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Arthritis und Rheuma 2021; 41(04): 243-254
DOI: 10.1055/a-1530-7216
Schwerpunkt

Das Knochenmarködemsyndrom

Pathophysiologie und differenzialdiagnostische ÜberlegungenBone marrow edema syndromePathophysiology and potential differential diagnoses
Constantin Schmidt∗
1   Institut für Osteologie und Biomechanik, Universitätsklinikum Hamburg-Eppendorf, Hamburg
1   Fachbereich Orthopädie, Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
,
Maximilian M. Delsmann∗
1   Institut für Osteologie und Biomechanik, Universitätsklinikum Hamburg-Eppendorf, Hamburg
,
Julian Stürznickel∗
1   Institut für Osteologie und Biomechanik, Universitätsklinikum Hamburg-Eppendorf, Hamburg
1   Fachbereich Orthopädie, Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
,
Florian Barvencik∗
1   Institut für Osteologie und Biomechanik, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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ZUSAMMENFASSUNG

Das Knochenmarködemsyndrom (KMÖS) ist eine durch pathologische Flüssigkeitsvermehrung im Knochenmark gekennzeichnete Erkrankung, die sich mittels MRT darstellen lässt. Das Spektrum potenziell verursachender Erkrankungen ist groß, wobei sich ätiologisch mechanische, metabolische, reaktive und ischämische KMÖS-Formen voneinander unterscheiden lassen. Zwar ist die Pathophysiologie des KMÖS noch unzureichend verstanden, doch wird ein lokal erhöhter Knochenumbau im Sinne einer aktivierten Knochenresorption angenommen, die zu einer erhöhten Vaskularisation mit konsekutiv vermehrter Flüssigkeitsansammlung führt. Ziel unserer Arbeit war es anhand der pathophysiologischen Überlegungen die möglichen verursachenden Erkrankungen differenzialdiagnostisch zu beleuchten und anhand derer einen diagnostischen Algorithmus zu präsentieren. Dabei zeigen wir, dass sich die verschiedenen KMÖS-Formen oft mittels typischer MRT-morphologischer sowie klinischer und laborchemischer Charakteristika unterscheiden lassen, sodass anhand der richtigen Diagnose gezielt therapeutische Maßnahmen getroffen werden können.

Summary

Bone marrow edema syndrome (BMES) is a disease characterized by a pathologic increase of fluid in the bone marrow which can be visualized by magnetic resonance imaging (MRI). There is a wide spectrum of potentially causative diseases including mechanical, metabolic, reactive, and ischemic forms of BMES. Although the pathophysiology of BMES is insufficiently understood, locally enhanced bone remodeling in terms of activated bone resorption is thought to lead to increased vascularization with consecutively increased fluid accumulation. The aim of our work was to point out possible differential diagnoses and to present a diagnostic algorithm for routine clinical practice. We show that there are typical MRI morphological as well as clinical and laboratory characteristics that help to differentiate the various forms of BMES, so that on the basis of the correct diagnosis specific therapeutic interventions can be taken.

Schlüsselwörter

Knochenmarködemsyndrom - KMÖS - Differenzialdiagnosen - Pathophysiologie

Keywords

Bone marrow edema syndrome - BMES - differential diagnoses - pathophysiology


Publikationsverlauf

Artikel online veröffentlicht:
19. August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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