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Das Knochenmarködem – Differenzialdiagnose zur aseptischen Hüftkopfnekrose

Bone marrow edema—differential diagnosis of the femoral head necrosis

Zusammenfassung

Für die differenzialdiagnostische Einordnung von Hüftschmerzen ist die klinische Untersuchung nur bedingt hilfreich. Wertvoll ist neben dem Patientenalter auch die Anamnese. Zudem kann die Bildgebung wichtige Hinweise für die korrekte Diagnose liefern. Heutzutage wird in Deutschland häufig als primäre Bildgebung eine Magnetresonanztomographie durchgeführt, die bei vielen verschiedenen Pathologien ein Knochenmarködem (KMÖ) zeigen kann. Das KMÖ tritt beim transitorischen Knochenmarködem und außerhalb der atraumatischen Hüftkopfnekrose auf, u. a. begleitend bei Koxarthrose, Arthritis, „herniation pit“ und Osteoidosteom. Der vorliegende Beitrag beschreibt einige häufige Differenzialdiagnosen und gibt Hinweise, wie die korrekte Zuordnung zu den jeweiligen Diagnosen gelingen kann.

Abstract

In patients with hip pain, clinical examination is of only restricted value in the differential diagnosis. Besides a patient’s age, their medical history is often helpful in finding the correct diagnosis. Additionally, imaging can give valuable hints for excluding or validating a differential diagnosis. Nowadays, magnetic resonance imaging (MRI) is often used as a primary imaging modality in Germany. These MRIs show a bone marrow edema (BME) in many different pathologies. BME occurs in transitory bone marrow edema and outside of the atraumatic femoral head necrosis, concomitant with coxarthrosis, arthritis, herniation pit, and osteoid osteoma, amongst other conditions. This article describes several frequent differential diagnoses and gives hints on how to find the correct diagnosis.

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Abbreviations

aFKN:

Atraumatische Femurkopfnekrose

DCE-MRI:

„Dynamic contrast-enhanced MRI“

DWI:

Diffusion-Weighted Imaging (Diffusionswichtung)

KMÖ:

Knochenmarködem

RFA:

Radiofrequenzablation

STIR:

Short Tau Inversion Recovery

TIRM:

Turbo Inversion Recovery Magnitude

tKMÖ:

Transitorisches Knochenmarködem

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Correspondence to PD Dr. P. Stumpp MME.

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Interessenkonflikt

P. Stumpp und A. Roth geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Stumpp, P., Roth, A. Das Knochenmarködem – Differenzialdiagnose zur aseptischen Hüftkopfnekrose. Orthopäde 47, 717–721 (2018). https://doi.org/10.1007/s00132-018-3621-9

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Schlüsselwörter

  • Hüfte
  • Koxarthrose
  • Arthritis
  • Stressfraktur
  • Osteoidosteom

Keywords

  • Hip
  • Coxarthrosis
  • Arthritis
  • Stress fracture
  • Osteoid osteoma