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DOI: 10.1055/a-2732-7610
Management of Bone Marrow Edema with Interventional Radiology: When and How
Authors
Abstract
Bone marrow edema, a typical and exclusive finding of magnetic resonance imaging, is a characteristic of multiple pathologies. There is still no consensus about its origin and histologic characteristics. In this article, we describe six causes of bone edema based on pathophysiologic characteristics: traumatic, infectious, inflammatory, degenerative, tumoral, and neuromediated. For each of them, we explain both the diagnostic and therapeutic role of interventional radiology. The fundamental importance of bone biopsy in characterizing the lesions associated with bone edema is also reviewed.
Publication History
Received: 04 July 2025
Accepted: 16 October 2025
Article published online:
20 February 2026
© 2026. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
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References
- 1 James SLJ, Panicek DM, Davies AM. Bone marrow oedema associated with benign and malignant bone tumours. Eur J Radiol 2008; 67 (01) 11-21
- 2 Manara M, Varenna M. A clinical overview of bone marrow edema. Reumatismo 2014; 66 (02) 184-196
- 3 Mirghasemi SA, Trepman E, Sadeghi MS, Rahimi N, Rashidinia S. Bone marrow edema syndrome in the foot and ankle. Foot Ankle Int 2016; 37 (12) 1364-1373
- 4 Maraghelli D, Brandi ML, Matucci Cerinic M, Peired AJ, Colagrande S. Edema-like marrow signal intensity: a narrative review with a pictorial essay. Skeletal Radiol 2021; 50 (04) 645-663
- 5 Hofmann S, Kramer J, Vakil-Adli A, Aigner N, Breitenseher M. Painful bone marrow edema of the knee: differential diagnosis and therapeutic concepts. Orthop Clin North Am 2004; 35 (03) 321-333 , ix
- 6 Giannotti S, Bottai V, Dell'Osso G. et al. Algodystrophy: complex regional pain syndrome and incomplete forms. Clin Cases Miner Bone Metab 2016; 13 (01) 11-14
- 7 Korompilias AV, Karantanas AH, Lykissas MG, Beris AE. Bone marrow edema syndrome. Skeletal Radiol 2009; 38 (05) 425-436
- 8 Faruch Bilfeld M, Lapègue F, Brun C. et al. Bone abnormalities of the knee: MRI features. Diagn Interv Imaging 2016; 97 (7-8): 779-788
- 9 Koch V, Müller FC, Gosvig K. et al. Incremental diagnostic value of color-coded virtual non-calcium dual-energy CT for the assessment of traumatic bone marrow edema of the scaphoid. Eur Radiol 2021; 31 (07) 4428-4437
- 10 Malghem J, Lecouvet F, Vande Berg B, Kirchgesner T, Omoumi P. Subchondral insufficiency fractures, subchondral insufficiency fractures with osteonecrosis, and other apparently spontaneous subchondral bone lesions of the knee-pathogenesis and diagnosis at imaging. Insights Imaging 2023; 14 (01) 164
- 11 Buturoiu MM, Ghiea S, Weber MA. Subchondral insufficiency fractures: overview of MRI findings from hip to ankle joint. Rofo 2024; 196 (11) 1143-1154
- 12 Koo JH, Lee J, Han K, Song HT, Ryu L, Lee YH. Preliminary study for prediction of benign vertebral compression fracture age by quantitative water fraction using modified Dixon sequences: an imaging biomarker of fracture age. Radiol Med 2023; 128 (08) 970-977
- 13 Kronthaler S, Boehm C, Feuerriegel G. et al. Assessment of vertebral fractures and edema of the thoracolumbar spine based on water-fat and susceptibility-weighted images derived from a single ultra-short echo time scan. Magn Reson Med 2022; 87 (04) 1771-1783
- 14 Cavallaro M, D'Angelo T, Albrecht MH. et al. Comprehensive comparison of dual-energy computed tomography and magnetic resonance imaging for the assessment of bone marrow edema and fracture lines in acute vertebral fractures. Eur Radiol 2022; 32 (01) 561-571
- 15 Tsoumakidou G, Too CW, Koch G. et al. CIRSE guidelines on percutaneous vertebral augmentation. Cardiovasc Intervent Radiol 2017; 40 (03) 331-342
