Das Knochenmarködem-Syndrom: interdisziplinäre Diagnosestrategie und Therapieoptionen

Zusammenfassung

Das Knochenmarködem (KMÖ) ist ein häufiger, rein deskriptiver Befund in der Magnetresonanztomographie (MRT). Schmerz ist das klinische Hauptsymptom. Knochenmarködeme unterscheiden sich wesentlich in Ursache, zugrundeliegender Erkrankung sowie in Therapie, Verlauf und Prognose. Diese Komplexität macht, zusammen mit dem Fehlen evidenzbasierter Leitlinien, die Identifizierung der Ursachen und deren Therapie zu einer großen Herausforderung. Ein interdisziplinärer Arbeitskreis des osteologischen Schwerpunktzentrums des LMU Klinikums hat ein KMÖ-Konsensuspapier erbarbeitet und publiziert [4]. Hier sollen die Ergebnisse mit einem Schwerpunkt auf das schmerzhafte KMÖ-Syndrom (KMÖS) präsentiert werden. In unserer klinischen Erfahrung kommt es zu deutlichen Verzögerungen bei Diagnose sowie Therapie, deshalb besteht nach wie vor die Notwendigkeit von interdisziplinären klinischen Empfehlungen. In der hier vorliegenden Arbeit ist nun eine Überarbeitung des Konsensuspapiers [4] mit Fokus auf dem Aspekt des schmerzhaften Knochenmarködem-Syndroms erfolgt. Aus erneuter Literaturrecherche, Überprüfung klinischer Erfahrungen (Expertenmeinung) und der ergebnisorientierten Überarbeitung des LMU-Konsenuspapiers wurde eine Zusammenfassung mit diagnostischen Maßnahmen, Differenzialdiagnosen und Therapieoptionen beim KMÖS erstellt. Ziel ist eine stratifizierte, klinische Herangehensweise hinsichtlich weiterführender Diagnostik und auch Therapie bei Vorliegen eines schmerzhaften KMÖS.

Abstract

Bone marrow edema (BME) is a common, purely descriptive finding in magnetic resonance imaging (MRI). Pain is the main clinical symptom. BME differs significantly in terms of cause, underlying disease, as well as therapy, course and prognosis. This complexity, together with the lack of evidence-based guidelines, makes identifying the causes and treating them a major challenge. The interdisciplinary working group of our Comprehensive Osteological Center DVO of the LMU has already developed a consensus paper on the BME and published it in English in detail [4]. If no underlying disease of the BME can be identified the term painful BME syndrome (BMES) should be used. In our clinical experience there are significant delays in diagnosis and therapy, which is why there is still a need for interdisciplinary clinical recommendations. In the present work, the consensus paper [4] has been revised with a focus on the painful bone marrow edema syndrome (BMES). A summary with diagnostic measures, differential diagnoses and therapy options in BMES was created from a renewed literature research, review of clinical experience (expert opinion) and the results-oriented revision of the LMU consensus paper. The aim is a stratified, clinical approach with regard to further diagnostics and also therapy in the presence of painful BMES. We expressly point out that this is a revised part of a work that has already been published in English.

Schlüsselwörter

interdisziplinärer Konsens - Algorithmus - Diagnose - Therapie - Knochenmarködem-Syndrom - Knochenmarködem

Key words

interdisciplinary consensus - algorithm - diagnosis - therapy - bone marrow edema - bone marrow edema syndrome

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