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    "titulo" => "From bone marrow edema to osteonecrosis. New concepts"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The widespread use of MRI in the diagnosis of articular pathology has allowed for an improved knowledge of a series of disturbances that occur with epiphyseal bone edema as a main radiological sign&#44; featured as low signal intensity of the bone marrow on T1 and high signal on STIR and fat saturated T2 sequences&#46; The new etiopathogenic theories postulate a clear differentiation between primary and secondary osteonecrosis&#46; While secondary osteonecrosis is related to risk factors&#44; primary osteonecrosis is a result of a subcondral insufficiency fracture&#46; Both have different characteristic and MRI criteria&#46; The pathogenesis of transient bone edema syndrome &#40;BMES&#41; is currently under discussion&#44; divided between the biomechanic theory and the more classic one that relates to the complex and poorly understood mechanisms associated with complex regional pain syndrome type I &#40;reflex sympathetic dystrophy&#41;&#46; The BMES&#44; classically considered a reversible form of osteonecrosis&#44; has enough differentiated features to be considered as a distinct disease&#46; Bone marrow edema can be as extensive in either insufficiency or fatigue stress fractures than in BMES&#46; The diagnostic key is the display of a subcondral bone fracture&#46; These can be resolved or occasionally evolve into a primary osteonecrosis&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El uso generalizado de la resonancia magn&#233;tica &#40;RM&#41; en el diagn&#243;stico de la enfermedad articular ha permitido conocer mejor una serie de trastornos que cursan con edema &#243;seo epifisario como signo radiol&#243;gico principal&#44; caracterizado por una hipose&#241;al de la m&#233;dula &#243;sea en secuencias T1 e hiperse&#241;al en STIR o saturaci&#243;n grasa T2&#46; Los nuevos conceptos etiopatog&#233;nicos acerca de la osteonecrosis postulan una clara diferenciaci&#243;n entre osteonecrosis primaria y secundaria&#46; Mientras que la osteonecrosis secundaria se relaciona con factores de riesgo&#44; la osteonecrosis primaria es consecuencia de una fractura subcondral de insuficiencia&#46; Ambas tienen criterios de imagen en RM caracter&#237;sticos y diferentes&#46; La etiopatog&#233;nesis del s&#237;ndrome del edema &#243;seo transitorio &#40;SEOT&#41; se debate actualmente entre la teor&#237;a biomec&#225;nica y la teor&#237;a m&#225;s cl&#225;sica que la relaciona con mecanismos complejos y poco conocidos asociados al s&#237;ndrome de dolor regional complejo tipo I &#40;algodistrofia simp&#225;tica refleja&#41;&#46; El SEOT&#44; cl&#225;sicamente considerado una forma reversible de osteonecrosis&#44; tiene caracter&#237;sticas suficientemente diferenciales como para considerarse una enfermedad con entidad propia y de curso distinto a la osteonecrosis&#46; En las fracturas de estr&#233;s&#44; ya sean de insuficiencia o de sobrecarga&#44; el edema puede ser tan extenso como en el SEOT y la clave diagn&#243;stica es la visualizaci&#243;n de fractura del hueso subcondral&#46; &#201;stas pueden resolverse o evolucionar ocasionalmente hacia una osteonecrosis primaria&#46;</p>"
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Vol. 5. Issue 5.
Pages 223-227 (September - October 2009)
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Vol. 5. Issue 5.
Pages 223-227 (September - October 2009)
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From bone marrow edema to osteonecrosis. New concepts
Del edema de médula ósea a la osteonecrosis. Nuevos conceptos
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Guillermo Fernández-Cantón
Centro OSATEK, Unidad de Dr. Areilza, Bilbao, País Vasco, Spain
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Abstract

The widespread use of MRI in the diagnosis of articular pathology has allowed for an improved knowledge of a series of disturbances that occur with epiphyseal bone edema as a main radiological sign, featured as low signal intensity of the bone marrow on T1 and high signal on STIR and fat saturated T2 sequences. The new etiopathogenic theories postulate a clear differentiation between primary and secondary osteonecrosis. While secondary osteonecrosis is related to risk factors, primary osteonecrosis is a result of a subcondral insufficiency fracture. Both have different characteristic and MRI criteria. The pathogenesis of transient bone edema syndrome (BMES) is currently under discussion, divided between the biomechanic theory and the more classic one that relates to the complex and poorly understood mechanisms associated with complex regional pain syndrome type I (reflex sympathetic dystrophy). The BMES, classically considered a reversible form of osteonecrosis, has enough differentiated features to be considered as a distinct disease. Bone marrow edema can be as extensive in either insufficiency or fatigue stress fractures than in BMES. The diagnostic key is the display of a subcondral bone fracture. These can be resolved or occasionally evolve into a primary osteonecrosis.

Keywords:
Bibliometrics
Rheumatology
Bibliometric analysis
Resumen

El uso generalizado de la resonancia magnética (RM) en el diagnóstico de la enfermedad articular ha permitido conocer mejor una serie de trastornos que cursan con edema óseo epifisario como signo radiológico principal, caracterizado por una hiposeñal de la médula ósea en secuencias T1 e hiperseñal en STIR o saturación grasa T2. Los nuevos conceptos etiopatogénicos acerca de la osteonecrosis postulan una clara diferenciación entre osteonecrosis primaria y secundaria. Mientras que la osteonecrosis secundaria se relaciona con factores de riesgo, la osteonecrosis primaria es consecuencia de una fractura subcondral de insuficiencia. Ambas tienen criterios de imagen en RM característicos y diferentes. La etiopatogénesis del síndrome del edema óseo transitorio (SEOT) se debate actualmente entre la teoría biomecánica y la teoría más clásica que la relaciona con mecanismos complejos y poco conocidos asociados al síndrome de dolor regional complejo tipo I (algodistrofia simpática refleja). El SEOT, clásicamente considerado una forma reversible de osteonecrosis, tiene características suficientemente diferenciales como para considerarse una enfermedad con entidad propia y de curso distinto a la osteonecrosis. En las fracturas de estrés, ya sean de insuficiencia o de sobrecarga, el edema puede ser tan extenso como en el SEOT y la clave diagnóstica es la visualización de fractura del hueso subcondral. Éstas pueden resolverse o evolucionar ocasionalmente hacia una osteonecrosis primaria.

Palabras clave:
Osteonecrosis
Necrosis avascular
Síndrome del edema óseo transitorio de
médula ósea
Fracturas de insuficiencia
Síndrome del dolor regional complejo tipo I
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