Bone Marrow Edema: Patterns and Clinical Implications

ABSTRACT

This article outlines the causes of bone marrow edema and classifies them by mechanism into congestive, vasogenic, traumatic, and tumorigenic forms. In particular, the article focuses on traumatic edema, emphasizing the differing patterns on the basis of mechanism of injury, impaction, distraction, and shear-type injuries. Finally the article reviews the impact of understanding mechanisms in image interpretation and in patient management.

KEYWORDS

Bone marrow edema - STIR - congestive - traumatic - tumorigenic - vasogenic

REFERENCES

• 1 Eustace S. General principles. In: Eustace S Magnetic Resonance Imaging of Orthopaedic Trauma. Philadelphia, PA; Lippincott Williams & Wilkins 1999: 60-65
• 2 Resnick D. Internal derangements of joints. In: Resnick D Diagnosis of Bone and Joint Disorders. 3rd ed. Philadelphia; WB Saunders 1995: 3152-3153
• 3 Schmid M R, Holder J, Vienne P, Binkert C A, Zanetti M. Bone marrow abnormalities of foot and ankle: STIR versus T1 weighted contrast enhanced fat-suppressed spin-echo MR imaging.  Radiology. 2002;  224 463-469
• 4 Tang Y M, Jeavons S, Stuckey S, Middleton H, Gill D. MRI features of bone marrow necrosis.  AJR Am J Roentgenol. 2007;  188 509-514
• 5 Lafforgue P. Pathophysiology and natural history of avascular necross of bone.  Joint Bone Spine. 2006;  73 500-507
• 6 Deely D M, Schweitzer M E. MR imaging of bone marrow disorders.  Radiol Clin N Am. 1997;  35 193-198
• 7 Ma L D, McCarthy E F, Bluemke D A et al.. Differentiation of benign from malignant musculoskeletal lesions using MR imaging, pitfalls in MR evaluation of lesions with a cystic appearance.  Am J Roentgenol. 1998;  170 1251-1255
• 8 Bollow M, Knauf W, Korfel  et al.. Initial experience with dynamic MR imaging in evaluation of normal bone marrow versus malignant bone marrow infiltration in humans.  J Magn Reson Imaging. 1997;  7 241-246
• 9 Park S W, Lee J H, Ehara S et al.. Single shot fast spin echo diffusion-weighted MR imaging of the spine; is it useful in differentiating malignant tumour infiltration from benign fracture edema?.  Clin Imaging. 2004;  28 102-108
• 10 Zajick D C, Morrison W B, Schweitzer M E, Parellada J A, Carrino J A. Benign and malignant processes: normal values and differentiation with chemical shift MR imaging in vertebral marrow.  Radiology. 2005;  237 590-596
• 11 Ryu K M, Jin W, Ko Y T et al.. MR characteristics and histological correlation in the young pig.  J Clin Imaging. 2000;  24 371-380
• 12 Graf B K, Cook D A, De Smet A A et al.. Bone bruises on magnetic resonance imaging of anterior cruciate ligament injuries.  Am J Sports Med. 1993;  21 220-223
• 13 Nonaka D, Tanaka M, Takaki K et al.. Gelatinous bone marrow transformation complicated by self induced malnutrition.  Acta Haematol. 1998;  100 88-90
• 14 Robertson P L, Schweitzer M E, Bartolozzi A R, Ligoni A. Anterior cruciate ligament tears: evaluation of multiple signs with MR imaging.  Radiology. 1994;  193 829-834
• 15 Virolainen H, Visuri T, Kuusela T. Acute dislocation of the patella: MR findings.  Radiology. 1993;  100 243-246
• 16 Sanders T G, Medynski M A, Feller J F, Lawhorn K W. Bone contusion patterns in the knee at MR imaging: Footprint of the mechanism of injury.  Radiographics. 2000;  20 S135-S151
• 17 Dietz G W, Wilcox D M, Montgomery J B. Segond tibial fracture: lateral capsular ligament avulsion.  Radiology. 1986;  159 467-469
• 18 Palosaari K, Vuotila J, Takalo R et al.. Rheumatology(Oxford). 2006 May 2 [Epub ahead of print]
• 19 Tanigawa N, Komemushi A, Kariya S et al.. Percutaneous vertebroplasty: relationship between vertebral body bone marrow edema pattern on MR images and initial clinical response.  Radiology. 2006;  239 195-200
• 20 Major N M. Role of MRI in prevention of metatarsal stress fractures inn collegiate basketball players.  AJR Am J Roentgenol. 2006;  186 255-258
• 21 Ward R, Caruthers S, Yablon C et al.. Analysis of diffusion changes in posttraumatic bone marrow using navigator-corrected diffusion gradients.  AJR Am J Roentgenol. 2000;  174 731-734
• 22 Yao L, Lee J K. Occult intraosseous fracture: detection with MR imaging.  Radiology. 1998;  167 749-751
• 23 Roemer F W, Bohndorf K. Long-term osseous sequelae after acute trauma of the knee joint evaluated by MRI.  Skeletal Radiol. 2002;  31 615-623
• 24 Boks S S, Vroegindeweij D, Koes B W et al.. Follow-up of occult bone lesions detected at MR imaging: systematic review.  Radiology. 2006;  238 853-862