PAINFUL BONE MARROW EDEMA: DIFFERENTIAL DIAGNOSIS AND THERAPEUTICAL CONCEPTS
S. Hofmann 1), M. Urban 2) , H. Plenk 3)
1) Orthopedic Dept. LKH Stolzalpe; 2) Radiology Dept. Danube Hospital; 3) Bone & Biomaterial Lab. Univ. Vienna, AUSTRIA

Introduction: Bone marrow edema (BME) patterns on MR-imaging in the adjacent bones of joints represent several etiologies with different clinical courses. To choose the specific therapy differential diagnosis is essential.

Patients & Methods: 78 patients with painful BME of the hip joint were evaluated clinical and with standard x-rays, MR-imaging and 3-phase bone scintigraphy in exceptional cases. FU was performed for at least 12 months or until disappearance of pathological MRI. Patients were allocated to three different etiological groups with nine pathologies.

Results: Ischemic BME (n=61) including bone marrow edema syndrome, complex regional pain syndrome and concomitant BME in osteonecrosis was the most common finding. Reactive BME (n=11) in combination with tumours, osteomyelitis and osteoarthritis and mechanical BME (n=6) including bone bruise, microfracture or stress BME were seen less common in this study.

Discussion & Conclusions: Painful BME in the joints includes nine different pathologies with specific therapeutical approaches including surgery, drug therapy and conservative treatment. History, clinical symptoms and morphological imaging patterns allow differential diagnosis in almost all cases.