Edema-like marrow signal intensity: a narrative review with a pictorial essay
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REVIEW ARTICLE
Edema-like marrow signal intensity: a narrative review with a pictorial essay Davide Maraghelli 1 & Maria Luisa Brandi 2 & Marco Matucci Cerinic 3 & Anna Julie Peired 1 & Stefano Colagrande 1 Received: 7 May 2020 / Revised: 24 September 2020 / Accepted: 24 September 2020 # The Author(s) 2020
Abstract The term edema-like marrow signal intensity (ELMSI) represents a general term describing an area of abnormal signal intensity at MRI. Its appearance includes absence of clear margins and the possibility of exceeding well-defined anatomical borders (for example, physeal scars). We can define “ELMSI with unknown cause” an entity where the characteristic MR appearance is associated with the absence of specific signs of an underlying condition. However, it is more often an important finding indicating the presence of an underlying disease, and we describe this case as “ELMSI with known cause.” It presents a dynamic behavior and its evolution can largely vary. It initially corresponds to an acute inflammatory response with edema, before being variably replaced by more permanent marrow remodeling changes such as fibrosis or myxomatous connective tissue that can occur over time. It is important to study ELMSI variations over time in order to evaluate the activity state and therapeutic response of an inflammatory chronic joint disease, the resolution of a trauma, and the severity of an osteoarthritis. We propose a narrative review of the literature dealing with various subjects about this challenging topic that is imaging, temporal evolution, etiology, differential diagnoses, and possible organization, together with a pictorial essay. Keywords Edema-like marrow signal intensity . MRI . Rheumatoid arthritis . SIFK . AVN
Abbreviations AVN Avascular necrosis DwI Diffusion-weighted imaging ELMSI Edema-like marrow signal intensity RA Rheumatoid arthritis SIFK Subchondral insufficiency fractures of the knee STIR Short T1 inversion recovery
* Stefano Colagrande [email protected] 1
Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence 50134, Italy
2
Department of Experimental and Clinical Medicine, Unit of Bone and Mineral Diseases, University of Florence - Azienda OspedalieroUniversitaria Careggi, Largo Brambilla 3, Florence 50134, Italy
3
Department of Experimental and Clinical Biomedical Sciences Division of Rheumatology, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence 50134, Italy
Introduction The term edema-like marrow signal intensity (ELMSI) represents a general term describing an area of abnormal signal intensity (SI) at MRI [1]. Currently, the term “ELMSI” replaces the old term “bone marrow edema,” which more properly represents a histopathological diagnosis, with the finding of an eosinophilic bone marrow extracellular fluid and swollen fat cells [1]. These areas of abnormal SI appear in very different conditions an
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