Analysis of bone marrow edema: a scoping review
OA Version
Citation
Abstract
BACKGROUND: Axial Spondyloarthritis (axSpA) is characterized by bone marrow edema (BME) on magnetic resonance imaging (MRI) of the sacroiliac joints. The histopathology of BME in axSpA is not fully understood. This study aims to understand the concept of BME in rheumatic diseases, critically examining its histopathological basis and seeking toclarify the true nature of BME as observed on MRI.
METHODS: A scoping literature review was conducted focusing on the histopathology of BME in musculoskeletal diseases excluding infection, fracture, and cancer. Vosviewer software was used to visualize interrelationships and frequency of keywords in the literature.
RESULTS: The comprehensive literature search yielded 37 studies (28 human and 9 animal studies) meeting the inclusion criteria. Studies of BME in humans included a diverse range of diseases with Osteoarthritis (OA) being the most studied condition, accounting for 8 of the 28 studies, followed by Bone marrow edema syndrome (BMES). A single study analyzed the histopathology of BME in axSpA. Five major histopathological findings were frequently reported across all human and animal studies: edema, necrosis, fibrosis, inflammation, and hypervascularity. Fibrosis was described in most diseases and was present in 82.1% of the studies, often along other pathologies, especially in OA. Edema was reported in only 71.4% of all human studies and was particularly prevalent in cases of BMES and OA. Hypervascularity was a notable feature in BMES and interestingly in Avascular necrosis (AVN).
CONCLUSION: The histopathology of MRI BME is not limited to the accumulation of extracellular fluid in the marrow; it also varies depending on the diagnosis, often involving fibrosis, inflammatory infiltrate, and hypervascularity. Only a single study has investigated the association of histopathological characteristics and MRI BME in patients with AS. The limited literature on the histopathology of BME in axSpA can be attributed to the invasive nature of obtaining bone marrow samples, impeding a thorough understanding of axSpA pathogenesis. This gap emphasizes the importance of increased research on the histopathological changes of BME in axSpA.
Description
2024
License
Attribution 4.0 International