- 16 Cazzato RL, Dalili D, De Marini P. et al. Bone consolidation: a practical guide for the interventional radiologist. Cardiovasc Intervent Radiol 2023; 46 (11) 1458-1468
- 17 Le Corroller T, Arrigoni F. ESR Essentials: Percutaneous bone consolidation-practice recommendations by the European Society of Musculoskeletal Radiology. Eur Radiol 2025; 35 (09) 5369-5380
- 18 Traina F, Errani C, Toscano A. et al. Current concepts in the biopsy of musculoskeletal tumors: AAOS exhibit selection. J Bone Joint Surg Am 2015; 97 (02) e7-e6
- 19 Boninsegna E, Piovan E, Sozzi C. et al. Advancing precision in CT-guided bone biopsies: exploring the potential of dual-energy CT imaging. Radiol Med 2025; 130 (02) 143-149
- 20 Huang AJ, Kattapuram SV. Musculoskeletal neoplasms: biopsy and intervention. Radiol Clin North Am 2011; 49 (06) 1287-1305 , vii
- 21 Veltri A, Bargellini I, Giorgi L, Almeida PAMS, Akhan O. CIRSE guidelines on percutaneous needle biopsy (PNB). Cardiovasc Intervent Radiol 2017; 40 (10) 1501-1513
- 22 Saifuddin A, Tyler P, Rajakulasingam R. Imaging of bone marrow pitfalls with emphasis on MRI. Br J Radiol 2023; 96 (1142) 20220063
- 23 Chan BY, Gill KG, Rebsamen SL, Nguyen JC. MR imaging of pediatric bone marrow. Radiographics 2016; 36 (06) 1911-1930
- 24 Reinert CP, Pfannenberg C, Dittmann H. et al. [18F]Fluoride positron-emission tomography (PET) and [18F]FDG PET for assessment of osteomyelitis of the jaw in comparison to computed tomography (CT) and magnetic resonance imaging (MRI): a prospective PET/CT and PET/MRI pilot study. J Clin Med 2022; 11 (14) 3998
- 25 Talbot BS, Weinberg EP. MR imaging with metal-suppression sequences for evaluation of total joint arthroplasty. Radiographics 2016; 36 (01) 209-225
- 26 Albano D, Gitto S, Messina C. et al. MRI-based artificial intelligence to predict infection following total hip arthroplasty failure. Radiol Med 2023; 128 (03) 340-346
- 27 Germann C, Filli L, Jungmann PM. et al. Prospective and longitudinal evolution of postoperative periprosthetic findings on metal artifact-reduced MR imaging in asymptomatic patients after uncemented total hip arthroplasty. Skeletal Radiol 2021; 50 (06) 1177-1188
- 28 Schett G, Lories RJ, D'Agostino MA. et al. Enthesitis: from pathophysiology to treatment. Nat Rev Rheumatol 2017; 13 (12) 731-741
- 29 Thaker S, Pesquer L, Rennie WJ. Ultrasound of the foot and ankle in peripheral spondyloarthritis. Semin Musculoskelet Radiol 2024; 28 (06) 740-748
- 30 Ruscio MD, Tinazzi I, Variola A, Geccherle A, Marchetta A, McGonagle D. Prevalence and real-world management of vedolizumab-associated enthesitis in successfully treated IBD patients. Rheumatology (Oxford) 2021; 60 (12) 5809-5813
- 31 Habib GS, Saliba W, Nashashibi M. Local effects of intra-articular corticosteroids. Clin Rheumatol 2010; 29 (04) 347-356
- 32 Al-Omari AA, Aleshawi AJ, Marei OA. et al. Avascular necrosis of the femoral head after single steroid intra-articular injection. Eur J Orthop Surg Traumatol 2020; 30 (02) 193-197
- 33 Alliston T, Hernandez CJ, Findlay DM, Felson DT, Kennedy OD. Bone marrow lesions in osteoarthritis: what lies beneath. J Orthop Res 2018; 36 (07) 1818-1825
- 34 Geith T, Stellwag AC, Muller PE, Reiser M, Baur-Melnyk A. Is bone marrow edema syndrome a precursor of hip or knee osteonecrosis? Results of 49 patients and review of the literature. Diagn Interv Radiol 2020; 26 (04) 355-362
- 35 Guermazi A, Neogi T, Katz JN. et al. Intra-articular corticosteroid injections for the treatment of hip and knee osteoarthritis-related pain: considerations and controversies with a focus on imaging- Radiology Scientific Expert Panel. Radiology 2020; 297 (03) 503-512
- 36 Pirri C, Sorbino A, Manocchio N. et al. Chondrotoxicity of intra-articular injection treatment: a scoping review. Int J Mol Sci 2024; 25 (13) 7010
