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Bone Marrow Edema: pathogenetic features
L Molfetta1, A Florian1, G Saviola2
1University of Genoa, School of Medical and Pharmacological Sciences, DISC Department, Research Center of Osteoporosis and Osteoarticular Pathologies, Genoa, Italy.
Abstract:
The term "bone marrow edema" was used for the first time in 1988 by Wilson. He noticed a high signal on fluid-sensitive sequences at MRI located in the subchondral bone. We can find bone marrow edema in many musculoskeletal diseases such as Inflammatory and Rheumatic diseases (Rheumatoid Arthritis, Spondylarthritis, etc.), Osteoarthritis (BMLs) and Bone Marrow Edema Syndromes (BMES). This classification is based on pathophysiological, histological and clinical differences despite the same imaging evidence. The distinction is useful also in terms of treatment. Bisphosphonates in association with NSAIDs or corticosteroids are the main therapy while TNF-a Inhibitors are used for the specific inflammatory origin. Bone marrow edema has become an important aspect to consider in the diagnostic path of the main musculoskeletal diseases. This paper starts from a systematic review of literature. We chose the most decisive contributions in order to develop a better description of the pathogenetic features about this "new" evidence.
Insights
Bone marrow edema (BME), first described in 1988, appears as a high MRI signal in subchondral bone. Understanding BME's diverse causes, from osteoarthritis to inflammatory diseases, guides effective treatment strategies.
Area of Science:
- Musculoskeletal Radiology
- Pathophysiology
- Medical Imaging
Background:
- Bone marrow edema (BME) is characterized by high signal intensity on fluid-sensitive MRI sequences within the subchondral bone.
- First described in 1988, BME is observed across various musculoskeletal conditions, including osteoarthritis, inflammatory and rheumatic diseases, and bone marrow edema syndromes.
- Despite similar imaging findings, these conditions exhibit distinct pathophysiological, histological, and clinical characteristics.
Purpose of the Study:
- To systematically review and describe the pathogenetic features of bone marrow edema.
- To highlight the diagnostic and therapeutic implications of differentiating various causes of BME.
- To provide a comprehensive overview of BME as a significant imaging finding in musculoskeletal diseases.
Main Methods:
- Systematic review of relevant scientific literature.
- Selection of key contributions to elucidate pathogenetic mechanisms.
- Analysis of pathophysiological, histological, and clinical differences among BME causes.
Main Results:
- Bone marrow edema is a common imaging finding in diverse musculoskeletal pathologies.
- Distinguishing between different etiologies of BME is crucial for appropriate therapeutic management.
- Therapeutic approaches vary, with bisphosphonates, NSAIDs, and corticosteroids used for general BME, while TNF-α inhibitors target inflammatory origins.
Conclusions:
- Bone marrow edema is a critical diagnostic consideration in musculoskeletal imaging.
- Understanding the specific etiology of BME is essential for tailoring patient treatment.
- Further research into the pathogenetic features of BME will refine diagnostic and therapeutic strategies.
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