To explore the clinical and MRI features of bone marrow edema syndrome (BMES) of femoral head.

From October 2014 to July 2019, the data of 60 patients with BMES of femoral head diagnosed by MRI and confirmed by clinical follow-up in Orthopedics Departments of the People′s Hospital of Fengxian and the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. All patients underwent coronal T₁WI, T₂WI and fat suppression sequence scans of MRI, the MRI and clinical features were analyzed. The pain domain scores in the Harris hip scores system and the WHO quality of life (WHO-QOL) scores before and after treatment were compared.

All patients were unilateral hip involved, and the clinical manifestations were unilateral hip pain, claudication and limited lower limb movement. The articular surfaces of the affected femoral head were smooth and the femoral head, neck and trochanter were high signal on fat suppression sequence of all MRI. After one month of conservative treatment, both the Harris hip scores and the WHO-QOL scores [(85.31±3.75)points, (93.48±6.91)points] were significantly higher than those before treatments [(61.08±4.29)points, (65.02±4.61)points] (t=12.60, 12.86, all P<0.01). During the follow-up period from 2 months to 2 years, the pain disappeared from the time of 29 days to 14 months, with an average (5.72±1.25) months. For the 37 patients undergoing MRI re-examinations after treatment, the time of pain disappearance in the 35 cases was earlier than that of high signal disappearance on fat suppression sequence images.

BMES is different from the femoral head necrosis, is characterized by smooth articular surface of femoral head and flaky high signal in fat suppression sequence on MRI, and it can be cured by conservative treatment.

Bone marrow edema syndrome; Hip joint; Femoral head necrosis; Magnetic resonance imaging; Diagnosis, differential