膝关节外伤性骨髓水肿的MR脂肪抑制术成像

目的 分析膝外伤所致周围骨质骨髓水肿的ＭＲＩ表现,探讨其形成的病理学机制。材料与方法 ＭＲＩ检查发现膝关节外伤性骨髓水肿４３例,除常规Ｔ１、Ｔ２加权像检查外,均有矢状面和冠状面脂肪抑制术检查。结果 ４３例患者中共发现膝关节周围水肿６８处,常规Ｔ１、Ｔ２加权像能显示大部分病灶,均呈相对低信号,脂肪抑制术后均可显示,呈明显的高信号。结论 ＭＲＩ脂肪抑制Ｔ２加权像有准确显示膝关节周围骨质的外伤性骨髓水肿     

STIR序列在外伤性骨髓水肿的应用

目的分析STIR序列对骨关节外伤后骨髓水肿的显示。方法外伤后骨髓水肿患者28例,除常规SE序列T1WI、FSE序列T2WI、GE序列T2WI扫描外,均行STIR序列扫描。结果28例共发现骨髓水肿36处,T1WI显示24处(67%),T2WI12处(33%),T2WI29处(80%),STIR36处(100%)。T1WI呈低信号;T2WI低信号8处,稍高信号4处;T2WI低信号14处,高信号15处;STIR脂肪抑制序列呈对比明显的高信号。结论SRIR序列能精确显示骨关节外伤性骨髓水肿。     

32例膝关节应力性骨髓水肿MRI诊断分析

目的分析膝关节应力性骨髓水肿的MRI表现,提高对膝关节应力性骨髓水肿的认识。方法回顾性分析32例训练后X线片阴性而MRI发现膝关节骨髓水肿的病例,分析应力性骨髓水肿的MRI表现。结果 44个膝关节发现应力性骨髓水肿共52处,在MRI上表现为骨髓腔内片状、小斑片状异常信号影;病灶在T1WI为稍低或等信号,在T2WI上为稍高或等信号,在压脂T2WI病灶为明显高信号影,且边界和范围较T1WI、T2WI显示更清楚。9例MRI复查见水肿信号范围明显缩小、部分小的水肿信号消失,未见骨折征象。结论 MRI能够敏感地发现应力性骨髓水肿,是早期诊断应力性骨损伤的重要影像学方法。     

膝关节外伤的低场MRI诊断

目的 分析膝关节外伤后的MRI表现并探讨低场强MRI在膝关节外伤中的诊断价值。方法 对经临床或手术证实的53例膝关节外伤患者行低场MRI检查，分析、总结其MRI表现。采用0．3T低场MR扫描机，常规应用冠状位和矢状位SE序列，GRE序列及脂肪抑制STIR序列T1WI，T2WI成像。结果 半月板损伤37例，韧带损伤43例，骨挫伤7例，骨折11例，合并关节积液25例，多种损伤可同时出现。结论 低场MRI可以很好显示膝关节损伤的各种表现，可作为膝关节外伤后检查的首选或重要手段。     

股骨头缺血坏死骨髓水肿的MRI研究

目的探讨股骨头缺血坏死(ANFH)骨髓水肿的MR I表现,评估骨髓水肿与ANFH分期的关系。方法对73例(99髋)ANFH股骨骨髓水肿的MR I表现进行分析,全部病例均行SE序列冠状位T1W I、T2W I,横轴位T1W I及STIR序列冠状位扫描,将股骨上段骨髓水肿分为0~3级进行统计,并将骨髓水肿分级与ANFH分期相联系。结果股骨骨髓水肿于冠状位T2W I及STIR上显示最清楚,61%的ANFH股骨上段可见1~3级骨髓水肿,股骨骨髓水肿与股骨头缺血坏死的病程进展有关,Ⅰ期ANFH股骨骨髓水肿较少见、范围较局限;Ⅱ、Ⅲ期ANFH股骨骨髓水肿多见,且范围广泛。结论骨髓水肿是ANFH发展过程中的一种伴随征象,骨髓水肿发生的几率和程度与ANFH分期密切相关;MR I是显示股骨骨髓水肿最敏感的无创方法。     

髋部骨髓水肿综合征的临床影像学分析

目的探讨髋部骨髓水肿综合征(bone marrow edema syndrome)的临床和影像学表现及其诊断价值。资料与方法回顾性分析7例经临床和MRI随访诊断的髋部骨髓水肿综合征患者的临床和影像学资料,其中男3例,女4例,包括7例MRI检查和5例X线平片检查,同时随访3~7个月。结果 7例患者因无明显诱因出现单侧髋部症状就诊,MRI上均表现为股骨近段较广泛的骨髓水肿信号,其中3例X线平片表现为相应部位的骨质疏松。所有患者保守对症治疗后3~7个月随访,临床症状消失,MRI上骨髓水肿信号消失,但其中1例对侧髋部又出现新的类似病变。结论掌握此病的临床和影像学表现,有助于正确诊断。     

