Dr. Tsuji holds stock or stock options in Amgen.
Bone erosions and bone marrow edema as defined by magnetic resonance imaging reflect true bone marrow inflammation in rheumatoid arthritis
Article first published online: 28 MAR 2007
Copyright © 2007 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 56, Issue 4, pages 1118–1124, April 2007
How to Cite
Jimenez-Boj, E., Nöbauer-Huhmann, I., Hanslik-Schnabel, B., Dorotka, R., Wanivenhaus, A.-H., Kainberger, F., Trattnig, S., Axmann, R., Tsuji, W., Hermann, S., Smolen, J. and Schett, G. (2007), Bone erosions and bone marrow edema as defined by magnetic resonance imaging reflect true bone marrow inflammation in rheumatoid arthritis. Arthritis & Rheumatism, 56: 1118–1124. doi: 10.1002/art.22496
- Issue published online: 28 MAR 2007
- Article first published online: 28 MAR 2007
- Manuscript Accepted: 21 DEC 2006
- Manuscript Received: 3 OCT 2006
- Austrian Ministry of Sciences (START prize award)
To investigate the pathologic nature of features termed “bone erosion” and “bone marrow edema” (also called “osteitis) on magnetic resonance imaging (MRI) scans of joints affected by rheumatoid arthritis (RA).
RA patients scheduled for joint replacement surgery (metacarpophalangeal or proximal interphalangeal joints) underwent MRI on the day before surgery. The presence and localization of bone erosions and bone marrow edema as evidenced by MRI (MRI bone erosions and MRI bone marrow edema) were documented in each joint (n = 12 joints). After surgery, sequential sections from throughout the whole joint were analyzed histologically for bone marrow changes, and these results were correlated with the MRI findings.
MRI bone erosion was recorded based on bone marrow inflammation adjacent to a site of cortical bone penetration. Inflammation was recorded based on either invading synovial tissue (pannus), formation of lymphocytic aggregates, or increased vascularity. Fat-rich bone marrow was replaced by inflammatory tissue, increasing water content, which appears as bright signal enhancement on STIR MRI sequences. MRI bone marrow edema was recorded based on the finding of inflammatory infiltrates, which were less dense than those of MRI bone erosions and localized more centrally in the joint. These lesions were either isolated or found in contact with MRI bone erosions.
MRI bone erosions and MRI bone marrow edema are due to the formation of inflammatory infiltrates in the bone marrow of patients with RA. This emphasizes the value of MRI in sensitively detecting inflammatory tissue in the bone marrow and demonstrates that the inflammatory process extends to the bone marrow cavity, which is an additional target structure for antiinflammatory therapy.