Bildgebung des Knochenmarködemsyndroms

 

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Zusammenfassung

Die Bildgebung ist von zentraler Bedeutung bei der Diagnosestellung des Knochenmarködemsyndroms. Die konventionelle Röntgendiagnostik kann eine umschriebene Osteo-penie darstellen, die bei der Erstbeschreibung der Erkrankung als „transiente Osteoporose” namensgebend war. Diese Veränderungen treten jedoch mit einer mehrwöchigen Latenzverzögerung auf. Im Gegensatz dazu kann die Magnetresonanztomografie (MRT) bereits ab Symptombeginn ödemähnliche Veränderungen des Knochenmarks frühzeitig darstellen. Bei Kenntnis des typischen MRT-Befundmusters ist diese primär reversible Erkrankung von anderen mit irreversiblem Verlauf und differentem Therapieregime gut abgrenzbar. Dieser Artikel beschreibt die Befunde des Knochenmarködemsyndroms in den unterschiedlichen Modalitäten der bildgebenden Diagnostik. Den größten Stellenwert in der frühzeitigen Diagnosestellung, der differenzialdiagnostischen Abgrenzung und in der Verlaufskontrolle der Erkrankung hat die Magnetresonanztomografie, deren typische Erscheinungsbilder diskutiert und anhand von Bildbeispielen illustriert werden.

Summary

Imaging is of utmost importance in the diagnosis of bone marrow edema syndrome. Plain radiographs may reveal regional osseous demineralization, which in the first studies were suggestive for the term „transient osteoporosis oft he hip” (TOH). However, these changes can not be detected in the first weeks after the onset of symptoms. Therefore magnetic resonance (MR) imaging is the modality of choice for detecting early changes of bone marrow. MRI gives the possibility to make an on time diagnosis and to monitor the progression of the disease. Furthermore, the knowledge of certain imaging features on MR imaging or other modalities may lead to a correct diagnosis and adequate therapy. Especially early differential diagnosis and surgical treatment in case of osteonecrosis is of crucial importance. This review article describes the imaging appearance of normal bone marrow and the typical imaging features of bone marrow oedema syndrome and its most important differential diagnosis by means of certain imaging examples of different modalities.