外伤性椎体压缩骨折骨髓水肿范围与骨折时间的相关性分析

目的:探讨椎体压缩骨折骨髓水肿的范围与骨折时间的相关性。方法:回顾性分析87例外伤性椎体压缩骨折患者的MRI资料,按照外伤时间分为7组,测定骨折后骨髓水肿的范围,分析骨髓水肿的范围与外伤时间的相关性。结果:60d内骨髓水肿范围无明显差别;60d后骨髓水肿范围明显缩小;120d后基本消失。散点图上骨髓水肿范围随骨折时间呈下降趋势,两者呈负相关(r=-0.411,P<0.05)。结论:MRI检查对外伤性椎体骨折的鉴定具有重要价值。     

低场MRI对膝关节外伤的诊断价值

目的 探讨膝关节外伤后X线、CT检查阴性,低场MRI进一步检查的诊断价值.方法 对36例膝关节外伤,X线、CT检查阴性的低场MRI资料进行分析.结果 单纯性滑膜囊或关节囊积液4 例;半月板撕裂伤14例;后交叉韧带撕裂伤3 例;内侧副韧带撕裂伤5 例;外侧副韧带撕裂伤3 例;骨挫伤5例;正常2例.其中膝关节损伤合并关节积液18例,骨挫伤合并韧带损伤2例,合并半月板损伤3例.结论 低场MRI对显示膝关节外伤优于X线平片及CT检查,可为临床治疗方式提供可靠依据.     

膝关节外伤后单纯性骨髓水肿的MRI评价

核磁共振检查(MRI)用于膝关节创伤后检查的价值已得到公认，一般对软骨、半月板、韧带等其他影像学检查较难发现的病变已有较全面的研究，但对外伤导致的骨髓水肿的意义很少关注，本通过对12例膝关节创伤后单纯性骨髓水肿回顾性分析，探讨如下。     

Shifting bone marrow edema of the knee

Objective. The purpose of our study is to describe shifting bone marrow edema in the knee as the MR imaging feature of intra-articular regional migratory osteoporosis of the knee.Patients and methods. Five men, aged 45–73 years, were referred by orthopedic surgeons for MR imaging evaluation of knee pain, which had been present for 2 weeks to 6 months. One patient had a prior history of blunt trauma. None had risk factors for osteonecrosis. Four patients had two MR examinations and the patient with prior blunt trauma had four. Plain radiographs were obtained in all patients.Results. In all cases, a large area of marrow edema initially involved a femoral condyle, with migration of the bone marrow edema to the other femoral condyle, tibia, and/or patella occurring over a 2- to 4-month period. Adjacent soft tissue edema was present in all five patients, while none had a joint effusion. Radiographs of two patients showed generalized osteopenia.Conclusion. In the absence of acute trauma or clinical suspicion of infection, a large area of bone marrow edema without a zone of demarcation may represent intra-articular regional migratory osteoporosis. Demonstration of shifting bone marrow edema on follow-up examinations suggests this diagnosis.     

膝关节骨关节炎软骨下水肿与MRI及临床表现的相关性研究

目的 探讨膝关节骨关节炎(OA)软骨下骨髓水肿与一般临床指标及股四头肌面积、半月板分级的相关性.方法 收集在本院就诊的膝关节OA 患者72例,行膝关节正侧位X线及常规MRI检查,并在12个月后不同时间点复查X线平片和MRI.对各膝关节进行K-L分级、骨髓水肿评分、半月板分级及VAS评分.采用t检验和秩和检验对2组一般资料进行比较,采用Spearman进行双变量相关性分析.结果 初次随访中有骨髓水肿组的年龄及VAS评分明显低于无骨髓水肿组(P<0.05),骨髓水肿的程度与年龄及VAS评分中度相关,与其他指标相关性不大.12个月后随访中,骨髓水肿组的体质量指数(BMI)及股四头肌面积与无骨髓水肿组出现差异(P<0.05).骨髓水肿程度与年龄、股四头肌面积及VAS评分中度相关.结论 关节炎进展中骨髓水肿范围与年龄、股四头肌面积、BMI及VAS评分相关,MRI测量指标较X线更能反映膝关节OA进展,同时也揭示了与膝关节OA进展相关的部分因素.     

MRI findings in the subchondral bone marrow: a discussion of conditions including transient osteoporosis, transient bone marrow edema syndrome, SONK, and shifting bone marrow edema of the knee

Bone marrow edema signal can be seen in many settings ranging from trauma and arthritis to less common conditions including transient osteoporosis, transient bone marrow edema syndrome, true osteonecrosis, spontaneous osteonecrosis, and shifting bone marrow edema. Terms such as spontaneous osteonecrosis of the knee (SONK) appear frequently in the radiology and orthopedics literature but are rarely described on true, histologic basis. This article reviews the less frequently encountered and less well understood entities and explores their potential pathophysiologies and significance.     

Migrating transient bone marrow edema syndrome of the knee: MRI findings in a new case

We report a case of transient bone marrow edema syndrome migrating within two different compartments of the same knee. This unusual pattern of migration of the marrow edema, which has been previously described only in three cases of transient osteoporosis, may raise the suspicion of an aggressive disease. Radiologists should be aware of this phenomenon in order to avoid an aggressive management of this self-limiting disease.     

