Cruz Isabela A N, Guimarães Júlio B, Ratti Marco A S, Link Thomas M, Nico Marcelo A C, Ormond Filho Alípio G
Department of Musculoskeletal Radiology, Fleury Medicina E Saúde Higienópolis, R. Mato Grosso, 306 - Higienópolis, São Paulo, Brazil.
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
Skeletal Radiol. 2025 Jul;54(7):1517-1523. doi: 10.1007/s00256-024-04823-z. Epub 2024 Nov 28.
This report describes bone marrow abnormalities arising as a consequence of therapeutic ultrasound diathermy, which are an uncommon diagnostic entity. Over the period from 2018 to 2023, 11 patients were identified that showed abnormalities of the bone marrow on MRI, as a direct result of ultrasound diathermy treatment. These abnormalities displayed consistent imaging features, characterized by areas of low T1W and high T2W signal intensity with well-demarcated geographic margins and central fatty areas, as can be seen in bone infarction. The imaging findings were localized in the superficial aspect of the bone, near the skin surface, corresponding to the site of ultrasound insonation. The clinical relevance of this report stems from the scarcity of documented cases and the unfamiliarity of this diagnostic entity among radiologists and orthopedic surgeons. The specificity of the imaging findings, their typical location, and the potential for resolution with cessation of the diathermy therapy reinforces the importance of this report. Recognition of this condition enables understanding potential adverse effects of ultrasound diathermy, increasing awareness regarding the importance of adhering to safe techniques and the use of this physical treatment modality in clinical practice. This information is also useful to athletic trainers, physical therapists, physical medicine and rehabilitation clinicians, and anyone who might perform ultrasound diathermy.
本报告描述了因治疗性超声透热疗法导致的骨髓异常，这是一种罕见的诊断实体。在2018年至2023年期间，共识别出11例患者，其骨髓在MRI上显示异常，这是超声透热疗法治疗的直接结果。这些异常表现出一致的影像学特征，其特点是T1加权像低信号和T2加权像高信号区域，边界清晰呈地图样，并有中央脂肪区，类似于骨梗死所见。影像学表现位于骨的浅表部位，靠近皮肤表面，对应于超声照射部位。本报告的临床意义源于记录在案的病例稀缺，以及放射科医生和骨科医生对这种诊断实体不熟悉。影像学表现的特异性、其典型位置以及停止透热疗法后可能消退，强化了本报告的重要性。认识到这种情况有助于了解超声透热疗法的潜在不良反应，提高对在临床实践中坚持安全技术和使用这种物理治疗方式重要性的认识。这些信息对运动训练师﹑物理治疗师﹑物理医学与康复临床医生以及任何可能进行超声透热疗法的人员也很有用。
