Role of Diffusion Weighted Magnetic Resonance Imaging in Evaluation of Bone Marrow Edema of the Knee

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Background: Bone marrow edema (BME) has not been recognized as a significant pain generator or as a primary contributor to disease until recently. Bone marrow edema is characterized by a non-specific pattern of ill-defined high signal intensity on short-tau inversion-recovery and T2-weighted magnetic resonance (MR) images and low signal intensity on T1-weighted images. Objective: To assess the value of diffusion weighted magnetic resonance imaging in the diagnosis and evaluation of bone marrow edema at the knee region. Patients and methods: This study was conducted on 130 patients referred with clinical suspicion of knee edema with or without history of trauma. They were divided into group “A” with lesions less than 15 mm and group “B” with lesions greater than 15 mm. Their ages ranged between 9 years and 75 years with mean age of 42 years old. They were 43 females and 87 males. Results: Between both groups A and B, we found that bone marrow lesions (BMLs) were approximately two times larger on apparent diffusion coefficient (ADC) maps than on FS PD-weighted TSE images. The most important value of adding the ADC-derived maps in routine MRI examination of the knee is to show additional bone marrow lesions that only can be detected at the ADC maps and could not be detected at the FS-PD. About 27 more lesions in 27 patients and one patient showed two more lesions. These non-concordant lesions accounted totally for 29 more bone marrow lesions. Conclusion: Magnetic resonance imaging (MRI) is the mainstay of diagnosis, staging and management plan of knee traumatic and non-traumatic disorders. ADC maps are more sensitive than corresponding FS PD weighted TSE images allowing for detection of significantly more and larger BMLs. In addition, they represent a valuable add-on in knee imaging protocols.

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