Intramedullary fat globules related to bone trauma: a new MR imaging finding

The purpose of this study is to describe intraosseous fat globules related to bone trauma that are detectable with magnetic resonance imaging (MRI), to define the relationship of this finding to fracture and bone contusion, to establish the frequency and associated findings. A proposed pathogenesis is presented.

We retrospectively reviewed 419 knee MRI examinations in patients with a history of recent injury and MRI findings of fracture or bone contusion. As a control population, 268 knee MRI examinations in patients without MRI findings of recent bone injury were also reviewed.

Eight of 419 (1.9%) patients with acute or subacute knee injury with positive findings of osseous trauma on MRI demonstrated intraosseous fat globules. The mean age of patients with fat globules was greater than that of those without fat globules, and the finding was more commonly seen in women. Fat globules were hyperintense to the normal fatty marrow present elsewhere in the bone on TI-weighted imaging and had a surrounding halo of high signal intensity on fluid-sensitive imaging.

Intramedullary fat globules related to bone injury visible on MRI are thought to be due to coalesced fat released by the necrosis of fatty marrow cells. The pathogenesis is supported by histologic studies of fat globules related to osteomyelitis, bone contusions and fractures. As the medullary cavity of long bones in older patients contains more fat than hematopoetic bone marrow, it is likely that this finding is more common with advancing age.