Bildgebung des Knochenmarködemsyndroms

Zusammenfassung

Die Bildgebung ist von zentraler Bedeutung bei der Diagnosestellung des Knochenmarködemsyndroms. Die konventionelle Röntgendiagnostik kann eine umschriebene Osteo-penie darstellen, die bei der Erstbeschreibung der Erkrankung als „transiente Osteoporose” namensgebend war. Diese Veränderungen treten jedoch mit einer mehrwöchigen Latenzverzögerung auf. Im Gegensatz dazu kann die Magnetresonanztomografie (MRT) bereits ab Symptombeginn ödemähnliche Veränderungen des Knochenmarks frühzeitig darstellen. Bei Kenntnis des typischen MRT-Befundmusters ist diese primär reversible Erkrankung von anderen mit irreversiblem Verlauf und differentem Therapieregime gut abgrenzbar. Dieser Artikel beschreibt die Befunde des Knochenmarködemsyndroms in den unterschiedlichen Modalitäten der bildgebenden Diagnostik. Den größten Stellenwert in der frühzeitigen Diagnosestellung, der differenzialdiagnostischen Abgrenzung und in der Verlaufskontrolle der Erkrankung hat die Magnetresonanztomografie, deren typische Erscheinungsbilder diskutiert und anhand von Bildbeispielen illustriert werden.

Summary

Imaging is of utmost importance in the diagnosis of bone marrow edema syndrome. Plain radiographs may reveal regional osseous demineralization, which in the first studies were suggestive for the term „transient osteoporosis oft he hip” (TOH). However, these changes can not be detected in the first weeks after the onset of symptoms. Therefore magnetic resonance (MR) imaging is the modality of choice for detecting early changes of bone marrow. MRI gives the possibility to make an on time diagnosis and to monitor the progression of the disease. Furthermore, the knowledge of certain imaging features on MR imaging or other modalities may lead to a correct diagnosis and adequate therapy. Especially early differential diagnosis and surgical treatment in case of osteonecrosis is of crucial importance. This review article describes the imaging appearance of normal bone marrow and the typical imaging features of bone marrow oedema syndrome and its most important differential diagnosis by means of certain imaging examples of different modalities.

Schlüsselwörter

Bildgebung, Knochenmarködemsyndrom - Magnetresonanztomografie

Keywords

Imaging - bone marrow edema syndrome - magnetic resonance tomography

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