Bone marrow edema syndromes of the hip: MRI features in different hip disorders

Abstract

The objectives of this study were to describe the essential magnetic resonance imaging (MRI) features of bone marrow edema syndromes affecting the hip joint. In addition, to evaluate the role of MRI in the assessment of hip joint involvement in different clinical settings that may share similar clinical findings. Thirty-four patients who complained of hip pain were studied consecutively. Of these, 21 were men (61.8%) and 13 were women (38.2%). After clinical assessment of possible hip disease, plain radiograph and MRI study of both hips were performed. The literature was searched using keywords: bone marrow edema, hip, and MRI. All patients had antalgic gait and limping. Initial clinical examination revealed painful limited internal and external rotation of the affected hip/hips suspect for hip disease. Unilateral hip involvement was identified in 31 patients (91.2%), and bilateral hip involvement was found in three patients (8.8%), with a total of 37 hips evaluated by MRI. The final diagnoses in our patients were: reactive arthritis (1), transient osteoporosis (7), avascular necrosis (10), osteoarthritis (2), tuberculous arthritis (4), septic arthritis (2), osteomyelitis (2), sickle cell anemia (2), lymphocytic leukemia (1), and femoral stress fracture (3). Bone marrow edema affecting the hip is neither a specific MR imaging finding nor a specific diagnosis and may be encountered in a variety of hip disorders due to different etiologies. MR imaging is the modality of choice when clinical examination is suspect for hip disease and plain radiographs are normal or equivocal. Early diagnosis and treatment is important in many of the disorders. The literature is reviewed regarding bone marrow edema of the hip.

Early Diagnosis of Hip Joint Involvement of Ankylosing Spondylitis Using Magnetic Resonance Imaging in the Absence of Clinical and X-Ray Findings

“…A number of studies have shown that subchondral bone marrow edema developes as a result of inflammation in various sites such as the sacroiliac joints, femoral heads, and the shoulders. [14][15][16] The sign of early involvement in AS is subcortical edema. Subcortical edema may be seen at the femoral head, symphisis pubis, and other sites of enthesis (Figure 1, 2).…”

Role of calcitonin in management of musculoskeletal pain

“…As bone and cartilage are closely interrelated, interventions affecting pain related to bone turnover may influence OA-relevant pain as well. Pain is a central part of the clinical presentation of OA, 6 and may drive patients to seek consultation for the later diagnosis of OA. Many and diverse structural features of the joint have been implicated in the pain associated with OA, including but not limited to the presence of osteophytes in the patellofemoral compartment, focal or diffuse cartilaginous abnormalities, subchondral cysts, bone marrow edema, subluxation of the meniscus, meniscal tears, and Baker cysts.…”

“…Many and diverse structural features of the joint have been implicated in the pain associated with OA, including but not limited to the presence of osteophytes in the patellofemoral compartment, focal or diffuse cartilaginous abnormalities, subchondral cysts, bone marrow edema, subluxation of the meniscus, meniscal tears, and Baker cysts. 6 However, pain perception is highly individual and very few features correlate to pain robustly. 6 Normal adult articular cartilage is thought to be avascular and aneural.…”

“…6 However, pain perception is highly individual and very few features correlate to pain robustly. 6 Normal adult articular cartilage is thought to be avascular and aneural. However, very recently sympathetic and sensory nerves were identified within vascular channels in the articular cartilage in both mild and severe OA.…”

Magnetic resonance imaging features of hip disorders in an Egyptian pediatric population

“…Coronal or sagittal images were obtained as necessary, depending on the topography of the marrow changes on the T1-WI. T1-w images were re-obtained after a 0.1 mmol/kg dose of gadolinium was administered (8).…”