Bone marrow edema
Updates to Article Attributes
Bone marrow oedema is the term given to abnormal fluid signalsignals seen within the bone marrow on MRI. It is a non-specific yet important imaging finding, usually indicating the presence of underlying pathology.
Terminology
The term oedema was coined on MRI as the signal in abnormal bone marrow is similar to that which would be seen with the presence of excess water; low T1, high T2. The term is, however, misleading as "oedema" implies that there is only excess fluid, whereas in reality, within areas of so-called bone marrow oedema, a wide variety of processes can exist, including infarction, haemorrhage, inflammatory cell infiltration, fibrosis, and hypervascularity 6.
Pathology
Aetiology
There is a long (long) list of possible causes of this finding:
primary:bone marrow oedema syndrome (no cause found)
trauma: fractures, bone contusion, ligamentous injury, etc.
arthropathy: e.g. degenerative joint disease, rheumatoid arthritis, etc.
hypoperfusion: e.g. sickle cell disease
infective: e.g. osteomyelitis, diskitis, septic arthritis
iatrogenic: e.g. chemotherapy, postoperative, chronic corticosteroid therapy
neurological: neuropathic arthropathy
neoplastic: malignancies e.g. bone metastases, and benign e.g. giant cell tumour, chondroblastoma, osteoid osteoma
miscellaneous: e.g. chronic renal failure
Radiographic features
CT
Dual-energy CT may demonstrate bone marrow oedema using fluid-sensitive "oedema maps", however, its sensitivity and specificity isare poorer than that of MRI 5,6.
MRI
Bone marrow oedema is generally primarily identified on MRI and is best investigated using fat-suppressed T2W sequences.
There will be intermediate T1 signal, with a high T2 signal in the fat of the bone marrow (usually fat-suppressed sequences required to see the increased T2 signal).
However other imaging modalities may then have a role in investigating the underlying cause.
-<p><strong>Bone marrow oedema</strong> is the term given to abnormal fluid signal seen within the <a href="/articles/bone-marrow" title="Bone marrow">bone marrow</a> on MRI. It is a <a href="/articles/non-specific" title="Non-specific">non-specific</a> yet important imaging finding, usually indicating the presence of underlying pathology.</p><h4>Terminology</h4><p>The term oedema was coined on MRI as the signal in abnormal bone marrow is similar to that which would be seen with the presence of excess water; low T1, high T2. The term is, however, misleading as "oedema" implies that there is <em>only</em> excess fluid, whereas in reality, within areas of so-called bone marrow oedema, a wide variety of processes can exist, including infarction, haemorrhage, inflammatory cell infiltration, fibrosis, and hypervascularity <sup>6</sup>.</p><h4>Pathology</h4><h5>Aetiology</h5><p>There is a long (long) list of possible causes of this finding:</p><ul>- +<p><strong>Bone marrow oedema</strong> is the term given to abnormal fluid signals seen within the <a href="/articles/bone-marrow" title="Bone marrow">bone marrow</a> on MRI. It is a <a href="/articles/non-specific" title="Non-specific">non-specific</a> yet important imaging finding, usually indicating the presence of underlying pathology.</p><h4>Terminology</h4><p>The term oedema was coined on MRI as the signal in abnormal bone marrow is similar to that seen with excess water; low T1, high T2. The term is, however, misleading as "oedema" implies that there is <em>only</em> excess fluid, whereas in reality, within areas of so-called bone marrow oedema, a wide variety of processes can exist, including infarction, haemorrhage, inflammatory cell infiltration, fibrosis, and hypervascularity <sup>6</sup>.</p><h4>Pathology</h4><h5>Aetiology</h5><p>There is a long (long) list of possible causes of this finding:</p><ul>
