Einteilung der Knochenmarködeme

Zusammenfassung

Das Knochenmarködemsyndrom ist eine selbstlimitierende Erkrankung mit einem Verlauf über einen Zeitraum von bis zu 24 Monaten. Die schmerzhafte Erkrankung betrifft überwiegend Hüft-, Knie- und Sprunggelenk und wird mittels MRT nachgewiesen. Abzugrenzen sind Knochenmarködeme aufgrund anderer Ursache, da die korrekte Erfassung der Ätiologie auch für die Therapieentscheidung eine wesentliche Rolle spielt. Die Knochenmarködeme können unterschiedlich eingeteilt werden, wobei eine Einteilung lediglich nach der Lokalisation eine Therapieentscheidung nicht ermöglicht. Daher hat sich mittlerweile die Einteilung in mechanische, ischämische und reaktive/posttraumtische Knochenmarködeme durchgesetzt. In dem vorliegenden Beitrag sollen die verschiedenen Formen der Knochenmarködeme und des Knochenmarködemsyndroms dargestellt und die wesentlichen Kriterien zur Unterscheidung erläutert werden.

Summary

Bone marrow edema syndrome is a self-limiting disease, with a spontaneous resolution in up to 24 months. The bone marrow syndrome mostly affects middle-aged men with an age between 30 and 50 years, or women in the third trimester of pregnancy. The painful disease is often localised hip, knee or ankle joint. Magnetic resonance imaging (MRI) shows large homogenous bone marrow edema involving the femoral head and sometimes the femoral neck. A possible evolution in toward an osteonecrosis is still debated, the differentiation is sometimes challenging. Bone marrow edema is also described with other clinical entities, which are all characterized by the same findings in MRI. But the differentiation in different etiologies is clinical relevant for the decision about the therapy. The classification by different localizations is not useful for the clinical situation and therapy decision. Most authors prefer a diversification in mechanical, ischaemic and reactive or posttraumatic causes. The current article shows different kinds of bone marrow edema and bone marrow edema syndrome and explains the relevant criteria for differentiation.

Schlüsselwörter

Knochenmarködem - Knochenmarködemsyndrom - transitorische Osteoporose - Osteonekrose

Keywords

Bone marrow edema - bone marrow edema syndrome - transitoric osteoporosis - osteonecrosis

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