Skip to main content
Top
Published in: Skeletal Radiology 5/2003

01-05-2003 | Article

Bone marrow edema syndrome of the foot: one year follow-up with MR imaging

Authors: Guillermo Fernandez-Canton, Oscar Casado, Ana Capelastegui, Elena Astigarraga, Jose Alejandro Larena, Amaya Merino

Published in: Skeletal Radiology | Issue 5/2003

Login to get access

Abstract

Objective

To describe the MR findings of bone marrow edema syndrome (BMES) of the foot and its evolution at 1 year follow-up.

Design and patients

Twenty-five of 32 patients with disabling foot and ankle pain unrelated to trauma diagnosed as BMES when MR imaging demonstrated a bone marrow edema pattern in one or more bones without any radiological or underlying clinical cause, were re-evaluated by MR imaging 1 year later.

Results

On the initial MR examinations an average of 4.7 individual bones were involved by bone marrow edema. Soft tissue edema was present in every patient and joint effusion in 10 patients. MR imaging at 1 year showed resolution of bone edema in 18 patients (72%), partial improvement in five (20%) and no improvement in two (8%). Six patients (24%) developed similar symptoms in the other foot during follow-up. Ten of 17 available plain radiographs showed some loss of radiodensity. Further bone marrow edema developed in bones of the same foot that were initially normal, or in uninvolved distant bone marrow areas in the same affected bone, in six of seven patients on follow-up MR imaging.

