Bone marrow edema-like lesions change in volume in the majority of patients with osteoarthritis; associations with clinical features

Abstract

Bone marrow edema-like lesions change in volume in the majority of patients with osteoarthritis; associations with clinical features Abstract It has been suggested that bone marrow edema-like (BME) lesions in the knee are associated with progression of osteoarthritis (OA). The purpose of our study in patients with OA was to evaluate prospectively changes of BME lesions over 2 years and their relationship with clinical features. Magnetic resonance (MR) images of the knee were obtained from 182 patients (20% male; aged 43-76 years; mean age 59 years) who had been diagnosed with familial symptomatic OA at multiple joint sites. MR images were made at baseline and at 2 years follow-up. BME lesions in 2 years were associated with clinical features assessed by Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores. A total of 327 BME lesions were recorded. Total size of BME lesions changed in 90 patients (66%). Size of individual lesions changed in 147 foci (45%): new lesions appeared in 69 (21%), existing lesions disappeared in 32 (10%), increased in size in 26 (8%) and decreased in size in 20 (6%) lesions. Increase or decrease of BME lesions, over a 2-year time period, was not associated with severity of WOMAC scores. BME lesions fluctuated in the majority of patients with OA over a 2-year time period. These changes were not associated with severity of WOMAC scores at the study end point.

In vivo microfocal computed tomography and micro–magnetic resonance imaging evaluation of antiresorptive and antiinflammatory drugs as preventive treatments of osteoarthritis in the rat

“…One such phenomenon is a bone marrow lesion (historically termed bone marrow edema), which presents as a highintensity, diffuse fluid signal within the epiphyses of the femur and tibia of many patients with knee OA (19,20). A bone marrow lesion is identified by increased signal on fat-suppressed, T2-weighted scans, with lower signal contrast to background in T1-weighted scans of the same subchondral bone marrow region.…”

“…The rat was placed supine in the MRI bed, and the right hind limb was extended and secured as described above. Using a flat surface-acquisition coil, we acquired images with anisotropic voxels with a resolution of 137 ϫ 137 ϫ 500 m. The MRI was operated in a fatsuppressed, spin-echo, T2-weighted scan mode specifically to visualize potential bone marrow lesion-like/edema-like phenomena in the tissue, as previously described (19,20). Each scan was ϳ15 minutes in duration.…”

Osteoarthritis revisited—again!

“…They suggested that BMLs were associated with knee pain [15], could be predictive of progression [16] especially if they enlarged [17] or were associated with varus or valgus angulation [16]. Later reports, however, were less clear-cut even suggesting that BMLs were not only unassociated with Western Ontario and McMaster Universities index of OA scores (WOMAC™) [18,19] and other measures of patient symptoms but also fluctuated over a period of time, resolving and/or worsening with new lesions coming and going elsewhere in the same joint [20,21]. Again, these lesions did not correlate with patient symptoms.…”

“…Two recent clues have emerged-firstly, that such lesions may progress to "cysts" [20,22] and also that at follow up progressive BMLs are associated with damage to overlying hyaline cartilage [23]. To understand these findings, it is timely to go back to some older literature.…”

The impact of MRI on the clinical management of inflammatory arthritides

“…This presumably represents a sclerotic response to more focal stress/hyaline cartilage damage ogy findings in OA suggest that BML seen on MRI reflects metaplastic fibrovascular tissue in the bone marrow together with trabecular remodeling. However, most BML fluctuate in size over time, which may be observed after only a few months suggesting that BML reflect more active histopathological changes than structural remodeling [150][151][152][153][154][155]. In one of these reports, fluctuations in BML scores over 3 months were positively correlated with changes in urinary C-terminal crosslinking telopeptide of type II collagen, a biomarker reflecting cartilage turnover [150].…”