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[骨髓水肿:定义、诊断价值及预后价值]

[Bone marrow edema: definition, diagnostic value and prognostic value].

作者信息

Blum A, Roch D, Loeuille D, Louis M, Batch T, Lecocq S, Witte Y

机构信息

Service d'Imagerie Guilloz, Hôpital central, CHU Nancy, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex.

出版信息

J Radiol. 2009 Dec;90(12):1789-811. doi: 10.1016/s0221-0363(09)73586-3.

Abstract

Bone marrow edema is easily identified on MRI. The terminology suggests that the water content of bone marrow is increased when it is T1W hypointense and T2W hyperintense. It is a misnomer since, histologically, the abnormality does not correspond to marrow edema. The histological findings vary based on the underlying etiology and the presence of fibrosis or inflammatory infiltrate is frequent and often predominant. In France, this terminology is used routinely to describe such lesions. The term osteitis is preferred to describe these marrow signal changes in the setting of rheumatic joint diseases. The detection of bone marrow edema is important because of its diagnostic and prognostic value. It occurs in isolation and is reversible in patients with bone contusion and complex regional pain syndrome. It indicates underlying structural damage and may modify management in patients with rheumatoid arthritis or spondylarthropathies. MR scores for disease activity rely mainly on the presence of marrow edema. Finally, diffusion weighted MR allows quantification of marrow edema and could be more sensitive than conventional MRI to detect inflammation. The purpose of this article is to review the imaging features of marrow edema, review the underlying etiologies and its diagnostic and prognostic value.

摘要

骨髓水肿在磁共振成像(MRI)上很容易识别。该术语表明,当骨髓在T1加权像上呈低信号、T2加权像上呈高信号时,其含水量增加。这是一个误称,因为从组织学角度来看,这种异常并不对应于骨髓水肿。组织学表现因潜在病因而异,纤维化或炎性浸润的情况很常见且往往占主导。在法国,这个术语通常用于描述此类病变。在风湿性关节疾病的背景下,用“骨炎”一词来描述这些骨髓信号变化更为合适。骨髓水肿的检测很重要,因为它具有诊断和预后价值。它可单独出现,在骨挫伤和复杂性区域疼痛综合征患者中是可逆的。它表明存在潜在的结构损伤,可能会改变类风湿关节炎或脊柱关节病患者的治疗方案。疾病活动度的磁共振评分主要依赖于骨髓水肿的存在。最后,扩散加权磁共振成像能够对骨髓水肿进行量化,并且在检测炎症方面可能比传统MRI更敏感。本文的目的是回顾骨髓水肿的影像学特征,探讨其潜在病因及其诊断和预后价值。

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