Migrating transient bone marrow edema syndrome of the knee: MRI findings in a new case

European Radiology - We report a case of transient bone marrow edema syndrome migrating within two different compartments of the same knee. This unusual pattern of migration of the marrow edema,...     

Subchondral bone marrow edema in patients with degeneration of the articular cartilage of the knee joint

PURPOSE: To retrospectively determine at magnetic resonance (MR) imaging the prevalence of subchondral bone marrow edema beneath arthroscopically proved articular cartilage defects. MATERIALS AND METHODS: The study was performed in compliance with HIPAA regulations, and a waiver of informed consent was obtained from the institutional review board before the study was performed. The study consisted of 132 patients (70 men, 62 women; average age, 53 years) with articular cartilage defects of the knee joint who underwent MR imaging of the knee and subsequent arthroscopic knee surgery. At the time of arthroscopy, each articular cartilage lesion was graded by using the Noyes classification system. MR examinations were retrospectively reviewed to determine the size, depth, and location of subchondral bone marrow edema without knowledge of the arthroscopic findings. Pairwise Fisher exact tests and two-sample t tests were used to correlate MR imaging findings of subchondral bone marrow edema with the arthroscopic grade of articular cartilage degeneration. RESULTS: Subchondral bone marrow edema was seen beneath 105 (19%) of 554 articular cartilage defects identified at arthroscopy. It was not observed beneath any of the six grade 1 cartilage defects but was observed beneath eight (4.9%) of 163 grade 2A defects, 40 (14.4%) of 278 grade 2B defects, 54 (55.1%) of 98 grade 3A defects, and three (33.3%) of nine grade 3B defects. Subchondral bone marrow edema was also seen beneath four (1.4%) of 238 articular surfaces that appeared normal at arthroscopy. The mean depth and cross-sectional area of subchondral bone marrow edema increased with increasing grade of the articular cartilage lesion. CONCLUSION: Higher grades of articular cartilage defects are associated with higher prevalence and greater depth and cross-sectional area of subchondral bone marrow edema.     

Subtle bone marrow edema assessed by frequency selective chemical shift MRI.

Subtle edema in yellow bone marrow from tumors (14 subjects) and osteomyelitis (9 subjects) were examined by selective nonexcitation (SENEX) water imaging using a short five pulse frequency selective excitation with lipid suppression greater than 96%. Standard spin-echo (SE) proton density-, T1- and T2-weighted images, and fat suppression methods such as short inversion time inversion recovery and also the chemical shift selective Dixon method are discussed in comparison with SENEX. Application of the SENEX method is described and images from four typical cases are demonstrated. Sensitivity to edema is obviously better using the SENEX chemical shift selective method than using other imaging techniques. Improved delineation of abnormal areas in yellow bone marrow is provided by SENEX water imaging in one slice after multislice standard imaging. After shimming, only one SE scan with frequency selective excitation is necessary to get a pure water image.     

Imatimid-induced bone marrow necrosis detected on MRI examination and mimicking bone metastases

Imatinib has revolutionized the treatment and prognosis of patients with gastrointestinal stromal tumors (GIST). In contrast to liver and/or abdominal involvement, bone metastases are an uncommon event in GIST. We report here two patients with metastatic GIST who developed pelvic bone marrow focal lesions visible on MRI examinations, while Imatinib dramatically improved other tumor sites. A biopsy in one patient diagnosed bone marrow necrosis. The other patient had a favorable follow-up over several years, without bone metastases. Focal bone marrow abnormalities, detected on MRI examinations and mimicking bone metastases in patients who were otherwise responding, should be considered as probable bone marrow necrosis.     

痛风性膝关节炎MRI骨侵蚀、骨髓水肿、滑膜炎与痛风石的相关性研究

目的探讨膝关节痛风性关节炎MRI特征,及骨侵蚀、骨髓水肿、滑膜炎与痛风石之间的相互关系,以研究痛风骨侵蚀和关节损伤的潜在机制。方法回顾性分析31例慢性痛风患者膝关节双能量CT和MRI影像检查,对比分析痛风石、骨髓水肿、骨侵蚀及滑膜炎之间的相关关系。结果4例患者为双侧膝关节检查,共35个膝关节纳入研究,其中34%的存在骨侵蚀,与痛风石有明显相关性,OR值76.4(95%CI 10.0,582.2)(P<0.001)。骨髓水肿不常见,发生率仅为1.2%(3/245),骨侵蚀和骨髓水肿之间没有明显相关性。在有骨侵蚀的膝关节中,75%的膝关节同时伴有滑膜炎,而在没有骨侵蚀的膝关节,43.4%的膝关节具有滑膜炎,骨侵蚀和滑膜炎之间的OR值为5.3(95%CI 1.1,25.5)(P=0.035)。结论痛风性关节炎骨侵蚀,与痛风石沉积明显相关;痛风骨髓水肿不常见,且水肿程度轻微。痛风石是骨侵蚀发生的主要危险因素之一。