Age / Sex : 40 / F

Transient bone marrow edema syndrome

Discussion

Findings:

Initial radiography shows osteopenia of left proximal femur.

Initial MR images shows patchy bone marrow edema involving left femoral head, neck and intertrochanteric region with joint effusion. Follow-up MR images obtained 1year later show reduction of bone marrow edema and joint effusion in left proximal femur.

Differential Diagnosis:

Osteonecrosis, stress fracture

Diagnosis: 

Transient bone marrow edema syndrome

Discussion:

.Middle-aged men or woman in the 3rd trimester of pregnancy.

.Mainly affects hip, knee and ankle

.Self-limited nature that presents spontaneously with sudden-onset pain in the hip, gradually resolving within 6–8 months.

.No intervention is needed for this condition, and management essentially involves symptomatic relief and avoiding excessive activity to minimize the risk of a pathologic fracture until the osteoporosis resolves.

. Image findings

-plain radiograph

   -early: normal

   -later: regional osseous demineralization

   -preserved joint space

-MRI

   -early diagnosis and monitoring the progression of the disease

   -low SI on T1-WI and high SI on (FS) T2-WI

   -joint effusion

  - bone scintigraphy : markedly increased homogeneous uptake

References:

1. Hayes CW, Conway WF, Daniel WW. MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics. 1993;13:1001-1011.

2. Anastasios V. Korompilias et al. Bone marrow edema syndrome. Skeletal Radiol 2009;38:425–436.