Conclusions

The evolution of the MR findings of BMES of the foot is to complete resolution or partial improvement at 1 year in the majority of cases. Migration to the other foot occurs in up to a quarter of patients.
Literature
1.
go back to reference Wilson AJ, Murphy WA, Hardy DA. Transient osteoporosis: transient bone marrow edema? Radiology 1988; 167:757–760.PubMed Wilson AJ, Murphy WA, Hardy DA. Transient osteoporosis: transient bone marrow edema? Radiology 1988; 167:757–760.PubMed
2.
go back to reference Galant GG, Fisher RL, Sziklas JJ. Transient regional osteoporosis of the ankle and foot. A report of four cases and review of the literature. Orthop Rev 1994; 23:405–409.PubMed Galant GG, Fisher RL, Sziklas JJ. Transient regional osteoporosis of the ankle and foot. A report of four cases and review of the literature. Orthop Rev 1994; 23:405–409.PubMed
3.
go back to reference Froberg PK, Braunstein EM, Buckwalter KA. Osteonecrosis, transient osteoporosis, and transient bone edema. Current concepts. Radiol Clin North Am 1996; 34:273–291.PubMed Froberg PK, Braunstein EM, Buckwalter KA. Osteonecrosis, transient osteoporosis, and transient bone edema. Current concepts. Radiol Clin North Am 1996; 34:273–291.PubMed
4.
go back to reference Bloem JL. Transient osteoporosis of the hip: MR imaging. Radiology 1988; 167:753–755.PubMed Bloem JL. Transient osteoporosis of the hip: MR imaging. Radiology 1988; 167:753–755.PubMed
5.
go back to reference Vande-Berg BC, Malghem JJ, Lecouvet FE, Jamart J, Maldague BE. Idiopathic bone marrow edema lesions of the femoral head: predictive value of MR imaging findings. Radiology 1999; 212:527–535.PubMed Vande-Berg BC, Malghem JJ, Lecouvet FE, Jamart J, Maldague BE. Idiopathic bone marrow edema lesions of the femoral head: predictive value of MR imaging findings. Radiology 1999; 212:527–535.PubMed
6.
go back to reference Glockner JF, Sundaram M, Pierron RL. Radiologic case study. Transient migratory osteoporosis of the hip and knee. Orthopedics 1998; 21:594–596. Glockner JF, Sundaram M, Pierron RL. Radiologic case study. Transient migratory osteoporosis of the hip and knee. Orthopedics 1998; 21:594–596.
7.
go back to reference Rosenberg ZS, Beltran J, Bencardino JT. MR imaging of the ankle and foot. Radiographics 2000; 20:S153–S179.PubMed Rosenberg ZS, Beltran J, Bencardino JT. MR imaging of the ankle and foot. Radiographics 2000; 20:S153–S179.PubMed
8.
go back to reference Calvo E, Alvarez L, Fernández-Yruegas D, Vallejo C. Transient osteoporosis of the foot. Bone marrow edema in 4 cases studied with MRI. Acta Orthop Scand 1997; 68:577–580.PubMed Calvo E, Alvarez L, Fernández-Yruegas D, Vallejo C. Transient osteoporosis of the foot. Bone marrow edema in 4 cases studied with MRI. Acta Orthop Scand 1997; 68:577–580.PubMed
9.
go back to reference Gigena LM, Chung CB, Lektrakul N, Pfirrmann CWA, Sung MS, Resnick R. Transient bone marrow edema of the talus: MR imaging findings in five patients. Skeletal Radiol 2002; 31:202–207.CrossRefPubMed Gigena LM, Chung CB, Lektrakul N, Pfirrmann CWA, Sung MS, Resnick R. Transient bone marrow edema of the talus: MR imaging findings in five patients. Skeletal Radiol 2002; 31:202–207.CrossRefPubMed
10.
go back to reference Zanetti M, Steiner CL, Seifert B, Hodler J. Clinical outcome of edema-like bone marrow abnormalities of the foot. Radiology 2002; 222:184–188.PubMed Zanetti M, Steiner CL, Seifert B, Hodler J. Clinical outcome of edema-like bone marrow abnormalities of the foot. Radiology 2002; 222:184–188.PubMed
11.
go back to reference Pal CR, Tasker AD, Ostlere SJ, Watson MS. Heterogeneous signal in bone marrow on MRI of children's feet: a normal finding? Skeletal Radiol 1999; 28:274–278.CrossRefPubMed Pal CR, Tasker AD, Ostlere SJ, Watson MS. Heterogeneous signal in bone marrow on MRI of children's feet: a normal finding? Skeletal Radiol 1999; 28:274–278.CrossRefPubMed
12.
go back to reference Deely DM, Schweitzer ME. MR imaging of bone marrow disorders. Radiol Clin North Am 1997; 35:193–212.PubMed Deely DM, Schweitzer ME. MR imaging of bone marrow disorders. Radiol Clin North Am 1997; 35:193–212.PubMed
13.
go back to reference Plenk H Jr, Hofmann S, Eschberger J, et al. Histomorphology and bone morphometry of the bone marrow edema syndrome of the hip. Clin Orthop 1997; 334:73–84.PubMed Plenk H Jr, Hofmann S, Eschberger J, et al. Histomorphology and bone morphometry of the bone marrow edema syndrome of the hip. Clin Orthop 1997; 334:73–84.PubMed
14.
go back to reference Doury P, Hofmann S, Plenk H. Bone marrow oedema, transient osteoporosis, and algodystrophy. J Bone Joint Surg Br 1994; 76:993–994.PubMed Doury P, Hofmann S, Plenk H. Bone marrow oedema, transient osteoporosis, and algodystrophy. J Bone Joint Surg Br 1994; 76:993–994.PubMed
15.
