Edema and Related Medical Conditions

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Sunday, January 22, 2006

Bone Marrow Edema

Subchondral Bone Marrow Edema in Patients with Degeneration of the Articular Cartilage of the Knee Joint.

Abstract Jan 19 2006 - Radiology Online

Kijowski R, Stanton P, Fine J, De Smet A.

1 Departments of Radiology and Statistics, University of Wisconsin Hospital, Clinical Science Center-E3/311, 600 Highland Ave, Madison, WI 53792-3252.


To retrospectively determine at magnetic resonance (MR) imaging the prevalence of subchondral bone marrow edema beneath arthroscopically proved articular cartilage defects.

Materials and Methods:

The study was performed in compliance with HIPAA regulations, and a waiver of informed consent was obtained from the institutional review board before the study was performed. The study consisted of 132 patients (70 men, 62 women; average age, 53 years) with articular cartilage defects of the knee joint who underwent MR imaging of the knee and subsequent arthroscopic knee surgery. At the time of arthroscopy, each articular cartilage lesion was graded by using the Noyes classification system. MR examinations were retrospectively reviewed to determine the size, depth, and location of subchondral bone marrow edema without knowledge of the arthroscopic findings. Pairwise Fisher exact tests and two-sample t tests were used to correlate MR imaging findings of subchondral bone marrow edema with the arthroscopic grade of articular cartilage degeneration.


Subchondral bone marrow edema was seen beneath 105 (19%) of 554 articular cartilage defects identified at arthroscopy. It was not observed beneath any of the six grade 1 cartilage defects but was observed beneath eight (4.9%) of 163 grade 2A defects, 40 (14.4%) of 278 grade 2B defects, 54 (55.1%) of 98 grade 3A defects, and three (33.3%) of nine grade 3B defects. Subchondral bone marrow edema was also seen beneath four (1.4%) of 238 articular surfaces that appeared normal at arthroscopy. The mean depth and cross-sectional area of subchondral bone marrow edema increased with increasing grade of the articular cartilage lesion.


Higher grades of articular cartilage defects are associated with higher prevalence and greater depth and cross-sectional area of subchondral bone marrow edema.

(c) RSNA, 2006.PMID: 16424243

[PubMed - as supplied by publisher]


[Bone marrow edema of the knee joint.]

Jan 4, 2006

[Article in German]

Breitenseher MJ, Kramer J, Mayerhoefer ME, Aigner N, Hofmann S.

Institut fur Radiologie, Waldviertelklinikum Horn/Osterreich, .

Bone marrow edema of the knee joint is a frequent clinical picture in MR diagnostics. It can be accompanied by symptoms and pain in the joint.

Diseases that are associated with bone marrow edema can be classified into different groups.

Group 1 includes vascular ischemic bone marrow edema with osteonecrosis (synonyms: SONK or Ahlback's disease), osteochondrosis dissecans, and bone marrow edema syndrome.

Group 2 comprises traumatic or mechanical bone marrow edema.

Group 3 encompasses reactive bone marrow edemas such as those occurring in gonarthrosis, postoperative bone marrow edemas, and reactive edemas in tumors or tumorlike diseases.Evidence for bone marrow edema is effectively provided by MRI, but purely morphological MR information is often unspecific so that anamnestic and clinical details are necessary in most cases for definitive disease classification. PMID: 16315067

[PubMed - in process]


Effective and rapid treatment of painful localized transient osteoporosis (bone marrow edema) with intravenous ibandronate.

Dec. 16, 2005

Ringe JD, Dorst A, Faber H.

Medizinische Klinik IV, Klinikum Leverkusen, University of Cologne, 51375 , Leverkusen, Germany, ringe@klinikum-lev.de.

Localized transient osteoporosis (LTO; bone marrow edema syndrome) is a rare disorder of generally unknown etiology that is characterized by acute onset of disabling bone pain.

Treatment options are currently limited and largely ineffective. The locally increased bone turnover and low bone mineral density (BMD) typical of LTO indicate a potential role for bisphosphonate therapy.

