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Osteologie 2016; 25(03): 167-175
DOI: 10.1055/s-0037-1619019
Muskuloskelettale Radiologie
Schattauer GmbH

Knochenmarködem

Pathophysiologie, Bildgebung und DifferenzialdiagnoseBone marrow oedemaPathophysiology, imaging, and differential diagnosis
C. Schäffeler
1   Muskuloskelettale Bildgebung, Zentrales Röntgeninstitut, Kantonspital Graubünden, Chur, Schweiz
,
K. Wörtler
2   Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
› Author Affiliations
Further Information

Publication History

eingereicht: 31 March 2016

angenommen: 10 April 2016

Publication Date:
21 December 2017 (online)

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Zusammenfassung

Der Begriff “Knochenmarködem” wird in der Diagnostik des Bewegungsapparates häufig verwendet. Er beschreibt typische, ätiologisch aber relativ unspezifische Signalveränderungen des Knochenmarks in der Magnetresonanztomografie (MRT), welche häufig mit Schmerzen und Krankheitsaktivität assoziiert sind. Es wird empfohlen, diesen MRTBefund als ödemähnliche Signalveränderungen zu beschreiben, da er zwar wie eine Wassereinlagerung imponiert, in histologischen Untersuchungen aber nicht mit einer reinen vermehrten Ansammlung extrazellulärer Flüssigkeit erklärbar ist. Vielmehr sind die zugrundeliegenden Pathologien vielgestaltig, und es bedarf neben der Anamnese und Klinik auch der Kenntnis spezifischer bildgebender Begleitbefunde, um die Ursache dieses pathologischen Bildes einzugrenzen. Dieser Artikel beschreibt die Darstellung des normalen Knochenmarks in der MRT, das typische Erscheinungsbild ödemähnlicher Veränderungen des Knochenmarks und seine Abgrenzung gegenüber zellulären Infiltraten. Verschiedene Konzepte der Entstehung ödemähnlicher Signalveränderungen des Knochenmarks werden diskutiert und anhand von Bildbeispielen illustriert.

Summary

Bone marrow oedema is a specific imaging finding on magnetic resonance (MR) imaging of the skeleton. Despite of its specific imaging features bone marrow oedema is unspecific regarding the underlying pathology. It has been described in many conditions including trauma, overuse syndromes, degenerative joint disease, osteomyelitis, inflammatory arthritides, tumours, and metabolic diseases. Hence histologic examinations of areas with bone marrow oedema on MR imaging shows only little real interstitial fluid this imaging feature is often referred to as “bone marrow lesion”. However, the clinical history and specific results of the physical examination together with certain imaging features on MR imaging or other modalities may lead to a correct diagnosis and adequate therapy. This review article describes the MR imaging appearance of normal bone marrow and the typical imaging features of bone marrow oedema. Different theories regarding the pathophysiology of bone marrow oedema will be discussed by means of certain imaging examples.

Schlüsselwörter

Knochenmarködem - Magnetresonanztomografie - Bildgebung

Keywords

Bone marrow oedema - bone marrow lesion - magnetic resonance imaging
 

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