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Bone Marrow Edema Pattern in Osteoarthritic Knees: Correlation between MR Imaging and Histologic Findings¹

¹ From the Departments of Radiology (M.Z., J.H.) and Orthopedic Surgery (J.R.), Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland; and the Department of Pathology, University Hospital of Zurich, Switzerland (E.B.). From the 1998 RSNA scientific assembly. Received March 1, 1999; revision requested May 12; final revision received September 14; accepted October 4. Address correspondence to M.Z. (e-mail: mzanetti@balgrist.unizh.ch).

PURPOSE: To correlate magnetic resonance (MR) images of a bone marrow edema pattern with histologic findings in osteoarthritic knees.

MATERIALS AND METHODS: Sixteen consecutive patients (age range, 43–79 years; mean, 67 years) referred for total knee replacement were examined with sagittal short inversion time inversion-recovery (STIR) and T1- and T2-weighted turbo spin-echo MR imaging 1–4 days before surgery. Tibial plateau abnormalities on MR images were compared quantitatively with those on histologic maps.

RESULTS: The bone marrow edema pattern zone (ill-defined and hyperintense on STIR images and hypointense on T1-weighted MR images) mainly consisted of normal tissue (53% of the area was fatty marrow, 16% was intact trabeculae, and 2% was blood vessels) and a smaller proportion of several abnormalities (bone marrow necrosis [11% of area], abnormal [necrotic or remodeled] trabeculae [8%], bone marrow fibrosis [4%], bone marrow edema [4%], and bone marrow bleeding [2%]). The bone marrow edema pattern zone and the zone with a normal MR imaging appearance differed significantly in the presence of bone marrow necrosis (P = .021), bone marrow fibrosis (P = .014), and abnormal trabeculae (P = .011) but not in the prevalence of bone marrow edema (P = .069). Bone marrow edema also was found in zones with an unremarkable MR appearance (perifocal zone, 5% edema; control zone, 2% edema).

CONCLUSION: A bone marrow edema pattern in osteoarthritic knees represents a number of noncharacteristic histologic abnormalities. Edema is not a major constituent of MR imaging signal intensity abnormalities in such knees.

Index terms: Bone marrow, abnormalities, 452.833 • Bone marrow, MR, 452.121411, 452.121413, 452.121415 • Knee, abnormalities, 452.77 • Knee, MR, 452.121411, 452.121413

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