go back to reference Ochoa JL. Truths, errors, and lies around "reflex sympathetic dystrophy" and "complex regional pain syndrome". J Neurol 1999; 246:875–879.CrossRefPubMed Ochoa JL. Truths, errors, and lies around "reflex sympathetic dystrophy" and "complex regional pain syndrome". J Neurol 1999; 246:875–879.CrossRefPubMed
16.
go back to reference Fournier RS, Holder LE. Reflex sympathetic dystrophy: diagnostic controversies. Semin Nucl Med 1998; 28:116–123.PubMed Fournier RS, Holder LE. Reflex sympathetic dystrophy: diagnostic controversies. Semin Nucl Med 1998; 28:116–123.PubMed
17.
go back to reference Veldman PHJM, Reynen HM, Arntz IE, Goris RJA. Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients. Lancet 1993; 342:1012–1016.PubMed Veldman PHJM, Reynen HM, Arntz IE, Goris RJA. Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients. Lancet 1993; 342:1012–1016.PubMed
18.
go back to reference Kurvers HA. Reflex sympathetic dystrophy: facts and hypotheses. Vasc Med 1998; 3:207–214.PubMed Kurvers HA. Reflex sympathetic dystrophy: facts and hypotheses. Vasc Med 1998; 3:207–214.PubMed
19.
go back to reference Baron R, Levine JD, Fields HL. Causalgia and reflex sympathetic dystrophy: does the sympathetic nervous system contribute to the generation of pain? Muscle Nerve 1999; 22:678–695.CrossRefPubMed Baron R, Levine JD, Fields HL. Causalgia and reflex sympathetic dystrophy: does the sympathetic nervous system contribute to the generation of pain? Muscle Nerve 1999; 22:678–695.CrossRefPubMed
20.
go back to reference Holder L, Cole LA, Myerson MS. Reflex sympathetic dystrophy in the foot: clinical and scintigraphic criteria. Radiology 1992; 184:531–535.PubMed Holder L, Cole LA, Myerson MS. Reflex sympathetic dystrophy in the foot: clinical and scintigraphic criteria. Radiology 1992; 184:531–535.PubMed
21.
go back to reference Kim YM, Oh HC, Kim HJ. The pattern of bone marrow oedema on MRI in osteonecrosis of the femoral head. J Bone Joint Surg Br 2000; 82:837–841.PubMed Kim YM, Oh HC, Kim HJ. The pattern of bone marrow oedema on MRI in osteonecrosis of the femoral head. J Bone Joint Surg Br 2000; 82:837–841.PubMed
22.
go back to reference Koo KH, Jeong ST, Jones JP Jr. Borderline necrosis of the femoral head. Clin Orthop 1999; 358:158–165.PubMed Koo KH, Jeong ST, Jones JP Jr. Borderline necrosis of the femoral head. Clin Orthop 1999; 358:158–165.PubMed
23.
go back to reference Hofmann S, Schneider W, Breitensesher M, Urban M, Plenk H. Transient osteoporosis as a special reversible form of femur head necrosis. Orthopade 2000; 29:411–419.CrossRefPubMed Hofmann S, Schneider W, Breitensesher M, Urban M, Plenk H. Transient osteoporosis as a special reversible form of femur head necrosis. Orthopade 2000; 29:411–419.CrossRefPubMed
24.
go back to reference Resnick D, Niwayama G. Osteonecrosis: diagnostic techniques, specific situations, and complications. In: Resnick D, Niwayama G, eds. Diagnosis of bone and joint disorders. Philadelphia: Saunders, 1988:3238–3288. Resnick D, Niwayama G. Osteonecrosis: diagnostic techniques, specific situations, and complications. In: Resnick D, Niwayama G, eds. Diagnosis of bone and joint disorders. Philadelphia: Saunders, 1988:3238–3288.
25.
go back to reference Stafford SA, Rosenthal KI, Gebhardt MC, Brady TJ, Scott JA. MRI in stress fracture. AJR Am J Roentgenol 1989; 147:553–556. Stafford SA, Rosenthal KI, Gebhardt MC, Brady TJ, Scott JA. MRI in stress fracture. AJR Am J Roentgenol 1989; 147:553–556.
26.
go back to reference Seabold JE, Flickinger FW, Kao SC, et al. Indium-111-leukocyte/technetium-99m-MNP bone and magnetic resonance imaging: difficulty of diagnosing osteomyelitis in patients with neuropathic neuroarthropathy. J Nucl Med 1990; 31:549–556.PubMed Seabold JE, Flickinger FW, Kao SC, et al. Indium-111-leukocyte/technetium-99m-MNP bone and magnetic resonance imaging: difficulty of diagnosing osteomyelitis in patients with neuropathic neuroarthropathy. J Nucl Med 1990; 31:549–556.PubMed
27.
go back to reference Schweitzer ME, White LM. Does altered biomechanics cause marrow edema? Radiology 1996; 198:851–853.PubMed Schweitzer ME, White LM. Does altered biomechanics cause marrow edema? Radiology 1996; 198:851–853.PubMed
28.
go back to reference Lazzarini KM, Troiano RN, Smith RC. Can running cause the appearance of marrow edema on MRI images of the foot and ankle? Radiology 1997; 202:540–542.PubMed Lazzarini KM, Troiano RN, Smith RC. Can running cause the appearance of marrow edema on MRI images of the foot and ankle? Radiology 1997; 202:540–542.PubMed
Metadata
Title
Bone marrow edema syndrome of the foot: one year follow-up with MR imaging
Authors
Guillermo Fernandez-Canton
Oscar Casado
Ana Capelastegui
Elena Astigarraga
Jose Alejandro Larena
Amaya Merino
Publication date
01-05-2003
Publisher
Springer-Verlag
Published in
Skeletal Radiology / Issue 5/2003
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-003-0622-4

Other articles of this Issue 5/2003

Skeletal Radiology 5/2003 Go to the issue