Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, Sao Paulo, Brazil.
Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
Skeletal Radiol. 2023 Sep;52(9):1721-1728. doi: 10.1007/s00256-023-04337-0. Epub 2023 Apr 11.
The purpose of this study is to establish the prevalence bone marrow edema of the phalanges of the feet and hands before and during the COVID-19 pandemic on MRI studies and correlate with clinically chilblain skin lesions and epidemiological data.
This observational retrospective study. In patients with confirmed bone marrow edema of the phalanges, epidemiological data and clinical findings were collected, including the history of current or remote COVID-19 infection and vaccination status. The two-proportion test was used to compare the frequency of bone marrow edema in the phalanges before and during the pandemic, and the comparison between the categories variables was performed using the one-proportion test.
Of the total of 7215 patients, only 20 presented isolated bone marrow edema of the digits in MRI studies; 2 (0.05%) were found two years before the pandemic's beginning, and 18 (0.64%) after the pandemic's onset, demonstrating an increase of 13-fold in this period. 16 were women with a mean age of 40.3 years and 4 were men with a mean age of 53.5 years. The most frequently reported clinical symptoms by the patients were pain (85.0%), and erythema of the skin (45.0%). Of the 18 patients found after the pandemic's onset, only 27.8% had COVID-19 infections confirmed by RT-PCR before the imaging study, and all cases were mild.
This study demonstrated a significant increase in the prevalence of bone marrow edema of the phalanges after the onset of the COVID-19 pandemic, particularly in middle-aged and younger women.
本研究旨在通过 MRI 研究确定 COVID-19 大流行前后手部和足部趾骨骨髓水肿的患病率，并将其与冻疮样皮损的临床特征和流行病学数据相关联。
这是一项观察性回顾性研究。在确诊有趾骨骨髓水肿的患者中，收集了流行病学数据和临床发现，包括当前或远程 COVID-19 感染和疫苗接种状况的病史。采用两样本比例检验比较大流行前后趾骨骨髓水肿的频率，采用单样本比例检验比较类别变量之间的差异。
在总共 7215 例患者中，仅 20 例患者在 MRI 研究中显示孤立性趾骨骨髓水肿；2 例（0.05%）在大流行开始前两年发现，18 例（0.64%）在大流行开始后发现，在此期间增加了 13 倍。16 例为女性，平均年龄为 40.3 岁，4 例为男性，平均年龄为 53.5 岁。患者最常报告的临床症状是疼痛（85.0%）和皮肤红斑（45.0%）。在大流行开始后发现的 18 例患者中，仅 27.8%在影像学研究前通过 RT-PCR 证实 COVID-19 感染，且所有病例均为轻症。
本研究表明，COVID-19 大流行后，趾骨骨髓水肿的患病率显著增加，尤其是在中年和年轻女性中。
