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MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance and radiological differential diagnosis

Roemer, F. W.; Frobell, Richard LU ; Hunter, D. J.; Crema, M. D.; Fischer, W.; Bohndorf, K. and Guermazi, A. (2009) In Osteoarthritis and Cartilage 17(9). p.1115-1131
Abstract
Objective: To discuss terminology, radiological differential diagnoses and significance of magnetic resonance imaging (MRI)-detected subchondral bone marrow lesions (BMLs) of the knee joint. Methods: An overview of the published literature is presented. In addition, the radiological appearance and differential diagnosis of subchondral signal alterations of the knee joint are discussed based on expert consensus. A recommendation for terminology is provided and the relevance of these imaging findings for osteoarthritis (OA) research is emphasized. Results: A multitude of differential diagnoses of subchondral BMLs may present with a similar aspect and signal characteristics. For this reason it is crucial to clearly and specifically define the... (More)
Objective: To discuss terminology, radiological differential diagnoses and significance of magnetic resonance imaging (MRI)-detected subchondral bone marrow lesions (BMLs) of the knee joint. Methods: An overview of the published literature is presented. In addition, the radiological appearance and differential diagnosis of subchondral signal alterations of the knee joint are discussed based on expert consensus. A recommendation for terminology is provided and the relevance of these imaging findings for osteoarthritis (OA) research is emphasized. Results: A multitude of differential diagnoses of subchondral BMLs may present with a similar aspect and signal characteristics. For this reason it is crucial to clearly and specifically define the type of BML that is being assessed and to use terminology that is appropriate to the condition and the pathology. In light of the currently used terminology, supported by histology, it seems appropriate to apply the widely used term "bone marrow lesion" to the different entities of subchondral signal alterations and in addition to specifically and precisely define the analyzed type of BML. Water sensitive sequences such as fat suppressed T2-weighted, proton density-weighted, intermediate-weighted fast spin echo or short tau inversion recovery (STIR) sequences should be applied to assess non-cystic BMLs as only these sequences depict the lesions to their maximum extent. Assessment of subchondral non-cystic ill-defined BMLs on gradient echo-type sequences should be avoided as they will underestimate the size of the lesion. Differential diagnoses of CA related BMLs include traumatic bone contusions and fractures with or without disruption of the articular surface. Osteonecrosis and bone infarcts, inflammation, tumor, transient idiopathic bone marrow edema, red marrow and post-surgical alterations should also be considered. Conclusion: Different entities of subchondral BMLs that are of relevance in the context of OA research may be distinguished by specific imaging findings, patient characteristics, symptoms, and history and are discussed in this review. (C) 2009 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Osteoarthritis, Knee, Magnetic resonance imaging, Bone marrow lesion, Bone marrow edema, Cartilage, Trauma
in
Osteoarthritis and Cartilage
volume
17
issue
9
pages
1115 - 1131
publisher
Elsevier
external identifiers
  • wos:000270118500001
  • scopus:67650657478
ISSN
1063-4584
DOI
10.1016/j.joca.2009.03.012
language
English
LU publication?
yes
id
758a50e9-9c82-4c95-9cff-accfd994939d (old id 1489954)
date added to LUP
2009-10-21 10:58:24
date last changed
2017-11-19 03:36:09
@article{758a50e9-9c82-4c95-9cff-accfd994939d,
  abstract     = {Objective: To discuss terminology, radiological differential diagnoses and significance of magnetic resonance imaging (MRI)-detected subchondral bone marrow lesions (BMLs) of the knee joint. Methods: An overview of the published literature is presented. In addition, the radiological appearance and differential diagnosis of subchondral signal alterations of the knee joint are discussed based on expert consensus. A recommendation for terminology is provided and the relevance of these imaging findings for osteoarthritis (OA) research is emphasized. Results: A multitude of differential diagnoses of subchondral BMLs may present with a similar aspect and signal characteristics. For this reason it is crucial to clearly and specifically define the type of BML that is being assessed and to use terminology that is appropriate to the condition and the pathology. In light of the currently used terminology, supported by histology, it seems appropriate to apply the widely used term "bone marrow lesion" to the different entities of subchondral signal alterations and in addition to specifically and precisely define the analyzed type of BML. Water sensitive sequences such as fat suppressed T2-weighted, proton density-weighted, intermediate-weighted fast spin echo or short tau inversion recovery (STIR) sequences should be applied to assess non-cystic BMLs as only these sequences depict the lesions to their maximum extent. Assessment of subchondral non-cystic ill-defined BMLs on gradient echo-type sequences should be avoided as they will underestimate the size of the lesion. Differential diagnoses of CA related BMLs include traumatic bone contusions and fractures with or without disruption of the articular surface. Osteonecrosis and bone infarcts, inflammation, tumor, transient idiopathic bone marrow edema, red marrow and post-surgical alterations should also be considered. Conclusion: Different entities of subchondral BMLs that are of relevance in the context of OA research may be distinguished by specific imaging findings, patient characteristics, symptoms, and history and are discussed in this review. (C) 2009 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.},
  author       = {Roemer, F. W. and Frobell, Richard and Hunter, D. J. and Crema, M. D. and Fischer, W. and Bohndorf, K. and Guermazi, A.},
  issn         = {1063-4584},
  keyword      = {Osteoarthritis,Knee,Magnetic resonance imaging,Bone marrow lesion,Bone marrow edema,Cartilage,Trauma},
  language     = {eng},
  number       = {9},
  pages        = {1115--1131},
  publisher    = {Elsevier},
  series       = {Osteoarthritis and Cartilage},
  title        = {MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance and radiological differential diagnosis},
  url          = {http://dx.doi.org/10.1016/j.joca.2009.03.012},
  volume       = {17},
  year         = {2009},
}