• Literatur

• 1 Karantanas AH. Acute bone marrow edema of the hip: role of MR imaging. Eur Radiol 2007; 17 (09) 2225-2236.
  CrossrefGoogle Scholar
• 2 Korompilias AV, Karantanas AH, Lykissas MG, Beris AE. Bone marrow edema syndrome. Skeletal Radiol 2009; 38 (05) 425-436.
  CrossrefPubMedGoogle Scholar
• 3 Curtiss Jr PH, Kincaid WE. Transitory demineralization of the hip in pregnancy. A report of three cases. J Bone Joint Surg Am 1959; 41-A: 1327-1333.
  CrossrefPubMedGoogle Scholar
• 4 Lequesne M. Transient osteoporosis of the hip. A nontraumatic variety of Sudeck’s atrophy. Ann Rheum Dis 1968; 27 (05) 463-471.
  CrossrefGoogle Scholar
• 5 Parker RK, Ross GJ, Urso JA. Transient osteoporosis of the knee. Skeletal Radiol 1997; 26 (05) 306-309.
  CrossrefGoogle Scholar
• 6 Vande BCBerg, Lecouvet FE, Koutaissoff S. et al. Bone marrow edema of the femoral head and transient osteoporosis of the hip. Eur J Radiol 2008; 67 (01) 68-77.
  CrossrefGoogle Scholar
• 7 Horiuchi K, Shiraga N, Fujita N. et al. Regional migratory osteoporosis: a case report. J Orthop Sci 2004; 09 (02) 178-181.
  CrossrefGoogle Scholar
• 8 Zbijewski W, Sisniega A, Stayman JW. et al. Dual-Energy Imaging of Bone Marrow Edema on a Dedicated Multi-Source Cone-Beam CT System for the Extremities. Proc SPIE Int Soc Opt Eng. 2015: 9412.
  Google Scholar
• 9 Pache G, Krauss B, Strohm P. et al. Dual-energy CT virtual noncalcium technique: detecting posttraumatic bone marrow lesions – feasibility study. Radiology 2010; 256 (02) 617-624.
  CrossrefGoogle Scholar
• 10 Wilson AJ, Murphy WA, Hardy DC, Totty WG. Transient osteoporosis: transient bone marrow edema?. Radiology 1988; 167 (03) 757-760.
  CrossrefGoogle Scholar
• 11 Eriksen EF. Treatment of bone marrow lesions (bone marrow edema). Bonekey Rep 2015; 04: 755.
  Google Scholar
• 12 Freyschmidt J. [Bone (marrow) edema in magnetic resonance imaging – finding or only signal? A brief look behind the mirror]. Z Rheumatol 2012; 71 (01) 8-11.
  CrossrefGoogle Scholar
• 13 Vande BCBerg, Malghem J, Lecouvet FE, Maldague B. Classification and detection of bone marrow lesions with magnetic resonance imaging. Skeletal Radiol 1998; 27 (10) 529-545.
  CrossrefGoogle Scholar
• 14 Schmid MR, Hodler J, Vienne P. et al. Bone marrow abnormalities of foot and ankle: STIR versus T1-weighted contrast-enhanced fat-suppressed spin-echo MR imaging. Radiology 2002; 224 (02) 463-469.
  CrossrefGoogle Scholar
• 15 Mayerhoefer ME, Breitenseher MJ, Kramer J. et al. STIR vs. T1-weighted fat-suppressed gadoliniumenhanced MRI of bone marrow edema of the knee: computer-assisted quantitative comparison and influence of injected contrast media volume and acquisition parameters. J Magn Reson Imaging 2005; 22 (06) 788-793.
  CrossrefGoogle Scholar
• 16 Malizos KN, Zibis AH, Dailiana Z. et al. MR imaging findings in transient osteoporosis of the hip. Eur J Radiol 2004; 50 (03) 238-244.
  CrossrefGoogle Scholar
• 17 Vande BCBerg, Malghem JJ, Lecouvet FE. et al. Idiopathic bone marrow edema lesions of the femoral head: predictive value of MR imaging findings. Radiology 1999; 212 (02) 527-535.
  CrossrefGoogle Scholar
• 18 O’Hare A, Shortt C, Napier N, Eustace SJ. Bone marrow edema: patterns and clinical implications. Semin Musculoskelet Radiol 2006; 10 (04) 249-257.
  Article in Thieme ConnectGoogle Scholar
• 19 Uzun M, Ayhan E, Beksac B, Karaman O. Regional migratory osteoporosis and transient osteoporosis of the hip: are they all the same?. Clin Rheumatol 2013; 32 (06) 919-923.
  CrossrefGoogle Scholar
• 20 Ozyurek S, Mahirogullari M, Cilli F. et al. Transient migratory osteoporosis. J Clin Rheumatol 2009; 15 (02) 101-102.
  Google Scholar
• 21 Levy D, Hinterbuckner C. Transient or migratory osteoporosis of lower extremity. N Y State J Med 1976; 76 (05) 739-742.
  Google Scholar
• 22 Cahir JG, Toms AP. Regional migratory osteo-porosis. Eur J Radiol 2008; 67 (01) 2-10.
  CrossrefGoogle Scholar
• 23 Mueller D, Schaeffeler C, Baum T. et al. Magnetic resonance perfusion and diffusion imaging characteristics of transient bone marrow edema, avascular necrosis and subchondral insufficiency fractures of the proximal femur. Eur J Radiol 2014; 83 (10) 1862-1869.
  CrossrefGoogle Scholar
• 24 ARCO (Association Research Circulation Osseous) Committee on terminology and classification. ARCO News. 1992; 04: 41-46.
  Google Scholar
• 25 Meier R, Kraus TM, Schaeffeler C. et al. Bone marrow oedema on MR imaging indicates ARCO stage 3 disease in patients with AVN of the femoral head. Eur Radiol 2014; 24 (09) 2271-2278.
  CrossrefGoogle Scholar
• 26 Klontzas ME, Vassalou EE, Zibis AH. et al. MR imaging of transient osteoporosis of the hip: an update on 155 hip joints. Eur J Radiol 2015; 84 (03) 431-436.
  CrossrefGoogle Scholar
• 27 Miyanishi K, Kaminomachi S, Hara T. et al. A subchondral fracture in transient osteoporosis of the hip. Skeletal Radiol 2007; 36 (07) 677-680.
  CrossrefGoogle Scholar
• 28 Mandalia V, Henson JH. Traumatic bone bruising – a review article. Eur J Radiol 2008; 67 (01) 54-61.
  CrossrefGoogle Scholar
• 29 Eustace S, Keogh C, Blake M. et al. MR imaging of bone oedema: mechanisms and interpretation. Clin Radiol 2001; 56 (01) 4-12.
  CrossrefGoogle Scholar
• 30 James SL, Panicek DM, Davies AM. Bone marrow oedema associated with benign and malignant bone tumours. Eur J Radiol 2008; 67 (01) 11-21.
  CrossrefGoogle Scholar
• 31 Schueller-Weidekamm C, Mascarenhas VV, Sudol-Szopinska I. et al. Imaging and interpretation of axial spondylarthritis: the radiologist’s perspective--consensus of the Arthritis Subcommittee of the ESSR. Semin Musculoskelet Radiol 2014; 18 (03) 265-279.
  Article in Thieme ConnectGoogle Scholar