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Transient bone marrow edema of the talus: MR imaging findings in five patients
Leopoldo M Gigena1, Christine B Chung, Nittaya Lektrakul
1Department of Radiology, Veterans Affairs San Diego Healthcare Systems, University of California, San Diego, 3350 La Jolla Village Drive, 92161, USA.
Objective:
To describe the MR findings of transient bone marrow edema (TBME) of the talus and to address the differential diagnostic considerations.
Design And Patients:
The imaging findings of TBME of six tali were retrospectively reviewed in five patients with a clinical history of pain without trauma. Inclusion criteria were MR imaging findings that, when compared with clinical data and results of follow-up assessment, allowed the diagnosis of TBME. MR imaging, standard radiography, and bone scintigraphy were performed. The images were reviewed with particular attention to the pattern and distribution of abnormal marrow signal intensity as well as associated findings.
Results:
In four cases the entire talus was involved, and in two cases only a portion of the bone was affected. No fractures were detected. MR imaging demonstrated diffuse decreased signal intensity of the marrow on T1-weighted images with corresponding increased signal intensity on T2-weighted images. In all six cases MR imaging detected associated findings, which included joint effusion and soft tissue edema. All patients improved clinically with conservative therapy over a period of 6 months to 1 year.
Conclusions:
Although unusual, TBME can involve the talus. Marrow edema without evidence of a fracture and in the absence of history of trauma is a characteristic MR imaging feature, allowing confident diagnosis and institution of conservative therapy.
Insights
Transient bone marrow edema (TBME) of the talus is an unusual condition presenting as bone marrow edema without fracture. MR imaging is key for diagnosis, enabling prompt conservative treatment.
Area of Science:
- Radiology
- Orthopedics
- Medical Imaging
Background:
- Transient bone marrow edema (TBME) is a recognized entity, but its occurrence in the talus is less common.
- Clinical presentation often involves pain without a history of trauma, posing diagnostic challenges.
Purpose of the Study:
- To characterize the magnetic resonance (MR) imaging findings of TBME specifically in the talus.
- To outline differential diagnostic considerations for talar bone marrow edema.
Main Methods:
- Retrospective review of MR imaging findings in six tali from five patients with atraumatic pain.
- Inclusion criteria focused on MR findings consistent with TBME, confirmed by clinical data and follow-up.
- MR imaging, standard radiography, and bone scintigraphy were utilized.
Main Results:
- TBME involved the entire talus in four cases and part of the talus in two cases; no fractures were identified.
- Characteristic MR findings included diffuse decreased T1 signal and increased T2 signal within the bone marrow.
- Associated findings on MR imaging were joint effusion and soft tissue edema in all cases.
Conclusions:
- TBME of the talus, though uncommon, is identifiable on MR imaging.
- The absence of fracture and history of trauma on MR imaging are key features for diagnosing TBME.
- Confident diagnosis allows for the initiation of conservative management, leading to clinical improvement.