Histopathological perspective on bone marrow oedema, reactive bone change and haemorrhage

Area of Science:

• Orthopedics
• Radiology
• Pathology

Background:

• Bone marrow edema (BME) is a non-specific magnetic resonance imaging (MRI) finding associated with infections, tumors, and avascular necrosis.
• Bone marrow edema syndrome (BMES) is diagnosed when BME occurs primarily with joint pain, without obvious bony pathology.
• Reactive bone changes involve increased bone formation, while bone marrow hemorrhage results from trauma, causing bone bruising.

Purpose of the Study:

• To systematically review the aetiopathogenesis and histopathological features of bone marrow edema, reactive bone change, and hemorrhage.
• To evaluate the diagnostic criteria and limitations of 'bone marrow edema syndrome' based on current literature.
• To discuss the histopathological correlates of MRI findings in bone marrow abnormalities.

Main Methods:

• Systematic review of biomedical literature.
• Analysis of radiology-histology correlational studies.
• Review of studies on bone marrow edema, reactive bone changes, and bone marrow hemorrhage.

Main Results:

• Bone marrow edema on MRI is often non-specific, seen in various conditions.
• Recent studies reveal interstitial edema, necrosis, fibrosis, and trabecular abnormalities in BMES, questioning its purely radiological diagnosis.
• Histopathological techniques have limitations in detecting increased extracellular fluid.

Conclusions:

• The term 'bone marrow edema syndrome' may be questionable in a radiological context due to non-specific MRI findings and histopathological variability.
• Further research is needed to clarify the natural history of bone bruising and associated osteochondral injuries.
• Understanding the histopathological basis of bone marrow abnormalities is crucial for accurate diagnosis and management.