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Transient Bone Marrow Edema and Regional Migratory Osteoporosis
Brady K. Huang, MD; Cheryl A. Petersilge, MD, MBA
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Transient bone marrow edema syndrome: painful bone marrow edema centered around joints; of uncertain etiology and self-limited
                • Transient regional osteoporosis (TRO): likely subset of transient bone marrow edema syndrome that shows bone marrow edema and radiographic osteoporosis
                  • Regional migratory osteoporosis: TRO that shows migratory pattern
                  • Transient osteoporosis of hip (TOH): TRO, specifically of hip (most common location)

            IMAGING

            • General Features

              • Imaging Recommendations

                • Radiographic Findings

                  • MR Findings

                    • Bone Scan Findings

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      Selected References

                                      1. Tarantino U et al: Bone marrow edema: overview of etiology and treatment strategies. J Bone Joint Surg Am. ePub, 2021
                                      2. Balfousias T et al: Lower limb pain attributed to bone marrow edema syndrome: a commonly ignored pathology. Cureus. 12(4):e7679, 2020
                                      3. Geith T et al: Is bone marrow edema syndrome a precursor of hip or knee osteonecrosis? Results of 49 patients and review of the literature. Diagn Interv Radiol. 26(4):355-62, 2020
                                      4. Ghasemi RA et al: Technologies in the treatment of bone marrow edema syndrome. Orthop Clin North Am. 50(1):131-8, 2019
                                      5. Geith T et al: Transient bone marrow edema syndrome versus osteonecrosis: perfusion patterns at dynamic contrast-enhanced MR Imaging with high temporal resolution can allow differentiation. Radiology. 283(2):478-85, 2017
                                      6. Klontzas ME et al: MR imaging of transient osteoporosis of the hip: an update on 155 hip joints. Eur J Radiol. 84(3):431-6, 2015
                                      7. Joshi V et al: Painless transient bone marrow edema syndrome in a pediatric patient. Skeletal Radiol. 43(11):1615-9, 2014
                                      8. Korompilias AV et al: Bone marrow edema syndrome. Skeletal Radiol. 38(5):425-36, 2009
                                      9. Roemer FW et al: MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance and radiological differential diagnosis. Osteoarthritis Cartilage. 17(9):1115-31, 2009
                                      10. Shabshin N et al: High-signal T2 changes of the bone marrow of the foot and ankle in children: red marrow or traumatic changes? Pediatr Radiol. 36(7):670-6, 2006
                                      11. Hofmann S: The painful bone marrow edema syndrome of the hip joint. Wien Klin Wochenschr. 117(4):111-20, 2005
                                      12. Gigena LM et al: Transient bone marrow edema of the talus: MR imaging findings in five patients. Skeletal Radiol. 31(4):202-7, 2002
                                      13. Vande Berg BC et al: Idiopathic bone marrow edema lesions of the femoral head: predictive value of MR imaging findings. Radiology. 212(2):527-35, 1999
                                      14. McCarthy EF: The pathology of transient regional osteoporosis. Iowa Orthop J. 18:35-42, 1998
                                      15. Hayes CW et al: MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics. 13(5):1001-11; discussion 1012, 1993
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Pathology

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Definitions

                                                  • Transient bone marrow edema syndrome: painful bone marrow edema centered around joints; of uncertain etiology and self-limited
                                                    • Transient regional osteoporosis (TRO): likely subset of transient bone marrow edema syndrome that shows bone marrow edema and radiographic osteoporosis
                                                      • Regional migratory osteoporosis: TRO that shows migratory pattern
                                                      • Transient osteoporosis of hip (TOH): TRO, specifically of hip (most common location)

                                                IMAGING

                                                • General Features

                                                  • Imaging Recommendations

                                                    • Radiographic Findings

                                                      • MR Findings

                                                        • Bone Scan Findings

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Gross Pathologic & Surgical Features

                                                                • Microscopic Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          Selected References

                                                                          1. Tarantino U et al: Bone marrow edema: overview of etiology and treatment strategies. J Bone Joint Surg Am. ePub, 2021
                                                                          2. Balfousias T et al: Lower limb pain attributed to bone marrow edema syndrome: a commonly ignored pathology. Cureus. 12(4):e7679, 2020
                                                                          3. Geith T et al: Is bone marrow edema syndrome a precursor of hip or knee osteonecrosis? Results of 49 patients and review of the literature. Diagn Interv Radiol. 26(4):355-62, 2020
                                                                          4. Ghasemi RA et al: Technologies in the treatment of bone marrow edema syndrome. Orthop Clin North Am. 50(1):131-8, 2019
                                                                          5. Geith T et al: Transient bone marrow edema syndrome versus osteonecrosis: perfusion patterns at dynamic contrast-enhanced MR Imaging with high temporal resolution can allow differentiation. Radiology. 283(2):478-85, 2017
                                                                          6. Klontzas ME et al: MR imaging of transient osteoporosis of the hip: an update on 155 hip joints. Eur J Radiol. 84(3):431-6, 2015
                                                                          7. Joshi V et al: Painless transient bone marrow edema syndrome in a pediatric patient. Skeletal Radiol. 43(11):1615-9, 2014
                                                                          8. Korompilias AV et al: Bone marrow edema syndrome. Skeletal Radiol. 38(5):425-36, 2009
                                                                          9. Roemer FW et al: MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance and radiological differential diagnosis. Osteoarthritis Cartilage. 17(9):1115-31, 2009
                                                                          10. Shabshin N et al: High-signal T2 changes of the bone marrow of the foot and ankle in children: red marrow or traumatic changes? Pediatr Radiol. 36(7):670-6, 2006
                                                                          11. Hofmann S: The painful bone marrow edema syndrome of the hip joint. Wien Klin Wochenschr. 117(4):111-20, 2005
                                                                          12. Gigena LM et al: Transient bone marrow edema of the talus: MR imaging findings in five patients. Skeletal Radiol. 31(4):202-7, 2002
                                                                          13. Vande Berg BC et al: Idiopathic bone marrow edema lesions of the femoral head: predictive value of MR imaging findings. Radiology. 212(2):527-35, 1999
                                                                          14. McCarthy EF: The pathology of transient regional osteoporosis. Iowa Orthop J. 18:35-42, 1998
                                                                          15. Hayes CW et al: MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics. 13(5):1001-11; discussion 1012, 1993