Вone marrow edema in the differential diagnosis of deases of the knee

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Abstract

INTRODUCTION: Bone marrow edema (a radiological term used in MR diagnosis) is characterized by low-intensity infiltration on T1-weighted sequences and high-intensity signal on T2-weighted short-tau inversion recovery (T2w-STIR) images.

CLINICAL CASE DESCRIPTION: The paper presents a case series in patients with knee pain, with subchondral bone lesions on MRI, characterized by bone marrow edema with no previous injury. The following diagnoses were made based on the type of bone edema and medical history: aseptic necrosis of the condyle, subchondral fracture, osteochondritis, secondary osteonecrosis, osteoarthritis, septic arthritis, and others. The paper describes the approach to differential diagnosis based on MRI findings.

CONCLUSION: An assessment of bone marrow edema found on MRI in patients with knee pain allows for timely diagnosis clarification and treatment initiation in some cases.

About the authors

Alexander N. Torgashin

Priorov National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: alexander.torgashin@gmail.com
ORCID iD: 0000-0002-2789-6172
SPIN-code: 8749-3890

MD, Cand. Sci. (Medicine)

Russian Federation, 10 Priorova str., 127229 Moscow

Alexander K. Morozov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: morozovak@cito-priorov.ru
ORCID iD: 0000-0002-9198-7917
SPIN-code: 4447-8306

MD, Dr. Sci. (Medicine);

Russian Federation, 10 Priorova str., 127229 Moscow

Anna V. Torgashina

Nasonova Research Institute of Rheumatology

Email: anna.torgashina@gmail.com
ORCID iD: 0000-0001-8099-2107
SPIN-code: 8777-2790

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Ruslan M. Magomedgadgiev

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: arthro@list.ru
ORCID iD: 0009-0004-6068-3592

MD

Russian Federation, 10 Priorova str., 127229 Moscow

Ivan A. Fedotov

Therapeutic and diagnostic center “Kutuzovsky”

Email: fedotovmed@gmail.com
ORCID iD: 0000-0002-5796-1238
Russian Federation, Moscow

Svetlana S. Rodionova

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: rod06@inbox.ru
ORCID iD: 0000-0002-2726-8758
SPIN-code: 3529-8052

MD, Dr. Sci. (Medicine), professor

Russian Federation, 10 Priorova str., 127229 Moscow

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Supplementary files

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2. Fig. 1. MR images of the knee: а, b — T2-weighted short-tau inversion recovery (T2w-STIR), с — T1-weighted sequences in the coronal projection and a graphic image of an osteonecrosis (d).

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3. Fig. 2. MRI images of the knee. a — coronal view in PD FS mode with signal suppression from adipose tissue, b — sagittal view in S mode with signal suppression from adipose tissue, c — sagittal view in T1-weighted sequences and a graphic image (d) with a subchondral fracture of the medial condyle of the tibia. The arrows mark the fracture line.

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4. Fig. 3. MRI scans of the knee: а, b — coronal and sagittal views in to suppress the signal from adipose tissue, c, d — coronal and sagittal views in T1-weighted sequences with a stress fracture of the medial condyle of the tibia. The arrows mark the fracture line.

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5. Fig. 4. MRI scans of the knee: а, b — coronal and sagittal views in to suppress the signal from adipose tissue with a transient bone marrow edema (TBME) medial condyle of the femur, c, d — coronal and sagittal views in to suppress the signal from adipose tissue after 3 months after start of treatment — bone restoration. Graphic image of a transient bone marrow edema (TBME) (е).

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6. Fig. 5. MRI scans of the knee: a, b — coronal and sagittal views in to suppress the signal from adipose tissue with an osteochondritis dissecans (OCD) medial condyle of the femur. Graphic image (с).

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7. Fig. 6. MRI scans of the knee: a, b — coronal and sagittal views in to suppress the signal from adipose tissue with a secondary osteonecrosis of the knee (SOK), с — coronal views in T1-weighted sequences, d — graphic image.

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8. Fig. 7. MRI scans of the knee: a, b — coronal and sagittal views in to suppress the signal from adipose tissue with an osteoarthritis knee, c — sagittal views in to T1. Graphic image of an osteoarthritis knee (d). Edema-like marrow signal intensity (ELMSI).

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9. Fig. 8. MRI scans of the knee: a, b — coronal and sagittal views in to suppress the signal from adipose tissue with a rheumatoid arthritis.

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10. Fig. 9. MRI scans of the knee: a, b — coronal and sagittal views in to suppress the signal from adipose tissue with a pyrophosphate arthropathy, c — coronal views in to T1 (white arrow — enchondroma of the femur, black arrow — area of osteochondral defect), d, e, f — arthroscopic views (black arrows — areas of deposition of calcium pyrophosphate crystals on the hyaline cartilage of the femoral condyle and on the surface of the meniscus) with pyrophosphate arthropathy of the knee joint.

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11. Fig. 10. MRI scans of the knee: a, b, c — coronal, sagittal and axial views in to suppress the signal from adipose tissue with a septic arthritis right knee. Marks — excessive amount of synovial fluid in the volvulus of the knee joint (synovitis), arrow — edema-like marrow signal intensity (ELMSI) of the internal condyle of the right tibia.

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12. Fig. 11. MRI scans of the knee: a, b — coronal and sagittal views in to suppress the signal from adipose tissue with a septic arthritis of the knee joint after COVID-19.

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13. Fig. 12. MRI scans of the knee: a, b — coronal and sagittal views in to suppress the signal from adipose tissue, c, d — coronal and sagittal views in T1-weighted sequences with chondroblastoma of the distal left femur. The arrow marks the tumor border.

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14. Fig. 13. a, b — MRI scans of the knee (coronal and sagittal views in to suppress the signal from adipose tissue), с — CT examination for osteoid osteoma of the proximal tibia.

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15. Fig. 14. MRI scans of the knee: a, b — coronal and sagittal views in to suppress the signal from adipose tissue, с — coronal views in T1-weighted sequences before arthroscopy, d, е — coronal and sagittal views in to suppress the signal from adipose tissue, f —coronal views in T1-weighted sequences 2 months after knee arthroscopy.

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