Department. of Biomaterials, University of Oslo, Oslo, Norway.
Department. of Orthopedic Surgery, Martina Hansen Hospital, Bærum, Akershus, Norway.
Osteoarthritis Cartilage. 2016 Oct;24(10):1745-1752. doi: 10.1016/j.joca.2016.05.009. Epub 2016 May 24.
Bone marrow lesions (BML), previously denoted bone marrow edema, are detected as water signals by magnetic resonance imaging (MRI). Previous histologic studies were unable to demonstrate any edematous changes at the tissue level. Therefore, our aim was to investigate the underlying biological mechanisms of the water signal in MRI scans of bone affected by BML.
Tetracycline labeling in addition to water sensitive MRI scans of 30 patients planned for total hip replacement surgery was undertaken. Twenty-one femoral heads revealed BML on MRI, while nine were negative and used as controls (CON). Guided by the MRI images cylindrical biopsies were extracted from areas with BML in the femoral heads. Tissue sections from the biopsies were subjected to histomorphometric image analyses of the cancellous bone envelope.
Patients with BML exhibited an average 40- and 18-fold increase of bone formation rate and mineralizing surface, respectively. Additionally, samples with BML demonstrated 2-fold reduction of marrow fat and 28-fold increase of woven bone. Immunohistochemical analysis showed a 4-fold increase of angiogenesis markers CD31 and von Willebrand Factor (vWF) in the BML-group compared to CON.
This study indicates that BML are characterized by increased bone turnover, vascularity and angiogenesis in keeping with it being a reparatory process. Thus, the water signal, which is the hallmark of BML on MRI, is most probably reflecting increased tissue vascularity accompanying increased remodeling activity.
骨髓病变（BML）以前被称为骨髓水肿，在磁共振成像（MRI）中被检测为水样信号。以前的组织学研究未能在组织水平上显示出任何水肿变化。因此，我们的目的是研究受 BML 影响的骨骼 MRI 扫描中水信号的潜在生物学机制。
对 30 名计划接受全髋关节置换手术的患者进行四环素标记和水敏感 MRI 扫描。21 个股骨头在 MRI 上显示出 BML，而 9 个为阴性，用作对照（CON）。根据 MRI 图像，从股骨头的 BML 区域引导提取圆柱形活检。从活检中取出的组织切片进行松质骨包壳的组织形态计量图像分析。
BML 患者的骨形成率和矿化表面分别平均增加了 40 倍和 18 倍。此外，BML 样本的骨髓脂肪减少了 2 倍，编织骨增加了 28 倍。免疫组织化学分析显示，BML 组的血管生成标志物 CD31 和血管性血友病因子（vWF）增加了 4 倍，与 CON 相比。
这项研究表明，BML 的特征是骨转换、血管生成和血管生成增加，这与修复过程一致。因此，MRI 上 BML 的标志性水样信号很可能反映了伴随重塑活动增加的组织血管生成增加。
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