Bone marrow edema: pathophysiology, differential diagnosis, and imaging

Abstract

Bone marrow edema (BME) has been a topic of increasing interest in the literature in recent years. BME is associated with numerous pathologies and is becoming recognized not only as a considerable pain generator, but also as an entity which is, in some cases, significantly linked to the worsening of patient prognosis. To date, no thorough imaging review of BME has been published. An electronic literature search was conducted through PubMed with a time parameter of January 1975 through December 2007. The primary search parameter was "bone marrow edema." Over 800 papers were listed as written in English and involving humans. Other refining parameters included "AND syndrome," "AND transient," "AND arthritis," "AND infection," "AND tumor," "AND neoplasm," "AND iatrogenic," "AND radiation therapy," and "AND inflammation." More current articles were favored over dated articles on the same topic. A total of 106 journal articles were collected concerning BME and multiple pathologic processes. The data contained therein was compiled and organized into a comprehensive format. BME can be caused by, and found concurrent with, a broad spectrum of pathologies which exhibit a variety of imaging findings. BME is also associated with the deterioration of certain pathologies. This presentation is a comprehensive discussion of different pathological conditions inducing or associated with BME. Differential diagnosis through appropriate imaging is vital to case management and could contribute to the prevention or decreased progression of certain pathologies. Continued investigation into the imaging of BME and its associated diseases, as well as the effect of BME on prognosis, is warranted.

Treatment of bone marrow lesions (bone marrow edema)

“…1 Since then a wealth of publications have detailed the presence of BML in a wide variety of conditions ( Table 1). The presence of BML has been shown to be associated with pain and progression of disease in numerous studies, 2 and therefore various modalities have been tested as treatment options in the hope that they might reduce pain and progressions of disease. The purpose of this review is to summarise our current knowledge about the role of BMLs in inflammatory and non-inflammatory disease and the effects of current treatment regimens.…”

Neoplazik Olmayan Kemik Iligi Bozukluklari

“…Uzun kemiklerde; önce epifiz ve apofiz, sonra diyafiz, en son olarak da sırasıyla distal ve proksimal metafizde yağlı konversiyon olur. Erişkin paternde kemik iliği 25 yaşına kadar tamamlanır ve kırmızı kemik iliği sadece aksiyel iskelette, sternumda, kotlarda, humerus ve femur metafizlerinde görülür [1][2][3].…”

“…Yağ baskılı T2A ve STIR'da ödem ve hemorajiye bağlı artmış sinyal izlenir (Resim 3A). T1A'da genellikle orta sinyalli belirsiz sınırlı heterojen subkortikal retiküler çizgilenmeler izlenir [3,6] (Resim 3B). Fakat travma mekanizmasına bağlı olarak subkondral alandan daha uzak yerleşimli de olabilir [6].…”

“…Tipik olarak tek taraflı izlenir [8]. Fokal yüzeysel subkondral lezyonlar olup, en sık yük taşıyan femur medyal kondilinde görülür [3,4]. Femur lateral kondili, patella ve tibiada da izlenebilir.…”

Osteopathology in the Equine Distal Phalanx Associated With the Development and Progression of Laminitis

“…44,45 In humans, ''bone marrow edema'' has been observed in a broad spectrum of local and multisystemic conditions, including degenerative, inflammatory, infectious, endocrine, metabolic, and neoplastic processes, and it is associated with increased pain, a more rapid progression, or a worsening prognosis. 48 Moreover, bone remodeling with associated bone marrow inflammation, neovascularization, stromal cell activation, and edema was observed histologically in an archived set of acute and chronically laminitic equine feet, providing the impetus for the current study. 13 Although the remodeling changes described in laminitic feet suggested that a direct correlation might exist between lamellar epidermal/dermal lesions and DP lesions in equine laminitis, the stepwise progression and extent of laminitis-associated DP pathology had not been thoroughly characterized or systematically quantified.…”