Prevalence, Determinants, and Clinical Relevance of Magnetic Resonance Imaging Signs of Osteitis Pubis in the Large Population-based Cohort SHIP

Purpose or Learning Objective: (1) To assess the prevalence of parasymphyseal bone marrow edema and cleft signs of the interpubic disk in 1.5-T magnetic resonance imaging examinations of the normal population. (2) To correlate these findings with determinants such as age, sex, body mass index, sports activity, profession, and number of pregnancies. (3) To compare the presence of parasymphyseal bone marrow edema and cleft signs of the interpubic disk with lower abdominal and/or leg pain.

Methods or Background: A total of 1,000 subjects (mean age: 51.5 years; female 52%; male 48%) from the SHIP-Trend-0 cohort of the population-based Study of Health in Pomerania (SHIP) underwent pelvic 1.5-T magnetic resonance imaging examinations. These subjects were representative of the normal northeastern German population. Parasymphyseal bone marrow edema was assessed on localization, extent, and intensity, both qualitatively and semiquantitatively. Cleft signs were classified as present or absent. Statistical analysis consisted of the chi-square, Fisher exact, and Mann-Whitney U tests, as well as binary logistic regression where appropriate.

Results or Findings: Among the subjects, the prevalence of parasymphyseal bone marrow edema was 11.1% and balanced equally to both sides (2.5% left, 3.1% right, 5.5% bilateral), and its mean extent from the interpubic disk was 9 mm. The prevalence of cleft signs of the interpubic disks was 6%. No significant correlation of parasymphyseal bone marrow edema was found with the determinants sex (P = 0.24), magnetic resonance imaging (P = 0.39), sports activity (P = 0.34), and profession (P = 0.12). However, a cleft sign was correlated with bone marrow edema (P < 0.01) and female sex (P = 0.02). Parasymphyseal bone marrow edema was related to the number of pregnancies (P = 0.04), and the probability of having bone marrow edema increased with the number of pregnancies by 24%. There was no significant correlation between bone marrow edema and cleft signs with lower abdominal pain (P = 0.72 and P = 0.83, respectively) and leg pain (P = 0.65 and P = 0.98, respectively) in the assessed normal population.

Conclusion: The prevalence of parasymphyseal bone marrow edema and cleft signs of the interpubic disks in the normal German population are 11% and 6%, respectively, and these findings were not correlated with symptoms, sports activity, and profession. This relatively high prevalence of bone marrow edema and cleft signs as incidental findings in the normal population should be considered when diagnosing osteitis pubis.

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Artikel online veröffentlicht:
02. Juni 2025