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MRI of bone marrow oedema associated with focal bone lesions
S L J James1, R J Hughes, K E Ali
1Department of Radiology, The Royal Orthopaedic Hospital, Northfield, Birmingham, UK. steven.james@roh.nhs.uk
Aim:
To quantify the volume of bone marrow oedema surrounding focal bone lesions and to identify its relevance relative to diagnosis.
Methods:
Three hundred and eighty-eight of 1456 patients included in the orthopaedic oncology database who underwent magnetic resonance imaging (MRI) demonstrated bone marrow oedema and were included in the study. There were 225 males and 163 females, age range 1-87 years (mean 29 years). MRI images were retrospectively reviewed and assessed for the extent of bone marrow oedema. The amount of oedema was graded: grade 1: oedema present but smaller than the lesion size; grade 2: oedema equivalent to the lesion size; grade 3: oedema greater than the lesion size.
Results:
There were 190 grade 1 lesions: 56% malignant, 33% benign, 11% non-neoplastic; 74 grade 2 lesions: 19% malignant, 50% benign, 31% non-neoplastic; and 124 grade 3 lesions: 10% malignant, 46% benign, 44% non-neoplastic. There was a significant relationship between oedema grade (i.e., volume of oedema) and final diagnosis (p<0.0005).
Conclusion:
Bone marrow oedema may be associated with a wide range of focal bony lesions, including malignant, benign and non-neoplastic causes. As the volume of bone marrow oedema increases relative to the size of the underlying lesion, the probability that the underlying lesion is benign is increased.
Insights
The volume of bone marrow edema surrounding focal bone lesions correlates with diagnosis. Increased edema volume relative to lesion size suggests a higher probability of benign bone conditions.
Area of Science:
- Orthopaedic oncology
- Radiology
- Medical imaging analysis
Background:
- Bone marrow edema on MRI is a common finding in focal bone lesions.
- Understanding the relationship between edema volume and lesion type is crucial for diagnosis.
Purpose of the Study:
- To quantify bone marrow edema volume around focal bone lesions.
- To determine the diagnostic relevance of edema volume in differentiating lesion types.
Main Methods:
- Retrospective review of 388 MRI scans from patients with bone marrow edema.
- Grading edema extent relative to lesion size (Grade 1: < lesion, Grade 2: = lesion, Grade 3: > lesion).
Main Results:
- Significant correlation found between edema grade (volume) and final diagnosis (p<0.0005).
- Higher edema grades (3) were more frequently associated with benign and non-neoplastic lesions (46% and 44% respectively).
- Lower edema grades (1) showed higher association with malignant lesions (56%).
Conclusions:
- Bone marrow edema is associated with diverse focal bone lesions, including malignant, benign, and non-neoplastic causes.
- Increasing bone marrow edema volume relative to lesion size increases the likelihood of a benign underlying lesion.
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