Ibandronate, a potent nitrogen-containing bisphosphonate, has proven efficacy in the management of postmenopausal osteoporosis and corticosteroid-induced osteoporosis when administered as a convenient intermittent intravenous (IV) injection with a between-dose interval of 2 or 3 months. In a study of 12 patients with LTO, ibandronate was administered as an initial 4-mg IV dose with a second, optional injection of 2 mg at 3 months. Daily calcium and vitamin D supplements were provided. Pain was measured at baseline and at 1, 2, 3, and 6 months using a visual analog scale (VAS) of 1-10, and BMD was measured at baseline and 6 months. IV ibandronate provided rapid and substantial pain relief. The mean (SD) VAS score decreased from 8.4 (1.3) at baseline to 0.5 (0.7) at 6 months, at which time seven patients had achieved complete pain relief. At 6 months, mean lumbar spine BMD had increased by 4.0% (range -0.8 to 7.7%) in the overall population. IV ibandronate injection affords advantages over currently available oral and IV bisphosphonates and thus offers a promising therapeutic advance in the treatment of LTO.PMID: 16228105

[PubMed - in process]


The relationship of bone marrow edema pattern in the mandibular condyle with joint pain in patients with temporomandibular joint disorders: longitudinal study with MR imaging.

Jan 2006

Chiba M, Kumagai M, Fukui N, Echigo S.

Division of Oral Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai #980-8575, Japan.


The purpose of this study was to investigate the course of bone marrow edema pattern (decreased signal intensity on T1- or proton-density-weighted images and increased signal intensity on T2-weighted fat-suppressed images) in the mandibular condyle after improvement in clinical symptoms, and to clarify its relationship with temporomandibular joint (TMJ) pain. This study was based on 14 joints of 11 patients (all female, mean age 37.5 years) with TMJ disorders showing condylar bone marrow edema pattern on initial magnetic resonance (MR) images. All joints were re-evaluated clinically and using MR images after relief of joint pain following arthrocentesis combined with non-surgical treatment. The time interval between the initial and follow-up MR images ranged from 14 to 27 months (mean 17 months). Of the 14 joints, 4 joints (28.6%) showed a normal bone marrow signal, whereas 10 joints (71.4%) showed persistent bone marrow edema pattern on follow-up MR images (P = 0.125). Therefore, the reduction in TMJ pain did not correlate with resolution of bone marrow edema pattern in most joints. The results of this study suggest that the bone marrow edema pattern in the mandibular condyle does not always contribute to the occurrence of joint pain in patients with TMJ disorders.PMID: 15964172

[PubMed - in process]


Transient bone marrow oedema of the knee.

Aug 12, 2005

Arjonilla A, Calvo E, Alvarez L, Fernandez Yruegas D.

Department of Radiology, Madrid, Spain.


OBJECTIVE: To evaluate the role of MRI in the diagnosis of transient bone marrow oedema of the knee.

DESIGN: All cases were analysed with plain film and MR. Bone scan was performed to one of them. Laboratory tests were obtained in all 8 cases and core decompression was performed in two cases.

PATIENTS: The study includes 8 patients, 7 men and 1 woman with ages ranging from 33 to 74 years with severe knee pain, tenderness and slightly limited range of motion.

RESULTS AND CONCLUSIONS: Radiographs were unremarkable in terms of osteopenia because they were obtained early in the course of the disease and proved to be of no value in the diagnosis. MR is the imaging modality of choice showing low signal intensity in T1WI and increased signal intensity in T2WI with no joint destruction, fractures, bone death, periostitis or cortical disruption. Bone scan showed increase uptake of the affected area. Laboratory tests were normal. Spontaneous resolution was the rule. It should not be a diagnosis of exclusion and it should be ruled out every time a patient presents with pain and limited range of motion in the absence of history of trauma.

Publication Types:

Evaluation Studies

PMID: 16026695

[PubMed - indexed for MEDLINE]