Clinical outcome of edema-like bone marrow abnormalities of the foot

Radiology. 2002 Jan;222(1):184-8. doi: 10.1148/radiol.2221010316.

Abstract

Purpose: To evaluate the clinical outcome of edema-like bone marrow abnormalities seen on magnetic resonance (MR) images of the foot when their cause is unknown.

Materials and methods: The clinical outcome of 31 patients (15 female patients, 16 male patients; mean age, 51; range, 10-79 years) with edema-like bone marrow abnormalities on MR images of the foot was determined. The relevance of three different edema patterns was compared: (a) exclusively ill-defined edema-like zones, (b) edema-like zones plus well-defined necrosis-like zones, and (c) edema-like zones plus linear structures indicating possible fractures. The different edema patterns were compared with persistence of pain.

Results: Fifty-four percent of all patients had pain persisting after 1 year, as calculated with the Kaplan-Meier method. The duration of pain in the various subgroups varied significantly (P =.049, log-rank test). The subgroup of patients with a well-defined necrosis-like zone had substantially longer-lasting pain than those with edema-like abnormalities only (n = 16) (P =.065). Only one of seven patients with a well-defined necrosis-like zone (n = 7) was pain free after 1 year. Conversely, patients with possible stress fracture (n = 8) had shorter pain compared with those with edema-like abnormalities only (P =.036); six of eight patients were pain free after 1 year.

Conclusion: Edema-like bone marrow abnormalities of the foot predict long-lasting pain. Analysis of the image patterns of such abnormalities allows prediction of the clinical outcome to a certain degree.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bone Marrow / pathology*
  • Bone Marrow Diseases / complications
  • Bone Marrow Diseases / diagnosis*
  • Bone Marrow Diseases / pathology
  • Child
  • Edema / etiology
  • Edema / pathology*
  • Female
  • Foot / pathology*
  • Fractures, Stress / complications
  • Fractures, Stress / diagnosis
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Necrosis
  • Pain / etiology
  • Proportional Hazards Models
  • Statistics, Nonparametric