- 37 Moser LB, Bauer C, Jeyakumar V, Niculescu-Morzsa EP, Nehrer S. Hyaluronic acid as a carrier supports the effects of glucocorticoids and diminishes the cytotoxic effects of local anesthetics in human articular chondrocytes in vitro. Int J Mol Sci 2021; 22 (21) 11503
- 38 Steens W, Zinser W, Rößler P, Heyse T. Infiltration therapy in the context of cartilage surgery. Arch Orthop Trauma Surg 2024; 144 (09) 3913-3923
- 39 Sconfienza LM, Adriaensen M, Alcala-Galiano A. et al. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part IV, hip. Eur Radiol 2022; 32 (01) 551-560
- 40 Le Corroller T, Parratte S, Amous Z, Flecher X, Argenson JN, Champsaur P. Focal articular cartilage defect treated by percutaneous radiofrequency ablation. J Vasc Interv Radiol 2010; 21 (10) 1599-1602
- 41 Maurel B, Le Corroller T, Bierry G, Buy X, Host P, Gangi A. Treatment of symptomatic para-articular intraosseous cysts by percutaneous injection of bone cement. Skeletal Radiol 2013; 42 (01) 43-48
- 42 Maybody M, Soliman MM, Hwang S. et al. Impact of magnetic resonance imaging (MRI) findings on management of symptomatic patients following radiofrequency ablation (RFA) of osteoid osteoma (OO). SN Compr Clin Med 2020; 2 (11) 2170-2177
- 43 Kroon HM, Bloem JL, Holscher HC, van der Woude HJ, Reijnierse M, Taminiau AHM. MR imaging of edema accompanying benign and malignant bone tumors. Skeletal Radiol 1994; 23 (04) 261-269
- 44 Shanmugasundaram S, Nadkarni S, Kumar A, Shukla PA. Percutaneous ablative therapies for the management of osteoid osteomas: a systematic review and meta-analysis. Cardiovasc Intervent Radiol 2021; 44 (05) 739-749
- 45 Balbaa MF, Spinelli MS, Arrigoni F. et al. CT-guided radiofrequency ablation of painful intra-articular osteoid osteoma in children: is there a concern for cartilage damage?. Radiol Med 2023; 128 (08) 999-1006
- 46 Masciocchi C, Arrigoni F, La Marra A, Mariani S, Zugaro L, Barile A. Treatment of focal benign lesions of the bone: MRgFUS and RFA. Br J Radiol 2016; 89 (1066) 20150356-20150357
- 47 Arrigoni F, Zoccali C, Evangelista L. et al. CT-guided RFA for management of surgical relapses of giant cell tumour of bone. Cardiovasc Intervent Radiol 2023; 46 (04) 508-511
- 48 Luigi Cazzato R, Auloge P, De Marini P. et al. Percutaneous image-guided ablation of bone metastases: local tumor control in oligometastatic patients. Int J Hyperthermia 2018; 35 (01) 493-499
- 49 Gennaro N, Sconfienza LM, Ambrogi F, Boveri S, Lanza E. Thermal ablation to relieve pain from metastatic bone disease: a systematic review. Skeletal Radiol 2019; 48 (08) 1161-1169
- 50 Leporace M, Lancellotta V, Baccolini V. et al. Magnetic resonance-guided focused ultrasound versus percutaneous thermal ablation in local control of bone oligometastases: a systematic review and meta-analysis. Radiol Med 2024; 129 (02) 291-306
- 51 Rehnitz C, Sprengel SD, Lehner B. et al. CT-guided radiofrequency ablation of osteoid osteoma: correlation of clinical outcome and imaging features. Diagn Interv Radiol 2013; 19 (04) 330-339
- 52 Kintzelé L, Brandelik SC, Wuennemann F. et al. MRI patterns indicate treatment success and tumor relapse following radiofrequency ablation of osteoblastoma. Int J Hyperthermia 2020; 37 (01) 274-282
- 53 Cazzato RL, Arrigoni F, Boatta E. et al. Percutaneous management of bone metastases: state of the art, interventional strategies and joint position statement of the Italian College of MSK Radiology (ICoMSKR) and the Italian College of Interventional Radiology (ICIR). Radiol Med 2019; 124 (01) 34-49
- 54 Capanna R, Springfield DS, Ruggieri P. et al. Direct cortisone injection in eosinophilic granuloma of bone: a preliminary report on 11 patients. J Pediatr Orthop 1985; 5 (03) 339-342
- 55 Grøvle L, Haugen AJ, Johansen M, Hasvik E. The terminologies of transient, migratory, or localized osteoporosis, and bone marrow edema syndrome: a scoping review. Osteoporos Int 2024; 35 (02) 217-226
