Reviewing Bone Marrow Edema in Athletes: A Difficult Diagnostic and Clinical Approach.

Umberto Tarantino,Chiara Greggi,Paolo Ferrante,Guglielmo Manenti,Ida Cariati,Elena Gasbarra,Matteo Primavera,Riccardo Iundusi,Andrea Gatti

doi:10.3390/medicina57111143

Umberto Tarantino, Chiara Greggi + Show 7 more

Open Access

https://doi.org/10.3390/medicina57111143

Copy DOI

Abstract

Bone marrow edema (BME) is defined as an area of low signal intensity on T1-weighted (T1W) MRI images and associated with intermediate or high signal intensity findings on T2-weighted (T2W) MRI images. BME represents a typical imaging finding that characterizes common stress-related bone injuries of professional and amateur athletes. The etiology of stress-related injuries is influenced by numerous factors, including the initiation of a new sports activity or changes in an existing training protocol. The clinical significance of BME remains unclear. However, a correlation between the imaging pattern of BME, the clinical history of the patient and the type of sports activity practiced is essential for correct diagnosis and adequate therapeutic treatment. It is also important to clarify whether there is a specific threshold beyond which exercise can adversely affect the bone remodeling process, as the clinical picture may degenerate into the presence of BME, pain and, in the most severe cases, bone loss. In our review, we summarize the current knowledge on the etiopathogenesis and treatment options for BME and highlight the main aspects that make it difficult to formulate a correct diagnosis and establish an adequate therapeutic treatment.

Highlights

Accepted: 18 October 2021Bone marrow edema (BME) is a nonspecific finding with multiple etiologies, defined as an area of low signal intensity on Tl-weighted (T1W) and high signal intensity findings on T2-weighted (T2W) on magnetic resonance imaging (MRI) [1]
54 patients with bone marrow edema syndrome, who complained of prolonged pain and presented
BME represents an aspecific clinical pattern with an unclear etiology that occurs in BME represents an aspecificand clinical pattern with an unclear etiology occurs in both symptomatic asymptomatic subjects

Summary

Introduction

Bone marrow edema (BME) is a nonspecific finding with multiple etiologies, defined as an area of low signal intensity on Tl-weighted (T1W) and high signal intensity findings on T2-weighted (T2W) on magnetic resonance imaging (MRI) [1]. On MRI what is detected is true local edema, histological evaluations have shown that lymphocyte infiltrates, fibrous tissue, increased vascularization, and decreased bone mineralization are present. For this reason, BME has only recently been placed in the more generic and inclusive context of bone marrow lesions (BML), a heterogeneous clinical picture including lesions of the osteochondral unit [2]. MRI is considered to be the gold standard for detecting bone marrow changes, guiding the decision-making process [6,7]

Results

Discussion

Conclusion