-</ul><h4>Radiographic features</h4><h5>CT</h5><p>Dual-energy CT may demonstrate bone marrow oedema using fluid-sensitive "oedema maps", however its sensitivity and specificity is poorer than that of MRI <sup>5,6</sup>.</p><h5>MRI</h5><p>Bone marrow oedema is generally primarily identified on MRI and is best investigated using fat-suppressed T2W sequences. </p><p>There will be intermediate T1 signal, with high T2 signal in the fat of the bone marrow (usually fat-suppressed sequences required to see the increased T2 signal).</p><p>However other imaging modalities may then have a role in investigating the underlying cause.</p>- +</ul><h4>Radiographic features</h4><h5>CT</h5><p>Dual-energy CT may demonstrate bone marrow oedema using fluid-sensitive "oedema maps", however, its sensitivity and specificity are poorer than MRI <sup>5,6</sup>.</p><h5>MRI</h5><p>Bone marrow oedema is generally primarily identified on MRI and is best investigated using fat-suppressed T2W sequences. </p><p>There will be intermediate T1 signal, with a high T2 signal in the fat of the bone marrow (usually fat-suppressed sequences required to see the increased T2 signal).</p><p>However other imaging modalities may have a role in investigating the underlying cause.</p>
References changed:
- 1. Patel S. Primary Bone Marrow Oedema Syndromes. Rheumatology (Oxford). 2014;53(5):785-92. <a href="https://doi.org/10.1093/rheumatology/ket324">doi:10.1093/rheumatology/ket324</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24080251">Pubmed</a>
- 2. Rios A, Rosenberg Z, Bencardino J, Rodrigo S, Theran S. Bone Marrow Edema Patterns in the Ankle and Hindfoot: Distinguishing MRI Features. AJR Am J Roentgenol. 2011;197(4):W720-9. <a href="https://doi.org/10.2214/AJR.10.5880">doi:10.2214/AJR.10.5880</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21940545">Pubmed</a>
- 3. Sudoł-Szopińska I, Kontny E, Maśliński W, Prochorec-Sobieszek M, Warczyńska A, Kwiatkowska B. Significance of Bone Marrow Edema in Pathogenesis of Rheumatoid Arthritis. Pol J Radiol. 2013;78(1):57-63. <a href="https://doi.org/10.12659/PJR.883768">doi:10.12659/PJR.883768</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23493495">Pubmed</a>
- 4. McQueen F & Ostendorf B. What is MRI Bone Oedema in Rheumatoid Arthritis and Why Does It Matter? Arthritis Res Ther. 2006;8(6):222. <a href="https://doi.org/10.1186/ar2075">doi:10.1186/ar2075</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/17169137">Pubmed</a>
- 5. Palmer W, Bancroft L, Bonar F et al. Glossary of Terms for Musculoskeletal Radiology. Skeletal Radiol. 2020;49(Suppl 1):1-33. <a href="https://doi.org/10.1007/s00256-020-03465-1">doi:10.1007/s00256-020-03465-1</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/32488336">Pubmed</a>
- 1. Patel S. Primary bone marrow oedema syndromes. (2014) Rheumatology (Oxford, England). 53 (5): 785-92. <a href="https://doi.org/10.1093/rheumatology/ket324">doi:10.1093/rheumatology/ket324</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24080251">Pubmed</a> <span class="ref_v4"></span>
- 2. Rios AM, Rosenberg ZS, Bencardino JT, Rodrigo SP, Theran SG. Bone marrow edema patterns in the ankle and hindfoot: distinguishing MRI features. (2011) AJR. American journal of roentgenology. 197 (4): W720-9. <a href="https://doi.org/10.2214/AJR.10.5880">doi:10.2214/AJR.10.5880</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21940545">Pubmed</a> <span class="ref_v4"></span>
- 3. Sudoł-Szopińska I, Kontny E, Maśliński W, Prochorec-Sobieszek M, Warczyńska A, Kwiatkowska B. Significance of bone marrow edema in pathogenesis of rheumatoid arthritis. (2013) Polish journal of radiology. 78 (1): 57-63. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596146">PMC (full text)</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23493495">Pubmed</a> <span class="ref_v4"></span>
- 4. McQueen FM, Ostendorf B. What is MRI bone oedema in rheumatoid arthritis and why does it matter?. (2006) Arthritis research & therapy. 8 (6): 222. <a href="https://doi.org/10.1186/ar2075">doi:10.1186/ar2075</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/17169137">Pubmed</a> <span class="ref_v4"></span>
- 5. William Palmer, Laura Bancroft, Fiona Bonar, Jung-Ah Choi, Anne Cotten, James F. Griffith, Philip Robinson, Christian W.A. Pfirrmann. Glossary of terms for musculoskeletal radiology. (2020) Skeletal Radiology. <a href="https://doi.org/10.1007/s00256-020-03465-1">doi:10.1007/s00256-020-03465-1</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/32488336">Pubmed</a> <span class="ref_v4"></span>