Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
Department of Radiology, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
Int J Mol Sci. 2023 Apr 5;24(7):6761. doi: 10.3390/ijms24076761.
Bone marrow edema (BME), also termed bone marrow lesions, is a syndrome characterized by bone pain and the appearance of high signal intensity on T2 fat-suppressed and short tau inversion recovery (STIR) MRI sequences. BME can be related to trauma or a variety of non-traumatic diseases, and current treatment modalities include non-steroidal anti-inflammatory drugs (NSAIDS), bisphosphonates, denosumab, extracorporeal shockwave therapy (ESWT), the vasoactive prostacyclin analogue iloprost, and surgical decompression. Spontaneous BME is a subset that has been observed with no apparent causative conditions. It is most likely caused by venous outflow obstruction and intraosseous hypertension. These are mechanistically related to impaired perfusion and ischemia in several models of BME and are related to bone remodeling. The association of perfusion abnormalities and bone pain provides the pathophysiological rationale for surgical decompression. We present a case of spontaneous BME and a second case of spontaneous migratory BME treated with surgical decompression and demonstrate resolution of pain and the high signal intensity on MRI. This report provides an integration of the clinical syndrome, MR imaging characteristics, circulatory pathophysiology, and treatment. It draws upon several studies to suggest that both the bone pain and the MRI characteristics are related to venous stasis, and when circulatory pathologies are relieved by decompression or fenestration, both the bone pain and the MRI signal abnormalities resolve.
骨髓水肿（BME），也称为骨髓病变，是一种以骨痛和 T2 脂肪抑制及短回波反转恢复（STIR）MRI 序列上高信号强度为特征的综合征。BME 可与创伤或多种非创伤性疾病有关，目前的治疗方法包括非甾体抗炎药（NSAIDs）、双膦酸盐、地舒单抗、体外冲击波治疗（ESWT）、血管活性前列环素类似物伊洛前列素和手术减压。自发性 BME 是一种没有明显病因的亚组。它很可能是由静脉流出阻塞和骨髓内高压引起的。这些在几种 BME 模型中的灌注和缺血受损机制上是相关的，并与骨重塑有关。灌注异常和骨痛的相关性为手术减压提供了病理生理学依据。我们报告了一例自发性 BME 和第二例自发性游走性 BME 病例，采用手术减压治疗，并证明疼痛和 MRI 上的高信号强度得到缓解。本报告综合了临床综合征、MR 成像特征、循环病理生理学和治疗。它借鉴了几项研究，表明骨痛和 MRI 特征都与静脉淤滞有关，当减压或开窗术缓解循环病理时，骨痛和 MRI 信号异常都会得到缓解。
