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Follow-up of Occult Bone Lesions Detected at MR Imaging: Systematic Review¹

¹ From the Department of Radiology, Rijnmond-Zuid Medical Center, Rotterdam, the Netherlands (S.S.B., D.V.); and Departments of General Practice (S.S.B., B.W.K., S.M.A.B.), Radiology (M.G.M.H.), and Epidemiology and Biostatistics (M.G.M.H.), Erasmus Medical Center, Rotterdam, the Netherlands. Received January 14, 2005; revision requested March 16; revision received April 17; accepted June 1; final version accepted June 1. Address correspondence to S.S.B., Duistere Steeg 4, 8051 ZR Hattem, the Netherlands (e-mail: s.boks{at}erasmusmc.nl).

Purpose: To perform a systematic review of the literature regarding the natural course of posttraumatic occult bone lesions (often referred to as bone bruises) detected at magnetic resonance (MR) imaging.

Materials and Methods: A systematic review of the literature was performed by searching the MEDLINE database (from January 1966 to February 2003) with the keywords bone bruise, trauma, follow-up, and MRI. Keywords were linked by using the Boolean operator AND. Studies were included if all of the following criteria were fulfilled: patients sustained trauma, MR imaging was used as a diagnostic method, results of clinical or MR imaging follow-up were available, and study was written in English, Dutch, German, French, Spanish, Italian, Swedish, Danish, or Norwegian. The quality of each study was assessed by using a standardized criteria set, and statistics were estimated to rate the level of agreement between the two reviewers. Results were compared with regard to study design and quality scores.

Results: The MEDLINE search identified 266 articles, 13 of which met the inclusion criteria. The quality of the included studies was moderate. The two reviewers initially agreed on 179 quality items ( = 0.84). The study population was generally small, and follow-up periods ranged from 1 to 73 months. Four different classification systems were used, and in two studies bone bruise was not specified. Study results suggest a generally good clinical prognosis of bone bruises. Normalization of MR imaging appearance is possible and is most often encountered after the occurrence of reticular lesions. Cartilage loss at follow-up is often found in cases of initial cartilage damage (impaction or osteochondral fracture).

Conclusion: In general, a healing response was often encountered after sustained posttraumatic occult bone lesions. The initial MR imaging appearance appears to have prognostic value.

© RSNA, 2006

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