomew S, Bell JS, Bennett C, Beyene K, et al. Global epidemiology of hip fractures: secular trends in incidence rate, post-fracture treatment, and all-cause mortality. J Bone Min Res. 2023;38:1064\u201375.","journal-title":"J Bone Min Res"},{"key":"2065_CR17","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1148\/radiology.206.3.9494495","volume":"206","author":"KH Koo","year":"1998","unstructured":"Koo KH, Dussault R, Kaplan P, Kim R, Ahn IO, Christopher J, et al. Age-related marrow conversion in the proximal metaphysis of the femur: evaluation with T1-weighted MR imaging. Radiology. 1998;206:745\u20138.","journal-title":"Radiology"},{"key":"2065_CR18","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1016\/j.injury.2020.02.067","volume":"51","author":"Y-C Park","year":"2020","unstructured":"Park Y-C, Um K-S, Hong S-P, Oh C-W, Kim S, Yang K-H. Preoperative computed tomography capsular sign for the detection of occult ipsilateral femoral neck fractures associated with femoral shaft fractures. Injury. 2020;51:1051\u20136.","journal-title":"Injury"},{"key":"2065_CR19","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1302\/0301-620X.72B3.2341431","volume":"72","author":"N Egund","year":"1990","unstructured":"Egund N, Nilsson LT, Wingstrand H, Str\u00f6mqvist B, Pettersson H. CT scans and lipohaemarthrosis in hip fractures. J Bone Joint Surg Br. 1990;72:379\u201382.","journal-title":"J Bone Joint Surg Br"},{"key":"2065_CR20","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1148\/radiology.187.2.8475292","volume":"187","author":"SF Quinn","year":"1993","unstructured":"Quinn SF, McCarthy JL. Prospective evaluation of patients with suspected hip fracture and indeterminate radiographs: use of T1-weighted MR images. Radiology. 1993;187:469\u201371.","journal-title":"Radiology"},{"key":"2065_CR21","doi-asserted-by":"crossref","unstructured":"Ingari JV, Smith DK, Aufdemorte TB, Yaszemski MJ. Anatomic significance of magnetic resonance imaging findings in hip fracture. Clin Orthop Relat Res. 1996;332:209\u201314.","DOI":"10.1097\/00003086-199611000-00028"},{"key":"2065_CR22","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1148\/radiol.2017161063","volume":"284","author":"TT Kellock","year":"2017","unstructured":"Kellock TT, Nicolaou S, Kim SSY, Al-Busaidi S, Louis LJ, O\u2019Connell TW, et al. Detection of bone marrow edema in nondisplaced hip fractures: utility of a virtual noncalcium dual-energy CT application. Radiology. 2017;284:798\u2013805.","journal-title":"Radiology"},{"key":"2065_CR23","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1007\/s00590-023-03696-7","volume":"34","author":"MJ Chen","year":"2024","unstructured":"Chen MJ, Chaparro A, Elder Waters MS, Zadeh FS, Chalian M, Beingessner DM, et al. Capsular distension in high-energy femoral shaft fractures is associated with occult femoral neck fracture: a preliminary retrospective comparative study. Eur J Orthop Surg Traumatol. 2024;34:599\u2013604.","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"2065_CR24","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1007\/s10140-018-1626-7","volume":"25","author":"JC Mandell","year":"2018","unstructured":"Mandell JC, Rocha TC, Duran-Mendicuti MA, Miskin NP, Shi J, Khurana B. Color postprocessing of conventional CT images: preliminary results in assessment of nondisplaced proximal femoral fractures. Emerg Radiol. 2018;25:639\u201345.","journal-title":"Emerg Radiol"}],"container-title":["Japanese Journal of Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11604-026-02065-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11604-026-02065-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11604-026-02065-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T08:53:29Z","timestamp":1787043209000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11604-026-02065-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":24,"alternative-id":["2065"],"URL":"https:\/\/doi.org\/10.1007\/s11604-026-02065-8","relation":{},"ISSN":["1867-1071","1867-108X"],"issn-type":[{"value":"1867-1071","type":"print"},{"value":"1867-108X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"assertion":[{"value":"5 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Financial interests: Kei Yamada received institutional research support from Doctor-NET Inc., Guerbet Japan, and Fukushima SiC Applied Engineering Inc.; honoraria from Bracco Japan and the Japan Medical Association; and expert testimony payments from Astellas Pharma and Bayer. All were unrelated to the present study. Non-financial interests: Kei Yamada serves as the President of the Japanese College of Radiology and Secretary General of the Asian-Oceanian Society of Neuroradiology and Head & Neck Radiology. All other authors declare that they have no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The requirement for written informed consent was waived by the institutional review board.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This retrospective study was approved by the institutional review board of Fukuchiyama City Hospital.","order":3,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}