Vanhoenacker F M, Snoeckx A
AZ Sint-Maarten Duffel-Mechelen, Department of Radiology, Rooienberg 25, B-2570 Duffel, Belgium.
Eur J Radiol. 2007 Apr;62(1):6-15. doi: 10.1016/j.ejrad.2007.01.013. Epub 2007 Feb 20.
This paper will discuss the value of medical imaging in the detection and follow-up of bone marrow edema (BME), resulting from acute and chronic trauma in sports. MR imaging is the only imaging technique that allows direct evaluation of bone marrow edema in sports medicine. The use of fat suppressed T2-weighted or STIR images is particularly appropriate to detect bone marrow edema. The extent of bone marrow edema reflects the biomechanics of trauma. Compressive forces between two bony structures will result in extensive areas of bone marrow edema, whereas distraction forces provoke more subtle areas of bone marrow edema at the insertion of supporting structures of joints. In most clinical situations, a combination of compression and distraction forces is present, causing a complex pattern of bone marrow edema. A meticulous pattern approach of the distribution of these bone marrow changes around a joint can reveal in most instances the underlying mechanism of trauma. This may be helpful to analyze which joint supporting structures may be at risk. In the acute setting, plain radiography and CT scan may have an additional role in the detection of small avulsion fractures occurring at the site of minor areas of bone marrow edema. The clinical significance and natural history of bone marrow edema is still a matter of debate.
本文将探讨医学成像在检测和随访运动中急慢性创伤所致骨髓水肿（BME）方面的价值。磁共振成像（MR成像）是运动医学中唯一能够直接评估骨髓水肿的成像技术。使用脂肪抑制T2加权像或短反转恢复序列（STIR）像对于检测骨髓水肿尤为合适。骨髓水肿的范围反映了创伤的生物力学情况。两个骨结构之间的压缩力会导致广泛的骨髓水肿区域，而牵张力则会在关节支撑结构的附着处引发更细微的骨髓水肿区域。在大多数临床情况下，压缩力和牵张力同时存在，导致骨髓水肿呈现复杂的模式。对关节周围这些骨髓变化分布进行细致的模式分析，在大多数情况下可以揭示潜在的创伤机制。这可能有助于分析哪些关节支撑结构可能处于危险之中。在急性期，X线平片和CT扫描在检测发生于骨髓水肿小区域部位的小撕脱骨折方面可能具有辅助作用。骨髓水肿的临床意义和自然病程仍是一个有争议的问题。
